Emergency management trauma course,wedding planning emergency kit key,emergency kit dental clinic - PDF 2016

Health care associated infections (HCAIs) are among top five leading cause of death in United States.
Goal: Promouvoir le travail des infirmieres en sante mentale en leur fournissant des outils a jour. Firstly, the checklist was developed to assess the practices of hand hygiene of all the health care providers working in the trauma room of the emergency department. Using various strategies, color ful banners and posters was the way towards the innovation itself. This project develops the sense of motivation and achievement in health care providers, working at emergency room. Main ContentThe purpose of this playbook is to provide guidance for executive decision makers within the Department of Health and Human Services (HHS) in the event of an actual radiological terrorist attack in a U.S. The playbook is based on the chronology of events outlined in the Radiological Attack scenario of the National Planning Scenarios (Scenario #11).
This Radiological Attack Playbook is prepared in accordance with the National Response Framework (NRF) and associated Federal regulating documents. Introduction: The introduction briefly addresses the purpose of the playbook and how it is structured.
Scenario: The Homeland Security Staff Council (HSC) (now National Security Staff-(NSS)) –in concert with the Department of Homeland Security (DHS) the federal interagency, and State and local homeland security agencies– has developed fifteen all-hazards planning scenarios for use in National.
Concept of Operations (CONOPs): This CONOPs evolves from a vision of actions and events and is a description of how a set of capabilities may be employed to achieve desired objectives or a particular end state for the radiological attack scenario.
Essential Elements of Information (EEIs): EEIs are those critical items of information needed to respond appropriately to circumstances surrounding the event. This playbook is based on the chronology of events in the National Planning Scenarios (Scenario #11) Radiological Attack - Radiological Dispersal Device. Information in a gray box contains non-essential supporting information and may be bypassed when using the playbook. The widespread availability of radioactive material for industrial and medical use provides a broad range of scenarios for the abuse and subsequent exposure of civilian populations to radioactive material in potential terrorist events.
RED- Radiological Exposure Device refers to a sealed radioactive source that is placed in a public place and causes exposure but not contamination to those in proximity. Radiation exposure (or irradiation) occurs when radiation penetrates tissue, for example, when a patient undergoes a diagnostic X-ray. Internal contamination is radioactive material that has entered the body by inhalation, ingestion, or absorption through the skin or wounds. External decontamination: This is often readily accomplished by removing the person's clothing and shoes and washing the skin and hair with soap and water. For both a non-explosive RDD and an RED, many people may present for medical care out of fear of possible exposure, far greater than those actually affected. Radiation Event Medical Management (REMM) is a web portal developed to assist health care providers to respond to mass casualty radiation events.
Health physicists must map radiation levels in contaminated area to assess safety and determine allowable response time in various zones due to radiation. Subject matter experts will provide recommendations for which medications will be needed based on the identified radionuclides. Both exposure and contamination will likely happen to those very near the center of an explosive RDD. Victims requiring treatment for acute radiation syndrome (ARS) are likely in the hundreds at most.
Individuals in need of counseling or consultation may be in tens of thousands, including responders. Unlike an IND event, an explosive RDD event produces no nuclear explosion or huge burst of radiation. Acute Radiation Syndrome (ARS) with nausea and vomiting can occur with doses above 0.75 Gray (Gy). Concentric radiation “response zones”: will be created at the scene based on the dose rates measured at the scene.
The boundary line for the “no entry zone” will likely be about 100 meters for a small to intermediate sized device and up to 600 meters for a very large device (Harper 2007).
In the absence of real time measured radiation data, a zone of approximately 500 meters is a reasonable first estimate but this will be rapidly refined as measurements are obtained. Boundaries of exclusion and short term activity are determined by local authorities, often with Federal advice.
Interagency Modeling and Atmospheric Assessment Center (IMAAC) models which account for event type and wind and weather data will be useful in creating response zones, but dose rate cannot be fully predicted because wind current and patterns are very complex, especially with the urban canyon effects.
Illustration of prototypical “response zones” are in Figure A1 and described in Table A2 below. Figure A1 shows typical radiation zones (outlined in Table A2) and illustrates how boundaries could be established and how the allowed “work time in a zone” can be estimated. Victims with only lower body contamination have a low likelihood of prior radionuclide inhalation and internal contamination, since they were probably exposed walking across the zone and not from the plume. Sheltering during the short-lived plume (about 20-30 min) may be beneficial, but evaluation of the incident and public messaging may not occur in time for this to be effective.
