2. 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 1

3. OBJECTIVE Assist pre-hospital responders in the initial management of a radiation accident/incident. Identify potential hazards when responding to a radiation accident 2

4. On Scene Basic Priorities Safety of responders Safety of victims Course of action development Contamination control Consequence management 3 Don’t be a Victim

5. SAFETY OF RESPONDERS What Hazards

7. 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. 6

8. 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 (  ) Area contamination status fixed, airborne, liquids 7

9. 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 8

10. Do not let Radiation fears exceed patient needs. 9

11. 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 10

12. 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 11

13. EPA Emergency Dose Guidelines No individual shall be required to perform rescue actions that might involve substantial personal risk. 12

14. EPA Emergency Dose Guidelines Manual Of Protective Action Guides And Protective Actions For Nuclear Incidents, United States Environmental Protection Agency, October 1991, Table 2-2. Dose Limit (rem) ActivityCondition 5all 10Protecting valuable propertyLower dose not practicable 25Life saving or protection of large populations Lower dose not practicable >25Lifesaving or protection of large populations Only on a voluntary basis to persons fully aware of the risks involved 13

15. Contamination Control Most contamination will be on clothes. At least outer clothing 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. 14

16. 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) 15

17. 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 16

19. Loading Area Ambulance Staging Area Control Lines Clothes Off/or Wrap the Pts. Treatment Rapid Transport Treat Life Threats Holding Area for Deceased Survey Holding area Clothes Off Re-triage Decon if stable Holding area Clothes Off Decon Pass victims across control line to ambulance gurney. Package for transport. Multi-Casualty Radiation Incident/Triage Site

20. Let’s Rescue a Patient From a Radioactively Contaminated Area 19

21. Normal Routine

22. RADIOACTIVE CONTAMINATION PROTOCOL Know Your Protocols

23. But I don’t have special suits! 22

24. 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) 23

25. Taping Initially Triple Glove 24

26. 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. 25

27. What are the Contamination Levels? Is it Safe to Enter? 26

28. Yep, it’s Safe

29. Check patient/pre-rolled three sheets Normal Log Roll

30. Remove Clothes Cut Away From Airway 29

31. Roll Contamination Away From Patient 30

32. 31 Cover and Roll Contaminated Clothing In Sheet #1

33. Contaminated Clothing Now Contained Roll Sheet Away From Airway 32

34. 33 Place Backboard Under Sheet #2 Clean Patient Clean Backboard Cocoon

35. Sheet #3 Provides a Clean Platform Leave at Scene 34

36. 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 35

37. 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 36

38. 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. 37

39. 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. 38

40. What’s the BIG picture You can handle this! 39

41. ? ? ? Questions ? ? ? 40