Pre-Hospital Response to Events Involving Radioactive Materials

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Pre-Hospital Response to Events Involving
Radioactive Materials

• Robert C. Beauchamp, RN BSN CEN NREMT-P
• REAC/TS
• Oak Ridge Institute for Science and Education

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OBJECTIVE

• Assist pre-hospital responders in the initial
  management of a radiation accident/incident.
• Identify potential hazards when responding to a
  radiation accident

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On Scene Basic Priorities

• Safety of responders
• Safety of victims
• Course of action development
• Contamination control
• Consequence management

Dont be a Victim
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Safety of Responders

• What Hazards

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Safety of Victims

• Physical hazards at the scene are most likely to
  force immediate evacuation
• At some scenes the chemical nature of the
  contaminant may be more of a threat to the
  patient than its radioactivity
• Immediate life-threatening problems will be
  medical and/or trauma in nature and must be cared
  for.

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Victim Risk Analysis

• Physical hazards assessment of the Scene.
• Life threatening dangers to the victim.
• Radiation level
• (accumulated dose to rescuers/victim)
• Irradiation vs Contamination
• Types of Contamination (a, b, g)
• Area contamination status fixed, airborne, liquids

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Mitigating the Radiation Exposure Hazard

• Limit time devoted to on scene treatments,
  remember the Golden Hour.
• Have a plan and stay focused.
• Perform only the skills needed to sustain life
  while on the scene.
• ABC, C-Spine, Massive external bleeding, major
  fracture stabilization

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Do not let Radiation fears exceed patient needs.
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Course of Action Development

• Scope of the Response
• Team Organization (availability)
• OIC prior to IC identification
• Haz/Mat, Medics. Firefighters, Police, ? Field
  Deployment Medical Team(s)
• PPE considerations public safety, police, fire,
  EMS, and hospital staff

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Course of Action Development (cont.)

• Equipment Survey meters, dosimeters, medical
  gear, litter device, extrication equipment,
  sheets.
• Ingress Egress routes with control measures
• On-scene actions TREAT LIFE THREATS Evacuation,
  search, medical care, victim identification

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EPA Emergency Dose Guidelines

• No individual shall be required to perform rescue
  actions that might involve substantial personal
  risk.

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EPA Emergency Dose GuidelinesManual Of
Protective Action Guides And Protective Actions
For Nuclear Incidents, United States
Environmental Protection Agency, October 1991,
Table 2-2.
Dose Limit (rem) Activity Condition
5 all
10 Protecting valuable property Lower dose not practicable
25 Life saving or protection of large populations Lower dose not practicable
gt25 Lifesaving or protection of large populations Only on a voluntary basis to persons fully aware of the risks involved
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Contamination Control

• Most contamination will be on clothes. At least
  outer clothing should be removed before transport
  of patient to hospital (to minimize spread of
  contamination to ambulance and ED).
• As much as possible, leave contaminated materials
  (including the clothes that were removed) at the
  incident scene. If receiving facility can
  identify source double bag and take it with you.
• Send victims identification (in plastic baggie)
  to the ED with the victim.

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Contamination Control

• Use sheet or pillowcase to keep from kneeling on
  contaminated ground
• Place equipment in plastic bags. Take in only the
  equipment you need.
• Cover exposed surfaces in ambulance with
  plastic/sheet. Dont create a hazard for
  yourself.
• Delineate the contaminated area (signage, tape,
  markings)

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Contamination Control

• Restrict access to essential personnel
  resources
• Designate entry exit points
• Provide radiation monitoring at all entry and
  exit portals if possible
• Establish decontamination sites as dictated by
  patient medical status
• Limit removal of items from contaminated areas

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Multi-Casualty Radiation Incident/Triage Site

• Pass victims across control line to ambulance
  gurney.
• Package for transport.

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Lets Rescue a Patient From a Radioactively
Contaminated Area
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Normal Routine
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Radioactive Contamination Protocol

• Know Your Protocols

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But I dont have special suits!
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Donning PPE

• Put on outer garment or scrubs (local protocol)
• Put on shoe covers (local protocol)
• Put on inner gloves (blue)
• Tape sleeves and pants legs (masking tape/duct
  tape)
• Outer gloves (two pair)
• Head cover
• Face shield
• Mask (airway protection per local protocol)

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Taping

• Initially Triple Glove

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Approaching the Scene

• Initial Decision Tree
• Are there chemical, physical or radiological
  threats to the responders?
• Are there patients to be treated?
• If radiation is the threat, then treat life
  threatening problems and remove patients from
  area.

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What are the Contamination Levels?Is it Safe to
Enter?
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Yep, its Safe
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• Check patient/pre-rolled three sheets

• Normal Log Roll

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Remove ClothesCut Away From Airway
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Roll Contamination Away From Patient
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• Cover and Roll Contaminated Clothing In Sheet 1

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• Contaminated Clothing Now Contained

• Roll Sheet Away From Airway

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• Place Backboard Under Sheet 2

• Clean Patient
• Clean BackboardCocoon

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Sheet 3 Provides a Clean Platform Leave at
Scene
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Removing PPE

• Outer booties (if worn)
• Outer gloves
• Pass dosimeter across control line (if used)
• Remove tape at cuffs and sleeves
• Head cover and face protection
• Outer garments (over shoe covers)
• Remove one shoe cover at a time/survey bottom of
  shoe/step across control line
• Remove inner gloves/drop back into contaminated
  trash
• Total body survey

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Consequence Management of a Radiation Event

• Continued medical support to
• victims responders
• Environmental clean-up decontamination
• Bioassays screening and, if indicated, whole-body
  counting
• Decorporation therapy (if indicated)
• Psychological counseling support
• Follow-up assistance

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Suggestions

• Assure warmth for disrobed victims.
• Showering of victims is NOT normally indicated.
• Control run-off of decon solution to avoid
  tracking to clean areas.

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What Have We Learned?

• Radiation incidents are manageable
• Immediate actions are related to medical needs
  and are not related to radiation exposure or
  contamination issues.
• Ionizing radiation is detectable and measurable.
• YOU CAN SEE IT WITH A METER
• Responders can safely care for contaminated
  victims.

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Whats the BIG picture

• You can handle this!

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? ? ? Questions ? ? ?