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Procedures for Medical Emergencies Involving Radiation *

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Procedures for Medical Emergencies Involving Radiation * Procedures for Medical Emergencies Involving Radiation * RADIATION EMERGENCY ALERT 3. If contamination is found or suspected, wipe 4. Irrigate with copious amounts of water or If there is a call that radiation accident victims will a cotton-tipped applicator over the area and normal saline. Save all contaminated fluids be sent to the hospital, immediately notify the place it in a labeled envelope for counting. in appropriately marked containers. nuclear medicine department, health physicist, 4. If contamination is found on the face, a 5. Gently swab with moistened cotton-tipped radiation safety officer and others who will be sterile, moistened cotton-tipped applicator applicator. concerned with patient treatment. should be wiped gently about the anterior 6. Re-survey. In order to determine if a patient is nares (not deep in the nose) and placed in 7. If necessary, and not irritating, use cotton- contaminated, the ambulance and the patient a labeled envelope for counting. tipped applicator moistened with soap. should be monitored before being brought into the emergency room. If the patient is contaminated, DECONTAMINATION PROCEDURES Contaminated Hairy Areas take the patient to a designated room in the Gross Whole Body Contamination 1. Survey and record results. emergency department. If the patient has received 1. Remove patient's clothing. external radiation exposure only and is not 2. Wrap or position patient to avoid spread of 2. If areas of high levels of radioactivity are contaminated, normal trauma procedures can be contamination. found,localize and mark. used. 3. Wash with soap and save all contaminated 3. Seal open wounds with plastic and/or Place any floor covering used to control fluids in appropriately marked barrels. waterproof adhesive tape to prevent contamination. 4. Dry with clean uncontaminated towel. Do contamination being washed into the Persons doing the monitoring, as well as the not shave hair. If necessary hair may be wounds. triage officer, should wear surgical scrub suits with cut, but do not injure skin. gloves, shoe covers, and film badges and/or pocket 4. Shower or wash with warm water and soap, 5. Re-survey and record. dosimeters. taking care that the contamination from high 6. If contamination persists, repeat above level areas is washed off rather than spread steps. over the rest of the body. Do not abrade the EMERGENCY SUPPLIES skin. All contaminated water should be kept In the event of a radiation emergency involving in appropriately marked containers. Disposition of Patient contamination, bring the following supplies to the Once the patient has been treated for both 5. As soon as body contamination is lowered, corridor outside the emergency room or to an trauma and contamination, transfer can be begin wound treatment or, if no wounds are adjacent room: made to an appropriate area within the present, shift to localized skin hospital. Collect all urine for 24 hours. 1. Surgical caps decontamination. 2. Surgical scrub suits Repeat monitoring of all contaminated 3. Surgical masks areas. Localized Skin Contamination 4. Plastic gloves 1. Mark the area of skin contamination. NOTIFICATION OF APPROPRIATE 5. Film badges and/or pocket dosimeters 2. Begin treatment of area of highest AUTHORITIES 6. Respirators (if necessary) contamination. 1. Notify Nuclear Regulatory Commission. 7. Adhesive tape 3. Do not injure or abrade skin. 2. Notify your state's department of 8. Plastic sheets and bags 4. Do not spread contamination to other areas radiological control and health services. 9. Surgical gowns of the skin. 3. Do not notify the newspapers or make any 10. Shoe covers public statements relative to the situation 5. Wash with water and soap using a gauze 11. Geiger counters until they have been cleared by the pad. Save all contaminated water in 12. Filter paper for smears Radiation Safety Officer, Administration and specially marked containers. 13. Signs and labels stating "radioactive Public Relations. 6. Put gauze pads used for decontamination material" and/or "radiation area" in a plastic bag and label. 14. Cotton-tipped applicators WASTE DISPOSAL 7. Re-survey, using a G-M counter and record 15. Large barrels, marked with radiation signs, 1. Collect contaminated water and put in results. in which all contaminated liquids and plastic containers for sampling and 8. Repeat steps 5 and 7 as necessary. clothing may be placed. appropriate disposal. 2. Put contaminated disposable supplies in HANDLING OF CONTAMINATED CASUALTIES Contaminated Wounds plastic bags for disposal. Priority for treatment or decontamination generally 1. Encourage bleeding when possible. 