Event Notification Report for October 18, 2024

DAMAGED TROXLER GAUGE

The following is a summary of information that was provided by the Bakerton Fire Department via phone:

On 10/18/2024 at 1450 EDT, a traffic accident occurred on US Route 340 in Harpers Ferry, West Virginia, near Shipley School Road. The accident involved a model 3430 Troxler moisture/density gauge (nominal activity of 8 mCi of Cs-137 and 40 mCi of Am-241/Be) that was knocked out of its case and was damaged in the accident. The Bakerton Fire Department isolated the area, and initially shut down all lanes of traffic on Route 340. Surveys were later conducted with no signs of contamination or exposure. The gauge is damaged, but the negative survey results indicate no release occurred. The authorities on scene notified the West Virginia Radiological Health Program of the accident. After surveys were conducted, all of the lanes were opened for traffic except for one of the northbound lanes on US Route 340. The company that owns the gauge is Hillis-Carnes based in Frederick, MD. At this time, the license number under which the Troxler gauge is held is unknown.

Notified the National Response Center, the West Virginia Radiation Health Program, DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, CISA Central Watch Officer, EPA EOC, FDA EOC (email), FEMA NWC (email), DHS Nuclear SSA (email), DHS NRCC (email), FEMA NRCC SASC (email), FERC (email)

* * * UPDATE ON 10/18/2024 AT 1905 EDT FROM GERALD SMITH TO ERNEST WEST * * *

The following is a summary of information provided by the radiation safety officer (RSO) for Hillis-Carnes:

The RSO passed that Homeland Security responded to the site as well. Homeland Security ensured there was no contamination by spreading anti-contamination material and performing surveys. The RSO also passed that the source rod was ejected from the gauge which was not relayed to the NRC headquarters operations officer previously. The RSO did not know how much exposure personnel may have received from the source rod, but the source rod is intact. Additionally, the RSO clarified that there was no actual vehicle collision. The RSO passed that the Troxler gauge was inside its case in the bed of the truck and the case was chained to the truck by the case's handle. The RSO claims that a load of concrete in the bed of the truck shifted which forced open the tailgate and broke off the handle of the case, freeing the case and allowing it to go into the road, where it was run over by a tractor trailer. The RSO has possession of the gauge, including both the Cs-137 source rod and the Am-241/Be source, and intends to bring the gauge to Northeast Technical Services for evaluation and/or disposal. The RSO passed that Hillis-Carnes' NRC license is 19-30304-02 and their Maryland Agreement State license is MD-21-041-01.

Notified R1DO (Lally), IR MOC (Crouch), NMSS (Williams), and NMSS Events Notification (email)

AGREEMENT STATE REPORT - CONTAMINATION EVENT WITH POSSIBLE OVEREXPOSURE

The following information was provided by the New York State Department of Health (NYSDOH) via phone:

On October 18, 2024, at 1800 EDT, NYSDOH was notified of a contamination event at NRD, LLC., in Grand Island, NY. A radiation worker performing waste packaging was contaminated at approximately 1200 EDT. The worker was decontaminated, but was found to have 2000 counts per minutes (cpm) on a nasal swab. Due to similar events at this location, the worker is suspected of exceeding 50 rem limit to the bone surfaces of their face. The Radiation Emergency Assistance Center Training Site (REAC/TS) was called for assistance. The worker was sent to a local hospital where chelating agents will be administered. The primary radioisotope of concern is Am-241. Po-210 and Ni-63 are a secondary concern. There is no indication of spread of contamination and no members of the public were exposed.

NYSDOH will perform an immediate reactive inspection.

* * * UPDATE ON 10/19/2024 AT 1240 EDT FROM NATHANIEL KISHBAUGH TO ERNEST WEST * * *

The following information was provided by the New York State Department of Health (NYSDOH) via email:

"On Friday, October 18, 2024, at approximately 1730 EDT, the NYSDOH received a call from the radiation safety officer (RSO) of NRD, LLC (license number C1391) providing information that a worker at NRD was packaging waste within a `buffer area' at their facility and was subsequently contaminated with suspected Am-241 waste. This event allegedly occurred at approximately 1200 EDT that same day. The exact [contamination] activities of the worker and the cause of contamination are unknown at this time. Based on information provided by NRD, LLC, it does appear that the extent of contamination was localized to the buffer area and that the affected individual (hereafter [referred to as] `Worker 1') was the only individual working in this area and [the only person who] received any contamination from this event.

"The circumstances in which Worker 1 identified that they had been contaminated is unknown at this time. Once Worker 1 identified that they had been contaminated, a whole-body frisk was performed. Measurements ranged from 23 [disintegrations per minute] (dpm) to 1734 dpm. The individual received removable contamination surveys on several different locations on their body, ranging from 7 dpm/100 square centimeters to 2196.80 dpm/100 square centimeters. Contamination levels on this individual were highest on the individual's left hand and arm (1734 dpm total contamination on the arm and 2196.80 dpm/100 square centimeters removable contamination on the hand). Contamination was highest in the following areas: left arm and hand, both feet, shoulders, right arm, and head.

