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( . | |||
PROCEDURES FOR ADMISSION AND MANAGEMENT OF RADIOACTIVELY CONTAMINATED PATIENTS AT SERNALILLO CCUNTY MEDICAL CENTER AND CANCER RESEARCH AND TREATMENT CENTER | |||
( | |||
THE UNIVERSITY OF NEW MEXICO ALBUQUERQUE, NEW MEXICO AUGUST 1979 0 | |||
REVIEWED DECEMBER 1981 8211160546 821108 PDR ADOCK 05000252 F PDR | |||
V : | |||
. DECONTAMINATION AND TREATMENT OF THE RADI0 ACTIVELY CONTAMINATED PATIENT TABLE OF CONTENTS Title Page Number Section 1 - Introduction and General Guidelines for Admissions and Management of Radioactively Contaminated Patients 1-1 Section 2 - Admission, Care and Treatment of Radiation Accident Patients - | |||
2-1 Section 3 - Telephone Numbers of Essential Personnel 3-1 Section 4 - Admission of Radiation Accident Casualities 4-1 Section 5 - Set-up of CRTC Radiosurgery Decontamination Suite (Room 1303) 5-1 Section 6 - Use of Protective Clothing and Dosimeters 6-1 Section 7 - Supply Inventory of Radiosurgery Decontamination Suite 7-1 i Section 8 - Procedures for Patient Decontamination l | |||
and Sample Taking 8-1 o | |||
l l | |||
t I | |||
'e s' | |||
. ATTACHMENTS Title Page Number Admission Procedures for Radiation Injury 2-1-1 Flow Chart for Radiation Injuries 2-2-1 Radiation Emergency Area (REA) 4-1 -1 Types of Dosimeters 6-1 -1 , | |||
Patient Radiation and Medical Status - | |||
Record Sheet. 8-1 -1 ll T | |||
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. SECTION 1 - | |||
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< INTRODUCTION AND GENERAL GUIDELINES FOR r* -- . | |||
u . . | |||
ADMISSION AND MANAGEMENT OF RADIOACTIVELY CONTAMINATED PATIENTS | |||
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'l.O BACKGROUND ~ :M+' . J.r | |||
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=R. ',' In 1979,. the...Bernalillo County Medical'.C.. enter and . .. | |||
. the Cancer Research and Treatment Center of The Univ-ersity of New Mexico established a formal protocol for the admission and management of radiation casualties | |||
~ | |||
arid designated a control 1ed area within. the Cancer Research..and Treatment Center (CRTCl for the . r.e. ception, | |||
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decontamination and emergency treatment'of.such. .. u patients. | |||
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This action. was taken in recognition of Mhe? expanding.. ~ ~- | |||
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.'. research in..- ** . . * * | |||
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New Mexico ' area.F 'Though'.'the" incidence | |||
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:ar The University | |||
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c-v- .. .smaller-hospitals | |||
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.. .:# Mexico : .-: .sha -. si:r:.:alr. -- . eddy.;est.abli:s:hed | |||
= .= . . . :.. . . := -- .-- -:: ..: . ...ai.:: Radiation. | |||
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M m, .-m. e t: =- - - admission and management'of | |||
.c radiation casualties. | |||
: 5. This | |||
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document expressesathese policies and.. specifies the | |||
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1. | |||
/ | |||
t 1.1 Purpose , , | |||
This manual is designed to give both general and specific instructions for the provision of effective care to victims of accidents involving radiation, for protection of patient and hospital staff from injury by radioisotopes, and for prevention of contamination of other hospital areas by the radioactive patient. | |||
1.2.0 COMPOSITION AND RESPONSIBILT. TIES OF THE RADIATION EMERGENCY COORDINATING COMMITTEE 1.2.1 Composition 1.2..l.1 Chairman': R.D. Moseley, Jr., M.D'. | |||
.. . .:. , 1.2 l.2. Members: as elected or appointed | |||
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====1.2.2 'ltesponsibilities==== | |||
See University of New Mexico Policy Manual. | |||
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. . .'E a . r ; . .. .- l..'.~2.d2. .l.'-Policy .and Procedui es - Writ. ten statements of policy | |||
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'f_.._9 M. ff. e W:.. f..and procedures for,the admission and management of i .7:' C.;:. .... .. | |||
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radiation casualties at Bernalillo County Medical Center (BCMC) and the CRTC shall be prepared, distributed to involved individuals, tested 7 | |||
periodically and reviewed annually. | |||
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I 1.2.2.2 Meetings.- | |||
Th.e Committee will meet at the call of the Chair-man. The Committee will consider such matters as affect the institution's preparedness to admit and' treat radi-ation casualties, including availability of trained | |||
. specialistsb statustofusuppliesrand: equipment .andt. : ' | |||
- status of training. | |||
1.2.2.3 Availability and Response - | |||
The Committee shall assure that a trained staff is airailable at all times }to respond to authorized | |||
- requests ,f6r consultaEion Telating-to, or for treat- | |||
,,- ment of' radiation casualties. . . '- | |||
g.- -. ~: ... . . . . . . .. _y | |||
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5 Consultation or ITreatment 5ir. | |||
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1.3.0 r-- - - | |||
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A . 1.3.1. . | |||
General . | |||
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Requirements for consultation or treatment of radi-ation casualties may arise'from cases presented by staff O".''. | |||
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membe. .r.s . of ' .BCMC .CRTC , non-staff physicians;-unannounced | |||
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'iRf=E J.E.w :.3 :.-;OpiQ.yMarrival . of.Jadiition. casualties 3ases).,_ . ~ | |||
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es4cr;c. requests | |||
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o ' ass stance om.non-me ica :--.. | |||
J.:f j ..&i? P?- :'.-*s = '*RjiM MI.i#:- i*Q3.:..-- .r-- - | |||
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_ . . . _ = _ . . . _r . _ . . . . - . , -.:w s =+.::. | |||
. ,t- m persons.,'--:.- du=s | |||
. . and. 2n tri. es ' and : . s . Institutions who.-.may in the haveYorhal hdemeisEs for radiation support. | |||
~ | |||
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.f ,futur It is expected that..if cases are presented from the last | |||
: a. : - ,. | |||
category, the iiidustry or institution will furnish the hospital with a current list of its affiliated plants and I | |||
health physics personnel. | |||
1-3 | |||
.. ,,j....,. - | |||
1.3.2. Cases Presented by Staff Members of BCMC-CRTC or | |||
( | |||
Non-S'taff Physicians | |||
* Staff members or physicians from the community having patients involved in radiation accidents will be referred to the Chairman, Radiation Control Committee (RCC). The Chairman, in consultation with RCC, will advise the physician in accordance with the procedures of this document. . | |||
1.3.3 Unannounced Arrival of Radiation Casualties at the Emercency Room - | |||
Personnel on duty at the Emergency Room shall act in accordance with the instructions contained in a memor- | |||
. . . . .. . ~ | |||
. . . . . w | |||
.; :.. . -..l- andum is included in this... document . | |||
LSection21.> A copy 1.s also on file in the Emergency.. Room. .. | |||
4:. - - | |||
_ . -;l?-ir - - . - | |||
ys.Q a - . | |||
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: 1. 3 . 4. ... Incuiries or: Recuests for Assistance from Non-Medical | |||
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. .- Persons a. = - = - | |||
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. $.' Such-inquiries or requests shall be directed to the | |||
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. Chairman or the Radiation Protection Officar by either | |||
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- - - . . . . . -- ~ | |||
,g, ._1the.te1ephone | |||
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3:-f.m . c 39 cperator or the staff. member receiving | |||
'_. ;...3..,,. ._.. ., | |||
}.p.m.a 2.i. %n .::::.nithe;-inquiry or request. | |||
The telephone operators are in e . i==;.- =1:n ~ .: 4~~ | |||
. ~.-w - ..-.,n2G A ' . s..';. 2. 3.*~~~ . L :..~.. L= -:- '. . . :: | |||
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J r m;:;:. ssession.of the m.emorandum, entitled; " Procedures : ~ ~- | |||
for r .@.:. ~ -:. | |||
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-=. | |||
ar.suw s u... -.~ ...es .. | |||
. u .+ ,-.-- = . | |||
.z. | |||
:- -; =: | |||
L 2.: .W. | |||
a v- .-T.M. Radiat.io.n. Injurv. ", .that 'contains explicit instructions id.&L- | |||
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: m. . , . .-.. ;concerning this matter. A copy of these instructions is | |||
. . . s. . . . . . | |||
."... included in this document (Section 2). | |||
l.3.5 Referrals from Associated Industries and Institutions | |||
, By prior agreement with BCMC-CRTC, employees of lk certain industrial firms and institutions may be trans-l l | |||
l ferred from " local supporting hospitals" to BCMC-CRTC I | |||
l l-~4 l | |||
l | |||
( or treatment of radiation injuries. It is anticipated that such transfers will result from deliberations be-i tween the local hospital staff, the firm or institution director, and the BCMC--CRTC staff. | |||
It is also anticipated that any patient transferred from a local hospital will have been decontaminated, as much as possible. Accordingly, patients in this category, although victims of radiation accidents, may not require admission through the Radiation Emergency Area of CRTC. | |||
, 1.4.0 HOSPITAL ADMISSIONS (see also Section 4) | |||
. -Every -reasonable:ceffort -wili be maderto admit patients who present a radiation or contamination hazard through the | |||
( .. Radiation Emergency Area (REA) (Room 1303) in the.CRTC. | |||
Since the REA can'be set'up.and' staffed for admission of | |||
. radiation casualties.at short notice, advance notification | |||
.., .,.of requirements for these fac'lities i should be made. As | |||
' ' ~ | |||
. used in this document, a radiation or contamination hazard | |||
.will be assumed.to exist if the radiation level emanating | |||
!.h . '!,b . '." - . . . . . e ifrom a radiation casualty or his apparel,is detectable T. .: D.Y.h ..- ".~;2 * ~ | |||
. - .. =- | |||
tTit:.h+i-'ru ~ . a .' .= : : :. . with a portiatile ' beta-gamma G.M. | |||
@Q :-:. z-q;--4fC ".-02 | |||
- ::~> .f"i(:i.ei, #Edice background) | |||
- ~- | |||
. - - ~: | |||
,< . . ..v.--..--- | |||
.u.e | |||
. .~ | |||
survey meter.. | |||
.v-- -:- - - | |||
.- s.. | |||
f - | |||
.: . v.. . .. | |||
1.4.1 . Preparation of Radiosurgerv Decontamination Suite r | |||
Upon notifih:ation of intent to admit a radiation casualty, BCMC shall assume the responsibility of super-j vising the preparation of the Radiosurgery Decontamination Suite in the operating room (1303) of the CRTC. This 1 'i | |||
preparation will be accomplished in accord with the 1 | |||
( | |||
procedure presented in Section 5. . | |||
1.5.0 RADIATION PROTECTION AND MONITORING OF ATTENDENTS Section 6 of this document presents specific operational procedures for personnel working in and supporting activities in the Decontamination Suite. | |||
1.6.0 TELEPHONE DIRECTORY OF ESSENTIAL PERSONNEL, A directory of essential personnel is included in this document as S'ection 3. It shall be the responsibility of the RCC secretary that this directory be kept current. | |||
^ | |||
1.7.0 ' AUDIT OF REA SUPPLIES AND EQUIPMENT | |||
. The UNM Radiation Safety Officer shall conduct an audit o5 the supplles and equipment maintained for use in | |||
: 4. . | |||
the REA. The audit shall be conducted semi-annually and | |||
-7. - | |||
following any actual use. Records of the findings of these audits shall be maintained. Findings that adversely affect | |||
.g , . , . g the state-of-readiness of this procedure shall be corrected | |||
~~.' - | |||
. ~ ~ ~.~ immediately . Significant deficiencies that cannot be | |||
_;.y:. . . | |||
..e. | |||
. i$ . '' O .5,M' corr'ected immediately shall.be brought,to the immediate | |||
~. .. | |||
-.t.. | |||
=. -.... . | |||
'. ...g.. . . - . . | |||
,- S$ datten' tion of the Chairman, RCC. A'n inventory of supplies | |||
.EE..f. | |||
'- maintained for use in the REA is shown in Section 7 of this manual. | |||
: 1. 8 .' O PUBLIC RELATIONS _ | |||
Radiation accidents are a rare and noteworthy event. | |||
i Consequently, they will draw considerable public attention. | |||
To avoid unnecessary alarm, misinterpretation and misunder-1-6 | |||
~ | |||
* e standing, it is imperative that correct and concise | |||
(' | |||
information be given. All reque'sts for information concerning the patient and the accident should be directed to BCMC, Public Relations Office, who will contact the following: . | |||
(1) Chairman, RCC | |||
. (2) Primary Care Physician (3) Director,' 3 CMC (4) Medical Director of Company involved The information on the radiation accident should be channeled by the Chairman,'RCC, through the BCMC Public Relations Office as the central source for news | |||
~~ | |||
dissemination to the media ~. | |||
~ | |||
(. - .:. | |||
e .. . | |||
.l.9.O AMENDMENTS ~AND REVISIONS 7 , | |||
. ~ | |||
,'.".u- - - The secretary, RCC, will submit recommendations for | |||
'T ameridments and/or revision of this document to RCC in the | |||
- course of evaluations made during implementation of its | |||
[- ~ | |||
1 .~ | |||
: i. . . . | |||
provisions, or as a result of his review of the document. | |||
-.x .. . ; -- _ | |||
~ | |||
.$.' The secretary'shd11 conduct an annual. review of the | |||
.'.''~ | |||
I. '}p . a ...;.7 Q. ' 'En%;4. | |||
: . . - . ~~. . . - ,y .--..,.-...~ | |||
- . . .u.- | |||
f.9_C.} * ' "I .Edocilment. and 'reporE | |||
=... | |||
his/lierifindings to. itCC during its i . n.,.q., : | |||
,y . .-- | |||
-_ first meeting of each calendar year. The secretary shall p, . . . .. . - - | |||
~ | |||
' 7- issue copies of approved amendments and revisions to individuals or departments identified in paragraph 1.10.0. , | |||
t 1.10.0 DISTRIBUTION k Copies of this document and all subsequently published amendments and revisions shall be distributed by the 17 , | |||
secretary as shown below: | |||
( . | |||
Radiology (6 copies) | |||
Internal Medicine (Hematology) | |||
- Surgery CRTC Nursing Service (2 copies) | |||
BCMC Nursing Service (3 copies) | |||
Director's Office, BCMC Director's Office, CRTC RCC Members (1 copy each) | |||
Diagnostic Imaging, CRTC Emergency Room , | |||
Radiation Safety Office, UNM (.3 copies) | |||
~ | |||
~ | |||
Telephone Switchboard Office Public Relations Office - | |||
~. | |||
. T,. ; .* . | |||
s- .. . . . , . . :~ _.. - | |||
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.. ,. i: - ,- ',!q : _. | |||
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7 . | |||
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4 | |||
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l-8 Reviewed: December 1981 | |||
,- ,- ~--;;r . ~~ - | |||
SECTION 2 i. | |||
ADMISSION, CARE'AND TREATMENT OF RADIATION ACCIDENT PATIENTS 2.O GENERAL-This memorandum is composed of two partse Part 1 provides administrative guidance on the admission of radiation accident patients. Part 2 provides guidance on emergency treatment of such patients. Radiation safety for BCMC-CRTC personnel is a responsibility of the Radiation Protection Officer. | |||
. PART 1 2.1.0 Admission Guidance'is provided for the unannounced arrival of accident patients under two circumstances: (A) Emergency | |||
.' Room personnel become aware of the patient's status as a | |||
, } | |||
" radiation accident patient..q". before the patient has been | |||
: . removed from the ambulance,Fand (B) the patient has been brought into the Emergency.' Room before his status as a | |||
'. " radiation accide t patient" has been determined. | |||
