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Evaluation of Hospital Disaster Drills: A Module-Based Approach

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Radiation Incident Addendum


This module was developed by the Johns Hopkins Evidence-based Practice Center under Contract No. 290-02-0018 from the Agency for Healthcare Research and Quality, Rockville, MD. The content of this module is intended to provide guidance for hospital disaster drill evaluation and should not be construed as representing standards of care or recommendations on how to respond to specific types of disasters. No statement in this module should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.


Instructions: Attach to Incident Command, Decontamination, Triage, and Treatment Zone Modules for radiation drills.

Note: Circle or check (_) as indicated. Y = Yes; N = No; U = Unclear; NA = Not applicable


Observer: ______________________________________________________________             Date: ____/____/____

Observer title: ___________________________________________________________

Zone: __________________________________________________________________

Hospital: _______________________________________________________________

Period of time of evaluation: _____________ AM / PM (Circle one) to _____________ AM / PM (Circle one)

Time Points

Event Time

RA1. Time that this zone became aware that radiation-exposed victims were involved: (Circle one)

AM / PM / U

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

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Information Flow

Question Response

RA2. How did this zone become aware that radiation-exposed victims were involved? (Check all that apply)

a. [  ] Informed by fire department
b. [  ] Informed by incident command center
c. [  ] Onsite alarm
d. [  ] Other (specify):
________________________________

RA3. Was the incident commander informed that a radiation exposure was present?

Y / N / U

RA4. How was the incident commander notified? (Check all that apply)

a. [  ] FAX sent
b. [  ] E-mail sent
c. [  ] Person-to-person contact
d. [  ] Telephone message
e. [  ] Unclear
f.  [  ] NA
g. [  ] Other (specify):
________________________________

RA5. If the incident commander was informed of a radiation exposure, how long after the radiation exposure was suspected did notification occur? (Check one)

O < 30 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O Unclear
O NA

RA6. Was the radiation safety officer or designee informed that a radiation exposure was present?

Y / N / U

RA7. How was the radiation safety officer or designee notified?(Check all that apply)

a. [  ] FAX sent
b. [  ] E-mail sent
c. [  ] Person-to-person contact
d. [  ] Telephone message
e. [  ] Unclear
f.  [  ] NA
g. [  ] Other (specify):
________________________________

RA8. If the radiation safety officer or designee was contacted, how long after the radiation exposure was suspected did notification occur? (Check one)

O < 30 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O Unclear
O NA

RA9. Did the radiation safety officer or designee provide an assessment of risk associated with the exposure?

Y / N / U / NA

Items RA10-RA19 are intended for the Incident Command Zone observer only. Observers in other zones should skip to item RA20.

Question Response
RA10. Was the radiation safety officer or designee informed that a radiation exposure was present? Y / N / U

RA11. How was the local and/or State health department notified? (Check all that apply)

a. [  ] FAX sent
b. [  ] E-mail sent
c. [  ] Person-to-person contact
d. [  ] Telephone message
e. [  ] Unclear
f.  [  ] NA
g. [  ] Other (specify):
________________________________

RA12. If the local and/or State health department was informed, how long after the radiation exposure was suspected did notification occur? (Check one)

O < 30 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O Unclear
O NA

RA13. Was a hazardous materials (HAZMAT) official informed that a radiation exposure was present?

Y / N / U

RA14. How was the HAZMAT official notified? (Check all that apply)

a. [  ] FAX sent
b. [  ] E-mail sent
c. [  ] Person-to-person contact
d. [  ] Telephone message
e. [  ] Unclear
f.  [  ] NA
g. [  ] Other (specify):
________________________________

RA15. If a HAZMAT official was informed, how long after the radiation exposure was suspected did notification occur? (Check one)

O < 30 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O Unclear
O NA

RA16. Was occupational health informed that a radiation exposure was present?

Y / N / U

RA17. How was occupational health notified? (Check all that apply)

a. [  ] FAX sent
b. [  ] E-mail sent
c. [  ] Person-to-person contact
d. [  ] Telephone message
e. [  ] Unclear
f.  [  ] NA
g. [  ] Other (specify):
________________________________

RA18. If occupational health was informed, how long after the radiation exposure was suspected did notification occur? (Check one)

O < 30 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O Unclear
O NA

RA19. Were municipal wastewater treatment officials notified?

