EMERGENCY MEDICAL MANAGEMENT OF RADIATION CAUSALTIES IN HOSPITAL Module XVII.

EMERGENCY MEDICAL MANAGEMENTEMERGENCY MEDICAL MANAGEMENTOF RADIATION CAUSALTIESOF RADIATION CAUSALTIES

IN HOSPITALIN HOSPITAL

Module XVII

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Hospital management of Hospital management of radiation accident victimsradiation accident victims

PotentialPotential problem of admitting victims of radiation accident

Plan & protocolPlan & protocol for emergency department needed to deliver prompt and appropriate medical care to victim

Slight potentialSlight potential for radioactive contamination of hospital team, equipment and facility

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Preparation for hospital care Preparation for hospital care of radiation accident victims of radiation accident victims

Organization of hospital radiological emergency response team

Facility preparation and staff training Patient reception and triage

Decontamination and decorporation procedures

Radiological monitoring & contamination control

Bioassay sampling Post-emergency activities

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Meet victims at ambulance or other transport vehicle at hospital entrance

Instruct ambulance personnel to stay with vehicle until surveyed and released by radiation safety officer (RSO)

Arrival of radiation accidentArrival of radiation accident victims at hospital victims at hospital

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Extended triage and reception of Extended triage and reception of victim at hospitalvictim at hospital

Lifesaving measuresLifesaving measures

Extended triageExtended triage If victim’s condition allows, perform brief radiological survey to check for contamination

Remove victim’s contaminated clothing in or near the ambulance

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Area Selection ConsiderationsArea Selection Considerations Outside entrance with easy access Away from main hospital traffic flow Availability of and storage capacity for

equipment and supplies Sufficient rooms of suitable size for

decontamination and treatment

Establishing radiation Establishing radiation emergency area (REA)emergency area (REA)

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Triage Area

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control control lineline

Plan of hospital reception area Plan of hospital reception area for radiation casualtiesfor radiation casualties

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Procedures for handling contaminated accident victims similar to strict reverse strict reverse isolation precautions and to protocol for isolation precautions and to protocol for “septic” surgical cases“septic” surgical cases

Prevents spread of radioactive contaminants and simplifies clean up

Preparation of radiation Preparation of radiation emergency area (REA) - Iemergency area (REA) - I

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Victim considered contaminated until proven otherwise

Remove patients, uncontaminated casualties, and non-essential personnel from REA before using it

Designate separated part of REA for patient decontamination

Preparation of REA - IIPreparation of REA - II

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Cover route from ambulance entrance to decontamination room, and floor of room and treatment area with wide strong rolled paper

Roped off route and mark “radiation area” Establish control linecontrol line at entrance to

decontamination room

Preparation of REA - IIIPreparation of REA - III

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Life support and other essential medical Life support and other essential medical equipment and supplies should be equipment and supplies should be available immediately and ready for use available immediately and ready for use

Prepare decontamination table and Prepare decontamination table and materials materials

Cover door handles and light switches to reduce contamination that might be spread by hand

Preparation of REA - IVPreparation of REA - IV

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• Prior to patient arrival, check radiation monitors

• Cover probe of contamination monitor

• Check and record background radiation level in decontamination room

Preparation for Preparation for radiological monitoringradiological monitoring

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1. Set up and equip controlled area

2. Restrict access

3. Use strict isolation precautions, including protective clothing and double

bagging

4. Monitor anyone/anything leaving controlled area

Procedures for Procedures for contamination controlcontamination control

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Necessary supply: Surgical gown and suit, mask, head cover, gloves, waterproof apron and shoe covers

Tape all clothing sleeves and cuffs Splash protection for eyes Double gloving procedures Issue personal dosimeters

Response team preparation forResponse team preparation forreceiving potentially contaminated receiving potentially contaminated

radiation victimsradiation victims

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Assessment and treatment of Assessment and treatment of non-contaminated patientnon-contaminated patient

Care for non-contaminated patientsnon-contaminated patients like any other emergency case

Victim of external exposure without contamination poses no radiological hazard

If exposure known or suspected, order blood cell count in particular to determine absolute lymphocyte count. Record time blood sample taken

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SumSummmary: assessment and ary: assessment and treatment of contaminated patienttreatment of contaminated patient

Contaminated patients can have radioactive material deposited on clothes, hair, skin, in wounds, or internally (ingested, inhaled, or absorbed)

Assess level of consciousness and vital signs on arrival

Reassess contaminated patient’s airway, breathing and Reassess contaminated patient’s airway, breathing and circulationcirculation first and stabilize condition After examining patient and identifying all injuries, conduct complete radiological survey (incl. nasal swabs and skin smears)