Radiologic/Nuclear Hazards

The U.S. Department of Homeland Security has provided guidance for protection and recovery following incidents involving radiologic dispersal devices (RDD), Radiological Exposure Devices (REDs), Improvised nuclear devices and Nuclear Energy Accidents.

Definitions:

• Acute Radiation Syndrome (ARS) - results from high dose exposure to penetrating radiation.
  • Usually involves multiple body systems: Hematopoietic, cutaneous, GI, Neurovascular
  • Dose dependant
• Contamination - results when a radioisotope (gas, liquid, or solid) is ingested, inhaled, or deposited on the body surface.
• Decontamination (radioactive): the reduction or removal of radioactive contamination from a structure, object, or person.
• Exposure - occurs when the body absorbs penetrating ionizing radiation from an external radiation source.
• First receivers - clinicians and other hospital staff who have a role in receiving and treating contaminated victims (e.g., triage, decontamination, medical treatment, and security) and those whose roles support these functions (e.g., set up and patient tracking)
• Improvised Nuclear Device (IND) an illicit fissile weapon
• Nuclear Reactor Accidents - exposure or contamination from system/ transportation failure or sabotage
• REM (roentgen equivalent, man) - an equivalent unit of absorbed dose, being replaced by the sievert (Sv), which is equal to 100 rem
• Radiological Dispersion Device (RDD) - any device that causes the purposeful dissemination of radioactive material without a nuclear detonation. Often refers to "dirty bomb" which uses explosive force to spread radioactive material
• Radiological Exposure Devices - a device intended to expose people to significant doses of ionizing radiation without their knowledge.

Radiological/Nuclear Event - Medical Facility Response

1. Activate Radiologic Response Plan including notification of other regional medical facilities, and civilian authorities such as fire and rescue, police, Hazmat, city and county executives and health departments.
2. Muster Radiological Emergency Medical Response Team - Members including Radiation Safety Officer and other specially trained staff.
3. Contamination control
   1. locate contaminated patient intake, triage/decontamination to areas with restricted access to main facilities, if possible.
   2. Control ventilation
   3. Contain contaminated waste, linen, clothing, belongings
   4. Control runoff from decontamination as possible
4. Assemble necessary supplies, personal protective equipment, distribute dosimeters.
5. Nursing staff provide direct patient care for decontaminated patients, may assist with decontamination when appropriately trained. If contamination is identified while treating, continue to provide lifesaving care.

PPE for medical facility staff when contamination is known to be radioactive

• Outer wear for working in areas contaminated with radiation:
  • Chemical-resistant body suit (e.g., Tyvek® suit)
  • Double layer protective gloves with inner pair and outer pair of two different colors (if possible) and gloves taped to body suit
  • Head covering and eye/face protection (if not part of the respirator)
  • Shoe covers or booties taped to body suit
• Respiratory Protection (decontamination zone)
  • NIOSH approved powered air purifying respirator (PAPR 1000)
  • Combination 99.97% high-efficiency particulate air (HEPA)/organic vapor/acid gas respirator cartridges (NIOSH-approved).
• Radiation monitoring
  • Radiation Safety Team will monitor environment
  • Personal dosimeters monitored by Radiation Safety Officer
• Pregnant women should be excluded from care of the contaminated victims
• Whenever a worker leaves a contaminated area, he/she must carefully remove personal contaminated garments, ensure that their personal dosimeter is returned to the RSO, undergo a personal radiation survey, and undergo personal decontamination if needed.
• Standard precautions PPE required to treat radiation exposed patients if they have not been contaminated.
• Reverse precautions may be necessary to protect radiation victims who are immunocompromised due to radiation exposure.

Recognizing Acute Radiation Syndrome

• Prodromal stage (N-V-D stage): The classic symptoms for this stage are nausea, vomiting, as well as anorexia and possibly diarrhea (depending on dose), which occur from minutes to days following exposure. The symptoms may last (episodically) for minutes up to several days.
  
• Latent stage: In this stage, the patient looks and feels generally healthy for a few hours or even up to a few weeks.
• Manifest illness stage: In this stage the symptoms depend on the specific syndrome and last from hours up to several months
• Recovery or death: Most patients who do not recover will die within several months of exposure. The recovery process lasts from several weeks up to two years.

Additional Resources

• Center for Disease Control and Prevention - Health Alert Network provides access to indepth information regarding emergency preparedness: Bioterrorism, chemical emergencies, mass casualties, natural disasters, radiation emergencies and emerging infectious disease
• Occupational Safety & Health Administration - Emergency Preparedness and Response - Responders provides access to training and tools for first responders and first receivers.

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