Basic Radiation Training

BASIC RADIATION TRAINING Emergency Medical Services Alabama Department of Public Health • Office of Radiation Control • 334.290.6244 • alabamapublichealth.gov/radiation Kevin Hicks, Director Emergency Planning & Environmental Monitoring [email protected]

Michael Hallman, Radiation Physicist Senior [email protected]

Tanner Jackson, Radiation Physicist [email protected] 2021 Basic Radiation Training Emergency Medical Services (EMS)

Alabama Department of Public Health Office of Radiation Control PHYSICAL: ADPH Training Center & Administrative Complex 208 Legends Court, Prattville, AL 36066 MAILING: P. O. Box 303017, Montgomery, AL 36130-3017 T: 334.290.6244 F: 334.285.9342 www.alabamapublichealth.gov/radiation Kevin Hicks, Director Emergency Planning & Environmental Monitoring Branch [email protected] Michael Hallman, Radiation Physicist, Senior [email protected] Tanner Jackson, Radiation Physicist [email protected] 24-hour ADPH ORC Duty Officer 334.324.0076

1 Table of Contents • QR Codes/URLs for Videos 4 •Alabama’s Nuclear Power Plants 5 • Alabama Radiological Emergency Response Plan 6 • Emergency Classifications Levels 7 • Radiation 8 • Roentgen Equivalent Man (REM) 9 • Average Annual Radiation Exposure 10 • Radioactive Material in Alabama 11 • Two Types of Radiation 12 • Ionizing Radiation: Alpha, Beta, and Gamma 13 • ALARA 14 • Controlling Exposure 15 • Protection from Radiation – Time 16 • Protection from Radiation – Distance 17 • Protection from Radiation – Shielding 18 • Exposure, Contamination & Decontamination 19 • Radiation Pathways 20 • Avoid Radioactive Contamination 21 • Contaminated Injured 22 • Radiation and Our Five Senses 23 • KI (Potassium Iodide) 24 • Pocket Dosimeters 25

The Federal Emergency Management Agency (FEMA), an agency of the Department of Homeland Security (DHS), is required to interview a certain number of emergency workers, personnel and equipment monitors to ensure that they are aware of their radiation dose limits, equipment, and the basics of radiation. The training manual has the following features: •Table of contents for looking up the answers for exercises, evaluations, real-time emergency situations •Forms located in the back of the book that can be used for reception centers, personal radiation exposure records, equipment setup, etc. •Maps for the two nuclear power plants’ 10-mile Emergency Planning Zones (EPZ) and the 50-mile Ingestion Pathway Zones (IPZ). •Glossary in the back of the book with radiation terms not routinely used.

Formatting for this guide is as follows: 1. Information on the PowerPoint slide 2. Information below the PowerPoint slide in the Notes section 3. Information discussed in the Basic Radiation Training course by the instructor

2 Table of Contents • Radiation Exposure 26 • Thermoluminescent Dosimeter 27 • Placement of TLD & Pocket Dosimeter 28 • Total Effective Dose Equivalent (TEDE) 29 • Radiation Dosage Limits for EWs and PEMs 30 • Reminders for EWs and PEMs 31 • Emergency Worker Equipment 32 • CDV-750 Dosimeter Charger 33-34 • EW Assessment 35 • Guidance for Emergency Medical Service Management 36 • Notification and Communication 37 • Radiation Supplies 38 • Preparing the Ambulance 39 • Response Team Preparation 40 • Safety Briefing 41 • Field Operations 42 • Preparing for Patient Decontamination 43 • Removal of Clothes and Cocooning of Patient 44 • Patient Decontamination: 3-Sheet Method 45 • Patient Transfer 46 • Radiation Emergency Assistance Center Contact 47 • Glossary 48-49

Everything you need to know about protecting yourself from radiation can be found in this manual. Therefore, please place this manual in a readily accessible location. For example, law enforcement might place it in a patrol car, or firemen might place a copy in each fire engine. EWS = Emergency Worker Station (where you get your equipment) EWD = Emergency Worker Decontamination CRC = Community Reception Center MCF = Mass Care Facility (where people are sheltered after going through the CRC, a.k.a. “shelter”) ***Potassium Iodide (KI) will be administered for Emergency Workers at each EWS and to the general public in affected areas at each CRC.*** Henry: EWS = Henry County EMA Parking Lot EWD = Houston County Farm Center CRC = Houston County Farm Center MCF = Westgate Recreation Center Houston: EWS = Houston County Farm Center EWD = Houston County Farm Center CRC = Houston County Farm Center MCF = Westgate Recreation Center Lauderdale: EWS = Lauderdale County High School EWD = Lauderdale County High School CRC = Brooks High School MCF = Florence High School Lawrence: EWS = Lawrence County EMA EWD = Moulton Recreation Center CRC = Moulton Recreation Center MCF = Moulton Church of Christ, Moulton Elementary School, Moulton Middle School Limestone: EWS = Athens/Limestone County Rescue Squad EWD = all CRCs CRC = Ardmore High School, West Limestone High School, East Limestone High School, Elkmont High School MCF = all CRCs Madison: EWS = N/A EWD = N/A CRC = Dr. Richard Showers Recreation Center ; Dublin Park Recreation Center, Madison ; UAH, Spragins Hall MCF = all CRCs that are activated. Morgan: EWS = Morgan County EMA (however, some equipment is prepositioned) EWD = Priceville Jr. High School CRC = Priceville Jr. High School, Hartselle Intermediate School MCF = Priceville Jr. High School, Hartselle Sparkman Civic Center 3 Table of Contents • Just in Time Videos 50 • Radiation Exposure Record 51 • Radiation Equipment Distribution Log 52 • Donning & Doffing Procedures 53 • Just-In-Time Training: Direct Read Dosimeter 54-55 • Browns Ferry Nuclear Plant 10-mile EPZ Map 56-57 • Browns Ferry Nuclear Plant 50-mile IPZ Map 58 • Farley Nuclear Plant 10-mile EPZ Map 59 • Farley Nuclear Plant 50-mile IPZ Map 60 • Example EMS Safety Briefing 61 • EMS Evaluation 62

QR codes/URLs for Videos

Video: 4 types of ionizing radiation: Alpha, Beta, Gamma, & Neutron https://youtu.be/2fIylibGJYM

Video: Time, Distance and Shielding https://youtu.be/2AcqRD5TTpc

Video: Radiological Basics https://youtu.be/QiwFg60V5DE

Video: Biological Effects of Radiation https://youtu.be/wMySBZ4GwCw

Video: Radiological Dosimetry https://youtu.be/qKtKaLkW5fk

4 Nuclear Power Plants • Alabama: Two active nuclear power plants – Browns Ferry – Joseph M. Farley

• BFNP 10-mile EPZ – 4 risk counties – 1 host county • FNP 10-mile EPZ – 2 risk counties

• 50-mile IPZ

• Universal Training and Equipment

In Alabama, there are two nuclear power plants: Farley Nuclear Plant in Houston County near Dothan, Alabama, and Browns Ferry Nuclear Plant in Limestone County near Athens, Alabama.

Browns Ferry has four risk counties (counties within the 10-mile EPZ) and one host county for the overflow of the evacuees. The risk counties are Limestone, Morgan, Lawrence, and Lauderdale. The host county is Madison.

Farley has only two risk counties (Houston & Henry). Because of geographic ownership of the Chattahoochee River, we share responsibility with Georgia (via Early County).

We train all emergency workers and personnel & equipment monitors in the 10-mile EPZ. We also have a different training program for the ingestion pathway counties (50-mile IPZ).

Training, equipment, and documentation are all standardized across the entire state of Alabama. Therefore, trained personnel can easily assist with a radiological event at either nuclear power plant, if requested.

5 Radiological Emergency Preparedness (REP) Plan • Plan for OFF-SITE emergency response & recovery. • Utility is responsible for ON- SITE emergency response & recovery. • County plan is specific and identifies responsible organizations. • Hospital plan for radiological events or incidents • State plan for radiological events or incidents with specific ADPH ORC Incident NEW! Annex

The Radiological Emergency Preparedness (REP) Incident Annex E of the State of Alabama Emergency Operations Plan (EOP) is the plan for dealing with radiological emergency response. The plan details the concept of radiological emergency planning and operation for off-site emergency response and recovery in the event of a radiological accident at a nuclear power plant. The plan is reviewed and updated annually. During an evaluated exercise, FEMA/DHS evaluates us according to our plan. As long as we follow our plan and procedures, we can’t go wrong! The county EMAs take what is needed from the state plan and put it in their county plan. The county plan is tailored to a county’s needs. If you are a county emergency responder, then follow your county plan. No one agency can handle a radiological emergency alone. We must build and rely on partnerships from the States, Counties, Utilities and Federal agencies. Contract hospitals for Browns Ferry Off-Site Organization (ORO) Response: Decatur Morgan Hospital – Main Campus Decatur Morgan Hospital – Parkway Campus Huntsville Hospital Contract EMS Services for Browns Ferry ORO Response: Greg’s Ambulance Service (Lawrence County EMS) Lifeguard Ambulance Service First Response Ambulance Service Contract Hospitals for Farley ORO Response: Southeast Health Medical Center Flowers Hospital Contact EMS for Farley ORO Response: Pilcher’s Ambulance (Dothan Ambulance Service)

6 Emergency Classification Levels • General

Emergency (GE) BWR: Boiling Water Reactor • Site Area (Browns Ferry Nuclear Plant) Emergency (SAE) • Alert • Notification of Unusual Event (NOUE) PWR: Pressurized Water Reactor (Joseph M. Farley Nuclear Plant)

