planning the medical response to radiation accidents radiation accidents module xxii
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PLANNING PLANNING THE MEDICAL RESPONSETHE MEDICAL RESPONSE TO TO
RADIATION ACCIDENTSRADIATION ACCIDENTS
Module XXII
Module Medical XXII
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Radiation accidents include radiological and nuclear accidents
Radiological accidents - in industry, medicine, research, teaching or agriculture - with radioactive material or devices generating ionizing radiation
Nuclear accidents - in nuclear facilities when accidental radioactive release affects radiological safety
Radiation Radiation accidentsaccidents
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Radiological Radiological accidentsaccidents
Radiological accidents
occur much more frequently than nuclear accidents
have more limited environmental impact can have serious health consequences and
rarely also environmental effects During planning phase register all possible radiation
sources No principal difference between nuclear or
radiological emergency planning/response
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Planning of mPlanning of medical edical preparedness for radiation preparedness for radiation
accidentsaccidents
must be considered as integral part of medical
emergency planning and preparedness
established within national framework for radiation protection and safety
included as inherent part of general radiation emergency plans
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Planning medical response to Planning medical response to radiological accidentsradiological accidents
Evaluation of possibilities for and types of accidents Authority familiar with types and
locations of radiation sources for region
Appropriate medical planning incorporated into emergency plans to deal with any radiological accident
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Simple classification of persons Simple classification of persons involved in radiation accidentinvolved in radiation accident
Persons with non-specific early symptoms and high probability of overexposure to radiation should be transported to specialized hospital
Persons with combined injures (radiation plus conventional trauma) should receive individualized treatment
depending on type of combined injury
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Simple classification of persons Simple classification of persons involved in radiation accident involved in radiation accident
Persons with suspected external/internal contamination should be monitored to assess degree
of contamination Persons with potential radiation
symptoms do not require immediate medical
treatment require urgent dose evaluation
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Unexposed persons with conventional trauma should be taken to specialized hospital
Persons believed uninjured & unexposed could be sent home
Simple classification of persons Simple classification of persons involved in radiation accidentinvolved in radiation accident
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Planning emergency medical Planning emergency medical response in hospital response in hospital
Treatment in hospital
Type of hospital/department
depends on condition of patient
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Planning for management of multiple casualties in radiation accidents
A. Designate treatment areas contaminated and non-
contaminated patients morgue areas for contaminated and
uncontaminated bodies Storage areas for a) contaminated clothing and
personal items b) waste Showers for ambulatory patients and staff
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Planning for management of multiple casualties in radiation accidents
B. Plan for efficient use of all trained personnel Organize training and drills annually
Rotate personnel if possible
Do not use pregnant personnel in contaminated areas
Allocate security personnel to triage area
Housekeeping personnel supply a lot of linen to both
contaminated and non-contaminated areas
Central supply and pharmacy supply both areas
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C. Plan to have a large enough area for triage, radiation monitoring and decontamination of patients (also of staff, as necessary)
D. Plan to have necessary equipment and supplies available for use at any time
Planning for management of multiple casualties in radiation accidents
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Planning for management of multiple casualties in radiation accidents
E. Plan for error free, efficient methods to identify patients (and victims) track laboratory samples and assessments perform procedures on patients who may
have been: internally or externally contaminated, irradiated and contaminated.
document (record) all treatment
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Planning for management of multiple casualties in radiation accidents
F. Plan to adapt medical care
Where will tests be done and who will do them?Will uninjured and uncontaminated but irradiated patients be admitted or sent home? Dose criteria?Is list of consultants (with phone numbers) available?What adaptations are necessary in trauma management (in combined injuries)?
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Type of exposure
Health consequence
Treatment at a hospital
IXEXTERNAL EEXPOSURE
Localized exposure,
more often to hands
Localized erythema with or without signs of development of blisters, ulcers and necrosis.
Desirable in a general hospital: Clinical observation and treatment. Specialist advice is necessary in severe cases.
Planning hospital treatment of exposed patients
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Type of exposure Health consequences Type of hospital for treatment
- Total or partial bodyexposurewith minimal anddelayed clinicalsign.
No clinical manifestation for 3hours or more followingexposure.Not life threatening!Minimal haematological changes.
Clinical observation, symptomatictreatment and sequentialhaematological investigations arenecessary in a general hospital
- Total or partial bodyexposurewith early prodromalsymptoms
Acute Radiation Syndrome ofmoderate to severe degreedependent on dose.
Treatment required in specialisedhospitalEarly full blood count and HLA typing are essential.