3. Keep contaminated equipment in the will be determined by the seriousness of non- 2. Irrigate with copious amounts of saline. controlled area until decontaminated. radiation injury, the levels of skin or clothing Save contaminated saline in specially contamination, and the possibility of radionuclides marked containers. PERSONNEL DISPOSITION entering the body through contaminated wounds. In 3. Do not wash skin contamination into the 1. All persons entering the control area will be general, trauma is more serious than contamination wound. dressed and equipped as the situation and must be treated first if it is life-threatening. All 4. Re-survey wound at periodic intervals using warrants. bleeding must be stopped and other life-support a G-M counter or wipe with sterile cotton- 2. Survey all persons when they leave the procedures instituted prior to decontamination. tipped applicator. Record findings. control area. Collect all urine for at least 24 hours in 5. Decontaminate skin around the wound. 3. Personnel contamination will be handled in appropriately marked containers. 6. When wound and surrounding skin are the same manner as described above. decontaminated, seal area with plastic or 4. When dressed in their street clothes, all DETECTION OF CONTAMINATION OF WOUNDS waterproof adhesive tape. personnel will again report to a control point 1. Survey wound areas with a Geiger-Mueller for a final recorded survey. (G-M) Survey Meter. If the surrounding area Eye Contamination 5. Request all personnel to collect successive is contaminated, the wound is considered to urine samples for analysis of radioactivity, if 1. The only treatment for cornea be contaminated. the situation warrants. contamination is copious irrigation. 2. Wipe separate sterile, moistened cotton- 6. The ambulance and ambulance personnel 2. Sample irrigation fluid at frequent intervals, tipped applicators over the wound and area will remain at the hospital until surveyed label samples and save for counting. Save around the wound prior to treatment. Place and declared free of contamination. irrigation fluids in specially marked the applicators in individual envelopes containers. which list the patient's name, date, time and LIMITS OF PERSONNEL EXTERNAL location wiped. 3. After decontamination, treat irrigation- RADIATION EXPOSURE induced conjunctivitis. 1. All practical efforts will be made to keep DETECTION OF RADIONUCLIDE personnel exposure to less than one (1) CONTAMINATION OF THE SKIN Contamination of Body Entrance Cavities rem.** 1. Make a G-M survey quickly over the entire 1. Survey and record results. 2. The allowance of greater personnel body with the clothes on. 2. Make sure the cavity is actually exposures will be at the discretion of the 2. If radioactivity is found, remove the clothing contaminated and not the surrounding area. health physicist. and re-survey. 3. Evaluate and decontaminate surrounding area. ** Higher levels can be chosen for life-threatening situations. EMERGENCY TELEPHONE NUMBERS Health Physicist Nuclear Medicine Physician Radiation Safety Officer Nuclear Medicine Technologist Hospital Administrator Public Relations Nursing Supervisor Others * Adapted from the Medical Radiation Emergency Plan of the Penn State Hershey Medical Center, Hershey, PA. The Oak Ridge Institute for Science and Education's (ORISE's) Radiation Emergency Assistance Center/Training Site (REAC/TS) offers several courses in handling radiation emergencies. Courses fill up quickly. The course brochure/registration form is available as a PDF file (611 KB). A new form must be submitted annually. Registration for these courses is accepted by mail or through our online registration form. Dates, course descriptions, and respective incidental fees can also be found below. Accreditation The Oak Ridge Institute for Science and Education (ORISE) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. ORISE takes responsibility for the content, quality, and scientific integrity of this ACCME activity. Respective courses are also accredited by the American College of Emergency Physicians and the American Academy of Health Physics. REAC/TS offers the following courses: Handling Radiation Emergencies by Emergency Department Personnel Oct. 19-22, 2004 Jan. 25-28, 2005 March 8-11, 2005 April 5-8, 2005 May 3-6, 2005 Sept. 13-16, 2005 Fee: $75 Maximum enrollment: 20 This 3 1/2-day course is intended for physicians, nurses, and physicians' assistants who may be called upon to provide emergency medical service in the event of a radiation emergency. The course emphasizes the practical aspects of handling a contaminated victim by discussing the fundamentals of radiation, how to detect and measure it, how to prevent the spread of contamination, how to reduce the radiation dose to the victim and attending personnel, and the role
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