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 |  | Identify all members of your incident response team |  |  |  |  |  |  |  | Identify all members of your incident response team |  |  |  |  |  |  |  |  |  |  |  |  | Select the Center type you are responding for. You will be directed to questions for your specific center type. | If a patient needs to be transferred to a burn/trauma center, how will you track their ARS? | By the end of FY2010 will the SOP you submit to RITN include your contact in your state Department of Public Health to receive material requested through the NMDP from the Strategic National Stockpile (SNS)? | By the end of FY2010 will the SOP you submit to RITN include your point of contact if you need aid from your state emergency management agency? | By the end of FY2010 will the SOP you submit to RITN include your point of contact at the state level if you need aid from a National Guard Civil Support Team (CST)? | Does your center have a procedure for external decontamination for radiation contaminants? |  | Do you have any mutual aid agreements that would facilitate patient decontamination? |  | Where will you house patients waiting to be screened for radiation contamination? | Who in the facility is responsible for coordinating for external decontamination of radiation patients (name and position)? | How many patients can your system decontaminate in an 8-hour period? | Identify the types of radiation survey equipment available? | How many staff are trained to conduct radiation surveys? | How long (on average) does it take a trained staff member to complete a radiation survey of an ambulatory patient? | Which types of radiation sources can your equipment identify (Select all that apply)? |  |  |  | Does your organization have radiation survey portals? | Does your organization have access through a partner organization to borrow radiation survey portals? | In the absence of an Emergency Use Authorization from the FDA, would your center use G-CSF off-label for a recipient with Acute Radiation Syndrome? |  | Once cord blood bank licensure occurs, will your center require an Emergency Use Authorization from the FDA before requesting cord blood units for infusion of recipients with Acute Radiation Syndrome, a diagnosis not covered by the currently proposed licensing guidance? |  | By the end of FY2010 will the SOP you submit to RITN include the following (Select all that apply): |  |  |  |  | Last year you were directed to incorporate detailed information answering the 2009 TTX questions into your SOP. By the end of FY2010 will your SOP include: (Select all that apply): |  |  |  |  | Is more than one person trained to conduct each or your critical tasks necessary to ship CBUs? |  | Do you have an established process to request [NAME] contingency cord blood shippers? | Once cord blood bank licensure occurs, will your center require an Emergency Use Authorization from the FDA before shipping product for recipients with Acute Radiation Syndrome, a diagnosis not covered by proposed licensing guidance? Explain. |  | Last year you were directed to incorporate detailed information answering the 2009 TTX questions into your SOP. By the end of FY2010 will your SOP include (Select all that apply): |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Is more than one person trained to conduct each of your critical tasks necessary to process donors for collection? |  | Do you plan to utilize volunteers to handle the potential increased work load? | If you plan to use volunteers, identify the roles you plan to have these volunteers fulfill. (Select all that apply).    If you will not use volunteers, please select option "i": |  |  |  |  |  |  |  |  | If you plan to utilize volunteers do you have a documented process to train them? | Do you anticipate regulatory issues if performing collections for recipients with Acute Radiation Syndrome? Describe. |  | Do you anticipate human research subject concerns if performing collections for recipients with Acute Radiation Syndrome? Describe. |  | Comments/Concerns/Questions?
 | How many people participated in your exercise? | Medical director | Another physician | Mid-level practitioner | Nurse (RN, LPN, etc..) | Emergency management staff | Executive management staff (admin) | Emergency medicine staff (ER) | Pharmacy staff | Health physicist | Logistics staff | Primary coordinator | RITN Point-of-contact | Admission process representative | Social worker | Representative from psychiatry/psychology | Radiation oncologist | Blood bank representative | Representative from physical exam provider | Representative from collection center or apheresis center | Vendor/contractors (laboratory for IDMs, etc…) | Other |  |  |  |  |  |  | Briefly describe: |  | Briefly describe: |  |  |  |  |  |  | Alpha: | Beta: | Gamma: | Other: |  |  |  | Please explain. |  | Please explain. | Point of contact for transporting mass radiation patients to your facility | On-hand decorporation agents | Point of contact for housing patients beyond normal capacity | Point of contact for approval of altered standards of care | None of these | Primary shipping company for cord blood shippers | Back-up shipping company for cord blood shippers | Name of person to contact and day phone numbers | After hours phone numbers and email (when appropriate) | None of the above |  | If so, how many? |  |  | Please explain: | a.	Primary hotel for donors | b.	Back-up hotel for donors | c.	Secondary back-up hotel for donors | d.	Addresses for hotels | e.	Names of persons to contact and day phone numbers at each hotel | f.	After hours phone numbers for each hotel | g.	Transportation assets for donors | h.	Back-up transportation for donors | i.	Names of persons to contact and day phone numbers for transportation companies | j.	After hours phone numbers for each transportation company | k.	Primary physical exam facility | l.	Back-up physical exam facility | m.	Secondary back-up physical exam facility | n.	Addresses for physical exam facilities | o.	Names of persons to contact and day phone numbers at each physical exam facility | p.	After hours phone numbers for each physical exam facility |  | If so, how many: |  | a.	Transportation to/from appointments | b.	Answering/returning telephone calls | c.	Administrative or clerical support | d.	Data entry | e.	General office errands (i.e. copies, faxing, restocking supplies, etc…) | f.	Shipping samples to labs with appropriate blood borne pathogen training | g.	Receiving donors at entrance | h.	Other | i.	Will not use volunteers |  |  | Please explain: |  | Describe:
 | 10 | x | x |  | x | x | x | x | x |  | x | x | x | x | x | x | x |  |  |  |  |  | Transplant Center | Through a tracking log mechanism.  Our closest burn/trauma center is within the IL Medical District and the next closest is within a 15 mile radius.  Our efforts will be coordinated through the radiation safety officers at the receiving hospital.  We will seek emergency privileges at the receiving hospital to track the ARS of the transferred patient. | Yes | Yes | Yes | Yes | Our procedure is delineated in an Emergency Management Plan (EMP) for a Hazarouds Material Contamination (Code Orange).  All Hazardous Material Response Team members will don proper protective equipment and will use detection devices such as a  [NAME] deterctor after the contaminated person has gone through the decon showering process. | No | However, the Chicago Fire Department will assist us in the decontamination process if available. | Patients waiting to be decontaminated will be staged in the park (Pasteur Park) across the street from the Emergency Department. | xxxxxx, Radiation Safety Officer | 60-80 patients | [NAME] Detectors | 6 | 2- 5 minutes |  | x | x |  | No | No | Yes | We will use the EUA while submitting for authorization. | Yes | We will consult with RITN staff.  In addition, we will prepare an IRB emergency release. | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Please clarify the term "survey portals".  Our team was not able to answer this question due to ambiguity.  We recommend to invite an RITN representative at next tabletop exercise.
 | 6 | x | x |  |  |  |  |  |  |  |  | x | x |  |  |  |  | x |  | x |  |  | Donor Center |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x |  | x | x |  | x | x | x |  | x | x |  | x | x |  | Yes |  | Yes | x | x | x | x | x |  | x |  |  | No | Yes |  | Yes
 | 10 | x | x |  | x |  |  |  | x | x |  |  | x |  |  |  | x |  |  |  |  | [NAME] from NMDP | Transplant Center | We will not receive burn patients, we would use Reddinet to transfer patients to the approproate facility, if needed. | No | No | No | Yes | Poolsm showeres and hoses. this would be used with radiation detection equipment. | Yes | Yes, LA county would be notified in an event like this that COH would be receiveing patients. They are our main Mutual aid support. | Patient would be assessed for injuries and housed at the appropriate triage location. | xxxx, Radiation Safety Officer | 12 per hour | Gieger counters, ion chambers, per dosimeters and portal monitor. | aminimum of 12 | 5 mins |  | x | x |  | Yes | Yes | Yes | We would use as needed | Yes | We will use as needed. |  |  |  |  | x
 | 3 |  |  |  |  |  | x |  |  |  | x |  | x |  |  |  |  |  |  |  |  |  | Cord Blood Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x |  |  | Yes | 2 shippers, 2 reviewers, 2 medical directors | No | Yes | Our understanding is that once a CBU is licensed, we can only ship for a licensed or IND use without further authorization.
