RADIATION EXPOSURE AWARENESS The University of South Alabama Center for Strategic Health Innovation

1. RADIATION EXPOSURE AWARENESS The University of South Alabama Center for Strategic Health Innovation © University of South Alabama Center For Strategic Health Innovation. All Rights Reserved. These slides are a part of the ARRTC program and cannot be reproduced for commercial purposes.

2. Course Objectives • Understand basic concepts of radiation exposure. • Recognize signs and symptoms of radiation exposure illness. • Specify healthcare priorities, including PPE, while treating radiation exposure patients.

3. What is Radiation? • Definition: • Energy moving through space in the form of high speed particles and/or electromagnetic waves. • Examples: • Heat, light, radio waves, microwaves, UV rays, infrared rays, X-rays, gamma rays, and alpha & beta particles.

4. Types of Radiation • Non-ionizing radiation: • Strong enough to heat and cause biological effects such as burns, but not to alter structure of atoms it contacts • Examples: micro, UV, radio, TV, visible light • Ionizing radiation: • Strong enough to alter structure of atoms it contacts • Can damage skin, tissues, cells, DNA • Examples: X-rays, gamma rays, alpha and beta particles

5. Types of Ionizing Radiation • Radioactive particles: • Exposure via contact, inhalation, ingestion • Alpha particles • Beta particles • Electromagnetic rays • Absorbed by body • Gamma Rays (risk of mass exposure) • X-rays (risk to isolated individuals)

6. Radioactive Materials:What are they? Material with unstable atoms (uneven # protons & neutrons) which releases electrons to achieve equilibrium Release gives off radiation This process called Radioactive Decay

7. Where could you find radioactive material? • Military - nuclear weapons • Nuclear power plants • Government facilities - Departments of Energy or Defense • Medical facilities • Research facilities • Industrial& construction facilities • Vehicular transportation • Terrorist sources

8. Types of Radiation

9. Alpha Particles • Two protons & two neutrons bound together • Very high energy levels, highly ionizing • Protection with standard Personal Protective Equipment (PPE): • Low penetration (Paper & cloth adequate barriers) • Travel distance - centimeters(Heavy particles) • Hazards:Ingestion or inhalation • Deposits in organs (kidneys, liver, lungs, bone) • Immediate damage and ongoing chronic exposure risk.

10. Beta Particles Single electrons or positrons High energy, high speed Special PPE required: Travel distance 10 to 15 feet (lighter weight) Penetrates skin (metals, plastic, glass barriers) Hazards:Contact, inhalation, ingestion Skin and eyes (burning w/ high enough levels) Deposits in organs (kidneys, liver, lungs, bone) Immediate and chronic exposure risk _ + or

11. Gamma rays • Electromagneticradiation (pass through) • Varyingenergy levels & speed • Standard PPE provides NO PROTECTION • High penetration, travels long distances • Time/Distance/Shieldinguntil Gamma rays pass; (concrete, steel dense barriers) • Hazard: Ionizing penetrating rays • Immediate cellular damage, ends when rays pass

12. SHIELDING Paper Aluminum plate Concrete or Lead

13. Radiation Accidents Most Probable Incident Type • Radiological accidents – • industry, medicine, research, teaching or agriculture • radioactive material or devices generating ionizing radiation • Nuclear accidents – • nuclear facilities when radioactive release affects radiological safety

14. Nuclear Detonation Least probable, all 3 types of radiation • Average energy distribution: • 50% Explosive damage • 35% Thermal Radiation • 15% Nuclear Radiation • High levels of penetrating radiation • Fine particles of radioactive material (may be inhaled, ingested or absorbed) • Contaminates area for a long time

15. Radiation Dispersal Device (RDD) Highly Possible Incident Type Also called Dirty Bomb Greatest risk – explosion, fear and panic Radiation Exposure Risk - inhalation, ingestion, absorption (inadequate for death, serious harm) “Weapon of mass disruption” but not “weapon of mass destruction” (U.S.N.R.C.)

