1. 1 Radiological Incidents

2. 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. 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. 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. 5 Radiological Detection Detecting Radiation –Cannot be sensed by humans Taste, smell, sight etc. –Detectors needed Geiger counters Dosimeters Alpha meters Ionizing chambers

6. 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. 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. 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. 9 Radiation Protection Principles Time Distance Shielding Quantity

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

11. Distance Source 1 meter Dose Rate 100 mrem/hr25 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. 13 Quantity Contaminated Clothing from 1 Victim 2 mrem/hr Contaminated Clothing from 50 Victims 100 mrem/hr

14. 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. 15 Exposure Vs. Contamination Exposure to radiation does NOT necessarily make victims contaminated or radioactive!

16. 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. 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. 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. 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. 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. 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. 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. 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. 24 Phases of Rad Syndrome & Trauma Radiation + Trauma =  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 24 - 48 Hours 3 Months Emergency Surgery No Surgery After 3 Months Surgery Permitted

25. 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. 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. 27 ARS - Central Nervous System Radiation dose > 1,000 rems Brain bleeding and swelling Very disoriented or unconsciousness Death within hours

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

29. 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. 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. 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. 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. 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. 34 Questions ?