.3.,.%, _ ,,a.q.-p ,- - . . . ;; a. - .:. | |||
iq';;'.. _ .;-{-( ; ... . , ...:ww.y | |||
:.-- . T.. = ?.i - . . . | |||
.-~ | |||
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.: = .. | |||
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r.,y , :.5.'. | |||
. . (_.AD.ls.'Patierit y.y.: -. | |||
, . . Still. in" Ambulance .. | |||
~~ -' | |||
'- : If minimum medical attention is required, treat | |||
:- . ..a a; . .. . | |||
~ | |||
patient in the ambulance as adequately as possible, while radiation area is being set up. Call the Nuclear Medicine ,, | |||
staff on call to assess the level of radiation contamination. | |||
Instruct driver, attendants and Emergency Room personnel who have been in contact with the patient to stay in the 1 | |||
I vicinity of the ambulance (but not inside the ambulance). | |||
I 2-1 | |||
-j | |||
.? , . | |||
Have security clear an area of about'8 feet around | |||
( ambulance and keep uhnecessary personnel and vehicles away. . | |||
Attend to patient's emergency medical condition as required. Use surgical gloves and mask. If immediate life saving measures are not necessary, observe patient from a distance until the radiation level is ascertained. | |||
1 All equipment and supplies used to attend the patient MUST stay in the vicinity of the ambulance. DO NOT carry anything back to the Emergency Room. | |||
If medical condition of patient is such that he must-be removed from ambulance: | |||
j, - Admit patient to the Radiosurgery becontamina-tion Suite (13031 of CRTC. Keys are in the | |||
( possession of the head nurse of the Emergency Room and the UNM Security dffice. | |||
- Evacuate the operating room of CRTC L1303) before bringing patient in. | |||
~ | |||
.lnstruct driver to stay with ambulance until a | |||
; ,, - ., , ;;;,::, radiation survey has been made. | |||
*q+;" | |||
.1=.3 ' :- | |||
.. .B | |||
. 2j-{pf . ,5 I , Y, .. : .y Bring necessary eq.uipment and supplies to treat | |||
~E + . . . - | |||
'.y.,-y. 7., :- f . 'w -.u . | |||
patient from Emergency Room to the CRTC operating | |||
'3- ' - ' | |||
room. ALL equipment, supplies and personnel entering operating room MUST stay there until l ' | |||
; arrival of radiation monitoring personnel. Estab- ' | |||
lish a guard at the door. Pass Emergency Room fi supplies and equipment into area but DO NOT allow i | |||
f 2-2 | |||
t personnel and equipment to come out. | |||
( Personnel attending patient in area should stand next to patient only as long as necessary to perform lifesaving measures. At all other times, stand about 5-8 feet back and observe patient. | |||
.= | |||
(B) Radiation Status Discovered After Admission' (i.e., on obtaining patient's history) | |||
Immediately secure and label the entire area through | |||
'which the patient has passed and in which he is located. | |||
Keep all personnel and equipment in the area. DO NOr allow anyone or anything to leave. Establish a control | |||
, point th. rough which necessary personnel anci equipment pass | |||
~ ~~ - ' " ~ | |||
'-~~- | |||
into restricted area. - | |||
e .- ... | |||
( Attend to patient's emergency medical condition as | |||
. required. Use surgical gloves, mask and gown when treating | |||
.[ * , | |||
patient. If immediate measures are not necessary observe the. patient from a distance of 5-8 feet. | |||
. .( ..' | |||
..j . ,q . .. | |||
... If possible, ascertain the means by which the patient | |||
,. ..g" .-- . .. . .". . ?.. . - ,~~was.'. transported.to the BCMC-CRTC and inform the Radiation | |||
. , ~ . . . | |||
. . . . ..= : .. - | |||
''4:.Ws.fi'!W:Y@sifety officei.4 - | |||
': i.+ 1. . i... | |||
'\ . | |||
w : .= r n.: e-- = + ...M. -~.c--.:. .: - c..=+...-.-.~... . .: . - . . | |||
-. + = . . -..- - | |||
w r.. s.. ew - .~.. | |||
.c :. ..a-..- - 17.s - ..: -~- - | |||
, w .. .s . .. v - .. . . - . - - :...- | |||
1 . --:c.a ca t ,.: . . m ..: ==. ,..= -. | |||
=- | |||
e. | |||
..w | |||
.:-=-m. | |||
.=..-.g.- | |||
< r. =- | |||
~. :. | |||
c: .-- | |||
.s. | |||
= - - - | |||
. . = .'~ . . . . | |||
' . . a.:, .q r : | |||
. .yj . . . . . ..n,- | |||
r- | |||
, h:,a. G-n | |||
: .. ~.- . .. | |||
?. | |||
f a l | |||
Reviewed: December 1980 l | |||
2-3 | |||
PART 2 I | |||
2.2.0 Emergenc Treatment of Radiation' Accidents ! | |||
2.2.1 General' . | |||
Emergency treatment of radiation acciden't may have to | |||
. be given before contact with or arrival of specialists having expertise in evaluation and managementi of these accidents. In this case, the management of the patient should~ | |||
take place in the following order: | |||
- Resuscitation and Stabilization - Including basic life support and CPR as necessary. | |||
- Initial Decontamination (if not previously done) . | |||
~ ...:. | |||
.((, - | |||
Evaluation of Radiation Status. , | |||
f - Initial treatment of Radiation Injury. | |||
.7 2.2.2 Resuscitation and Stabilization Since radiation injury is not immediately life-43 ;g. . . | |||
.. threatening, primary attention should always be directed T.'- . .' - ~ ' 'ioLtraumatic life-threatening injuries -- maintenance of t | |||
.r.-. - | |||
-2 , . . .l._gt.ta.G ay.z.and breathing, arrest bleeding, treatment of shock, | |||
.g,4 ::. :. h~;.-:yi.v.-.4.h=;+ . . g.:. . . ; - .. | |||
. - - ~ - - - - . ::.. . . . . ... | |||
. . ;.1 a . .: | |||
l -3 | |||
,. ., g_ W cg=;* | |||
'.y, | |||
,, a..- etc, I | |||
, ~ ~ . ;;; . , , . | |||
l ~ ;: ;7.:: | |||
.y.,_ *_...*.~,*.;..,es_,_..-,..-....;.;.. | |||
2 ' | |||
. Decontamination. .' | |||
l Mig - - ~ ' ' - - | |||
i: -- -' | |||
p, . . ... | |||
#6U - - | |||
Concomitantly with the procedure above, or as soon as | |||
~ | |||
possible, the patient should b'e decontaminated. In the initial decontamination: | |||
Survey with a G-M tube and note levels of | |||
' contamination on the radiation status sheets at the end of Section 8. | |||
1A | |||
,* . f : ''i 7 - | |||
.m.: | |||
" %', .s :- p | |||
.v-. 7, | |||
,., ys _- | |||
') | |||
- Removo .nll' , clothing". s | |||
- Remove obvious dirt and debris - bathe, if I - | |||
necessary, while protecting' wounds. | |||
- - Flush wounds with copious amounts f sterile water and/or saline.r. . | |||
- Flush crifices with[ water or saline. Do not i allow patient to swallow. [. , , | |||
s , | |||
7. | |||
2.2.3 Evaluation of Radiation Exposure Status | |||
. 1 History: . | |||
ff | |||
- When did accident occur? , | |||
h | |||
- Source'of accident? '< | |||
. . . ~ | |||
- Type of radioactive' isotopes involved? | |||
- How long was patient in accident environment? | |||
y | |||
. 2 .. . . . . , - . | |||
/ | |||
(- Dose Evaluation: . . | |||
~'' ~ . .. . | |||
This will require the assistance of persons knowledge- .- | |||
.. 4 able in. radiation. This assistance can be by someone on ' | |||
u .- . .. - . | |||
.s location or by telephone._ Inlany case,~ gather as much of , | |||
..e | |||
. the following information as possible: | |||
i . '.- .-.1 .. | |||
g m. . .. . | |||
-.: y 3.._ | |||
4 . | |||
. . D_,: jP. .. ..,.. ~. .. .., .%. | |||
m .:- .. . . .. - Level of. radiat. ion="-i.n accidddf.~. env.ironment. . | |||
..w | |||
:.-15 : . .;w .T+2~: : :. . :.r1. - - , . - :- a.= --! a. - . | |||
M C s.l*1 7 .lf.ff O /: 3 {-i! ?. V " - .i N . -Surface {andaircontiminatiog+;in~/ accident t:ww pr.L ...r;+. :.-- - :. .. ; --- . | |||
- ,.n : -- . -- | |||
m.- | |||
:y. | |||
~~' | |||
).MT*??T'X?.Q. r *F'"~~--* ? . '' environment. =nt=- 1-n, m:sy 3. g . | |||
u | |||
- Level of radiation'o'n patient's or other's | |||
. . . +.:c. | |||
q.*. # , . | |||
dosimeters. ... | |||
. - - 'evel of residuar contamination (Beta, Gamma) on patient using open window G-M tube (mark areas on anatomical diagrams) | |||
- Calculation of dose to the patient and to ( | |||
' attendants , | |||
2-5 'c | |||
. - 'c . | |||
Clinical Picture: | |||
( , | |||
i A good estimation of the severity of the patient's radiation exposure can be obtained by observing the following clinical symptoms and signs: . | |||
Nausea and vomiting: >100 rem (whole body) | |||
Beginning within 2 hours: >4 00 rem (WB) | |||
Beginning within 4 hours: <200 rem (WB) | |||
Skin - Erythema: >300 rem Diarrhea: >400 rem to abdomen CNS symptoms (only relichle in the absence of | |||
. cerebral trauma) : >1000 rem Lymphocyte count within 48 hours: | |||
3 | |||
>l200/mm : good prognosis . | |||
3 s.. 300/1200mm : guarded prognosis 3 | |||
<300/mm : poor prognosis I*' 2.2.4 | |||
, Initial Treatment of Radiation Injurv | |||
[. 5. . .' .,., | |||
..( j Detailed Decontamination - I.t- i's parti'cul'a rl' y/ important 7.m'' | |||
j .., 4 , . . . | |||
at this stage to remove'high' level contamination -- | |||
,,}.?; _ . ' - caused _by penetrating missiles or splinters and | |||
; .: = - - .-:.. - - . . . - .. .:.; ..x | |||
.-- :. - a. .: wounds. . | |||
= . . | |||
. 43g.. .- :;, : .. | |||
J;. ...~; . . - y = .i- - : . | |||
.v .n. .y.- | |||
.-,c..-;;. | |||
Overexposure.. Sinc.e: overexposure to rad. tat-. . | |||
ws: . . , . - .. . | |||
#,3 | |||
,~- | |||
.:j-results in a slowly unfolding course e-i- - | |||
r of time, there is little in the wa-treatment in the initial stage Treatment is symptomatic i patient confortable and a. | |||
k may require an;;ametics, flu analgesics. | |||
o | |||
*% o* | |||
,. _ _ _ _ . _ _ _ _ _ _ _ . _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - ~ - ~ ~ - - ~ ~ | |||
Internal Contamination - Except in a few specific | |||
( . . | |||
instances, there is also little to offer in the | |||
~ way of specific treatment in the initial stages. | |||
Generally, specific treatment to eliminate any absorbed radioactivity requires rather detailed and complex analysis, including whole body count-ing, and measurements performed on serum, red cells, urine, feces and expired gas. If it has been determined that an appreciable amount of radioactivity has been ingested (which is seldom the casel a stomach lavage, emetics (ZnSO 1 or 4 | |||
catharties (10% MgSO ) may be indicated. | |||
4 Suggested permissible levels of attend. ant. exposure | |||
( in the cr urse of treating a patient are: | |||
to 5 rem - routine treatment and decontamination to 25 rem - emergency treatment and decontamination to 100 rem - life-saving treatment and decontamination To estimate attendant exposure, pass the probe of the dose rate meter 6" above the patient. If | |||
~ , | |||
the reading is SR/ hour, and estimate of attendant exposure would be SR if treatment without a shield | |||
"- should take one hour. With a shield, the dose will be reduced by 80%. | |||
Experience shows it is extremely unlikely that : | |||
an accident would be so severe that an attendant would receive an exposure of over SR. In high radiation fields, personnel should be rotated l | |||
2-7 | |||
l in order to minimize the exposure to any single | |||
( individual. I't is also su.ggested that anticipated exposures over SR should be on a voluntary basis. | |||
1 If it has been determined that the patient absorbed I considerable amount of: | |||
Tritium (3 H) - | |||
f rce fluids Iodine L1I) I - | |||
give Lugol's Solution (8 drops in glass of water = 100mg) inject 250mg of potassium perchlorate intraven ously 2.3.0 Principles of Radiation Protection Certain precautions to minimize exposure to attendants are necessary when dealing with a patient who has external | |||
.( ' | |||
contamination, specifically: | |||
Always wear surgical scrub suits, masks, caps, and gloves. | |||
Use the shielding if available in unknown or high levels of patient contamination (greater than | |||
...u .. | |||
,,,{ , ; I ,, SR/ hour gamma radiation at one -footl-when treat- | |||
' , ' ,' ing the patient. | |||
- As few attendants as necessary should be in the same room with patient. | |||
Only in the performance of emergency treatment . | |||
and initial decontamination should attendants be next to patients. At all other times, e.g., | |||
\ | |||
while evaluating the situation, attendants 2-8 | |||
should stand ct least 5-8 fact from the pnticnt and observe.from a distance.. | |||
Rope off and control the area in which the | |||
~ patient is being treated. | |||
ALL persons, equipment and supplies that enter this area MUST stay there until Radiation Emergency Teams arrive to assist in the monitoring and de-contamination of people and equipment. | |||
2.4.0 Initial Bioassay Samples When a patient has suffered internal contamination, | |||
. or when it is suspe.cted, each of the following bioassay samples should be obtained as soon as possible and label-led with*name, date, time and type of specimen. Avoid cross-contamination of samples from external sources of | |||
( | |||
contamination. | |||
. 2.4.1 PBBH Laboratory Blood: | |||
- 10cc for bioassay of radioactive isotopes (1 red top, 2 lavender top tubes) | |||
,- - .~ - - | |||
5,cc (Heparinized) for chramosomes (keep samples i J '. . .. - | |||
, . -v , .. . | |||
- ~ chilled in a glass of ice) (1 green top tube) u .. ~ | |||
l .. 2 .. | |||
- ~10cc for hemogram - complete CBC with differential | |||
. (1 lavender top tube) | |||
- Chemistries - SMAC (1 red top tube) r 2.4.2 other Laboratory Analysis Using the kit provided, samples of the following | |||
( | |||
will be sent to other laboratories (Los Alamos, etc.) | |||
- Urine - first urine - instruct patient initially to | |||
,.a | |||
I | |||
. . . l void when he is medi'cally able. Save this and evsry j | |||
( subsequent voiding. | |||
,All urine - Label with. time, date, and patient name. DO NOT discard any urine. . | |||
Feces - first 4 days - Every sample should be | |||
- collected and refrigerated after being marked with name, date, and time of collection. | |||
Sputum Vomitus Tissue (note location) | |||
Irrigation fluids Filter paper or cotton smears of crifices, wounds, skin areas (note location) | |||
All samples with the exception of routine hematology | |||
( and blood chemistry will be picked up by Radiology | |||
. . (See Page 2.1.2 | |||
. .~* | |||
. s . | |||
r. | |||
( | |||
Reviewed: December 1981 | |||
?_1n | |||
ADMISSIOtrPROCEDURES FOR a* . | |||
RADIATION INJURY , | |||
: 1. Treat traumatic injury (resuscitate and stabjlize) | |||
: 2. Ascertain whether the patient is contaminated: | |||
a) Call the hospital radiation safety office - | |||
UNM ext. or BCMC ext. , in Nuclear , | |||
Medicine and state the situation, asking for assistance. | |||
b) If the radiation safety officer is not available, call the Radiology Staff on call. Utilize the count rate meter in the health physics emergency locker, located in the CRTC operating room entrance area. | |||
., Follow the procedure below: | |||
Turn meter to "batt" position; the indicator should move to the "batt" position on the scale. If it 7- | |||
- does proceed to the next step (if not, plug it into | |||
'a 110v outlet) move the dial to the- XI position. j- | |||
~~.. : > | |||
.','*_,7 ., | |||
Wait until the meter has time to react, then utilize s ],' , | |||
s . | |||
*r . | |||
the probe attached. Pass it over the patient, | |||
.y . . | |||
- assuring that you do not touch body. If you get a marked increase in the number of clicks, you must : | |||
ll assume the patient is contaminated. | |||
, i c) If in doubt... admit patient to the radiosurgery de- ! | |||
d contamination suite in the CRTC. | |||
: 3. If contaminated, decontaminate in the radiosur cry decontamination suite of the CRTC. | |||
~ | |||
: 4. Call for as'istance: s | |||
' Day:. Nuclear Medicine i . Night: Nuclear Medicine Page , | |||
'^ | |||
Radiation Safety Office: Day: | |||
. BCMC Security Office: > | |||
UNM Security Office: | |||
i BCMC Emergency Room: | |||
i I | |||
4 e | |||
i e | |||
S 4 | |||
8 e' | |||
8 9 | |||
4 4 | |||
P . . | |||
( O' 9 e o | |||
* e 4 o | |||
90 e e | |||
* e | |||
.- . * *.;.*- -.i J . . , | |||
t, * . | |||
7 =* *; ; | |||
* G.. + | |||
s | |||
,. s ,e . . * | |||
# ~ = | |||
, .s. :. | |||
4 e | |||
j, 9 | |||
k 2-1-2 | |||
l ,. . i | |||
( | |||
FLOW CHART FOR RADIATION INJURIES j l | |||
l | |||
, ,IS PATIENT MEDICALLY STABLE? | |||
YES NO | |||
\/ | |||
IS PATIENT REALLY / Begin Resuscitative CONTAMINATED? Procedures YES NO WAS THE RADIATION | |||