 | 9 | x |  | x | x |  |  |  | x |  |  | x | x |  |  |  |  |  |  |  |  |  | Transplant Center | We are a freestanding hospital so do not have capability for burn/trauma patients.  If we did, would follow symptoms (nausea/vomiting, neurologic  changes) and leukocyte counts. | Yes | Yes | Yes | Yes | For patients transferred from outside our hospital, would be diverted to closest Decon Facility Hospital- which is located across the street.  For w/in our hospital, have SOP [EMP-13] and decontamination team- under Chairman of radiology. | Yes | Yes, closest Hazmat Decontamination Facility is at hospital across the street from our facility. | Physical Therapy are has been designated and area is adjacent to parking for ease of entry. | xxxxxx Chairman of Radiology | 4 per team | [NAME] counter | Radiation safety officer | 20 min when we demonstrated | x |  |  | x | No | No | Yes | Patient’s receiving significant radiation with known risk of [NAME] would be medically indicated for G-CSF | Yes | Patients receiving significant radiation with known risk of [NAME] would be medically indicated for transplant & we are licensed for UCB transplants |  | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | We currently could not receive contaminated patients or those with acute injuries--- they would need to be sent to other hospitals in our area---- we could easily do the transplant piece, but the hospital isn't equipped for emergency care, trauma or burns.  If needed the staff are willing to volunteer to go to other sites to assist this.
 | 20 |  |  | x | x | x | x |  | x |  |  | x | x |  |  |  |  | x | x | x |  | Cryopreservation Lab staff | Transplant Center | Our center implemented  a database in January, 2010 which is used to track and organize patient care.  This database is not a medical record but contains patient demographics, lab work and  test results.  It also contains systems to track and implement the many processes needed as a patient moves toward transplant.   It serves as a communication tool to multiple departments and generates various work lists.     Upon arrival to our center,  each patient will be entered into the database.   Details regarding the patient's location (facility, point of contact, etc) will be entered so work lists including the transfered patients can be generated.   A team of nursing and support staff will be assigned to monitor this patient population and provide a daily update to the BMT medical team. | Yes | Yes | Yes | Yes | Our center has 3 levels of establishing decontamination areas.   *  6 showers in the ED.  This area has  its own ventilation and water supply  * Tents containing shower facilities which will be located at the entrance of the ED.   This area will also have its own ventilation and water supply  * Access to trailer from Dep of Homeland Security containing a mobile decontamination facility.   The trailer would be located in a park adjacent to the hospital and approx. one block from the ED.    Water would be obtained from the fire hydrant located in the park with a mobile warmer attached. | Yes | Our center is a member of 3 local emergency preparedness agencies.  Each agency would be accessed and provide assistance  with patient decontamination.  1) STARRS (St.  Louis Regional Response System) - this includes all emergency responders and resources  in the St. Louis metropolitan region.    2) SMOC (St Louis Medical Operation Center) - this includes all St. Louis metropolitan medical facilities  3) CEMA (City of St. Louis Emergency Management Agency) - our center is located in the city of St. Louis so would have access to the cities emergency response resources. | Patients will be housed in the ED department and tent facilities placed at the ED entrance and/or parking structure adjacent to the ED.    Trailers can also be requested and would be located adjacent to the ED. | xxxxx,  Director of Environment Health and Safety, Director of [NAME],  Director of Occupational Health | 80-100 patients per hour can be processed if all resources are activated. | [NAME] counters | 15-20 | 15 minutes | x | x | x |  | No | Yes | Yes | Our center's Chief Medical Officer can approve the use of medications for off label indications in emergency situations. | No | Our center will request an Emergency Use Authorization before requesting a cord blood unit.  However, if a patient's condition warrants proceeding with transplant before receiving the authorization,  approval to proceed will be requested from our CMO. | x |  |  | x
 | 14 | x |  | x | x | x |  |  | x |  | x | x | x |  | x |  |  |  |  |  |  | Cellular Therapy Integrated Services | Transplant Center | Utilize the existing electronic patient tracking system. | Yes | Yes | Yes | Yes | Center for Emergency Medicine has existing facilities to provide decontamination. | Yes | Local Fire Departments | Remain in the same modality in which they were transported.  Obtain portable lavoratories. | Emergency Management Services Radiation Safety Officer | 240 | Mobile Radiation Detector (two)  [NAME] (portable)  [NAME] held radiation detectors  Portable Monitors | 12 | 2 minutes |  | x | x |  | Yes | Yes | Yes | Physicians prescribe documenting  good standard of care | Yes | Hospital policy will permit two physicians documenting in the medical record that medical care must be administered urgently, while pursuing Emergency Use Authorization from the FDA.  In addition, both the legal and ethics departments will be consulted.   Reference CP16 Consent for Procedure, Blood and /or Sedation | x |  |  | x
 | 22 | x | x | x |  | x | x | x | x |  | x | x | x |  |  |  |  | x | x | x |  |  | Donor Center |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | Yes | We have 4 people trained for donor workups and 6 people trained for CT’s , but will expand this to our University of Iowa Hospitals outpatient clinics located throughout the state. We also have documents on hand to send them to do PE’s if needed. | Yes | x |  |  |  |  |  |  |  |  | Yes | No | We do not anticipate issues. | No | We do not anticipate issues or concerns.
 | 12 | x | x | x | x | x | x |  |  | x |  | x | x |  | x | x |  |  |  | x |  |  | Transplant Center | We intend to utilize the ARS algorithm posted on the RITN website. There will be a physician/mid-level/coordinator team that will be responsible for overseeing the patients transferred off site.     In addition to this team overseeing the these patients, we will be providing staff education to the local centers caring for these patients. | Yes | Yes | Yes | Yes | Personnel Decontamination:    	If the body is suspected of being contaminated    	1.	Scan with a Beta/Gamma survey meter to determine the contaminated areas of the body.    	2	If cuts, abrasions, or open wounds are contaminated, dry clean the area with suction apparatus and swabs. (Wet cleaning may increase absorption.)  	3.	If the skin is contaminated in the area of cuts, abrasions and open wounds, use wet swabs in a direction away from the wound, taking care not to spread activity over the body or into the wound.	    	If the skin appears to be intact:    	1.	Wet hands and apply a mild soap, work up a good lather keeping the lather wet. Work the lather into the contaminated area by rubbing gently for three minutes. Apply water frequently.    	2.	Rinse thoroughly with lukewarm water (limiting the water to contaminated areas). Repeat the above procedures twice more, as necessary.    	3.	Skin contamination should be reduced below 0.1 mR/hr as measured with a GM survey [NAME] above the skin with the window open.    	4.	If contamination is still not removed to background levels, consult with the Emergency Room Medical Director and RSO for further procedures. | No | There are no mutual aid agreements to facilitate patient decontamination because we can do this internally. | .  A separate controlled area outside of the Emergency Room will be used to temporarily house patients until an initial assessment of contamination level is determined. | xxxxx(Radiation Safety Officer), xxxxx (Alternate Radiation Safety Officer), andxxxx (Emergency Response/hyperbaric therapy) will coordinate decontamination efforts with Nuclear Medicine and Emergency Room personnel support. | Assuming an average 10 decontaminations performed concurrently, a total of 80 decontaminations can be performed in an 8 hour period. | Portable [NAME] counters, alpha detector, gamma scintillation detectors, and ion chamber survey meters represent available radiation survey equipment. | 8 staff members are trained to conduct radiation surveys. | An initial radiation survey of an ambulatory patient should take an average time of 3-5 minutes. | x | x | x |  | Yes | No | Yes | We have an extensive amount of experience with the using GCSF in our patient population. We would be prepared to use this off-labe as supportive care for patients with ARS. | No | We are currently performing cord blood transplants at our institution. Our transplant team has experience with selection, ordering, and transplanting cord blood units. Our experience will also allow for support care following the transplant.     We hope in the furture that we will be able to develop a standard of care treatment guideline for this indication. | x | x | x | x
 | 6 | x | x | x | x | x | x | x |  |  | x | x | x | x | x |  |  |  |  |  |  |  | Transplant Center | We would track through our electronic medical records | Yes | Yes | Yes | Yes | Plan outlined in our EOP, ED Staff are the first recievers trained per 29 CFR 1910.120 for to operations level.  Isolate patient gross decon, call for radiation safety monitoring conduct technical decon if necesarry. | Yes | Through County Operational Area Mutial Aid Plan | Mulit-stage housing from point of arrival through designated surge area in hospital up to and including surge tents. | xxxx, Director Office of Emergency Management | 16 patients doing technical decon | Gieger Counters, Film Badges | 12 | 3-5 minutes | x | x | x |  | No | Yes | Yes | would be considered and go through internal approval process, and clinical oversight steering team | Yes | would be considered and go through internal approval process, and clinical oversight steering team | x | x | x | x
 | 22 | x | x | x | x | x | x | x | x |  | x | x | x |  |  |  |  | x | x | x |  |  | Transplant Center | We have inhouse burn center - track inhouse. | Yes | Yes | Yes | Yes | Part of our Emergency Operations Plan | Yes | Part of our Emergency Operations Plan- Mercy Iowa City, Mercy Cedar Rapids and St. Lukes Cedar Rapids as part of our agreement through the Duane Arnold nuclear power plant. | Initial screening when land in Des Moines as part of our State Emergency Plan.  Once arrive in Iowa City, we can handle inhouse but are now asking our National Guard for permission to use their facility strategically located on the corner of Interstate 80 and Interstate 380/Hwy 218. | Activation of Hospital Incident Command System (HICS); copy sent with updated SOPs. | 18 - 20 per hour x 8 ~ 150 to 160 | Radiation survey portals; [NAME] meters, ion chambers, alpha counters | 20+ - active plan with 3 other area hospitals as part of an emergency response team for the Duane Arnold Nuclear Plant. | approximately 2 minutes to go through large screen device and wands. | x | x | x |  | No | Yes | Yes |  | Yes |  | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | What level of triage will be done prior to patients arriving in Iowa?  We will notify our partners in Des Moines (where patients would land if this happened now) to do another triage.  Should be triage a third time here in Iowa City before patient arrives at our door to disperse patients to our partners who do not need BMT personnel expertise?
