Model of medical management in a healthcare facility The healthcare facility must provide for: • Undressing of the patients. Undressing removes 90% of the contamination. The patients are then directed to a full decontamination structure. • An external zone or a well ventilated room and a marked out route to establish a circuit between the entrance and a waiting zone. • The personal protective equipment for the hospital personnel who will be managing the patient. • “Contaminated victim” kits and posters explaining the procedure for the emergency contamination of uninjured victims. The hospital personnel give each victim a kit, guide them through the procedure and put identification on the personal effects bags. • Management of the waste and rehabilitation of the premises. SEE SHEET 29 Radioactive waste management The arrival and treatment of potentially contaminated victims and management of the contaminations produce radioactive waste whose volume depends on the nature and scale of the accident. The waste can be liquid (washing water, etc.) or solid: vinyl covers, clothing, used Personal Protective Equipment (PPE), decontamination products, etc. The key aspect of waste management lies in its radiological characterisation (nature of the radionuclides present) to determine whether on-site management of radioactive decay is possible or not. In normal situations, the current regulations11 allow on-site management of radioactive decay of waste and effluents containing radionuclides with a physical half-life of less than 100 days. Under these conditions, the aqueous effluents can be discharged into the environment provided that the activity concentration is less than 10 Bq/l and less than 100 Bq/l for effluents contaminated with iodine. The solid waste can be disposed of by conventional routes when the contact dose rate is less than two times the background radiation. If possible, the waste must be collected in containers that comply with the TMD‑ADR12 regulations for class 7, supplied by Andra, the French national radioactive waste management agency. It shall then be stored on site in the radioactive waste room in conformity with the regulations, if the facility has one (waste storage bunker of the nuclear medicine department, for example). In a radiological emergency, the public authorities, together with the Prefect and the Regional Health Agency, are responsible for indicating what is to become of the waste and possibly collecting it on a storage site created for the circumstance or its transfer to an existing disposal facility. SEE SHEET 29 THE THREE HEALTHCARE FACILITY CATEGORIES The healthcare facilities are classified by the Regional Health Agencies for the Orsan plan and their Orsan CRN plan. The classification is determined according to the technical platform, the presence or not of an Accident & Emergency department, a SAMU, and the proximity of the facility to risks, sensitive sites or identified threats 1st line, including the RRHH RN The 1st line facilities are capable of taking in and treating absolute urgencies (AUs) and relative urgencies (RUs) involving RN agents. They have an authorised Accident & Emergency department, a medicalsurgical technical platform, and a continuous care and/or resuscitation capability. The context of their action (decontamination of victims) is set by the management plan for exceptional public health situations (“White plan”, CRN section). They include: the healthcare facilities close to industrial sites, sites transporting hazardous materials and other sites presenting specific risks, the reference healthcare facilities and a few other specialised facilities. They are capable of treating irradiated and/or contaminated patients. 2nd line The 2nd line facilities have a technical platform and can be mobilised for second-line treatment. They help to increase the capacity of the 1st line facilities. They might have to provide care to patients requiring medical treatments after full decontamination (resuscitation, etc.). 3rd line The 3rd line facilities can be mobilised as a complement to the 1st and 2nd line healthcare facilities. They must ensure the minimum response when potentially contaminated persons self-present at the facility. SEE SHEET 36 i 11. ASN resolution 2008-DC-0095 of 29th January 2008. 12. International regulation on the transport of dangerous goods coming under class 7 (radioactive materials) by road. REGULATORY FRAMEWORK Arrangements specific to healthcare facilities SHEET 10 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 39
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