16. Accident Terrorists The higher the probability for an incident, the lower the expected #’s of casualties. Single Detonation Isolated Nuclear Conflict Worldwide Nuclear Conflict

17. Personal Protective Equipment PPE required for emergency & healthcare workers is based on type of radiation exposure

18. Personal Protective Equipment • Particulate Radiation ExposureContact, Inhalation, Ingestion Risk • A high efficiency particulate air (HEPA) filter • Standard universal precautions clothing or chemical suits (gown/suit, gloves, goggles) • Electromagnetic Radiation Exposure • No PPE needed after gamma rays pass

19. N-95 masks • Half face respirator HEPA (High Efficiency Particulate Filter) • Face shields, safety glasses, goggles

20. Hazards Myths • It’s impossible for a living patient to pose a radioactive threat to healthcare providers – FALSE • Lethally exposed patients do not pose a radioactive risk to healthcare providers – FALSE • A patient with external contamination and/or gamma ray exposure makes his/her body radioactive - FALSE

21. Radiological Decontamination For External Contamination: • Wet patient down to reduce airborne particles • Remove clothing… even underwear!! • Flush with large amounts of water • Soap and water to remove from skin and hair. • Measure residual radiation • Re-dress 95% effective in contaminant removal NASAL SWABS!

22. Priorities for Healthcare • Protect yourself & your facility!!! • Respiratory and skin (barrier) PPE • Decontaminate if necessary • Externaldecontamination if necessary • Local wound decontamination if possible • Stabilize acute trauma injuriesbefore radiation injuries are considered

23. Radiation Cell Damage CELL Ionizing Radiation CELL DAMAGE Altered Metabolism & Function Repair Cell Death Transformation Scarring

24. Radiation Dose Measures Radiation Absorbed Dose(RAD) • Measure of amountof energy deposited in matter • Dose = amount of energy absorbed per gram of tissue. • U.S. uses RAD, International Unit is the Gy (Gray) • 1 Gy = 100 RAD Sievert (Sv) • Measure of biological effects; quantity to produce same effect as 1 rad of high penetration X-rays • Sv = Gy x Q Factor & N Factor

25. Acute Radiation Syndrome Hemopoietic Gastrointestinal Cardiovascular vascular Sub-Clinical CNS 0 RAD > 500 RAD Increasing Dose

26. Acute Radiation Syndrome 2.5 - 5 Gy (250- 500 RAD) Survival Possible Treatment for Infections, Fluids, Blood System is Necessary 1-2.5 Gy (100-250 RAD) Survival Probable Treatment for Infections, Fluids, Blood System PRN > 5 Gy (500 RAD) Survival Unlikely Supportive Care with Fluids and Electrolytes < 1 Gy (100 RAD) Survival Fairly Certain No Treatment Necessary 0 RAD > 500 RAD Increasing Dose

27. Radiation Symptoms Hematopoietic Disorders • Anemia • Bleeding • Infections • Delayed healing Neurovascular Symptoms ·Burning sensations ·Poor balance ·Confusion • Gastrointestinal Symptoms • Nausea/Vomiting • Diarrhea • Mouth / Throat Sores • ↓ Appetite & Weight Loss • Cutaneous Tissue Symptoms • Burns, blistering • Skin sloughing • Hair Loss

28. Treat Based on Symptoms • Fluid and Electrolytereplacement • Drugs • Anti nausea • Antibiotics / Antivirals • Hematopoietic Growth Factors • Potassium Iodide • Transfusions - Blood/Platelet • Bone Marrow/ Stem Cell Transplant • Wound Care

29. Radiation ExposureIn Summary • Ionizing radiation ~can be particles or rays • Decon & PPE ~ for particle exposure only • Radiation accidents ~ highest probability event • Wash down & clothing removal ~ 95% effective for decontamination • ARS symptoms ~ guide to exposure severity and treatment needs • RDD Risk ~ particles, not gamma rays

30. Questions ?