MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY

1. MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY Module II

2. Syllabus • Introduction • Medical aspects of radiation accidents • Most frequent medical consequences • Medical preparedness and response • Infrastructure and functional requirements • On- and off-site medical response • Summary Module II

3. Introduction • General objectives of emergency response • To reduce risk or mitigate consequences of accident at source • To prevent or reduce deterministic health effects • To reasonably reduce risk of stochastic effects • Clear understanding by each member of emergency response organization of basic radiation medicine • Clear understanding of role of each emergency response team and organization Module II

4. Objectives of emergency medical preparedness and response • To treat life threatening injuries • To implement actions needed to meet general objectives of emergency response • To participate in training, drills, and exercises to update and enhance basic knowledge and skills necessary to meet general objectives of emergency response Module II

5. Accident Critical organ Major source of dose Reactors (power, research, ship) Whole body (bone marrow) Skin Thyroid Gamma Beta Radioiodine Spentreactor fuel storage or reprocessing Whole body (bone marrow) Gamma Industrial and medical gamma sources (sealed) Whole body (bone marrow) Skin Gamma Gamma Industrial and medical gamma sources (damaged, unsealed) Whole body (bone marrow) Skin Gamma Beta Pu - weapons damage or manufacture Lung Alpha Medical aspects of radiation accidents Module II

6. What do we need to know ? …. about the most frequent medical consequences of the radiological accidents • They are usually • connected with radiological accidents involving lost or stolen sources • manifest in radiation burns Module II

7. What do we need to know? • They are often • combined with contamination of the body • result of inadequate public knowledge about radiation • recognized late because of poor awareness of general practitioners of medical consequences of radiation Module II

8. Requirements for medical preparedness • Infrastructure • must be in place to ensure that functional requirements of response can be performed when needed • Functional • should be fulfilled to achieve the response objectives Module II

9. Common Specific Co-operative Requirements for emergency preparedness and response Infrastructure Functional Module II

10. Infrastructure requirements • Infrastructure • Authority, command and control • Organizational responsibilities • Response co-ordination • Plans and procedures • Logistical support • Training, drills and exercises Module II

11. Functional requirements • Initial accident assessment and classification • Notification and activation • Accident condition mitigation • Urgent protective action • Public education and instruction • Emergency worker protection • Medical, fire fighting and police assistance • Media relations • Longer term protective action • Psychological impact mitigation Module II

12. Functional requirements:medical assistance • Establish a capability to provide immediate on-site first aid during an emergency • Develop guidelines for decontamination • Provide means to transport and initially treat contaminated, exposed and injured people • Develop agreement to treat highly exposed people at an existing institution with capability to provide required specialized treatment • Make plans to triage and treat radiation exposed persons using existing medical facilities most effectively Module II

13. Minimum information required for medical preparedness • Locations where radiation or radioactive materials are used • Types and activities of radioactive source • Types of radiation generating device • Information on transportation of radioactive materials through area in question • Spectrum of possible accidents • Estimated number of people potentially affected in severe radiation accident Module II

14. Planning stage:prepare lists • Telephone numbers and addresses of medical and support staff in each location • Medical facilities at local, regional and national levels • Specialized national medical centres for treating radiation induced skin lesions or immunosuppression • Specialized medical facilities in other countries • Equipment and supplies needed for emergency response • Agreements with ambulance transport services Module II

15. Response stage • Basic principles of medical care of exposed persons • General methods • Specific methods for possible health effects of radiation and contamination • Medical care • On site (on the scene of an accident) • Off site (in medical institutions) Module II

16. Emergency response: medical personnel • On site • Emergency medical responders • Off site • Medical specialists in general hospitals and specialized medical centres Module II

17. Emergency medical responder Fire service Facility responder Police On-site response:generic organization Module II

18. Medical assistance in radiation emergencies: interfaces and activities Module II

19. Tasks of emergency medical responders on site • Procedure C4 of the IAEA-TECDOC-1162 “Generic procedures for assessment and response during a radiological emergency” suggests seven steps: • Step 1: • If you are first at the scene assume the role of on-scene controller until relieved • If not, get briefed by on-scene controller • Step 2: • If you have personal dosimeters wear them • Wear protective clothing as required Module II

20. Tasks of medical responders: search and rescue • Step 3: • Search for and rescue injured people as soon as possible • Perform medical triage. Assess and treat life-threatening injuries immediately DO NOT DELAY LIFE SAVING ACTIONS DUE TO THE PRESENCE OF RADIATION • Provide routine emergency care during extrication procedures • Remove injured people from the hazard area as soon as possible • If necessary, request additional medical help Module II

21. Tasks of medical responders: radiological triage • Step 4: • With support of decontamination team, perform radiological triage and isolate contaminated people • Remove all contaminated clothing unless medically contraindicated • Isolate (bag and secure) clothing, shoes, and personal belongings • Cover wounds with sterile dressings and prepare injured people for transport to hospital • Transport in a manner suitable to prevent further contamination of victims, ambulance, and attending personnel. Module II

22. Tasks of medical responders: establish contacts • Step 5: • Establish contact with police to obtain names and addresses of the involved population for further interview • Step 6: • Inform receiving hospital about nature of conventional injuries and any known or suspected radioactive exposure or contamination • Identify radioactive material if known • If not known, ask radiological assessor to identify radioactive materials involved Module II

23. Tasks of medical responders: checking contamination • Step 7: • With support of decontamination team, check personal and equipment for contamination or request assistance from radiological assessor • When medical conditions do not require urgent hospitalization, DO NOT leave the scene of accident before being checked for personal contamination Module II

24. Step 7 (cont’d) • DO NOT take any equipment out of area before having it checked for contamination • If you have to leave the scene urgently, contamination control procedures should be carried out as soon as reasonable Module II

25. Emergency medical response off site • Undressing order: • Remove tape from gown, then shoe covers • Outer gloves • Remove tape from inner gloves • Dosimeter • Gown • Lower trousers to below knee • Sit on chair placed on clean side of border line • Take off trousers • Splash protector • Mask • Shoe covers • Inner gloves • Dressing order: • Shoe covers • Trousers • Surgical gown • Tape gown opening • Tag both sides of gown • Surgical cap and mask • Inner gloves • Seal gloves and gown sleeves with tape • Dosimeter • Outer gloves Module II

26. Emergency medical response off site • Treatment in reception area • Priorities • Life threatening injuries • If internal contamination is suspected, quickly assess nature and degree • Assess extent and magnitude of contamination, and decontaminate as necessary Module II

27. Minimum requirement for equipment and supply for initial hospital treatment • Radiation survey instruments • Personal protective equipment • Supplies • Supporting documentation • Transport Module II

28. Responsibilities of responding medical facility • Designate appropriate staff • Further train staff if necessary • Develop detailed emergency plan and procedures • Indicate space where reception and treatment can take place • Provide and properly maintain special equipment and all necessary material Module II

29. Summary • Medical response is a component and important part of the overall emergency response • Infrastructure and functional requirements of emergency planning are valid for medical planning • On-site and off-site medical response – what should be done in accordance with priorities Module II