Advanced Tabletop Exercise - International Atomic Energy ... · Tabletop Exercise Scenario ......

1

Training Course on Medical Preparedness and Response

for a Nuclear or Radiological Emergency

Tabletop Exercise Scenario –

Basic

Assessment of Patient’s Exposure

2

Case 1: An accident involving workers in a nuclear power plant

At a nuclear power plant, a pipe of the primary water cooling system cracked and hot water leaked

from the primary system into the containment of the reactor. Three days after the reactor was cooled

down, some workers entered the containment with a full face mask. The temperature was still high in

the containment. Wearing an anorak and a full face mask made these workers feel sick. During

decontamination, a worker fell from the work platform at a height of 3 meters and hit his waist on a

corner of equipment made of metal. His water proof anorak was torn, and he suffered a 5 cm diameter

(20 cm2) shallow scratch. However, no information on the iliac bone fracture and other severe injuries

was provided to the hospital.

The main contaminant was an oxide form of Cobalt-60 (Co-60). The level of contamination was

2 000 0000 counts per minute (cpm) (2×106 cpm) on the floor when measured by a GM survey meter

with a large diameter window (20 cm2). The contamination level of surfaces with -emitting

radioactive material in the working area1 is usually less than 5000 disintegrations per minute per

100 cm2.

Question 1

A nurse from the medical service at the facility was informed of the accident and decided to send the

patient to your hospital. You are an attending physician responsible for radiation emergencies at your

hospital.

1) How do you receive the patient?

2) How do you prepare for this?

3) What is your plan for the patient’s care?

4) What plan is there in your hospital for a radiological emergency?

Question 2

A contamination of 1 000 000 cpm (1.0×106 cpm) was detected at the wound by a large diameter

window (20 cm2) GM survey meter.

1) How much is the surface activity concentration?

2) How do you manage this contamination?

Question 3

A contamination of 1 000 000 cpm (1.0×106 cpm) was detected around the wound by a large

diameter window (20 cm2) GM survey meter.

1) What is the skin RBE weighted dose at the wound area if no decontamination was performed?

Question 4

Decontamination procedures did not work for this patient. If it is supposed that all the radioisotopes in

the wound were absorbed, how much is the dose for internal contamination? Despite searching for

reference books, you could only find the effective dose and RBE weighted organ dose coefficients of

inhalation or ingestion in Refs [1, 2 and 3], and could not find data for absorption through the wound.

For an initial estimate it could be assumed that intake through a wound is similar to direct injection of

radioactive material into a systemic circulation. In this particular case:

1) How do you evaluate the dose for internal contamination in this situation?

1 Radiological control, DOE Standard DOE-STD-1098-99, U.S. Department of Energy, Washington, D.C. (1999).

3

2) How do you evaluate dose coefficients for the case when 1 Bq of Co-60 goes into a systemic

circulation through wound?2

3) How much is the committed effective dose and 30 day committed RBE weighted dose in red

marrow?

Question 5

You tried decontamination of the wound, but it was difficult to decontaminate. How do you deal with

a contaminated wound that was difficult to decontaminate?

2 Use GSR Part 3 Table III-2A [2], EPR MEDICAL Table XII-D1-1 and Table XII-D2-2 [3], EPR-D-VALUES Table 19

[1].

4

Reference data 1:

Surface activity concentration

605.0100

100

Wf

d

CCA B

S

AS - Surface activity concentration (Bq/cm2）

C - Contamination (cpm)

CB - Background contamination (cpm)

Iβ - Emission rate of β-particles (%)

d - Efficiency of detection of β-particles (%)

W - Window area（cm2)

Eff

icie

ncy

of

regis

trat

ion, %

/2π

maximum energy of β-ray （MeV)

Eff

icie

ncy

(%/2π

)

Eβ, MeV

Figure 1. GM efficiency of registration as a function of maximal energy of β-spectrum, Eβ

Condition of measurements: source-detector distance = 5 mm; source size = 10×10 cm

Co-60 emits -particles with maximal energy of 0.318 MeV with 99.9% emission rate. Efficiency of

the GMsurvey meter to -ray emitted from Co-60 is about 32% according to the manufacture

document (see Figure 1.). Supposing, there is no counting loss and the area of window of the survey

meter was 20 cm2.

5

Deposited activity

SAA S

A - Deposited activity (Bq);

AS - Surface activity concentration (Bq/cm2);

S: - Contaminated area (cm2).

According to GSR Part 3 Table III-2B [2] the gut transfer factor for cobalt oxides in the case of

ingestion intake by workers is 0.05. This means that 0.05 Bq of Co-60 is absorbed into the systemic

circulation from GI tract after ingestion of 1 Bq of Co-60 oxide. Approximately, the effective dose

and 30 day committed RBE weighted dose in red marrow coefficient for ingestion is caused by 0.05

Bq Cobalt-60 entering the systemic circulation, because a fraction of the Co-60 excreted directly in

early faeces may not contribute to the mentioned dose coefficients.

Because the absorption rate of the cobalt oxide into the wound is not known, we can assume all Co-60

in the patient’s wound would be absorbed promptly (i.e. providing that absorption rate is 100%) and

goes into the systemic circulation. Therefore, the activity deposited on the wound will be injected into

the systemic circulation.

Dose of internal exposure

Pathwaymarrowdmarrowd

Pathway

AdAAD

eAE

,ReRe )()(

)()(

E(τ) – committed effective dose (Sv);

AD(Δ)Red marrow – 30 day committed RBE weighted dose in red marrow (Gy);

A - Intake of radioactive material (Bq);

Ad(Δ)Red marrow, Pathway –coefficient of 30 day committed RBE weighted dose in red marrow for unit

intake of radionuclide through given pathway (Gy/Bq);

e(τ)Red marrow, Pathway – a radionuclide specific coefficient committed effective dose for unit intake of

radionuclide through given pathway (Gy/Bq).

Dose coefficients are provided in three publications of the IAEA, in Refs [1, 2 and 3]:

According to GSR Part 3 Table III-2A [2] and EPR MEDICAL Table XII-D1-1 [3] or EPR-D-

VALUES Table 19 [1], the effective dose coefficient for ingestion of Co-60 (cobalt oxide) is 2.5

×10-9

Sv/Bq (namely, committed effective dose per 1 Bq in a case of ingestion).

According to EPR MEDICAL Table XII-D2-2 [3], the dose coefficient of 30 day committed RBE

weighted dose in red marrow for a case of ingestion of Co-60 is 5.8×10-10

Gy/Bq.

Dose from contamination

dermaSkinSdermaSkin AdtAAD

ADSkin derma – RBE weighted dose in skin derma (Gy);

AdSkin derma – coefficient of RBE weighted dose rate in skin derma ((Gy/s)/(Bq/cm2));

AS - Surface activity concentration (Bq/cm2).

Dose coefficient are collected in three publications of the IAEA in Refs [1,2 and 3]:

6

According to GSR Part 3 Table III-2A [2] and EPR MEDICAL Table XII-D1-1 [3] or EPR-D-

VALUES Table 19 [1], the effective dose coefficient for ingestion of Co-60 (cobalt oxide) is

2.5×10-9

Sv/Bq;

According to EPR MEDICAL Table XII-D2-2 [3], the dose coefficient of 30 day committed RBE

weighted dose in red marrow for a case of ingestion of Co-60 is 5.8×10-10

Gy/Bq.

Evaluation of exposure

The IAEA safety standard [4] provides generic criteria for the evaluation of exposure cases in

emergency exposure situation.

7

Case 2: an accidental exposure to radiation in an industry

A radiation accident occurred in a facility in your town. At this facility, agricultural and medical

products are sterilized by a radioactive Co-60 (30×109 MBq) source in a moveable rack. Products are

irradiated using an internal transport system in a controlled manner. Following a jam in the product

transport system, the operator tried to check the system. Ignoring a number of the safety systems,

including the alarm, he entered the radiation facility. When he entered the facility, he thought that the

source was in the safe position (the source was shielded). However, on entering the facility, the source

was in the working position (the source was not shielded). Thus, the operator was exposed to radiation

for about 1 to 2 minutes and then noticed that the source was in the irradiation position. The accident

was reported to the manager of the facility and the operator was transported to your hospital with a

radiation safety officer. He started vomiting 5 minutes after irradiation.

Question 1

1) How do you take care of this patient when you receive him?

2) What plan is there in your hospital for a radiological emergency?

Question 2

1) How much is your dose assessment from his clinical appearances?

2) What is your plan for medical response?

Question 3

After 30 minutes of his arrival, a journalist calls your hospital and asks about the patient’s name, age,

chronology of the accident, your name, your phone number, and contact person in your hospital.

1) How do you respond to this?

Question 4

When the operator was exposed to radiation, he was at a distance of 4 to 4.7 m from the source rack.

1) How much was the RBE weighted dose to the red marrow of operator at that time?3

Question 5

1) Supposing the operator survived the acute phase, what will be the long-term problem?

2) How will you undertake a medical follow-up?

3 Use EPR-D-VALUES Table 15 [1]

8

Reference data 2:

RBE weighted dose in red marrow

Pathwaymarrowdmarrowd Adr

tAAD ,Re2Re

ADRed marrow - RBE weighted dose in red marrow (Gy)

AdRed marrow - coefficient of RBE weighted dose rate in red marrow at 1 m (Gy/(Bq×s))

A - Source activity (Bq)

t - Exposed time (s)

r - Distance between source and reference point (m)

According to EPR-D-VALUES Table 15 [1] the coefficient of RBE weighted dose rate in red marrow

at 1 m for Co-60 is 4.1×10-17

(Gy/(Bq×s)).

9

Case 3: lost source

A 13 year old boy visited your outpatient clinic with complaints of burn-like symptoms on both hands.

He had mild nausea and mild diarrhoea. He did not remember touching hot or warm materials by hand

recently. However, he told you that he found an unfamiliar shaped metal object in a pocket of his

father’s jacket almost one week ago. He kept it in a drawer of the kitchen. The metal object had been

brought to his home by his father one month ago. His father suffered a small burn-like injury in his

right leg at that time, and he had become severely ill suddenly and died two weeks ago, although the

wound had not been large. The doctor who saw his father diagnosed him with sepsis. Additionally,

the family pet dog that slept in the kitchen suffered from vomiting for a while and died yesterday. The

boy lived with his mother and grandmother, and his family had many visitors.

Question 1

1) How do you proceed with the diagnostic process?

2) What is your plan for treatment of the boy?

3) What should you do in addition to the diagnosis and treatment of the boy?

Question 2

The police notified you the next day that the metal object was Cs-137 radioactive source sealed in a

metal package, which has about 2×1012

Bq (2 TBq = 2×106 MBq) activity.

1) Supposing that the duration of contact was 1 minute, how much was the RBE weighted dose

to soft tissue of the hand? 4

Question 3

1) Supposing that the boy remained at an average distance of 4 m from the source, for 12 hours

every day, how much was the red marrow exposure dose for this one month?