Y / N / U

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Materials and Supplies

Question Response

RA20. If prophylaxis for the given agent was needed, was it available?

Y / N / U / NA

RA21. Were specialized cleaning supplies available for contaminated equipment? Y / N / U / NA

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If using RADIATION INCIDENT ADDENDUM in the INCIDENT COMMAND ZONE, STOP HERE, do not complete the rest of module.

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Zone Description

Question Response

RA22. Was the radiation decontamination zone separate from the triage zone?

Y / N / U

RA23. Was the radiation decontamination zone separate from the treatment area? Y / N / U

RA24-26. Was the integrity of the boundaries of the following zones assessed by the use of radiation detectors?

RA24. Radiation Decontamination Y / N / U / NA
RA25. Triage Y / N / U / NA
RA26. Treatment Y / N / U / NA

RA27. Within the radiation decontamination zone, were the areas designated as: (Check all that apply)

a. [  ] Hot versus cold
b. [  ] Hot versus warm versus cold
c. [  ] No designations
d. [  ] Other (specify):
_________________________________

RA28. Was the decontamination for radiation exposure performed within hot, warm, or cold areas? (Check all that apply)

a. [  ] Hot
b. [  ] Warm
c. [  ] Cold
d. [  ] Unclear
e. [  ] NA
f.  [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

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Safety: Isolation Precautions

Question Response

Were the following available?

   RA29. Dosimeters Y / N / U
   RA30. Floor covering Y / N / U
   RA31. Radiation signs Y / N / U
   RA32. Radiation survey meters Y / N / U
   RA33. Striped tape Y / N / U

   RA34. Radioactive and mixed waste (Bio/Rad) disposal containers

Y / N / U

   RA35. Other (specify): _______________________________________ Y / N / U

RA36. Did health care workers sign in and out of the decontamination zone?

Y / N / U

RA37. Were entry and exit times entered? (Check all that apply)

a. [  ] Entry times entered
b. [  ] Exit times entered
c. [  ] No times entered
d. [  ] Unclear

RA38. Were the records of entry and/or exit times given to the radiation safety officer?

Y / N / U

RA39. Were breaches in precautions observed?

(If breaches in precautions were observed, specify in comment box at end of this section.)

Y / N / U

RA40. Were lists of exposed and nonexposed victims generated?

Y / N / U / NA

RA41. Did the institutional safety officer arrive in this zone to assess the activity?

Y / N / U / NA

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

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Safety: Personal Protective Equipment (PPE)

Question Response
RA42. Was PPE needed to protect health care workers?

   If needed, were these safety materials available for the health care workers?

Y / N / U

If safety materials were not available, circle "N" in column "a" and go to the next row.

Safety Materials a. Available? b. Used by staff? c. Adequate Supply?
RA43. Passive (negative pressure) filtration (e.g., N95 or N99 masks) Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA44. Powered (positive pressure) filtration (e.g., PAPR) Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA45. Self-contained breathing apparatus Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA46. Level B or higher suits (e.g., heat bound or serged seams) Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA47. Double latex gloves Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA48. Face-masks with shields Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA49. Waterproof gowns Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA50. Surgical caps Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA51. Waterproof shoe covers Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA52. Other (specify): _______________ Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA53. Other (specify): _______________ Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA
RA54. Other (specify): _______________ Y / N / U/ NA Y / N / U/ NA Y / N / U/ NA

Question Response
RA55. Did you observe staff without PPE interacting with contaminated victims? Y / N / U/ NA

RA56. If the staff was interacting with contaminated victims without PPE, what types of staff were they? (Check all that apply)

a. [  ] Ancillary staff
b. [  ] Nurses
c. [  ] Physicians
d. [  ] Did not observe
e. [  ] NA
f.  [  ] Other (specify):
__________________________________

RA57. Were dose rates to victims measured or estimated?

Y / N / U

RA58. Were dose rates to staff measured or estimated? Y / N / U

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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