"Initial nasal swabs were performed and indicated that Worker 1 had 705.29 dpm of Am-241 in one nostril and 1304.23 dpm in the other nostril (combined for 2009.52 dpm). This exceeded the immediate notification threshold required by NRD, LLC's License (C1391) Condition Number 28.B. [333 dpm]. In accordance with [National Council on Radiation Protection and Measurements] Report 161, this amount of Am-241 within the nostrils could constitute an intake exceeding the occupational dose limits prescribed by 10 [New York Codes, Rules and Regulations (NYCRR)] 16.6. It is estimated that this dose may be approximately 151 rem committed dose equivalent (CDE) to the bone surfaces and 9 rem committed effective dose equivalent (CEDE). These dose estimates should not be regarded as the official dose of record as they aim to provide a rough estimate to initiate non-routine bioassays and seek clinical guidance from REAC/TS.

"NRD, LLC, immediately decontaminated Worker 1 and resurveyed until all areas on the worker were indistinguishable from background. NRD, LLC also immediately placed Worker 1 on a 24-hour urinalysis collection. NRD then contacted REAC/TS and was informed that the amount of Am-241 located in the nostrils may suggest that Worker 1 was overexposed and should seek calcium-diethylenetriamine pentaacetate (Ca-DTPA) and zinc-DTPA (Zn-DTPA) treatments as soon as possible. Ca-DTPA and Zn-DTPA are chelating agents used to mitigate the amount of Am-241 uptake in the bone surfaces of Worker 1. Following this information, NRD, LLC contacted NYSDOH for assistance.

"NYSDOH immediately contacted REAC/TS to corroborate the information provided and discuss clinical recommendations. The REAC/TS contact confirmed that one Ca-DTPA (aerosolized via nebulizer) dose was required for immediate administration that evening and up to five Zn-DTPA doses (intravenously administered) may be needed on subsequent days (1 dose per day). Dosage information for both types of DTPA were 1 gram per day. Following this, NYSDOH sourced doses of Ca-DTPA and Zn-DTPA and contacted the local hospital to coordinate the arrival of this patient and provide information for REAC/TS to assist with clinical guidance in administering these chelation medications.

"These doses were rush transported by New York State troopers at approximately 2130 [on October 18, 2024,] and arrived at the medical facility at 0100 on October 19, 2024. The doses were prepared and administered approximately 13.5 hours after the suspected intake occurred.

"The NRC [headquarters operations officer] was called at 2103 on October 18, 2024, to meet the reporting requirement for this event (4 hours post-notification) as this constituted a contamination event meeting the criteria in 10 CFR 30.50(a) and a potential overexposure under 10 CFR 20.2202. This report was filed under [Event Notification] 57391.

"Following this notification, NRD informed the Department that a survey was performed in adjacent areas to where this contamination event was thought to have occurred and contamination has been localized to the area where this individual was doing work. NRD is continuing surveys of areas throughout their facility to confirm that no contamination is present in any other areas. At this moment, NYSDOH Bureau of Environmental Radiation Protection (BERP) is planning a site visit to interview staff and perform independent characterization from the location where this contamination event occurred. Additional information is needed to determine the exact scope of this contamination event and independently validate the information provided by NRD, LLC.

"NYSDOH BERP is actively monitoring this event under Incident Number 1503. Additional information will be provided to [the NRC Nuclear Material Events Database (NMED)] once available."

Notified R1DO (Lally), NMSS (Williams), and NMSS Events Notification (email)

AGREEMENT STATE REPORT - DISCOVERY OF CO-60 SCRAP MATERIAL

The following information was received from the Wisconsin Department of Health Services (WI DHS) via email:

"On October 18, 2024, WI DHS identified Co-60 [material] in a rejected scrap load using a portable radionuclide identification device. The scrap material was determined to be from a nearby manufacturing facility.

"On October 25, 2024, WI DHS performed a site visit at the manufacturing facility where the scrap material originated. Multiple metal castings and a bin of metal swarf were identified as contaminated with Co-60. Exposure rates on contact with most items ranged from approximately 100-200 microR/hr, with the highest reading of approximately 950 microR/hr.

"The manufacturing facility purchased the metal castings from a WI foundry. It was determined that contaminated metal castings were purchased from a single WI foundry that had imported the castings from a foundry in India. The WI foundry only sold the casings to one manufacturing facility. On October 30 and November 27, 2024, WI DHS performed site visits at the WI foundry and confirmed the presence of Co-60 in additional metal castings from the same foundry in India. The WI foundry did not perform any manufacturing processes on the imported items. The WI foundry is continuing to screen items from the India foundry for elevated radiation levels.

"Preliminary dose assessments by WI DHS indicate that public dose limits have not been exceeded at any of the facilities nor while in transportation. No removable contamination has been identified. WI DHS continues to monitor as additional items are identified and a final disposition of the radioactive material is determined."

WI Event Report ID No: WI240005.