Question 4

Following media coverage of this accident, local residents visit or call your hospital with anxiety.

They ask, for example, “Am I dying because I also do not feel well for these weeks?”, or “Will my

descendants have genetic diseases?” Unfortunately your name was included in newspaper articles.

1) How do you react to these inquiries?

Question 5

1) Supposing that the boy survived the acute phase, what will be the long term problem for him?

4 Use EPR-D-VALUES Table 15 [1]

10

Reference data 3:

RBE weighted dose in soft tissue

tissueSofttissueSoft AdtAAD

ADSoft tissue - RBE weighted dose in soft tissue (Gy)

AdSoft tissue – coefficient of RBE weighted dose in soft tissue from adjusent source (Gy/Bq/s)



According to EPR-D-VALUES Table 15 [1] the coefficient of RBE weighted dose rate in in soft

tissue from adjusent source for Co-60 is 5.9×10-15

(Gy/(Bq×s)).

RBE weighted dose in red marrow

marrowdmarrowd Adr

tAAD Re2Re


AdRed marrow - coefficient of RBE weighted dose rate in red marrow at 1 m (Gy/(Bq×s))




According to EPR-D-VALUES Table 15 [1] the coefficient of RBE weighted dose rate in red marrow

at 1 m for Co-60 is 4.1×10-17

(Gy/(Bq×s)).

11

References

[1] INTERNATIONAL ATOMIC ENERGY AGENCY, Dangerous Quantities of Radioactive

Material, Emergency Preparedness and Response Series EPR-D-VALUES, IAEA, Vienna (2006).

[2] INTERNATIONAL ATOMIC ENERGY AGENCY, Radiation Protection and Safety of

Radiation Sources: International Basic Safety Standards. Interim edition, General Safety

Requirements Part 3, Safety Standard Series No. GSR Part 3 (Interim), IAEA, Vienna (2011).

[3] INTERNATIONAL ATOMIC ENERGY AGENCY, WORLD HEALTH ORGANIZATION,

Generic procedures for medical response during a nuclear or radiological emergency, Emergency

Preparedness and Response Series EPR-MEDICAL, IAEA, Vienna (2005).

[4] FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS,

INTERNATIONAL ATOMIC ENERGY AGENCY, INTERNATIONAL LABOUR

ORGANIZATION, PAN AMERICAN HEALTH ORGANIZATION, WORLD HEALTH

ORGANIZATION, Criteria for Use in Preparedness and Response for a Nuclear or Radiological

Emergency, IAEA Safety Standards Series No. GSG-2, IAEA, Vienna (2011).

1

Dose calculation

Case 1 Question 2 Surface activity concentration

605.0I

100

100

Wd

CCA B

S

AS - Surface activity concentration (Bq/cm2）

C - Contamination (cpm)

CB - Background contamination (cpm)

Iβ - Emission rate of β-particles (%)

d - Efficiency of detection of β-particles (%)

W - Window area（cm2)

60 – umber of seconds in one minute

0.5 – effectiveness of registration in 2π geometry

C = 1.0×106 cpm (GM counts)

One doesn’t need to consider CB , because C is much higher than

background.

d = 32 % (From Figure 1)

Iβ = 99.9% (From Co-60 decay scheme) [4]

W = 20 cm2

AS =1.0×106 (cpm)/((32/100)×(100/99.9)×0.5×20 (cm

2)×60 (s/min))

= 5.2×103 Bq/cm

2

Question 3 Skin (derma) RBE weighted dose rate

dermaSkinSdermaSkin AdtAAD

ADSkin derma – RBE weighted dose in skin derma (Gy);

AdSkin derma – coefficient of RBE weighted dose rate in skin derma ((Gy/s)/(Bq/cm2));

AS - Surface activity concentration (Bq/cm2).

AdSkin derma = 3.4×10-11

((Gy/s)/(Bq/cm2)) (Table 19 from [1])

t = 1 h = 3600 s

ADSkin derma = 3.4×10-11

((Gy/s) /(Bq/cm2))×2.24×10

2 (Bq/cm

2)×3.6×10

3 (s/h)

= 2.5×10-5

Gy/h ≈ 0.03 mGy/h

2

Question 4 1) Dose of internal exposure from intake of radionuclide

Pathwaymarrowdmarrowd

Pathway

AdAAD

eAE

,ReRe )()(

)()(

E(τ) – committed effective dose (Sv);

AD(Δ)Red marrow – 30 day committed RBE weighted dose in red marrow (Gy);

A - Intake of radioactive material (Bq);

Ad(Δ)Red marrow, Pathway –coefficient of 30 day committed RBE weighted dose in red

marrow for unit intake of radionuclide through given pathway (Gy/Bq);

e(τ)Red marrow, Pathway – a radionuclide specific coefficient committed effective dose for

unit intake of radionuclide through given pathway (Sv/Bq).

2) Dose coefficients for intake of Co-60 oxide through wound Absorption rate of cobalt oxide from GI tract is 5 % Therefore, if patient ingests 1 Bq

of Co-60, 0.05 Bq of Co-60 is absorbed into circulation system. If 1 Bq of Co-60 is

totally absorbed into circulation system from wound, the ratio of dose coefficients for

ingestion intake and wound intake will be about 0.05:1.0.

Coefficient of committed effective dose for ingestion of Co-60 (e(τ)Red marrow, ingestion) is

2.5×10-9

Sv/Bq (Use GSR Part 3 Table III-2A [2] and EPR MEDICAL Table XII-D1-

1 [3]). Therefore

e(τ)Red marrow, wound = 2.5 x 10-9

(Sv/Bq)×(1/0.05)

= 50×10-9

Sv/Bq

Coefficient of 30 day committed RBE weighted dose in red marrow for ingestion of

Co-60 (Ad(Δ)Red marrow, ingestion) is 5.8×10-10

Gy/Bq (Use EPR-D-VALUES Table 19

[1])

Therefore

Ad(Δ)Red marrow, wound = 5.8×10-10

(Gy/Bq)×(1/0.05)

= 1.18×10-8

Gy/Bq

3) Dose from intake of Co-60 oxide through wound Intake:

S = 20 cm2.

AS = 5.2×103 Bq/cm

2.

A =20 (cm2)×5.2×10

3 (Bq/cm

2)

= 1.04×104 Bq

Committed effective dose:

E(τ) = 50×10-9

(Sv/Bq)×1.04×104 (Bq)

= 5.2×10-3

Sv ≈ 5 mSv

3

30 day committed RBE weighted dose in red marrow:

AD(Δ)Red marrow = 1.14×10-8

(Gy/Bq)×1.04×104 (Bq)

= 1.1×10-4

Gy ≈ 0.1 mGy

4

Case 2 Question 4 RBE weighted dose in red marrow

Pathwaymarrowdmarrowd Adr

tAAD ,Re2Re


AdRed marrow - coefficient of RBE weighted dose rate in red marrow at 1 m

(Gy/(Bq×s))




The operator had been irradiated maximum at 4m form the source rack for 2 minutes,

and minimum at 4.7 m from the source rack for 1 minute.

AdRed marrow : 4.1×10-17

(Gy/(Bq×s)) (Use EPR-D-VALUES Table 15 [1])

A = 30×109 MBq= 3×10

16 (Bq)

h =1/60 hour or 2/60 hour = 60 (s) or 120 (s)

r = 4.7 m or 4 m

AdRed marrow = 4.1×10-17

(Gy/(Bq×s))×3×1016

(Bq)×120 (s) /42

= 9.2 Gy Maximum

AdRed marrow = 4.1×10-17

(Gy/(Bq×s))×3×1016

(Bq)×60 (s) /(4.7)2

= 3.3 Gy Minimum

5

Case 3 Question 2 RBE weighted dose in hand

tissueSofttissueSoft AdtAAD

ADSoft tissue - RBE weighted dose in soft tissue (Gy)

AdSoft tissue – coefficient of RBE weighted dose in soft tissue from adjusent

source (Gy/Bq/s)



The radiation dose to the hand

AFSoft tissue =5.9×10-15


S = 2×1012

(Bq)

h = 1/60 hour = 60 (s)

AFSoft tissue = 5.9×10-15

(Gy/(Bq×s))×2×1012

(Bq)× 60 (s)

= 0.708 Gy

Question 3 RBE weighted dose in red marrow

marrowdmarrowd Adr

tAAD Re2Re


AdRed marrow - coefficient of RBE weighted dose rate in red marrow at 1 m

(Gy/(Bq×s))




AFRed marrow = 9.6×10-18


S =2×1012

(Bq)

h = 12 hour×30 days = 12×30× 3600 = 1.3× 106 (s)

r = 4 m

ADRed marrow = 9.6×10-18

(Gy/(Bq×s))×2×1012

(Bq)×1.3× 106 (s) / 4

2

= 1.56 Gy

6

References

[1] INTERNATIONAL ATOMIC ENERGY AGENCY, Dangerous Quantities of

Radioactive Material, Emergency Preparedness and Response Series EPR-D-

VALUES, IAEA, Vienna (2006).

[2] INTERNATIONAL ATOMIC ENERGY AGENCY, Radiation Protection and

Safety of Radiation Sources: International Basic Safety Standards. Interim edition,

General Safety Requirements Part 3, Safety Standard Series No. GSR Part 3

(Interim), IAEA, Vienna (2011).

[3] INTERNATIONAL ATOMIC ENERGY AGENCY, WORLD HEALTH

ORGANIZATION, Generic procedures for medical response during a nuclear or

radiological emergency, Emergency Preparedness and Response Series EPR-

MEDICAL, IAEA, Vienna (2005).

[4] INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION,

Nuclear Decay Data for Dosimetric Calculations, ICRP Publication 107, Ann.

ICRP, Ann ICRP Vol. 38 (3), Pergamon Press, Oxford (2008).