: -( ' IS THE CONTAMINATION EASIL.Y REMOVED? EXPOSURE SIGNIFICANT? | |||
hO YES NO s y %f Complete Evaluation by Routine D'econtamina - A Hemotologist, s tio_n P.rocedure ; | |||
f Radiation Protec- 4Mildh Evaluation ti n Officer and Id.- H* | |||
o lding Uni . | |||
Health Phys 2.c:.st l Severe l | |||
\/ | |||
Additional Treatment as Necessary Reviewed: December 1981 , | |||
O $ 1 | |||
SECTION 3 | |||
{ . | |||
TELEPHONE NUMBERS OF ESSENTIAL PERSONNEL OFFICE HOME | |||
: 1. UllM and CRTC Administration (area code BCMC Director, Dr. Pitcher CRTC Director, Dr. Tomasi | |||
: 2. Radiology Decartment Dr. Moseley Dr. Christie Dr. Mettler Dr. Kelsey | |||
( | |||
~ | |||
,3 . Nursing Service a) Supervisor b) Emergency Room Charge Nurse | |||
: 4. .F.:diation Emercencv on-Call Roster - BCMC | |||
. .' , (In order of Listing Until Response is Obtained) | |||
.i :. ..a) | |||
'Radiologv Staff on call - | |||
BCMC page | |||
.b) | |||
On call Nuclear Medicine - BCMC page c) Radiation Protection Officer Mr. William Tabor | |||
: 5. Security Decartment, BCMC UNM 3-1 (continued) | |||
6 4 | |||
' - (- | |||
: 6. Department of Surgery . ,. | |||
j Emergency Room Resident on call 1 | |||
s | |||
: 7. De c artment of Medicine (.Hematologyl i | |||
l . Hematologist on call BCMC Operator J. | |||
1 i | |||
if 1 | |||
1 | |||
) | |||
+ , | |||
A J | |||
l I | |||
4 | |||
, 1 . | |||
.{ . ._ | |||
1....-.. . | |||
.. e | |||
,.8.. | |||
1... . * , . ;- * | |||
...- .v. | |||
.* , .)b. .. . . | |||
1..t.- * | |||
* a . | |||
.li v*J 7 4 . . .' . | |||
, . . * *t | |||
.7 e-.- .* | |||
. . : .; .. e . e.s . 4. l..; | |||
s | |||
: 1. - | |||
4 .. ** . .. . | |||
;. m e* , . . " . ' * | |||
*... , e | |||
* j 7 ..s* .. .. | |||
4 J , , . . .' . - . . | |||
,1' | |||
+,. * + | |||
.-s | |||
* f **i * . .T. . . | |||
,.* * * . .' . Ar | |||
* e ., . . | |||
: e. ..- ?- . . . | |||
,. , -e | |||
- =e * .1 9 9. . * ..? . + t | |||
. s ,. | |||
, c. .' 1 - . . ; t e,- | |||
I | |||
. 1 r | |||
1 | |||
* \ | |||
Reviewed: December 1981 j .- 3-2 | |||
f . | |||
S8CTION 4 | |||
( . . | |||
4 ADM5SSION OF RADIATION ACCIDENT PATIENTS | |||
. STAGES IN RADIATION CASUALTY MANAGEMENT | |||
~ | |||
: 1. Area Preparation | |||
: 2. Report of Accident | |||
: 3. Medical Stability Defined | |||
: 4. General Decontamination | |||
: 5. Initial Cleanup | |||
: 6. Wound Decontamination . | |||
: 7. Detailed Cleanup | |||
,j 8. Patient Transfer | |||
'0 ,. | |||
... :... . IMP 9. Exit of Patient | |||
*:--"; .' -. .= =- , | |||
l | |||
: 10. Area and Personnel Cleanup | |||
; ..). . | |||
. .. s-; - | |||
- h- ; . | |||
- w:s | |||
( . . . , . | |||
1 . | |||
l , | |||
6 'e. , | |||
*..- , , 9 4 -* . ., | |||
, oe | |||
=.86 " | |||
8 g g | |||
\ . | |||
1- . s.. | |||
* .m l | |||
l l | |||
l l | |||
l | |||
SECTION 4 | |||
( . . | |||
OPERATIONAL PHASES OF RADIATION ACCIDENT CASUALTY CARE 9 | |||
4.1 Unannounced Admissions The procedure to be followed in the event that a victim of ,a radiation accident arrives unannounced at the Emergency Ward is presented in Section 2. | |||
4.2 Announced Arrival of Radiation Casual' ties The Chief of the Radiation Emergency Team (. Team Chief) is responsible for the general guidance as to the proper management of the accident cases, including | |||
, transportation of these cases to BCMC-CRTC. | |||
( | |||
g.g. .. ; ,_. | |||
Further action involving BCMC-CRTC will take place in five phases: the alert phase, the notification phase, | |||
..g. , , | |||
,. the arrival phase, the clean-up phase, and definitive | |||
! -:3- ..... | |||
care phase. | |||
.3 . . , | |||
: a. . . . | |||
4.2 1;.The Alert Phase | |||
; i': | |||
z :yr: .m.. . . ..~.. | |||
;T.7,f W '.-i'd41- As'ascon as possible, the Team Chief will alert the PBBH x... .- :. . . - .c :: | |||
.u.O.. . .s t. - . ..-a | |||
;- .. . .;u | |||
,gg ry ,-7 . s.: ^P-- .Emer.gencylWard Head' Nurse.of the possible referral of s-- | |||
a;'5- . ..' . '.a f [.4 f.; (a) patient (s) , indicating the most probable arrival | |||
, . #r . | |||
time and the nature and extent of the patient's injuries and condition. . | |||
- The Team Chief will then alert the BCMC switchboard personnel, who will in turn alert other involved members L | |||
of BCMC-CRTC. | |||
Responsibilities of Alerted Personnel | |||
- Surgery: assure availability of an anesthesiologist and other surgeons. | |||
- Administration: alert UNM and BC.MC Security. | |||
- Nursing: stand by ready to set up the Holding Unit. | |||
Assure availability of nursing personnel. Assure ear-marked equipment is ready and available. In the event | |||
' that the Alert is cancelled, notify personnel identified on the Notification Personnel List. | |||
4.2.2 Notification Phase | |||
- As soon as it has been decided that (a) patient (s) will be referred to BCMC-CRTC for observation or treatment, notification will be given by the Team Chief to the Emergency Ward Head Nurse. | |||
( | |||
- This notification' shall contain the following information: | |||
Number and names of patients | |||
. . Estimated time of arrival | |||
~ | |||
-< . Condition of patient (s) | |||
Description of injuries Degree and type of contamination | |||
. 3. 2. .- .. | |||
..:... . e:g . , .. . | |||
Special needs for equipment and/or personnel | |||
..'i; -y: | |||
. ,.=. n:- - - - | |||
. t.; .. , .- . | |||
Responsibilities of Notified Personnel u.. .. | |||
Emergency Ward Personnel | |||
- Supervise and assist in thesetting up of the Radiosurgery | |||
* Decontamination Suite in the CRTC, to include transfer of patients. | |||
- Brief assembled staff on safety procedures to be followed in the operational management of the patient. | |||
4-2 | |||
- Assure that required equipment is ready for use. | |||
I Administration | |||
- Assure that Security Department is instructed to perform the following duties: | |||
- Clear vehicle access to the CRTC. | |||
- Post guards at Emergency Entrance and CRTC-BCMC corridor. | |||
1 | |||
. - Clear access route to CRTC Room 1303 of unauthorized personnel. | |||
- Alert Public Relations, Housekeeping, and such other departments as may become involved. | |||
Radiation Safety Office / Nuclear Medicine i 4 | |||
- Check'all dosimeters and monitoring equipment. | |||
g .;_ , | |||
- Prepare for contaminated sample collections. * | |||
; .r: .' | |||
. v. . . ' i.Q Q.' | |||
;." .,. + 4 , .,, | |||
4 2;3 1. Arrival Phase | |||
- . -;..' .h .. | |||
, - ]j. ;- | |||
j :, -:. | |||
T..BCMC and UNM Security will proceed as follows: . | |||
W . S i-i - : '5,R- - | |||
. j,.j,; .J,. , | |||
- Direct ambulance to BCMC-CRTC common corridor- | |||
. :. . .r :. - . | |||
. ~ *: ,- | |||
* entrance. | |||
. . 2. %. . | |||
~ .. | |||
-- 4 . - | |||
- Secure area around ambulance. | |||
-+ .. . , :s . | |||
: c. - Hold ambulance until cleared by the Radiation 2 . ; | |||
:.; .;.~. - . | |||
~- | |||
' p:- - - | |||
; - J r. ... . .. t. ". ,- . Safety Officer. | |||
SL.The emergency room physician in charge, the Radiation Protection Officer, Radiology staff on call, will meet i | |||
the ambulance at the CRTC. The Radiation Safety Officer i or Radiologist will evaluare the radiation and contamina-i tion status of the patient, ambulance personnel and the i ambulance. They will consult with the Radiation Protection Officer to advise on radiation safety precautions to be i | |||
4-3 | |||
~ | |||
followed. The emergency ward physician will ascertain | |||
( the medical status of the patient. | |||
- The patient will then be brought into the CRTC, Room 1303. | |||
Ambulance attendants and litter bearers will meet beside the ambulance where the radiologist and/or health physicist will monitor them and instruct them regarding | |||
, their personal decontamination. When they have comple-ted decontamination, they will be rechecked by monitoring and permitted to leave the CRTC. | |||
- Only persons and equipment necessary for patient care and treatment will be' permitted in the Radiation Emergency Area (REA). | |||
- After the arrival of the contaminated patient, all persons or items leaving the CRTC will be monitored for radio-3 . | |||
active contamination at the central point. Persons or items found to be contaminated will be decontaminated | |||
. before leaving the CRTC. | |||
$ 4> , | |||
'-. - Should there be a numbhr of patients, the customary mass casualty triage system will be used. | |||
4.2f[, | |||
3 Clean-upPhase | |||
~ | |||
. . =n J - | |||
.,,- .;[y- After the patient has been moved from the CRTC Radiation Emergency Area to the main hospital, attending personnel | |||
#- will proceed with removal of protective apparel, personnel monitoring and decontamination in accordance with procedures e | |||
given in Section 6. | |||
- Radiation Safety Office will provide decontamination instructions and will monitor attending personnel. | |||
- Radiation Safety Office will decontaminate equipment 4-4 _ - _ -- | |||
and all facilities and will collect and dispose of non-( salvageable items. - | |||
As soon as convenient following clean-up activities, all | |||
. personnel who were involved in the care or. treatment of the patient will attend a post-accident conference | |||
. convened by the Chairman of the RCC or the Radiation Protection Officer. The conference will cover such subjects as follows: | |||
Medical review of the event. | |||
Operational review of the event. | |||
Exposures for bioassay of attendant personnel. | |||
Requirement for bioassay of attendant personnel. | |||
s Recommendation for future handling of radiation | |||
.(,- | |||
casualties. | |||
*/ ~ . | |||
Following the post-accident conference, Radiation Safety | |||
.r . | |||
~ '' | |||
.. : will submit a complete report of events to RCC, to concerned regulatory authorities, and to th$e Medical | |||
,c[ | |||
Director or Consultant of the company responsible for the | |||
. accident. | |||
s . _ :-' | |||
..: ., n. - | |||
-' .U' | |||
.- .M . .:. | |||
s . .. . . . | |||
. s.e | |||
?. | |||
l Reviewed: December 1981 4-5 | |||
,,. , ,. .,. ~ . . * - - -* | |||
a e I | |||
'Leatas PAR kin G . | |||
) f | |||
?AmnG: | |||
1 Il(1 1If # | |||
",f * | |||
.., . I E,, , | |||
.,. . . . ., . h . | |||
. . 3 t ; | |||
._...r.h.., _og_ . | |||
4 | |||
. . *b p. . ,. ....e.. | |||
.. s . . A. , . . & '., ..g.a * .. .e .h. | |||
,,.'A.. . . - | |||
~~ | |||
l | |||
', g. | |||
, f, | |||
,.,.A *.. .l t ;. .e*L ? .*: . -!.,. ? ,*.*' .;. | |||
'%' *: .''.yg l_:= . , ! . , | |||
-r | |||
. :: **u*..?**- | |||
.:, e. g. | |||
! . 4, / ., [ . .. . .: 3 .. . Q. .g' 3..,.g'. | |||
i., t .. .. :.., r. +' .v, .~,~s-- . v. ," .~2 * | |||
.r; | |||
: e. .< .. -~,.*. ~ ..e s .f, ': ... 3n :s. . ,. | |||
..s....r.~ .- | |||
, y ., ** | |||
; - "a...;,...._, ..g g,; - | |||
: ,. ; s s r . .v... _ - | |||
..:. . ..<e' | |||
.'. : ., . ...}.t:.. | |||
4 Se%.tDiagi~am:.4 4_1a _ %... 4, s.,., y., :: *. &.c .,~-.z.c... t. el+. g. - | |||
y | |||
<y. n . ...,!. . ... ;,i./. s .. s. .. .:r | |||
. ..... :r. . : 4.1. . | |||
. :s | |||
[ .- | |||
, i, -~.- ?d*:"".~.x,. | |||
n.;:2 . | |||
,_:#~,. | |||
.? ,, ..- . , , ...~ g. - ~ , .p.'. . | |||
I l . | |||
2; g. . . . | |||
e.ca nason - | |||
77An ' | |||
amG.kh r\\\\ \L | |||
.sses I; , .c . | |||
2 - =- | |||
i'6. I.;i. $s! _4-c;_ ~[Eb _. _ _,<. . e- . .- *t j * | |||
.*1-'s5- e-- | |||
Ja 1. . . | |||
. .r .:.,- -.. g ;.. .s .b'. . ->s , | |||
j | |||
-y s .. ,I ss | |||
.M&:e A~.:,. m ..-e,4, > | |||
t .c | |||
~- - - | |||
.cs.a.- @;m. .w w . - %- | |||
e n .t.' | |||
%. . . % *2/:. y;.,.'d..=''-.? Jj .. tJ e s,+., -- | |||
* 4;t p " | |||
: l. . .-;. . | |||
'~~~:..-.- , | |||
i ' ;, - | |||
. .i.?. 3. - . .*. - -' . . -.*.;. | |||
.. 4 C "O. ., | |||
: i fni.'t.: . y . 7.:t.~-i.,'/7., O . ' | |||
..v .. , ..:... , ., . . . .: . . . | |||
--s . s . | |||
e | |||
* e *e S . | |||
4 . | |||
asm 4 | |||
i DIAGRAM 4-1 | |||
_. __. ,_ _ . . _ . . __ _ _ _ _ _ . _ _ _ _ _ _ _ _ _.4 1 | |||
8 i | |||
,( | |||
* 4 i | |||
. YELLOW ROPE BARRIER t I t l l | |||
Nf | |||
, I ' | |||
. I I | |||
I / | |||
I y I | |||
,, 6ECONTAMINATION 1303 G STORED AREA SUPPLIES | |||
[ _ | |||
\ ' | |||
1303 F | |||
1303 E 1303 | |||
;[ . | |||
\ < | |||
=- | |||
J 122 | |||
] - en en . | |||
1303 w-I YELLOW ROPE | |||
' "\ - | |||
JJ -- - -- p BARRIER t | |||
; . ..O; . :- : . . | |||
~. 1303 C - | |||
, HOLDING i'' | |||
' OPERATING ROOM AREA 4 | |||
i Reviewed: December 1981 - | |||
4-1-2 DIAGRAM 4-2 | |||
S5CTION 5 | |||
( . | |||
PREPARATION OF THE RADIATION EMERGENCY AREA 5.1 Purpose To outline procedures for preparing to receive a radi-ation casualty into the CRTC Operating Room of the | |||
. University of New Mexico. | |||
5.2 Definitions 5.2.1 Radiosurgery Decontamination Suite - Room 1303 The area by the scrub sinks (see Diagram 4.21 will be used for decontamination and initial treatment of patients exposed.to accidents involving radioisotopes, s . . | |||
'( 5.2.2 Radiation Emergency Area This designation is given to the Radiosurgery Decontamina-i . . | |||
tion Suite, the adjacent floor passage areas and storage | |||
,. shelves (the Buffer Z~onel , and the utility rooms . During reception and care of a radiation casualty, the Radiation i | |||
Emergency Area is identified by radiation tape and is off | |||
. limits to personnel without dosimeters, i | |||
l ^ | |||
. '5.3 ~ Procedures i 5.3.1 A verbal communication, from either the contamination site a | |||
or the Radiation Protection Officer, will be received by l | |||
the Emergency Ward Charge Nurse stating that the hospital ; | |||
l will be receiving a radiation casualty, with information | |||
, , stating the condition of the patient, estimated time of i | |||
arrival and nature of exposure. | |||
5-1 | |||
5.3.2 ~~The? charge nurse who received the communication in | |||
,( the Emergency Ward will complete appropriate notifications (see Section 3, Telephone numbers of essential personnel).. | |||
At this time, hospital security will be directed to cordon off the parking lot receiving site and to coritrol patient, employee and spectator traffic 2. | |||
5.3.3 The disaster supply closet will be opened by Radiology and appropriate supplies transferred to the Decontamination Suite (see Section 7, supply Inventory). | |||
I' 5.3.4 A regulation stretcher positioned leng'hwise t in the 1 | |||
decontamination suite to accommodate the decontamination tub. A large round plastic radioisotope disposal barrel | |||
'~ | |||
will be positioned,just.underneath the tub drain. | |||
,5.3.5 . The hose showerhead will be attached and tested by the | |||
, , , ,jf,*. ' , | |||
i charge nurse to ensure its functional status. | |||
. 3;1 ~.' . , | |||
C.. 6.1. :, v - | |||
' NO .- . | |||
: 5. 3 . 6' The Buffer Zone, the area immediately outside the | |||
. . w;:: ,- . . . . . . | |||
. t ;.- | |||
Decontamination Suite will be identified with special | |||
. . .:: b. ; . . .: ? '~ a ... | |||
T' A nuclear | |||
~ | |||
a-c | |||
-3' radiation tape provided for this purpose. | |||
~. $.ikil *}ZZ:V$ . . . ." '.. - ide = ~. , | |||
technologist or a physicist will be positioned Pl%Wi; -i#My i | |||
" v5 | |||
^lU~*755r. :- . | |||
.r2*;v.w a? . me'd tiL ,h:W,s. . | |||
cu.> - w?. ' . . *: ' . | |||
i z , . -- | |||
..r.f.'y'A " J.'*.'"..;@~ '.CEF p'g~?goutside z,the Buffer Zone to assist active participants of | |||
?.a L ;; . - . .. w e. - ;n . | |||
' ' f;!~ "V "the Decontamination and/or treatment procedures with appropriate coverings and equipment (ring dosimeters, caps, masks, double sterile gowns, and gloves, foot coverings . | |||
and plastic aprons), with monitoring and packaging of samples and waste, with communications, record keeping and the logistic support. | |||
l 5-2 | |||
( 5.4 Radiation Casualty Treatment Team Personnel required during a radiation decontamination are as follows (see Figure 5.4) : | |||
~ | |||
(1) Surgeon and Nurse A to treat and clean the patient directly within the Decontamination Suite. | |||
~ | |||
(2) Nuclear Medicine Technologist or physicist A to measure radiation levels during decontamination of the patient. | |||
(3) The Radiation Protection Officer or physicist | |||