Since air handling in some buildings may concentrate radiation, it is not easy to have simple guidelines for shelter-in-place recommendations during and after the plume passes by. Evacuation routes from the affected zones need to be planned, with radiological monitoring of victims at exits to see which victims need decontamination and possible treatment. For uninjured people, ambulatory decontamination is primarily removal of outer garments and showering. Sampling of the environment using specialized radiation detectors will ordinarily detect the radionuclide(s) involved.
Laboratory analysis of human samples (nasal swabs, feces, urine), may be necessary to evaluate which victims need treatment and evaluate the efficacy of that treatment. Most likely radionuclides for an RDD or RED event include Cesium chloride, Cobalt, Americium, Iridium, although others may also be used. Physical half life describes the length of time it takes for a radioactive substance to lose one-half of its radioactivity. Biologic half life describes time required for the radioactivity of material taken in by a living organism to be reduced to half its initial value by a combination of biological elimination processes and radioactive decay. Conceptual triage approach (see Figure A2-A3) is similar in concept to that of an IND in that the functions at the RTR, MC and AC sites are similar- described below) (Hrdina publication). Multiple simultaneous or closely spaced events may lead to a situation in which regional Emergency Medical Assistance Compacts (EMAC) may not be honored due to concern for additional events.
Nonetheless, whatever the size of a radiological event, a national response will likely be initiated immediately, with resources allocated as needed.
Due to wind currents and other factors, there may be irregular shaped zones and the zones will change over time.
Special concerns need to be paid to the following groups and issues: Victims injured on the scene potentially requiring life-saving medical intervention prior to decontamination. The need to avoid contaminating Emergency Departments and other receiving areas including Red Cross shelters.
Personal external decontamination could take place in a number of places: At entry points to medical facilities, to avoid contaminating the facility. At home or remote sites for self-decontamination of those who leave the scene before decontamination sites are established or who flee the scene. Transportations sites for DOD transportation (no contamination is allowable) or other transportation hubs. Referral for surgical or medical internal decontamination may be needed for any victim with the following conditions: Adequate external decontamination does not result in removal of radiation levels to below about 2 times background, thus indicating possible significant internal contamination. Emergency personnel: various HHS medical personnel and materiel assets will likely be deployed, at least on a stand-by basis. Keeping transport vehicles free from internal contamination is a high priority so that they can remain “on line.” This may not be entirely possible when transporting the critically injured.
Medical Responders May Be At Risk for Significant Dose Life-threatening injuries must be managed before dealing with decontamination (Smith, 2005). Removal of outer garments and washing of exposed skin and hair from the victims and showering will usually remove about 90% of the victims’ contamination,. First responders should use appropriate Personal Protective Equipment (PPE) to minimize contamination and have appropriate personal radiation dosimeters to guide the time they can be exposed to radiation. Figure A5 illustrates how medical personnel might be exposed to radiation from shrapnel embedded in a victim. The closer to the source, the more likely doses resulting in ARS could be produced over an hour or so. 5 rem total dose is the annual limit for occupational radiation workers doing their normal jobs. Higher dose limits are permissible for Emergency Response Workers in certain specific circumstances (Table A6) 25 rem is the guideline limit with only a few exceptions.
In general, the risk of a radiation-induced cancer is 8% for 100 rem (5 rem is less than 1% and 25 rem is about 2%). Limit Emergency Worker Exposure.Sheltering of PublicEvacuation of Public Administration of Prophylactic Drugs.
Appropriate Personal Protective Equipment, including respiratory protection, is necessary for responders who may be exposed to any radionuclides. Fatality management and management of radioactive remains will be coordinated through HHS using established guidelines (CDC). Diagnostic assessment of victims potentially exposed to and internally contaminated by radiation is essential. These analyses will be coordinated through the Centers for Disease Control (CDC) Radio-bioassay laboratory. Annual limit on intake (ALI) - is the derived limit for the amount of radioactive material taken into the body by inhalation or ingestion in a year.
Most authorities do not recommend treatment of internal contamination when the body burden is less than one annual limit of intake (ALI).
