PHASE 3 PHASE 4 MEDICAL MANAGEMENT BY TYPE OF VICTIM Medical-surgical urgencies take priority over the treatment of contamination and irradiation. If child victims are involved, plan for them to be accompanied by a family member or a person they know whenever possible. Post-crisis During this phase the health system gradually returns to normal functioning and the lessons learned from the event are established. MOBILISING REINFORCEMENTS The Regional Health Agency of the defence zone organises the inventorying of the human resources, health products (medicines, including radionuclide antidotes/ chelating agents and oxygen) and the equipment available in the region. Reinforcements can be mobilised: • zonal reinforcements of the defence zone by the Regional Health Agency at the request of the Regional Health Agency and activation of the Zonal Healthcare Resources Mobilisation Plan (PZMRS). The FRS reinforcements are coordinated by the Zone Operational Centre (COZ) of the defence zone affected by the crisis; • national reinforcements by the Operational Centre for Regulating and Responding to Public Health and Social Emergencies – Health Crisis Centre (CORRUSS‑CCS). The national means of the FRS are activated by the Interministerial Crisis Management Operational Centre. These reinforcements are mobilised under the national Orsan plan, possibly in collaboration with the Health Service of the Armed Forces. SEE SHEET 19 i Hospital care This phase covers the hospital treatment and rehabilitation of the victims. • The healthcare facilities are mobilised under the plan for managing hospital resource shortages and exceptional public health situations: “Chemical, Radiological, Nuclear” – CRN section and, if there is a massive influx of victims, the “Mass reception of non-contaminated victims” – AMAVI section, by activating level 2 of the “White plan”. • As soon as the alert is received, the healthcare facilities get prepared to receive the victims sent to them after regulation by the SAMU (EU). A Crisis Medical Director (CMD) organises the victims’ intra-hospital care pathway in collaboration with the hospital crisis unit and the SAMU. They apply a strategy for protecting the personnel and the infrastructure. • If self-presented victims arrive, hospital decontamination is carried out at the entrance of the healthcare facilities. It aims to ensure the protection of the personnel and the facility during the medical management of the victims. It is carried out in two stages: 1. emergency decontamination at the HVAA; 2. full decontamination in the Hospital Decontamination Unit (HDU). SEE SHEETS 29 to 35 TYPE OF VICTIM MEDICAL MANAGEMENT Injured victims present on the site of the event The urgent medical actions are taken before full decontamination Absolute Urgencies (AU), including Extreme urgencies (EU) ● Medical treatment and rapid transfer after stabilisation without full decontamination. ● EUs must receive medical and/or surgical treatment without delay. They are transferred directly after stabilisation. Relative Urgencies (RU) ● Prehospital emergency and full decontamination, followed by residual contamination check before transfer to a healthcare facility. Uninjured victims present at the site of the event Potentially contaminated ● Assemblyrouping of the victims in a Reception Centre for Uninjured Persons (RCUP). ● Internal and external contamination check in the RCUP if this was not done at the scene of the event. ● Questionnaire to classify the victims in one of 3 groups (irradiated, contaminated, irradiated and contaminated). ● Clinical examination, samples and further examinations if necessary. ● Decontamination if necessary. ● Psychological support from the Emergency Psycho-Medical Unit (EPMU), etc. Noncontaminated ● Assembly of the victims in an RCUP and psychological support from the EPMUs. Population near the site of the event Permanent or occasional residents ● Medical management identical to that of the uninjured, potentially contaminated victims present on the site. ● An information and support unit associated with medical-psychological support may be put in place in order to identify people requiring subsequent medical follow-up. REGULATORY FRAMEWORK Organisation of relief and medical care SHEET 09 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 35
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