~ | |||
to oversee the progress of decontamination, interpret radi'r : ion level measurements and to handle patient blood, _ | |||
fluid, and exudate samples. | |||
7 . | |||
^. . .~, . , ~ . ^ . ' . ' . . . . ' ' . (4)~ Two Nurses, B and C, . gowned and positioned within the Buffer Zone, to assist the surgeon and Nurse A, as 1..; .. . t. needed. . | |||
.s. .* | |||
; *-i- 5.5 Cleanup Procedures a . ~.. . | |||
. o -, ...: | |||
;.. When the decontamination patient has been | |||
.y . , -d'. .? '.' .. | |||
transferred from the Radiation Emergency Area, cleanup | |||
:dGj.- s ,. . | |||
~~' '. , ' '- . . .. . .. . | |||
.. procedures will be supervised by the Radiation Protection Officer. Ho sekeeping with the assistance of nuclear medicine technologists, will safely package all radio- , | |||
active waste and wash materials in fiber barrels lined with polyethylene. A through washdown of the area will ensue, and normal useage will be resumed when approved by the Radiation Protection Officer. | |||
Reviewed; December 1981 | |||
, . . , . . .. . . o. . .._ | |||
SECTION 6 t | |||
USE OF' PROTECTIVE CLOTHING AND DOSIMETERS 6.1' To prevent personnel from becoming contaminated with radioactive material, protective clothing will be issued in the CRTC operating room (Rm. 13 03) . | |||
6 '. 2 Standard protective clothing is available: | |||
Standard protective clothing. Essentially consisting of the same items normally used by surgeons in the operating room, i.e., a scrub suit,. surgical gown, latex gloves, and a surgical mask and cap, aug- | |||
~ | |||
s mented by shoe covers and a vinyl apron; to be worn by males and females. | |||
t | |||
:1... '.6.3. Conditions recuiring protective clothing | |||
' "~ | |||
? ,. . . . | |||
(1) All work.past the Buffer Zone boundary requires | |||
.,y, . C'-. protective clothing, independent of the degree of | |||
. m.. .= . y .... , | |||
: . . s ,. . | |||
. l. contamination present on the patient or his clothing. | |||
I | |||
\ .. . . . - | |||
Standard protective clothing will suffice in all | |||
.. 7 '. , ' | |||
. . .. 7.AG&..;:. .. cases where gross decontamination has been performed | |||
~~' | |||
% ws.a .%..k.:. | |||
~ | |||
ni. . ..* .~i.rr.; ... _ | |||
. ' : .* v. q,?-i.&. . c:a. :. x: Sis o..*.* : a;" . ,- ... | |||
... :li.e.,. where very,~ilittl'e " loose" contamination is present) | |||
: mEIF. | |||
'M 14,. | |||
: u. 5:W. | |||
N. C:~2w+:: | |||
. . ~ . . . .. | |||
_ s.wd' G.."'t; 'l'*RhGV | |||
- ^* | |||
* T | |||
:. *. .: F.:+ .,~=~ .= ~- | |||
b....m. or.where the. contamination is confined to a relatively W. ~u..-.li: s w : | |||
.xn .: . . | |||
. . . . . small area. | |||
(2) For complete protection, taping of full protective t. | |||
clothing around the hood, and at the wrists and ankles may be required. For this purpose, 3-inch wide gray tape is available. | |||
6-1 | |||
e . | |||
>( 6.4 Removing contaminated protective clothing (1) Upon completion of their activities in the contamination and treatment room, personnel will proceed to the rope between the contaminated area and the . | |||
Buffer Zone (see Diagram 4.1) , take off the outer layer of the protective clothing and deposit garments in a plastic laundry bag, in the following order: | |||
a) remove tape and hood, if any; i | |||
!, b) remove apron and gown, or coveralls, turning l .. ; . ,, | |||
hhem inside out; | |||
' 2' | |||
'c) remove shoe covers, one at a time, stepping out | |||
,'..:..*..'.r' ' | |||
j of the contaminated area - over the rope - with. | |||
the uncovered shoe; p 1 .g | |||
)..,. | |||
. ..~- | |||
1:. . | |||
g-1e .. . | |||
ic | |||
,yf--- d) remove gloves, mask, and cap. | |||
~ | |||
n. | |||
V - 1. e-' . > . . .* .h M.n.:'.~.G. | |||
- w:: - | |||
: a. .......z.- 2. - . | |||
l! ' - 3? ~ ; ;.i . -;." .,;r - (2). . After rertoval of the outer layer, personnel y_.. . . . . | |||
. : . . a ggr - , proceed'to the Control Point (without crossing the rope between the Buffer' Zone and the uncontrolled i | |||
l . | |||
j hospital area) to have their dosimeters removed j , | |||
and to be monitored for any contamination. | |||
i, I | |||
6-2 | |||
. - - . . e. | |||
Illik - | |||
r 6.5 ~ Clearance procedures (1) In case no contamination is found, personnel may proceed e | |||
l - , | |||
to the change area and put on their normal clothing. . After | |||
. a final check at the Control Point, they will be cleared to enter the uncontrolled hospital area. | |||
(2) In case persons are found to be contaminated, they will take a shower, be monitored again, and, if free from contamination, be supplied with disposable garments; then proceed as described above. The Radiation Protection Officer should be consulted if there is difficulty vich d'econtamination. | |||
'E=- 6.6 hse of dosimeters 9 | |||
:2 . -e : W - | |||
,............:a. | |||
(1) Dosimeters will be supplied at the Control Point to all | |||
. i | |||
~ | |||
s | |||
~ ti.E ~. , personnel entering the Radiation Emergency Area. | |||
-???.5ile,' | |||
No'- - | |||
s', 1,'.rj'.j. . ' JQ.V., " . | |||
,, (2) Desimeters are of three types (see pi= cures at the end of | |||
: t. ' | |||
! this section): | |||
[ . | |||
~. . . | |||
l t' - . ''-f | |||
~- , r. - | |||
a) Direct. reading dos i=e cers (" pen-dosime ters"), tinich | |||
:,' ,. ,,1..- ' .: . . . .d '' .: ' a. - | |||
* .- .', are supplied to all personnel; | |||
, a ., ... . . | |||
l' b' 3adge dosimeters (!~.3 type), also supplied to all l . | |||
re: sonne;; | |||
-\ . | |||
e . . e e u. *. e - % .e " . e o e i m ,s==s (ar.e <. 1= a,s1,=a,.=, a m. , i r. = a s e t ,. e .. . | |||
[ . . | |||
i i t | |||
. . - . -- ... -a. , ..r.u ..* . . r. . | |||
: k. e .' | |||
~ | |||
~ | |||
have to remove highly radioactive foreign bodies. | |||
4= . . | |||
(3) Dosimecars are to be worn: | |||
a) Above the ' sternum, clippe'd to the scrub suit (pen and | |||
> badge do' s imeters) i.e. , under the outer layer of the protective clothing. | |||
. b) On the ring finger of the right and left hand under the glove (ring dosimeters). | |||
(4) Upon leaving the Radiation Emergency Area, the wearer should | |||
* - surrender his dosimeters to the Nuclear Medicine Technologist, who will record the reading of the pen dosimeter and retain y .. | |||
thE TLD dosimeters for later processing. | |||
. . .r . | |||
' , - . . i | |||
: a. . | |||
:~...... | |||
, .1 . | |||
. . . . . . . ( 5. )...The Radiation. ., | |||
4 | |||
.Protection Officer must assure that the records j..4 ; .; .. . . ', . . | |||
. s A; - c'learly show the serial number of.each dosimeter worn by | |||
*~ | |||
J y ., - ,'each individual. who occup ed | |||
- i. the. Rad . | |||
l atiod i 5'mergency Area | |||
. . s. . | |||
w.,. . . . . , . . . . . . | |||
2. | |||
'w . . ,, : ' . | |||
'and duration o' f' time each individual sperit in the REA. | |||
.x.. % | |||
'. ';:.:.~. :. . . ... . .. . | |||
.L . | |||
.u,.f.t..., . :. , ... .. | |||
J. . . ..r. .: . , | |||
.; ... ' - - . . :;g .. . . .. - ; L .. . . ..: .:. . . ;.~ y. . . | |||
s+ ...a...** .m. | |||
* w. .. . . . . | |||
. y:, : | |||
. -:a . , . _ , gg.. | |||
. . . . : . .. ., . , . .m . | |||
,~. . : . | |||
: s. . . ::;.r:t:;. .- u- - .s, s ..-. . | |||
r, g,em. . .- | |||
t . . -.,-- r, * | |||
.w..-- .- | |||
,. ::M. | |||
.; . ,c4- .. .W..$.? . ... . | |||
-} .v. .,.c * | |||
.p . s. | |||
s . . .+ - | |||
. . . . ,$... ,m .. . | |||
p , , .e - .- | |||
rr*.T. | |||
?: c ' . . .:. e-- - | |||
w.c . .. . . - | |||
u. | |||
n3- .. | |||
' .J.e . * . .. a . . . . | |||
r. | |||
l l | |||
s Reviewed: December 1981 | |||
~ | |||
_. SEC'" ION 7 t | |||
SUPPLY I?NENTORY 7.1 Supply Inventory Camma Dose Rate Survey Instrument Digi-Master 1 0.1 mR/H co 100 R/H or PIC 6A Beta-Camma Monitor, R.M. 14 with H.P. 240 Probe 1 | |||
~ | |||
Self-Reading Pocket Dosimeters, 0-1 R 10 The rmo luminescent Oosimeters , Pocket Type 10 The rmoluminesc ent Dosimeters, Ring Type 20 Charger for Self-Reading Dosimeters 1 4 | |||
. . Decontamination Table-Top with Stretcher, Side Panels, 1 Mose, 2 each 5 gallon Containers I.ead Container, high activity samples 1 Kit, decontamination and sample taking. 1 4 | |||
~~' | |||
. ...(see Accachment for inventory) | |||
,g .. | |||
. ..:. . . Hose, low pressure, with shower head and valve 1 | |||
. c; . .L .-- - | |||
~. '6 | |||
. Plastic sheets, 4-5 mils 1 | |||
'.~.. | |||
. ..a . | |||
b. | |||
' ' . - .. Herculite,.50 | |||
',cf.* | |||
. -i.: | |||
i.'.y,..- | |||
. .s. * | |||
-? ' inch vidth , | |||
1 roll s . A , E ,- .. | |||
M..x - i. , ,., .M.a s k i n g tape, 2 inch 4' v.p.: . - 1.- . .-; . r.e - _- | |||
.e .., . , , . : .*Ser,. radiation warning signs, tape and rope f;. .. | |||
1 | |||
. .s, . . . ,3acteries ,. :or ins truments 4 | |||
-s-..- ... .- p.~ .:. - | |||
. .. . 1 -~ - | |||
_17.7 ..'. .- . | |||
. . H. ea.. | |||
d Covers 12 | |||
. 3., : - | |||
Le. - | |||
Coveralls, disposable 12 i' r shoecovers 12 pairs | |||
%; Eazs ;;arze) 20 | |||
=:'. ?a:s : sr.a ' ' ' .. 20 A . u :~ - .: isre . 3" x 1"" I re '.1 i | |||
,,e_. . . ~[ ..v.;:., j5. , .;u *e. ~ ~::.w:. ..: ... -~--~~*r'~~*- ?:- -- - - ~ - ~ ------ --Y:1::.~;,~: .., _ .:: ;;;.-. . . . __ ,,..? ~ ~ | |||
, . . . . . ..._...un......... . T :: :::.:: :~". | |||
- 4g.~3- - - - - - - 4.:;... . | |||
.. ,s. . | |||
* re . * .' p- . | |||
w,.y - * . * | |||
* D(a.. . . | |||
e e.. .e e. . .w. ... , | |||
e * | |||
. . . . . . y '.; - .- :-... . | |||
~ | |||
Signs " Caution Radiation Area". , | |||
4 | |||
'r' | |||
* Signs " Caution Radioactive Material'.' ~ , | |||
4 | |||
. .a: . ., . | |||
S ticke rs , ". Contaminated Material''~ .. | |||
10 | |||
. Barrier Tape . . . I roll t v: - | |||
.:.r- . | |||
~ | |||
Plastic can, 30 gallon, lined with dual 2 polyethylene bags 9 | |||
e. | |||
e 4 % me s | |||
. . . . :. ee, * | |||
* e . easemen a f q" D. | |||
O * | |||
* ?. | |||
+ | |||
5... = | |||
. p e | |||
g'- 6 S | |||
4 | |||
. G i . . | |||
1 e | |||
9 6 . . | |||
no I | |||
e . | |||
W | |||
.-,c , , _ _ _ _ .- - - - - - , -- - , , . , ..-,,,..y y - - __ .t-__ | |||
s!: 7 | |||
: v. . | |||
. 1 | |||
)I ' | |||
p u | |||
{ | |||
... n | |||
( p i i i 7.2 Decontamination Kit .' | |||
\' | |||
k l\ | |||
* / t c | |||
.N s | |||
-l | |||
* \ ' | |||
. t | |||
: 1. Skin Decontamination (a) Utensils: s Absorbent balls, extra large box (l) | |||
Sponge - Holdicg forceps 1 Plasti,e beaker, large 2 (co discard used sponges) | |||
Pre-op sponges 6 | |||
~- | |||
( for large area decontamination) ,, | |||
. surgical hand brushes | |||
. k' ash bottle 1 | |||
.3 (co hold water for decontamination) l' , | |||
1 l - | |||
(b) Decontaminants: t l | |||
l- , | |||
2 Ivory Soap e | |||
l'n | |||
( for first decon effort, r .u l> | |||
i 2 | |||
i Radine Wash | |||
( f:: se:end decen ei h r:) | |||
l Ilorox, bottle 1 ) . | |||
.. .::_.i .aaninz a :ensi's: . | |||
~ | |||
p-t . , | |||
-A " | |||
/ 'J | |||
/ r, k | |||
l - | |||
T" Sterile nauze pads, 4x4-inch, . box (l) i'n box | |||
' Surgical gloves, assorted sizes 5 t - | |||
. g sterile, pair | |||
: s. : | |||
1 L ' , Solu-# on bowl, pl astic Plungerless syringes, 50cc, 1 ei | |||
, sterile j | |||
' I ii t F | |||
/ Cotton tipped applicators pkg(1) i (b) Cleansina asents: - | |||
t I | |||
Salin'e solutions, normal 1 ,! | |||
sterile, bottle , | |||
Hydrogen Peroxioe, 3% solution 1 j- | |||
- bottle 3 | |||
s | |||
,P - i | |||
. 21 f, Miscellaneous Y.acerials | |||
) n F - | |||
l Nivea cream, jar 1 l (amply on dry skin after complete decon) | |||
A . | |||
, Prep Kit 1 | |||
.? ,.' | |||
~ | |||
(for clipping and shaving) | |||
Nail clippers, pair 1 l . | |||
- 5:it.' sors , heavy duty HARE, paramedic 1 Medica'. and Radia:icn 5:a:us Card 3 r | |||
T.:s:.: ta:s, asser: en: . | |||
:: s.cid de::r ma:er.als af:er usef Tar.s, vi:h vira li f | |||
s- >, | |||
.l | |||
1 , | |||
= | |||
0 (to indicace concents of con =ainer and bags) | |||
Tissde paper, box 1 | |||
!!otebook | |||
* Pencils i | |||
6 O | |||
e O | |||
f e | |||
O e | |||
e 4 | |||
-9 g O | |||
O | |||
?. | |||
N | |||
* ,f a | |||
w- | |||
t 7.3 Sample Takine Xit I | |||
I I | |||
: 1. Blood Samoling | |||
. Vacu tainers , heparinized, 6 10 m1, s cerile Vacutainers. uncoated, 6 10 ml, sterile vacutainers, oxalated, 6 10 ml, sterile Vacutainers , EDTA 6 10 m1, ster.ile Needle-holder combination, sterile 12 Alcohol wipes, sterile, 12 | |||
~ | |||
- pre packaged | |||
: 2. 'Jou n 'd Fluid , Nose Swabs Cotton tipped applicato.s, in test tube, sterile F.nve lop e s , (for storate of nose swabs) | |||
Tissue paper, box ( for nose blows) box (1) | |||
: 3. Small Soecimens (hair,. nails, tissue samples, sputum) s-3sceles, wide mouth, 100 ml 5 | |||
. Excreta. Irrication Fluids. Vo=itus . | |||
.:r. las:i: f:: feces sa=rles 2 | |||
'- i e: see:i::iners. 25?: 5 | |||
- : : '. | |||
* s . v :e .ou:h, 5 ' .. f: : | |||
: .'e::ic | |||
. :f irri;a:ien f'.uids | |||
* .*e e e | |||
_ - _ , . - - _ . _ . -. y - __ _ | |||
g . , | |||
***++ | |||
(. NUCON _ smear pads, witN envelopes 50 | |||
: 6. Miscellaneous Items _ | |||
Plastic bags, assorted sized 10 Tats, with wire 20 ' | |||
Labels, self-sticking 20 Medical & Radiation Status Card 5 Notebook | |||
. Pencils 1' | |||
i _ | |||
:q 1 | |||
~ | |||
l- . . | |||
s . | |||
s s | |||
i 4 | |||
J r. | |||
I . | |||
i Reviewed: December 1981 | |||
e . . | |||
SECTION 8 P (OCEDLIREh FOR PATIENT DECONTAMINATION AND SAMPLE TAKING 3.0 Ceneral These procedures cover the use of the Decontamination and Sample Taking Kits. The kits provide all the necessary items for the decontamination of a radioactively contaminated patient and the collection of specimens of this contamination. | |||
The collection of specimens is a prerequisite for a thorough evaluation of the medical and radiation status of the patient. | |||
,, It should be performed in conjunction with patient deconta=ination. | |||
. Section 7 provides a parts list for each of the two kits. There | |||
, , is also a parts list in each kit. Following use, the lists should be consulted for replenishment. The intended use of several of the items is indicated on the parts list. | |||
This section contains a copy of "?atient Radiation and Medical | |||
. '. Stacus Record Sheet". | |||
This form should be used to record essential i | |||
.s. | |||
data on the satient's medical and radiation status. | |||
ma 5 '. | |||
/ | |||
A.1 Patient Dec'ontamination Procedures I | |||
8.1.1 Principles | |||
: a. The objectives of decontamination are: | |||
, -(1) to prevent injury caused by the presence of radioactive, substances on the body; (2) to prevent the spread of contamination over and into the patient; (3) to protect attending personnel from becoming contaminated themselves or (in extreme cases) from being exposed to a source of radiation. | |||
. _; . . b. Although decontamination should be started as soon as i | |||
possible, primary _ attention should be given to the alleviation | |||
. . of life-threatening conditions created by traumatic injury. | |||
: c. Decontamination is essentially the physical removal of | |||
: 1. .' | |||
radioactive dirt from the skin, vounds, or body orifices. | |||
- M.ost decontaminants contain detergents or other chemical | |||
~. | |||
', agents to facilitate this removal. Therefore, most decontaminants are suitable for decontamination of the intact skin only, i.e., are not appropriate for wound cleansing | |||
. :: irriga:icn of body orifices. | |||
: d. :ecen:aminati:n is perforned: . | |||
s '. , from :he '. oves: level of con:amina: ion :s the hi;hes:: | |||
5-f | |||
r: | |||
9 (2) starting vi,th the simplest procedure (e.g., soap and water) to more complicated procedures; (3) with due regard to contamination of wounds, body orifices, etc. (see below for specific guidelines). | |||
: e. Usually, the effect of decontamination is greatest in the aarliest stages, i.e. , most of the radioactive material is removed during the f.irst decontamination ef fort. Continued decontamination may show diminishing effectiveness. At some point, a decision has to be made to either accept some | |||
~ | |||