If there is concern about a possible diagnosis and need for treatment of Acute Radiation Syndrome, monitoring of blood counts and possibly special biodosimetry analysis (if available) may be needed. An event with radioactive iodine would require appropriate identification (by determination through, survey or interview of likely proximity or ingestion or inhalation) of exposed children and young adults so KI could be provided to prevent later development of thyroid cancer.


The development of Acute Radiation Syndrome severe enough to require countermeasures for treatment is unlikely for those receiving whole body doses below 2 Gy. The disruptive aspect of an RDD will quickly become the major aspect of this event including health fears, economic loss, and infrastructure disruption.
Fear of damage to fetuses and concerns about genetic mutations that could be passed along to future generations will likely arise as well. It is possible that there will be suspicion of any comments from government officials who are not medical experts, so HHS will try to use academic and medical radiation experts.
For those victims who had potential for low dose exposure, cytogenetic biodosimetry studies may be conducted. Given the time and expense of these tests, only those who were clearly within a zone in which exposure may have been relatively high and those who had suspected contamination determined by a health physicist will be subject to study. As has been learned with genetic testing for cancer risk, many people do not want to know if they are at increased risk for developing a disease or illness.
HHS, through ESF #8 and in consultation with the coordinating agency, coordinates Federal support for population decontamination. HHS assists and supports State, tribal, and local governments in performing monitoring for internal contamination and administering available pharmaceuticals for internal decontamination, as deemed necessary by State health officials. CDC hosted a roundtable in Atlanta on population monitoring with participants from Federal agencies, state and local health departments, academia and many professional organizations. CDC chairs a small interagency working group of technical experts to discuss practical aspects of population monitoring. CDC has prepared a planning guide for state and local public health planners highlighting the many challenges in a mass casualty radiation incident and suggesting ways to address those challenges. CDC is planning on developing a planning decision tool (software) for optimizing the design and operation of community reception centers used to screen population in mass casualty radiation emergencies.
Conduct a national radiation exercise with an ESF #8 focus on Population Monitoring issues. The intermediate phase of the response may follow the early phase response within as little as a few hours.
The late phase is the period when recovery and cleanup actions designed to reduce radiation levels in the environment to acceptable level area commenced, and it ends when all the recovery actions have been completed. When I first joined emergency services, I noticed a lot of the guys at my hall drank a lot and not really understanding why.
According to recent study in 2011, trauma patients who develop HCAIs in emergency room had approximately 2-3 times increases the cost of hospital admission and the chances mortality increases (WHO, 2011). Secondly, the group of the health care providers were emerged comprises of the separate category of critical care nurse (CCN), registered nurse (RN), critical care technician (CCT), nursing assistant (NA), and nursing porters. Staff was emphasized to follow 5 moments of hand hygiene proposed originally by World Health Organization.
All the health care providers were excited to participate in the project, by demonstrating their best practice of rhand hygiene. Also, it created self awareness in the health care providers by highlighting the importance of hand hygiene especially in managing trauma patient. It is provided for information only.Sanofi assumes no responsibility for the information presented on this external website. Steady state operations and advance preparations are initiated for a large-scale response to a radiological attack, based upon credible intelligence of a plan to detonate a Radiological Dispersal Device (RDD) or a Radiological Explosive Device (RED) in a U.S. The strategy is to provide surge capacity and rapidly deploy ESF #8 assets to provide assistance to State, Territorial, Tribal, or local officials in saving lives, minimizing adverse health effects, stabilizing public health, medical and human services infrastructure. The goal of this phase is to effect a smooth and transparent transition to long-term recovery while continuing to provide technical expertise to regional, state and local authorities as they rebuild their public health and medical infrastructure. This section also provides an overview of radiological dispersal devices and radiological explosive devices providing relevant information for preparedness and response operations. CONOPs take into account the steps and procedures that may be found in State, local, and Federal response plans to a radiological attack.
EEIs provide decision makers at all levels insight into how and where resources should be applied to achieve maximum benefit for the general population in easing suffering or protecting infrastructure.
Since the emergency response has generic (triage, beds, medicines, transportation) and specific components (radionuclide specific response) some of the supporting details are useful but not essential for general operations personnel. Note: An exposed person is not necessarily contaminated because exposure does not require contact with radioactive material.
When medically indicated, decorporation agents, such as laxatives or chelating compounds, are administered to speed up excretion of internal contamination. Cobalt, Cesium, Iridium, Iodine, Strontium) determines the chemical properties and biological distribution in the body.
