1. MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY
Purpose
To give an overview of medical preparedness and response in a nuclear or radiological emergency
Objectives
To enable the participants to:
refresh the objectives of emergency response
characterize the most frequent medical consequences of a radiological accident
understand the role and place of medical preparedness and response in the overall organizational emergency response structure
be able to list infrastructure and functional requirements for medical response preparedness
have minimum knowledge required for medical preparedness
understand the role and tasks of emergency medical responders on the scene of an accident
be aware of necessary co-ordination between different response groups on site
to list medical categories of affected persons involved in radiation accidents using simple classification
Scope
This module places medical specialists in the overall organization of emergency preparedness and response; infrastructure and functional requirements for medical preparedness: interfaces with the other elements of overall response organization; tasks of emergency medical responders on site; general description of the response off-site; simple classification of affected persons involved in the radiological accidents.
Activity
Lecture and discussion
Duration
1 hr
References
IAEA-TECDOC Generic Procedures for assessing and response during a radiological emergency, IAEA, Vienna, 2000
IAEA-TECDOC-953. Method for the development of emergency response preparedness for nuclear or radiological accidents, IAEA, Vienna, 1997.
IAEA - WHO. Diagnosis and treatment of radiation injuries, Safety Reports Series No. 2, IAEA, Vienna, 1998.
IAEA - WHO. Planning the medical response to radiological accidents, Safety Reports Series No. 4, IAEA, Vienna, 1998.
Ricks, R.C., Prehospital Management of Radiation Accidents, ORAU 223, Oak Ridge Associated Universities, Oak Ridge, TN, 1984.
Jarrett, D. ed. Medical management of radiological casualties. Handbook. AFRRI, Bethesda, MD, 1999.
Turai, I., Crick, M., Nogueira de Oliveira, C., Ortiz-López, P. and Wrixon, A.: Response to Radiological Accidents: the Role of the International Atomic Energy Agency, Radioprotection, 36(4): , 2001
Module II

2. Syllabus Introduction Medical aspects of radiation accidents
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
Many people of different professions are involved in emergency response and preparedness to respond in nuclear or radiological emergencies. Being integrated in the overall organization of emergency response, they need to know the general purpose of radiation protection for population and workers, and the aim of the activities in emergency response. The necessity for protection of the population from ionizing radiation emerges from current knowledge about effects of ionizing radiation on human health, consequences of known accidents, and radiation medicine.
Therefore, specialists in different professions should acquire basic information about radiation and human health. Such information will enable a better understanding of emergency response objectives and in the long run will help to organize the activities of emergency response in the most efficient way.
In this lecture we will use the term “radiation accident, radiation emergency” as a common term for a nuclear or radiological accident/emergency.
Module II

3. Introduction General objectives of emergency response
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
The emergency response programme has three primary objectives. The first objective is to take action at the source of the accident to mitigate or reduce the potential risk. The second objective is to ensure that people will not receive doses high enough to result in deterministic health effects induced by the accident. The third objective is to take reasonable actions to reduce the chance of stochastic health effects. It’s obvious that the second and the third objectives are directly related to human health. Medical terminology is used even in statements of the objectives. Therefore, every person participating in emergency response has to know and understand the terms; and the relationships between radiation physics, radiation induced health effects and radiation protection.
Effective medical response is a necessary component of an overall response to nuclear or radiological emergencies. In general, the medical response to radiation accidents may represent a difficult challenge to the authorities due to the complexity of the situation, often requiring highly qualified specialists and organizational and material resources. Therefore, adequate planning is needed.
Module II

4. Objectives of emergency medical preparedness and response
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
The main objective of emergency medical response is to treat life threatening injuries. This is the first priority task, which should be carried out without taking into account the presence of radiation. The general rule is: do not delay life saving actions due to the presence of radiation.
All actions within the responsibility of medical specialists (e.g. medical actions) should be consistent with the general objectives of emergency response. Therefore, the second objective of the emergency medical response is to implement actions needed to meet these objectives.
In order to meet the objectives of emergency medical preparedness and response, medical organizations should participate in training, drills, and exercises to update and enhance the necessary basic knowledge and skills, which can also be considered an objective.
Module II