residual contamination, or proceed with the use of more potent decontaminants (more specific guidelines below). | |||
'8 .1. 2 Measures to be Taken before Decontamination 1 | |||
, . a. Assuming that gross decontamination has been performed at the Nuclear Power Station, it can be expected that the | |||
. ., residual contamination is minor, and/or that serious contamina: ion is localized, e.g. , around and in a wound. | |||
. . Before decontamination, :he following s:eps should be taken: | |||
-.r . . | |||
(1) judge whether the patient's condition requires immediate | |||
'~ | |||
. c. . ,c. . A, $ r | |||
,, .,,.. .?;, - . Int e rvention; if so, proceed, covering the contaminated | |||
~,- area with a plastic drape or ,a covel; (2) obtain a briefing from the Na:1 ear Power Station heal:h | |||
?. | |||
physi:is: as to :he con:amina:icn s:atus of :he pa:ien: | |||
and as :o :he specifi: naasures :o be :aken by at:ending 5-3 | |||
I p'ersonnel dich regard to their protection. Confirm this in consultation with.'the Radiation Protection | |||
. Officer. | |||
(3) monitor the patient with the radiation survey instrument by scanning the entire body (holding the probe about 2 inches from the skin) and record the findings on the | |||
. PATIENT STATUS RECORD SHEET; decide in which order skin decontamination shall be performed; (4) inspect wounds, inquire about their decontaminatien at the site of accident, and decide whether further | |||
.vound decontamination or creatment can safely be postponed until completion of skin decontamination; | |||
__.=- | |||
(5) make a decision as to whether certain samples should f | |||
be taken (see paragraph 8.2 for further details). | |||
. ~. | |||
: b. In case no decontamination has been performed | |||
..,- ..~ | |||
c | |||
~ ~ | |||
. , ., (mos: likely because of an urzent need for emergency surgical creatment): | |||
-. . .. " . tas- (1) perform a gross decontamination by removing all clo:hing | |||
.i... - 5.w 4 . . .. , . , , | |||
< ._ ' and obvious dtrc and debris; if immediate intervention | |||
, is necessary, cover the contaminated area vich a plastic drape and preceed; | |||
. .i a: :he s a=e :i=e, ob:ain a briefine fre: any accompanying personnel as :o :ne =easures :: | |||
be taken by at:ending personnel vi:h regard :o :hei: | |||
3- | |||
e . . | |||
proceetion;" | |||
~;. y 4 | |||
after the emergency creatment, proceed with the applicable steps described under 8.1.2a(2) to (5) above. | |||
8 .1. 3 Decontamination Technioues | |||
: a. General | |||
. Two general rules apply to the performance of decontamication: | |||
(1) check the effectiveness of the technique applied by monitoring periodically; (2) , avoid the spread of radioactive materials from the area being decontaminated to areas of lesser contamination | |||
=L by covering the adjacent area. | |||
Except when prohibitive degre s of contamination are present on/in any of the locations listed below, | |||
, ,, decontamination is performed in the following order: | |||
(1) wounds and adjacent skin; (2) body orifices and adjacent skin; | |||
.. .., . .1- . . . | |||
'. t;@a. s | |||
~.'27.". | |||
~...:,,. . . | |||
e ~ . ~: (3) other skin areas. | |||
' T.m+ . | |||
. M1 | |||
..'ag.' | |||
* . ,[ , | |||
: b. Decontamination of Wounds (1) use acerture drape | |||
* isolate ene :enta=inated area: | |||
3-5 | |||
-(2) take sample' (see paragraph 8.2.la): | |||
(3) decontaminate skin adjacent to wound as described below; (4) depending on surface and depth of wound, irrigate wound with sterile saliae. dab with v | |||
gauze pads and sterile saline | |||
. or use applicators to cleanse wound; collect all materials used, and place in labeled containers; (5) remove obviously necrotic and devitalized tissue surgicall'y; keep all tissue specimens removed (see | |||
~ | |||
paragraph 8.2); | |||
~ | |||
(6] monitor wound; record result , | |||
.,.~":. | |||
(7) if contamination persists - consult with Radiological Proteccion Officer to determine further course of action; (8) if wound clean - creat wound as indicated. | |||
: c. Decontamination of Body Orifices | |||
. .._3. | |||
(1) take samples of activity in nares, ear canals, and other | |||
:., ..y .zi.; . ; .g . ..- : | |||
i4. 3. ,. u*. ..,'f. | |||
' I .~- orifices as indicated (see paragraph 8.2.la); | |||
.: . p... .' . .. . | |||
c . . . . . -. | |||
w.-. . | |||
,_' (2) deconta=inate area surrounding orifices as described be low; | |||
' 3 '. ;ently c'.ean erifice using wetted swabs * . | |||
s a) if nose swab indicates significant radioactivity in "6 | |||
nasal cavic'y, irrigate _. | |||
( 5 )' collect all materials used, and label containers. | |||
: d. Decontamination of Skin p | |||
(1) take smear sample of area (see paragraph 8.2.la); | |||
- (2) protect ad jacent area by covering with plastic drape or towels; (3) cleanse skin area: | |||
around wounds and orifices: | |||
tepid water, using large absorbent balls. | |||
cover entire contaminated surface with a good lather, repeatedly renewing cotton balls. | |||
~ | |||
remove lather after 2-3 minutes by wiping repeatedly | |||
. '.,- with wetted cotton balls; monitor; record result, other skia areas: wash thoroughly with Turco decon | |||
~. | |||
u.. ' ... . | |||
1 | |||
. ' . ~. . . . . . - | |||
soaps- - . 'and tepid water, using either cotton | |||
. .l .. | |||
., _ y.. | |||
: .a ; .. : . 7 . .. - ,. , | |||
~ | |||
*" * ~" | |||
. balls, _ . . _ , pre-op sponges, or hand brushes; | |||
: f. j - | |||
. . cover area vtch a good lather; rinse off ate 2-3 minutes with unning water; =onitor; record result. . | |||
'. ;. if centa=inati n persists: repeat step (3) once; 5-7 | |||
1 | |||
( . . | |||
(5) if contamination still persists: try gentle application of clorox or hydrogen peroxide NOTE: | |||
(avoid any of these entering wound or body openings); | |||
repeat a few times using new cotton balls; remove | |||
? decontaminants with water; monitor; record result P | |||
(6) af ter complete decontamination: dry skin and apply skin cream (7) if residu'al contamination is present: consult with the Radiation Protection Officer to decide whether further efforts are indicated; if it is decided to accept residual contamination, dry the skin and apply collodion, mark area involved, record, | |||
. (8) collect all materials used and label containers: | |||
NOTES: | |||
8 in case of serious contamination around a wound, rapid removal of the bulk of radioactivity can be obtained | |||
< =:- . : . | |||
3'- . . . | |||
by shaving ,_ | |||
the adjacent skin; | |||
...~ | |||
in case of serious conta=ination of hair, or undernails: | |||
.? | |||
clip | |||
-.: ?recedures for Sa=cle Takint - | |||
. . . Princioles e-S | |||
: a. The objectives of collecting specimens from a radiation acci' dent victim are: | |||
(1) to evaluate crA amount and composition of the radioactive contami..- a and in the body; (2) to obtain-data,vich regard to the patient's exposure to external, and internal radiation. | |||
(3) to supply information on the biological injury inflicted by the irradiation. | |||
. b. To me e t these objectives, the following types of specimens are c"ollected routinely: , | |||
(1) materials containing the external contaminant (swabs, smears, tissue samples, contaminated cleansing fluids, | |||
. etc.); | |||
(2) specimens containing internal contaminant (feces, stools, | |||
~ | |||
~ | |||
sputum, etc.): Collect all samples. Remember an initial negative result does not indicated-no internal cont:=in. | |||
.. . . cion..(eg.. material may not be in ur in e , etc. yet). | |||
in case of neutron irradiation: materials in which (3) | |||
\ @- * | |||
.. . - :, - ~~ | |||
*' | |||
* neutron induced radioactivity may be present | |||
, f, ., | |||
. - .-.... . ./" ..~ .. . | |||
j '..g ,;j.7, . +2. . 1 (hatr, nati citppings); | |||
j '. . f. , . . . . - . g. ._ :. - | |||
i j .:. -e.: ., e. ..w. . . | |||
's ( !. ) he=atological specimens (whole blood in heparinited, | |||
! :xalated, and uncoated t'ubes; blood s= ears, leukocyte a | |||
counts?. | |||
: t. As the analysis of radioactive samples with regard to their l | |||
50 Y | |||
l L- | |||
composition is only possible in samples with a relatively high radioactivic'y, care should be taken to collect and store these samples separately from the usually bulky samoles wich' rather low radioactivity (such as cleansing fluids, drapes. | |||
towe ls , e tc. ) . | |||
i | |||
: d. A sample which is not identifiable as to its source (locstion, time taken) may h e practically worthless: therefore, take care to properly collect, store, and mark all san.ples. | |||
R.2.2 Samole Taking Technioues and Indications | |||
. a. External Contamination Sefore decontamination, the following samol'es shall be obtained: - | |||
(1) skin smears: use smear pads: moisten with a few drops of water, smear a skin area of about 100 cm2 (4 | |||
~ | |||
x4 in.), if possible. by allowing sticky side of the | |||
..,. ..~ , | |||
- - - smear to' adhere to sloves, and rub the smear nad over | |||
..'--. the surface to be sam: led; place smear on record nacer, | |||
. *f. | |||
3.. . . + -v; . - | |||
record location and time, and area smeared L: otner v..., ... .*-:'.y3~4 | |||
.u a. _ ..:: ~g - | |||
t* . | |||
...e..+.,. . | |||
than 100 cm,.- | |||
: 7. .y......a.,. | |||
. (2) wound samples: use either one of the following methods: | |||
7 latte vcunds with risible blood or scund fluii: | |||
i ? | |||
ebtiin a few :: 's usinc d:::per. . ::ansfer * | |||
:: bottle and lacel: | |||
.: -10 | |||
superficial wounds: rub gently with cotton swab - | |||
. return -to tube, label; | |||
- wounds with visible di.rt or debris: remove with applicscor SWN1 or use tweezers, and transfer sample to samil glass vial, label. | |||
: b. Internal contaminac. ion | |||
. in all cases where internal contamination is suspected: | |||
' collect all urine and feces in containers supplied and | |||
.._ .. - . . . s.__. | |||
record time of voiding.' | |||
.__/ .. | |||
: c. External Exoosure ~ ~ | |||
In all cases where a whole body dose of more than 10 rads | |||
. . '. is known or susoected: | |||
. .' (1) obtain a blood smear for differential: | |||
. ; .n. . .y | |||
.. . g- | |||
. . . re,q[zp.. . | |||
, ..y. ..;. . .wlTF.. .. .. | |||
(2) obtain a leukocyte count; | |||
- ,~ . | |||
r | |||
(.... | |||
, s . , . t. . | |||
. ... wi--> - | |||
.~o M (3) obtain 30 ml of blood in vacutainers (green, red, gray | |||
. -r _ - _ . -. | |||
"~~T ' and lavender scopo j ab.m gm G | |||
8.ecord date and ti :e :5ese ra rles we e taken. | |||
c_;- | |||
i i | |||
cesa==- = | |||
. =e===sIMIENT lW)lATIO!! A!O IfDIG1L-SIRIU3 IMEM EHLw (ni sump.iny paacent;9 ~ ' | |||
= yt e = a c e.:c a n e = = = ' | |||
~ i 1 ' I ME"'# 0 ~E - : | |||
~ | |||
!!aa.c of patients- - | |||
A90: J_ | |||
Location, date,~and time of>locilent:- f - . . , | |||
Su :nry description of indjd,en,li . d r: .- | |||
.. :. 6 p: . . . ,- - | |||
========================c=====d=,===============h,==========;===============u =___ ____==TG= G I:= E====u= .: 2=u G .b.f | |||
,F. . E. L P .0 r ? | |||
?S U '{l. 5 [ I N .i U R Y i%I*h''?$.CI: | |||
..,y r, a r, .or , it; f : | |||
IDtH)S | |||
.,R,..C. D'M. E.w.g g@n py;' SKlH {0NDUlmT10N lillEIVBl. COMN111RT10f1 ye:;/no - | |||
; ; eyes /no {,. ,y - yes7ifo~ yes/qo uhcre?'.ir;dicate overicaf | |||
~' ' r nherc? iu:dicata onceleaf hou? axii:nda/ingantion/inini. | |||
how serious? where? $shole body how much? indicato meter how much? | |||
!t readinga overleaf ' | |||
''I E M10cai wha t? what? ' | |||
general condition? hou much?% ' rons mixe:1 fission' products? mixed fission products'? | |||
(likely/ other(describc): other(describc): __ | |||
what? 8 l7 lpossible) ,ncutr- , . | |||
..=========================o =======================, === =========- ======================u=====u=====uuuusu. | |||
MEAS il R R S TAXEN tuna: tima: time: | |||
time: | |||
f trst aid: synptoms? nausca +/- decon: nose blow: | |||
umicing f/- technique: '- | |||
sample kept? ' | |||
skin erythema +/- | |||
other? effect: decon of orifices; medical: symptomatic treatmentT ' Where? | |||
(indicate decontaminated hou? | |||
blood samples taken? areas overleaf) residual contamination decon fluids kept? | |||
badge tal:en? at time of' transfer? | |||
(describe; mark on skin): other samples taken; uound decon: IIEUTRON IRRADIATION ONE,Y:_ urinc? . | |||
, hou: ving taken? icces? . | |||
other? | |||
buttons, hair, nait clip-cffect: pinga taken? | |||
Course / follow-up: | |||
1 . | |||
o I | |||
q;; | |||
--_______.__._W | |||
Irl0!CATE C0!! tai 1111 ATE 0 AREAS AS TO LOCATI0tl, DECREE OF CONTAf4IfMTION, DEC0tl EFFORT IttDICATE LOCATIOr! CF k'0Utl0S (use additioncL sheets if neccsscry) 6 | |||
's j=r. | |||
A s | |||
m | |||
./ | |||
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. - ;) ,- | |||
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'.' - lj | |||
\ / | |||
- /- t , ) $.G | |||
. % >. < .&. . .:;~ \ ,,, | |||
/ ) - 1 | |||
'\ '. \ | |||
l'#s/ | |||
l l .t%s i | |||
.} . | |||
@ :.k l | |||
i .,..-- | |||
, .# -[W.,6. Q. | |||
' . $ :y. | |||
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! .-5j,fN.0.' T. _. r k | |||
,j | |||
, I . . | |||
;,._ ' i , | |||
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' Q- s-i s | |||
/, ,. | |||
I- | |||
* el it | |||
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c, | |||
/fl t} | |||
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'S f ' ;t ' '- c' b | |||
$ '.~.;i .' -l /. & | |||
l?%gl! - | |||
l" $ ~ | |||
ff \\\fh i | |||
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1 } | |||
h l '{ - | |||
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f f | |||
4 | |||
'\, | |||
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{f l | |||
;\ | |||
f ' | |||
'\ %N:-U | |||
~. | |||
e O | |||
Ji \\kl/, | |||
s il f | |||
l a | |||
I t \ ) . | |||
1 | |||
'1 A1 | |||
;i | |||
/ . .. , . " . | |||
o '' | |||
' \ | |||
Y | |||
\ ; I \ 'o l '. j | |||
''(fe ;. | |||
_. n . | |||
{ j' j | |||
! j l | |||
.. ( e ; | |||
6 4 ' | |||
j / l \ | |||
. v. ',\\ | |||
7 g' 7 | |||
- N ', , | |||
I ' | |||
\ , q . | |||
*k!.* ) \.' Q$ | |||
-f y- %_ ~ - | |||
( | |||
. v. r r a.: .. . . ..; . . . . e. . . . . | |||
[ . :~:i *:: c :i:'. :ni r.:.=." *.- | |||
... ...._ ...... ~ -..- .... '"~ ;;.- .U* | |||
Reviewed: December 1981* ''^"- '" ' | |||
l | |||
- _ ,}} | |||
Latest revision as of 07:13, 15 March 2020
| ML20028A183 | |
| Person / Time | |
|---|---|
| Site: | University of New Mexico |
| Issue date: | 12/31/1981 |
| From: | NEW MEXICO, UNIV. OF, ALBUQUERQUE, NM |
| To: | |
| Shared Package | |
| ML20028A169 | List: |
| References | |
| PROC-811231, NUDOCS 8211160546 | |
| Download: ML20028A183 (61) | |
Text
{{#Wiki_filter:y' a,' ( . PROCEDURES FOR ADMISSION AND MANAGEMENT OF RADIOACTIVELY CONTAMINATED PATIENTS AT SERNALILLO CCUNTY MEDICAL CENTER AND CANCER RESEARCH AND TREATMENT CENTER ( THE UNIVERSITY OF NEW MEXICO ALBUQUERQUE, NEW MEXICO AUGUST 1979 0 REVIEWED DECEMBER 1981 8211160546 821108 PDR ADOCK 05000252 F PDR
V :
. DECONTAMINATION AND TREATMENT OF THE RADI0 ACTIVELY CONTAMINATED PATIENT TABLE OF CONTENTS Title Page Number Section 1 - Introduction and General Guidelines for Admissions and Management of Radioactively Contaminated Patients 1-1 Section 2 - Admission, Care and Treatment of Radiation Accident Patients -
2-1 Section 3 - Telephone Numbers of Essential Personnel 3-1 Section 4 - Admission of Radiation Accident Casualities 4-1 Section 5 - Set-up of CRTC Radiosurgery Decontamination Suite (Room 1303) 5-1 Section 6 - Use of Protective Clothing and Dosimeters 6-1 Section 7 - Supply Inventory of Radiosurgery Decontamination Suite 7-1 i Section 8 - Procedures for Patient Decontamination l and Sample Taking 8-1 o l l t I
'e s'
. ATTACHMENTS Title Page Number Admission Procedures for Radiation Injury 2-1-1 Flow Chart for Radiation Injuries 2-2-1 Radiation Emergency Area (REA) 4-1 -1 Types of Dosimeters 6-1 -1 ,
Patient Radiation and Medical Status - Record Sheet. 8-1 -1 ll T i 9 l i l
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. SECTION 1 -
n I
< INTRODUCTION AND GENERAL GUIDELINES FOR r* -- .