IAEA International Atomic Energy Agency

Medical Preparedness and Response for

a Nuclear or Radiological Emergency

Assessment of Patient’s Exposure

Tabletop Exercise - Basic

IAEA 2

Contamination of the Individual

Contamination of the individual

· Surface activity concentration: AS [Bq/cm2]

· Total deposited activity: A [Bq]

Contamination of the individual

· Surface activity concentration: AS [Bq/cm2]

· Total deposited activity: A [Bq]

Contamination monitor

· Contamination (Monitor reading): C [cpm]

· Window area: S [cm2]

Contamination monitor

· Contamination (Monitor reading): C [cpm]

· Window area: S [cm2]

Radioactive leakage

· Radionuclide: R· Maximal energy of β-spectrum: Eβ [MeV]

Radioactive leakage

· Radionuclide: R· Maximal energy of β-spectrum: Eβ [MeV]R

CC

AS

AAS

A

IAEA 3

Contamination of the Individual (2)

AS: Surface activity concentration (Bq/cm2）

C: Contamination (cpm)

CB: Background contamination (cpm)

Iβ: Emission rate of β-particles (%)

d: Efficiency of detection of β-particles (%)

W: Window area（cm2)

A: Deposited activity (Bq)

S: Contaminated area (cm2)

SAAS

60W5.0

I

100

100

d

CC

AB

S

β

IAEA 4

Efficiency of Registration of β-decay

Maximal energy of

β-spectrum, MeV

Maximal energy of

β-spectrum, MeVEff

icie

nc

y o

f re

gis

tra

tio

n, %

/2π

Eff

icie

nc

y o

f re

gis

tra

tio

n, %

/2π

5 mm

2π

2π

60Co 0.318 MeV

137Cs 0.514 MeV

192Ir 0.675 MeV

IAEA

Emission Rate in Radioactive Decay

Emission rate of β-particles in Cu-64 decay is 55.1%

For Co-60 decay it is 99.9% 5

IAEA 6

Dose from Intake of Radionuclide

Committed RBE

weighted organ

dose

Committed

effective dose

Intake

of R Exposure scenario

Pathway,marrowdRemarrowdRe

Pathway

)(AdA)(AD

)(eA)(E

ΔΔ

ττ

IAEA

Skin Dose from Surface Contamination

dermaSkinS

dermaSkin

AdtA

AD

7

IAEA

Soft Tissue Dose from Adjacent Source

tissueSoft

tissueSoft

AdtA

AD

h = 0 mm

d = 5 mm

8

IAEA

Red Marrow Dose from Distant Source

Pathway,marrowdRe2marrowdReAd

r

t

AAD

No shielding, χ = 0

9

IAEA

Use of Default Dosimetric Model (DDM)

Default dosimetric model expands Elementary

model to irradiation of a reference man

10

Training Course on Medical Preparedness and Response

for a Nuclear or Radiological Emergency

Tabletop Exercise Manual –

Advanced

2

CONTENT

1.0 GENERAL INFORMATION FOR PLAYERS ......................................................................... 3 1.1 Introduction ............................................................................................................................ 3 1.2 Exercise objectives ................................................................................................................. 3 1.3 Exercise scope ........................................................................................................................ 4 1.4 Exercise organization ............................................................................................................. 5 1.5 Exercise management ............................................................................................................. 8 1.6 Exercise rules ......................................................................................................................... 8 1.7 Preparation for the exercise .................................................................................................... 8 1.8 Equipment .............................................................................................................................. 8 1.9 Radiological data .................................................................................................................... 9 1.10 Start state .............................................................................................................................. 10

2.0 EXERCISE TEAM INSTRUCTIONS ..................................................................................... 11 2.1 Exercise organization ........................................................................................................... 11 2.2 Roles and responsibilities ..................................................................................................... 11 2.3 Exercise schedule ................................................................................................................. 11 2.4 Instructions for Lead Controller ........................................................................................... 11 2.5 Instructions for controllers during the exercise .................................................................... 12 2.6 Logistics ............................................................................................................................... 12

3.0 SCENARIO .............................................................................................................................. 13 3.1 Narrative ............................................................................................................................... 13 3.2 Start state .............................................................................................................................. 13 3.3 Master events list (MEL) ..................................................................................................... 14 3.4 Radiological data .................................................................................................................. 16 3.5 Medical data ......................................................................................................................... 16

4.0 EXERCISE INJECTS .............................................................................................................. 17 5.0 EXERCISE DATA ................................................................................................................... 34

5.1 Radiation data ....................................................................................................................... 34 5.2 Medical data ......................................................................................................................... 35

6.0 CONSEQUENCES OF VICTIMS AND WITNESS ............................................................... 36 6.1 Victims ................................................................................................................................. 36 6.2 Witnesses .............................................................................................................................. 43

3

DISTRIBUTE THIS SECTION TO THE PLAYERS

1.0 GENERAL INFORMATION FOR PLAYERS

1.1 Introduction

TEX-01 is a tabletop exercise that is part of the basic course on emergency preparedness and

response for terrorist acts involving radioactivity.

1.2 Exercise objectives

On-site management objectives

On-site command and control is promptly established.

The medical response at the scene is well coordinated with other response organizations,

particularly radiological response, in terms of cooperation, command and control and

communication links.

The medical responders at the accident scene (critical first aid) promptly address the

immediate medical consequences of an acute event involving trauma, internal and external

contamination and acute radiation syndrome.

Life-saving medical first aid is given priority over decontamination.

The radiological response at the scene is well coordinated with other response organizations,

particularly medical response, in terms of cooperation, command and control and


Triage of those involved at the scene of an accident (workers, responders, and public) is

performed appropriately based on medical needs, contamination and potential overexposure.

The transfer of responsibility at the site, if it occurs, is carried out seamlessly and effectively

while minimizing the spread of contamination.

Immediate conventional hazards are promptly mitigated.

Notification of public health is demonstrated.

An effective media management strategy for dealing with the threat is identified.

Media management measures at the scene are implemented.

Hospital management objectives

Hospital management is promptly established.

Effective initial and subsequent medical management of symptomatic, asymptomatic,

externally contaminated, and internally contaminated patients is provided.

Medical treatment for serious conditions is given priority over decontamination.

The medical response at the hospital is well coordinated with on-scene command and control

and communication links.

The radiological response at the hospital is well coordinated with command and control and


Medical authorities correctly assess the current and potential public health issues related to

the accident and notify authorities.

Measures are promptly taken to confine contamination.

Triage victims on hospital scene.

Media management measures at the hospital are implemented.

4

1.3 Exercise scope

The exercise will be a tabletop exercise. Area maps will be used to simulate the movement and

deployment of response teams. Colour-coded chips will be used to simulate the position of different

teams.

The exercise will last two hours. It will involve the participation of all workshop attendees. No

outside organization will participate.

5

1.4 Exercise organization

The players will be divided into the following:

On-Site team

Position Role Resources

Emergency medical

service team

Tactical coordination of medical first

responders and ambulance services.

You normally work from the city’s

emergency response centre.

You are responsible for providing first aid

for injured persons using standard methods

for medical first, and also you might be the

first responders until arrival of the first

responders.

4 major hospitals, 2 of which have a

system to respond to radiological

emergencies.

Medical transport team You are responsible for transporting the

casualties from the scene of the emergency

to the Emergency Departments of the

hospital.

10 ambulances distributed

throughout the city, with two

attendants per ambulance, all

trained in advanced life support

(ALS).

Radiation technicians Radiation safety officer for one of the

hospitals.

Secondary duty as special advisor to the

local chief of civil defence on preparedness

issues for radiological accidents.

Trainer for city emergency response

personnel on radiation detection and

protection.

Access to a network of 3 radiation

safety officers, all trained in the use

of detection instruments and

radiation protection.

Triage physicians You normally work for the Emergency

Department of the hospital. In case of mass

casualty you dispatch to the scene.

2 physicians and they have first aid

kit.

Triage nurses You normally work for the Emergency

Department of the hospital. In case of mass

casualty you dispatch to the scene with

physicians.

2 nurses.

Medical officer You normally work for the Department of

health at the local level.

You are responsible for the public health

and respond to the public and media.

Social assistant You notify the public about possible threats

and initiate the response.

Administrator/Coordinator You coordinate the EMS and hospital.

Security staff You are responsible for the security on the

scene.

They all have personal protect equipments.

6

Hospital A team

Hospital A is located in 2km away from Stephansplatz.


The head of hospital In normal situations, you are

responsible for policies of the hospital.

In times of emergency, you remain the

executive in charge of any policy issue

affecting the safety and well-being of

the patients in your hospital.

Official hospital spokesperson.

The emergency medical

manager

In normal situations, you manage the

emergency department. In times of a

disaster, you are requested to manage

the medical response team in your

hospital.

You report to the head of the hospital.

Emergency physicians You decide on maintaining the patient

in the appropriate services of the

hospital and provide resuscitation for

patients that are in life threatening

conditions.

2 emergency physicians.

Medical specialists You are responsible for providing the

necessary treatment for the patient.

1 surgeon, 2 internists and 1

orthopedist.

Nurses You take care of the patients and assist

emergency physicians and medical

specialists.

4 nurses.

Radiation safety/protection

personnel

Radiation safety officer the hospital. 5 radiation safety officers all

trained in the use of detection

instruments and radiation

protection.

Laboratory technicians You are responsible for examining

blood and urine in the hospital

laboratory and you report the results to

doctors.

You are unable to radiation

measurements.

Administrator/Coordinator You coordinate the hospital and EMS.

7

Hospital B team

Hospital B is located 5km from Stephansplatz.


The head of hospital In normal situations, you are

responsible for policies of the hospital.

In times of emergency, you remain the

executive in change of any policy issue

affecting the safety and well-being of

the patients in your hospital.

Official hospital spokesperson.

The emergency medical

manager

In normal situations, you manage the

emergency department. In times of a

disaster, you are requested to manage

the medical response team in your

hospital.

You report to the head of the hospital.

Emergency physicians They make a decision about

maintaining the patient in the

appropriate services of the hospital and

provide resuscitation for patients that

are in life threatening conditions.

3 emergency physicians.

Medical specialists They are responsible for providing the

necessary treatment for the patient.

1 brain surgeon, 1 internist and 1

general surgeon.

Nurses You take care of the patients and assist

emergency physicians and medical

specialists.

5 nurses.

Radiation safety/protection

personnel

Radiation safety officer for the hospital. 4 radiation safety officers all

trained in the use of detection

instruments and radiation

protection.

Laboratory technicians You are responsible for examining

blood and urine in the hospital

laboratory and you report the results to

the doctors.

You are unable to use radiation

measurements.

Administrators You coordinate the hospital and EMS.

8

1.5 Exercise management

The exercise will be conducted by controllers. Controllers will provide simulated information and

data (injects). They are NOT there to help with procedures or to guide you in your response. If you

have questions about aspects of the exercise that are not clear, or if you need to access

organizations/agencies that are not simulated in the exercise, talk to a controller.

1.6 Exercise rules

Play your role seriously.

Do not fight the scenario.

Simulated data will be provided by the controllers if the appropriate actions are taken.

No outside calls.

The On-site group and hospital groups can (and should) communicate with each other, but

only through telephone.

Resources will be simulated using colour-coded chips/magnets.

The position and movement of resources will be simulated by placing the chips on city maps

provided. Each group will have its own map.

Additional information can be entered on the maps using grease pencils provided.

The situations and symptoms that you can see and hear of each victim and witness are all

written on the “card”.

If you need the data, ask the controller to provide the data.

1.7 Preparation for the exercise

Before the exercise can start, the following actions must take place:

Roles must be assigned and explained;

Groups must be organized.

1.8 Equipment

You should have the following equipment:

a. Maps and layouts for each group;

b. Pencils;

c. Resource chips (see colour code below, which may change depending on availability of

chips);

d. Paper and pens;

e. Triage tags.