There are four Emergency Classification Levels (ECL) at all U.S. nuclear power plants. Nuclear power facilities use the ECLs as the method of communicating different types of incidents. Each ECL describes the specific actions that must be completed by both the licensee and the offsite emergency responders. Emergency classifications are declared for events that are occurring or have occurred affecting plant radiation safety or plant security. Each time an ECL is declared or changed, the State Emergency Operations Center (EOC) and/or the Utility (owner of plant) is required to make notifications to the responsible state agency: the Office of Radiation Control (ORC). Notification of an Unusual Event – The least serious of the four classifications. Events in this class indicate: •Potential degradation of plant safety •Security threat to facility protection is initiated •No release of radioactive material unless plant conditions degrade Alert – Events in this class indicate: •Potential or actual degradation in plant safety •Lives of onsite personnel may be threatened or site equipment may be damaged due to a hostile action *Prattville’s State Radiological Monitoring & Assessment Center (SRMAC) will stand up and monitor the situation closely. This includes watching radiation levels for the pressurized ionization chambers (PICs) installed around both nuclear plants. Site Area Emergency – Events in this class indicate: •Actual or likely plant functions failure. Plant functions would be needed to protect the public’s health and safety •Hostile actions that result in an intentional damage to plant personnel or equipment used to protect the public •Malicious acts that could lead to failure of equipment used to protect the public or could prevent effective access to said equipment used to protect the public *If not already accomplished, Radiation Control will issue two health orders: Public Warning and Restricted Access (of the 2- mile radius of the plant) and will send out radiological field monitoring teams to survey the area. We have state-trained and county-trained radiological field monitoring teams. *If not already accomplished, Radiation Control will move forward to the Decatur SRMAC (beside Morgan County EMA) or the Dothan SRMAC (beside Dothan/Houston County EMA). General Emergency – Events in this class indicate: • Actual or imminent significant core degradation or melting. •There is a potential for loss of containment integrity which may result in radioactive material to the atmosphere. • Hostile action that results in an actual loss of physical control of the facility *Based on the field measurements, wind speed, wind direction, and status of the plant, Radiation Control could issue evacuation health orders or other health orders that are applicable.

7 Radiation

Radiation is energy that gamma rays travels in the form of waves or high-speed particles. It occurs naturally in sunlight and sound waves. Man- made radiation is used in X-rays, nuclear weapons, nuclear power plants, and cancer treatment. gamma rays

Radiation is a process where energy travels from one point to another by waves or particles, like the waves on the surface of the ocean. Radiation comes in various forms. A good example is the sun. Radiation is used everyday to improve our quality of life, from medical treatments to warming leftovers.

Atoms are the basis for all matter, consisting of a nucleus made up of neutrons, protons, and electrons. Naturally, only certain combinations of protons and neutrons occur. Some are stable and some unstable. Stable nuclei have no excess energy, but unstable nuclei become stable by releasing energy. This releasing energy is commonly called radioactivity. Radiation takes the form of either non-ionizing radiation or ionizing radiation.

8 REM (Roentgen Equivalent in Man)

• A unit of radiation dose equivalent used to measure the amount of damage to human tissue caused by all types of ionizing radiation

The REM is the unit of dose equivalence and is the measure which accounts for the varying effects of different types of radiation on the human body. Two other units that are important in the scientific study of radiation are the ROENTGEN and RAD (radiation absorbed dose). But for our purposes, one roentgen equals one rad equals one rem.

Roentgen (R) is a unit of measurement for radiation exposure in air from x-rays or gamma rays.

RAD is an acronym for Radiation Absorbed Dose. It is a dose unit which is used to describe the amount of radiation absorbed by an object or person.

REM is an acronym for Roentgen Equivalent in Man. It is measurement of the effect of all types of radiation on the human body.

9 Average Annual Radiation Exposure

• ~620 mR/yr – ~310 mR from natural radiation – ~310 mR from man-made radiation – <1 mR from nuclear power generation

Virtually everything emits radiation. Radiation is a natural part of our environment. Radiation is in the air we breathe, the food we eat, the soil, our homes, sunshine, and even our bodies. Radiation is also present in consumer products such as tobacco products, smoke detectors, lantern mantels, and building supplies. The radiation naturally occurring or existing in our environment is called background radiation. The amount of background radiation varies from one location to another. People may also be exposed to radiation through medical procedures (diagnostic & therapy) and dental x-rays.

The health effects of radiation exposure to people are measured in units called millirem. A millirem is 1/1000th of a rem. On average, Americans receive a radiation dose of about 620 millirem each year. Half of this dose comes form natural background radiation. Most of this background exposure comes from radon in the air, with smaller amounts from cosmic rays and the Earth itself. The other half (310 millirem) comes from man-made sources of radiation which includes medical, commercial and industrial sources. In general, a yearly dose of 620 millirem from all radiation sources has not been shown to cause humans any harm. Less than 1 millirem comes from nuclear power generation.

• Protective Action Guide for Nuclear = 1,000 millirem Power Plants Evacuations • Chest X-ray (posterior/anterior) = 10 millirem • Panoramix Dental X-ray = 1 millirem • Abdominal X-ray = 7 millirem • CT of Abdomen = 800 millirem • PET Scan for Cancer Staging = 1,410 millirem • Cardiac Stress Test with Thallium-201 = 4,070 millirem • PET CT = 4,500 millirem

10 Radioactive Material in Alabama

• Nuclear Power Plants

• Medical Uses

• Industrial Uses

• Research

• Naturally Occurring Radioactive Material (NORM)

• Waste Isolation Pilot Plant (WIPP)

In Alabama, we have two nuclear power plants and approximately 400 licensees that are authorized to use radioactive material. The types of licensed uses include medical, industrial and research. We also have naturally occurring radioactive material or (NORM) in the state. In addition, the Department of Energy (DOE) has shipments of low level waste as part of the Waste Isolation Pilot Plant (WIPP) that come down I-59 and I-20. Nuclear Power Plants: Browns Ferry and Joseph M. Farley Medical Uses: Medical uses include hospitals, cancer centers, cardiology clinics and nuclear pharmacies. Industrial Uses: Industrial radiography companies in Alabama use radioactive material to x-ray welds at temporary job sites including paper mills, chemical plants, shipyards, oil and gas pipelines, etc. Well logging companies use radioactive material to help study geological formations. Moisture density gauges are commonly used by highway construction crews at job sites to help determine moisture content and compaction of the soil. Research: Most of the universities in Alabama have radioactive material licenses for research purposes. NORM: Naturally Occurring Radioactive Material. In South Alabama around Citronelle or Gilbertown, you will find elevated levels of NORM due to the scale that has accumulated on the gas wells’ piping and in the tanks. If it is greater than 50 microR/hr at the surface, we require them to dispose of it through a radioactive waste broker. We have also seen piping from paper mills that had elevated radiation levels caused by kaolin clay used in the process. Kaolin is a white clay found primarily in Alabama and Georgia containing elevated levels of uranium and thorium decay series. In the paper process, it is used to produce high gloss for magazines and beer packaging. Up in Muscle Shoals, there is a giant slag pile with elevated radiation levels that exceed 100 microR/hr due to the byproducts created as part of the National Fertilizer Company in the 1970’s. This is under exclusive federal jurisdiction as part of TVA. WIPP: The WIPP program started in 1999 and its purpose is to secure national defense related transuranic waste below ground in the remote desert of New Mexico. Shipments come through Alabama from Oak Ridge National Lab and Savannah River National Lab. We are notified of these shipments and have computer access to track these shipments via GPS while they travel through Alabama. Transuranic waste is man-made isotopes that are heavier than uranium.

11 Two Types of Radiation

• NON-IONIZING: Radio and TV Waves, Infra-Red, Microwaves, UV-A & UV-B rays • IONIZING: Alpha & Beta Particles, Gamma Rays, X-rays, UV-C rays

There are two types of radiation: non-ionizing and ionizing.

Non-ionizing radiation has enough energy to cause electrons within atoms to move and vibrate but not enough to remove them from the atom itself. For example, microwave ovens use microwaves to force the electrons in food to move around, thus producing heat and heating the food. However, these electrons do not break away from the atoms of the food. We also come in contact with many types of non-ionizing radiation daily, such as the sun that delivers light and heat. Other examples of non-ionizing radiation include visible light and radar waves.

Ionizing radiation comes in two forms: particulate and waves/rays. Ionizing radiation is more energetic than non-ionizing radiation. Ionizing radiation has enough energy to remove electrons from atoms, thus forming ions. When ionizing radiation passes through material, it deposits enough energy to break molecular bonds and displace (or remove) electrons from atoms, thus creating ions. Ions are electrically charged particles which may cause changes in living cells of plants, animals, and people. These types of radiation are associated with nuclear power plant generation. In nuclear power generation, fission (splitting an atom’s nucleus) takes place which results in radiation being produced by splitting an atom’s nucleus and may be emitted in three forms: alpha particles, beta particles, and gamma rays.

12 Ionizing Radiation

Alpha particles

Beta particles

Alpha particle –A positively charged particle emitted from the nucleus of an atom. Alpha particles are charged particles, which are emitted from naturally occurring materials (such as uranium, thorium, and radium) and man-made elements (such as plutonium and americium). Alpha emitters are primarily used (in very small amounts) in items such as smoke detectors. In general, alpha particles have a very limited ability to penetrate other materials. In other words, these particles of ionizing radiation can be blocked by a sheet of paper, skin, or even a few inches of air. As a result, alpha particles do not usually make anything radioactive. Nonetheless, materials that emit alpha particles are potentially dangerous if they are inhaled or ingested, but external exposure generally does not pose a danger. Beta particle – A negatively charged particle emitted from the nucleus of an atom. In general, beta particles are lighter than alpha particles, and they generally have a greater ability to penetrate other materials. As a result, these particles can travel a few feet in the air, and can penetrate skin. Nonetheless, they can be stopped by several sheets of paper, a thick book, or even a sheet of aluminum or plastic. Beta particles are both an internal and external hazard which can damage the skin and cause second-degree burns and eye damage. Elements with beta emitters can be used for medical purposes, such as treating eye disease. Gamma ray – A photon originating from the nucleus of an atom. Gamma rays and x-rays consist of high-energy waves that can travel great distances at the speed of light and generally have a great ability to penetrate other materials. For that reason, gamma rays (such as cobalt-60) are often used in medical applications to treat cancer and sterilize medical instruments. Similarly, x-rays are typically used to provide static images of body parts (such as teeth and bones), and are also used in industry to find defects in welds. X-rays and gamma rays have great penetrating power and can easily pass through the human body. Thick, dense shielding, such as lead, is necessary to protect against gamma rays. The higher the energy of the gamma ray, the thicker the lead must be. X-rays pose a similar challenge, so x-ray technicians often give patients receiving medical or dental X-rays a lead apron to cover other parts of their body. Gamma rays are external and internal hazards. Gamma rays are an external and internal hazardous.

