1. PLANNING THE MEDICAL RESPONSE TO RADIATION ACCIDENTS RADIATION ACCIDENTS Module XXII

2. Module Medical XXII - 2 Radiation accidents include radiological and nuclear accidents Radiological accidents - in industry, medicine, research, teaching or agriculture - with radioactive material or devices generating ionizing radiation Nuclear accidents - in nuclear facilities when accidental radioactive release affects radiological safety Radiation accidents

3. Module Medical XXII - 3 Radiological accidents occur much more frequently than nuclear accidents have more limited environmental impact can have serious health consequences and rarely also environmental effects l During planning phase register all possible radiation sources l No principal difference between nuclear or radiological emergency planning/response

4. Module Medical XXII - 4 Planning of medical preparedness for radiation accidents must be considered as integral part of medical emergency planning and preparedness established within national framework for radiation protection and safety included as inherent part of general radiation emergency plans

5. Module Medical XXII - 5 Planning medical response to radiological accidents Evaluation of possibilities for and types of accidents Authority familiar with types and locations of radiation sources for region Appropriate medical planning incorporated into emergency plans to deal with any radiological accident

6. Module Medical XXII - 6 Simple classification of persons involved in radiation accident l Persons with non-specific early symptoms and high probability of overexposure to radiation should be transported to specialized hospital l Persons with combined injures (radiation plus conventional trauma) should receive individualized treatment depending on type of combined injury

7. Module Medical XXII - 7 Simple classification of persons involved in radiation accident l Persons with suspected external/internal contamination should be monitored to assess degree of contamination l Persons with potential radiation symptoms do not require immediate medical treatment require urgent dose evaluation

8. Module Medical XXII - 8 l Unexposed persons with conventional trauma should be taken to specialized hospital l Persons believed uninjured & unexposed could be sent home Simple classification of persons involved in radiation accident

9. Module Medical XXII - 9 Planning emergency medical response in hospital l Treatment in hospital Type of hospital/department depends on condition of patient

10. Module Medical XXII - 10 Planning for management of multiple casualties in radiation accidents A.Designate u treatment areas contaminated and non- contaminated patients u morgue areas for contaminated and uncontaminated bodies u Storage areas for a) contaminated clothing and personal items b) waste u Showers for ambulatory patients and staff

11. Module Medical XXII - 11 Planning for management of multiple casualties in radiation accidents B.Plan for efficient use of all trained personnel u Organize training and drills annually u Rotate personnel if possible u Do not use pregnant personnel in contaminated areas u Allocate security personnel to triage area u Housekeeping personnel supply a lot of linen to both contaminated and non-contaminated areas u Central supply and pharmacy supply both areas

12. Module Medical XXII - 12 C.Plan to have a large enough area for triage, radiation monitoring and decontamination of patients (also of staff, as necessary) D.Plan to have necessary equipment and supplies available for use at any time Planning for management of multiple casualties in radiation accidents

13. Module Medical XXII - 13 Planning for management of multiple casualties in radiation accidents E.Plan for error free, efficient methods to u identify patients (and victims) u track laboratory samples and assessments u perform procedures on patients who may have been: F internally or externally contaminated, F irradiated and contaminated. u document (record) all treatment

14. Module Medical XXII - 14 Planning for management of multiple casualties in radiation accidents F. Plan to adapt medical care F Where will tests be done and who will do them? u Will uninjured and uncontaminated but irradiated patients be admitted or sent home? Dose criteria? u Is list of consultants (with phone numbers) available? u What adaptations are necessary in trauma management (in combined injuries)?

15. Module Medical XXII - 15 Planning hospital treatment of exposed patients

16. Module Medical XXII - 16 Planning hospital treatment of exposed patients

17. Module Medical XXII - 17 Planning treatment of contaminated patients in general hospital

18. Module Medical XXII - 18 Planning treatment of contaminated patients in general hospital

19. Module Medical XXII - 19

20. Module Medical XXII - 20 [Ref.: IAEA-WHO Safety Report No.4., IAEA, Vienna, 1998]

21. Module Medical XXII - 21 Medical information form l Medical findings (to be filled by physician) l Name of physician (in block letters) l Name of patient (in block letters) l Date of examinationhour l Astheniayesno l Headache yesno l Nausea yesno time of appearance:number of appearances l Vomiting yesno time of appearance:number of appearances l Diarrhoea yesnoquantity l Temperature l Pulse

22. Module Medical XXII - 22 Medical information form l consciousness normalabnormal agitation delirium sleepiness coma l equilibrium disturbance yesno l co-ordination disturbance yesno l skin and mucosa oedema yesno erythema yesno l other

23. Module Medical XXII - 23 Medical information form Medical information form Treatment and investigations l Undressing*:yesno l Decontamination:yesno l DTPA administration:yesno If yes, administration pathway:aerosol intravenous l Stable iodine administration:yesno When? (date & time) How much? mg/d For how many days?

24. Module Medical XXII - 24 [Ref.: IAEA-WHO Safety Report No.4., IAEA, Vienna, 1998] Medical information form Laboratory tests l BLOOD SAMPLES * First sample (if possible, before the third hour) Date Hour * Blood for cell and platelets count:yesno * Blood for cytogenetic examination (10 ml) :yesno * Blood sample for spectrometry:yesno * Second blood sample (if possible, 2 hours after the first one), date & hour * Blood cell count, platelets:yesno * HLA typing:yesno l URINE SAMPLES:(If possible, for gamma-spectrometry) Is it the first urination after the accident?yesno l DESTINATION OF THE PATIENT (IF SENT FOR FURTHER TREATMENT): l PHYSICIAN'S CONCLUSIONS: l Date:(Signature)

25. Module Medical XXII - 25 Training initial medical carers at accident site Regular training of on-site emergency team to provide initial treatment (emergency aid) Specific training and rehearsal for paramedical or ambulance personnel in safe handling and transport of victims

26. Module II - 26 Training of hospital staff l Who should be trained? l Topics of training l Type of training Lectures Drills Exercises Joint exercises

27. Module Medical XXII - 27 Summary l Radiation accidents are rare but cannot be excluded l Plan medical response and preparedness for effective management of radiation casualties l Planning should include designation of appropriate treatment area regular training and rehearsal provision of necessary equipment and materials for prompt use establishing and updating contact addresses