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Radiologic Events:

Radiologic Events:

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  1. Radiologic Events: Attack on a Nuclear Power Plant

  2. Objectives • Recognize the potential consequences of a terrorist attack on a nuclear power plant • Describe the different types of radiation particles and waves and their effect on the body

  3. Objectives • Differentiate between radiation exposure and contamination • Recognize the characteristic signs and symptoms of acute radiation syndrome • Learn to perform rapid assessment of nuclear/radiation events in a disaster situation

  4. Objectives • Learn specific antidotes and medical interventions for nuclear/radiation terrorism victims • Learn specific pre-hospital and hospital management strategies including proper notification of radiation disasters

  5. Case • Terrorists attack a nuclear power plant 30 miles outside a major metropolitan area by flying a high jacked jet liner into the plant. • The impact results in an explosion and fire. • Fire fighters and paramedics are called to the scene.

  6. Case • There are multiple casualties and several trauma victims are being transported to your health care facility. • The news media is questioning your health team regarding radiation exposure risks

  7. Nuclear Power Plant Disaster: Chernobyl, 1986

  8. Attacks on Reactors • Radioisotopes released • Large quantities of radioiodines and radiocesiums • A large variety of other radioisotopes may be released in smaller quantities

  9. Attacks on Reactors • Which way is the wind blowing? • The radioactive cloud from the burning reactor will travel according to wind direction.

  10. Attacks on Reactors • Prevention • Individuals in the path of the radioactive cloud need to be evacuated

  11. Electromagnetic Radiation • Electromagnetic radiation includes a wide spectrum of radiation energy characterized by frequency and wave length. • Ionizing radiation has high frequency and short wave length

  12. Ionizing Radiation • Ionizing radiation includes both electromagnetic (X and gamma rays) and particulate radiation

  13. Particles • Alpha • Beta • Neutrons

  14. ++ n n Alpha Particles • A helium nucleus • Unable to penetrate skin • Emitted from radioisotopes such a plutonium, uranium

  15. Beta Particles • Able to penetrate skin • Negatively charged • Can produce skin superficial burns • Emitted by several radioisotopes (e.g. Cobalt 160)

  16. Neutron particles • Uncharged • Able to penetrate deeply • Hazard inside nuclear reactors

  17. Penetration Abilities of Different Types of Radiation Alpha Particles Stopped by a sheet of paper Beta Particles Stopped by a layer of clothing or less than an inch of a substance (e.g. plastic) Radiation Source Gamma Rays Stopped by inches to feet of concrete or less than an inch of lead Neutrons Stopped by a few feet of concrete

  18. X-Rays and Gamma Rays • Gamma and X radiation differ by source: gamma rays comes from the nucleus and X-rays come from the electron orbits • Because they don’t have mass or charge, they penetrate very deeply

  19. Detecting Radiation RADIATION CANNOT BE SEEN, HEARD, TASTED OR SMELLED But, it can be easily measured if you have the right equipment

  20. Radiation Detectors Alpha Survey Meter Beta and Gamma Survey Meter

  21. Radiation Dose Units

  22. Contamination • Contact with radioactive material (radionuclides) that can be spread to other people / properties • Inhaled, ingested, transferred from surface to surface

  23. Exposure vs. Contamination External Exposure: external irradiation of the body with rays or particles  absorbed dose Contamination: radioactive material (radionuclides) on patient (external) or within patient (internal).

  24. Adapted from CDC Bioterrorism Web site

  25. If the patient is externally contaminated with radionuclides, you can Decontaminate

  26. If radionuclides have gotten inside the body, consider chelation therapy

  27. Factors Determining Radiation Exposure • Time • Distance • Shielding

  28. Injuries Associated with Radiological Incidents • Acute Radiation Syndrome (ARS) • Localized radiation injuries/cutaneous radiation syndrome • Internal or external contamination • Combined radiation injuries with - Trauma - Burns • Fetal effects

  29. Acute Radiation SyndromeA Spectrum of Disease

  30. Exposure Prodromal Stage Latent Stage Manifest Illness Recovery Time (days to years) Phases of Acute Radiation Syndrome www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp

  31. Stages of Acute Radiation Syndrome Stage 1:(50-150 rads) • No symptoms or minimal viral symptoms for up to 48 hours • Spontaneous recovery usually occurs • Sterility is a risk

  32. Stages of Acute Radiation Syndrome Stage 2: The Hematopoetic Syndrome (150- 400 rads) • Whole body exposure • Bone marrow suppression occurs with loss of WBC and platelets • Infection and bleeding problems occur • LD 50 250-400 rads

  33. Stages of Acute Radiation Syndrome Stage 3: Severe Hematopoetic Syndrome (150-400 rads) • Life saving bone marrow transplantation needed • Care rationing during MCI will lower LD50

  34. Absolute Lymphocyte Count • Measure every 4 - 6 hours initial 48 hours • Normal: approx 2500 cells/ml • > 1200: probably non-lethal • 300 to 1200 cells/ml: significant (hospitalize) • < 300 cells/ml: critical

  35. 1: 1 Gy 2: 4 Gy 3: 6 Gy 4: 7.1 Gy Andrews Curve

  36. Stages of Acute Radiation Syndrome Stage 4: The Gastrointestinal Syndrome (150-400 rads) • GI lining cells die • Severe diarrhea and electrolyte losses • Life saving fluid and electrolyte replacement

  37. Stages of Acute Radiation Syndrome Stage 5: The CNS Syndrome (>1500 rads) • Confusion, ataxia, and sensory deficits • Death within 48 hrs regardless of treatment • Early appearance of CNS symptoms is an ominous sign

  38. Pre-Hospital Management • Evacuation of persons who are in the path of a radiation cloud is the most effective pre-hospital measure – this action is the responsibility of public health authorities • Need effective communication with residents as to steps they can take to reduce exposure

  39. Patient Management - Priorities • Initial triage and decontamination are ideally done outside the hospital (have a plan in place) to avoid contamination of the ED • Patients exposed only to external EM radiation (e.g. x-ray or gamma rays) are not radioactive; patients exposed to particulate radiation will be radioactive • Standard medical triage is the highest priority • Radiation exposure and contamination are secondary considerations

  40. Patient Management - Protocol Based on: • Injuries • Signs and symptoms • Patient history • Contamination survey

  41. Hospital Management • Security • Radiation Safety Officers/dosimeters, GM • 24-hour hotline (217) 785-0600 • Radiation Duty Officer @ Illinois Department of Nuclear Safety • Waste disposal • Labeled, plastic bags

  42. Management • Contaminated patient – immediately isolated until monitored & decontaminated • Monitor EMS and ambulance • ABC’s • Cover all wounds • Radiation burns are like sun burns

  43. 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

  44. Patient Decontamination • Remove and bag the patient’s clothing and personal belongings (this typically removes 80 - 90% 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

  45. Protecting Staff from Contamination • Use standard precautions • Survey hands and clothing frequently • Replace contaminated gloves or clothing • Keep the work area free of contamination

  46. Examples of Radiation Skin Burns

  47. Decontamination of Skin • Use multiple gentle efforts • Use soap & water • Cut hair if necessary (do not shave) • Promote sweating • Use survey meter

  48. 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