Simulation Exercise Scenario:

Immediate Response and the First Two Hours

May 1, 2021, 7:40 AM – Fire and law enforcement units respond to the incident scene. They are careful to approach the incident scene as the incident scene is near the nuclear power plant.

First responders can visually view a mushroom cloud in the area of the incident scene as they make their approach to the incident.

• Upon arrival, the first responding EMS units start to size up the scene from a safe distance. They see many cars on fire on the roadway, there are victims from the explosion on the ground and walking around looking for help.
• Fire and Law Enforcement units realize that the explosion is not at the nuclear power plant but at the law enforcement checkpoint established that morning.
• Fire and EMS are attempting the activation of mutual aid assistance from other departments in the area.
• Fire, EMS, and Law Enforcement reach out to emergency management and the local hospitals as best as possible and inform them that an explosion with a Mass Casualty Incident (MCI) has occurred.
• Minutes later, emergency management and hospital facilities receive information from first responders arriving on the scene recommending emergency management send a shelter-in-place protective action to Bobsville and General County communities. There is a potential that this is some sort of nuclear detonation.  Bobsville Emergency Management puts out an immediate notification instructing citizens to Shelter-in-Place due to an explosion with unknown hazards until further notice.

Bobsville emergency management sends out the following message:

Citizens of Bobsville – there has been a potential nuclear detonation near the nuclear power plant, and Bobsville emergency management is implementing the following protective action:

Shelter-in-Place immediately to minimize time spent near a radioactive source. The less time exposed to the source of radiation, the lower the dose received.

Maximize the distance from a radioactive source. The farther one is from the source of radiation, the lower the dose received.

Shielding yourself from the outside – Shielding means having something that will absorb radiation (such as concrete) between yourself and the source of the radiation. Keep as much protection between oneself and the source as possible.

• Bobsville Emergency Operations Center has been activated and is being staffed by assigned personnel, elected, and appointed leaders.
• The General County Health Department has requested that surveillance systems be initiated both in the county and in Bobsville and at any established evacuation sites.
• EMS and Fire first responders located at the scene are reporting a significant number of injuries as traffic was at a standstill at the Law Enforcement checkpoint in and around SR-323 and I-58.
• EMS and Fire first responders are starting to establish zones around the event. EMS is beginning to provide care to victims that are furthest away from the blast location. EMS providers are reporting various levels of injuries and must decide who and what type of treatment they can provide.

During the first two hours of the event, Bunnyville General Hospital emergency department (ED) begins receiving patients by Personal Operated Vehicle (POV) with a spectrum of injury types and severity, including eye, blast, thermal burns, heat, and fire injuries.  Medical assets are limited and rapidly becoming scarce.

Key staff have not shown up to work at critical infrastructure locations in Bobsville; some reside in General County and have not reported to work.  Staff members want to leave their employment locations, including Bunnyville General Hospital, to find family members in General County or at schools, workplaces, and homes. Most of the population are fearful and anxious.

Community health centers are receiving an increasing number of calls and self-presenting patients that do not want to wait for treatment in what appears to be overcrowding at the Bunnyville hospital emergency department.

Responders report a plume is headed in a southwesterly direction and is starting to enter portions of Bobsville.

Key Issues

• First responders see a mushroom cloud coming from the area of the explosion.
• Upon arrival at the incident scene, first responders see many victims and immediately implement notifications for an MCI.
• Victims are being treated at the incident site.
• A Shelter-In-Place protective action has been issued to the community of Bobsville.
• Hospitals and community health centers in the General County and Bobsville region begin experiencing patient surge within two hours of the event. 
• Patients are presenting with a variety of injuries with varying severity from the blast and resulting infrastructure destruction.
• The public, medical staff and patients are fearful, frantic, and anxious.
• A plume is moving towards Bobsville.

Discussion Questions:

Based on the information provided, participate in the discussion concerning the issues raised in Week 5. Identify any additional requirements, critical issues, decisions, or questions you may have at this time.

1. How will public health, EMS and hospital partners ensure the information received will be sufficient to inform decision-makers regarding immediate lifesaving and life-sustaining activities? 
2. What system(s) should be utilized by EMS and Fire personnel as they arrive on the scene and start sorting and treating patients? 

 radcover2 (fema.gov) – Unit 1, 2, 4 and 5 

 Backgrounder On Dirty Bombs | NRC.gov 

 5 triage lessons learned from the Boston Marathon Bombing (ems1.com) 

Must be 400 words or more APA format with the references provided.