Chip colour Simulated persons

White Triage physician, Triage nurse, Nurse, Medical specialist

Red Medical officer, Head of hospital

Yellow Security service, emergency medical manager

Orange Emergency medical service, Emergency physician

Blue Medical transport, Laboratory technician

Green Radiation technician

Red + cross Social assistant, Administrator/Coordinator

Black Journalists

9

1.9 Radiological data

Ambient dose rates and air sampler readings will be simulated using an exercise software based on

the location of the reading. If you want radiation readings, you need to:

1. Indicate to the controller what resources you have at the scene that can detect radiation;

2. Tell the controller where you are taking readings.

10

1.10 Start state

We are in Bredonia. The International Newcomers (INO) is hosting a meeting of the General

Council. One of the discussion items is the enhancement of non-proliferation inspections in West-

Asian countries. The issue has been met with skepticism by some countries who feel that this

represents added pressure and control on their programs for the peaceful use of nuclear energy by

Western countries.

In the morning, a local radio station receives a call from an unknown individual with a foreign accent

(accent unknown but the person communicated in English) , they said that there would be a dirty

bomb attack on a busy Bredonia district to protest against the interference of the INO in West Asia

domestic affairs. They intend to go with a report on the news.

It is tourist season in Bredonia. There is a classical music festival throughout the streets of the first

district. Most hotels are fully booked. Today, two major concerts are planned at noon at West

District and the East District. Each is expected to attract thousands of people.

There are two hospitals both of them has an emergency department and ICU. Many patients are

always waiting their turn in both emergency departments. Today you are working as usual ……

11

DO NOT/NOT DISTRIBUTE THIS SECTION TO PLAYERS

2.0 EXERCISE TEAM INSTRUCTIONS

2.1 Exercise organization

There will be three controllers for this exercise: one for lead and two for support. Roles will be

assigned before the exercise.

2.2 Roles and responsibilities

The lead controller is responsible for the overall conduct of the exercise.

Controllers are responsible for ensuring that the scenario inputs are provided in accordance with the

master events list, for ensuring that the scenario stays on track and for monitoring the safety of the

actions taken. In case of safety concerns, the controllers will stop the exercise, notify the lead

controller and wait for safe conditions to be re-established before resuming.

2.3 Exercise schedule

30 minutes before start time Briefing of players

Exercise 2 hours duration

30 minutes after exercise Evaluation and debriefing

2.4 Instructions for Lead Controller

Day before the exercise

Assign players roles.

Review the scenario with the controllers and assign roles.

Make required adjustments to the times on the input messages.

Ensure the room for the exercise is ready. Depending on the size of the room and the groups,

three rooms may be required. If so, ensure that there is a telephone link between the rooms. The

three groups must be physically separated (although they can be in the same room if big enough).

Ensure that all equipment is available for the next day (maps, figures, grease pencils, note pads,

pens and victim cards).

Select 2 victim cards from delayed category, 4 victim cards from minor category, and 4

witnesses. And put remaining cards on the map (Stephansplatz).

Briefing and preparation

Go through the players guide part of this document.

Give the team sufficient time to get organized.

During the exercise

Start the exercise only when you feel that the participants are ready. Do not delay too much.

Make sure that all controllers know the exact start time and, if required, make last minute

adjustment to the exercise timing.

12

2.5 Instructions for controllers during the exercise

Identify yourself as controller to the organization being evaluated at the start of the exercise;

Confirm you have reached an exercise participant before delivering scripted messages;

Begin each message with “THIS IS AN EXERCISE” and the name of the organization/individual

being simulated;

Begin and end hard copy messages with “EXERCISE, EXERCISE, EXERCISE”;

Closely follow the instructions in the Master Event List;

If the scenario gets off track, immediately report the problem to the Lead Controller;

Do not provide additional information unless requested by the organization being evaluated, and

then, only within the limits of the scenario;

Do not accelerate the exercise by providing information ahead of schedule, unless directed by the

Lead Controller;

Immediately halt an activity that is unsafe and report the action to the Lead Controller;

Report to and seek permission from the Lead Controller to terminate the exercise when a real

emergency occurs;

Monitor exercise play and make minor adjustments only when necessary to keep the exercise on

track or to maintain a safe environment.

2.6 Logistics

The following equipment will be required:

Map of first district (A3-size);

Map of Bredonia (A3-size);

Layout of the hospital A and hospital B (A3-size);

Layout of the emergency departments of hospital A and hospital B;

Victim and witness consequence cards;

Pencils;

Note pads;

Pens;

Telephones (if the groups are in three separate rooms);

EPR-MEDICAL 2005 (one for each group)

13

3.0 SCENARIO

3.1 Narrative

At 10:00 h, the Bredonia emergency dispatcher (emergency call service) receives a call from the INO

security section informing them that an unknown individual with a foreign accent (accent unknown

but the person communicated in English) called to say that there would be an dirty bomb attack on a

busy Bredonia district to protest against the interference of the INO in West Asia domestic affairs.

At 10:30 h, a local radio station receives a similar call and contacts the city media relations manager

to warn him. They intend to go with a live report on the 12:00 h news.

At 14:00, an explosion occurs in the Stephansplatz U-bahn station, near the Rottendrumstrasse exit.

The bomb contained 1000 Ci of Cs-137. The bomb was carried by a suicide bomber, who is now

dead and unrecognizable.

Fifty people are seriously injured and smoke quickly fills the U-bahn station. Smoke is seen coming

out of the U-bahn exit. There are approximately 500 people around Stephansplatz. Street performers

are present. The explosion causes panic. Most people leave the scene running. Approximately 50

people stay around to help people coming out of the U-bahn station with various degrees of injuries.

Some are filming the event.

At 15:00, five victims and witnesses go to the Hospital A and Hospital B by themselves, and they are

not surveyed by radiation detector or decontaminated at the scene.

At 15:20, there are approximately 20 journalists at the scene, from different nations. Many were

present at a press conference at the INO and went to the scene when they heard about the explosion.

At 15:30, National coordinator for radiological resources tells the On-site team that the radionuclide

used for the bomb is Cs-137.

By 16:00, medical officers are urged to respond to public health. And 2 victims start vomiting.

By 16:20, there are 10 journalists at Hospital B, and are interfering with the medical response.

By 18:20, all victims are decontaminated and referred for further hospital care or discharged.

3.2 Start state

See players guide.

14

3.3 Master events list (MEL) # Simulated

time

Inject real

time (min)

Prevent to Inject/controller instructions Points for discussion

-0:30 All Start state

1 1400 0 On-site team On-site team receives call about an explosion on

Stephansplatz.

□ What is your assessment of the situation?

□ What actions should you take and what are the priorities?

2 1410 5 On-site team On-site team goes to the scene and receives a situation

report from the scene.

When the on-site team starts triage, controller gives

them “victim and witness information card”.



□ Contamination control

□ Safety of responders and victims

□ Communication with other organization

□ What are the implications for the hospital?

3 1430 15 Hospital A and B Commander of first responders requests to receive

victims.

(When there is no request from the site within 15

minutes)



□ How do you establish the hospital management?

4 1430 15 Hospital A Hospital A receives a situation at their hospital. □ How do you prepared the hospital to receive the victims?

□ What should you do to regular admissions and

outpatients?

□ How many victims can you receive?

5 1430 15 Hospital B Hospital B receives a situation at their hospital. □ How do you prepare the hospital to receive the victims?

□ What should you do to regular admissions and

outpatients?

□ How many victims can you receive?

6 1500 30 Hospital A 5 victims and witnesses come to the Hospital A and B

by themselves, and they are not surveyed for

contamination.

(Controller selects a victim from yellow category and 2

victims from green category, and 2 witnesses)

□ How do you manage this situation?

7 1500 30 Hospital B 5 victims and witnesses come to the Hospital A and B

by themselves, and they are not surveyed for

contamination.

(Controller selects a victim from yellow category and 2

victims from green category, and 2 witnesses)

□ How do you manage this situation?

8 1520 40 On-site team 20 journalists come to the scene and they are asking a

lot of questions and interfering with the EMS action.

□ How do you make the communication with media on

scene?

15

# Simulated

time

Inject real

time (min)

Prevent to Inject/controller instructions Points for discussion

9 1530 45 On-site team The national coordinator for radiological resources

informs that the radionuclide is Cs-137.

□ What should you do for contamination?

□ How do you let hospital staff know this?

10 1600 60 Medical officer Health Department receives many calls from witnesses

who already left the site, then, health department asks

the medical officer.

□ What should you need to answer the questions?

□ How do you get the information to answer the questions?

□ What and how do you answer to them?

11 1610 65 Hospital ? Victim #1 and #3 start vomiting.

(Give inject to Hospital which received victim #1

and/or #3.)

□ What is needed for dosimetry and which organization do

you ask for radiological dosimetry?

12 1620 70 Hospital A The head of the hospital receives media inquiries. □ What do you answer to the media?

13 1620 70 Hospital B 10 journalists come to hospital B and they are asking a

lot of questions and interfering with medical response.

□ How do you communicate with the media?

14 1800 90 On-site team All victims are transported to another area and all

witnesses are decontaminated.

(When victims or witnesses are still on scene,

controller tells them all victims are transported to

hospital or other place.)

□ How do you leave the area?

□ What are necessary for cleanup of the area and which

organization will do it?

15 1820 100 Hospital A and B All victims are decontaminated and referred for further

hospital care or discharged.

□ How do you recover the emergency department?

120 ENDEX

This exercise is terminated when the final patient has

received emergency care, been decontaminated and

been referred for further hospital care or discharged

and all witnesses have been decontaminated.

16

3.4 Radiological data

When responders are at the scene and when they indicate that they have radiation detection

instruments, provide ambient gamma readings and air samples as requested for the location

requested.

When responders indicate radiological survey for contamination, give them readings of more than 2

times of background levels. All victims and witnesses are externally contaminated; their clothes,

shoes, face, hands and arms.

3.5 Medical data

All victims are normal for lymphocyte count in initial 6 hours.

For Victim #7 and #15, AST and ALT are increased because of abdominal injury.

17

4.0 EXERCISE INJECTS

18

EXERCISE EXERCISE EXERCISE

Inject number 1

Simulated time 14:00 h

To: EMS and On site team

The emergency medical service just received a call that there has been an explosion at Stephansplatz.

It appears that the explosion happened in the U-bahn station. Many people are injured.


19


Inject number 2


Situation report from the accident scene

Explosion originated in Stephansplatz U-bahn station, rottendrumstrasse exit.

The station is filled with smoke.

Smoke is spilling out in the street, on Stephansplatz side.

50 casualties in the station.

5 people outside the station suffering from smoke inhalation

About 50 people on the street helping people and taking videos

One person in the U-bahn station is blown to pieces; looks like he/she may have been a suicide

bomber; body is unrecognizable.

Electronic dosimeters in alarm.

Dose rate around 2 mSv/ at 50 m from the U-bahn exit.

