Transcript Hospital Preparation for a Radiation Patient

Emergency Department
Preparation for Receiving
Radiation
Exposed/Contaminated Patients
Radiation Exposure/Contamination
• Accidents
•
•
•
•
•
Nuclear reactor
Medical radiation therapy
Industrial irradiator
Lost/stolen radioactive sources
Transportation
• Terrorist Event
• Radiological dispersal device (dirty
bomb)
• Attack on or sabotage of a nuclear
facility
• Low-yield nuclear weapon
Scope of Event
Event
Radiation
Accident
Radioactive
Dispersal
Device
Low-Yield
Nuclear Weapon
Number of Deaths
Most Deaths Due to
None/Few
Radiation
Few/Moderate
Blast Trauma
Large
Blast Trauma
Thermal Burns
Radiation Exposure
(Depends on size of
explosion and proximity
of persons)
(e.g., tens of thousands in
an urban area even from
0.1 kT weapon)
(Depends on Distance)
Emergency Preparedness
 Medical stabilization is the highest priority.
 Contamination control should not delay critical medical
care.
 Be prepared for multiple hazards, including
chemical, radiological, and biological.
 Be prepared for multiple events, e.g., a 1st event
followed by 2nd event used to take out first
responders if terrorists are involved.
 Be prepared for:
 Large numbers of potentially contaminated individuals.
 Large numbers of uninjured and uncontaminated but
concerned and frightened individuals.
Emergency Preparedness

Triage Goals for Mass Casualty
 Evaluate and sort patients by immediacy of treatment.
 Do the greatest good for the most people.
 In mass casualty event, may need to deal with
thousands of persons in need of contamination
and exposure assessment.
 Pre-plan to ensure adequate supplies and
survey instruments are available.
 Training and drills are essential to competence
and confidence.
Systematic Approach
• A systematic approach to handling large
numbers of potentially contaminated individuals
is necessary.
• Such an approach should provide for surveying,
mass decontamination, resurveying, advanced
decontamination (if necessary), resurveying,
and additional decontamination or medical care
as indicated.
• Depending on weather, decontamination sites
may have to be established indoors or in a
temporary shelter.
Contaminated but Uninjured and Worried Well
• An incident caused by nuclear terrorism may
create large numbers of contaminated people
who are not injured and worried people who
may not be injured or contaminated.
• Measures must be taken to prevent these
people from overwhelming the emergency
department.
Controlled Triage Site
• A controlled triage site
should be established
away from the
emergency department
to intercept the large
numbers of
contaminated people
who are not injured and
people who are
uncontaminated but
worried and divert them
to appropriate locations.
Triage Site Control
• Control of movement through the site is
•
•
necessary to minimize the potential for
contaminating clean areas of the site.
The triage site should be staffed with medical
staff, radiation monitors, and security personnel.
Precautions should be taken so that people
cannot avoid the triage center and go directly to
the emergency department.
Decontamination Center
• Establish a decontamination center for people who
are contaminated, but not significantly injured.
• Center should provide showers for many people.
• Replacement clothing must be available.
• Provisions to transport or shelter people after
•
•
decontamination may be necessary.
Staff the center with medical staff with a radiological
background, health physicists or other staff trained
in decontamination and use of radiation survey
meters.
Psychological counselors available
Movement Through the Triage/Decontamination
Areas
• The path through the
triage/decontamination
area must be clearly
marked and individuals
assigned to keep traffic
moving in the right
direction and to prevent
potentially contaminated
individuals from walking
into clean areas, except
by the designated route.
photo credits: M. Meehan
Directions
• Clear directions (in
appropriate
languages) are
necessary to help
individuals
understand what is
expected of them.
Handling of Mass Casualties
Access for
Staff, Press,
Officials
Main
Hospital
Near Emergency
Department
Access for
Selfreferred
patients
Controlled
Triage
Site
Triage for Injury &
Contamination
• Perform first aid
• Perform
decontamination
Community
Area for
deceased
Serious
Injury/Illness
Emergency
Department
Admit
patients
or treat &
discharge
Ambulance
Traffic
Only
Facility Preparation
• Activate hospital plan:
• Obtain radiation survey meters.
• Call for additional support: Staff from Nuclear
•
•
Medicine, Radiation Oncology, Radiation Safety
(Health Physics).
Establish area for decontamination of
uninjured persons.
Establish triage area.
Facility Preparation
• Plan to control contamination:
• Instruct staff to use universal precautions and
•
•
•
double glove.
Establish multiple receptacles for
contaminated waste.
Protect floor with covering if time allows.
For transport of contaminated patients into the
emergency department, designate separate
entrance, designate one side of corridor, or
transfer to clean gurney before entering, if time
allows.
CLEAN
AREA
BUFFER
ZONE
CONTAMINATED
AREA
Treatment Area Layout
Separate
Entrance
ED
Staff
Radiation
Survey
&
Charting
Trauma Room
Contaminated
Waste
Waste
STEP
OFF
PAD
Radiation
Survey
Clean
Gloves,
Masks,
Gowns,
Booties
HOT
LINE
Additional Considerations
• Develop prepared information packets
with Media Relations in advance with
message for incidents involving radiation.
• CDC Web site (www.cdc.gov) has
Emergency Instructions for Individuals
and Families
Available in
English
Español
Deutsch
Français
Tagalog
Chinese
photo credits: CDC
 Health Physics Society
Disclaimer: The information contained herein was current as of 13 Aug 2008 and is
intended for educational purposes only. The authors and the Health Physics Society
(HPS) do not assume any responsibility for the accuracy of the information presented
herein. The authors and the HPS are not liable for any legal claims or damages that
arise from acts or omissions that occur based on its use.
*The Health Physics Society is a nonprofit scientific professional organization whose
mission is to promote the practice of radiation safety. Since its formation in 1956, the
Society has grown to approximately 6,000 scientists, physicians, engineers, lawyers,
and other professionals representing academia, industry, government, national
laboratories, the Department of Defense, and other organizations. Society activities
include encouraging research in radiation science, developing standards, and
disseminating radiation safety information. Society members are involved in
understanding, evaluating, and controlling the potential risks from radiation relative to
the benefits. Official position statements are prepared and adopted in accordance
with standard policies and procedures of the Society. The Society may be contacted
at 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101; phone: 703-790-1745;
fax: 703-790-2672; email: [email protected].