1. EMERGENCY MEDICAL MANAGEMENT OF RADIATION ACCIDENTS ON SITE AND PRE-HOSPITALIZATION Module XVI

2. Module Medical XVI. - 2 Medic’s problem What is a radiation accident? Is it frequent? What kind of health consequences may it lead to? What are the main types of radiation injury? What are the risks to myself and my colleagues in treating a radiation accident victim? What should I do first? How can I reduce the harm in a radiation accident?

3. Module Medical XVI. - 3 Radiation accident statistics, 1944–June 2001 l Radiation accidents are rare: l In 1944-June 2001 420 radiation accidents led to significant overexposure of at least one person Among 3000 overexposed persons 133 fatalities registered l However, loss of control over radiation sources has led to more severe accidents recently

4. Module Medical XVI. - 4 Types of accidental exposure and associated risk to medical staff l Medical response depends on type and extent of exposure: Exposure of public, workers, patients External exposure only External/internal contamination Combined exposure and injuries l NO radiation threat yet to medical responders on site

5. Module Medical XVI. - 5 Triage Triage Triage - first task for multiple casualties:  Sorting of victims depending on condition, urgent needs and number  Decision on s prompt FIRST medical intervention - life saving s immobilization of fractures s urgent investigations

6. Module Medical XVI. - 6 Radiation does not cause: l Immediate death l Immediate burns or wounds l Irradiation alone not immediate threat to victim not threat to responders or others

7. Module Medical XVI. - 7 l Team co-ordinator l Emergency physician l Triage officer l Nurse l Technical recorder Radiological emergency response team

8. Module Medical XVI. - 8 l Radiation safety officer l Public information officer l Administrator Security personnel Security personnel l Maintenance personnel Laboratory technician Laboratory technician Radiological emergency response team

9. Module Medical XVI. - 9 Assessment of accident scene l What hazards present? l People injured? l How long accident in progress? l How material released to environment? l Where victim in relation to radioactive material?

10. Module Medical XVI. - 10 Assessment of accident scene

11. Module Medical XVI. - 11 Get call-back number and verify accident prior to assembling radiological emergency response team Assume victim is contaminated until proven otherwise Advise ambulance personnel of any special entrance to emergency department for the radiation accident victim Notification and accident verification

12. Module Medical XVI. - 12 Number of victims s Each victim’s medical status s Radiological status of victims (exposed/contaminated) Notificationto receive Notification to receive radiation accident victims

13. Module Medical XVI. - 13 Contamination control during rescue operations l Use personal protective measures and means l Do not eat, drink, smoke, rub eyes, or apply make-up in contaminated area l Use good work practices appropriate equipment control lines. assume contamination when in doubt

14. Module Medical XVI. - 14 Contamination control: patient care l Remove contaminated clothing l Cover patient and secure l Transfer patient l Clean team transfer

15. Module Medical XVI. - 15 Contamination control for ambulance personnel l Remove protective gear at control line and get surveyed Clean team can transport patient to hospital OR Remove protective gear, put on clean gloves and gown, and transport patient l At hospital, transfer patient to clean treatment table in contaminated patient area l Await survey for contamination

16. Module Medical XVI. - 16 SUMMARY - Actions of primary significance in pre-hospital medical management of radiation accidents 1. Rescue, resuscitation, emergency aid 2. Medical stabilization of general condition of victim and of serious injuries 3. Removal of patients from contaminated area 4. Assessment of external contamination 5. Decontamination and decorporation - preventing internal contamination of patient and contamination of staff