There are no first responders.


20


Inject number 3

Simulated time 14:30

To: Hospital A and B

Hospital A and B just received a call from the medical service that there has been an explosion at

Stephansplatz. It appears that the explosion happened in the U-bahn station. Many people are

injured. And you are required to receive the victims.


21


Inject number 4


Situation of Hospital A

10 people are waiting in the emergency department.

2 emergency physicians and 4 nurses are working in the emergency department.

Hospital A has 10 intensive care units (ICU), 2 units are vacant today.

There are 4 rooms for hospitalizing in the emergency department.

Hospital A has 200 beds; there are 10 vacant rooms and 14 beds for hospitalizing today.

Hospital A has 3 operating rooms and all of them are booked.

Hospital A has the following medical countermeasures:

Potassium iodide

Dimercaprol

Penicillamine

Deferoxamine

Prussium blue

Ca-DTPA

Zn-DTPA

ED has enough medical equipment for receiving victims.


22


Inject number 5


Situation of Hospital B

10 people are waiting in the emergency department.

3 emergency physicians and 4 nurses are working in the emergency department.

Hospital B has 8 intensive care units (ICU), 1 unit is vacant today.

There are 3 rooms for hospitalizing in the emergency department.

Hospital B has 150 beds, there are 8 vacant rooms and 12 beds for hospitalizing today.

Hospital B has 3 operating rooms and all of them are booked.

Hospital B has these medical countermeasures:

Potassium iodide

Dimercaprol

Penicillamine

Deferoxamine

Prussium blue

Ca-DTPA

Zn-DTPA

ED has enough medical equipment for receiving victims.


23


Inject number 6


Hospital A

Two witnesses come to Hospital A in their own vehicle with a victim.

And two victims come to the Hospital A by themselves.

They have not been surveyed at the scene.


24


Inject number 7


Hospital B

Two witnesses come to Hospital A in their own vehicle with a victim.

And two victims come to the Hospital A by themselves.

They have not been surveyed at the scene.


25


Inject number 8


Situation report

20 journalists are at the scene. They are asking a lot of questions and interfering with rescue efforts.


26


Inject number 9


From: National coordinator for radiological resources (Nuclear regulatory agency)

To: On-site team

The radionuclide that was used for the bomb is Cs-137.

No other radionuclides are identified from samples of contamination.


27


Inject number 10


To: Medical officer

Health Department receives many calls from witnesses who have already left the site, such as the

following:

1) I was near the station when the incident happened, was I exposed?

2) Am I contaminated?

3) What should I do now? Should I go to hospital?

4) Will I get cancer later?

The health department requests the medical officer to respond to these questions.


28


Inject number 11


Controller tells the doctor:

Victim #1 and #3 have started vomiting.


29


Inject number 12


To: Head of the Hospital A

The head of the Hospital A receives the following inquiries from the media:

1) What is happening?

2) Is the threat serious?

3) What are you doing about it?

4) How many victims did you receive in your hospital?

5) How many people died?


30


Inject number 13


At Hospital B

10 journalists are at Hospital B. They are asking a lot of questions and interfering with the medical

response.


31


Inject number 14


On-site team

All victims are transported to another area and all witnesses are decontaminated.


32


Inject number 15


Hospital A and B

All victims are decontaminated and referred for further hospital care or discharged.


33


Inject number 16

Simulated time --

ENDEX


34

5.0 EXERCISE DATA

5.1 Radiation data Raw downwind data (approximate)

Distance

(m) Ambient dose rate (microSv/h) after plume

Air sample reading (during plume) in CPS

50 710 1.5 M

100 200 0.45 M

200 50 0.1 M

500 10 0.03 M

35

5.2 Medical data

Complete blood cell counts Complete blood cell counts

Victim #

3,6,9, 11,13

WBC 6000 /mm3

Victim # 7

WBC 5500 /mm3

Lym 2300 /mm3 Lym 2200 /mm

3

RBC 2.7 x106/mm

3 RBC 3 x10

6/mm

3

Hb 11 g/dl Hb 10 g/dl

Ht 30 % Ht 25 %

Plt 18 x104/mm

3 Plt 13 x10

4/mm

3

Blood Chemical Analysis Blood Chemical Analysis

AST 20 IU/l AST 200 IU/l

ALT 18 IU/l ALT 150 IU/l

BUN 13 mg/dl BUN 12 mg/dl

Crea 0.7 mg/dl Crea 0.6 mg/dl

Glu 96 mg/dl Glu 98 mg/dl

Complete blood cell counts Complete blood cell counts

Victim # 15

WBC 5000 /mm3

Victim #

others

WBC 5000 /mm3

Lym 2000 /mm3 Lym 2000 /mm

3

RBC 4.5 x106/mm

3 RBC 4.5 x10

6/mm

3

Hb 13 g/dl Hb 15 g/dl

Ht 40 % Ht 40 %

Plt 20 x104/mm

3 Plt 25 x10

4/mm

3

Blood Chemical Analysis Blood Chemical Analysis

AST 350 IU/l AST 16 IU/l

ALT 300 IU/l ALT 12 IU/l

BUN 15 mg/dl BUN 15 mg/dl

Crea 0.8 mg/dl Crea 0.8 mg/dl

Glu 100 mg/dl Glu 100 mg/dl

36

6.0 CONSEQUENCES OF VICTIMS AND WITNESS

6.1 Victims # Consequence On-site card Hospital card Category

1

Right tension pneumothrax External contamination Internal contamination Dose received = 2 - 3 Sv

Age 54, Male Right chest pain, Can’t walk Vitals; RR 40/min CRT 1sec Can follow simple command

Age 54, Male Right chest pain, varicose jugular vein, loud breathing, decreased in right, trachea deviated to left, Vitals; RR 40/min PR 120/min BP 76/40mmHg SpO2 84% GCS E3V5M6

IMMEDIATE

2

Brain injury External contamination Internal contamination Dose received < 1 Sv

Age 32, Male Unconscious, can’t walk Vitals; RR 16/min CRT 1sec Can't follow simple commands

Age 32, Male Unconscious, anisocoria Vitals; RR 12/min PR 50/min BP 180/100mmHg SpO2 96% GCS E1V2M3

IMMEDIATE

3

Bilateral femur fracture, shock External contamination Internal contamination Dose received = 2 - 3 Sv

Age 45, Female Bilateral leg pain, can’t walk Vitals; RR 20/min CRT 3 sec Can follow simple command

Age 45, Female Deformation of bilateral thigh, X-p; bilateral femur fracture Vitals; RR 26/min PR 126/min BP 70/40mmHg SpO2 98% GCS E3V5M6

IMMEDIATE

4

40% burn External contamination Internal contamination Dose received < 1 Sv

Age 36, Male Severe burn on face, body, arms, can’t walk Vitals; RR 38/min CRT 1Sec Can follow simple commands

Age 36, Male DDB+DB burn (BSA 40%), dyspnea Vitals; RR 40/min PR 118/min BP 136/70mmHg SpO2 86% GCS E3V5M6

IMMEDIATE

5

40% burn and right antebrachal bone fracture External contamination Dose received < 1 Sv

Age 12, Female Severe burn on face, body, arms, can’t walk Vitals; RR 38/min CRT 1sec Can follow simple commands

Age 12, Female DDB+DB burn (BSA 40%) , dyspnea Vitals; RR 38/min PR 112/min BP 126/68mmHg SpO2 88% GCS E3V4M5

IMMEDIATE

6

Pelvic fracture, shock External contamination Internal contamination Dose received < 1 Sv

Age 60, Male Abdominal pain, face is pale, can’t walk Vitals; RR 20/min CRT 3 sec Can follow simple command

Age 60, Male Abdominal pain, FAST; positive, X-p; pelvic fracture, anemic palpebral conjunctiva Vitals; RR 24/min PR 136/min BP 74/40mmHg SpO2 96% GCS E3V5M6

IMMEDIATE

7

Abdominal injury, face burn External contamination Internal contamination Dose received < 1 Sv

Age 46, Male Intestine prolapse, abdominal pain, burnt face, can’t walk Vitals; RR 20/min CRT 3 sec Can follow simple commands

Age 46, Male Intestine prolapse, abdominal pain, difficulty in breathing Vitals; RR 24/min PR 122/min BP 60/40mmHg SpO2 94% GCS E3V5M6

IMMEDIATE

37

# Consequence On-site card Hospital card Category

8

Cervical vertebra fracture External contamination Internal contamination Dose received < 1 Sv

Age 26, Female Neck pain, total paralysis, abdominal breathing, can’t walk Vitals; RR 12/min CRT 3 sec Can follow simple commands

Age 26, Female Neck pain, total paralysis, abdominal breathing, X-p; C3-4 fractures Vitals; RR 12/min PR 40/min BP 80/40mmHg SpO2 99% GCS E4V5M6

IMMEDIATE

9

30% burn and left femur fracture External contamination Internal contamination Dose received < 1 Sv

Age 38, Male Severe burnt face, body, arms, legs, can’t walk Vitals; RR 36/min CRT 3sec Can follow simple commands

Age 38, Male Severe burns (DDB+DB, BSA 30%) Vitals; RR 40/min PR 130/min BP 74/40mmHg SpO2 96% GCS E3V5M6

IMMEDIATE

10

Brain injury External contamination Internal contamination Dose received < 1 Sv

Age 40, Female Unconscious, can’t walk Vitals; RR 20/min CRT 1sec Can't follow simple commands

Age 40, Female Unconscious, anisocoria Vitals; RR 20/min PR 88/min BP 150/70mmHg SpO2 96% GCS E1V2M4

IMMEDIATE

11

Left femur open fracture External contamination Internal contamination Dose received < 1 Sv

Age 24, Male Left leg deformation, bleeding and pain, can’t walk Vitals; RR 20/min CRT 3sec Can follow simple commands

Age 24, Male Left femur open fracture Vitals; RR 20/min PR 138/min BP 70/54mmHg SpO2 96% GCS E3V5M6

IMMEDIATE

12

Pelvic fracture, right upper arm open fracture External contamination Internal contamination Dose received < 1 Sv

Age 62, Male Abdominal pain, right upper arm deformation, bleeding, can’t walk Vitals; RR 20/min CRT 4sec Can follow simple commands

Age 62, Male Right upper arm bleeding, abdominal pain, FAST; positive, X-p; Pelvic fracture, right upper arm open fracture Vitals; RR 20/min PR 138/min BP 64/44mmHg SpO2 96% GCS E3V5M6

IMMEDIATE

13

Right upper arm traumatic amputation External contamination Internal contamination Dose received < 1 Sv

Age 27, Male Right upper arm traumatic amputation, bleeding and pain, can’t walk Vitals; RR 20/min CRT 3sec Can follow simple commands

Age 27, Male Right upper arm traumatic amputation, bleeding Vitals; RR 20/min PR 144/min BP 74/56mmHg SpO2 96% GCS E4V5M6

