PLANNING THE MEDICAL RESPONSE TO RADIATION ACCIDENTS

1. PLANNING THE MEDICAL RESPONSETO RADIATION ACCIDENTS Module XXII

2. 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 Module Medical XXII

3. Radiological accidents • Radiological accidents • occur much more frequently than nuclear accidents • havemore 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 Module Medical XXII

4. 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 Module Medical XXII

5. 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 Module Medical XXII

6. 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 Module Medical XXII

7. 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 Module Medical XXII

8. 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 Module Medical XXII

9. Planning emergency medical response in hospital • Treatment in hospital • Type of hospital/department • depends on condition of patient Module Medical XXII

10. 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 Module Medical XXII

11. 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 Module Medical XXII

12. 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 Module Medical XXII

13. 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 Module Medical XXII

14. 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)? Module Medical XXII

15. Planning hospital treatment of exposed patients Module Medical XXII

16. Planning hospital treatment of exposed patients Module Medical XXII

17. Planning treatment of contaminated patients in general hospital Module Medical XXII

18. Planning treatment of contaminated patients in general hospital Module Medical XXII

19. Module Medical XXII

20. [Ref.: IAEA-WHO Safety Report No.4., IAEA, Vienna, 1998] Module Medical XXII

21. 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 Module Medical XXII

22. 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 Module Medical XXII

23. 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? Module Medical XXII

24. 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] Module Medical XXII

25. Training initial medical carers at accident site • Regular training of on-site emergency team to provide initial treatment (emergency aid) • Specific training and rehearsalfor paramedical or ambulance personnel in safe handling and transport of victims Module Medical XXII

26. Training of hospital staff • Who should be trained? • Topics of training • Type of training • Lectures • Drills • Exercises • Joint exercises Module II

27. 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 Module Medical XXII