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Hospital Preparedness: A Pilot Program for Radiation Monitoring in Emergency Departments

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Hospital Preparedness: A Pilot Program for Radiation Monitoring in Emergency Departments CAPT Michael A. Noska, MS, USPHS Dept. of Health and Human Services/ – PowerPoint PPT presentation

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Title: Hospital Preparedness: A Pilot Program for Radiation Monitoring in Emergency Departments


1
Hospital Preparedness A Pilot Program for
Radiation Monitoring in Emergency Departments
CAPT Michael A. Noska, MS, USPHS Dept. of Health
and Human Services/ Food and Drug
Administration Susan E. Eckert, RN,
MSN Washington Hospital Center/ ER One Institute
2

This work was performed under HHS Contract
HHSP2332006425OEC Pilot Program for Radiation
Monitoring in Emergency Departments
3
Disclaimer
  • The use and description of specific products in
    this study does not imply endorsement of a
    manufacturer by the Department of Health and
    Human Services.

4
Project Overview
  • Primary Purpose To assess the effectiveness of
    using radiation monitors in hospital emergency
    department entrances
  • Secondary Purpose To provide ED clinicians and
    staff with necessary tools and resources to mount
    an initial response to a radiological event

5
Project Goals
  • Fulfill HHSs ESF-8 responsibility for medical
    and public health emergency response, including
    population monitoring, decon, medical
    countermeasures, etc.
  • Provide early notification to hospital of
    contaminated patients for triage, treatment and
    response
  • Protect hospital staff and facilities

6
Why is protection needed?
  • National Planning Scenarios 1 10
  • Unknown/uncertain contamination
  • Self-referring victims
  • Surreptitious exposure
  • Early Assessment
  • Radiation type
  • External vs. internal
  • Contamination control

7
Rationale for Selection of System
  • Technical features
  • Energy
  • Detector type
  • Alarm methodology and sensitivity
  • Human factors
  • Cost
  • Data management and networking

8
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9
Laboratory Testing
  • AFFRI Low Dose Irradiation Facility
  • Optimize operational parameters
  • Test sensitivity
  • Construction of gantry
  • Sources
  • PC monitoring

10
System Set-Up
  • Area monitor configuration
  • 2 inch by 2 inch NaI scintillation detector
    wrapped in a 1/32 (0.39mm) lead shield
  • 300 keV discriminator
  • Based on anticipated hospital use of isotopes vs.
    agents used in RDD
  • Firmware set to ignore bursts of energy exceeding
    the discriminator threshold for 1 second
  • Response to X-Ray machine
  • Voltage set by factory in response to Ba-133
  • Voltage set at 525V-575V

11
Project Methodology
  • Ludlum Area Monitors 375-10, configured based on
    the AFRRI study, were installed at the entrances
    of three Emergency Departments
  • Washington Hospital Center (WHC)
  • Franklin Square Hospital Center (FSH)
  • Georgetown University Hospital (GUH)
  • Data collected daily at all sites for a 6 month
    period
  • Minimum, maximum and average radiation levels
  • Alarm conditions

12
Project Methodology
  • Additional testing performed to evaluate the
    devices
  • Check Source Testing
  • Nuclear Medicine Patient Trial
  • Reference materials developed for clinicians
  • Procedures
  • Receipt and Install of Equipment
  • Establishing Background Radiation Levels
  • Establishing Check Source Ranges
  • Establishing-Setting Alarm Limits
  • Quality Assurance Testing

13
Project Methodology
  • Reference materials developed for clinicians
  • Quick Reference Tools
  • Response guide (algorithm)
  • Isotopes that cause/do not cause an alarm
  • PPE- don-doff procedure
  • Geiger counter operations-performing a patient
    survey
  • Education
  • On-line/printed modules
  • Geiger counter operations
  • Performing a patient survey
  • Pre-post tests
  • 3D Simulations
  • Geiger counter
  • Area monitor

14
Project Methodology
  • Reference materials developed for clinicians
  • Tools
  • Staff talking points
  • Remote alarm signage
  • Dosimeter log
  • QA documentation tool- area monitor
  • Radiation survey patient documentation tool

15
Project Methodology
  • Drills conducted once training provided at the 3
    main sites
  • Exercise materials developed based on Homeland
    Security Exercise and Evaluation Program (HSEEP)
    and AHRQ Drill Evaluation Tool
  • Objectives, outcome measures, scope of play,
    safety procedures, logistics, scenario, master
    event scenario list (MSEL) victim cards, player
    briefing, evaluation tool, after action report
    (AAR) and corrective action plan templates
  • Materials revised as needed

16
Project Methodology
  • Toolkit created
  • Included
  • Equipment
  • All educational and reference materials
  • Toolkit deployed to
  • Childrens Hospital Boston
  • Mary Washington Hospital, Fredericksburg, VA
  • Final revisions to materials completed