IMMEDIATE

14

Left tension pneumothrax External contamination Internal contamination Dose received < 1 Sv

Age 31, Female Left chest pain, can’t walk Vitals; RR 36/min CRT 1sec Can follow simple commands

Age 31, Female Left chest pain, varicose jugular vein, loud breathing decreased in left, trachea deviated to right Vitals; RR 40/min PR 138/min BP 84/40mmHg SpO2 84% GCS E4V5M6

IMMEDIATE

38


15

Abdominal injury External contamination Internal contamination Dose received < 1 Sv

Age 42, Male Abdominal pain, can’t walk Vitals; RR 32/min CRT 1sec Can follow simple commands

Age 42, Male Abdominal involuntary guarding, tenderness, FAST; positive, intestinal perforation Vitals; RR 32/min PR 138/min BP 110/60mmHg SpO2 96% GCS E4V5M6

IMMEDIATE

16

Cardiac tamponade External contamination Internal contamination Dose received < 1 Sv

Age 78, Male Chest pain, can’t walk Vitals; RR20/min CRT 4 sec Can follow simple commands

Age 78, Male Chest pain, FAST; positive, Cardiac tamponade Vitals; RR 20/min PR 138/min BP 60/40mmHg SpO2 96% GCS E3V5M6

IMMEDIATE

17

Right tibia fracture External contamination Internal contamination Dose received < 1 Sv

Age 18, Female Right leg pain, can't walk Vitals; RR20/min CRT 1 sec Can follow simple commands

Age 18, Female Right tibia disformation, swelling, X-p; right tibia fracture Vitals; RR 20/min PR 100/min BP 120/74mmHg SpO2 96% GCS E3V5M6

DELAYED

18

Bilateral tibia fracture External contamination Internal contamination Dose received < 1 Sv

Age 80, Female Bilateral leg pain, can't walk Vitals; RR18/min, CRT 1 sec Can follow simple commands

Age 80, Female Bilateral tibia disformation, swelling, X-p; bilateral tibia fracture Vitals; RR 18/min PR 88/min BP 118/56mmHg SpO2 92% GCS E4V5M6

DELAYED

19

Severe soft tissue injury External contamination Internal contamination Dose received < 1 Sv

Age 44, Male Left femur bleeding, can't walk Vitals; RR16/min, CRT 1 sec Can follow simple commands

Age 44, Male Left femur bleeding, soft tissue injury Vitals; RR 18/min PR 88/min BP 138/68mmHg SpO2 92% GCS E4V5M6

DELAYED

20

Right arm and leg wound External contamination Internal contamination Dose received < 1 Sv

Age 16, Male Right arm bleeding, right leg injury and pain, can't walk Vitals; RR16/min, CRT 1 sec Can follow simple commands

Age 16, Male Right arm bleeding, right leg wound and bleeding Vitals; RR 18/min PR 78/min BP 120/70mmHg SpO2 100% GCS E4V5M6

DELAYED

21

Left humerus and tibia fracture External contamination Internal contamination Dose received < 1 Sv

Age 35, Female Left upper arm and leg pain, can’t walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 35, Female Left upper arm and leg disformation, swelling, pain X-p; left humerus and tibia fracture Vitals; RR 14/min PR 68/min BP 108/52mmHg SpO2 99% GCS E4V5M6

DELAYED

22

Left upper arm wound External contamination Internal contamination Dose received < 1 Sv

Age 33, Male Left upper arm injury and bleeding, can't walk Vitals; RR12/min, CRT 1 sec Can follow simple commands

Age 33, Male Left upper arm bleeding and pain Vitals; RR 14/min PR 66/min BP 132/88mmHg SpO2 99% GCS E4V5M6

DELAYED

39


23

Right femur fracture External contamination Internal contamination Dose received < 1 Sv

Age 29, Male Right leg pain, can't walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 29, Male Right femur disformation, swelling, pain, X-p; right femur fracture Vitals; RR 14/min PR 70/min BP 108/52mmHg SpO2 99% GCS E4V5M6

DELAYED

24

Left ribs bone fracture External contamination Internal contamination Dose received < 1 Sv

Age 15, Female Left chest pain, feel hard to breath, can’t walk Vitals; RR 22/min, CRT 1 sec Can follow simple command

Age 15, Female Left chest pain, difficulty in breathing, X-p; left ribs fracture Vitals; RR 24/min PR 68/min BP 126/54mmHg SpO2 99% GCS E4V5M6

DELAYED

25

Left tibia fracture and upper arm wound External contamination Internal contamination Dose received < 1 Sv

Age 17, Female Left upper arm bleeding, left leg pain, can’t walk Vitals; RR16/min, CRT 1 sec Can follow simple commands

Age 17, Female Left upper arm bleeding, left tibia disformation, X-p; left tibia fracture Vitals; RR 16/min PR 88/min BP 112/64mmHg SpO2 99% GCS E4V5M6

DELAYED

26

Right ribs fracture External contamination Internal contamination Dose received < 1 Sv

Age 54, Female Right chest pain, feel hard to breath, can't walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 54, Female Right chest pain, feel hard to breath, X-p; right ribs fracture Vitals; RR 24/min PR 92/min BP 118/52mmHg SpO2 99% GCS E4V5M6

DELAYED

27

Right femur fracture and lower leg wound External contamination Internal contamination Dose received < 1 Sv

Age 29, Male Right femur pain, lower leg bleeding, can't walk Vitals; RR12/min, CRT 1 sec Can follow simple commands

Age 29, Male Right femur disformation, swelling, pain, X-p; right femur fracture, right lower leg bleeding Vitals; RR 14/min PR 70/min BP 128/54mmHg SpO2 99% GCS E4V5M6

DELAYED

28

Right tympanic membrane rupture and right femur wound External contamination Internal contamination Dose received < 1 Sv

Age 15, Male Right ear pain, fight femur bleeding, can't walk Vitals; RR 18/min, CRT 1 sec Can follow simple commands

Age 15, Male Hearing disorder of right ear, right tympanic membrane rupture, right femur wound Vitals; RR 18/min PR 92/min BP 110/54mmHg SpO2 99% GCS E4V5M6

DELAYED

29

Left tympanic membrane rupture, head bruise External contamination Internal contamination Dose received < 1 Sv

Age 21, Female Left ear pain, vertigo, can't walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 21, Female Hearing disorder of left ear, left tympanic membrane rupture, vertigo Vitals; RR 14/min PR 76/min BP 106/48mmHg SpO2 99% GCS E3V5M6

DELAYED

40


30

Head bruise External contamination Internal contamination Dose received < 1 Sv

Age 57, Female Headache and dizziness, can’t walk Vitals; RR20/min, CRT 1 sec Can follow simple commands

Age 57, Female Dizziness and headache, neurological exam is normal Vitals; RR 20/min PR 88/min BP 132/52mmHg SpO2 99% GCS E3V5M6

DELAYED

31

Bilateral arm burn and abdominal bruise External contamination Internal contamination Dose received < 1 Sv

Age 43, Male Abdominal pain, burnt arms, can't walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 43, Male Abdominal pain, FAST; negative, burnt arms (SDB, BSA14%) Vitals; RR 14/min PR 80/min BP 116/60mmHg SpO2 99% GCS E4V5M6

DELAYED

32

Chest bruise External contamination Internal contamination Dose received < 1 Sv

Age 19, Female Feel hard to breath, chest pain, can’t walk Vitals; RR22/min, CRT 1 sec Can follow simple commands

Age 19, Female Chest pain, FAST; negative, X-p; no fracture Vitals; RR 22/min PR 76/min BP 122/62mmHg SpO2 99% GCS E4V5M6

DELAYED

33

Bilateral arm burn and right tympanic membrane rupture External contamination Internal contamination Dose received < 1 Sv

Age 39, Male Burnt arms and right ear pain, can't walk Vitals; RR18/min, CRT 1 sec Can follow simple commands

Age 39, Male Burnt arms (SDB, BSA 10%), hearing disorder of right ear, tympanic membrane rupture Vitals; RR 18/min PR 70/min BP 118/56mmHg SpO2 99% GCS E4V5M6

DELAYED

34

Left ankle sprain External contamination Internal contamination Dose received < 1 Sv

Age 51, Female Left ankle pain, swelling, can’t walk Vitals; RR 16/min, CRT 1 sec Can follow simple command

Age 51, Female Left ankle pain and swelling, X-p; no fracture Vitals; RR 16/min PR 66/min BP 126/62mmHg SpO2 99% GCS E4V5M6

DELAYED

35


Age 63, Male Dizziness and headache, can't walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 63, Male Dizziness and headache, neurological exam is normal Vitals; RR 14/min PR 76/min BP 114/52mmHg SpO2 99% GCS E3V5M6

DELAYED

36

Left ribs fracture External contamination Internal contamination Dose received < 1 Sv

Age 49, Male Chest pain, can't walk Vitals; RR18/min, CRT 1 sec Can follow simple commands

Age 49, Male Left chest pain, X-p; left ribs fracture Vitals; RR 18/min PR 70/min BP 130/62mmHg SpO2 99% GCS E4V5M6

DELAYED

37


Age 30, Female Headache and nausea, can't walk Vitals; RR12/min, CRT 1 sec Can follow simple commands

Age 30, Female Headache, nausea, neurological exam is normal Vitals; RR 14/min PR 88/min BP 108/52mmHg SpO2 99% GCS E4V5M6

DELAYED

41


38

Abdominal bruise External contamination Internal contamination Dose received < 1 Sv

Age 49, Male Abdominal pain, can't walk Vitals; RR24/min, CRT 1 sec Can follow simple commands

Age 49, Male Abdominal pain, FAST; negative, physical exam is normal Vitals; RR 24/min PR 68/min BP 112/58mmHg SpO2 99% GCS E4V5M6

DELAYED

39

Chest bruise External contamination Internal contamination Dose received < 1 Sv

Age 67, Female Chest pain, can’t walk Vitals; RR16/min, CRT 1 sec Can follow simple commands

Age 67, Female Chest pain, FAST; negative, physical exam is normal Vitals; RR 16/min PR 66/min BP 124/68mmHg SpO2 99% GCS E4V5M6

DELAYED

40

Left tympanic membrane rupture External contamination Internal contamination Dose received < 1 Sv

Age 8, Male Left ear pain, can't walk Vitals; RR24/min, CRT 1 sec Can follow simple commands

Age 8, Male Hearing disorder of left ear, tympanic membrane rupture Vitals; RR 24/min PR 70/min BP 102/48mmHg SpO2 99% GCS E4V5M6

DELAYED

41

Laceration on hands and arms External contamination Internal contamination Dose received < 1 Sv

Age 29, Male Right leg pain, can walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 29, Male Laceration on hands and arms Vitals; RR 14/min PR 70/min BP 112/48mmHg SpO2 99% GCS E4V5M6

