Managing Radiation Emergencies
Guidance for Hospital Medical Management
Hospital Emergency Care of the Radiation Accident Patient
Meet the radiation accident victim at the ambulance or at a triage area established near the treatment area. Instruct EMS personnel to stay with their vehicle until they, their vehicle, and equipment are surveyed and released by a radiation safety officer.
During triage, consideration is given to medical and radiological problems. Serious medical problems always have priority over radiological concerns, and immediate attention is directed to life-threatening problems. Radiation injury rarely causes unconsciousness or immediate visible signs of injury and is not immediately life threatening; therefore other causes of injury or illness must be considered.
Noncontaminated patients are admitted to the usual treatment area. Contaminated patients are admitted to a specially prepared area. When in doubt, a critically injured patient should be taken immediately into the prepared area. If the victim's condition allows, an initial, brief radiological survey can be performed to determine if the victim is contaminated. Any radiation survey meter reading above background radiation levels indicates the possibility of contamination. A more thorough survey will be performed once life-threatening problems are addressed.
The victim's contaminated clothing should be removed before arrival at the hospital (at the accident scene), if this can be accomplished without causing harm or delay. Otherwise, the clothing should be removed as promptly as possible (without compromising life or limb), using care to avoid spread of any contaminants embedded in or on the clothing. Clothing, and any accompanying sheets, blankets, etc. should be placed in a plastic bag. Care-givers should change gloves after handling clothing or other potentially contaminated items.
Assessment and treatment of the noncontaminated patient
Noncontaminated individuals can be cared for like any other emergency case. A specially prepared treatment area is not needed. Following attention to medical needs, question the patient to determine the possibility of radiation exposure from an external source. Remember, the victim of exposure without contamination poses no radiological hazard to anyone. If exposure is known or suspected, a stat CBC should be ordered with particular attention given to determining the absolute lymphocyte count. Be sure to record the time the blood sample is taken. For differential diagnosis, refer to acute radiation injury.
Assessment and treatment of the contaminated patient
Contaminated patients can have radioactive materials deposited on skin surfaces, in wounds, or internally (ingested, inhaled, or absorbed). Reassessment of the contaminated patient's airway, breathing, and circulation are done in the decontamination room prior to attention to the patient's radiological status. Level of consciousness and vital signs are assessed promptly and the patient's condition is stabilized. After examining the entire patient and identifying all injuries, a complete radiological survey should be done.
The patient should be questioned about allergies, currently used medications, any history of chronic or recent illness, and recent nuclear medicine tests. The patient's level of anxiety should be noted, and psychological support offered. A complete and detailed medical, occupational, and accident history should be taken, and a physical examination completed.
Certain clinical and radiological laboratory analyses (see Radiological and Clinical Laboratory Assessments section below) are essential to the care of the radiation accident patient. These laboratory tests are done to assess the biological effects of radiation injury; to identify abnormalities that might complicate treatment; to locate, identify, and quantify radionuclide contamination; and to provide information useful in accident analysis.
Radiological and clinical laboratory assessments
All samples must be placed in separate, labeled containers that specify name, date, time of sampling, area of samples, and size of area samples. It is suggested that blood, urine, feces, or other samples taken in the emergency treatment period be retained for subsequent investigation. Appropriate advice (legal, radiation safety, etc.) should be obtained regarding the storage and disposition requirements of collected samples.
Good judgement is essential in determining decontamination priorities. Since some radioactive materials are corrosive or toxic because of their chemical properties, medical attention might have to be directed first to a non-radiological problem if radioactive materials are components of acids, fluorides (uranium hexafluoride-UF6), mercury, lead, or other compounds.
In general, contaminated wounds and body orifices are decontaminated first, followed by areas of highest contamination levels on the intact skin. The purpose of decontamination is to prevent or reduce incorporation of the material (internal contamination), to reduce the radiation dose from the contaminated site to the rest of the body, to contain the contamination, and to prevent its spread. Please note that frequent glove changes will be necessary.
Patient comfort and emotional support
A patient involved in a radiation accident needs explanations of procedures and actions being taken (isolation, use of survey meters, taking of samples, decontamination, etc.) in the radiation emergency area. A knowledgeable person should answer the patient's questions and provide reassurance. For example, explain use of protective clothing and surgical masks during treatment. Following initial care and treatment, someone with a knowledge of radiation effects should spend adequate time answering the patient's questions. Preferably, this person should be the attending physician who continues to treat the patient until discharge. Reporters and news-hunters should get their reports from the hospital's public information officer.
Routine precautions for patient safety should not be forgotten. Be especially alert for potential falls or slips on wet floors, excessive heating or chilling, and electrical hazards.
In addition to routine medical records, note survey readings, samples taken (and time), descriptions of the accident, and the effectiveness of decontamination. Take care to note pre-existing conditions such as rashes, healing wounds, or scars. This information will be extremely valuable to medical consultants and health physicists in reconstructing the accident accurately and making a prognosis.
Post-emergency patient transfer
A final complete-body survey is performed following decontamination procedures. A new floor covering is laid from the clean area to the patient stretcher. A clean stretcher is brought in, the patient is transferred to it by clean attendants (those involved in the decontamination procedure may now be contaminated), and the patient is wheeled to the door. After the radiation safety officer makes a final check of the patient and the stretcher (especially the wheels), the patient is taken from the room.
Staff exit from the controlled area
Each member of the decontamination team goes to the control line and removes his protective clothes as described below:
After staff exit, the decontamination room should be secured and a sign reading "CAUTION -- CONTROLLED AREA -- DO NOT ENTER" should be posted. Unless it is needed for emergency medical reasons, the decontamination room remains secured until it can be checked and decontaminated, if necessary, by the radiation safety officer or other health physics expert.
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