Depending of the size of the explosion, an RDD detonation could generate a modest number of patients with physical trauma, thermal burns, contamination, and (in rare cases) radiation injury. An RED incident may be realized by direct discovery of an RED or by clinical recognition of an incident due to a number of people presenting at an Emergency Department, (not discovering the device per se), developing symptoms, and signs of radiation injury. Both the psychological impact of these events and the economic factors related to a contaminated environment can be substantial and long lasting. It takes health physicists (includes other radiation protection specialists) to detect radionuclide, interpret data from radiation monitors, determine exposure rate, initially and over time, and help manage safety issues of the response to the event on site.
If patients have ingested or inhaled radioactive material, or taken that material into their body through a wound or other means, they could be internally contaminated. Further away, victims will likely have less intense contamination and consequently a lower exposure rate. The number of casualties is very scenario dependent (nature of explosive, amount and type of radioactive material dispersed, location of the event, number of individuals affected, weather, etc.). The radiation dose from an explosive RDD can accumulate over time and the radiation injury depends on the duration and amount of exposure or contamination. Evacuation is recommended around 150 m and 1-15 km from the epicenter of detonation for these devices respectively.
Concentric radiation “response zones” will be based on the dose rates measured at the scene. Given the short-lived duration of most airborne radionuclides (about 20-30 min), it is not likely that shutting down a building ventilation system will be effective. The size of the event will help determine whether ambulatory decontamination will be done primarily in formal decontamination sites or at home.
This information will help determine the possible physical damage from the event, as isotopes can only be “weaponized” in certain ways, based on their physical properties (Harper 2007). However, large events may require substantial support from regional partners and possibly federal resources.
It is likely that the local hospital network will have adequate resources although regional facilities may be needed.
There are various systems in place with work ongoing to establish national standards or at least to try to establish compatibility among systems. ESF#8 will assist local authorities with coordination of decontamination of victims, responders, and persons exposed to contamination by an RDD.
Those needing life-saving care will require careful handling to minimize impact on care-givers and on the facility. In lieu of a complex flow diagram illustrating these many possibilities, Figure A4 is a schematic as to how victim flow may occur at an RDD event, particularly one in which the event is obvious. Life-Field triage will separate out the seriously injured, ensuring that life-threatening injuries are treated first and such patients are transported to the hospital immediately, even if contamination survey has not been done.
While this is event dependent, major medical packs from the SNS will not likely be necessary for modest sized RDD events. Nevertheless, there are settings in which medical personnel might be exposed to a relatively high dose of radiation, as with cobalt radioactive shrapnel embedded in a victim. The closer to the source (the victim’s body surface), the more likely doses resulting in ARS could be produced over an hour or so.
Special counseling will be needed for pregnant victims including efforts to estimate their fetus’ exposure.
Improvisation may be necessary for people in the affected zones who do not have appropriate PPE. This includes but is not limited to: History, physical examination, hematology (blood counts) and blood chemistry evaluation. Therefore, bioassay (to measure the type of radionuclide) and dose calculation (with biodosimetry) are important in knowing which patients need therapy. If the number of casualties is large, the laboratory capacity may be insufficient, and patients will be managed clinically. The identification of the radionuclide is important so that unnecessary toxicity is avoided.
Many countermeasures have an unfavorable risk-to-benefit ratio when used to treat persons having low levels of internal contamination. The major health fear is likely to be the “perceived risk” of the inevitability of developing a radiation-induced cancer. These fears are best addressed by education including public media presentations and also by regional face-to-face meetings with medical and epidemiological experts.
These include staff from the National Cancer Institute, CDC, NIH, epidemiologists involved in the Japanese atomic bomb studies including the Japanese Radiation Effects Research Foundation (REFR) and from the Chernobyl studies. Radiation produces characteristic chromosome changes in white blood cells (called dicentrics) that are stable for many years so that the Radiation Laboratory Response Network (Rad-LRN which is still being established) could study potential victims and correlate the number of dicentrics with estimated dose (see REMM). While the exact cut-off would be determined at the time of the event, a suspected dose of less than 50 - 75 cGy (rem) would not require study as this would raise the lifetime risk by about 4% at most. It may be that lifestyle changes (no smoking) and routine recommended medical screening test (colonoscopy, mammograms) may be the mainstay of medical follow up. The relative risks, expense, time, and possibility for site clean up should be determined as clearly and as quickly as possible to expedite the community’s recovery. This is based on the concept of PODs (points of dispensing) and will use field data on radiation screening. This includes the Commissioned Corps, Medical Reserve Corps, or other assets that can be used to assist with population monitoring. The intermediate phase of the response is usually assumed to begin after the source and releases have been brought under control and protective action decisions can be made based on measurement of exposure and radioactive materials that have been deposited as a result of the incident. Being in emergency services for so long now, I have seen a lot of good people lost from within, because they were left alone to deal with a traumatic event by themselves; and especially within volunteer departments, with our Macho "nothing can hurt me" "Be a man" attitude has left a lot to bear the pain inside alone.