MINOR

42


Age 33,Female Laceration on hands and arms, can walk Vitals; RR16/min, CRT 1 sec Can follow simple commands

Age 33, Female Laceration on hands and arms Vitals; RR 16/min PR 66/min BP 108/52mmHg SpO2 99% GCS E4V5M6

MINOR

43


Age 35, Male Laceration on hands and arms, can walk Vitals; RR18/min, CRT 1 sec Can follow simple commands


MINOR

44


Age 7,Female Laceration on hands and arms, can walk Vitals; RR 22/min, CRT 1 sec Can follow simple commands

Age 7, Female Laceration on hands and arms Vitals; RR 22/min PR 112/min BP 108/52mmHg SpO2 99% GCS E4V5M6

MINOR

42


45


Age 10, Male Laceration on hands and arms, can walk Vitals; RR26/min, CRT 1 sec Can follow simple commands


MINOR

46

Laceration on hands and face External contamination Internal contamination Dose received < 1 Sv

Age 5,Female Laceration on hands and face, can walk Vitals; RR 22/min, CRT 1 sec Can follow simple commands

Age 5, Female Laceration on hands and face Vitals; RR 22/min PR 120/min BP 108/52mmHg SpO2 99% GCS E4V5M6

MINOR

47

Laceration on hands and face External contamination Internal contamination Dose received < 1 Sv

Age 54, Male Laceration on hands and face, can walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 54, Male Laceration on hands and face Vitals; RR 14/min PR 68/min BP 128/64mmHg SpO2 99% GCS E4V5M6

MINOR

48

Laceration on hands and legs External contamination Internal contamination Dose received < 1 Sv

Age 58,Female Laceration on hands and legs, can walk Vitals; RR 16/min, CRT 1 sec Can follow simple commands

Age 58, Female Laceration on hands and legs Vitals; RR 16/min PR 98/min BP 142/52mmHg SpO2 99% GCS E4V5M6

MINOR

49

Laceration on legs External contamination Internal contamination Dose received < 1 Sv

Age 29, Male Laceration on legs, can walk Vitals; RR14/min, CRT 1 sec Can follow simple commands

Age 29, Male Laceration on legs Vitals; RR 14/min PR 60/min BP 122/72mmHg SpO2 99% GCS E4V5M6

MINOR

50

Laceration on hands and legs External contamination Internal contamination Dose received < 1 Sv

Age 44,Female Laceration on hands and legs, can walk Vitals; RR 16/min, CRT 1 sec Can follow simple commands

Age 44, Female Laceration on hands and legs Vitals; RR 16/min PR 86/min BP 122/66mmHg SpO2 99% GCS E4V5M6

MINOR

43

6.2 Witnesses

# Consequences

1 to 12

Helping the victims External contamination Laceration on legs and arms Very small internal contamination W-6,7,8 are females

13 to 31

Helping the victims External contamination Very small internal contamination No injury W-14,17-21,27 are females

32 to 45

Helping the victims External contamination No injury W-35,43 are females

46 to 48

Making video recording External contamination No injury

49 to 50

Making video recording No external contamination No injury

EMS 1

EMS 2

EMS 3

EMS 4

EMS 5

EMS 6

EMS 7

EMS 8

EMS 9

EMS 10

Medical Transport 1

Medical Transport 2

Medical Transport 3

Medical Transport 4

Medical Transport 5

Medical Transport 6

Medical Transport 7

Medical Transport 8

Medical Transport 9

Medical Transport 10

Figures for On-site team

Security Staff

Radiation Technician 1



Triage Physician 1

Triage Physician 1

Triage nurse 2

Triage nurse 1

Medical Officer

Social Assistant

Administrator

Head of hospital

Emergency Medical Manager

Emergency Physician

Emergency Physician

Surgeon

Internist

Internist

orthopedist

Radiation Protection Personnel





Administrator

Laboratory Technician


Figures for Hospital A

Nurse Nurse

Nurse Nurse

Head of hospital

Emergency Medical Manager

Emergency Physician

Emergency Physician

Emergency Physician

Brain Surgeon

Internist

General Surgeon





Administrator



Figures for Hospital B

Nurse

Nurse

Nurse

Nurse

Nurse

Figures for OthersFirst aid Kit First aid Kit First aid Kit

□ Can’t move ambulatory

□ CRT > 2sec □ Can’t Do□ > 30/min or need head tilt

□ Can move ambulatory

R P M□ ≤ 29/min □ CRT < 2sec □ Can Do

□ No after head tilt

S L U D G E MSalivation Lacrimation Urination Defecation GI Distress Emesis Miosis

Circle Nature of Contaminant Dry DeconGross DeconTechnical Decon

Decon Solution

Radionuclide Contamination After Decon; No contaminationStill Contaminated

Need medical exam. of rad. exposure?

DECEASED

IMMEDIATE

DELAYED

MINOR

Name

Age Sex MF

No.

AddressPhone

Weight Lbkg

Zip

Bio Rad Toxin

Location of Triage Date/Time

No. 000001

No. 000001

No. 000001

No. 000001

No. 000001

DECEASED IMMEDIATE DELAYED MINOR

No contamination

NoVomit

YesDiarrhoeaNausea Headache( )Others

DECEASED

IMMEDIATE

DELAYED

MINOR

O2 Sat.Resp.PulseB/PTime

RateDoseMedicationTime

OtherTransOtherTransOtherTriage

No. 000001

No. 000001

No. 000001

No. 000001

No. 000001

IV Location Solution: Rate:Airway Adjunct Size: Depth:

□ Can’t move ambulatory

□ CRT > 2sec □ Can’t Do□ > 30/min or need head tilt

□ Can move ambulatory

R P M□ ≤ 29/min □ CRT < 2sec □ Can Do

□ No after head tilt

S L U D G E MSalivation Lacrimation Urination Defecation GI Distress Emesis Miosis

Circle Nature of Contaminant Dry DeconGross DeconTechnical Decon

Decon Solution

Radionuclide Contamination After Decon; No contaminationStill Contaminated

Name

Age Sex MF

No.

AddressPhone

Weight Lbkg

Zip

Bio Rad Toxin

Location of Triage Date/Time

No. 000001

DECEASED IMMEDIATE DELAYED MINOR

No contamination

Need medical exam. of rad. exposure? NoVomit

YesDiarrhoeaNausea Headache( )Others

V – 1 (On-site)

Age 54, Male

Right chest pain, Can’t walk

Vitals; RR 40/min CRT 1sec

can follow simple command

V – 1 (Hospital)

Age 54, Male

Right chest pain, varicose jugular vein,

Breath sounds decreased in right, Trachea

deviated to left

Vitals; RR 40/min PR 120/min

BP 76/40mmHg SpO2 84% GCS E3V5M6

V – 2 (On-site)

Age 32, Male

Unconsciousness, Can’t walk


Can't follow simple command

V – 2 (Hospital)

Age32 , Male

Unconsciousness, anisocoric


BP 180/100mmHg SpO2 96% GCS

E1V2M3

V – 3 (On-site)

Age 45, Female

Bilateral leg pain, Can’t walk

Vitals; RR 20/min CRT 3 sec

Can follow simple command

V – 3 (Hospital)

Age45 , Female

Deformation of bilateral thigh, X-p; bilateral

femur fracture



V – 4 (On-site)

Age 36, Male

Severe burn on face, body, arms, Can’t walk

Vitals; RR 38/min CRT 1Sec


V – 4 (Hospital)

Age36 , Male

II+III burn (BSA 40%), dyspnea



Please turn over when you start

medical assessments


medical assessments


medical assessments


medical assessments

V – 5 (On-site)

Age 12, Female

Severe burn on face, body, arms, Can’t walk



V – 5 (Hospital)

Age 12, Female

DDB+DB burn (BSA 40%) , dyspnea

Vitals; RR 38/min PR 112/min BP

126/68mmHg SpO2 88% GCS E3V4M5

V – 6 (On-site)

Age 60, Male

Abdominal pain, Face is pale, Can’t walk



V – 6 (Hospital)

Age 60, Male

Abdominal pain, FAST; positive, X-p; pelvic

fracture, anemic palpebral conjunctiva



V – 7 (On-site)

Age 46, Male

Intestine prolapse, abdominal pain, burnt

face, Can’t walk



V – 7 (Hospital)

Age 46, Male

Intestine prolapse, abdominal pain, difficulty

in breathing



V – 8 (On-site)

Age 26, Female

neck pain, total paralysis, abdominal

breathing, Can’t walk



V – 8 (Hospital)

Age 26, Female

Neck pain, total paralysis, abdominal

breathing, X-p; C3-4 fractures




medical assessments


medical assessments


medical assessments


medical assessments

V – 9 (On-site)

Age 38, Male

Severe burnt face, body, arms, legs



V – 9 (Hospital)

Age 38, Male

Severe burnt (DDB+DB, BSA 30%)



V – 10 (On-site)

Age 40, Female

Unconsciousness


Can't follow simple command

V – 10 (Hospital)

Age 40, Female

Unconsciousness, anisocoric



V – 11 (On-site)

Age 24, Male

Left leg deformation, bleeding and pain



V – 11 (Hospital)

Age 24, Male

Left femur open fracture



V –12 (On-site)

Age 62, Male

Abdominal pain, right upper arm

deformation, bleeding, Can’t walk



V – 12 (Hospital)

Age 62, Male

Right upper arm bleeding, abdominal pain,

FAST; positive, X-p; pelvic fracture, right

upper arm open fracture




medical assessments


medical assessments


medical assessments


medical assessments

V – 13 (On-site)

Age 27, Male

Right upper arm traumatic amputation,

bleeding and pain, Can’t walk



V – 13 (Hospital)

Age 27, Male

Right upper arm traumatic amputation,

bleeding



V – 14 (On-site)

Age 31, Female

Left chest pain, Can’t walk



V – 14 (Hospital)

Age 31, Female

Left chest pain, varicose jugular vein, Breath

sounds decreased in left, Trachea deviated

to right



V – 15 (On-site)

Age 42, Male

Abdominal pain, Can’t walk



V – 15 (Hospital)

Age 42, Male

Abdominal involuntary guarding,

tenderness, FAST; positive, intestinal

perforation



V –16 (On-site)

Age 78, Male

Chest pain, Can’t walk

Vitals; RR20/min CRT 4 sec


V – 16 (Hospital)

Age 78, Male

Chest pain, FAST; positive, Cardiac

tamponade




medical assessments


medical assessments


medical assessments


medical assessments

V – 17 (On-site)

Age 18, Female

Right leg pain, can't walk

Vitals; RR20/min CRT 1 sec


V – 17 (Hospital)

Age 18, Female

Right tibia disformation, swelling, X-p; right

tibia fracture



V – 18 (On-site)

Age 80, Female

Bilateral leg pain, can't walk

Vitals; RR18/min, CRT 1 sec


V – 18 (Hospital)

Age 80, Female

Bilateral tibia disformation, swelling, X-p;