13 The ALARA philosophy is the foundation for all exposure (dose) limits. ALARA is based on the assumption that radiation exposure of any amount is a potential hazard. ALARA means making every reasonable effort to maintain exposures to ionizing radiation as far below the dose limits as practical, thus As Low As Reasonably Achievable.

Do not spend more time than necessary near a radiation source. Stay as far away from a radiation source as you can. Place material between you and the source of radiation.

Use a common sense approach when dealing with radiation!

14 Controlling Exposure

We cannot eliminate radiation from our environment. But we can, however, reduce our risk by controlling our exposure to it. Radiation is very easily detected. There are several simple, sensitive instruments capable of detecting minute amounts of radiation from natural and man-made sources. There are three ways in which people can protect themselves from ionizing radiation: 1.Time 2.Distance 3.Shielding

15 Protection from Radiation: Time ShortenShorten time while being close to Less time with radioactive materials ionizing radiation = Less radiation exposure

For people who are exposed to radiation, in addition to natural background radiation through their work, the dose is reduced and the risk of illness essentially eliminated by limiting exposure time.

If you decrease the amount of time you spend near the source of radiation, you will decrease the amount of radiation exposure you receive. To imagine this, think of a trip to the beach as a comparison. For instance, if you spend a lot of time on the beach, you will be exposed to the sun, and, ultimately, get a sunburn. If you spend less time in the sun and more time in the shade, your sunburn will be much less severe. This is a comparison of how radiation exposure works.

The less time you spend in a radiation area, the less dose you will receive. Emergency workers will be assigned to work in a radiation area only for the amount of time required to accomplish their particular task.

For example, if you were working in an area where the exposure rate was 50mR/hr and you stayed there for one (1) hour, you would receive a dose of 50 millirem. But if you remained there for only a half an hour (30 minutes), you would receive half the dose or 25 millirem.

16 Protection from Radiation: Distance KeepKeep away Greater the distance from ionizing radiation = Less radiation exposure

The farther away you are from a source of ionizing radiation, the less dose you will receive. In the same way that heat from a fire is less the farther away you are, the intensity of radiation decreases farther from its source.

Because of the inverse square law (1/d2), each time you double your distance from a point source of radiation, you will receive one-fourth (1/4) of the dose. If you triple the distance from a point source of radiation, you will only receive one-ninth (1/9) of the dose.

Example: If your exposure rate at a distance of one (1) foot from a point source of radiation is 100 mR/hr, then if the distance is doubled to two (2) feet away, then the exposure rate will now only be 25 mR/hr.

Example: The farther away you are from a radiation source, the less dose you will receive. Compare this to an outdoor concert. You can sit directly in front of a speaker, 50 yards from the stage, or on the grass in the park across the street. If you sit in front of the speaker, you will probably suffer some damage to your hearing. If you sit 50 yards from the stage, you will be exposed to an average amount of music. If you sit in the park across the street, the noise is even further reduced and you might not even hear the concert, or even know what song they are playing.

17 Protection from Radiation: Shielding PlacePlace something heavy in between Thicker/Denser Material = Less radiation exposure

The use of shielding, such as lead, steel, concrete, or earth, between you and a source of radiation will also reduce your exposure. The amount of reduction depends on the type and thickness of the shielding material. Barriers of lead, concrete, or water give good protection from penetrating radiation such as gamma rays. Radioactive materials are therefore often stored or handled underwater, or by remote control in rooms constructed of thick concrete or lined with lead.

If you increase the shielding around a radiation source, it will decrease your exposure. For example, if you stand out in the rain without an umbrella, you will get wet. But, if you use an umbrella to shield you from the rain, you will remain dry and protected. This is similar to the idea of shielding in radiation protection.

So when possible, emergency workers in radiation areas should take advantage of shielding (standing behind buildings, cars, or some other means of shelter) to reduce their exposure. Keep something substantial between you and a point source of radiation. In the event of a radioactive plume, sheltering while the plume passes may be helpful.

18 Exposure, Contamination & Decontamination • Radiation is a type of energy

• Contamination is material

• Radioactive contamination emits radiation

• Exposure to radiation will not contaminate you

Radiation exposure is energy that passes through and may do damage but does not contaminate. So when a person is exposed to radiation it does not necessarily mean that the person is contaminated. In order to become contaminated, a person has to be physically in contact with the radioactive material. When radioactive material is where it is not wanted (e.g., on the ground, in water, or on you), we refer to it as “contamination”. Contamination is measured in counts per minute (cpm) and disintegrations per minute (dpm).

If someone is contaminated (externally), most of the material could be easily removed from the body by removing the clothing and washing with a mild soap and shampoo.

Example: We all go to the dentist and periodically receive an x-ray of our dental work. The energy of the x-ray travels through our tissue and teeth which develops the film to be read by the dentist. The x-ray passed through our teeth but did not physically touch our body in any way. Note: X-rays, CT scans, fluoroscopy, any machine producing radiation does not contaminate the patient.

If a radiological incident or accident occurs at a nuclear power plant in Alabama, the risk counties have procedures in place to open reception centers in order to monitor evacuees and emergency workers for radiation contamination and if needed, decontaminate. At reception centers, the evacuees and/or emergency workers can be decontaminated by gender, which typically takes place at school gymnasiums, recreation centers, or decontamination tents.

19 Radiation Pathways • Inhalation

• Ingestion

• Absorption

• Injection

External hazards of radiation dose are beta particles and gamma rays. Beta particles can cause burns to the skin. Gamma rays are very energetic and can penetrate through internal organs. Internal hazards of radiation dose are alpha particles, beta particles, gamma rays, and neutron particles. Once inside the body, they all become very harmful internal hazards. Radiological materials may enter the body by ingestion, by inhalation, by absorption through the skin, or by injection through a cut or break in the skin, such as a wound. • Inhalation – a major route of entry; either exhaled or deposited in the respiratory tract. If deposited, damage can occur through direct contact with tissue or may diffuse into the blood through the lung-blood interface. Substances absorbed into the blood are circulated and distributed to organs that have an affinity for that radioactive element. Health effects can then occur in the organs. • Ingestion –inadvertently gets into the mouth and is swallowed; can be absorbed through the lining of the gastrointestinal tract and then transported by the blood to internal organs. • DIRECT: in the plume drinking contaminated water • INDIRECT: eating meat from cattle that have fed on contaminated grass • Injection: Substances may enter the body if • Absorption – Skin (dermal) contact is the method of absorption into the body; can also cross the skin barrier and be absorbed into the blood system, producing systemic damage to internal organs; eyes are particularly sensitive to absorption. • Injection – Substances may enter the body if the skin is penetrated or punctured by contaminated objects. Effects can then occur as the substance is circulated in the blood and deposited in the target organs. Open wounds can also be a sources for injection. Examples: inhalation of airborne contaminants such as radon ingestion of contaminated food or liquids absorption of vapors such as tritium oxide through the skin injection of medical radioisotopes such as technetium-99m

20 Avoid Radioactive Contamination Do not: • Eat Use PPE while on the scene of an incident involving radioactive material. • Drink • Smoke • Chew/Dip • Lip balm • Make-Up

Contamination occurs when an individual comes in contact with radioactive material. This may be external, internal, or a combination of the two.

When people walk through, touch, or have radioactive material spill or fall upon them, they are externally contaminated. The contamination causes exposure because the radioactive material is deposited on the person’s body and/or clothing. Removing the clothing and showering with a mild soap will probably remove the external contamination. In stubborn cases, a second shower may be required.

A trained person with a survey instrument will be able to detect contamination on an individual and will be able to decontaminate them externally.

21 Contaminated Injured

Decontamination Protocols Saving lives

A contaminated individual may have also sustained a physical injury. In all cases, the treatment of an injury takes priority over decontamination.

Contamination is nothing more than a nuisance. Injuries come first, and decontamination comes second.

22 Radiation & Our Five Senses

• We are aware of our environment through our five senses.

• You must rely on instruments to detect the presence of radiation.

Ionizing radiation cannot be detected by our five (5) senses. We cannot feel, taste, smell, see, or hear radiation. The safety of emergency responders is the most important consideration when responding to a radiological incident. Safety is accomplished by the use of radiological instruments which help the first responder detect, measure, and document the amount of radiation in a radiological response. Therefore, we must use radiation detection instruments such as pocket dosimeters and other equipment to know if, when, and how much radiation is present.

You must learn to read the instruments properly because the instruments will let you know if radiation is present. You have to rely on them.

23 KI (Potassium Iodide) • Thyroid Blocking Agent

• Fills the thyroid gland with non- radioactive iodine

• Helps radioactive iodine from being absorbed into the thyroid

• Adult dosage: 130 mg/day – Effective for 24 hours

• Distributed at the Emergency Worker Station & the Community Reception Center by an ADPH nurse who is KI- trained

In a radiation emergency at a nuclear power plant, radioactive iodine in the form of I-131 may be released into the air. Potassium Iodide can help prevent radioactive iodine from being absorbed into your thyroid.

All radioactive material targets different parts of our bodies. Some are organ seekers, bone seekers, blood seekers, etc.. Radioactive iodine is a thyroid seeker. Our thyroid gland works like a sponge. We’re going to fill the thyroid gland up with nonradioactive iodine in the form of KI (Potassium Iodide). So if radioactive iodine happens to be breathed in, the thyroid gland is already full and would not accept much more, if any. So the radioactive iodine would be excreted from your body with minimal damage.

When there is a need for Potassium Iodide, KI will be made available to you. Potassium Iodide is stockpiled at the county health departments (Houston, Henry, Morgan, Lawrence, Lauderdale, and Limestone) in the possession of the county health nurse. If you are told to take KI, take 1 dose for every 24 hours (Daily dose = (1) 130 mg tablet or (2) 65 mg tablets) you are exposed to radioactive iodine. Do not take more often and do not take this drug if you know you are allergic to iodine.