u . . ADMISSION AND MANAGEMENT OF RADIOACTIVELY CONTAMINATED PATIENTS
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'l.O BACKGROUND ~ :M+' . J.r
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=R. ',' In 1979,. the...Bernalillo County Medical'.C.. enter and . ..
. the Cancer Research and Treatment Center of The Univ-ersity of New Mexico established a formal protocol for the admission and management of radiation casualties
~
arid designated a control 1ed area within. the Cancer Research..and Treatment Center (CRTCl for the . r.e. ception,
' ~
decontamination and emergency treatment'of.such. .. u patients.
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This action. was taken in recognition of Mhe? expanding.. ~ ~- c
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. .a . ... . . . _ .. use of nuclear materials in industry,.medicinerand....
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.'. research in..- ** . . * *
- the *.. .
New Mexico ' area.F 'Though'.'the" incidence
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..f 4." - centralized Radiation Medic.ine- Center would preclude. ._.
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. 22 . t4 e uneConom1Ca . pro 1.4.eration o -Cost y s,aca ltles
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- ar The University
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c-v- .. .smaller-hospitals
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M m, .-m. e t: =- - - admission and management'of
.c radiation casualties.
- 5. This
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document expressesathese policies and.. specifies the
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1.
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t 1.1 Purpose , , This manual is designed to give both general and specific instructions for the provision of effective care to victims of accidents involving radiation, for protection of patient and hospital staff from injury by radioisotopes, and for prevention of contamination of other hospital areas by the radioactive patient. 1.2.0 COMPOSITION AND RESPONSIBILT. TIES OF THE RADIATION EMERGENCY COORDINATING COMMITTEE 1.2.1 Composition 1.2..l.1 Chairman': R.D. Moseley, Jr., M.D'.
.. . .:. , 1.2 l.2. Members: as elected or appointed
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1.2.2 'ltesponsibilities
See University of New Mexico Policy Manual.
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1.g. .. a- . ;.;;,2 : .; =.- . . MSd.. ya 1
. . .'E a . r ; . .. .- l..'.~2.d2. .l.'-Policy .and Procedui es - Writ. ten statements of policy &t ;uu.~;:: - n.&,th:-n M .:. . . . . . . . .- 'f_.._9 M. ff. e W:.. f..and procedures for,the admission and management of i .7:' C.;:. .... .. . n u. + . . , ,
radiation casualties at Bernalillo County Medical Center (BCMC) and the CRTC shall be prepared, distributed to involved individuals, tested 7 periodically and reviewed annually. l ( i 1-2
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I 1.2.2.2 Meetings.- Th.e Committee will meet at the call of the Chair-man. The Committee will consider such matters as affect the institution's preparedness to admit and' treat radi-ation casualties, including availability of trained
. specialistsb statustofusuppliesrand: equipment .andt. : '
- status of training.
1.2.2.3 Availability and Response - The Committee shall assure that a trained staff is airailable at all times }to respond to authorized
- requests ,f6r consultaEion Telating-to, or for treat-
,,- ment of' radiation casualties. . . '-
g.- -. ~: ... . . . . . . .. _y
. . . _ g. .-
. . t. ....:.. . 5 Consultation or ITreatment 5ir.
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1.3.0 r-- - -
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A . 1.3.1. . General .
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Requirements for consultation or treatment of radi-ation casualties may arise'from cases presented by staff O".. ?:-
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e, s. _.... .., .. .-. membe. .r.s . of ' .BCMC .CRTC , non-staff physicians;-unannounced
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'iRf=E J.E.w :.3 :.-;OpiQ.yMarrival . of.Jadiition. casualties 3ases).,_ . ~
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. ,t- m persons.,'--:.- du=s
. . and. 2n tri. es ' and : . s . Institutions who.-.may in the haveYorhal hdemeisEs for radiation support.
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.f ,futur It is expected that..if cases are presented from the last
- a. : - ,.
category, the iiidustry or institution will furnish the hospital with a current list of its affiliated plants and I health physics personnel. 1-3
.. ,,j....,. -
1.3.2. Cases Presented by Staff Members of BCMC-CRTC or ( Non-S'taff Physicians
- Staff members or physicians from the community having patients involved in radiation accidents will be referred to the Chairman, Radiation Control Committee (RCC). The Chairman, in consultation with RCC, will advise the physician in accordance with the procedures of this document. .
1.3.3 Unannounced Arrival of Radiation Casualties at the Emercency Room - Personnel on duty at the Emergency Room shall act in accordance with the instructions contained in a memor-
. . . . .. . ~
. . . . . w
.; :.. . -..l- andum is included in this... document .
LSection21.> A copy 1.s also on file in the Emergency.. Room. .. 4:. - - _ . -;l?-ir - - . - ys.Q a - .
. f~h
- 1. 3 . 4. ... Incuiries or: Recuests for Assistance from Non-Medical
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. $.' Such-inquiries or requests shall be directed to the
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. Chairman or the Radiation Protection Officar by either
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,g, ._1the.te1ephone
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3:-f.m . c 39 cperator or the staff. member receiving '_. ;...3..,,. ._.. ., }.p.m.a 2.i. %n .::::.nithe;-inquiry or request. The telephone operators are in e . i==;.- =1:n ~ .: 4~~
. ~.-w - ..-.,n2G A ' . s..';. 2. 3.*~~~ . L :..~.. L= -:- '. . . ::
yi p.; :: 1.= a :n- .- J r m;:;:. ssession.of the m.emorandum, entitled; " Procedures : ~ ~- for r .@.:. ~ -:.
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- m. . , . .-.. ;concerning this matter. A copy of these instructions is
. . . s. . . . . .
."... included in this document (Section 2).
l.3.5 Referrals from Associated Industries and Institutions , By prior agreement with BCMC-CRTC, employees of lk certain industrial firms and institutions may be trans-l l l ferred from " local supporting hospitals" to BCMC-CRTC I l l-~4 l l
( or treatment of radiation injuries. It is anticipated that such transfers will result from deliberations be-i tween the local hospital staff, the firm or institution director, and the BCMC--CRTC staff. It is also anticipated that any patient transferred from a local hospital will have been decontaminated, as much as possible. Accordingly, patients in this category, although victims of radiation accidents, may not require admission through the Radiation Emergency Area of CRTC.
, 1.4.0 HOSPITAL ADMISSIONS (see also Section 4)
. -Every -reasonable:ceffort -wili be maderto admit patients who present a radiation or contamination hazard through the
( .. Radiation Emergency Area (REA) (Room 1303) in the.CRTC. Since the REA can'be set'up.and' staffed for admission of
. radiation casualties.at short notice, advance notification
.., .,.of requirements for these fac'lities i should be made. As
' ' ~
. used in this document, a radiation or contamination hazard
.will be assumed.to exist if the radiation level emanating
!.h . '!,b . '." - . . . . . e ifrom a radiation casualty or his apparel,is detectable T. .: D.Y.h ..- ".~;2 * ~
. - .. =-
tTit:.h+i-'ru ~ . a .' .= : : :. . with a portiatile ' beta-gamma G.M.
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1.4.1 . Preparation of Radiosurgerv Decontamination Suite r Upon notifih:ation of intent to admit a radiation casualty, BCMC shall assume the responsibility of super-j vising the preparation of the Radiosurgery Decontamination Suite in the operating room (1303) of the CRTC. This 1 'i
preparation will be accomplished in accord with the 1 ( procedure presented in Section 5. . 1.5.0 RADIATION PROTECTION AND MONITORING OF ATTENDENTS Section 6 of this document presents specific operational procedures for personnel working in and supporting activities in the Decontamination Suite. 1.6.0 TELEPHONE DIRECTORY OF ESSENTIAL PERSONNEL, A directory of essential personnel is included in this document as S'ection 3. It shall be the responsibility of the RCC secretary that this directory be kept current. ^ 1.7.0 ' AUDIT OF REA SUPPLIES AND EQUIPMENT
. The UNM Radiation Safety Officer shall conduct an audit o5 the supplles and equipment maintained for use in
- 4. .
the REA. The audit shall be conducted semi-annually and
-7. -
following any actual use. Records of the findings of these audits shall be maintained. Findings that adversely affect
.g , . , . g the state-of-readiness of this procedure shall be corrected
~~.' -
. ~ ~ ~.~ immediately . Significant deficiencies that cannot be
_;.y:. . .
..e.
. i$ . O .5,M' corr'ected immediately shall.be brought,to the immediate
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=. -.... .
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,- S$ datten' tion of the Chairman, RCC. A'n inventory of supplies
.EE..f.
'- maintained for use in the REA is shown in Section 7 of this manual.
- 1. 8 .' O PUBLIC RELATIONS _
Radiation accidents are a rare and noteworthy event. i Consequently, they will draw considerable public attention. To avoid unnecessary alarm, misinterpretation and misunder-1-6
~
- e standing, it is imperative that correct and concise
(' information be given. All reque'sts for information concerning the patient and the accident should be directed to BCMC, Public Relations Office, who will contact the following: . (1) Chairman, RCC
. (2) Primary Care Physician (3) Director,' 3 CMC (4) Medical Director of Company involved The information on the radiation accident should be channeled by the Chairman,'RCC, through the BCMC Public Relations Office as the central source for news
~~
dissemination to the media ~.
~
(. - .:. e .. .
.l.9.O AMENDMENTS ~AND REVISIONS 7 ,
. ~
,'.".u- - - The secretary, RCC, will submit recommendations for
'T ameridments and/or revision of this document to RCC in the
- course of evaluations made during implementation of its
[- ~ 1 .~
- i. . . .
provisions, or as a result of his review of the document.
-.x .. . ; -- _
~
.$.' The secretary'shd11 conduct an annual. review of the
.'.~
I. '}p . a ...;.7 Q. ' 'En%;4.
- . . - . ~~. . . - ,y .--..,.-...~
- . . .u.-
f.9_C.} * ' "I .Edocilment. and 'reporE
=...
his/lierifindings to. itCC during its i . n.,.q., :
,y . .--
-_ first meeting of each calendar year. The secretary shall p, . . . .. . - -
~
' 7- issue copies of approved amendments and revisions to individuals or departments identified in paragraph 1.10.0. ,
t 1.10.0 DISTRIBUTION k Copies of this document and all subsequently published amendments and revisions shall be distributed by the 17 ,
secretary as shown below: ( . Radiology (6 copies) Internal Medicine (Hematology)
- Surgery CRTC Nursing Service (2 copies)
BCMC Nursing Service (3 copies) Director's Office, BCMC Director's Office, CRTC RCC Members (1 copy each) Diagnostic Imaging, CRTC Emergency Room , Radiation Safety Office, UNM (.3 copies)
~ ~
Telephone Switchboard Office Public Relations Office -
~.
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l l l l l-8 Reviewed: December 1981
,- ,- ~--;;r . ~~ -
SECTION 2 i. ADMISSION, CARE'AND TREATMENT OF RADIATION ACCIDENT PATIENTS 2.O GENERAL-This memorandum is composed of two partse Part 1 provides administrative guidance on the admission of radiation accident patients. Part 2 provides guidance on emergency treatment of such patients. Radiation safety for BCMC-CRTC personnel is a responsibility of the Radiation Protection Officer.
. PART 1 2.1.0 Admission Guidance'is provided for the unannounced arrival of accident patients under two circumstances: (A) Emergency
.' Room personnel become aware of the patient's status as a
, }
" radiation accident patient..q". before the patient has been
- . removed from the ambulance,Fand (B) the patient has been brought into the Emergency.' Room before his status as a
'. " radiation accide t patient" has been determined.
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. . (_.AD.ls.'Patierit y.y.: -.
, . . Still. in" Ambulance ..
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'- : If minimum medical attention is required, treat
- - . ..a a; . .. .
~
patient in the ambulance as adequately as possible, while radiation area is being set up. Call the Nuclear Medicine ,, staff on call to assess the level of radiation contamination. Instruct driver, attendants and Emergency Room personnel who have been in contact with the patient to stay in the 1 I vicinity of the ambulance (but not inside the ambulance). I 2-1
-j
.? , .
Have security clear an area of about'8 feet around ( ambulance and keep uhnecessary personnel and vehicles away. . Attend to patient's emergency medical condition as required. Use surgical gloves and mask. If immediate life saving measures are not necessary, observe patient from a distance until the radiation level is ascertained. 1 All equipment and supplies used to attend the patient MUST stay in the vicinity of the ambulance. DO NOT carry anything back to the Emergency Room. If medical condition of patient is such that he must-be removed from ambulance: j, - Admit patient to the Radiosurgery becontamina-tion Suite (13031 of CRTC. Keys are in the ( possession of the head nurse of the Emergency Room and the UNM Security dffice.
- Evacuate the operating room of CRTC L1303) before bringing patient in.
~
.lnstruct driver to stay with ambulance until a
; ,, - ., , ;;;,::, radiation survey has been made.
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. 2j-{pf . ,5 I , Y, .. : .y Bring necessary eq.uipment and supplies to treat
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patient from Emergency Room to the CRTC operating
'3- ' - '
room. ALL equipment, supplies and personnel entering operating room MUST stay there until l '
- arrival of radiation monitoring personnel. Estab- '
lish a guard at the door. Pass Emergency Room fi supplies and equipment into area but DO NOT allow i f 2-2
t personnel and equipment to come out. ( Personnel attending patient in area should stand next to patient only as long as necessary to perform lifesaving measures. At all other times, stand about 5-8 feet back and observe patient.
.=
(B) Radiation Status Discovered After Admission' (i.e., on obtaining patient's history) Immediately secure and label the entire area through
'which the patient has passed and in which he is located.
Keep all personnel and equipment in the area. DO NOr allow anyone or anything to leave. Establish a control
, point th. rough which necessary personnel anci equipment pass
~ ~~ - ' " ~
'-~~-
into restricted area. - e .- ... ( Attend to patient's emergency medical condition as
. required. Use surgical gloves, mask and gown when treating
.[ * ,
patient. If immediate measures are not necessary observe the. patient from a distance of 5-8 feet.
. .( ..'
..j . ,q . ..