- Total or partial bodyexposurewith severe injury
Possible severe combinedinjuries, life-threatening.
Treat life-threatening conditions.Early transfer to a specialisedcentre is necessary.
Planning hospital treatment of exposed patients
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Type of exposure Health consequences Treatment at ageneral hospital
EXTERNALCONTAMINATION
- Low-level contamination of
intact skin which can be cleanedpromptly
Unlikely. Mild radiationburns are possible days toweeks later.
Not necessary, orjust for the time of
decontamination.
- Low-level contamination of
intact skin when cleaning isdelayed
Possible radiation burns
Possible percutaneousintake of radionuclides.
Reasonable:
Specialist advicemay be sought.
Planning treatment of contaminated patients in general hospital
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Type of exposure Possibleconsequences
Treatment at a general hospital
INTERNALCONTAMINATION
Inhalation and ingestion ofradionuclides, or absorptionthrough a wound ininsignificant quantity (activity)
No immediateconsequences
Reasonable, sufficient !
Specialist advice must be sought.
Inhalation and ingestion ofradionuclides, or absorptionthrough a wound in
significant quantity (activity)
No immediateconsequences
Not sufficient ! Nasopharyngeallavage important.Early transfer to a specialisedcentre is essential to enhanceexcretion of radionuclides.
Planning treatment of contaminated patients in general hospital
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ACCIDENT INFORMATION FORM
1. Identification of informer:2. Number and condition of uncontaminated patients:
3. Number and condition of contaminated patients:
4. Location of accident:(a) Irradiation condition:Source - Distance - Time - Estimated dose –
(b) Contamination (external):Radionuclides involved - Activity level - Body area involved –
(c) Contamination (internal):Ingestion - Inhalation -(d) Contaminated wound -(e) Whether initial decontamination done –
5. Expected time of arrival of patients at the Hospital
Date: (Signature)
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Sample of Identity Tag on Accidental Exposure (front and back view of Identity Tag)
IDENTITY TAG(FIRST-AID POST)IDENTITY TAG
(FIRST-AID POST)NameDept: DIVN.Contamination: Y/NSite of contamination: Injury: Y/NSite of injuryOverexposure: Y/NPreliminary actions taken:TreatmentFirst aidDecontamination:
To: PERSONNEL OFDECONTAMINATIONCENTRE, SITE ORHOSPITAL
[Ref.: IAEA-WHO Safety Report No.4., IAEA, Vienna, 1998]
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Medical information formMedical information form
Medical findings (to be filled by physician) Name of physician (in block letters) Name of patient (in block letters) Date of examination hour Asthenia yes no Headache yes no Nausea yes no
time of appearance: number of appearances Vomiting yes no
time of appearance: number of appearances Diarrhoea yes no quantity Temperature Pulse
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Medical information formMedical information form
consciousness normal abnormal agitation
deliriumsleepinesscoma
equilibrium disturbance yes no co-ordination disturbance yes no
skin and mucosa oedema yes noerythema yes no
other
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Medical information formMedical information formTreatment and investigations
Undressing*: yes no Decontamination: yes no DTPA administration: yes no
If yes, administration pathway: aerosol
intravenous
Stable iodine administration: yes no
When? (date & time) How much? mg/d For how many days?
Module Medical XXII
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Medical information formMedical information formLaboratory testsLaboratory tests
BLOOD SAMPLES
* First sample (if possible, before the third hour) Date Hour
* Blood for cell and platelets’ count: yes no
* Blood for cytogenetic examination (10 ml) : yes no
* Blood sample for spectrometry: yes no
* Second blood sample (if possible, 2 hours after the first one), date & hour
* Blood cell count, platelets: yes no
* HLA typing: yes no URINE SAMPLES: (If possible, for gamma-spectrometry)
Is it the first urination after the accident? yes no DESTINATION OF THE PATIENT (IF SENT FOR FURTHER TREATMENT):
PHYSICIAN'S CONCLUSIONS:
Date: (Signature)
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Training initial medical carers at Training initial medical carers at accident site accident site
Regular training of on-site emergency team to provide initial treatment (emergency aid)
Specific training and rehearsal for paramedical or ambulance personnel in safe handling and transport of victims
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Training of Training of hospital staffhospital staff
Who should be trained? Topics of training Type of training
Lectures Drills Exercises Joint exercises
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SummarySummary
Radiation accidents are rare but cannot be excluded
Plan medical response and preparedness for effective management of radiation casualties
Planning should include designation of appropriate treatment area regular training and rehearsal provision of necessary equipment and materials for
prompt use establishing and updating contact addresses
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