5. Medical aspects of radiation accidents
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
Medical aspects of radiation accidents
Alpha
Lung
Pu - weapons damage or manufacture
Gamma
Beta
Whole body (bone marrow) Skin
Industrial and medical gamma sources (damaged, unsealed)
Whole body (bone marrow)
Skin
Industrial and medical gamma sources (sealed)
Spent reactor fuel storage or reprocessing
Radioiodine
Thyroid
Reactors (power, research, ship)
Major source of dose
Critical organ
Accident
Every possible effort should be made to prevent anyone receiving doses above the threshold for serious deterministic effects. Critical organs can be identified for many types of accidents. If the dose is kept below the threshold for deterministic health effects in these critical organs, then deterministic health effects will be prevented in all the organs. Studies and experience have shown that the types of accident that can result in severe deterministic effects (e.g. deaths or severe deep radiation burns leading to amputation of extremities) are rare. They include individuals unknowingly handling highly radioactive sealed sources, industrial accidents where workers are accidentally exposed and releases from large power reactors or reprocessing facilities.
Medical consequences of the radiological accidents may occur among public or workers. In general, radiological accidents are related to acute overexposure and affect more often professionals than members of the general public. The majority of accidents affect very few individuals – those who were using or handling the source.
Module II

6. What do we need to know ? They are usually
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
Nuclear accidents, the most dramatic example of which is the Chernobyl accident, may cause general public overexposure. Professionals and emergency workers may receive doses above the threshold for deterministic health effects.
The most frequent medical consequences are connected with the radiological accidents in industry, medicine and research. More and more emergencies are related to lost or stolen industrial radiation sources which are found by individuals unaware of the hazard. Radiological accidents connected with medical misadministration in diagnosis and therapy are significant as well because they involve general public.
One of the most frequent consequences is local radiation burn of the leg or/and hand of the person who found the lost or stolen source.
Module II

7. What do we need to know? They are often
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
When the accident is characterized by damage to the source or demolition of the source capsule, contamination of the persons involved in the accident can be expected. In such a case, radiation burns could be combined with radioactive contamination.
Very often human exposure in a radiation accident is the result of inadequate knowledge about radiation. This includes ignorance of radiation warning symbols on the part of either members of the public or people professionally involved in dealing with radiation. Furthermore, there is evidence of lack of such knowledge among physicians, reflected by recognition of radiation injuries. There have been several emergencies involving exposures from sources during which individuals suffering from radiation induced injuries made several visits to medical professionals before the radiation exposure symptoms were recognized. In each of these cases, other information prompted the doctors to consider radiation exposure as a cause of the symptoms.
Therefore, at the stage of emergency preparedness, information on the symptoms and other indicators of radiation exposure along with the immediate actions to be taken if radiation exposure is suspected should be provided to local and emergency room doctors. Information should include medical as well as other indicators of radiation induced injures (e.g. victims seeing the radiation symbol, strange objects involved, type of activities performed).
Module II

8. Requirements for medical preparedness
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
In order to be effectively implemented, emergency medical response should be planned and organized in accordance with particular infrastructure and functional requirements.
Being the part of overall emergency preparedness and response, medical response should take the same approach to requirements as is given in the IAEA TECDOC-953 “Method for the development of emergency response preparedness for nuclear or radiological accidents” for all response organizations.
The infrastructure requirements must be in place to ensure that the functional requirements of a response can be performed when needed. Planning objectives are provided for each infrastructure requirement, and response objectives are given for each functional requirement, along with items to be considered in developing the capability to fulfil the requirements. See IAEA TECDOC-953 for details.
Module II

