12FICHE Arrangements specific to healthcare facilities REGULATORY FRAMEWORK The respective missions of the healthcare facilities defined in the Orsan plan set the framework of their action to provide medical care for the victims and to decontaminate them if this has not been done beforehand. All the healthcare facilities must ensure a minimum level of personnel protection and emergency decontamination in the event of self-presentation of potentially contaminated persons. 10SHEET 10. Circular on the national doctrine concerning the use of emergency and medical care resources in response to a terrorist attack involving radioactive materials. Prehospital decontamination of victims in the field is the responsibility of specialised units of the emergency services The injured or uninjured persons are decontaminated on the site of the event or in the immediate vicinity by the specialised units of the emergency services. This procedure complies with the circulars on the national doctrine concerning the use of emergency and medical care resources in the event of a terrorist attack involving radioactive materials. Interministerial circular No. 800/SGDSN/PSE/PPS of 18 February 201110 provides for the possibility of evacuating a non-decontaminated absolute urgency (AU) to a Regional Reference Hospital for the Radiological and Nuclear Risk (RRH RN), subject to agreement between the Medical Operational Coordinator (MOC) and the medical consultant of the RRH RN. It is nevertheless possible for victims to miss the prehospital screening Some victims may self-present at the nearest healthcare facility or the one they usually go to for treatment. Most of these victims are able-bodied, but some may be incapacitated and brought in by third parties. There is a potential risk of transferring contamination to the healthcare facility and its personnel. Appropriate protection and victim hospital decontamination measures must be taken (see i “Implementation principles” on the next page). Hospital decontamination measures apply to the healthcare facilities • All healthcare facilities must be suitably prepared for the medical management of potentially contaminated self-presenting persons who have been exposed to a radiological risk. • The victims who flee the site of a radiological or nuclear (RN) event present themselves unassisted or are brought in by third parties. In principle these people are not AU cases, but they are potentially contaminated by an RN agent and an aggravation of their condition is always possible. • The hospital decontamination of these victims aims to allow their medical management in complete safety, by protecting the personnel and infrastructure of the facility against contamination. Each healthcare facility must have considered this possibility and prepared a “Chemical, Radiological, Nuclear” (CRN) section in its Plan for managing hospital resource shortages and exceptional public health situations (“White plan, RN section”). • The hospital decontamination measures differ between the 1st, 2nd and 3rd line healthcare facilities (see i “The three healthcare facility categories” on page 39). • The management of decontamination operations applies not only to the 1st line facilities likely to receive non-decontaminated patients (EUs), but also to all healthcare facilities having received contaminated victims. It is quite similar to the usual servicing and cleaning operations, but features several particularities. Rehabilitation of the premises must be declared after the absence of residual contamination has been confirmed by a competent entity. SEE SHEET 29 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 37
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