Chemical, biological, radiological, nuclear, and explosive (CBRNE) events are low in frequency, but high in consequence, requiring a frequent and more targeted emphasis on the way that responders train and learn. Radiation is often not well understood. It can be intimidating for both the public and for first responders. Radiation cannot be seen, smelled, or heard. Yet, risk is relatively easy to mitigate when responders have been adequately trained and equipped.
One training checklist responders can use is the acronym “PRIMED,” which stands for Prepare, Recognize, Input, Monitor, Experience, and Decision.
A Six-Step Training Checklist
Prepare. Radiation events can be overwhelming and chaotic. Preparation must be done before the event and should be based on best practices. Meetings and trainings with support agencies like local state radiation regulatory agencies, Civil Support Teams, and Radiological Assistance Program teams should occur before the need arises. This sets a critical foundation in a successful working relationship: responders arriving on scene can integrate with radiation officials to work quickly and effectively. A radiation specialist from the closest hazmat response team can be an effective resource, so it is important to build rapport and cross-team familiarization with local hazardous materials response teams.
Recognize. Upon arriving on scene, responders should check-in with incident command and perform a quick situational assessment. Rushing in before recognizing hazard zones and personal protective equipment (PPE) requirements is dangerous. Basic recognition of the scene type and scope of the incident can prevent a minor scene from becoming a catastrophe. It is imperative to recognize the possibility of the presence of radiation.
Input. Identify scene “cues and clues.” These are important pieces of the much larger incident picture. Ionizing radiation can be anywhere within a community. Knowing what type it is and where it is helps responders to develop a safe and effective plan. There are four basic categories of ionizing radiation: naturally occurring radioactive material, industrial, medical, and special nuclear material. Understanding where each of these types of radiation are located in the community helps responders quickly recognize anything unusual, which should raise suspicion. One key input item here is an explosion with an unidentified source. In this case, the possibility of radiation should be suspected. Once radiation is ruled out, responders can then proceed with other scene priorities.
Monitor. Responders to a CBRNE incident must be able to assess radiation levels, verify radiation boundaries, define contamination areas, and, when possible, attempt to identify specific radionuclides. This could be a critical piece of information in the attempt to determine whether an event is accidental or intentional. It is important to remember that equipment provides only a partial assessment and is only as good as the knowledge and skill of the user.
Experience. Ultimately, the brain is the best tool in the field. Experience is vital, but should be based on tested operational truths from other events and then learned. Only then can this experience be integrated into daily response habits. This is especially critical when dealing with radioactivity because there are few incidents to learn from.
Decision. The final but perhaps most important step in the PRIMED process is making a decision. Radiation incidents, though overwhelming, have common patterns. If these patterns are recognized early, they can help pave the way to safer decision making under stress. Radiation is a predictable physical phenomenon, which can be used to a responder’s advantage.
Although radiation is naturally occurring energy, responders should strive to avoid any additional amount of ionizing radiation. Once it has been determined that radiation is present, responders must keep exposure or dose of radiation to a minimum by observing ALARA, which stands for “As Low As Reasonably Achievable.” This term refers to radiation exposure and reminds responders to always pay attention to personal safety. ALARA is a regulatory requirement but, aside from that, ionizing radiation is still a major health and safety hazard. Without applying the principles of ALARA, a worker who is continually exposed to ionizing radiation can receive irreversible cell damage, which can manifest in harmful ways (e.g., increased risk for cancer, genetic mutations, organ failure, and even death).
In addition to practicing ALARA, it is critical that first responders use appropriate PPE when responding to a radiation incident. Three factors should be considered for minimizing the effects of radiation exposure:
- Time – Responders should spend as little time as possible in a radiation field to minimize dose.
- Distance – Responders should put distance between them and the source. Further distance from a radiation source means less exposure.
- Shielding – Responders should wear appropriate PPE (including respiratory protection) and keep dense materials between them and the radiation field. Ionizing radiation exists in the form of energy (x-rays, gamma rays) and sub-atomic particles (alpha and beta particles). High-density materials such as lead and thick steel or concrete can provide some shielding from the high-energy waveform of ionizing radiation, though generally not practical on an emergency scene.
The essential point is that responders must observe ALARA during radiation events and always remember radiation rule #1: “Turn it on and put it on.” A personal radiation-monitoring device (PRD) is critical to alert responders to the presence of radiation. PRDs are important tools that can save lives by alerting responders when they have entered a significant radiation field or have accumulated a significant dose of radiation. Good education and field guides based on operationally tested factors are key to helping organize on-scene priorities. Radiation safety is of the utmost importance. By following the principles from the PRIMED training checklist and heeding the protection mantra ALARA, responders can minimize their risk of radiation exposure.