 | 15 | x | x | x | x | x | x | x | x |  | x | x | x | x | x |  |  | x |  |  |  |  | Transplant Center | ARS will be tracked through the Brigham & Women's Hospital. | Yes | Yes | Yes | Yes | A fixed decontamination unit that would be used for either ambulatory or non-ambulatory patients up to 10 victims.  For any patients/victims over 10, the Brigham & Women's hospital has a mass decontamination unit that is operated with support from the Boston Fire Department. | Yes | Mutual aid is through the city of Boston. | Plans would have patients queued in the Brigham & Women's ambulance bay until decontamination is conducted. | xxxxx, Radiation Safety Officer at xxxxxxx | Approximately 80 (10/hour) | 2 handheld ion chambers  5 GM detectors  1 portable MCA | 12 | under 5 minutes |  | x | x |  | Yes | Yes | Yes | [NAME] and Brigham & Women's Pharmacy departments are aware of this need. | Yes | xxxx and xxxx Hospitals are part of a centralized Emergency Plan Activation Team, who will obtain the authorization. |  |  | x | x
 | 8 | x | x |  | x |  |  |  |  |  |  | x | x |  |  |  |  |  |  | x |  |  | Cord Blood Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  | x | x |  | Yes | 3 | Yes | No | We will distribute these units on an off-label type of need, under the NMDP IND.
 | 16 | x | x |  | x | x | x |  |  | x |  | x | x | x |  |  |  |  |  |  |  | AOD, Area coordinator NDMS, State DHS - public emergency preparedness, Oregon Health Authority Radiation Protection Services | Transplant Center | MDs would not physically go to another center; communication would be by phone or email at set times. ARS guidelines would be provided. Data tracking tools would be used. | Yes | Yes | Yes | Yes | The ED maintains a dedicated, pass-through decon shower that can accomodate one to two people at a time. There is a decon tent that can be rapidly deployed to accomodate two gender-specific lanes and a third, assisted lane. Throughput is approx 25 people per hour. Serviced outside the ED with hot water and warm air.  In Portland, decon would most likely be performed at the airport before transport to the center. This would keep the EMS vehicles and buses from becoming contaminated. | Yes | Local fire departments. HazMat could set up a portable facility on site or at another site. All area hospitals have decon capabilities. | If screening takes place at the airport prior to transport to the center, State department of public health and County Health Dept would set up tents to house people if the wait times required it. | In the case of a surge capacity situation with the ED, the ED charge nurse is the incident commander. He/she would be responsible for coordinating external decontamination.4-7500 | 200 people under ideal conditions. Public health and state emergency mgnt resources can deconaminate up to approx 400 per hour depending upon staff allocation. | Count rate meters and dose rate meters. | OHSU - 10 advanced; 30 basic.  Community has resources that could be called upon to conduct surveys. | 5 minutes | x | x | x |  | No | Yes | Yes | G-CSF is used to support patients post-transplant who need assistance in boosting the WBC count. This is an off-label use and is an accepted standard. Use of G-CSF with ARS patients would be a similar use. | No | ARS would lead to bone marrow failure. Bone marrow failure (i.e. aplastic anemia) is treated by infusion of stem cells (e.g. cord blood). We would be treating the bone marrow failure not the ARS with the infusion. | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | It would be helpful to have a list of recommended decorporation agents.  It would be helpful if there were nursing management guidelines developed and made available, similar to the physician treatment guidelines for patients with ARS.
 | 16 | x | x | x | x | x | x | x | x | x | x |  | x |  |  |  |  |  |  |  |  |  | Transplant Center | Notice put in chart. Will utilize the REMM website criteria. | Yes | Yes | Yes | Yes | Part of EPlan and Rad Safety procedures. Utilize intake point at Rockefeller Research Labs entrance. | Yes | NYPH also has an external decon area setup and we are able to utilize and have participated in joint training of that process with them. | Rockefeller Research Labs garage and hallway areas. | xxxxxx, Rad Safety Officer | 30-50 | GM, NaI, [NAME], [NAME] probes. | 10 primary, 10 secondary | 10-15 minutes by [NAME], < 1 minute with walkthrough portal |  | x | x | x | Yes | Yes | Yes |  | Yes |  | x |  | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Suggest having institutions run an exercise with many less patients, such as 10-20 and have the exercise manage internal aspects of care over time for such patients rather than concentrating on surge plans for up to 500. Surge plans for other disasters already exercise those aspects. We need to concentrate on RITN management over time.
 | 15 | x |  |  | x | x | x |  |  | x |  | x | x |  |  |  |  | x |  | x |  | [NAME], Transplant Coordinators, Nuclear Med Technologists | Transplant Center | Request daily CBC results to be faxed to the Transplant Coordinator. Facilitate HLA testing in patients with potential for transplant. Only extreme burn injuries would be transferred. The patient could be sent to another RITN facility in Minneapolis or Omaha if space is available. | Yes | Yes | Yes | Yes | The "Radiological Emergency Protocol" is located in the Nuclear Medicine Department with a copy in the BMT Program Offices. | Yes | Our city fire department has 3 haz mat teams and would also ask for assistance from other facilities in our network. The city/county EOC could ask for assistance through the Governor from the Air Guard unit in town or the 5th Army Chemical Reserve Unit also in town. | The triage plan includes the establishment of an assessment center, separate from the emergency department. This can be housed in the ambulance bay. The area can be used to rapidly screen patients for injury and contamination as well as an area where decontamination for victims can occur. | The Radiation Safety Officer, xxxxx (medical physicist) would be in charge of coordinating external decontamination of patients. xxxxxxxEnvironmental Safety, and xxxxx, Manager of Nuclear Medicine, would also be directly involved. | A thorough whole body survey of each patient should take approximately 5-8 minutes. Additional time would be needed for the actual decontamination process. An estimate would be 15 minutes total per patient. This would allow for 32 patients per available nuclear medicine tech in an 8 hour period not to exceed the number of available meters. | One "cutie pie" survey meter and approximately 10 Gieger-Muller survey meters are located in various locations in [NAME] and could be quickly accessed. [NAME] has 10 nuclear medicine gamma cameras that would detect radiation contamination on a patient if necessary. | 18 nuclear medicine techs are trained to conduct radiation surveys. | It takes at least 5-8 minutes to perform a thorough survey moving the probe no faster than 2-3" per second. | x | x | x |  | No | No | Yes | If this treatment is deemed necessary to decrease morbidity and mortality our institution would ask for emergency IRB approval for the use of this drug. | Yes | If this treatment is the only option to decrease mortality our institution would ask for emergency IRB approval to utilize cord blood in patients without an acceptable HLA match. | x | x | x | x
 | 25 | x |  | x | x | x | x | x | x | x | x | x | x | x |  |  |  | x |  | x |  | Local Emergency Management, Local Hospitals Representatives, Communications Director, | Transplant Center | We have available a newly acquired software package involving a patient tracking system for electronic charting through the Federal Coordinating Center.  In addition, Guest Relations would track patients for their family.   We also would provide guidelines from our Radiation Safety Policy including following hematopoietic syndrome with CBC, differentials and absolute lymphocyte counts, GI syndrome, cerebrovascular/central nervous sytem syndrome and skin syndrome.   All coordiantion at the HUP Command Center. | Yes | Yes | Yes | Yes | Start with brief radiological survey.   Remove clothing promptly, change gloves after each step.  Decontaminate wounds by draping with waterproof material, irrigating with saline or water.   More than one irrigation usually necessary with monitoring after each one.   [NAME] drapes and dressings before each monitoring.  Decontaminate body orifices such as mouth, nose, eyes, and ears, by brushing teeth and rinsing frequently, gargling with peroxide, gastric lavage when necessary.  Decontaminate intact skin by washing with soap and water under stream of water, then scrub with soft brush using warm water.  [NAME] for 3 to 4 minutes, then rinse for 2 to 3 minutes, repeating as necessary.  Decontaminate hair by shampooing several times.  [NAME] if necessary. | Yes | Master Mutual Aid Agreement in place with hospitals in the Delaware Valley Hospital (DVHC) Southwest zone.  We have 130 trained staff here at [NAME] to decontaminate and the local hospitals also have trained staff available to us.   Hospitals will share trained people and supplies based on individual hospital needs.  The value of the existing mutual aid agreements in place with hospitals was evident during the exercise. | Per our radiation safety officers, the patients would be kept on the bus that transports from the airport and decontaminated in order.   We have the capability to set up tents on site in order to decontaminate more people more quickly.  Police and [NAME] in conjunction with the Office of Emergency Management would most likely start the deontamination at the airport.   Our radiation Safety Officer said that 90 percent of the contamination is gone once the clothing is removed. | xxxxx is our Radiation Safety Officer.   He was an active participant and provided input on the role that his office would provide during such an event. | The Penn System can decontaminate 160 patients in an 8-hour period.   Our neighboring hospitals can help facilitate decontamination at their facilities also.  It was noted that it would also depend on whether patients were ambulatory or not. | [NAME]'s survey equipement includes hand held portal monitors and survey meters and doorway portal monitors that patients walk through.   All area hosptitals attending said their monitors would be available to us. | At [NAME] we have 130 trained staff for decontamination and radiation survey.  We are in very close proximity to Presbyterian Hospital, Children's Hospital of Philadelphia, VA Hospital and Mercy Philadelphia Hospital, all of whom were represented at our Tabletop Exercise.  Each of these hospitals has trained staff that would also be available to us. | It was mentioned that according to FEMA it takes 17 minutes, however, this group felt that it would take several minutes less than that to do a survey.   And it would depend on patient acuity. | x | x | x |  | Yes | Yes | Yes | Emergency use authorization, although very important and necessary, may have to be waived in the setting of the life threatening neutopenia for these patients. | Yes | We would be willing to use cord blood.   We believe this is an acceptable stem cell source when a well-matched related or unrelated donor cannot be quickly identified.  Since we use cord blood for these reasons for patients with hematologic malignancies, myelodysplasia, and even aplastic anemia, we would be willing to use it in a situation where stem cell replacement is required but well matched donors cannot be identified.   Of course emergency use authorization would be extremely useful from a risk management standpoint and when seeking reimbursement.   However, in the setting of life threatening exposure we believe this is an appropriate alternative stem cell source. | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Wow, this turned out to be an amazing exercise.   thank you.
