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Radiological Incidents

Radiological Incidents. Objectives. To identify 4 radiation protection principles To describe differences between radiological exposure and contamination To identify key hospital contacts in the event of radiologically contaminated patients. Nuclear and Radiological Risks.

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Radiological Incidents

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  1. Radiological Incidents

  2. Objectives • To identify 4 radiation protection principles • To describe differences between radiological exposure and contamination • To identify key hospital contacts in the event of radiologically contaminated patients

  3. Nuclear and Radiological Risks • Radiological Dispersal Device • Aka: Dirty Bomb • Greatest risk • Simple radiological sources • Transportation of radioactive material, • Likely-Not expected to be mass casualty event • Nuclear irradiation • Bomb (terrorism) • Leak (reactor)

  4. Radiation Basics • Ionizing radiation is electromagnetic energy, or energy containing particles emitted from a source. • In living systems, this causes damage to cells and interrupt normal biological processes.

  5. Radiological Detection • Detecting Radiation • Cannot be sensed by humans • Taste, smell, sight etc. • Detectors needed • Geiger counters • Dosimeters • Alpha meters • Ionizing chambers

  6. Radiation Measurements Measurements: • counts per minute • rads: measure of energy absorbed • rems: measure of potential biological damage International Units: • 1 gray (Gy) = 100 rads • 1 sievert (Sv) = 100 rems Typical Range: • 1 mrad = 10 μGy • 1 mrem = 10 μSv

  7. Radiation Experts Hospitals are well prepared for a radiological event • Experts abound • Radiologists, Nuclear Med, Radiation Safety Officers, etc. • Detection methods already in place & they know how to use them! • LA Co MAC 24/7 (866) 940-4401 • Contact LA Co Radiation Mgmt Office (213) 351-7897 • State (800) 852-7550

  8. Radiation Surrounds Us Natural background and manmade radiation (year) 360 mrem Flight from LA to Paris 4.8 mrem Diagnostic chest x-ray 10 mrem Occupation exposure limit, annual 5,000 mrem Smoking 1.5 ppd - 1 year dose 16,000 mrem Heart catheterization 45,000 mrem Lifesaving exposure guideline 50,000 mrem Mild acute radiation sickness 200,000 mrem Lethal dose for irradiation (approx) 450,000 mrem Protection against ALL radiation follows 4 basic guidelines: mrem = millirem = 1/1000 of a rem

  9. Time Distance Shielding Quantity Radiation Protection Principles

  10. Time 12 Dose 25 mrem Result 9 3 Source 6 100 mrem per hour x 15 minutes (.25 hour) = 25 mrem Limit time of treatment based on Radiation Safety Officers recommendations

  11. Distance 1 meter 1 meter Dose Rate Source 100 mrem/hr 25 mrem/hr A little distance means a lot

  12. Shielding • Alpha Particle • Beta Particle • Gamma Rays • Stopped by thin paper or clothing • Travels several cm. In air with few microns in tissue • Some protection by PPE • Travels up to a few meters in air, millimeters in tissue • PPE will not protect against • Very difficult to shield against, very penetrating

  13. Quantity 2 mrem/hr 100 mrem/hr Contaminated Clothing from 1 Victim Contaminated Clothing from 50 Victims

  14. Radiation Protection Principles • Practical applications of the 4 principles • If standard working PPE is inadequate as shielding, use the following to make a bad situation safer • Limit time in area • Decrease time dealing with the disaster • Increase working distances • Use long handled tools and grabbers • Don’t allow contaminated clothing bags to accumulate in quantity • Spread out contained materials over a large area

  15. Exposure to radiation does NOT necessarily make victims contaminated or radioactive! Exposure Vs. Contamination

  16. Contamination • External Contamination • Material deposited on skin, clothes, hair • Dirty bomb – material exploded into air • Decontamination necessary • Victims are NOT radioactive, but the ‘dust’ is • Internal Contamination • Material becomes integral part of the body • Ingestion-DO NOT lick lips • Absorption from mucous membrane • DO NOT touch eyes, mouth nose • Nuclear imaging or therapy

  17. Management of Radiation Victims • Immediately • Secure hospital entrances and perimeter • Establish triage area outside of hospital if possible • Control ventilation • Issue protective clothing & dosimeters to staff • Establish area for contaminated waste/clothes

