1. Decontamination of Patients
External
Skin
Wound
Internal
Decorporation agents
DHS/NTC
B461 Course

2. Patient Decontamination
Remove and bag the patient’s clothing and personal belongings (this typically removes % of contamination)
Handle foreign objects with care until proven non-radioactive with survey meter
Survey patient and collect samples
Survey face, hands and feet
Survey rest of body
Note: Avoid contamination of the probe.
DHS/NTC
B461 Course

3. External Contamination
Radioactive material (usually in the form of dust particles) on the body surface and/or clothing
Radiation dose rate from contamination is usually low, but while it remains on the patient it will continue to expose the patient and staff
DHS/NTC
B461 Course

4. External Contamination – Remove with Showering
DHS/NTC
B461 Course

5. Decontamination Priorities
Wounds
Intact skin (areas of highest contamination first)
Change outer gloves frequently to minimize spread of contamination
DHS/NTC
B461 Course

6. Decontamination of Wounds
Contaminated wounds:
Irrigate and gently scrub with surgical sponge
Debride surgically only as needed
Contaminated thermal burns:
Gently rinse
Changing dressings will remove additional contamination
Avoid overly aggressive decontamination
Change dressings frequently
DHS/NTC
B461 Course

7. Decontamination of Skin
Use multiple gentle efforts
Use a mild soap & water solution
Cut hair if necessary (do not shave)
Promote sweating:
Plastic wrap, glove, etc.
Use survey meter
DHS/NTC
B461 Course

8. Cease Patient Decontamination
When decontamination efforts produce no significant reduction in contamination
When the level of radiation of the contaminated area is less than twice background
Before intact skin becomes abraded
Consider internal contamination
DHS/NTC
B461 Course

9. Internal Contamination
Radioactive material may enter the body through:
- Inhalation
- Ingestion
- Wounds
Internal contamination generally does not cause early signs or symptoms
Internal contamination will continue to irradiate the patient
DHS/NTC
B461 Course

10. Treatment of Internal Contamination
Rare earths
- Plutonium
- Transplutonics
- Yttrium
Uranium
Cesium, rubidium, thallium
Tritium
DHS/NTC
B461 Course

11. Potassium Iodide (KI) Only helpful in blocking thyroid gland
KI saturates the thyroid gland with stable iodine
KI must used prior to or within hours of exposure to radioactive iodine
See the FDA web site:
Decorporation agent
Provide to Decon Team Members
DHS/NTC
B461 Course

12. Immediate Medical Management of Radiation Exposed Patients
Triage
Acute Radiation Syndrome (ARS)
localized/cutaneous
combined injury
Initial stabilization and treatment
Psychological effects
Record keeping/Dose assessment
DHS/NTC
B461 Course

13. Management - Priorities of Radiation Exposed Patients
Standard medical triage is the highest priority
Radiation exposure and contamination are secondary considerations
DHS/NTC
B461 Course

14. Management – Protocol of Radiation Exposed Patients (Cont)
Based on:
Injuries
Signs and symptoms
Patient history
Contamination survey
DHS/NTC
B461 Course

15. Prenatal Radiation Exposure
Human embryo and fetus highly sensitive to ionizing radiation
At higher doses, effects depend on dose and stage of gestation
Pregnant patients should receive special dose assessments and counseling
Information on prenatal radiation exposure
DHS/NTC
B461 Course

16. Required Conditions for Acute Radiation Syndrome
Large dose
Penetrating
Most of body exposed
Acute
DHS/NTC
B461 Course

17. Never delay critical care because a patient is contaminated
Acute Radiation Syndrome
Never delay critical care because a patient is contaminated
DHS/NTC
B461 Course

18. 1986 Chernobyl Accident
“When workers at Chernobyl who were in the reactor area at the time of the nuclear accident were decontaminated, the medical personal at the site received less than 10 mGy of radiation.”
Mettler and Voelz, New England Journal of Medicine, 2002; 346:
DHS/NTC
B461 Course

19. Skin Effects Epilation Erythema Pigmentation Dry desquamation,
(Shedding, flaking off)
Moist desquamation that heals
NUREG / CR-4214, p II-68
DHS/NTC
B461 Course

20. Treatment of Large External Exposures
Treat patients symptomatically
Prevent and manage infections:
Hematopoietic growth factors, e.g., GM-CSF, G-CSF (24-48 hr) (Neupogen®)
Irradiated blood products
Antibiotics/reverse isolation
Electrolytes
More information on ARS:
Treat patients symptomatically
Prevent and manage infections:
Hematopoietic growth factors, e.g., GM-CSF, G-CSF (24-48 hr) (Neupogen®)
Irradiated blood products
Antibiotics/reverse isolation
Electrolytes
More information on ARS:
DHS/NTC
B461 Course

21. Treatment of Cutaneous Radiation Syndrome
Lesions do not appear for days to weeks
Perform surgical treatments within 48 hrs
Consult Radiation Emergency Assistance Center/ Training Site (REAC/TS) for advice for further treatment, or
DHS/NTC
B461 Course

22. Dealing With Staff Stress
Preplanning
Establish information center
Train staff on radiation basics
Post Event
Debrief immediately after event
Offer counseling
DHS/NTC
B461 Course

23. Bomb Blast - Injury Patterns
Most survivors suffer secondary and tertiary blast effects
Primary blast injury is infrequent in survivors
15% of survivors require hospital admission
The remaining are treated and released from the emergency department
DHS/NTC
B461 Course

24. Staff Preparedness Plan for the needs of the unaffected population:
Ratios range from 5-15 to 1
5-15 “worried well” to 1 actual injured patient
This can paralyze your ED
Prepare to receive large numbers of casualties
Rotate staff to avoid congestion and fatigue
Monitor staff in chemical protective clothing & equipment (CPC&E)
DHS/NTC
B461 Course

25. Logistics/Supplies
Highest priority: getting the right resources to the right place at the right time:
Chemical protective clothing and equipment
Medications / antidotes / vaccines
Mechanical ventilators
Isolation rooms remote from other patients
Identify current inventory and augment as necessary
Develop a procedure to access external assets
DHS/NTC
B461 Course

26. Maximal Utilization of Hospital Space
Identify alternative medical treatment areas
Planning for use of available space:
Open areas
Isolated areas
Temporary morgue
Conference room
Cafeteria
Physical Therapy
DHS/NTC
B461 Course

27. EVIDENCE Handling of Evidence
Maintaining evidence is critical for an investigation:
Clothing
Embedded foreign bodies
Decontamination runoff
Chain of Custody must be maintained
EVIDENCE
DHS/NTC
B461 Course

28. Table Top Exercise
Hospital Incident Management System (HIMS) Hands-on Exercise - Overview

29. Table Top Exercise
Hospital Incident Management System (HIMS) Hands-on Exercise - Report Out