24 Pocket Dosimeters

Roentgens

Roentgens 0 1.0 2.0 3.0 4.0 5.0 0 5 10 15 20

Milliroentgens 0 50 100 150 200 • Look through the dosimeter toward a light source

The Direct-Read Dosimeters (DRD) are designed to measure gamma radiation and x-rays. The DRD is a pencil-shaped tube with an eyepiece at the clip end and an ion-chamber equipped with a charging pin at the opposite end. Dosimeters are fairly accurate, rugged, and can be read directly by the user. Direct-Read Dosimeters give the advantage of immediately knowing the amount of gamma radiation that the wearer has been exposed to. DRDs are not expensive and are fairly easy to use.

The pocket dosimeter is read by pointing it toward a good source of light and viewing the scale and hairline through the lens at the clip end of the dosimeter. When reading pocket dosimeters, always keep the scale in the horizontal position to ensure an accurate reading.

If the dosimeter is exposed to radiation, the hairline will move along the scale to indicate the amount of exposure.

While performing the tasks of an emergency worker, read your dosimeter at least every 30 minutes. Record the beginning and ending dosimeter readings on the Radiation Exposure Record. The difference between the beginning and the ending is your exposure.

25 Radiation Exposure • Dosimeter = Odometer – It doesn’t go back down once it goes up. • Can be used by anyone else after it is zeroed. • Accumulated Exposure

Emergency workers measure their radiation exposure with a pocket dosimeter/direct-read dosimeter (DRD). Pocket dosimeters are a piece of equipment which can be read immediately by the wearer. Radiation exposure is measured in Roentgen (R) and Milliroentgen (mR). The pocket dosimeter will let you read how much dose you have received.

Pocket dosimeters are similar to odometers. The accumulated exposure recorded on a dosimeter can be compared to the accumulated distance on an odometer.

All emergency workers working in a radiation field will be issued two (2) pocket dosimeters. One (1) low-range dosimeter reading in 0-200 mR and one (1) high- range dosimeter reading in either 0-20 R or 0-5 R.

If your DRD is dropped (consider it contaminated) and the needle is no longer visible, then use the reporting levels from your team member. The use of another team member’s DRD reading is considered Group Dosimetry.

26 Thermoluminescent Dosimeter

Wearer Number • Records radiation dose for legal/permanent exposure records • Can not be used by anyone else once issued • Results not immediately available

The thermoluminescent dosimeter (TLD) is a laminated wallet-sized card which provides a permanent record of the wearer’s dose. TLDs are extremely accurate and will give the exact amount of exposure. The TLD card serves as your legal/permanent record to radiation.

TLD cards are so precise, they will give the exact amount of dose from radiation. TLDs contain two (2) lithium fluoride chips which absorb and store the energy received from exposure to radiation. Unlike the pocket dosimeters, TLD cards cannot be read directly by the user. When you complete your emergency worker duties, you will turn the TLD card in, your TLD will be sent off to be read, and you will be notified of your dose.

Remember: the thermoluminescent dosimeter serves as your legal/permanent record.

27 Placement of the TLD & Pocket Dosimeter TLD Pencil/Pocket

TLDs and pocket dosimeters should be placed between the shoulder and the waist (preferably on the chest area).

Since TLDs cannot be read by the wearer, TLDs should be placed on street clothes or under protective clothing.

Pocket dosimeters need to be placed on the outside of the clothing whether it’s street clothing or protective clothing so they can easily be accessible when reading and reporting at predetermined time intervals (i.e. at least every 30 minutes).

28 TEDE (Total Effective Dose Equivalent)

• Total Dose = External + Internal • External = Pocket Dosimeter Reading • External = Internal • Therefore… • TEDE = 2 x Pocket Dosimeter Reading

In Alabama, the administrative limit is stated in terms of the external dose, which is measured by a pocket dosimeter. To account for the internal dose, which cannot be measured prior to or during a mission, the internal dose is assumed to be equal to the external dose. The two doses (internal & external) added together is the Total Dose or TEDE. In Alabama, twice (2x) the pocket dosimeter reading is recorded as a person’s TEDE.

29 Radiation Dosage Limits for Emergency Workers and Personnel & Equipment Monitors

Although emergency workers are not expected to be exposed to significant levels of radiation, the dosimeter reading values are shown in the right hand column. The administrative limit for emergency workers in Alabama is set at one-half of the EPA-recommended limits. This table shows the dosimeter readings that will most likely keep the TEDE (Total Dose) from exceeding the EPA limit. Do not exceed the limits in the right hand column, and you will not exceed your TEDE (Total Dose). The green wallet size card is for Emergency Workers (EWs) and Personnel & Equipment Monitors (PEMs). The 6 radiation dose limits apply to all EWs and PEMS. EWs and PEMs are instructed to seek relief at 100 mR on their dosimeter. Do not wait until the dosimeter is on 100 mR before you request relief. Remember, you are recording your dosimeters at least every 30 minutes. Call to request relief when your dosimeter approaches 100 mR; this gives your replacement ample time to travel to your destination to relieve you. ▪ Remember 100 mR on dosimeter (external) + 100 millirem (internal) = 200 mrem TEDE. ▪ Which dosimeter would you be reading? Answer: Low-range (black or silver) EWs and PEMs are allowed to receive 1 rem per day TEDE; your dosimeter would be reading 500 mR. ▪ 500 mR on dosimeter (external) + 500 millirem (internal) = 1000 mrem = 1 rem TEDE. ▪ Which dosimeter would you be reading? High-range (yellow) EWs and PEMs are allowed to receive 5 rem maximum per accident TEDE; your dosimeter would be reading 2.5 R. ▪ 2.5 R on dosimeter (external) + 2.5 rem (internal) = 5 rem TEDE. ▪ Which dosimeter would you be reading? High Range (yellow) The Annual Occupational Limit (AOL) for individuals who work in the radiation area are allowed to receive 5 rem per/year TEDE. Additional radiation dosage limits for EWs and PEMs: one could receive up to 25 rem TEDE for life saving situations. At that point your dosimeter should be reading 12.5 R. 12.5 R on dosimeter (external) + 12.5 rem (internal) = 25 rem TEDE.

30 Reminders for Emergency Workers and Personnel & Equipment Monitors

The back of the green wallet size card shows key reminders for both EWs and PEMs as well as key reminders for just PEMs.

Remember – You can carry/have the green wallet-sized card at all times. This green card lists all your limits and keynotes since you may not have access to the manual.

31 Emergency Worker Equipment

1. KI tablet a. When do you take the KI? (when your county EMA has instructed you to) b. How often and how many should you take? (one (1) 130 mg tablet or two (2) 65 mg tablets every 24 hours as needed) c. Who should not take KI? (a person who has a known medical history to iodine ) 2. Thermoluminescent Dosimeter (TLD Card) a. Can you read a TLD card? (No) b. What does the TLD card serve as? (Your legal permanent record) 3. Two Pocket Dosimeters. One low-range and one high-range. a. By color, which is the high range? (Yellow) b. What units are used by the high range dosimeter? (0-20 Roentgen) or (0-5 Roentgen) c. How often would you check and record your dosimeters? (at least every 30 minutes; Read 15 minutes in > 1 mR/hr field or every 30 minutes < 1 mR/hr field) d. What is your seek relief limit measurement on your dosimeter? (100 milliroentgen) e. Which dosimeter would you be reading to begin with? (Black or Silver - Low range, 0-200 milliroentgen) 4. Record your pocket dosimeter readings on the Radiation Exposure Record.

32 CDV-750 Dosimeter Charger

Clamp Clamp Trigger

Discharge Button

Generator Lever

The dosimeter charger is used to charge or zero the pocket dosimeters with different lengths and ranges. The charger provides 200 volts to the direct-read dosimeter that moves the hairline down to zero.

Instructions on using the CDV-750 dosimeter charger: 1. Adjust the clamp to fit the length of the dosimeter. 2. Pull the clamp trigger back and insert the dosimeter with the clip toward the back. The dosimeter must have a snug fit. Make sure the scale of the dosimeter is horizontal. 3. Look to see if there is a hairline. If there is a hairline, pump the black generator lever to “charge” or zero the dosimeter. If you don’t have a hairline, then give the generator lever a few slow pumps, and the hairline will appear on the right hand side. Continue pumping the generator lever until the hairline is on zero. 4. If the hairline falls below zero, press the black discharge button to bring the hairline back to zero. 5. To remove the dosimeter from the charger, squeeze the clamp trigger and lift the dosimeter above the end of the clamp, pulling it straight back to disengage it from the charging contact. 6. Once removed from the charger, read the dosimeter to ensure that the hairline has remained on the zero reading. It may be necessary to re-zero the dosimeter.

3333 Milliroentgens Milliroentgens Milliroentgens 0 50 100 150 200 0 50 100 150 200 0 50 100 150 200

Reload dosimeter onto charger if: 1. Filament won’t move/appear 2. Filament “floats” (keeps on moving while Milliroentgens on the charger 100 150 200 Get a new dosimeter (or charger) if above cannot be resolved

Get a new dosimeter if 1. The filament still moves when off of the charger

Milliroentgens 0 50 100 150 200

Milliroentgens 0 50 100 150 200

34 EVERYONE TAKE THIS NOW!!!!!!! EVERYONE: https://bit.ly/ADPHORCEW 1. Turn in TLD 2. Turn in dosimeters 3. Turn in chargers 4. Pass EW assessment with 80% or greater for credit (2 attempts)

35 Guidance for Emergency Medical Service Management

Radioactive materials are among the many kinds of hazardous substances Emergency Medical Service (EMS) personnel may have to deal with. It is prudent, as emergency personnel, to know your role in responding to a radiation accident should one occur in your community. Emergency Medical Service personnel should always follow procedures in order to handle radiation accidents properly.

As emergency workers, EMS personnel will perform duties such as life-saving activities and packaging and transporting potentially radioactively contaminated patients.

36 Notification & Communication

1.Immediately notify the receiving hospital of the possibility of a radioactively contaminated patient, and request information on any special entrance to the Emergency Department for the possibly contaminated patient. 2.Provide the receiving hospital… 1. …the estimated time of arrival 2. …the number of victims 3. …the medical status of each. 3.If during a drill, before each transmission, say “This is a drill.”