9. Requirements for emergency preparedness and response
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
Requirements for emergency preparedness and response
Infrastructure
Functional
Common
Specific
Infrastructure and functional requirements for effective response can be divided into:
common, applied to all organizations involved in emergency response,
specific, applied only to medical response, and
Co-operative, applied when joint efforts are needed.
Common requirements should be discussed at the early stages of emergency planning by emergency planners and managers from all involved organizations, including medical ones.
Specific requirements are the responsibility of medical organizations. In developing their own specific tasks medical organizations are more independent from others. However, there are no completely independent tasks in an emergency. Therefore, medical organizations should be aware of the common interest in implementation of the tasks and inform others about their activities.
Co-operative requirements are usually related to the tasks and responsibilities where joint efforts are necessary at all stages, and call for maximum joint efforts at all stages of preparedness and response. They should be taken into account by all response organizations.
Common features - all medical response requirements are:
connected with the other elements of the overall response organization,
applicable to all threat categories.
Co-operative
Module II

10. Infrastructure requirements
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
Infrastructure requirements
Infrastructure
Authority, command and control
Organizational responsibilities
Response co-ordination
Plans and procedures
Logistical support
Training, drills and exercises
The majority of requirements which are considered to be common to other organizations involved in emergency response are infrastructure requirements. This is a logical consequence of the statement that infrastructure requirements must be in place to ensure that the functional elements of a response can be performed when needed. Therefore, emergency preparedness will start from development of infrastructure requirements. It’s necessary to stress that after discussions and agreements between all involved organizations, the same infrastructure requirements have to be developed in medical organizations taking into account their own specific goals and responsibilities. For example, all involved medical organizations will be represented by one medical authority at the national level during the planning process. This authority will be involved in response co-ordination, writing plans and procedures at the national level. However, one step lower, within medical organizations response co-ordination and written plans and procedures are needed as well. These activities will be secondary or derived from the activity at the national level, and will have more specific features applicable to medical facilities. Another example could be participation in training, drills and exercises. These activities will be organized between all response organizations and within medical community as well.
We can conclude that at the national level, all listed infrastructure requirements are common, as they are applied to all organizations involved in emergency response, including medical. Such requirements as “Plans and Procedures”, “Logistical support” and “Training, drills and exercises” have some specific features reflecting the peculiarities of medical response at both the national and local levels. However, for the fulfilment of requirements for “Plans and Procedures” and “Training, drills and exercises” joint efforts are needed, so these requirements should still be considered as co-operative.
Module II

11. Functional requirements
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
All functional requirements are listed on this slide. The specific requirement for medical response is “medical assistance”. However, medical organizations have to participate adequately in the implementation of other functional requirements as well, especially regarding:
urgent protective actions
public education and instruction
longer term protective actions
psychological impact mitigation.
These four requirements are co-operative in the nature of their fulfilment.
Module II

12. Functional requirements: medical assistance
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
There are several planning items to be fulfilled at facility, local or national levels of medical assistance. These items, applicable for the planning category I facilities (facilities for which events, including very low probability events, that could give rise to severe deterministic health effects off site are postulated or have occurred in similar facilities) are listed here.
The number of items to be planned depends on the planning category. Detailed description and explanation is given in IAEA-TECDOC-953 “Method for the development of emergency response preparedness for nuclear or radiological accidents”.
Module II

13. Minimum information required for medical preparedness
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
Medical preparedness begins with awareness of where and what type of ionizing radiation and radioactive materials are used in a country. This database should include the above information.
This information is needed for adequate planning of the use of medical capabilities. General and specialized medical centres may be needed, depending on the degree and nature of the radiation induced injuries.
Specialized advice may not be routinely available at the scene of the accident, except at medical facilities that use sources, such as medical irradiation therapy hospitals, where there are medical professionals who are experienced in dealing with radiation injuries or who have some relevant knowledge. A national emergency plan needs to identify organizations, plans and procedures for providing such assistance.
Module II