... If possible, ascertain the means by which the patient
,. ..g" .-- . .. . .". . ?.. . - ,~~was.'. transported.to the BCMC-CRTC and inform the Radiation
. , ~ . . .
. . . . ..= : .. -
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-. + = . . -..- -
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=-
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f a l Reviewed: December 1980 l 2-3
PART 2 I 2.2.0 Emergenc Treatment of Radiation' Accidents ! 2.2.1 General' . Emergency treatment of radiation acciden't may have to
. be given before contact with or arrival of specialists having expertise in evaluation and managementi of these accidents. In this case, the management of the patient should~
take place in the following order:
- Resuscitation and Stabilization - Including basic life support and CPR as necessary.
- Initial Decontamination (if not previously done) .
~ ...:.
.((, -
Evaluation of Radiation Status. , f - Initial treatment of Radiation Injury.
.7 2.2.2 Resuscitation and Stabilization Since radiation injury is not immediately life-43 ;g. . .
.. threatening, primary attention should always be directed T.'- . .' - ~ ' 'ioLtraumatic life-threatening injuries -- maintenance of t
.r.-. -
-2 , . . .l._gt.ta.G ay.z.and breathing, arrest bleeding, treatment of shock,
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. - - ~ - - - - . ::.. . . . . ...
. . ;.1 a . .:
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2 '
. Decontamination. .'
l Mig - - ~ ' ' - - i: -- -' p, . . ...
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Concomitantly with the procedure above, or as soon as
~
possible, the patient should b'e decontaminated. In the initial decontamination: Survey with a G-M tube and note levels of
' contamination on the radiation status sheets at the end of Section 8.
1A
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.m.:
" %', .s :- p
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,., ys _-
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- Removo .nll' , clothing". s
- Remove obvious dirt and debris - bathe, if I -
necessary, while protecting' wounds.
- - Flush wounds with copious amounts f sterile water and/or saline.r. .
- Flush crifices with[ water or saline. Do not i allow patient to swallow. [. , ,
s , 7. 2.2.3 Evaluation of Radiation Exposure Status
. 1 History: .
ff
- When did accident occur? ,
h
- Source'of accident? '<
. . . ~
- Type of radioactive' isotopes involved?
- How long was patient in accident environment?
y
. 2 .. . . . . , - .
/
(- Dose Evaluation: . .
~ ~ . .. .
This will require the assistance of persons knowledge- .-
.. 4 able in. radiation. This assistance can be by someone on '
u .- . .. - .
.s location or by telephone._ Inlany case,~ gather as much of ,
..e
. the following information as possible:
i . '.- .-.1 .. g m. . .. .
-.: y 3.._
4 .
. . D_,: jP. .. ..,.. ~. .. .., .%.
m .:- .. . . .. - Level of. radiat. ion="-i.n accidddf.~. env.ironment. .
..w
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M C s.l*1 7 .lf.ff O /: 3 {-i! ?. V " - .i N . -Surface {andaircontiminatiog+;in~/ accident t:ww pr.L ...r;+. :.-- - :. .. ; --- .
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~~' ).MT*??T'X?.Q. r *F'"~~--* ? . environment. =nt=- 1-n, m:sy 3. g .
u
- Level of radiation'o'n patient's or other's
. . . +.:c.
q.*. # , . dosimeters. ...
. - - 'evel of residuar contamination (Beta, Gamma) on patient using open window G-M tube (mark areas on anatomical diagrams)
- Calculation of dose to the patient and to (
' attendants ,
2-5 'c
. - 'c .
Clinical Picture: ( , i A good estimation of the severity of the patient's radiation exposure can be obtained by observing the following clinical symptoms and signs: . Nausea and vomiting: >100 rem (whole body) Beginning within 2 hours: >4 00 rem (WB) Beginning within 4 hours: <200 rem (WB) Skin - Erythema: >300 rem Diarrhea: >400 rem to abdomen CNS symptoms (only relichle in the absence of
. cerebral trauma) : >1000 rem Lymphocyte count within 48 hours:
3
>l200/mm : good prognosis .
3 s.. 300/1200mm : guarded prognosis 3
<300/mm : poor prognosis I*' 2.2.4
, Initial Treatment of Radiation Injurv
[. 5. . .' .,.,
..( j Detailed Decontamination - I.t- i's parti'cul'a rl' y/ important 7.m
j .., 4 , . . . at this stage to remove'high' level contamination --
,,}.?; _ . ' - caused _by penetrating missiles or splinters and
; .: = - - .-:.. - - . . . - .. .:.; ..x
.-- :. - a. .: wounds. .
= . .
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J;. ...~; . . - y = .i- - : .
.v .n. .y.-
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Overexposure.. Sinc.e: overexposure to rad. tat-. . ws: . . , . - .. .
#,3
,~-
.:j-results in a slowly unfolding course e-i- -
r of time, there is little in the wa-treatment in the initial stage Treatment is symptomatic i patient confortable and a. k may require an;;ametics, flu analgesics. o
*% o*
,. _ _ _ _ . _ _ _ _ _ _ _ . _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - ~ - ~ ~ - - ~ ~
Internal Contamination - Except in a few specific ( . . instances, there is also little to offer in the
~ way of specific treatment in the initial stages.
Generally, specific treatment to eliminate any absorbed radioactivity requires rather detailed and complex analysis, including whole body count-ing, and measurements performed on serum, red cells, urine, feces and expired gas. If it has been determined that an appreciable amount of radioactivity has been ingested (which is seldom the casel a stomach lavage, emetics (ZnSO 1 or 4 catharties (10% MgSO ) may be indicated. 4 Suggested permissible levels of attend. ant. exposure ( in the cr urse of treating a patient are: to 5 rem - routine treatment and decontamination to 25 rem - emergency treatment and decontamination to 100 rem - life-saving treatment and decontamination To estimate attendant exposure, pass the probe of the dose rate meter 6" above the patient. If
~ ,
the reading is SR/ hour, and estimate of attendant exposure would be SR if treatment without a shield
"- should take one hour. With a shield, the dose will be reduced by 80%.
Experience shows it is extremely unlikely that : an accident would be so severe that an attendant would receive an exposure of over SR. In high radiation fields, personnel should be rotated l 2-7
l in order to minimize the exposure to any single ( individual. I't is also su.ggested that anticipated exposures over SR should be on a voluntary basis. 1 If it has been determined that the patient absorbed I considerable amount of: Tritium (3 H) - f rce fluids Iodine L1I) I - give Lugol's Solution (8 drops in glass of water = 100mg) inject 250mg of potassium perchlorate intraven ously 2.3.0 Principles of Radiation Protection Certain precautions to minimize exposure to attendants are necessary when dealing with a patient who has external .( ' contamination, specifically: Always wear surgical scrub suits, masks, caps, and gloves. Use the shielding if available in unknown or high levels of patient contamination (greater than
...u ..
,,,{ , ; I ,, SR/ hour gamma radiation at one -footl-when treat-
' , ' ,' ing the patient.
- As few attendants as necessary should be in the same room with patient.
Only in the performance of emergency treatment . and initial decontamination should attendants be next to patients. At all other times, e.g.,
\
while evaluating the situation, attendants 2-8
should stand ct least 5-8 fact from the pnticnt and observe.from a distance.. Rope off and control the area in which the
~ patient is being treated.
ALL persons, equipment and supplies that enter this area MUST stay there until Radiation Emergency Teams arrive to assist in the monitoring and de-contamination of people and equipment. 2.4.0 Initial Bioassay Samples When a patient has suffered internal contamination,
. or when it is suspe.cted, each of the following bioassay samples should be obtained as soon as possible and label-led with*name, date, time and type of specimen. Avoid cross-contamination of samples from external sources of
( contamination.
. 2.4.1 PBBH Laboratory Blood:
- 10cc for bioassay of radioactive isotopes (1 red top, 2 lavender top tubes)
,- - .~ - -
5,cc (Heparinized) for chramosomes (keep samples i J '. . .. - , . -v , .. .
- ~ chilled in a glass of ice) (1 green top tube) u .. ~
l .. 2 ..
- ~10cc for hemogram - complete CBC with differential
. (1 lavender top tube)
- Chemistries - SMAC (1 red top tube) r 2.4.2 other Laboratory Analysis Using the kit provided, samples of the following
( will be sent to other laboratories (Los Alamos, etc.)
- Urine - first urine - instruct patient initially to
,.a
I
. . . l void when he is medi'cally able. Save this and evsry j
( subsequent voiding.
,All urine - Label with. time, date, and patient name. DO NOT discard any urine. .
Feces - first 4 days - Every sample should be
- collected and refrigerated after being marked with name, date, and time of collection.
Sputum Vomitus Tissue (note location) Irrigation fluids Filter paper or cotton smears of crifices, wounds, skin areas (note location) All samples with the exception of routine hematology ( and blood chemistry will be picked up by Radiology
. . (See Page 2.1.2
. .~*
. s .
r. ( Reviewed: December 1981
?_1n
ADMISSIOtrPROCEDURES FOR a* . RADIATION INJURY ,
- 1. Treat traumatic injury (resuscitate and stabjlize)
- 2. Ascertain whether the patient is contaminated:
a) Call the hospital radiation safety office - UNM ext. or BCMC ext. , in Nuclear , Medicine and state the situation, asking for assistance. b) If the radiation safety officer is not available, call the Radiology Staff on call. Utilize the count rate meter in the health physics emergency locker, located in the CRTC operating room entrance area.
., Follow the procedure below:
Turn meter to "batt" position; the indicator should move to the "batt" position on the scale. If it 7-
- does proceed to the next step (if not, plug it into
'a 110v outlet) move the dial to the- XI position. j-
~~.. : >
.','*_,7 .,
Wait until the meter has time to react, then utilize s ],' , s .
- r .
the probe attached. Pass it over the patient,
.y . .
- assuring that you do not touch body. If you get a marked increase in the number of clicks, you must :
ll assume the patient is contaminated.
, i c) If in doubt... admit patient to the radiosurgery de- !
d contamination suite in the CRTC.
- 3. If contaminated, decontaminate in the radiosur cry decontamination suite of the CRTC.
~
- 4. Call for as'istance: s
' Day:. Nuclear Medicine i . Night: Nuclear Medicine Page ,
'^
Radiation Safety Office: Day:
. BCMC Security Office: >
UNM Security Office: i BCMC Emergency Room: i I 4 e i e S 4 8 e' 8 9 4 4 P . . ( O' 9 e o
- e 4 o
90 e e
- e
.- . * *.;.*- -.i J . . ,
t, * . 7 =* *; ;
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s ,. s ,e . . *
- ~ =
, .s. :.
4 e j, 9 k 2-1-2
l ,. . i ( FLOW CHART FOR RADIATION INJURIES j l l
, ,IS PATIENT MEDICALLY STABLE?
YES NO
\/
IS PATIENT REALLY / Begin Resuscitative CONTAMINATED? Procedures YES NO WAS THE RADIATION
- -( ' IS THE CONTAMINATION EASIL.Y REMOVED? EXPOSURE SIGNIFICANT?
hO YES NO s y %f Complete Evaluation by Routine D'econtamina - A Hemotologist, s tio_n P.rocedure ; f Radiation Protec- 4Mildh Evaluation ti n Officer and Id.- H* o lding Uni . Health Phys 2.c:.st l Severe l
\/
Additional Treatment as Necessary Reviewed: December 1981 , O $ 1
SECTION 3 { . TELEPHONE NUMBERS OF ESSENTIAL PERSONNEL OFFICE HOME
- 1. UllM and CRTC Administration (area code BCMC Director, Dr. Pitcher CRTC Director, Dr. Tomasi
- 2. Radiology Decartment Dr. Moseley Dr. Christie Dr. Mettler Dr. Kelsey
( ~
,3 . Nursing Service a) Supervisor b) Emergency Room Charge Nurse
- 4. .F.:diation Emercencv on-Call Roster - BCMC
. .' , (In order of Listing Until Response is Obtained)
.i :. ..a)
'Radiologv Staff on call -
BCMC page
.b)
On call Nuclear Medicine - BCMC page c) Radiation Protection Officer Mr. William Tabor
- 5. Security Decartment, BCMC UNM 3-1 (continued)
6 4
' - (-
- 6. Department of Surgery . ,.
j Emergency Room Resident on call 1 s
- 7. De c artment of Medicine (.Hematologyl i
l . Hematologist on call BCMC Operator J. 1 i if 1 1 ) + , A J l I 4
, 1 .
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Reviewed: December 1981 j .- 3-2
f . S8CTION 4 ( . . 4 ADM5SSION OF RADIATION ACCIDENT PATIENTS
. STAGES IN RADIATION CASUALTY MANAGEMENT
~
- 1. Area Preparation
- 2. Report of Accident
- 3. Medical Stability Defined
- 4. General Decontamination
- 5. Initial Cleanup
- 6. Wound Decontamination .
- 7. Detailed Cleanup
,j 8. Patient Transfer
'0 ,.
... :... . IMP 9. Exit of Patient
*:--"; .' -. .= =- ,
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- 10. Area and Personnel Cleanup
- ..). .
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SECTION 4 ( . . OPERATIONAL PHASES OF RADIATION ACCIDENT CASUALTY CARE 9 4.1 Unannounced Admissions The procedure to be followed in the event that a victim of ,a radiation accident arrives unannounced at the Emergency Ward is presented in Section 2. 4.2 Announced Arrival of Radiation Casual' ties The Chief of the Radiation Emergency Team (. Team Chief) is responsible for the general guidance as to the proper management of the accident cases, including
, transportation of these cases to BCMC-CRTC.
( g.g. .. ; ,_. Further action involving BCMC-CRTC will take place in five phases: the alert phase, the notification phase,
..g. , ,
,. the arrival phase, the clean-up phase, and definitive
! -:3- ..... care phase.
.3 . . ,
- a. . . .
4.2 1;.The Alert Phase
- i'
z :yr: .m.. . . ..~..
- T.7,f W '.-i'd41- As'ascon as possible, the Team Chief will alert the PBBH x... .-
- . . . - .c ::
.u.O.. . .s t. - . ..-a
;- .. . .;u
,gg ry ,-7 . s.: ^P-- .Emer.gencylWard Head' Nurse.of the possible referral of s--
a;'5- . ..' . '.a f [.4 f.; (a) patient (s) , indicating the most probable arrival , . #r . time and the nature and extent of the patient's injuries and condition. .
- The Team Chief will then alert the BCMC switchboard personnel, who will in turn alert other involved members L
of BCMC-CRTC. Responsibilities of Alerted Personnel
- Surgery: assure availability of an anesthesiologist and other surgeons.
- Administration: alert UNM and BC.MC Security.
- Nursing: stand by ready to set up the Holding Unit.
Assure availability of nursing personnel. Assure ear-marked equipment is ready and available. In the event
' that the Alert is cancelled, notify personnel identified on the Notification Personnel List.
4.2.2 Notification Phase
- As soon as it has been decided that (a) patient (s) will be referred to BCMC-CRTC for observation or treatment, notification will be given by the Team Chief to the Emergency Ward Head Nurse.
(
- This notification' shall contain the following information:
Number and names of patients
. . Estimated time of arrival
~
-< . Condition of patient (s)
Description of injuries Degree and type of contamination
. 3. 2. .- ..
..:... . e:g . , .. .
Special needs for equipment and/or personnel
..'i; -y:
. ,.=. n:- - - -
. t.; .. , .- .
Responsibilities of Notified Personnel u.. .. Emergency Ward Personnel
- Supervise and assist in thesetting up of the Radiosurgery
- Decontamination Suite in the CRTC, to include transfer of patients.
- Brief assembled staff on safety procedures to be followed in the operational management of the patient.
4-2
- Assure that required equipment is ready for use.
I Administration
- Assure that Security Department is instructed to perform the following duties:
- Clear vehicle access to the CRTC.
- Post guards at Emergency Entrance and CRTC-BCMC corridor.
1
. - Clear access route to CRTC Room 1303 of unauthorized personnel.
- Alert Public Relations, Housekeeping, and such other departments as may become involved.
Radiation Safety Office / Nuclear Medicine i 4
- Check'all dosimeters and monitoring equipment.
g .;_ ,
- Prepare for contaminated sample collections. *
; .r: .'
. v. . . ' i.Q Q.'
;." .,. + 4 , .,,
4 2;3 1. Arrival Phase
- . -;..' .h ..
, - ]j. ;-
j :, -:. T..BCMC and UNM Security will proceed as follows: . W . S i-i - : '5,R- -
. j,.j,; .J,. ,
- Direct ambulance to BCMC-CRTC common corridor-
. :. . .r :. - .
. ~ *: ,-
- entrance.
. . 2. %. .
~ ..
-- 4 . -
- Secure area around ambulance.
-+ .. . , :s .
- c. - Hold ambulance until cleared by the Radiation 2 . ;
- .; .;.~. - .
~-
' p:- - -
- - J r. ... . .. t. ". ,- . Safety Officer.
SL.The emergency room physician in charge, the Radiation Protection Officer, Radiology staff on call, will meet i the ambulance at the CRTC. The Radiation Safety Officer i or Radiologist will evaluare the radiation and contamina-i tion status of the patient, ambulance personnel and the i ambulance. They will consult with the Radiation Protection Officer to advise on radiation safety precautions to be i 4-3
~
followed. The emergency ward physician will ascertain ( the medical status of the patient.
- The patient will then be brought into the CRTC, Room 1303.
Ambulance attendants and litter bearers will meet beside the ambulance where the radiologist and/or health physicist will monitor them and instruct them regarding
, their personal decontamination. When they have comple-ted decontamination, they will be rechecked by monitoring and permitted to leave the CRTC.