When the Emergency Medical Service (EMS) personnel are notified of an accident victim who is involved with or possibly contaminated with radioactive material, a planned course of action should be followed, and communication should be established immediately with the receiving hospital.

If any doubt about contamination exists, assume the victim is contaminated until proven otherwise. EMS dispatch should immediately notify the receiving hospital of the possibility of a potentially radioactively contaminated patient and request information on any special entrance to the emergency department for the possibly contaminated patient. Also provide the receiving hospital the estimated time of arrival, number of victims, and medical status of each.

If during a drill, before each transmission, say “This is a drill.”

37 Radiation Booklet & Response Tote

Each ambulance service is provided with two copies of the “Radiation Accident Booklet” and a response tote. It is recommended that one book be kept with the radiation response tote and one book be placed with dispatch. The booklet is intended to provide a team leader guidance when assigning duties and equipment to Emergency Medical Service personnel during an event with a nuclear power plant. The booklet also has a guide for dressing and undressing personal protective clothing and preparing an ambulance for response.

38 Preparing the Ambulance for Contamination Control

To prevent the spread of radiation contamination and to continue ambulance operations, EMS personnel should take the time to prepare their ambulance.

Four (4) things are needed to prepare an ambulance:: • sheets • masking tape • radiation-labeled garbage bag (or yellow radioactive waste plastic bag) • undress procedure poster

1. Cover the bench and floors of the ambulance with sheets. Tape seams along walls and doorway. 2. Use tape to secure the sheets to prevent a tripping hazard. 3. Close all doors and cabinets, and stow any unnecessary articles or items inside of the ambulance. 4. Cover any equipment which may be used such as hand held radios with a clear bag . 5. Additional sheets (use 3-sheet method) are needed for the preparation of wrapping/cocooning the patient for transport and to be used during the initial assessment at the accident scene. 6. Include a radiation-labeled garbage bag (or yellow radioactive waste plastic bag) in the back of the ambulance. The bag is to be used as contamination control for radioactive waste (e.g. glove exchange, victim’s clothing, etc.). 7. Tape up the Undress (Doffing) procedure poster titled “Radiation Accident Protocol: Exit of the Decontamination Team” to the back door of the ambulance to assist in undressing when instructed by the hospital Radiation Safety Officer (RSO). 8. Place a box of gloves (both base pair and outer pair) out for easy access. 9. If additional bags are needed, then affix a radiation label to the bag.

39 Response Team Preparation

The purpose of protective clothing is to keep bare skin and personal clothing free of contaminants. EMS personnel should properly dress out in anti-C clothing and follow the instructions on the “Dress Out Instructions” poster or packet. It is been shown that dressing out together in tandem on each step is helpful to ensure that all steps are followed in the correct order. To assist with the response team preparation of anti-C clothing and equipment, place the “Dress-Out Instructions” poster on the wall and follow instructions to ensure all response team members are properly dressed out.

Anti-C clothing consists of coveralls, head cover, mask w/eye and mouth protection, gloves, and waterproof shoes covers (yellow). All open seams and cuffs should be taped using masking tape. Fold-over tabs at the end of each taped area will aid in removal. Two pairs (inner orange nitrile, outer nitrile of any color) of surgical gloves should be worn. The first pair of gloves (orange), called the “base pair,” should be secured by tape to the sleeve of the coveralls. The second pair of gloves should be easily removable and replaced if they become contaminated.

A direct-read dosimeter (DRD) should be assigned to each team member and attached to the outside of the anti-C clothing at the neck where it can be easily removed and read. A TLD badge should be worn under the anti-C clothing. EMS personnel responding to a radiological incident should implement the buddy system to read (monitor) DRDs at least every 30 minutes and record information on the Radiation Exposure Record.

The team leader will assign a person to distribute all radiation equipment to EMS personnel responding to an area that has been evacuated and is potentially contaminated with radioactive material. The Radiation Equipment Distribution Log is necessary for record keeping for the specific equipment issued to an individual and for the duration of the accident/incident.

Upon arrival at the hospital, EMS team should follow the “Exit Instructions” to ensure that undressing from the PPE is followed using the correct method. Be sure to help the person that is getting undressed if you are still in your PPE and designated as being in the “hot zone” that the hospital has laid out at the designated ambulance entrance.

40 Safety Briefing •Equipment •Dose limits •PPE

All Emergency Workers will be issued the following equipment: • Radiation Exposure Record • Thermoluminescent Dosimeter (TLD card) Fill out Radiation Exposure Record information • Low Range Pocket Dosimeter (0-200mR) Fill out Radiation Exposure Record information Black • High Range Pocket Dosimeter (0-20R) Fill out Radiation Exposure Record information Yellow • Maximum Radiation Dosage Limit Card (green card) • Potassium Iodide (KI) will be issued by ADPH KI Nurse. DO NOT TAKE UNTIL TOLD TO DO SO BY EMA. • When reading your dosimeter, point toward a good light source. Read through the clip end. Keep the scale in the horizontal position to assure an accurate reading. • Read your dosimeters at least every 30 minutes, and record on your radiation exposure record. • The TLD card is your permanent record and cannot be read in the field. • Read your dosimeters and record on the Radiation Exposure Record at least every 30 minutes. • Seek relief at 100mR (black dosimeter) • Do not wait until the dosimeter is on 100mR before requesting relief; call when it is approaching 100mR. • Your TLD should be worn under your PPE and dosimeters should be worn on the trunk of the body on the outside of the PPE. • If you reach the limit on your black low range dosimeter (200mR), use your yellow high range dosimeter (20R). • Authorization to exceed emergency worker exposure guidelines must be obtained from the State Health Officer prior to any exposure limit being exceeded. This will be done through the local EMA office. • Remember to stay in contact with your department’s safety officer. • If you have any questions, contact the local EMA office for assistance. • Follow all donning and doffing directions when putting PPE on and taking PPE off. • Do not eat, drink, chew gum, smoke, apply make-up, or put on lipstick/lip balm while on duty as an emergency worker.

41 Field Operations Overview

1. Dosimeters should be checked at least every 30 minutes and recorded on the Radiation Exposure Record. 2. Assess and treat life-threatening injuries immediately. Assessing injuries should always take priority over decontamination. 3. Place a sheet on the ground to prevent you (your knees) and your equipment from becoming possibly contaminated. 4. Exchange out gloves frequently (universal precautions) to prevent the spread of contamination. 5. Remove the victim’s clothing, and prepare & transport the victim as soon as possible. 6. Place the victim’s clothing in the prepared radiation labeled yellow garbage bag or a bag with a “Radioactive Material” label on it. 7. Do not eat, drink, smoke, rub eyes or nose, apply lip balm/lipstick/makeup while conducting response operations.

42 Preparing for Patient Decon

1. Scene assessment: Are there any hazards? Read dosimeters at least every 30 minutes and record on the radiation exposure record (refer to the documents in the back of this book). 2. Perform a patient assessment: stable or unstable? If unstable, cocoon then “Load and Go”. Contact the hospital with any relevant information. 3. Place a blanket/sheet on the ground for trauma bag or equipment. The ground cover is to prevent items from being contaminated. It also provides a place to kneel down while assessing the patient. 4. Place a face shield or towel over the patient’s airways (if clear) to prevent inhalation of radioactive contaminants. This can be performed right before the removal of the patient’s clothes. 5. Use a large bag and remove the patient’s shoes. Seal and set aside. Change gloves. 6. Responders or equipment should never intentionally come in direct contact (knees or hands) with the ground. If this occurs, then consider yourself or the equipment to be contaminated. Use a clear bag to cover the item and affix a label with “radioactive material” before removing an item or equipment from the ground (e.g. dosimeters, stethoscope). If an item or article is not needed (e.g. shears), then leave it at the scene. 7. Responders and the entire inside and outside of the ambulance will be surveyed by personnel using a radiation survey instrument at the hospital or other designated location.

If during a drill, before each transmission say, “This is a drill.”

43 Patient Decontamination: Clothes Removal and Cocoon

1. Start cutting slowly at the shoulder at same rate of speed, and go down to the wrist. Roll clothing inside out, and tuck it underneath the patient’s exposed arms. 2. Start cutting slowly down the patient’s side, and, with the free hand, grab the clothing. Roll the clothing while lifting it up and away from the patient’s skin. 3. Continue cutting slowly all the way to the ankles, and roll the clothing down and away from the patient. Roll the clothes inside out and tuck underneath the patient. Change gloves. 4. One responder will log roll the patient while the other responder slowly folds the top sheet over the clothes. Be careful not to step onto the second sheet/blanket. 5. Now, log roll the patient to the opposite side, and fold the top sheet over the other seam. 6. Start rolling the top sheet from the head toward the feet, and place out away from the patient. Change gloves. 7. Conduct an assessment, and determine the mechanism of injury (MOI). Treat according to local policy and procedures. 8. Changes gloves as needed using “Universal Precautions” to prevent contamination spread from one location to another. 9. Wrap patient entirely with second sheet/blanket, and attach back board straps/mega mover. Use additional sheets/blankets to cocoon feet and head if needed. Change gloves. 10.Transfer patient from the ground to the stretcher. Be careful not to let straps from the stretcher touch the ground. Change gloves. 11.Read dosimeters, and record upon departure. Relay to hospital estimated time of arrival and include “patient may be contaminated with radioactive material”.

44 Patient Decontamination: 3-Sheet Method 3-Sheet Method 1. Top Sheet: Cocoon Clothes 2. Middle Sheet: Cocoon Patient 3. Bottom Sheet: Remains at Scene

Backboard

1. Is the patient still stable? Is scene safe? If “Yes,” then proceed with response operations. 2. Prepare and fold 3-sheets/blankets as one article. 3. Slide a back board (or mega mover) below the second sheet. Follow policy and procedures on usage of backboard versus mega mover. 4. Place folded sheets/blankets beside patient and SLOWLY unfold the top and bottom of the sheet/blanket. This prevents material from becoming an airborne hazard. 5. Slowly unfold one side of sheet/blanket and place under log rolled patient. Do the same to the opposite side until patient is on top of the sheets/blankets.

If there is critical change in patient’s status, cocoon then “Load and Go”.