14. Planning stage:prepare lists
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
At the planning stage, lists containing information about medical facilities, equipment and supplies, etc. should be prepared. In contrast to the list of minimum information required for medical preparedness (presented at the previous slide), these lists should be prepared by medical officials.
The collected information should appear in detail in the emergency medical plan of medical facilities involved in response, at the local, regional and national levels.
Module II

15. Response stage Basic principles of medical care of exposed persons
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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)
The principles of the medical handling of exposed persons are based, to a large degree, on the methods used for handling other types of accidents, taking into account the specificity of the possible health effects of radiation and problems with contamination.
In exposed persons, high levels of external dose are rare and usually found in employees or other professionals. In the case of a lost or stolen source, limited groups of the general public may receive doses that can lead to deterministic health effects. Such a situation requires special medical care and supportive treatment for the early effects of acute radiation exposure.
Medical handling in an emergency situation is normally divided into medical care at the scene of the accident (more often for workers) and medical care off site (for workers and the affected population).
Module II

16. Emergency response: medical personnel
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
Emergency response: medical personnel
On site
Emergency medical responders
Off site
Medical specialists in general hospitals and specialized medical centres
In general, there are three levels of response for on-site and off-site actions, according to the degree of complexity, availability of necessary resources for assistance and the severity of consequences:
first aid provided at the scene of the accident;
initial medical examination, detailed investigation and medical treatment in a general hospital; and
complete examination and treatment in a specialized medical centre for treatment of radiation injuries.
In other words, emergency response on site is known as prehospital response; response off site as hospital response. Hospital response or health care in hospital may include initial medical examination, general medical treatment and special medical treatment depending on the patient’s condition. Complete radiological monitoring, decontamination and decorporation are also carried out in hospital.
Module II

17. On-site response: generic organization
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
On-site response: generic organization
Fire service
Police
Facility
responder
Emergency medical responder
This chart gives an overview of the generic organization needed to respond to a radiological emergency.
All on-site responders and their responsibilities are presented in the chart.
The response initiator is usually the duty officer, the radiation safety officer or a responsible laboratory supervisor. However, if facility personnel are not present, the response initiator can be a security officer or the fire department dispatcher.
As the purpose of this lecture is to present the overview of emergency medical response, and therefore, role of medical responders, only their roles and responsibilities will be discussed below.
Emergency medical personnel already have an important role at the stage of first response. The medical team may be the first who arrived at the scene of an accident or may come after other responders. In either case, the actions of medical responders should be fully incorporated into the joint emergency response.
Module II

18. Medical assistance in radiation emergencies: interfaces and activities
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
Medical assistance in radiation emergencies: interfaces and activities
Since medical response is part of the overall response, it is connected first of all with radiological teams. Radiological support plays a very important role in the effective medical response. The general structure of their relations is presented in this slide.
Module II

19. Tasks of emergency medical responders on site
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
Detailed step-by-step procedures for the specific tasks of emergency medical responders on the scene of an accident are presented in seven steps of the Procedure C4 of the IAEA-TECDOC-1162 “Generic Procedures for assessment and response during a radiological emergency”(Vienna, 2000).
Emergency medical responders will most likely arrive on the accident scene a short time after the accident occurs. Until then, police, fire service, or other personnel who have been adequately trained in techniques of basic first aid can provide emergency first aid for injured persons.
If the medical team arrives first on the scene of an accident, the senior person there normally assumes the role of the on-site controller until relieved by appropriate authorities. The first on the scene should:
approach the site with caution – look for evidence of hazardous materials;
if radiation hazard is suspected, position personnel, vehicles, and command post at a safe distance upwind of the site;
notify proper authorities and hospital.
Module II