 | 18 | x | x | x | x |  | x |  | x | x | x | x | x | x | x | x | x | x |  |  |  |  | Transplant Center | With integrated computerized charting and ordering system and the burn center care in-house, patient monitoring will be accomplished with ease. | Yes | Yes | Yes | Yes | Yes. Located outside the emergency department are decontamination pods that can be used in the event decontamination is needed. | Yes | The City of Birmingham Fire and Rescue Department in the event of an emergency can aid in providing on-site decontamination using their Hazmat Team. In the event of a large disaster the City of Birmingham FD has mutual aid agreement with other local municipalities to call for aid with their Hazmat Teams. | Through the activation of the Emergency Management Plan, the Hospitals will provide closed off sections of streets around the emergency department with tents prior to being evaluated for exposure. | xxx (Radiation Safety Officer) | 160 | Various (Waiting on entire list) | 12 | 1 min. |  | x | x |  | No | No | Yes | Yes - if the patient had declining white cells and had a radiation dose that we thought was marrow suppressive rather than marrow ablative, supporting the counts with G-CSF would be a "medical" indication although not a formal FDA indication.  Please note that most of the drugs used in transplant do not have an FDA indication. [NAME]. | No | No, the center has standard treatment protocols in place to manage treating patients off study in the event of emergency. | x |  | x | x
 | 8 | x | x | x | x | x | x |  | x |  | x | x | x | x |  |  | x | x | x | x | x |  | Donor Center |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x | x | x | s | x | x | x | x | x | x | x | x | x | Yes | 6 | Yes | x | x | x | x | x | x | x | x |  | Yes | No |  | No
 | 25 | x | x | x | x | x | x |  |  | x | x |  | x |  |  |  |  |  |  |  |  | multiple members of emergency managment from area hospitals and FD | Transplant Center | The UMC physician will maintain open contact with the burn/trauma physician who is managing patient care.  The UMC physician will provide medical guidance to the burn team to assess and treat the patient with ARS.  ARS symptoms and management to include recommendations for labwork, blood product support, antibiotic, antiviral and antifungal prophylaxis, use of growth factors and symptom management.  Communication will be done via best means available. | Yes | Yes | Yes | Yes | External contamination is described in the Radiation Accident Emergency Plan.  Appropriate protection clothing is to be provided for those responsible for decontamination.  General decontamination procedure description:  [NAME] patient clothing, use lukewarm water and mild non-abrasive soap, if patient still has evidence of contamination after first cleaning, apply detergent and water for 2-3 minutes; use soft brush or pad; repeat 3-4 times.  Avoid: thermal, mechanical or chemical irritation.  Measure activity in washing fluid.  Do not break the skin.  If hair is contaminated, shampoo; clip hair if necessary.  Plan further explains care for contaminated wounds and optional decontamination agents if soap and water do not work sufficiently.  External decontamination at UMC can be done in the designated Decon Room or in a portable external decon space set up outside the ED. | Yes | We anticipate that patients would arrive to Tucson at DM Air Force Base or Tucson International Airport and dispersed to local hospitals from there.  Surveying of incoming casualties will be done at that time and provided  by MMRS for initial contamination screening and decontamination.  Appropriate disposition of patients and companions will then commence.  Final survey and decontamination (if necessary) will occur at receiving hospital. | The holding area for contamination screening will be a designated area feasibly near the deplaning location.  Every effort will be made to process people through the portals and/or survey stations as quickly as possible to reduce the size of the pre-screening holding area. | The Facility/Equipment Decontamination Unit Leader (member of the Radiation Control Emergency Team headed by the Health Physicist). | approximately 72 | MC has the capacity to acquire 80 Ludlums and provide a staff of eight.  Two portals are also available from another site. | A dedicated ED Radiation Response Team is trained annually on the radiation survey technique.  This represents 12 people.  Three members of the BMT Team are also educated to survey. | Approximately 5 minutes.  For staff with intermittant training it may require 10-15 minutes/amb. patient until sufficiently practiced. | x | x | x |  | No | Yes | Yes | We would use G-CSF or GM-CSF off-label, if in our medical judgment, the administration of that growth factor was critical to hematopoietic recovery and patient survival post myelotoxic injury. | Yes | We would use cord blood for transplantation in victims of marrow-lethal radiation injury without EUA if, in our medical judgment, the patient had no chance of survival without allogeneic hematopoietic cell transplantation, and if we were unable to identify any other suitable, HLA-compatible related or unrelated volunteer bone marrow or peripheral blood stem cell donors in a timely manner. |  |  |  |  | x
 | 21 | x | x | x | x | x | x | x |  | x |  | x | x |  |  |  | x | x | x | x |  | Oral Dentristy/Forensics Specialist and Director of Ambulatory Services | Transplant Center | EMR Bed Tracking System will track physical location of patient , Clinical Information System will be the repository for information pertaining to ARS. | Yes | Yes | Yes | Yes | We have a Level I Trauma Center and a full service ED on campus, both of which are fully equipped to perform decontamination and have trained personnel to carry out this function. | Yes | A Mutual Aid Agreement does exist with the DMC and the South East Michigan Region 2 South Emergency Operations System. We also have a State of Michigan Burn Surge Plan. | We will set up decontamination waiting areas designated within the North Parking Structure which is in proximity to the ED. | Radiation Safety Officer | Dependent upon resources. Approximately 75-100. | [NAME] counters, survey portal | The entire rad onc team in addition to the certified ED staff. | 5-10 minutes incuding interview questions/screening. | x | x | x |  | Yes | Yes | Yes | Due to the level of expertise among our Center's  Transplantation Medical Team we are comfortable with growth factors and would administer accordingly (with or with out Emergency Use Authorization). | Yes | We would prefer Emergency Use Authorization from the FDA before infusing Cord Blood Units in recipients with ARS due to the complexity of cord blood transplantation. |  |  | x | x
 | 16 | x | x | x | x | x | x | x | x |  |  |  | x |  |  |  | x |  |  |  |  |  | Transplant Center | Medical record numbers will be issued to all incoming patients at the time of reception and triage to facilitate their entry into our system.  Alternative treatment areas will be at the discretion of the on-duty physician.  Accordingly, these transfers will be communicated to the admitting area that will make the appropriate tracking changes. | No | No | No | Yes | Not exactly sure where it would occur, per the radiation officer. | Yes | State Board of Health;  [NAME].; Nuclear Regulatory Commission Region 3.; US Public Health | Emergency Room and the 9th and 10th floors. | xxxx- MS Radiation Safety Officer | 80-100 | GM Survey Meters | 10 | 5 minutes | x | x | x |  | No | No | Yes | We would use G-CSF if clinically indiacted for neutropenia. | Yes | We would request donor units as clinically indicated and inform our institutions IRB of the clinical circumstance.  We would peform the treatment unless the IRB had objections. |  |  |  |  | x