Amongst all, the infected hands of the health care providers, working in the trauma room of the emergency section contribute highest proportion of HCAIs in the patients. All the staffs were assessed according to their level of qualification (degree achieved) and their knowledge level.
Specifically, it outlines key measures and options to aid the Secretary in making essential decisions and directing the HHS response to a radiological attack.The playbook functions as a resource document to the Assistant Secretary for Preparedness and Response (ASPR) to assist in coordinating the Department’s Emergency Support Function (ESF #8) with other Federal and local emergency support agencies. In addition, it covers some technical discussions which may be of interest primarily to subject matter experts. These scenarios are designed to be the foundational structure for the development of coordinated national preparedness standards from which homeland security capabilities can be measured or assessed, The Radiological Attack scenario is an account or synopsis of a projected event.
The approaches incorporate the synchronized activities and capabilities under consideration and add the resource management details of whom, and where resources may be applied to achieve desired mitigating outcomes. In this playbook, information requirements are derived as they relate to the preparedness and response activities for a radiological dispersal device attack.
It is critical to understand the difference between (a) exposure to radiation and (b) contamination with radiation.
However, as long as a person remains contaminated they will continue to be exposed to the radiation being emitted by the radioactive material with which they are contaminated. As long as the radiation source remains closed and sealed, there will NOT be any contamination. Serious injuries are likely to be in the hundreds; victims requiring decontamination and medical care may be in the thousands. The dose from an RED depends on the radionuclide used and how long any individual was near the radionuclide. After the plume has passed, the inside of some buildings may have higher air concentrations than outside, depending on the air system, filtration, etc. Contaminated garments and personal property require proper disposal for potential forensic evaluation and safety. Decontamination for others will be improvised, understanding that life-saving measures always take precedence over decontamination. In addition, the appropriate medical countermeasure for those who need treatment is generally radionuclide-specific. There will likely be intermediate zones established so that time spent and dose received by responders will be limited. RTR sites form spontaneously: Victims immediately in the blast site may have injury from the blast, fairly heavy contamination from radiation or combined injury (physical trauma and burn plus radiation). While there may be some re-suspension of radioactive material most of the residual radiation will be a footprint on the ground and not a plume.
Other seriously injured victims are also stabilized first before addressing contamination.While still within the “outer cordoned area” (or “Outer Zone”) contaminated patients are isolated among the non-critically injured victims.
However, resources and supplies may be needed to support local hospitals over time, possibly including FMS and decorporation agents. If actual dosimeters are not used, cumulative dose can be estimated based on physical measurements of dose rate by environmental survey meters. Radiation-induced cancer has long latency (10-30+ years) so that younger people are at greater risk. Internal contamination requires accurate analysis and usually repeated sampling for appropriate clinical management. If empirical treatment is started before measurements are available, as might be done with DTPA (plutonium, americium) or Prussian Blue (Cesium), the treatment course may be discontinued if unnecessary. In general, treatment for internal contamination is given is 10 times the ALI is calculated. For internal contamination levels greater than 1 ALI and less than 10 ALI, clinical judgment dictates treatment of internal contamination. Those suspected of having received a dose above 3 Gy probably need prompt medical intervention with “mitigating agents” such as hematological growth factors for granulocytes.
There may be insurance coverage issues should a victim be determined to be at higher risk so that legal protection and privacy must be considered. Coordination with all these resourced needs to be done proactively in the specific context of population monitoring. Also, the note of appreciation was filed in HCPs credentials to motivate them to continue safe and best practices.