20. Tasks of medical responders: search and rescue
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
At facilities with radioactive sources where there are trained personnel on every shift, they should normally provide any first aid required. In the case of serious injury, medical personnel from suitable off-site medical centres should be available.
The purpose of medical care on the scene of an accident is to prevent traumatic injuries from threatening life, and also assessment of possible contamination and performance of procedures to control the spread of contamination.
After searching for injured persons and giving emergency aid it is necessary to perform medical triage, and assess and treat life-threatening injures immediately. Remember that there should not be any delay in advanced life support if victims cannot be moved or it is impossible to assess contamination status. After performance of routine emergency care during extrication procedures, victims should be moved away from the radiation hazard area, using proper patient transfer techniques to prevent further injury. Procedures not to spread contamination should be applied.
Remember that radiation exposure or contamination does not cause immediate signs or symptoms, therefore if accident victims are unconscious, disoriented, burned, or otherwise in distress, - look for causes other than radiation.
Module II

21. Tasks of medical responders: radiological triage
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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.
Victims should be monitored at the contamination check point for possible contamination only after they are medically stable. Radiation levels above background indicate the presence of contamination. Simple decontamination (by changing outer dress, and taking thorough shower) could be carried out on the scene if necessary.
Make all possible efforts to prevent the spread of contamination:
move the ambulance bed to the clean side of the contamination control line and unfold a clean sheet or blanket over the bed;
place the patient on the covered bed and fold the sheet or blanket over the individual to “package“ the patient to aid in contamination control; do not wrap injured persons in plastic as this may lead to hyperthermia; do not remove the victim from the blackboard if one was used;
Contaminated wound should be thoroughly and repeatedly irrigated with saline or water if prompt transport to the hospital is delayed for any reason. Wound irrigation should be repeated according to the wound monitoring data. In cases of light superficial wounds, it may be effective as can remove up to 95% of radioactive materials. Skin surrounding the wound should be covered with waterproof material to limit the spread of radioactive material. Contaminated drapes and washing fluids should be collected and monitored (gamma and in most cases beta radiation can easily be detected; detection of weak beta and alpha contaminants needs highly sophisticated wound probes which are normally available in working places where this type of contamination may be anticipated). If injured persons are properly wrapped in a sheet or blanket it is not necessary to cover the inside of the ambulance although plastic covering for the floor may be desirable.
Module II

22. Tasks of medical responders: establish contacts
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
All persons involved in a radiation accident should be carefully interviewed to provide a detailed description of the emergency situation, positions of persons at the scene of an accident and time spent there. This is necessary for the purpose of dose reconstruction.
All necessary information forms - Accidental Exposure Form and Medical Information Form - should be filled in as far as possible on site (see: IAEA - WHO. Diagnosis and treatment of radiation injuries, Safety Reports Series No. 2, IAEA, Vienna, 1998, p.35-40). These or similar forms may then be amended in the hospital in accordance to further clinical, laboratory or contamination data.
When contacting the hospital emergency department, give the staff additional appropriate information and ask for any special instructions the hospital may have. Upon arrival to the hospital follow the hospital’s radiological protocol.
Module II

23. Tasks of medical responders: checking contamination
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
Before leaving the controlled area, medical responders should remove protective clothing at the contamination check point. If possible, the victim should be transported by personnel who have not entered the controlled area. Ambulance personnel attending victims should wear gloves.
The ambulance and crew should not return to regular service until the crew, vehicle, and equipment have undergone monitoring and decontamination, if needed.
[Ref.: IAEA- TECDOC-1092, “Generic Procedures for Monitoring in a Nuclear or Radiological Emergency”, IAEA, Vienna, 1999]
Module II

24. Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
Emergency medical responders should not eat, drink, or smoke at the accident site, in the ambulance, or at the hospital until they have been released.
Detailed procedures how to perform personal and equipment contamination check are given in IAEA-TECDOC-1092 “Generic Procedures for Monitoring in a Nuclear or Radiological Emergency” (Vienna, 1999)
Module II

