Preparing for the Patient and DecontaminationWm. Mark Hart MS RN EMT-PREAC/TS Nurse/Paramedic & Education Coordinator

24/7 Emergency Phone: 865-576-1005 (DOE Oak Ridge Operations)

Developed in cooperation with Rob Beauchamp RN NREMTP REAC/TS Nurse/Paramedic

FRS radio, safe separation device, 6v btryexplosives, blasting caps

450 Ci Cobalt 60 source from Mexico. The source contained 6000 pellets with magnetic properties. Each pellet contained~75 mCi with an exposure rate at 50cm of 0.4 R/h

137 Cesium Chloride

ED Protocol for Radiation AccidentsActivation & Notification (Alert Process)Information SynthesisED PreparationPatient ProcessingDecontaminationED DischargeClean-up & Recovery

Information SynthesisScene communicationsIncident commander/POC/designeeLocation & Time of accidentMechanism of injuryNumber of patients & condition (Medical & Radiological)Identification of radioactive materialType(s) of radiation injuryIn-house or outside expertise

REAC/TS Radiation Patient Treatment algorithm. Used by permission.

Preparing the Area

The areas readytime to get dressed.

Dressing Out

The Finished Product!!!

Patient Care(rememberMEDICAL CARE FIRST!)

treat life threatening problems first when medically stable, remove clothing approximately 80% of contamination is removed by disrobing patient

cut clothes from the head towards the feet

roll clothes outward keep contamination away from patient

log roll protect cervical spine, if necessary fold sheet over clothing

Complete log roll Roll sheet from head to feet Keep contaminated material away from patient's skin and airway

Remove contaminated material from immediate area Survey patient's back for contamination

Double bag contaminated linens and clothes Remove from immediate area Keep in designated holding area

Medical problems come first Treat life threatening problems immediately If patient is stable, remove clothing and survey for radioactive contamination

when possible, use distance to lower exposure rate

bag wound dressing label with name, date, time and meter reading in cpm double bag and remove from immediate area

survey and define area of contamination at wound site document initial reading in cpm

drape area with water proof drapes

tape edges of drapes to skin

direct run off into lined garbage can

pads help protect from splashing

wash and irrigate wound avoid high pressure flushing

only blot wound one time with each 4x4 do not spread contamination

cover and protect wound remove drapes and pads

place clean chucks or pads remove contaminated trash from immediate patient area

repeat survey compare current readings to initial survey repeat washings as long as they produce a decrease in survey readings reasonable goal - less than three times background level

draping and washing process is repeated for each decontamination effort stop when no longer getting lower survey readings

bandage and wrap decontaminated wound

Stitches??? Surgery??? Make decisions based on medical needs, NOT contamination concerns REAC/TS 865-576-3131

Lets get out of here!

EgressTime to go!

And now youre free!

Clean-up & RecoveryExit procedure of decon teamRadiological surveyspersonnelroomequipmentHandling of contaminated wastedisposalownershipmonitoringsecurity

QUESTIONS????

Now, lets talk about what needs to be done when it is known that a radiological or nuclear incident has occurred and what needs to be done in the hospital to receive and manage the victims. The REAC/TS Radiation Patient Treatment algorithm is meant to provide decision-support to providers. It is lacking a lot of detail but contains all of the essentials needed to manage radiological patients effectively and efficiently.

Talking points - some to be discussed in more detail throughout the presentation.

The emergency management of victims from radiological and nuclear (R/N) incidents follows some very logical and quite simple pathways. 2) How to deal with staff and patient concerns for radiation exposure needs to be managed IN ADVANCE of an incident. These issues must be addressed and taught in planning and preparation stages. 3) Radiation protection and contamination control need attention but are actually not that much different than management of biological and chemical hazards. There are only a few additional considerations.

Protection of personnel and patients can be accomplished with:

a) Universal precautions; b) Appropriate personal protective equipment and anti-contamination clothing; and c) Following the principles of ALARA (As Low As Reasonably Achievable) to be discussed later.