Planning med resp

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PLANNING THE MEDICAL RESPONSE TO RADIATION
ACCIDENTS
Module XXII
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Radiation accidents

• 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

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Radiological accidents

• 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 medical preparedness for radiation
accidents

• 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 radiological
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 involved 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 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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Simple classification of persons involved in
radiation accident

• Unexposed persons with conventional trauma
• should be taken to specialized hospital
• Persons believed uninjured unexposed
• could be sent home

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Planning emergency medical 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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Planning for management of multiple casualties
in radiation accidents
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
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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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Planning hospital treatment of exposed patients
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Planning hospital treatment of exposed patients
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Planning treatment of contaminated patients in
general hospital
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Planning treatment of contaminated patients in
general hospital
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(No Transcript)
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Ref. IAEA-WHO Safety Report No.4., IAEA,
Vienna, 1998
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Medical 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 form

• consciousness normal abnormal agitation
• delirium
• sleepiness
• coma
• equilibrium disturbance yes no
• co-ordination disturbance yes no
• skin and mucosa
• oedema yes no
• erythema yes no
• other

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Medical 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 formLaboratory 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)

Ref. IAEA-WHO Safety Report No.4., IAEA,
Vienna, 1998
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Training initial medical carers at 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 hospital staff

• Who should be trained?
• Topics of training
• Type of training
• Lectures
• Drills
• Exercises
• Joint exercises

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Summary

• 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