45 Patient Transfer

The hospital staff will meet the ambulance outside the emergency department or designated receiving area. A patient in stable condition should be transferred to a clean stretcher. A whole body radiation survey of the patient can be conducted prior to entering the decontamination room. The EMS personnel should remain with the ambulance. Do not eat, drink, dip, apply lip balm/lipstick/make-up while awaiting release by the Radiation Safety Officer.

To properly remove the anti-C clothing and equipment and to eliminate unnecessary cross contamination, when exiting the controlled area, place the “Radiation Accident Protocol Exit of the Decontamination Team” poster on the wall beside the decontamination room doorway and within view of the step off pad. Follow the step-by-step instructions on the guide. If a response member needs help with the removal of coveralls, remember to exchange gloves when finished with the task. A chair (metal or cover chair) may be used to assist with balance while doffing the personal protective equipment.

Before leaving the area, the ambulance and personnel shall be monitored for contamination. If contamination is found, a shower and change of clothing is required. A final survey by the hospital’s Radiation Safety Officer (RSO) is required before leaving the area. If the ambulance is found to be contaminated, the ambulance will be directed to the emergency worker decon station to be decontaminated (cleaned).

Contact the county EMA or your point of contact in the county Emergency Operations Center (EOC) when activated for the locations of the Emergency Workers Decontamination Stations.

46 Radiation Emergency Assistance Center/Training Site (REAC/TS) 24-Hour Emergency Phone: 865-576-1005 Ask for REAC/TS

Normal Work Hours Phone: 865-576-3131

On the Web: orise.orau.gov/reacts

The REAC/TS staff are available 24 hours a day/seven days a week to deploy and provide emergency medical consultation for incidents involving radiation anywhere in the world. REAC/TS is recognized for its expertise in the medical management of radiation incidents.

47 Glossary

• ALPHA RADIATION – A positively charged particle emitted from the nucleus of a radioactive element. It has a low penetrating power and has a short range - a few inches. Alpha particles are not an external hazard but are extremely hazardous when introduced into the body.

• ALARA – An acronym for As Low As Reasonably Achievable. An approach to radiation protection to control or manage exposures as low as social, technical, economic, practical, and public policy considerations permit. ALARA is not a dose limit but a process to keep dose levels as far below applicable limits as reasonably achievable.

• BACKGROUND RADIATION – The radiation in the natural environment, including cosmic rays and radiation from the naturally radioactive elements, both outside and inside the bodies of humans and animals. It is also called natural radiation. The average individual exposure from background radiation is 620 millirem per year.

• BETA RADIATION – A negatively charged particle emitted from the nucleus during radioactive decay. It has a medium penetrating power and a range of up to a few feet. Large amounts of beta radiation may cause skin reddening, and are harmful if they enter the body. Beta radiation is an external and internal hazard.

• CONTAMINATION – The deposition of unwanted radioactive material on the surface of structures, areas, objects, or personnel. Radioactive material in a location where it is unwanted.

• CPM – An acronym for counts per minute and is associated with contamination surveys. The pancake probe (44- 9) with the Ludlum 14C is used when detecting for contamination.

• DECONTAMINATION – The reduction or removal of radioactive material from a location where it is unwanted.

• DOSIMETER – A portable instrument or device used for measuring and registering the total accumulated exposure to ionizing radiation. Examples are pocket dosimeter, TLD or film badge.

• EMERGENCY CLASSIFICATION Levels – 1. Notification of an Unusual Event (NOUE), 2. Alert, 3. Site Area Emergency, 4. General Emergency.

Glossary • EMERGENCY WORKER – An individual performing duties to protect the health and safety of the public during a radiological emergency (e.g., firemen, school bus driver, police, highway personnel, medical personnel, etc.)

• EXPOSURE – The absorption of radiation or ingestion of a radionuclide.

• EXPOSURE RATE – The measure of radiation by a device (survey meter) over some time period, usually an hour.

• GAMMA RADIATION – A high energy photon emitted from the nucleus of an atom. It has the most penetrating power and a range of up to hundreds of feet. Gamma rays will penetrate the internal organs, therefore, they are an internal and external hazard.

• GEIGER-MUELLER COUNTER – A radiation detection and measuring instrument. It consists of a gas-filled tube containing electrodes, between which there is an electrical voltage but no current flowing. When ionizing radiation passes through a tube, a short intense pulse of current passes from the negative electrode to the positive electrode and is measured or counted. The number of pulses per second measures the intensity of radiation.

• ION – An atom that has too many or too few electrons, causing it to be chemically active; an electron that is not associated (in orbit) with a nucleus.

• IONIZING RADIATION – Any radiation capable of displacing electrons from atoms, thereby producing ions. Examples: alpha, beta, gamma, x-rays, neutrons and ultraviolet light. High doses of ionizing radiation may produce severe skin or tissue damage.

• INVERSE SQUARE LAW – The law states the gamma rays intensity is inversely proportional to the square of the distance from a point source. Therefore, doubling the distance from a point source of gamma radiation decreases the exposure rate to one-fourth (1/4) the original exposure rate.

48 Glossary • IONIZATION – The process of adding one or more electrons to, or removing one or more electrons from, atoms or molecules, thereby creating ions. High temperatures, electrical discharges, or nuclear radiation can cause ionization.

• LITHIUM FLUORIDE – A chemical compound used in thermoluminescent dosimeters.

• KCPM – An acronym for kilo counts per minute (thousands of counts per minute).

• MILLI – A prefix meaning one-thousandth (1/1000) or divides a basic unit by 1000. For example, millirem is one-thousandth part of a rem )

• PERSONNEL MONITORING EQUIPMENT– Devices designed to be worn by a single individual for the assessment of dose equivalent such as film badges, thermoluminescent dosimeters (TLDs), and pocket dosimeters.

• POTASSIUM IODIDE (KI) – A chemical form of stable iodine that can be used by the body to block absorption of radioiodine by the thyroid gland.

• RAD – An acronym for Radiation Absorbed Dose . The special unit of absorbed dose. One (1) rad is equal to an absorbed dose of 100 ergs/gram or 0.01 joule/kilogram (0.01 gray).

• RADIATION – Is energy in the form of rays or high-speed particles. Radiation occurs naturally as in sunlight. Radiation is also manmade in the form of x-rays, medical treatments, nuclear weapons, and commercial nuclear power facilities. All forms of electromagnetic radiation make up the electromagnetic spectrum.

• RADIOACTIVE MATERIAL – Any material which spontaneously emits particle or photon radiation in an effort to expend excess energy.

• RADIOACTIVITY – The spontaneous emission of radiation, generally alpha or beta particle often accompanied by gamma rays from the nucleus of an unstable isotope.

Glossary • RCA – An acronym for Radiation Control Agency.

• REM – Roentgen Equivalent in Man. The special unit of dose equivalent in man. It is measurement of the effect of all types of radiation on the human body.

• ROENTGEN (R)– A unit of exposure to ionizing radiation in air. It is radiation effect in air from x-rays or gamma rays.

• SHIELDING – Any material or obstruction that absorbs radiation and thus tends to protect personnel or material from the effects of ionizing radiation

• SURVEY METER – Any portable radiation detection instrument adapted for inspecting an area to establish the existence and amount of radioactive material present.

• TEDE – An acronym for Total Effective Dose Equivalent. Total Dose = External Dose + Internal Dose.

• THERMOLUMINISCENT DOSIMETER (TLD) – An extremely accurate device used to measure and provide a permanent record of exposure to radiation.

• X-RAY – A photon originating from the electron cloud rather that from the nucleus of an atom. One form of electromagnetic radiation. It has penetrating power like gamma radiation. X-rays will penetrate the internal organs, therefore, they are an internal and external hazard.

49 Just In Time Videos • Pocket Dosimeter Zeroing: Using CDV-730 Charger (quick overview) – https://youtu.be/0yxneFuqDQE

• Pocket Dosimeter: Usage of Low & High Range Dosimeters – https://youtu.be/Nez1_pi_8z4 – Note: Although many protocols in the video are in line with ADPH protocols, always follow ADPH protocols

•Donning PPE (ADPH-produced) – https://youtu.be/UANQNAd1a4c

• Doffing PPE (ADPH-produced) – https://youtu.be/MNU6uaIdNQA

ADPH VERSION OF VIDEOS COMING SOON!

Just In Time Videos • 3-Sheet Method for Field Decontamination of Patient (ADPH-produced) – https://youtu.be/F-6GgSq2qeA

• FEMA EMS Response – https://youtu.be/zh9i8hLd8bU

50 Name: SS# (last 4): 200 mR ( )5R ( ) 20R Agency: DOS#: Date: (MM/DD/YY) TLD#: Note! Read dosimeter at least every 30 minutes 06/2019 Reading Status () # Time (24 hr) Low Range (mR) High Range (R) Start End Total 1 Initial Reading 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

51 # Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card 52 SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading

# Date (MM/DD/YY): Name: Dosimeter(s) TLD Card SS# (last 4): Agency: Low (200 mR) #: High ( )5R ( )20 R #: #: Initial Reading End Reading Initial Reading End Reading RADIATION ACCIDENT TEAM DRESS-OUT PACKAGE

ITEM QUANTITY Disposable Booties 1 (pair) Yellow Plastic Waterproof Shoe Covers 1 (pair) Disposable Coveralls 1 (suit) Disposable “Orange” Nitrile Gloves 1 (pair) Disposable Non-latex Gloves 1 (pair) Protective Mask w/Splash Visor Eye Shield 1 Disposable Hood 1

Note: You will need a roll of masking tape.

DRESS-OUT INSTRUCTIONS

1. Record TLD number, personal dosimeter serial numbers, and initial dosimeter readings on Radiation Exposure Record before entering controlled area.

2. Attach TLD to clothes (upper body).

3. Put on disposable booties.

4. Put on (yellow) plastic waterproof shoe covers over disposable booties.

5. Put on disposable coveralls. a. Tape zipper – leave a tab for easy removal of tape. b. Tape to booties – leave a tab for easy removal of tape.