 | 11 | x | x | x | x | x | x | x | x | x |  | x | x | x | x | x | x | x |  | x |  | Infectious Disease Physician | Transplant Center | In order to accept a surge of RITN patients, DHMC would have to transfer all possible patients prior to arrival of RITN surge, and Incident Command would initiate a process for tracking all transferred patients and for centralized follow up communications for all patients.      Recipient centers for RITN patients would initially be sent a copy of the Transplant Center’s RITN SOP, containing all basic clinical information regarding ARS management. They would also have contact information for the Transplant Center individual tasked with follow up communication.  This individual at the Transplant Center (MD or ARNP) would then be tasked with a minimum of once daily communication with their respective point of contact at the recipient center.        Specific communication between DHMC and the recipient center would include:  1) Initial review and explanation of our RITN SOP with the recipient center and discussion of the patient’s condition, including details of radiation exposure and ARS status, with required interventions at the time of transfer.      2)  At least daily follow-up discussions, related to ARS support, thermal burn care, and necessary preparations for allogeneic stem cell transplant, as care at the recipient center moves forward. | Yes | Yes | Yes | Yes | We have three areas for external decontamination, two in the ED for ambulatory or stretcher borne and a high volume ambulatory location in our helicopter hanger. | Yes | We have mutual aid agreements of a general nature but our own facilities are adequate for most emergencies requiring decontamination. Our Fire/EMS services provide on scene decontamination before transport. | Incoming patients could be housed in their vehicles or buses until decon can be arranged in inclement weather. Alternatively, the Incident Commander could designate an out-of-hospital site (e.g. remote admin building) for triage and queing. An off-site alternate Incident Command Center is already designated, and could be used to sequester ICS or it could be used for incoming patient triage and holding. | xxxx, RSO, [NAME]. is responsible for coordinating radiological decon. | ED Ambulatory Shower 2 bays X 6/hr X 8 hr = 96 patients/8 hrs ; ED Stretcher Decon Tent  1 bay X 3/hr X 8 hr = 24 “ ; [NAME] bays X 6/hr X 8 hr = 240 “ | Approximately 30 meters are available throughout institution plus multichannel analyzers. | 15-20 staff can do radiation surveys and 20 more can be trained JIT. | An average survey takes 2 min. | x | x | x |  | Yes | Yes | Yes | FDA does not state in their standards to use G-CSF.  However, in any situation where such intervention was felt to be in the best interest of the patient, including risk/benefit tradeoff that favored G-CSF utilization to optimize survival potential, we would pursue use of this via all possible channels.      First, we would appeal to RITN authorities (NMDP) for appropriate authorization or recommendation in the absence of FDA emergency use authorization.  Such support would be anticipated, and we recommend that this be a standard consideration built into the RITN Central (Minneapolis) SOP, to expedite resolution of this issue for all participating RITN Transplant Centers in the absence of FDA authorization.  RITN Central (NMDP) support from the outset, under such circumstances, would help Transplant Centers to act expeditiously and hopefully minimize patient mortality.                    In the absence of RITN authorization, we would appeal to our center’s ethics committee with representation from appropriate clinical providers and senior leadership/administrative and risk management representatives to resolve this issue, again considering the patient’s ultimate risk as our highest priority.  In the absence of time to pursue the above channels, we would make our best clinical decision on behalf of the patient. | No | Since we are not a cord blood transplant center, we would utilize another transplant center performing UCB transplants for such patient referrals.  The one such center in the general vicinity that does undertake cord blood transplants is Massachusetts General Hospital (MGH), in Boston.  We have an existing record of such referrals to that center and an intact working relationship already in place with the MGH Transplant Coordinators and Staff. | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Questions #19 and #20 did not give an option to include explanations. We answered "Yes" to both of these questions, however we have specific responses to both questions.  See below:    19. Does your organization have radiation survey portals?   We have a portal system which is fixed and uses NaI detectors which are too sensitive for this application.    20. Does your organization have access through a partner organization to borrow radiation survey portals?   We could probably get survey portals on trailers from two nearby Nuclear Power Plants TBD.
 | 16 | x | x | x | x | x | x | x | x | x | x | x | x | x | x |  |  | x |  |  |  | KDHE SNS Coordinator | Transplant Center | The medical team will track the patients ARS by assessing symptoms, interventions, patient status, etc… keeping in mind the next closest burn center is located ~150 to 200 miles away.  Add a representative from Children’s Mercy to discuss pediatric burn patients. | Yes | Yes | Yes | Yes | See Annex Y Attachment 3A and Attachment B and Attachment 7A of the Emergency Operations Plan (EOP). | Yes | Stated in the Regional Mass Casualty Incident Plan, October 2008.  (Check with VA/NDMS to see if they have a contract for bus transportation. (Procedures for activation of the decontamination team and RITN task force through the communicator emergency notification system. | In the designated triage area outside the emergency department entrance. | Radiation Safety Officer (RSO) and/or the Hazmat Branch Director of the Hospital Incident Command Structure. | 10 shower heads (ambulatory) x 15 minutes x 4 = 40 patients per hour (4 external non ambulatory shower heads not included in figure) | [NAME], Ionization Chamber, [NAME], Neutron Detector | There are ~24 staff who know how to conduct a radiation survey.  Nuclear Medicine techs (hospital and MAC), medical physicists, Environment of Care Department and University of Kansas Medical Center Safety Department. | It depends on what we’re looking for.  If it’s been 5 days since the detonation, wouldn’t these patients have been decontaminated externally?  Radiation surveys in this case would be for internal contamination – what is the radiation level rather than contamination levels.  In that case a survey shouldn’t take but a few minutes.  More importantly would be an assessment of excreta to see how much, if any, internal contaminants are being excreted.  In the event that we are a first responder and have to survey patients for contamination, it would take an average of 5-10 minutes for the initial survey; but a lot longer if there are contaminated wounds that need to be surveyed during the decontamination process. (Per RITN evaluator average survey time is 4-6 minutes) | x | x | x | x | No | Yes | Yes |  | No | We would not require an emergency use authorization (EUA) in order to request cord blood units for the affected patients. | x | x | x | x
 | 43 | x | x | x | x | x | x | x | x | x | x | x | x | x | x |  |  | x |  |  |  | [NAME]. reps, radiation safety officer, regional health and safety health and medical operations manager | Transplant Center | King County Healthcare Coalition Regional Disater Plan covers shared resources between hospitals, however, they are working on development of an online tracking system that would facilitate communication. | Yes | Yes | Yes | Yes | Health and area medical command invoke public response with fire dept EOC at airport for decon.  Each hospital would have it's own decon capability depending on site, (our center has a procedure). | Yes | King County Healthcare Coalition Regional Disater plan covers shared resources between hospitals. | Kingo County Healthcare Coalition has several sites in the region that could could be used for triage of victims, (including one at the Seattle Center, which is 1 mile for our facility). | Our affiliate hospital, xxxx has an emergency preparedness officer, xxxx | [NAME] has capability for mass decon, (for the less injured), our affiliate hospital UWMC can decon 10-12 acute care patients. | Between UWMC, the Seattle Fire Dept and our center:  2 Ludlum pancake wands, 6 porto-monitors, Physicians RA devices.  Miscellaneous detection equipment, including [NAME] of detectors, pancake wands, ion chamber and alpha detectors. | Between our three partner affiliates and the Seattle Fire Dept. we could not get an exact estimation, but likely over 100 staff members have had training. | 5 minutes |  | x | x |  | No | Yes | Yes | If we were operating under latered standards of care as OK;d by tour state Dept. of health, and if we had an adequate supply, and if it were clinically indicated. | Yes | it is likely that we would be operating under altered standards of care as OKd by our state Dept. of public health, and time woudl be of the essence. | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Many ideas and concersn came up - I will send a separate detailed list to the RITN folks.