Bilateral tibia fracture



V – 19 (On-site)

Age 44, Male

Left femur bleeding, can't walk



V – 19 (Hospital)

Age 44, Male

Left femur bleeding, soft tissue injury



V –20 (On-site)

Age 16, Male

Right arm bleeding, right leg injury and pain,

can't walk



V – 20 (Hospital)

Age 16, Male

Right arm bleeding, right leg wound and

bleeding




medical assessments


medical assessments


medical assessments


medical assessments

V – 21 (On-site)

Age 35, Female

Left upper arm and leg pain, can’t walk



V – 21 (Hospital)

Age 35, Female

Left upper arm and leg disformation,

swelling, pain X-p; left humerus and tibia

fracture



V – 22 (On-site)

Age 33, Male

Left upper arm injury and bleeding, can't

walk



V – 22 (Hospital)

Age 33, Male

Left upper arm bleeding and pain



V – 23 (On-site)

Age 29, Male

Right leg pain, can't walk



V – 23 (Hospital)

Age 29, Male

Right femur disformation, swelling, pain, X-

p; right femur fracture



V –24 (On-site)

Age 15, Female

Left chest pain, feel hard to breath, can’t

walk

Vitals; RR 22/min, CRT 1 sec


V – 24 (Hospital)

Age 15, Female

Left chest pain, feel hard to breath, X-p; left

ribs fracture




medical assessments


medical assessments


medical assessments


medical assessments

V – 25 (On-site)

Age 17, Female

Left upper arm bleeding, left leg pain, can’t

walk



V – 25 (Hospital)

Age 17, Female

Left upper arm bleeding, left tibia

disformation, X-p; left tibia fracture



V – 26 (On-site)

Age 54, Female

Right chest pain, feel hard to breath, can't

walk



V – 26 (Hospital)

Age 54, Female

Right chest pain, feel hard to breath, X-p;

right ribs fracture



V – 27 (On-site)

Age 29, Male

Right femur pain, lower leg bleeding, can't

walk



V – 27 (Hospital)

Age 29, Male

Right femur disformation, swelling, pain, X-

p; right femur fracture, right lower leg

bleeding



V –28 (On-site)

Age 15, Male

Right ear pain, fight femur bleeding, can't

walk



V – 28 (Hospital)

Age 15, Male

Hearing disorder of right ear, right tympanic

membrane rupture, right femur wound




medical assessments


medical assessments


medical assessments


medical assessments

V – 29 (On-site)

Age 21, Female

Left ear pain, vertigo, can't walk



V – 29 (Hospital)

Age 21, Female

Hearing disorder of left ear, left tympanic

membrane rupture, vertigo



V – 30 (On-site)

Age 57, Female

Headache and dizziness, can’t walk



V – 30 (Hospital)

Age 57, Female

Dizziness and headache, neurological exam

is normal



V – 31 (On-site)

Age 43, Male

Abdominal pain, burnt arms, can't walk



V – 31 (Hospital)

Age 43, Male

Abdominal pain, FAST; negative, burnt arms

(SDB, BSA14%)



V –32 (On-site)

Age 19, Female

Feel hard to breath, chest pain, can’t walk



V – 32 (Hospital)

Age 19, Female

Chest pain, FAST; negative, X-p; no fracture




medical assessments


medical assessments


medical assessments


medical assessments

V – 33 (On-site)

Age 39, Male

Burnt arms and right ear pain, can't walk



V – 33 (Hospital)

Age 39, Male

Burnt arms (SDB, BSA 10%), hearing

disorder of right ear, tympanic membrane

rupture



V – 34 (On-site)

Age 51, Female

Left ankle pain, swelling, can’t walk



V – 34 (Hospital)

Age 51, Female

Left ankle pain and swelling, X-p; no fracture



V – 35 (On-site)

Age 63, Male

Dizziness and headache, can't walk



V – 35 (Hospital)

Age 63, Male

Dizziness and headache, neurological exam

is normal



V –36 (On-site)

Age 49, Male

Chest pain, can't walk



V – 36 (Hospital)

Age 49, Male

Left chest pain, X-p; left ribs fracture




medical assessments


medical assessments


medical assessments


medical assessments

V – 37 (On-site)

Age 30, Female

Headache and nausea, can’t walk



V – 37 (Hospital)

Age 30, Female

Headache, nausea, neurological exam is

normal



V – 38 (On-site)

Age 49, Male

Abdominal pain, can't walk



V – 38 (Hospital)

Age 49, Male

Abdominal pain, FAST; negative, physical

exam is normal



V – 39 (On-site)

Age 67, Female

Chest pain, can’t walk



V – 39 (Hospital)

Age 67, Female

Chest pain, FAST; negative, physical exam

is normal



V –40 (On-site)

Age 8, Male

Left ear pain, can't walk



V – 40 (Hospital)

Age 8, Male

Hearing disorder of left ear, tympanic

membrane rupture




medical assessments


medical assessments


medical assessments


medical assessments

V – 41 (On-site)

Age 29, Male

Laceration on hands and arms, can walk



V – 41 (Hospital)

Age 29, Male

Laceration on hands and arms



V – 42 (On-site)

Age 33,Female




V – 42 (Hospital)

Age 33, Female




V – 43 (On-site)

Age 35, Male




V – 43 (Hospital)

Age 35, Male




V – 44 (On-site)

Age 7,Female




V – 44 (Hospital)

Age 7, Female





medical assessments


medical assessments


medical assessments


medical assessments

V – 45 (On-site)

Age 10, Male




V – 45 (Hospital)

Age 10, Male




V – 46 (On-site)

Age 5, Female

Laceration on hands and face, can walk



V – 46 (Hospital)

Age 5, Female

Laceration on hands and face



V – 47 (On-site)

Age 54, Male

Laceration on hands and face, can walk



V – 47 (Hospital)

Age 54, Male

Laceration on hands and face



V – 48 (On-site)

Age 58, Female

Laceration on hands and legs, can walk



V – 48 (Hospital)

Age 58, Female

Laceration on hands and legs




medical assessments


medical assessments


medical assessments


medical assessments

V – 49 (On-site)

Age 29, Male

Laceration on legs, can walk



V – 49 (Hospital)

Age 29, Male

Laceration on legs



V – 50 (On-site)

Age 44, Female

Laceration on hands and legs, can walk



V – 50 (Hospital)

Age 44, Female

Laceration on hands and legs



V – (On-site) V – (Hospital)

V – (On-site) V – (Hospital)


medical assessments


medical assessments


medical assessments


medical assessments

W – 1 (On-site)

Helping the victims

Age 32, Male

Laceration on legs and arms

Can walk

Helping the victims

Age 26, Male


Can walk

W – 3 (On-site)

Helping the victims

Age 48, Male


Can walk

Helping the victims

Age 55, Male


Can walk

W – 5 (On-site)

Helping the victims

Age 47, Male


Can walk

Helping the victims

Age 22, Female


Can walk

W – 7 (On-site)

Helping the victims

Age 36, Female


Can walk

Helping the victims

Age 47, Female


Can walk

W – 2 (On-site)

W – 4 (On-site)

W – 6 (On-site)

W – 8 (On-site)

W – 9 (On-site)

W – 11 (On-site)

W – 13 (On-site)

Helping the victims

Age 25, Male

No injury

Can walk

Helping the victims

Age 35, Female

No Injury

Can walk

W – 15 (On-site)

Helping the victims

Age 33, Male

No injury

Can walk

Helping the victims

Age 47, Male

No injury

Can walk

W – 10 (On-site)

W –12 (On-site)

W – 14 (On-site)

W – 16 (On-site)

Helping the victims

Age 50, Male


Can walk

Helping the victims

Age 44, Male


Can walk

Helping the victims

Age 44, Male


Can walk

Helping the victims

Age 50, Male


Can walk

W – 17 (On-site)

Helping the victims

Age 43, Female

No injury

Can walk

Helping the victims

Age 26, Female

No injury

Can walk

W – 19 (On-site)

Helping the victims

Age 34, Female

No injury

Can walk

Helping the victims

Age 52, Female

No injury

Can walk

W – 21 (On-site)

Helping the victims

Age 27, Female

No injury

Can walk

Helping the victims

Age 37, Male

No Injury

Can walk

W – 23 (On-site)

Helping the victims

Age 45, Male

No injury

Can walk

Helping the victims

Age 52, Male

No injury

Can walk

W – 18 (On-site)

W – 20 (On-site)

W – 22 (On-site)

W – 24 (On-site)

W – 25 (On-site)

Helping the victims

Age 34, Male

No injury

Can walk

Helping the victims

Age 19, Male

No injury

Can walk

W – 27 (On-site)

Helping the victims

Age 48, Female

No injury

Can walk

Helping the victims

Age 51, Male

No injury

Can walk

W – 29 (On-site)

Helping the victims

Age 23, Male

No injury

Can walk

Helping the victims

Age 34, Male

No Injury

Can walk

W – 31 (On-site)

Helping the victims

Age 44, Male

No injury

Can walk

Helping the victims

Age 52, Male

No injury

Can walk

W – 26 (On-site)

W – 28 (On-site)

W – 30 (On-site)

W – 32 (On-site)

W – 33 (On-site)

Helping the victims

Age 21, Male

No injury

Can walk

Helping the victims

Age 17, Male

No injury

Can walk

W – 35 (On-site)

Helping the victims

Age 40, Female

No injury

Can walk

Helping the victims

Age 23, Male

No injury

Can walk

W – 37 (On-site)

Helping the victims

Age 29, Male

No injury

Can walk

Helping the victims

Age 33, Male

No Injury

Can walk

W – 39 (On-site)

Helping the victims

Age 41, Male

No injury

Can walk

Helping the victims

Age 49, Male

No injury

Can walk

W – 34 (On-site)

W – 36 (On-site)

W – 38 (On-site)

W – 40 (On-site)

W – 41 (On-site)

Helping the victims

Age 26, Male

No injury

Can walk

Helping the victims

Age 59, Male

No injury

Can walk

W – 43 (On-site)

Helping the victims

Age 38, Female

No injury

Can walk

Helping the victims

Age 46, Male

No injury

Can walk

W – 45 (On-site)

Helping the victims

Age 49, Male

No injury

Can walk

Taking the video

Age 49, Male

No Injury

Can walk

W – 47 (On-site)

Taking the video

Age 26, Male

No injury

Can walk

Taking the video

Age 21, Male

No injury

Can walk

W – 42 (On-site)

W – 44 (On-site)

W – 46 (On-site)

W – 48 (On-site)

W – 49 (On-site)

Taking the video

Age 18, Male

No injury

Can walk

Taking the video

Age 35, Male

No injury

Can walk

W – (On-site)

W – (On-site)

W – (On-site)

W – 50 (On-site)

W – (On-site)

W – (On-site)

W – (On-site)

Advanced Tabletop Exercise - International Atomic Energy ... · Tabletop Exercise Scenario ......

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