6. Put on inner pair of “orange” nitrile gloves. a. Tape to sleeve – leave a tab for easy removal of tape.

7. Put on outer pair of non-latex gloves (do not tape!).

8. Label your position “title” on masking tape. a. Place on front and back of coveralls.

9. Attach pocket dosimeters to upper body (outside coveralls).

10. Put on mask w/splash visor eye shield.

11. Put on disposable hood.

Last Revised: January 2021

53 RADIATION ACCIDENT PROTOCOL EXIT OF THE DECONTAMINATION TEAM

HOSPITAL: Post in sight of step-off pad AMBULANCE: Post in back window of ambulance

1. Have Inside Radiation Safety Officer (RSO) frisk hands before beginning Exit Process. If contamination is found, remove and replace outer pair of non-latex gloves and continue instructions.

2. Give pocket dosimeter to RSO. Be sure that reading is recorded upon exit.

3. Remove disposable hood. Put in a waste container.

4. Remove (yellow) plastic waterproof shoe covers. Put in a waste container.

5. Remove tape from wrists, coveralls, and booties. Put in a waste container.

6. Remove coveralls (slowly pull downward to ankles). Step out of coveralls. Put in a waste container.

7. Remove disposable booties (one at time). Put in a waste container while stepping over the control line. a. RSO should monitor bottom of shoes at this time.

8. Remove outer pair of non-latex gloves. Put in a waste container.

9. Remove TLD and give to RSO.

10. Remove mask w/splash visor eye shield. Put in waste container

11. Remove inner pair of “Orange” nitrile gloves. Put them in a waste container.

12. Receive a complete whole-body survey with a Geiger-Mueller survey meter from the hospital personnel (should take several minutes). a. If survey indicates the presence of contamination, DO NOT leave the area until assisted by the RSO.

Last Revised: January 2021

54 Equipment/supplies needed for “Just in Time Training”: Thermoluminescent Dosimeters (TLD cards) Clips for TLD Cards Low Range Pocket Dosimeters (0-200 mR) High Range Pocket Dosimeter (0-5 R or 0-20 R) CDV-750 Dosimeter Charger(s) Radiation Dosage Limits Cards for Emergency Workers and Personnel & Equipment Monitors Radiation Equipment Distribution Log(s) NOTE: Record all EWs and PEMs with the appropriate issued equipment. Radiation Exposure Record(s) Pen(s) and/or Pencil(s)

All EWs and PEMs will be issued the following equipment (pouches): 1. Thermoluminescent Dosimeter (TLD Card) 2. Low Range Pocket Dosimeter (0-200 mR) 3. High Range Pocket Dosimeter (0-5 R or 0-20 R) 4. Radiation Exposure Record 5. Radiation Dosage Limit Card 6. Potassium Iodide (KI) will be made available, if needed (EWs only)

Follow the steps below to conduct “Just in Time” Training: Zero pocket dosimeters (instructions on back) Track each EW and PEM issued dosimetry on the Radiation Equipment Distribution Log Prepare a Radiation Exposure Record for each EW and PEM Instruct each EW and PEM on the use and specific details of dosimetry (see below) Inform each EW that Potassium Iodide (KI) will be made available, if needed (EWs only) Issue each EW and PEM a Radiation Dosage Limit Card and discuss the allowable limits Remember: TIME, DISTANCE and SHIELDING! At the end of mission, return dosimetry, etc. to the Command Post and/or EW station. Dosimetry will be recorded. (EWs only) If contamination is present, EWs will be directed to a local community reception center for decontamination. (EWs only)

 TLD card(s) serve as a permanent/legal  Pocket dosimeters can be read directly by the user record.(user specific; not interchangeable)  Place pocket dosimeters on the outside of the top  Place clip on TLD card layer of clothing between the neck and waist  Clip TLD card to street clothes or under (preferably chest area) protective clothing between the neck and waist  Read both (low and high) pocket dosimeters at least (preferably chest area) every 30 minutes (clip end/good source of light)  Can NOT be read in the field; will be read at the  Record readings on the Radiation Exposure Record completion of the emergency  Seek relief at 100 mR on the low dosimeter

55 Radiation Dosage Limits: Emergency Workers Personnel & Equipment Monitors

Instructions on how to zero a pocket dosimeter

1. Adjust the clamp to fit the length of the dosimeter. 2. Pull the clamp trigger back and insert the dosimeter with the clip toward the back. The dosimeter must have a snug fit. Make sure the scale of the dosimeter is horizontal. 3. Look to see if there is a hairline. If there is a hairline, pump the black generator lever to “charge” or zero the dosimeter. If you don’t have a hairline, then give the generator lever a few slow pumps, and the hairline will appear on the right hand side. Continue pumping the generator lever until the hairline is on zero. 4. If the hairline falls below zero, press the black discharge button to bring the hairline back to zero. 5. To remove the dosimeter from the charger, squeeze the clamp trigger and lift the dosimeter above the end of the clamp, pulling it straight back to disengage it from the charging contact. 6. Once removed from the charger, read the dosimeter to ensure that the hairline has remained on the zero reading. It may be necessary to re-zero the dosimeter.

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Version 3.4 G Farley Nuclear Plant 500 kV Primary Limited Dec 2019 Access or Interstate $1 Field Monitoring Stream/River Highways Points Joseph M. Farley Nuclear Plant Water Body Primary US and State ! Sirens Highways Swamp/Marsh æ Churches Secondary State and Emergency Planning Zone County Highways µ ï Cemeteries k Minor Roads Miles Schools 0 1 2 4 10 Mile Radius Local Street

59 STHY 39 STHY 27

STHY 41 STHY 41 Americus Kite Rd Americus Macon 431 STHYSTHY 26 26 SpurSpur STHYSTHY 153 153 280 Richland STHYSTHY 165 165 Richland Russell Preston Plains Plains STHY 195

STHY 195 STHYSTHY 110110 280 STHY 49 Jimmy Carter NHS STHY 49 STHY 308

CORD 37

CORD 37 STHYSTHY 2727 STHY 41 STHY 39 Conn STHY 41 A STHY 39 Conn Lumpkin Sumter Union Springs Webster Leslie De Soto N Stewart B STHYSTHY 377377 82 Bullock Weston STHY 520 STHYSTHY 39 39 NNE 19 STHYSTHY 5151 10 0 Smithville 20 R 350 Parrott

NNW 82 30

King Rd King Rd Bronwood Montgomery 340 Eufaula STHYSTHY 195 195 STHY 239

Philema Rd S Philema Rd S Georgetown STHY 45 C Quitman 40 STHYSTHY 118118 Lee

DaleDale Rd Rd

STHY 30 NE STHYSTHY 3232 Clayton Terrell 330 Barbour Leesburg STHYSTHY 3232 Dawson Worth

STHY 55 STHY 55

STHY 39 STHY 39 Shellman CuthbertRandolph Sasser STHY 41 STHY 41

50 STHYSTHY 91 91 CORD 105 STHYSTHY 223 223

29 STHYSTHY 133133 Banks 320 Q STHY 45 STHY 130 STHY 45 STHY 130 NDoublegate Dr Trojan Way NDoublegate Dr Gibbs St Gibbs St Louisville CORD 1 N Maple St Hwy 130 N Maple St

27 N Westover Blvd 19 Business Pike NW N Westover Blvd Dawson Rd AlAl HwyHwy 130130 11th11th AveAve Troy STHYSTHY 300300 STHYSTHY 95 95 Coleman Clark Ave STHY 93 Clark Ave STHY 93 60 STHY 87 STHY 87 STHYSTHY 234234 Albany 19 Business

STHYSTHY 266 266 Radium Springs Rd Radium Springs Rd

Clio S MockRd Clio STHYSTHY 131131 S MockRd Brundidge 310 Clay D HollyHolly DrDr Fort Gaines SchoolSchool BusBus RdRd Blue Springs STHYSTHY 3737 DoughertyENE STHY 39 Edison Morgan CORDCORD 66 STHYSTHY 6262 STHY 10 Putney STHYSTHY 51 51 Calhoun 70

STHY 216 STHY 216

Dixie Hwy Leary Dixie Hwy Abbeville Bluffton Ariton 300 STHYSTHY 123123 Henry STHYSTHY 45 45 STHY 93 STHYSTHY 6262 STHY 93

OldOld Ga Ga P Arlington Baconton STHY 27 STHY 27 80 STHY 173 STHY 62 WNW STHY 173 STHY 62

Kolomoki Park Rd STHYSTHY 105 105 Kolomoki Park Rd Bainbridge Hwy

Old 231 Old 231 STHY 45 STHYSTHY 125125 431 STHY 45 19 Haleburg Haleburg Blakely Newville Early Baker Old 91 290 Ozark Dale STHY 95 STHYSTHY 51 51 STHYSTHY 2727

STHYSTHY 167167 STHY 200 STHY 200 STHY 37 Damascus STHYSTHY 9191 Camilla Headland Elba Coffee 62 Elba STHY249 STHY249 CORDCORD 123 123 E

Old Stedman Rd Old Stedman Rd 90 STHYSTHY 122122 Mitchell

Columbia Old Pelham Rd Columbia Old Pelham Rd New Brockton Newton STHYSTHY 134134

STHY 87

STHY 87 Midland City STHYSTHY 370370 Fort Rucker Midland CityNapier Field E Pinckard STHYSTHY 9797 Kinsey STHY 45 Kinsey STHY 45 Denton Rd STHYSTHY 134134 Denton Rd Grimes LineviewLineview Ln Ln 52 280 Enterprise STHYSTHY 248248 Headland Ave Headland Ave Boll Weevil Cir Boll Weevil Cir

John OdomD Rd Daleville John OdomD Rd STHY 93 Level Plains Webb STHY 93 USHY 84 Bus Pelham USHY 84 Bus Deerpath Rd Pelham STHY 253 Deerpath Rd STHY 253 STHY 65 STHY 12 0 Colquitt Colquitt STHY 3 STHY 85 STHY 85 Whigham Rd Whigham Rd STHY 112 STHYSTHY 134134 STHY 112 WestgateWestgate PkyPky

STHYSTHY 9595 Honeysuckle Rd Honeysuckle Rd Dothan CORD 59 Dothan CORD 59 EE BurdeshawBurdeshaw StSt Miller STHY 273 12 STHY 273

