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Frequently Asked Questions

Scenario

1. What scenarios will cause a mass casualty marrow toxic incident?

1.1. Mass casualty marrow toxic injuries have limited possible incidents that would cause them. While nuclear power plant meltdowns, radiological dirty bombs and radiological exposure devices all can produce casualties with acute radiation syndrome it is not likely that the number of casualties would exceed the local or regional medical capacity. That leaves the detonation of an improvised nuclear device which would result in tens of thousands of casualties with severe trauma, radiation exposure and combined radiation and trauma injuries that would overwhelm the local and regional capacity.

2. How will medical providers be protected from radioactive patients?

  2.1. Medical providers will need to follow strict protective protocols, including the use of personal protective equipment (PPE) and radiological surveys to ensure their safety. Decontamination procedures must be meticulously carried out to prevent the spread of radioactive contamination. This includes the use of specialized decontamination areas and the proper disposal of contaminated materials. See dangerous imbedded particles below.

Expectations of hospitals in RITNSM

3. Do we have to accept patients?

  3.1. That is a little more complicated to answer. According to the NDMS MOA there is a line that states hospitals will accept patients based on their resources and availability. 

4. Will patients be contaminated?

4.1. All patients should be externally decontaminated before being transferred to RITN hospitals outside the event area. This procedure is essential to avoid unnecessary delays caused by the need to decontaminate transportation vehicles such as aircraft or ambulances. However, it's worth noting that almost all RITN hospitals plan to radiologically survey patients upon arrival as an added layer of caution and assurance to their employees about their safety.

4.2. Internal contamination: following an IND there should not be significant internal contamination. They would have to consume contaminated food or water, or look up at the fallout with their mouths open since the particles are large enough, they should not be able to breathe them in.

4.3. What about dangerous imbedded radioactive particles from an RDD? According to REAC/TS there has yet to be a significant dose absorbed by a medical care provider while treating a contaminated patient when following protective measures. For an imbedded particle to be immediately dangerous it would have to have such a high level of activity that the patient would not survive after a few hours of exposure.

5. Who will conduct radiological survey, decontamination and triage of patients?

5.1. Trained personnel conduct decontamination and triage, prioritizing patients based on injury severity and radioactive exposure. Hospital radiological decontamination teams are responsible for contamination surveys and work closely with staff to follow procedures, minimizing contamination risk. Organizations transporting patients require them to be decontaminated before transport to prevent vehicle contamination.

Medical countermeasures

6. What medications are available to treat ARS?

6.1. Available medications for Acute Radiation Syndrome (ARS) include cytokines, supportive treatments like fluids, antibiotics and blood transfusions. The Strategic National Stockpile (SNS) contains these essential medications to ensure prompt treatment availability.

7. What medications are there for internal radionuclide contamination?

7.1. Potassium iodide to block radioactive iodine uptake from a nuclear power plant melt down, Prussian blue to treat cesium or thallium contamination, and DTPA for plutonium, americium, or curium exposure. The Strategic National Stockpile (SNS) contains these essential medications to ensure prompt treatment availability.

Patient movement

8. How patients will be moved?

8.1. Patients will be moved by the National Disaster Medical System (NDMS) a Department of Health and Human Services program. NDMS has the ability to move patients by air or ground depending on the distance and the speed of transportation necessary.

9. Can family come with patients?

9.1. Hurricane response is the most frequent historical activation of NDMS to move patients out of harms way prior to landfall. In these instances a companion is often allowed to travel with the patient. However following the detonation of an IND it is not clear if that will be possible, except for minors with a parent or legal guardian.

10. What you need to know about NDMS?

10.1. https://aspr.hhs.gov/ndms/Pages/default.aspx 

Care & Reimbursement

11. Who will pay for patients care?

11.1. Payment for care falls on the patient’s insurance carrier first, then to DHHS at 100% CMS or 125% CMS for hospitals that were part of NDMS prior to the disaster.

