ACTION TO TAKE ON THE SITE OF THE EVENT Organising the medical pathway of the victims in the 3 zones In a radiological or nuclear (RN) emergency, the Civil Protection Service puts in place the zoning system which comprises three zones: an exclusion zone, a controlled zone and a support zone. The aim of this organisational set-up is to treat as many victims as possible. It is governed by Interministerial Circular No. 800/SGDSN/PSE/PPS of 18 February 20114. Responders • Emergency response teams: FRS • Emergency medical teams: SMUR, RRHU • Medical and pharmaceutical teams (if Mobile Medical Station – MMS – kits and antidotes are present) • Internal security forces + 18SHEET 4. Circular relative to the national doctrine concerning the use of emergency and medical care resources in the event of a terrorist attack involving radioactive materials. The organisation follows the go-forward principle: the victims go from the most contaminated zone (exclusion zone) towards a clean zone (support zone), WITHOUT any possibility of backtracking. The level of radiological risk and personnel protection differ from one zone to the next. The protection is specific to each zone. CONTROLLED ZONE Reserved for prehospital medical care and triaging of the victims and uninjured persons (Victim Assembly Area – VAA RN). Triaging by emergency responders is done visually. It is followed by medical categorisation. • The victims are divided up according to their classification: able-bodied, incapacitated, Extreme Urgencies (EU). • Transfer of victims out of zone: only the victims identified as EU cases requiring medical-surgical treatment are transferred directly to a 1st line healthcare facility which has been duly informed by the regionally competent SAMU (medical regulation). Unlike the other victims, EU victims do not go through a decontamination shower. • Uninjured persons go through the portable radiological contamination portal monitor (see page 61) or any other available device that can detect external contamination. As a complement to the Civil Protection Service response, the emergency medical aid mobilises the medical skills and resources of the SMUR and RRHU to ensure the medical care of the patients at the VAA. The victims are counted in the field using the SINUS application implemented by the Civil Protection Services. WHO DECIDES ON THE TRANSFER OF EU CASES? The decision falls upon the Emergency Operations Commander (EOC) and the Medical Operational Coordinator (MOC), with the regionally competent SAMU. The SAMU is responsible for organising the patient’s medical care pathway and their transfer by ambulance to the receiving healthcare facility. i EXCLUSION ZONE The zone closest to the event, reserved for evacuation of the victims. • Only emergency medical actions performed by a medical professional wearing appropriate Personal Protective Equipment (PPE) can be carried out in this zone. SUPPORT ZONE Reserved for the medical care and stabilisation of the victims after full decontamination. The exercises and training sessions, particularly the interministerial zonal training sessions serve to test the operational readiness of the set-up and the services. 58 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY
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