 | 13 | x | x | x | x | x |  |  |  |  |  | x | x | x |  |  | x | x |  |  |  | Bone Marrow Transplant, Stem Cell Transplant Coordinator, Medical Director | Transplant Center | 6.	Set up the Incident Command Center, and utilize our resources on campus.  All patients will be treated on campus.         If patient critically burned beyond the expertise of OUMC, could transfer to Baptist MC Burn Center. | Yes | Yes | Yes | Yes | Portal monitor (1), Portable [NAME] (3), and [NAME]. | Yes | [NAME] with MERC (Medical Emergency Response Center). After OUMC activates ICC we would notify The MERC which would, at our request, activate. This would allow OUMC to access all Region 6&8 hospitals for resources. We could request decontamination workers and even have other facilities open their decon units to us. Although, OUMC’s Decontamination Unit, with an ambulatory rate of 93 and non-ambulatory rate of 10 patients per hour, makes the necessity of activating this scenario remote. | 12.	[NAME] with MERC (Medical Emergency Response Center) will coordinate to Western Electric Building in OKC. | xxxx and xxxxxx – xxxx ICC Hazmat Director | 14.	Hour 1 – 84 patients, hours 2-8 @ 103 patients per hour. Total 8 hours = 805 patients. | Portal Monitor , Pancake and [NAME], Gamma Counters | Approximately 50 | Portable Monitor in 3-5 seconds. Manually approximately 5 minutes. | x | x | x |  | Yes | Yes | Yes |  | Yes |  | x | x | x | x
 | 17 | x | x | x |  | x | x | x | x | x | x |  | x |  |  |  |  |  |  |  |  | community based emergency response representative | Transplant Center | serial blood counts, physical exam | Yes | Yes | Yes | Yes | procedure is being revised.  a draft decon protocol will be included in center SOP | Yes | Duke has memo's of understanding with the VA hospital across the street from the main hospital. | unclear at this point since previously designated staging area is now a construction site | xxxx EM Clinical Operation Director | 250 | hand held meters, portal monitors | 24 | 5 min | x | x | x |  | Yes | Yes | Yes | would be used a physician's discretion as best practice | Yes |  | x | x | x
 | 18 |  |  |  | x | x | x | x |  | x |  | x | x |  | x |  | x |  |  |  |  |  | Transplant Center | WIll have BMT personnel form University hospital act as liaison with the burn unit at the University hospital. | Yes | Yes | Yes | Yes | We have a specific decontamination room adjacent to the Emergency Department, complete with showering facilities and haz mat gear and scanning devices for staff to use. | No | Currently  exploring a collaborative arrangement with local fire dept. | In the decomtamination tent that will be set up outside the ED | xxxx, Emergency Management Coordinator | 144 | expector exp aplpha, beta, gamma survey meter | 5 | 10 minutes |  | x | x |  | Yes | No | Yes |  | No |  | x |  | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Had we not incorporated the assistance of our emergency mgmnt coord., we would not have known how to answer some of these questions, given we only had BMT clinical expertise.
 | 16 | x | x | x | x | x | x |  | x | x | x | x | x | x |  |  |  |  |  |  |  | Cell Processing Lab, Transplant Unit Inpatient and Outpatient Managers, Research Data Analyst, Cancer Institute Manager | Transplant Center | The Western Pennsylvania Hospital has a burn center, those patients would be tracked through the portal system and consult to oncology physicians.  If a patient must be transferred to a trauma center, those patients would be sent to a system hospital, Allegheny General Hospital.  The oncologist/fellow rounding at that hospital would be consulted, results of testing can be accessed through the portal system. | Yes | Yes | Yes | Yes | The procedure for external decontamination for radiation contaminants is located at the Intranet site for The Western Pennsylvania Hospital, Emergency Preparedness Manual, Radiological Emergency Procedures. | Yes | The Western Pennsylvania Hospital has verbal agreements with local hospital that would facilitate patient deconamination.  This facility is a part of Region 13 that would assist in facilitating decontamination. | This information is located in our Radiological Emergency Procedures.  The patients would be housed in the Emergency Department, Rehabilitation Department, or in case of large numbers of victims, the grassy area across from the Emergency Department on Millvale Avenue. | xxxx- Director for Radiation Physics and Radiation Safety at xxxx and staff. | Depending upon the extent of contamination, approximately 12. | Portal unit, ionization chambers, end window GM survey meters, [NAME] and meter, gamma counter. | 20 with at least 20 others with preliminary knowlege who could be oriented. | 5-15 minutes depending upon the extent of contamination. | x | x | x |  | Yes | No | Yes | After determining the ARS of each patient, a decision by the medical director would be made to utilize G-CSF off label. | Yes | After determining the ARS of each patient, the decision to request cord blood unit for infusion by the medical director. | x | x | x | x
 | 6 | x | x | x | x | x | x | x | x |  |  | x | x | x | x |  |  | x |  |  |  |  | Transplant Center | Texas Children's Hospital will evaluate as many of the four Acute Radiation Syndrome sub-syndromes by degree of severity.  Guidelines for identifying the neurovascular, hematopoietic, cutaneous and gastrointestinal sub-syndromes are found in our "Raiological and/or Nuclear Response Plan".  Treatment modality is assigned to patients based on highest degree of severity in any sub-syndrome.  Patients with suspected ARS will be evaluated upon arrival and daily thereafter by a member of the bone marrow transplant team.  There are guidelines and charts for monitoring ARS in our Radiological SOP. | Yes | Yes | Yes | Yes | It is the policy of Texas Children's to establish and maintain a decontamination team.  This team will serve as first-receivers in the event that patients are brought to Texas Children's Hospital that have been exposed to chemical, biological, or radiological materials.  The Facilities Operations Department is responsible for the storage and deployment of decontamination equipment.  The Office of Emergency Management is responsible for training decontamination personnel and maintaining a list of employees qualified to use decontamination equipment.  The Emergency Center is responsible for the medical management of TCH decontamination personnel in the field.      All patients suspected of radiation exposure will be treated appropriately with the Radiation Safety Office (Nuclear Medicine Service) involved in the decontamination and treatment.  In the event of a nuclear exposure, the Radiation Officer must deem the involved individual “clear” prior to them leaving the decontamination area. | Yes | Texas Children's Hospital has a Memorandum of Understanding between local health care facilities which allow the following: #1 Transfer of patients between facilities to optimize care for patients; #2 Exchange of needed supplies, equipment or pharmaceuticals; #3 Ability to exchange staff or send staff from one facility, with their patients, to another. | Decontamination tents and associated personal protective equipment (PPE) are stored in the locked storage area in the Doctor’s Parking Lot, adjacent to the Emergency Center.  Decontamination staff will assemble at their primary staging location in the Abercrombie Lobby near the Volunteer Offices.  PPE and Team assignments will be distributed by decontamination team leaders.  The Deon Team has established procedures for assignment of personnel, patient flow processes, triage, communication, and safety measures.   The Hospital may be isolated for a period of time as authorities establish control over the situation.    Texas Children's Hospital Emergency Department (ED) will be evacuated.   All patients or others near the route from the ambulance entrance to the decontamination area will be moved to other areas.  Patients with non-critical problems will be moved to waiting rooms or other suitable areas.  Floors of rooms will be prepared by placing tape on the floor at the entrance to the decontamination side from the non-contaminated side.  Route from the ambulance entrance to decontamination room will be covered with a roll of plastic, paper, or with sheets.  Covering will be secured to the floor with tape.  Above the route will be taped off and marked “Radioactive” until cleared by the RSO.  Nonessential equipment will be removed from the room or covered with plastic. | xxxx Chief of Service, Nuclear Medicine | 64 | Texas Children's Hospital has the necessary equipment and trained personnel to provide gross decontamination on site.  Modified Level C protections (including a full-face Powered Air Purifying Respirator (PAPR),  is the PPE chosen by the Regional Hospital Preparedness Council as meeting and/or exceeding hospital decontamination needs and the PPE utilized by the Decontamination team at Texas Children's Hospital.  Mobile: 5 [NAME] pancake probes and 1-Nal probe; 1 Fieldspec hand held spectrophotometer | 23 | 1.5-3 minutes | x | x | x | x | No | No | Yes | If people are neutropenic because of radiation exposure, the hospital will provide GCSF. | No | The Hospital would anticipate that the FDA will approve due to the emergent need for transplantation. | x | x | x | x
 | 12 | x | x | x | x |  |  |  |  |  | x | x |  | x | x |  |  | x | x | x |  |  | Transplant Center | follow our hospital flow chart for diaster planning | Yes | No | No | Yes | patients clothes are removed if further decontamination is necessary pt is directed to a shower or is decontaminated by trained staff wearing appropriate PPE | No |  | ambulatory pt would be housed in a secure location on campus, non-ambulatory pt would be triaged, emergent cases would receice immediate medical care to stabilize their condition, decontamination would proceed after appropriate medical treament in ED | xxxx, CHP Radiation safety Officer | ambulatory 30-40  Non_ambulatory 15-30 | [NAME] survey meters for detection of beta and gamma radiation [NAME] (T1) survey meters for detecting gamma radiation, portable scintillation detectors for detection of alpha radiation | 6 | 3 minutes | x | x | x |  | Yes | No | Yes | would use per hospital pharm as a diaster plan | No | we are further looking into this but believe this is no | x |  | x | x
 | 10 |  | x |  | x | x | x |  |  |  |  | x | x |  | x |  |  | x |  |  |  | Infection Control | Transplant Center | We have a burn center in our facility and electronic medical records which allows Hem/Onc to follow easily. | Yes | Yes | Yes | Yes | Yes we have a decontamatation process that allows for 50 people per hour to be processed outside of the ED. | Yes | Yes the SMAT activated to facilitate the process. | Alternate care site close to the Cancer Hospital to do screen. | xxxx, RSO | 400 | GM & Ion Chamber | 10 | 5 - 10 minutes | x | x | x |  | Yes | No | Yes | Supportive treatment! | Yes | There are many factors that we would have to have  more information on but from a medical stand point we could do cord blood transplants without EUA. | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | We have many concerns about the finanical and logistical issues raised for people requiring transplant.
