Guidance for Radiation Accident Management


Basics of Radiation



Safety Around Radiation Sources

Types of Radiation Exposure

Managing Radiation Emergencies

How do you manage emergencies?

Guidance for Hospital Medical Management

Managing Emergency Care of Patients Contaminated with Radioactive Materials

Notification and Accident Verification

When the hospital receives a call that a radiation accident victim is to be admitted, a planned course of action should be followed. The individual receiving the call should get as much information as possible, including the following:

1. Number of accident victims

2. Each victim's medical status and mechanism of injury

3. If victims have been surveyed for contamination

4. Radiological status of victims (exposed vs. contaminated)

5. Identity of contaminant, if known

6. Estimated time of arrival

If any doubt about contamination exists, assume the victim is contaminated until proven otherwise. Advise ambulance personnel of any special entrance to the emergency department for the radiation accident victim. If the accident notification comes from a source other than usual emergency communications, get a call-back number and verify the accident prior to assembling the radiological emergency response team and preparing for patient admission.



The Radiological Emergency Response Team

Each member of this team should be familiar with the hospital's written plan and be required to participate in scheduled drills. More frequent drills (quarterly or semiannually) should be considered by subgroups such as decontamination, triage, or radiological monitoring. Special training must be instituted to accommodate staff turnover. Training should also be part of the hospital inservice program and should include EMTs and paramedics since they play an important role in assisting the emergency department staff through notification procedures before arrival and proper transport of radiation accident victims.

Radiological Emergency Response Team

Personnel Role


Team coordinator Leads, advises, and coordinates
Emergency physician Diagnoses, treats, and provides emergency medical care; can also function as team coordinator or triage officer
Triage officer Performs triage
Nurse Assists physician with medical procedures, collection of specimens, radiological monitoring, and decontamination; assesses patient's needs and intervenes appropriately
Technical recorder Records and documents medical and radiological data
Radiation safety officer Supervises all aspects of monitoring and contamination control
Radiation safety personnel Monitors patient and area and advises on contamination and exposure control; maintains survey equipment
Public information officer Releases accident information to public media
Administrator Coordinates hospital response and assures normal hospital operations
Security personnel Secures the radiation emergency area and controls crowds
Maintenance personnel Aids in preparation of the radiation emergency area for contamination control
Laboratory technician Provides routine clinical analysis of biological samples



The Goals of Contamination Control are to Prevent the Spread of Radioactive Materials From:

A. The patient

In most circumstances the victim will be the source of the contamination; however, in rescue and extrication, some contamination may have been transferred to others.

B. The rescue personnel

C. The gurney and equipment used in patient care (stethoscope, BP cuff, etc.)

D. The ambulance

This contamination can be transferred to:

1. Care providers as they touch or move the patient to correct the medical problem

2. The equipment used to assess the patient's condition and to treat the medical emergency

3. The surrounding area (treatment gurney, floor, etc.)

4. In rare cases where dust or powders are present, the air could contain radioactive particles



Techniques of Contamination Control

1. Set up a controlled area large enough to hold the anticipated number of victims.

2. Prevent tracking of contaminants by covering floor areas and monitoring at exits of controlled areas.

3. Restrict access to the controlled area.

4. Monitoring anyone or anything leaving the controlled area.

5. Use strict isolation precautions, including protective clothing and double bagging.

6. Use a buffer zone or secondary control line for added security.

7. Control waste by using large, plastic-lined containers for clothing, linens, dressings, etc.

8. Control ventilation.

9. Change instruments, outer gloves, drapes, etc., when they become contaminated.

10. Use waterproof materials to limit the spread of contaminated liquids; for example, waterproof aperture drapes.



If Radioactive Contamination Is Discovered After Patient Has Been Admitted

1. Continue attending to the patient's medical needs.

2. Secure entire area where victim and attending staff have been.

3. Do not allow anyone or anything to leave area until cleared by the radiation safety officer.

4. Establish control lines, and prevent the spread of contamination.

5. Completely assess patient's radiological status.

6. Personnel should remove contaminated clothing before exiting area; they should be surveyed, shower, dress in clean clothing, and be resurveyed before leaving area.



Response Team Preparation

Protective clothing

The purpose of protective clothing is to keep bare skin and personal clothing free of contaminants. Members of the radiological emergency response teams should dress in surgical clothing (scrub suit, gown, mask, cap, eye protection, and gloves). Waterproof shoe covers also should be used. All open seams and cuffs should be taped using masking or adhesive tape. Fold-over tabs at the end of each taped area will aid removal. Two pairs of surgical gloves should be worn. The first pair of gloves should be under the arm cuff and secured by tape. The second pair of gloves should be easily removable and replaced if they become contaminated. A radiation dosimeter should be assigned to each team member and attached to the outside of the surgical gown at the neck where it can be easily removed and read. If available, a film badge or other type of dosimeter can be worn under the surgical gown. A waterproof apron can also be worn by any member of the team using liquids for decontamination purposes.

This protective clothing is effective in stopping alpha and some beta particles but not gamma rays. Lead aprons, such as those used in the x-ray department, are not recommended since they give a false sense of security -- they will not stop most gamma rays.


Preparing the Treatment Area for Contamination Control

If possible, select a treatment room near an outside entrance. Clear the area of visitors and patients. Remove or cover equipment that will not be needed during emergency care of the radiation accident victim.

Several large plastic-lined waste containers will be needed. The treatment table should be covered with several layers of waterproof, disposable sheeting. Plastic bags in all sizes will be needed and should be readily available.

Survey instruments should be checked and ready for use before the patient arrives. Background radiation levels should be documented.

The treatment team should be prepared to meet the patient at the ambulance where the patient can be transferred to the prepared treatment gurney.

Covering floor areas

Rolls of brown wrapping paper or butcher paper three to four feet wide can be unrolled to make a path from the ambulance entrance to the decontamination room. Ordinary cloth sheets or square absorbent pads can be used if paper is unavailable. Whatever the floor covering, it should be taped securely to the floor. This route should then be roped off and marked to prevent unauthorized entry. The floor of the decontamination room or treatment area should be covered in a similar way if time allows. This will make cleanup of the area easier.

A control line should be established at the entrance to the decontamination room. A wide strip of tape on the floor at the entrance to the room should be marked clearly to differentiate the controlled (contaminated) from the non-controlled (uncontaminated) side.

Control ventilation

While it may be desirable that the room, or rooms, have either a ventilation system that is separate from the rest of the hospital or a means of preventing the unfiltered exhaust air of the radiation emergency area from mixing with the air that is distributed to the rest of the hospital, there is very little likelihood that contaminants will become suspended in air and enter the ventilation system. Hence, no special precautions are advised. (Ref.: AMA. A Guide to the Hospital Management of Injuries Arising from Exposure to or Involving Ionizing Radiation. 1984).


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