25. Emergency medical response off site
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
Emergency medical response off site
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
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
Upon notification on the arrival of the accident victims, emergency medical personnel should perform necessary preparations including personal protection.
If a victim is contaminated or suspected to be contaminated, emergency medical personnel at all levels of response should put on and take off protective clothing in the order described on the slide.
Wear protective clothing (surgical clothing, including scrub suit, gown, mask, cap, eye protection, and gloves). Wear waterproof shoe covers. Tape all open seams and cuffs using masking or adhesive tape. Wear two pairs of surgical gloves. The first pair of gloves should be under the arm cuff and secured by tape. The second pair of gloves should be easily removable and replaced if contaminated. Attach personal dosimeter to the outside of the surgical gown at the neck where it can be easily removed and read. If available, a film badge or other type of dosimeter (TLD) can be worn under the surgical gown. A member of the team using liquids for decontamination purposes should wear a waterproof apron .
The purpose of protective clothing is to keep bare skin and personal clothing free of contaminants. Fold-over tabs at the end of each taped area will aid removal.
This protective clothing is effective in stopping alpha and some beta particles but not gamma rays. Lead aprons, such as those used in the X-ray department, are not recommended since they give a false sense of security - they will not stop most gamma rays.
Module II

26. Emergency medical response off site
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
Once the patient arrives at the preplanned reception area, the trained staff determines the general condition of the patient and the severity of any associated injury.
Therefore, the task of medical staff at the first off-site stage should be to identify the type, origin, severity and urgency of the cases. Treatment should be made in accordance with priorities based on patients’ condition. The basic principle is that treatment of serious or life threatening injuries must take priority over other actions.
The medical team members must be capable of carrying out a preliminary assessment, conducting a careful interview and performing triage and any necessary treatment of the exposed persons. This team should include physicians, surgeons, nurses, and a physicist or technician competent in the monitoring and assessment of radiation exposure and radionuclide contamination.
Module II

27. Radiation survey instruments Personal protective equipment Supplies
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
Minimum requirement for equipment and supply for initial hospital treatment
Radiation survey instruments
Personal protective equipment
Supplies
Supporting documentation
Transport
Requirements for the equipment needed at the off-site facility performing initial treatment are presented in the IAEA-TECDOC-953 “Method for the development of emergency response preparedness for nuclear or radiological accidents”.
These requirements cover:
radiation survey instruments: surface contamination monitors, and low range survey instrument to check source.
personal protective equipment: self reading dosimeters for each team member, permanent dosimeters for each team member, protective overalls, overshoes and gloves.
Supplies: plastic covers for preventing spread of contamination, radiation warning labels and signs, administrative supplies.
Supporting documentation: equipment operations manuals, response co-ordination procedures, procedures for conducting contamination survey, for conducting patients decontamination, for transporting contaminated patients, for evaluation of overexposure and for determining if patients should receive specialized treatment, for referral to WHO facility, for recording results, and for personal radiation protection.
Transport: medical transportation vehicle.
Module II

28. Responsibilities of responding medical facility
Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
The management of every designated medical facility is responsible for :
designation and, if necessary, additional training of appropriate staff;
development of detailed emergency plan and procedures;
identification and preparation of reception area and its provision with the necessary decontamination equipment and materials, contamination survey meters, surgical instruments, medicine, etc.;
indication of space where treatment of contaminated patients can take place; and
provision and proper maintenance of special equipment and all necessary materials.
Module II

29. Module II: Medical Preparedness and Response in a Nuclear or Radiological Emergency
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
To test the understanding of the lecture, the following multiply choice questions are proposed. Choose the right answer(s) to each question.
QUIZ:
1. What are the main health effects of ionizing radiation?
a) Psychological effects b) Deterministic and stochastic c) Brain damage
2. What is the example of deterministic effects?
a) Hereditary effects b) Heart attack c) Acute radiation sickness
3. What is the main difference between stochastic and deterministic effects?
a) Existence of the threshold dose
b) Different time of occurrence
c) Location of the injury
4. What is the first priority in on-site managing of victims of a radiological accident?
  a) Perform radiological assessment of the situation
b) Give conventional first aid
c) Collect data for future reconstruction of the accident situation
5. What action should be performed first with the injured contaminated person?
a) Protect environment from the spread of contamination
b) Move injured person to the clean area
c) Provide injured person with conventional first aid
Module II