12. How long can patients be cared for?

12.1. The NDMS MOA currently states 

12.1.1. Completion of medically indicated treatment ends (within 30 days or unless otherwise directed by HHS);

12.1.2. Voluntary refusal of care by the NDMS federal patient; or

12.1.3. Return to originating facility or other location for follow-on care.

13. How will patients be repatriated home?

13.1. Logistics for repatriating patients' home will be coordinated by NDMS to streamline the process and minimize disruptions. Effective tracking systems will be used to monitor patients throughout their care journey, providing a transparent and efficient framework for patient management.

14. Who will authorize care of minors?

14.1. The NDMS will also be responsible for the authorization of care for minors to ensure that appropriate medical decisions are made on their behalf.

15. Who is responsible for tracking patients?

15.1. NDMS will coordinate with hospitals to ensure patient care, status and discharge are tracked. 

Resources:

ASPR TRACIE NDMS: https://asprtracie.hhs.gov/technical-resources/resource/3140/national-disaster-medical-system-ndms-information-technology

ASPR TRACIE Radiological and Nuclear topics: https://asprtracie.hhs.gov/technical-resources/32/radiological-and-nuclear/27

NDMS: https://aspr.hhs.gov/NDMS/Pages/patient-mvmt.aspx 

From: FAQ for RITN Interaction with Nuclear Power Plants (FINAL-RITN-Nuc-PP-FAQ-2018.docx)
The purpose of this Frequently Asked Questions sheet is to answer questions related to nuclear power plant preparedness and the interaction of the Radiation Injury Treatment Network (RITN). 

The RITN Concept of Operations has historically omitted nuclear power plant accidents since the medical surge is not anticipated. However, in recent years RITN centers have been increasingly approached by NPPs or reached out to local responders to collaborate. This has resulted in many questions that RITN has not previously answered.

1. RITN Exercises – Is it permitted to invite or agree to allow my local nuclear power plant to participate in our RITN exercise? How much should we expect/ask for?

a. Each RITN center may invite or permit anyone to observe or participate in their RITN exercise. 

b. Note that it is important for new participants to understand the role of RITN in a response (e.g., not first responders, receivers). 

c. Prior to observing or participating, directing any new participants to take the ‘Introduction to RITN’ or the ‘RITN Concept of Operations’ would be highly recommended. See ritn.net/training 

d. At a minimum encourage them to watch the “RITN What you need to know” video on the RITN YouTube Channel: https://www.youtube.com/channel/UCkd45X1DlPqeRr-u5lph6Og

2. If a nuclear power plant has questions about RITN, who should they ask?

a. They may be directed to the RITN website which has several sections describing RITN (About, Exercises, Resources and Contact). See RITN.net 

b. Questions can always be sent to RITN@nmdp.org

3. Who overseas planning for incidents at commercial nuclear facilities?

a. The United States Nuclear Regulatory Commission (NRC) regulates nuclear power plants, which encompasses emergency preparedness. These preparedness efforts incorporate extensive plans as well as the testing of them on a regular basis. For more information see https://www.nrc.gov/about-nrc/emerg-preparedness.html

4. What’s the current response plan for a nuclear power plant accident?

a. This question is best answered by your local nuclear power plant as each facility is different. 

5. Should our center expect to receive patients from an incident at a nuclear power plant?

a. Unless your facility is already designated as a Medical Services (MS) hospital, you probably will not receive patients.

b. If your facility is in close proximity to a nuclear power plant, you may be a designated receiving facility (aka medical services hospital) and should speak with your center’s emergency management/safety department for more information.

c. During an incident occurring at a nuclear power plant it is likely that hospitals in the region will see an increase in emergency department visits from concerned citizens (worried well). To assist in addressing their questions/concerns hospitals should reference the Communicating

During and After a Nuclear Power Plant Incident (https://www.fema.gov/media-library/assets/documents/33011?id=7651 document produced by FEMA.

6. What assistance could RITN centers provide to nuclear power plants?

a. RITN-designated medical personnel may be asked to provide ARS subject matter expertise to local hospitals.

7. Where can I learn more information about the Federal Emergency Management Agency’s (FEMA) Radiological Emergency Preparedness Program (REP)?

a. The FEMA REP website is the best place to learn more. See https://www.fema.gov/radiological-emergency-preparedness-program

Additional Resources