  18. Management of Radiation Victims • At patient arrival • Treat life-threatening conditions first! • Consider irradiation/contamination second • Survey patient for radiation ASAP • Use usual triage methods based on complaints • Remove and bag victim’s clothing

  19. Management of Radiation Victims • Decontamination • If there is an open wound decontaminate first, then rest of skin • Cover wound with sterile dressing • Soap/water decon (including hair) • Re-survey patient for radiation • If radiation present, send back through decon • Refer for needed surgery

  20. Management of Internal Contamination • Various medications available for limiting uptake or facilitate removal of radioactive material • KI • Radiogardase (Prussian blue) • DTPA • Bicarbonate • Now part of response stockpiles

  21. Why Radiation Makes You Sick • Some cells in your body have a short life cycle (they reproduce and die rapidly). • Radiation most affects the rapidly reproducing cells which are in the gut, bone marrow and skin/hair. • Once these cells are damaged by radiation, they are unable to reproduce.

  22. Acute Radiation Syndrome (ARS) • Follows a predictable course over a few hours to several weeks • Group of symptoms that develop after total body irradiation (> 100 rems) • Patients are classified in three categories based on signs and symptoms: • Survival probable: < 100 rems • Survival possible: 200 - 800 rems • Survival improbable: > 800 rems

  23. ARS - Phases Prodromal Phase - occurs in the first 48 to 72 hours post-exposure and is characterized by nausea, vomiting, and anorexia. At doses below about 500 rems this lasts 2 to 4 days. Latent Phase - follows the prodromal phase and lasts for approximately 2 to 2 1/2 weeks. During this time, predisposed to infection due to decrease of infection fighting cells. Illness Phase - period when overt illness develop such as infection, electrolyte imbalances, diarrhea and shock. Recovery or Death Phase - may take weeks or months

  24. Phases of Rad Syndrome & Trauma • Radiation + Trauma = á Mortality • Surgical procedures that are not done in the first 48 hours generally are delayed for 2 to 3 months • Major use of hospital resources due to increased risk for infection, bleeding and time in the hospital No Surgery Emergency Surgery Surgery Permitted 24 - 48 Hours After 3 Months 3 Months

  25. ARS - Hemopoietic Syndrome • Radiation dose > 100 rems • Nausea, vomiting and anorexia start within12 hrs & lasts 1-2 days. • Bone marrow depression - lymphocyte count at 48 hours indicates severity • Complications - sepsis, hemorrhage, anemia, impaired wound healing

  26. ARS - Gastrointestinal Syndrome • Radiation dose > 600 rems • Damages intestinal lining • Nausea and vomiting within the first 2 - 4 hours • May develop diarrhea • Associated with severe infections • Bloody diarrhea and persistent high fever are an ominous sign

  27. ARS - Central Nervous System • Radiation dose > 1,000 rems • Brain bleeding and swelling • Very disoriented or unconsciousness • Death within hours

  28. ARS - Skin Black and crunchy Red like a sunburn Weeping skin Blistered Response Flaky 300 600 1000 >1500 >5000 Dose Onset varies from hours to weeks.

  29. Hospital Considerations • Utilize radiation experts in your facility • Call MAC if you suspect a radiologically contaminated patient has arrived at hospital • Phone 24/7 (866) 940-4401 • Contact LA County Radiation Management Office (213) 351-7897 • State (800) 852-7550

  30. Hospital Considerations • Time-Distance-Shielding-Dose • Do not delay treatment for life threatening injuries or illnesses for decontamination • Universal fear of radiation can lead to panic & misunderstandings • Accurate public information essential!

  31. Hospital Considerations • Long-term care and resources may be needed to care for these patients • Internally contaminated victims may need to be isolated from other patients • Most victims will be able to be decontaminated, treated and sent home

  32. Additional Resources • H&HS: Radiation Event Medical Management: remm.nlm.gov • Oak Ridge Institute for Science and Education orise.orau.gov • CDC bt.cdc.gov/radiation • Los Angeles County: MARRP (Multi-Agency Radiation Response Plan)

  33. Summary • Radiation Protection: Time. Distance, Shielding, Quantity • Radiation exposure alone does not usually result in contamination. • Do not delay life-saving treatment to decontaminate radiologically contaminated victims. • Identify your local radiological experts.

  34. Questions ?

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