Pre-Hospital Response to Events Involving Radioactive Materials Robert C. Beauchamp, RN BSN CEN NREMT-P REAC/TS Oak Ridge Institute for Science and Education
OBJECTIVE • Assist pre-hospital responders in the initial management of a radiation accident/incident. • Identify potential hazards when responding to a radiation accident
On Scene Basic Priorities • Safety of responders • Safety of victims • Course of action development • Contamination control • Consequence management Don’t be a Victim
What Hazards Safety of Responders
Safety of Victims • Physical hazards at the scene are most likely to force immediate evacuation • At some scenes the chemical nature of the contaminant may be more of a threat to the patient than its radioactivity • Immediate life-threatening problems will be medical and/or trauma in nature and must be cared for.
Victim Risk Analysis • Physical hazards assessment of the Scene. • Life threatening dangers to the victim. • Radiation level (accumulated dose to rescuers/victim) • Irradiation vs Contamination • Types of Contamination (a, b, g) • Area contamination status fixed, airborne, liquids
Mitigating the Radiation Exposure Hazard • Limit time devoted to on scene treatments, remember the Golden Hour. • Have a plan and stay focused. • Perform only the skills needed to sustain life while on the scene. • ABC, C-Spine, Massive external bleeding, major fracture stabilization
Course of Action Development • Scope of the Response • Team Organization (availability) OIC prior to IC identification Haz/Mat, Medics. Firefighters, Police, ? Field Deployment Medical Team(s) • PPE considerations – public safety, police, fire, EMS, and hospital staff
Course of Action Development (cont.) • Equipment: Survey meters, dosimeters, medical gear, litter device, extrication equipment, sheets. • Ingress & Egress routes with control measures • On-scene actions: TREAT LIFE THREATS Evacuation, search, medical care, victim identification
EPA Emergency Dose Guidelines No individual shall be required to perform rescue actions that might involve substantial personal risk.
EPA Emergency Dose GuidelinesManual Of Protective Action Guides And Protective Actions For Nuclear Incidents, United States Environmental Protection Agency, October 1991, Table 2-2.
Contamination Control • Most contamination will be on clothes. Atleastouterclothing should be removed before transport of patient to hospital (to minimize spread of contamination to ambulance and ED). • As much as possible, leave contaminated materials (including the clothes that were removed) at the incident scene. If receiving facility can identify source double bag and take it with you. • Send victim’s identification (in plastic baggie) to the ED with the victim.
Contamination Control • Use sheet or pillowcase to keep from kneeling on contaminated ground • Place equipment in plastic bags. Take in only the equipment you need. • Cover exposed surfaces in ambulance with plastic/sheet. Don’t create a hazard for yourself. • Delineate the contaminated area (signage, tape, markings)
Contamination Control • Restrict access to essential personnel & resources • Designate entry & exit points • Provide radiation monitoring at all entry and exit portals if possible • Establish decontamination sites as dictated by patient medical status • Limit removal of items from contaminated areas
Holding Area for Deceased Clothes Off Re-triage Decon if stable Clothes Off/or Wrap the Pts. Treatment Multi-Casualty Radiation Incident/Triage Site Control Lines Clothes Off Decon Pass victims across control line to ambulance gurney. Package for transport. Survey Rapid Transport Treat Life Threats Holding area Holding area Loading Area Ambulance Staging Area
Know Your Protocols Radioactive Contamination Protocol
Donning PPE • Put on outer garment or scrubs (local protocol) • Put on shoe covers (local protocol) • Put on inner gloves (blue) • Tape sleeves and pants legs (masking tape/duct tape) • Outer gloves (two pair) • Head cover • Face shield • Mask (airway protection per local protocol)
Taping Initially Triple Glove
Approaching the Scene Initial Decision Tree • Are there chemical, physical or radiological threats to the responders? • Are there patients to be treated? • If radiation is the threat, then treat life threatening problems and remove patients from area.
Check patient/pre-rolled three sheets Normal Log Roll
Contaminated Clothing Now Contained Roll Sheet Away From Airway
Place Backboard Under Sheet #2 Clean Patient Clean BackboardCocoon
Removing PPE • Outer booties (if worn) • Outer gloves • Pass dosimeter across control line (if used) • Remove tape at cuffs and sleeves • Head cover and face protection • Outer garments (over shoe covers) • Remove one shoe cover at a time/survey bottom of shoe/step across control line • Remove inner gloves/drop back into contaminated trash • Total body survey
Consequence Management of a Radiation Event • Continued medical support to victims & responders • Environmental clean-up & decontamination • Bioassays screening and, if indicated, whole-body counting • Decorporation therapy (if indicated) • Psychological counseling & support • Follow-up assistance
Suggestions • Assure warmth for disrobed victims. • Showering of victims is NOT normally indicated. • Control run-off of decon solution to avoid tracking to clean areas.
What Have We Learned? • Radiation incidents are manageable • Immediate actions are related to medical needs and are not related to radiation exposure or contamination issues. • Ionizing radiation is detectable and measurable. YOU CAN SEE IT WITH A METER • Responders can safely care for contaminated victims.
What’s the BIG picture You can handle this!