 | 11 | x | x |  | x | x | x |  | x | x |  | x | x |  |  |  |  |  |  |  |  | Quality Coordinator | Transplant Center | The hospital patient access system has a "dummy account" that is used in emergency mamagement that allows patients triaged to be assigned into a quick registration number that will alow you to track the master list of patients and where they may have been sent. Further, thought needs to be given to how to retrieve information and resources involved in retrieving this data once patients are dipersed. | Yes | Yes | Yes | Yes | Code Yellow in our emergency preparedness manual; hazmat showers outside of ER | Yes | Local hospitals including pediatric facility. We have another hospital directly across the street and a peds hospital adjacent. Both we have agreements with. | ER Bay; hospital parking lot | ER charge this is an ER function | 160 patients | We have several [NAME] survey meters with thin window probes which can detect alpha and beta particles, as well as standard probes for gamma radiation. We also have several portable ion chambers which can be used to measure exposure. Nuclear medicine has a well chamber and a wipe test counter for assaying wipes or contaminates. | All staff in Nuclear Medicine is trained to perform surveys, as well as many of the x-ray technicians. There are three (3) physicists who are also trained to perform surveys. Some physicians (Radiologists, Radiation Oncologists) can perform surveys if needed. | Few minutes | x | x | x |  | No | Yes | Yes | Clinical decsion making and urgent medical need | Yes | Clinical decision making and urgent medical need |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | This survey seemed very focused on decontatmination; There was concern that from previous understnading of tabletops that patients would not be transported unless decontamination has been confirmed.
 | 13 |  | x | x | x | x |  | x |  | x |  | x | x |  |  |  |  |  |  |  |  | Clinical Research Coordinator, Cell Processing Lab | Transplant Center | Provider-to-provider communications unless the burn/trauma center has capacity and facility to care for ARS. | Yes | Yes | Yes | Yes | Transplant center cooperates with an adjoining transplant center which serves adult patients. The hospital has a portable decontamination tent as well as access to a fixed decontamination area in the ambulance bay of the adjoining emergency departments. The CHW "Radiation, Biological or Chemical (RBC) Agent [NAME] is scalable. | Yes | The hospital has many informal but effective agreements with:   State Radiation Control Program  Area FBI Field Office  County Emergency Management Administrator  Wauwatosa Health Department Director  Wauwatosa Health Department/Incident Command Center  Wauwatosa Health Department Public Info Officer  County Emergency Operation Center  State Health Department  REAC/TS  Medical Radiobiological Advisory Team (MRAT)  HAZMAT National Response Center (Coast Guard)  Nuclear Regulatory Commission (NRC)  Federal Emergency Management Agency (FEMA)  Wisconsin DNR Spill Hotline  WHEPP 7 | The hospital's from point of the ambulance bay would be "clean"; as required, the transplant center would work with agencies described in item #11 for tents outside. | EDTC Charge Physician, Incident Commander, Radiation Safety Officer (on any given day, different people can be assigned these roles) | 144 (5 minute wash x use of 1.5 decontamination tents = 36/hour x 8 hours) | Pancake Geiger-Mueller Detector 	  NaI Scintillation Detector 	  Ionization Chamber 	  Personal Dosimeters 	  Multi-Channel Analyzer | >20 | 5 minutes |  | x | x | x | No | No | Yes | We may seek IRB clearance for emergent non-protocol use and it takes 24 hours. | Yes | We may seek IRB clearance for emergent non-protocol use and it takes 24 hours. | x | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TCs 512 and 542 routinely collaborate on emergency management/surge response so the NMDP RITN drill was conducted jointly by the [NAME] to assure we responses are realistic and reflective of what would occur in the case of an actual event.
 | 10 | x | x |  | x | x | x | x | x |  | x | x | x | x | x | x |  | x |  | x | x | Emergency Management | Transplant Center | All patient transfer coordination and communications are performed by Mississippi Med-Com, a medical communications center housed at the University of Mississippi Medical Center. | Yes | Yes | Yes | Yes | Our facility has a two-tiered approach to external decontamination. For small events, we have a decon station outside the ED. Large scale incidents will be managed by a deployable decon shower system capable of both ambulatory and litter patients. | Yes | We are a recognized ESF-8 support agency and have MOAs with mulitiple state, county and local agencies/entities. | According to our plan, a patient receiption site would be established - all decon would be performed in this location (i.e. airport, parking lot, etc.) | xxxx, Emergency Management Coordinator | 2000 | Hand-held servey meters are kept in the ED decon area. Hand-held meters are also deployable to any patient receiption site. | over 200 | 7 minutes |  | x | x | x | No | No | Yes |  | Yes |  | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Thank you for the opportunity to participate in this program, it greatly enhances our all-hazards approach to emergency management.
 | 22 | x | x | x | x | x | x |  |  | x | x | x | x | x |  |  |  | x | x | x | x |  | Donor Center |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x | x | x | x |  | x | x | x | x | x | x | x | x | Yes | 8 | Yes | x | x | x |  | x |  | x |  |  | No | Yes | Standards of care may be altered to expedite testing (IDM's).  There may be leeway granted to donors that may normally be ineligible or unsuitable. | No
 | 29 | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | Food Services, Pastoral Care, [NAME], Cell Processing Laboratory | Transplant Center | Currently, BGSMC can utilize the Telemedicine System to connect directly with Maricopa Medical Center (primary burn center in Phoenix).  This is a portable system that goes to the patient, wherever they are.  Burn specialists at MMC are able to view the patient's burns on a large TV screen and work with physicians at BGSMC to care for the wounds as necessary.  This will allow us to keep many patients in house. | Yes | Yes | Yes | Yes | With the proximity of a nuclear power plant (Palo Verde) to our hospital in the metropolitan Phoenix area, our Level 1 Trauma Center has procedures in place to deal with the external decontamination for radiation contaminants.  We also have a decontamination team of approx. 60 volunteers that drill on a regular basis in order to be prepared for such an event. | Yes | MC Decontamination Team, Phoenix Fire Department and Arizona National Gurard. | Decontamination area will be established by the hospital's decontamination team.  Currently this area is located in the West Tower parking lot. | xxxx(Emergency Preparedness Coordinator) and xxxx (co-chair). | 96 | The Nuclear Medicine department has:  3 Capintec Survey meters  1 Biodex Survey meter    Emergency Dept has:  2 Pancake friskers  2 Survey meters | 7-8 employees are on site at any one time who can all survey patients.  In addition we have a total of 13 employees who can be called in to survey. | 30 mins |  | x | x |  | No | Yes | Yes | We would use GCSF under a protocol as guidance, under the direction of a Transplant MD.  We would consider its use for patients receiving an estimated dose of >2-3 cGy as clinically indicated. | Yes | See explanation #21. | x | x | x | x
 | 19 | x | x |  | x | x | x |  | x | x | x | x |  |  |  |  | x |  |  |  |  |  | Cord Blood Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x |  | Yes | 3 | Yes | Yes | Would be required to inform the FDA of the emergency use of CBU's
 | 12 | x |  |  |  | x |  |  |  |  |  | x | x | x |  |  |  | x |  |  |  |  | Cord Blood Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | Yes | Minimum of two staff are trained | Yes | Yes | Yes,if the product release require an Emerhency Use Authorization for recipients with ARS.  The alternate process is to release the product under IND guidance.
 | 10 | x | x |  | x |  | x |  |  |  | x | x | x |  |  |  |  |  |  |  |  |  | Cord Blood Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x |  | Yes | 2 | Yes | No | We will choose to distribute under an IND.  However, after negotiations with FDA occur, this response could be amended to Yes.