17
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18
Project Specifics
  • Monitors mounted at ED entrances
  • Total of 9 devices in 3 hospitals
  • Devices have local alarms and remote alarms at
    central area
  • Data transmitted from each device via software
    every 5 seconds (2 seconds if alarm condition)
  • Min/Max/Avg readings calculated daily
  • QA check with Cesium-137 check source performed
    weekly

19
Software
  • Pulls data from device
  • Extensive testing and revisions performed
  • 2 upgrades to existing program
  • 1 new release
  • Allows viewing from any site, multiple users to
    access data, user-friendly screens and queries
  • NOT tested fully
  • Problems also experienced at pilot sites

20
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21
Data Summary
22
Device Data Summary
23
Device Data Alarm Activity
  • Evaluated number of false, positive and unknown
    alarms for all 9 monitors over the 6 month period
  • Included QA and other testing sources
  • Results
  • Devices alarmed as anticipated
  • Alarms from unknown source relatively low
  • Range 4-25
  • Highest in 1 month 5
  • Mean 5.4 among all monitors

24
Data Summary
  • Devices work as anticipated
  • Screen out most hospital isotopes, screen in
    possible agents used in an RDD
  • Alarm conditions not overwhelming for ED
    environment/clinicians
  • Differences in readings expected based on
    background, building material, storage of items
    near monitors

25
Impact in the Hospital Environment
  • Installation
  • Site selection devices and fixed alarms
  • Power and dataports
  • Monitoring alarms remotely
  • Supplementing manufacturers materials
  • Sustainment
  • Quality Assurance checks

26
Staff Preparation- Not Labor Intensive
  • Introduction to system
  • Management of alarms
  • Development of reference tools
  • 1 page maximum
  • Laminated, wallet poster size
  • Development of response algorithm

27
ED RADIATION ALARM RESPONSE GUIDE QUICK
REFERENCE
ALARM Triage nurse responds Charge RN and MD
back up triage
Locate and identify source (Stop all potential
persons immediately)
No threat 1. Release person(s) 2.
Reset alarm 3. Debrief staff
Recent Nuclear Medicine Procedure?
Yes
No
  • Notify Radiation Safety Officer.
  • Establish control zone.
  • Pull PPE radiation response supplies.
  • To decon area for survey/decon.

Medically stable?
Yes
No
  • Notify Radiation Safety Officer.
  • Establish control zone.
  • Address need to activate disaster plan.

Treat Patient Pull PPE/Radiation Response Supplies
28
Radiological Response
  • Development and provision of education on
    managing a radiological event
  • Differentiating small vs. large events
  • Ensuring initial treatment steps clearly
    understood
  • Treat first, remove clothing, proper PPE
  • Defining control zones inside and outside
  • Evaluating devices needed for mass casualties
  • Hardwiring access to external resources
  • REMM, REAC/TS, WRAMC RAMT

29
Drills
  • Essential for identifying gaps
  • PPE
  • Control zones
  • Surveying
  • Establishing background, documenting
  • Critical in increasing confidence and competence

30
Lessons Learned
  • Detection Devices worked as anticipated
  • Screened out most hospital isotopes
  • Screened in possible agents used in an RDD
  • Alarm conditions not overwhelming for an ED
    environment /clinicians
  • Natural alarms from hospital isotopes kept staff
    mindful (doctrine of daily routine)
  • Differences in background readings occurred
    secondary to location, building material and
    storage of items near monitors

31
Lessons Learned 2
  • Detectors should be mounted at 5 foot height not
    3 feet
  • Alarm notification at entrance portal PLUS in
    main clinical arena
  • Alarms both auditory and visual
  • Alarms activate 1 5 x a month from hospital
    isotopes
  • I-131 usual cause of alarm
  • Level of knowledge of radiation emergencies by
    average health care provider Low

32
Lessons Learned 3
  • There is enormous opportunity to improve the
    management of a radiological event by hospital
    personnel
  • Installation of the system had the unintended
    benefit of increasing confidence and competence
    of staff
  • Simple messaging is most likely to succeed

33
Lessons Learned 4
  • Technical factors cannot be considered in a
    vacuum (human factors)
  • Need to be aware of operational environment
  • Strong collaboration between physicists, hospital
    personnel and vendor
  • Protocols, SOPs and training

34
Project Summary
  • Devised and validated a simple, low cost system
    for radiation detection following accidents or
    terrorist events
  • Developed a deployable toolkit for hospital
    emergency response
  • Developed a rad training and response program for
    hospital personnel

35
THANKS TO
  • Project Officer Dr. George Alexander
  • AFFRI Staff LCDR John Crapo,
  • LT Anamarie Dent
  • HHS Staff Dr. Norm Coleman
  • Healthcare Partners Childrens Hospital-Boston,
    Franklin Square Hospital, Georgetown University
    Hospital, Mary Washington Hospital, Washington
    Hospital Center
  • Industry Partners Atlantic Nuclear, Ludlum
    Instruments

36
Contact Info
  • CAPT Michael Noska
  • Michael.Noska_at_fda.hhs.gov
  • 240-276-3331
  • Susan Eckert
  • Susan.e.eckert_at_medstar.net
  • 202-877-3113
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