The primary strategy is to closely monitor events and begin advance preparations for an effective and timely response. This scenario is used in policy planning within the Department of Health and Human Services (HHS) in an effort to set the conditions for conventional thought on how the department would approach, plan for, and possibly test strategies against uncertain future developments. The CONOPs do not describe how to conduct preparedness activities but merely serve as a discussion point for Federal, State, local, tribal, regional and territorial, planners to use as a baseline for a coordinated preparedness effort. Contamination can be external (outside of the body) or internal (inside of the body) or both. Knowledge of the chemical nature of the contaminant is essential in making initial treatment decisions.
Responders, too, can have profound psychological effects from participating in the response to an incident and will need assistance.
If there is environmental contamination, highly contaminated areas will have to be cordoned. Doses above 5 rem (5,000 mrem), but especially above 25 rem (25,000 mrem) would be of concern. Removed personal effects and clothes should be bagged, labeled, and kept away from people and animals.
RTR2 site(s) will be set up near the “outer radiation zone” where responders’ time will still be carefully monitored. The radiation dose is likely to be limited as there is no detonation effect as with an IND but rather the radiation is being accumulated over time.
Decontamination protocols are administered before treating for minor injuries and before entering the “clean area” to transport them to other facilities. The size of the event and potential number of victims will be used to determine how to utilize the limited laboratory assay capabilities. Emphasis on studying young people is important because the latency for radiation-induced cancer is usually at least one decade, often 3 or more.
The early phase (or emergency phase) is the period at the beginning of the incident when immediate decisions for effective use of protective actions are required and actual field measurement data is generally not available. After assessing the hand hygiene skills, the hand-hygiene checklist was compiled and results were drawn according to the level and grade of the staffs. Not only was this, the names of the highest scorers pasted on the main notice boards of the main emergency room.
The radiological attack scenario alerts us to different ways that future events could unfold.
In this instance, the incident can be detected by physical detection devices or by an astute clinician who recognizes the syndromes related to radiation injury.
If there has been population contamination, decontamination of victims will be required for their safety and to prevent contamination of transportation, medical facilities, individuals or the environment.
It is calculated from the knowledge of the radionuclide and from the amount a person has within them. Most ambulatory victims will be assessed, and those with ARS (Acute Radiation Syndrome) may receive immediate care, and others will be directed as appropriate to Evacuation Centers and predetermined Medical care sites (MC) for treatment or Assembly Centers (AC) limited care and transport to nearby facilities and victim tracking. RTR sites will be identified “on the fly” by responders and coordinated with the Emergency Operations Center (EOC). This will reduce the possibility of spreading contamination beyond the initial perimeter of potential contamination. Information recorded by the dosimeters must be carefully stored during and after the event. Beyond one meter distance, however, even for Cobalt-60, external contamination produces very little exposure to personnel. For example, nasal swabs, skin or hair swabs might be done for a small-sized event, but not a large one. Other medical factors would be considered regarding biodosimetry study and the need and type of long-term screening. In addition to that, the picture clips were taken of the health care providers without disclosing their names and demonstrated the wrong and right practices, while dealing with the critical patients in trauma room. This scenario should not be used to forecast future events, but rather, it offers a plausible story line to account for possible future events leading toward a radiological attack as depicted in National Planning Scenario #11.
For low exposure (less than ~100 centiGrays (cGy) whole body dose) particularly with protracted exposure, there may be few telltale symptoms to suggest radiation injury.
A ZIP file with almost all the REMM files can be downloaded to a personal computer or to a PDA device. RTR3 sites will be set up outside the outer perimeter and act as collection sites for affected persons leaving the blast area; RTR3 sites will provide paramedic acute care, stabilize victims and direct them as appropriate to MCs, ACs, Evacuation Centers, or transport them to outside facilities. Health physicists and other radiation protection specialists will provide subject matter expertise to help interpret the readings obtained by emergency responders. After compilation of all the data, a three day “Infection Control Week Celebration” was organized in emergency room. The decision to use the HSC scenarios in the development of the playbooks provides a common set of conditions that provide interoperability with Federal, State and local emergency responders. Removal of outer garments, showering and superficial decontamination removes about 90% of the external contamination.
RTR1 will have limited time for emergency workers but the high dose zone will be small and most likely a few hundred meters in diameter. It also allows HHS to work closely with our interagency partners through the National Response Framework (NRF) and the National Incident Management System (NIMS) to ensure efficiency and interoperability in responding to radiological incidents.



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