 | 11 |  | x | x | x | x |  |  | x |  |  | x | x | x | x |  |  | x |  |  |  |  | Transplant Center | pts are sent to the Univ of Utah Hospital | Yes | Yes | Yes | Yes | This procedue if performed by our emergency department.  They survey the pt after decontamination and if need be, the pt is run thru decontamination again | Yes | With local fire department | outside | xxxx, Director of Radiation Safety, Rad Safety Officer | 16 | [NAME] | Approx 40 - all staff in the Emergency Dept | 15-30 minutes |  | x | x |  | No | No | Yes | We would use for neutropenia and sepsis | No | We have in house protocols for using cord blood as a stem cell source for BMT | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | The issue of payment for services rendered for these patients was addressed.  We would like to know where that stands and what other centers are prepared to do.
 | 40 |  |  |  |  | x |  |  |  |  |  | x |  | x |  |  |  | x |  |  | x |  | Donor Center |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x | x | x | x | x | x | x | x |  | x | x | x | x | Yes | 3 | Yes | x | x | x | x | x | x | x |  |  | No | Yes | Changes in need i.e. volunteers and turnaround time, consent requirements storage and distribution. Volunteer involvement. | Yes | Added donor consent requirements, storage and distrubtion challenges.
 | 17 | x | x |  | x | x | x |  | x |  | x | x | x | x |  |  |  |  |  |  |  | University Police, Environmental Health and Safety | Transplant Center | MD Anderson Cancer Center Stem cell Transplantation faculty would consult. | Yes | Yes | Yes | No | No, we don't have a procedure.  If we were to received people, we would make them change from their street clothes, shower, change into tyvex coveralls (or something similar), survey the entire body for contamination, decontaminate any areas of contamination as needed, and then make a decision on whether or not they are at a level where it is safe for them to receive non-life saving medical care.  If they need life saving medical care, then we would skip all the decontamination and survey steps and stabilize the patient. | Yes | xxxx is part of the xxxxs Regional Advisory Council (xxxx).  As a member institution we have signed a standing mutual aid agreement with other member institutions.  As such we could tap resources from other member institutions. xxxx also has a mutual aid agreement with the xxxxsystem. | Staging area, garage 2 | Environmental Health and Safety | It is impossible to determine how many can be decontaminated in 8 hours as we do not know the level of contamination. | xxxx has three 2 lane and six individual showers for decontamination.  All of the showers are portable and include sump pumps and containment bladders for capture of water runoff.  Our Emergency Center also has a decontamination shower with a holding tank for runoff.    We have access to fifteen pancake [NAME] counters for surveys.  The institution also has 160 decon kits which include red and green poncho type coveralls to maintain modesty while going through the decontamination process.   These kits include a bag for personal belongings.  The Environmental Health and Safety staff undergoes annual training on use of decontamination equipment. | 12 | 20 minutes | x | x | x |  | No | No | Yes | CIND or IRB approval | Yes | CIND or IRB approval | x |  | x | x
 | 20 | x | x | x | x | x | x | x | x |  |  | x | x | x | x | x | x | x | x | x | x |  | Transplant Center | It is monitored by blood tests. | Yes | Yes | Yes | Yes | "Code triage NBC":  process for external decontamination | Yes | First receivers are 100+ employees trained and there is a mutual agreement with all San Francisco Hospitals and UC Facilities. | The ER parking lot has a "hot zone" and "cold zone" setups in the ER parking lot according to Code Triage NBC. | xxxx (Environmental Hlth and Safety Officer in coordination with the Dept. of Nuclear Medicine and Radiation | approx. 720 patients at 60/hr. | Radiation survey [NAME] counter; multi-channel organizer | All staff in nuclear medicine; 20 members of EH&S, campus researchers have been designated | less than 5 minutes | x | x | x |  | Yes | Yes | Yes | An altered standard of care would be used for what is needed. | No | We think we would do what needed to be done as we do cord blood transplants, however this question needs to be clarified = what cord blood bank licensure?? | x |  | x | x
 | 22 | x | x | x | x |  | x |  | x |  |  | x |  |  | x |  |  |  |  |  |  |  | Transplant Center | Data manager will go to the site. | No | No | No | Yes |  | No | Not sure what this means | Sabin auditorium | xxxx, [NAME] safety program | 400 | Mny pancake monitors | 200 | 2 | x |  |  |  | No | No | Yes | Most drugs are off-label fo rpediatrics | Yes | Not sure what I should be explaining |  |  |  |  | x
 | 14 | x |  |  | x | x |  | x | x |  | x | x | x | x |  |  |  |  |  |  |  | Radiation Safety Officer; Burn Center Nursing Manager | Transplant Center | N/A.  We have an acredited burn center on site. | Yes | Yes | Yes | Yes | We currently have approximately 60 employees trained to the hazmat first receivers decon level.   We also currently use a system of four commercially manufactured decon tent systems; however, we also currently have a permanent decon facility under construction that will facilitate both ambulatory and non-ambulatory patients.  Completeion date is scheduled for mid July 2010. | Yes | Every hospital in North Carolina has signed The North Carolina Hospital Association Mutual Aid Agreement.  Mass casualty decon is indcluded in that agreement. | Will likely perform a "gross decon" at the receiving airport, then conduct a second decon here on site.  We currently have two Western Shelter hospital tent systems that could be called into service for post decon holding areas if that becomes necessary. | xxxx, Disaster Management Coordinator; and xxxx, Hospital Fire Marshall | 88 ambulatory patients per hour; 704 per 8 hours | Various models of [NAME] and an Ion Chamber | 52 | 10 to 20 minutes | x | x | x |  | No | No | Yes | If there is a demonstrated medical necessity and appropriate approvals have been obtained from Hospital Administration and Legal Affairs. | Yes | Administrative staff would need approval for off label use of cord blood products prior to the physician being allowed to order administration of the product. | x | x | x | x
 | 6 | x | x | x | x |  |  |  |  |  |  |  | x |  |  |  |  | x |  |  |  |  | Transplant Center | Provider-to-provider communications unless the burn/trauma center has capacity and facility to care for ARS. | Yes | Yes | Yes | Yes | Transplant center cooperates with an adjoining transplant center which serves pediatric patients. [NAME] has a portable decontamination tent as well as access to a fixed decontamination area in the ambulance bay of the  emergency departments. The [NAME] plan is "Radiation Incident Response Plan" | Yes | The hospital has many informal but effective agreements with:   State Radiation Control Program  Area FBI Field Office  County Emergency Management Administrator  Wauwatosa Health Department Director  Wauwatosa Health Department/Incident Command Center  Wauwatosa Health Department Public Info Officer  County Emergency Operation Center  State Health Department  REAC/TS  Medical Radiobiological Advisory Team (MRAT)  HAZMAT National Response Center (Coast Guard)  Nuclear Regulatory Commission (NRC)  Federal Emergency Management Agency (FEMA)  Wisconsin DNR Spill Hotline  WHEPP 7 | The hospital's from point of the ambulance bay would be "clean"; as required, the transplant center would work with agencies described in item #11 for tents outside. | EDTC Charge Physician, Incident Commander, Radiation Safety Officer (on any given day, different people can be assigned these roles) | 144 (5 minute wash x use of 1.5 decontamination tents = 36/hour x 8 hours) | Pancake Geiger-Mueller Detector          NaI Scintillation Detector            Ionization Chamber            Personal Dosimeters            Multi-Channel Analyzer | > 20 | 5 minutes |  | x | x | x | No | No | Yes | We may seek IRB clearance for emergent nonprotocol use and it takes 24 hours. | Yes | We may seek IRB clearance for emergent nonprotocol use and it takes 24 hours. | x | x | x | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TCs 512 and 542 routinely collaborate on emergency management/surge response so the NMDP RITN drill was conducted jointly by the [NAME] to assure we responses are realistic and reflective of what would occur in the case of an actual event.
 | 5 |  |  |  |  |  | x |  |  |  |  | x | x |  |  |  |  |  |  |  |  |  | Cord Blood Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x |  | Yes | 3 | Yes | No
 | 16 | x | x |  | x | x | x |  | x |  |  |  |  | x |  |  |  | x |  | x |  |  | Transplant Center | We would keep trauma patients but any burn patients would go to HCMC or Regions Hospitals. We would assign a data manager to collect any data along with a Peds/Adult Medical Director to communicate with physicians/center about progress. | Yes | Yes | Yes | Yes | Two campuses can shower 25-50 people per hour and utilize geiger counters to assess decontamination. | Yes | Civil support team Fire, Police, Hospital Compact. | [NAME] will provide direction based on available facilities, time of day, and according to weather. | xxxx ER Director/xxxx ER Medical Director | 500 | 4 Geiger Counters with pancake probes | 150 | 5 minutes |  | x | x |  | No | No | Yes | Routinely Done | No | We would accept the Dx as requiring [NAME] transplantation. | x | x | x | x
 | 4 | x | x |  | x | x | x | x | x |  | x | x | x | x | x | x | x |  |  |  |  |  | Donor Center |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x