PLANNING PLANNING THE MEDICAL RESPONSETHE MEDICAL RESPONSE TO TO

RADIATION ACCIDENTSRADIATION ACCIDENTS

Module 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?

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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