3rd Ave 3rd Ave Cowarts 210 100 CORDCORD 4040 Ashford BoykinBoykin RdRd Clayhatchee Ashford BabcockBabcock RdRd 231 Bus Avon STHYSTHY 262262

STHY 27

STHY 363 STHYSTHY 5252 Gordon STHY 363

STHY 93 Houston STHY 93 N STHYSTHY 9191 Old 179 N Taylor Old

Old 179 270 Old 179 HarrellHarrell RdRd CORDCORD 1919 Jakin STHYSTHY 123 123 STHYSTHY 111 111 STHYSTHY 97 97 STHY 103 W STHY 103

STHY 45 Malvern Rehobeth STHY 53 STHY 45 Coffee Springs Rehobeth 84

CORDCORD 1919 Old 179 N Donalsonville Old 179 N Slocomb STHY 285 STHY 95 STHY 285 Mars Hill Church Rd STHY 95 Mars Hill Church Rd Hartford STHYSTHY 5252 IronIron CityCity 110 STHY 167 Cottonwood OldOld 179179 231

STHY85 STHY85 Brinson Brinson STHY 188 Geneva STHY 188 Samson STHYSTHY 309309 CORD 220 CORD 220 STHYSTHY 311 311

STHY 109 STHY 109 Madrid Old 179 N Cairo F

STHY 87 STHYSTHY 153153 STHY 87 CORD 271 STHYSTHY 9191 260 STHY 52 OldOld US US RdRd STHYSTHY 22 STHY 52 PondPond ChurchChurch RdRd STHYSTHY 312312 Whigham Grady Bainbridge

STHY 310 STHY 310 ESE CORD 165 Geneva Eunola CORD 165 Seminole Malone Climax CORD 171 Climax CORD 171

CORD 89 Black CORD 89 Black STHY 93 CORDCORD 173173 Decatur Esto Noma STHYSTHY 7777 Bascom

STHY 374 Graceville Campbellton STHY 374

STHY 39 STHY 39 STHY 179 STHY 179 CORDCORD 165a165a 120 STHYSTHY 253253 CloverdaleCloverdale RdRd

CORDCORD 2a2a CORD 164 STHY 97 CORD 164 STHY 83STHY STHYSTHY 185185 STHY 97

STHY 83STHY

STHY 167 CORD 181 W STHY 193 STHY 167 CORD 181 W STHY 193 CORD 162 Greenwood

STHY77 STHY77 STHY 169 Jacob City HwyHwy 162162 STHY 309 STHY71 250 STHY71 CORDCORD 277 277 STHYSTHY 262262

STHYSTHY 179 179 CORDCORD 177a 177a CORDCORD 162162 STHYSTHY 273 273 STHY 177 Attapulgus M CORDCORD 185185

River Rd STHY 302 River Rd STHY 302 WSW CORD 181 Holmes STHY 73 CORDCORD 164164 130 CORDCORD 164164 CORD 164 Jackson

STHY 69 STHY 69 CORDCORD 173 173 Cottondale CORD 164a

CORD 271 CORD 271 STHYSTHY 241CORD241 159 CORD 183b 90 Marianna STHYSTHY 267267

CORD 195 CORD 195 CORD 181 E CORD 277 STHYSTHY 1212 240 CORD 277 CORDCORD 166166 CORD 1084 CORD 1084 Chipley 10 STHY 280a Bonifay Grand Ridge Sneads Chattahoochee STHYSTHY 6565

STHY 83 STHY 83 CORD 269a BrickyardBrickyard RdRd CORD 183a STHY 81 CORD 269 STHY 81 CORD 269 CORD379 STHYSTHY 276276 CORD 275 CORD379 Caryville CORD 275 G CORD 69a CORD 69a Westville CORD 280 CORD 280 Bannerman Rd CORD 273 Bannerman Rd CORD 273

STHY 71 STHY 71 CORD 264a CORD 264a 140 STHYSTHY 1212

VeldaDairy Rd SE VeldaDairy Rd STHY 79 CORD 279 STHY 79 Alford CORD 279 CORDCORD 280280 Alford HardawayHardaway HwyHwy CORD 183 N CORD 276a CORD 183 N CORD 276a Gretna CORD 10a CORD 276 CORD 276 C CORDCORD 276276 W King St CORD 270 CORD 264 STHYSTHY 286 286 CORDCORD 276a276a CORD 264 CORD 270a Ponce de Leon CORDCORD 278278 Quincy Edison Ave 331 230 Edison Ave CORDCORD 278278 Gadsden CORDCORD 270270 PilgrimPilgrim RestRest ChurchChurch RdRd

CORDCORD 268268

De Funiak Springs CORDCORD 278278 Maclay Rd STHY 275 STHY 275 Greensboro CORDCORD 278278 CORD 69a CORDCORD 278278 CORD 69a CORDCORD 270270

STHY 73 STHY 73 CORDCORD 159 159

Lakepoint Rd Lakepoint STHYSTHY 280280 Rd Lakepoint Nortek Blvd

STHY 155 NortekNortek BlvdBlvd 150 STHY 155 STHYSTHY 277277 CORD 170 Wausau CORD 0361 STHY 263 CORD 0361 STHY 263 Altha Midway HastyHasty PondPond RdRd CORDCORD 151151 CORDCORD 347347 220 W Tharpe St STHY 278 STHY 278 Blairstone Rd L STHY 73b Blairstone Rd CORDCORD 183183 SS Washington STHY 73b

Bates Rd Vernon Bates Rd CORDCORD 280280 EE Vernon STHYSTHY 61 61 CORD 194 Tallahassee CORD 279 CORD 194 CORD 69a CORD 279 CORD 69a CORDCORD 167167

CORD 284a CORD 284a SW Leon STHYSTHY 366366 160 STHYSTHY 265265 STHYSTHY 274274 STHY 71

CORDCORD 284284 STHYSTHY 1212 H STHYSTHY 371371 STHY 267 CORD 271 STHY 267 Paul Russell Rd 210 CORD 271 Paul RussellSTHY 259 Rd 331 Walton TALLAHASSEE REGIONAL

STHY 363 STHYSTHY 77 77 170 SSE STHYSTHY 287287 200 Blountstown Bristol 20 Freeport 190 Calhoun 180

STHY 275 STHY 275 STHYSTHY 71 71 Liberty STHY 267 STHYSTHY 373 373 Woodville STHYSTHY 260260 CORD 67 20 CORDCORD 357357 STHY 61 STHY 61 20 K Apalachicola NF STHYSTHY 373a373a

STHY 65 Ebro J CORDCORD 6767 STHY 65 SSW Scotts Ferry Xing S STHY 394 Bay SpringSpring CreekCreek HwyHwy CORD 375 Wakulla

STHY 71

STHY 71

River Rd STHY 12 River Rd STHY 12 319

STHY 388 CORDCORD 6161 STHY 388 HwyHwy 2301 2301 STHYSTHY 73 73

Legend 5 2.5 0 5 10 15 20 25 Miles Farley Nuclear Plant Roads Airport Area Limited Access Higwhay Runway US Highway Joseph M. Farley Nuclear Plant State Highway Parks Railroads Ingestion Planning Zone Lakes Streams Swamp or Marsh 50 Mile IPZ Grid 50 Mile Radius City Limits Version 0.0

60 RADIOLOGICAL SAFETY BRIEFING - EMS

All Emergency Workers will be issued the following equipment:

o Radiation Exposure Record o Thermoluminescent Dosimeter (TLD card) o Fill out Radiation Exposure Record information o Low Range Pocket Dosimeter (0-200mR) o Fill out Radiation Exposure Record information. o Black o High Range Pocket Dosimeter (0-20R) o Fill out Radiation Exposure Record information. o Yellow o Maximum Radiation Dosage Limit Card (green card) o Potassium Iodide (KI) will be issued by ADPH KI Nurse. DO NOT TAKE UNTIL TOLD TO DO SO BY EMA. . When reading your dosimeter, point toward a good light source. Read through the clip end. Keep the scale in the horizontal position to assure an accurate reading. . Read your dosimeters at least every 30 minutes, and record on your radiation exposure record. . The TLD card is your permanent record and cannot be read in the field. . Your dosimeters should be worn on the outside of your PPE, close to your neck/chest area. . Your TLD should be worn under your PPE, but also in your neck/chest area. . If your reach the limit on your black low range dosimeter (200mR), use your yellow high range dosimeter. . Authorization to exceed emergency worker exposure guidelines must be obtained from the State Health Officer prior to any exposure limit being exceeded. This will be done through the EMA office. . Remember to stay in contact with your department’s safety officer. . If you have any questions, contact the County EMA office for assistance.

EMS PERSONNEL:

 All EMS personnel will wear… o disposable coveralls (Tyvek suit) o disposable booties (white & slip resistant) o disposable “Orange” nitrile gloves (base pair) o disposable nitrile gloves (outer pair) o plastic waterproof shoe covers (yellow) o disposable head cover (hood) o protective mask with a splash visor eye shield. . Follow all donning and doffing directions when putting PPE on and taking PPE off. . Do not eat, drink, chew gum, smoke, dip, apply make-up, or put on lip balm/lipstick while on duty as an emergency worker.

61 EVERYONE TAKE THIS NOW!!!!!!! https://bit.ly/adphorcemsreview

1. Fill out feedback form 2. KEEP book 3. KEEP green card

62 RADIOLOGICAL EMERGENCY ASSISTANCE CONTACTS USE FOR INCIDENTS INVOLVING RADIOACTIVE MATERIAL

24-hour State EOC Communication Center (205) 280-2310 (800) 843-0699

If contact is not established, please call: Alabama Radiation Control Duty Officer (334) 324-0076

For additional contacts, please call the following: Radiation Control Office (334) 290-6244

NAME CELL David Turberville (334) 314-6323 Myron Riley (334) 224-4035 Nick Swindall (334) 322-8397 Kevin Hicks (334) 314-6326 Cason Coan (334) 320-3457 Undria McCallum (334) 296-2105

*Current as of July 1, 2021 Alabama Department of Public Health Office of Radiation Control *Destroy all Prattville, AL Earlier Editions 21 ADPH-RAD-1/REV.10-21