- Only persons and equipment necessary for patient care and treatment will be' permitted in the Radiation Emergency Area (REA).
- After the arrival of the contaminated patient, all persons or items leaving the CRTC will be monitored for radio-3 .
active contamination at the central point. Persons or items found to be contaminated will be decontaminated
. before leaving the CRTC.
$ 4> ,
'-. - Should there be a numbhr of patients, the customary mass casualty triage system will be used.
4.2f[, 3 Clean-upPhase
~
. . =n J -
.,,- .;[y- After the patient has been moved from the CRTC Radiation Emergency Area to the main hospital, attending personnel
#- will proceed with removal of protective apparel, personnel monitoring and decontamination in accordance with procedures e
given in Section 6.
- Radiation Safety Office will provide decontamination instructions and will monitor attending personnel.
- Radiation Safety Office will decontaminate equipment 4-4 _ - _ --
and all facilities and will collect and dispose of non-( salvageable items. - As soon as convenient following clean-up activities, all
. personnel who were involved in the care or. treatment of the patient will attend a post-accident conference
. convened by the Chairman of the RCC or the Radiation Protection Officer. The conference will cover such subjects as follows:
Medical review of the event. Operational review of the event. Exposures for bioassay of attendant personnel. Requirement for bioassay of attendant personnel. s Recommendation for future handling of radiation
.(,-
casualties.
*/ ~ .
Following the post-accident conference, Radiation Safety
.r .
~
.. : will submit a complete report of events to RCC, to concerned regulatory authorities, and to th$e Medical
,c[
Director or Consultant of the company responsible for the
. accident.
s . _ :-'
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-' .U'
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s . .. . . .
. s.e
?.
l Reviewed: December 1981 4-5
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4 . asm 4 i DIAGRAM 4-1 _. __. ,_ _ . . _ . . __ _ _ _ _ _ . _ _ _ _ _ _ _ _ _.4 1
8 i
,(
- 4 i
. YELLOW ROPE BARRIER t I t l l
Nf
, I '
. I I
I / I y I
,, 6ECONTAMINATION 1303 G STORED AREA SUPPLIES
[ _
\ '
1303 F 1303 E 1303
- [ .
\ <
=-
J 122
] - en en .
1303 w-I YELLOW ROPE
' "\ -
JJ -- - -- p BARRIER t
; . ..O; . :- : . .
~. 1303 C -
, HOLDING i
' OPERATING ROOM AREA 4
i Reviewed: December 1981 - 4-1-2 DIAGRAM 4-2
S5CTION 5 ( . PREPARATION OF THE RADIATION EMERGENCY AREA 5.1 Purpose To outline procedures for preparing to receive a radi-ation casualty into the CRTC Operating Room of the
. University of New Mexico.
5.2 Definitions 5.2.1 Radiosurgery Decontamination Suite - Room 1303 The area by the scrub sinks (see Diagram 4.21 will be used for decontamination and initial treatment of patients exposed.to accidents involving radioisotopes, s . .
'( 5.2.2 Radiation Emergency Area This designation is given to the Radiosurgery Decontamina-i . .
tion Suite, the adjacent floor passage areas and storage
,. shelves (the Buffer Z~onel , and the utility rooms . During reception and care of a radiation casualty, the Radiation i
Emergency Area is identified by radiation tape and is off
. limits to personnel without dosimeters, i
l ^
. '5.3 ~ Procedures i 5.3.1 A verbal communication, from either the contamination site a
or the Radiation Protection Officer, will be received by l the Emergency Ward Charge Nurse stating that the hospital ; l will be receiving a radiation casualty, with information , , stating the condition of the patient, estimated time of i arrival and nature of exposure. 5-1
5.3.2 ~~The? charge nurse who received the communication in
,( the Emergency Ward will complete appropriate notifications (see Section 3, Telephone numbers of essential personnel)..
At this time, hospital security will be directed to cordon off the parking lot receiving site and to coritrol patient, employee and spectator traffic 2. 5.3.3 The disaster supply closet will be opened by Radiology and appropriate supplies transferred to the Decontamination Suite (see Section 7, supply Inventory). I' 5.3.4 A regulation stretcher positioned leng'hwise t in the 1 decontamination suite to accommodate the decontamination tub. A large round plastic radioisotope disposal barrel
'~
will be positioned,just.underneath the tub drain.
,5.3.5 . The hose showerhead will be attached and tested by the , , , ,jf,*. ' ,
i charge nurse to ensure its functional status.
. 3;1 ~.' . ,
C.. 6.1. :, v -
' NO .- .
- 5. 3 . 6' The Buffer Zone, the area immediately outside the
. . w;:: ,- . . . . . .
. t ;.-
Decontamination Suite will be identified with special
. . .:: b. ; . . .: ? '~ a ...
T' A nuclear
~
a-c
-3' radiation tape provided for this purpose.
~. $.ikil *}ZZ:V$ . . . ." '.. - ide = ~. ,
technologist or a physicist will be positioned Pl%Wi; -i#My i
" v5
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cu.> - w?. ' . . *: ' . i z , . --
..r.f.'y'A " J.'*.'"..;@~ '.CEF p'g~?goutside z,the Buffer Zone to assist active participants of
?.a L ;; . - . .. w e. - ;n .
' ' f;!~ "V "the Decontamination and/or treatment procedures with appropriate coverings and equipment (ring dosimeters, caps, masks, double sterile gowns, and gloves, foot coverings .
and plastic aprons), with monitoring and packaging of samples and waste, with communications, record keeping and the logistic support. l 5-2
( 5.4 Radiation Casualty Treatment Team Personnel required during a radiation decontamination are as follows (see Figure 5.4) :
~
(1) Surgeon and Nurse A to treat and clean the patient directly within the Decontamination Suite.
~
(2) Nuclear Medicine Technologist or physicist A to measure radiation levels during decontamination of the patient. (3) The Radiation Protection Officer or physicist
~
to oversee the progress of decontamination, interpret radi'r : ion level measurements and to handle patient blood, _ fluid, and exudate samples. 7 .
^. . .~, . , ~ . ^ . ' . ' . . . . ' ' . (4)~ Two Nurses, B and C, . gowned and positioned within the Buffer Zone, to assist the surgeon and Nurse A, as 1..; .. . t. needed. .
.s. .*
; *-i- 5.5 Cleanup Procedures a . ~.. .
. o -, ...:
;.. When the decontamination patient has been
.y . , -d'. .? '.' ..
transferred from the Radiation Emergency Area, cleanup
- dGj.- s ,. .
~~' '. , ' '- . . .. . .. .
.. procedures will be supervised by the Radiation Protection Officer. Ho sekeeping with the assistance of nuclear medicine technologists, will safely package all radio- ,
active waste and wash materials in fiber barrels lined with polyethylene. A through washdown of the area will ensue, and normal useage will be resumed when approved by the Radiation Protection Officer. Reviewed; December 1981
, . . , . . .. . . o. . .._
SECTION 6 t USE OF' PROTECTIVE CLOTHING AND DOSIMETERS 6.1' To prevent personnel from becoming contaminated with radioactive material, protective clothing will be issued in the CRTC operating room (Rm. 13 03) . 6 '. 2 Standard protective clothing is available: Standard protective clothing. Essentially consisting of the same items normally used by surgeons in the operating room, i.e., a scrub suit,. surgical gown, latex gloves, and a surgical mask and cap, aug-
~
s mented by shoe covers and a vinyl apron; to be worn by males and females. t
- 1... '.6.3. Conditions recuiring protective clothing
' "~
? ,. . . .
(1) All work.past the Buffer Zone boundary requires
.,y, . C'-. protective clothing, independent of the degree of
. m.. .= . y .... ,
- . . s ,. .
. l. contamination present on the patient or his clothing.
I \ .. . . . - Standard protective clothing will suffice in all
.. 7 '. , '
. . .. 7.AG&..;:. .. cases where gross decontamination has been performed
~~'
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~
ni. . ..* .~i.rr.; ... _
. ' : .* v. q,?-i.&. . c:a. :. x: Sis o..*.* : a;" . ,- ...
... :li.e.,. where very,~ilittl'e " loose" contamination is present)
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b....m. or.where the. contamination is confined to a relatively W. ~u..-.li: s w :
.xn .: . . . . . . . small area.
(2) For complete protection, taping of full protective t. clothing around the hood, and at the wrists and ankles may be required. For this purpose, 3-inch wide gray tape is available. 6-1
e . >( 6.4 Removing contaminated protective clothing (1) Upon completion of their activities in the contamination and treatment room, personnel will proceed to the rope between the contaminated area and the . Buffer Zone (see Diagram 4.1) , take off the outer layer of the protective clothing and deposit garments in a plastic laundry bag, in the following order: a) remove tape and hood, if any; i
!, b) remove apron and gown, or coveralls, turning l .. ; . ,,
hhem inside out;
' 2'
'c) remove shoe covers, one at a time, stepping out
,'..:..*..'.r' '
j of the contaminated area - over the rope - with. the uncovered shoe; p 1 .g )..,.
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,yf--- d) remove gloves, mask, and cap.
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- w:: -
- a. .......z.- 2. - .
l! ' - 3? ~ ; ;.i . -;." .,;r - (2). . After rertoval of the outer layer, personnel y_.. . . . .
. : . . a ggr - , proceed'to the Control Point (without crossing the rope between the Buffer' Zone and the uncontrolled i
l . j hospital area) to have their dosimeters removed j , and to be monitored for any contamination. i, I 6-2
. - - . . e.
Illik - r 6.5 ~ Clearance procedures (1) In case no contamination is found, personnel may proceed e l - , to the change area and put on their normal clothing. . After
. a final check at the Control Point, they will be cleared to enter the uncontrolled hospital area.
(2) In case persons are found to be contaminated, they will take a shower, be monitored again, and, if free from contamination, be supplied with disposable garments; then proceed as described above. The Radiation Protection Officer should be consulted if there is difficulty vich d'econtamination.
'E=- 6.6 hse of dosimeters 9
- 2 . -e : W -
,............:a.
(1) Dosimeters will be supplied at the Control Point to all
. i
~
s
~ ti.E ~. , personnel entering the Radiation Emergency Area.
-???.5ile,'
No'- - s', 1,'.rj'.j. . ' JQ.V., " .
,, (2) Desimeters are of three types (see pi= cures at the end of
- t. '
! this section): [ .
~. . .
l t' - . -f
~- , r. -
a) Direct. reading dos i=e cers (" pen-dosime ters"), tinich
- ,' ,. ,,1..- ' .: . . . .d .: ' a. -
* .- .', are supplied to all personnel;
, a ., ... . . l' b' 3adge dosimeters (!~.3 type), also supplied to all l . re: sonne;;
-\ .
e . . e e u. *. e - % .e " . e o e i m ,s==s (ar.e <. 1= a,s1,=a,.=, a m. , i r. = a s e t ,. e .. . [ . . i i t
. . - . -- ... -a. , ..r.u ..* . . r. .
- k. e .'
~
~
have to remove highly radioactive foreign bodies. 4= . . (3) Dosimecars are to be worn: a) Above the ' sternum, clippe'd to the scrub suit (pen and
> badge do' s imeters) i.e. , under the outer layer of the protective clothing.
. b) On the ring finger of the right and left hand under the glove (ring dosimeters).
(4) Upon leaving the Radiation Emergency Area, the wearer should
* - surrender his dosimeters to the Nuclear Medicine Technologist, who will record the reading of the pen dosimeter and retain y ..
thE TLD dosimeters for later processing.
. . .r . ' , - . . i
- a. .
- ~......
, .1 .
. . . . . . . ( 5. )...The Radiation. .,
4
.Protection Officer must assure that the records j..4 ; .; .. . . ', . .
. s A; - c'learly show the serial number of.each dosimeter worn by
*~
J y ., - ,'each individual. who occup ed
- i. the. Rad .
l atiod i 5'mergency Area
. . s. .
w.,. . . . . , . . . . . . 2.
'w . . ,, : ' .
'and duration o' f' time each individual sperit in the REA.
.x.. %
'. ';:.:.~. :. . . ... . .. .
.L .
.u,.f.t..., . :. , ... ..
J. . . ..r. .: . ,
.; ... ' - - . . :;g .. . . .. - ; L .. . . ..: .:. . . ;.~ y. . .
s+ ...a...** .m.
- w. .. . . . .
. y:, :
. -:a . , . _ , gg..
. . . . : . .. ., . , . .m .
,~. . : .
- s. . . ::;.r:t:;. .- u- - .s, s ..-. .
r, g,em. . .- t . . -.,-- r, *
.w..-- .-
,. ::M.
.; . ,c4- .. .W..$.? . ... .
-} .v. .,.c *
.p . s.
s . . .+ -
. . . . ,$... ,m .. .
p , , .e - .- rr*.T.
?: c ' . . .:. e-- -
w.c . .. . . - u. n3- ..
' .J.e . * . .. a . . . .
r. l l s Reviewed: December 1981
~
_. SEC'" ION 7 t SUPPLY I?NENTORY 7.1 Supply Inventory Camma Dose Rate Survey Instrument Digi-Master 1 0.1 mR/H co 100 R/H or PIC 6A Beta-Camma Monitor, R.M. 14 with H.P. 240 Probe 1
~
Self-Reading Pocket Dosimeters, 0-1 R 10 The rmo luminescent Oosimeters , Pocket Type 10 The rmoluminesc ent Dosimeters, Ring Type 20 Charger for Self-Reading Dosimeters 1 4
. . Decontamination Table-Top with Stretcher, Side Panels, 1 Mose, 2 each 5 gallon Containers I.ead Container, high activity samples 1 Kit, decontamination and sample taking. 1 4
~~'
. ...(see Accachment for inventory)
,g ..
. ..:. . . Hose, low pressure, with shower head and valve 1
. c; . .L .-- -
~. '6
. Plastic sheets, 4-5 mils 1
'.~..
. ..a . b.
' ' . - .. Herculite,.50
',cf.*
. -i.:
i.'.y,..-
. .s. *
-? ' inch vidth ,
1 roll s . A , E ,- .. M..x - i. , ,., .M.a s k i n g tape, 2 inch 4' v.p.: . - 1.- . .-; . r.e - _-
.e .., . , , . : .*Ser,. radiation warning signs, tape and rope f;. ..
1
. .s, . . . ,3acteries ,. :or ins truments 4
-s-..- ... .- p.~ .:. -
. .. . 1 -~ -
_17.7 ..'. .- .
. . H. ea..
d Covers 12
. 3., : -
Le. - Coveralls, disposable 12 i' r shoecovers 12 pairs
%; Eazs ;;arze) 20
=:'. ?a:s : sr.a ' ' ' .. 20 A . u :~ - .: isre . 3" x 1"" I re '.1 i
,,e_. . . ~[ ..v.;:., j5. , .;u *e. ~ ~::.w:. ..: ... -~--~~*r'~~*- ?:- -- - - ~ - ~ ------ --Y:1::.~;,~: .., _ .:: ;;;.-. . . . __ ,,..? ~ ~
, . . . . . ..._...un......... . T :: :::.:: :~".
- 4g.~3- - - - - - - 4.:;... .
.. ,s. .
- re . * .' p- .
w,.y - * . *
- D(a.. . .
e e.. .e e. . .w. ... , e *
. . . . . . y '.; - .- :-... .
~
Signs " Caution Radiation Area". , 4
'r'
- Signs " Caution Radioactive Material'.' ~ ,
4
. .a: . ., .
S ticke rs , ". Contaminated Material~ .. 10
. Barrier Tape . . . I roll t v: -
.:.r- .
~
Plastic can, 30 gallon, lined with dual 2 polyethylene bags 9 e. e 4 % me s
. . . . :. ee, *
- e . easemen a f q" D.
O *
* ?.
+
5... =
. p e
g'- 6 S 4
. G i . .
1 e 9 6 . . no I e . W
.-,c , , _ _ _ _ .- - - - - - , -- - , , . , ..-,,,..y y - - __ .t-__
s!: 7
- v. .
. 1
)I '
p u {
... n
( p i i i 7.2 Decontamination Kit .'
\'
k l\
* / t c
.N s
-l
* \ '
. t
- 1. Skin Decontamination (a) Utensils: s Absorbent balls, extra large box (l)
Sponge - Holdicg forceps 1 Plasti,e beaker, large 2 (co discard used sponges) Pre-op sponges 6
~-
( for large area decontamination) ,,
. surgical hand brushes
. k' ash bottle 1
.3 (co hold water for decontamination) l' ,
1 l - (b) Decontaminants: t l l- , 2 Ivory Soap e l'n ( for first decon effort, r .u l> i 2 i Radine Wash ( f:: se:end decen ei h r:) l Ilorox, bottle 1 ) .
.. .::_.i .aaninz a :ensi's: .
~
p-t . ,
-A "
/ 'J
/ r, k
l - T" Sterile nauze pads, 4x4-inch, . box (l) i'n box
' Surgical gloves, assorted sizes 5 t -
. g sterile, pair
- s. :
1 L ' , Solu-# on bowl, pl astic Plungerless syringes, 50cc, 1 ei
, sterile j
' I ii t F
/ Cotton tipped applicators pkg(1) i (b) Cleansina asents: -
t I Salin'e solutions, normal 1 ,! sterile, bottle , Hydrogen Peroxioe, 3% solution 1 j-
- bottle 3
s
,P - i
. 21 f, Miscellaneous Y.acerials
) n F -
l Nivea cream, jar 1 l (amply on dry skin after complete decon) A .
, Prep Kit 1
.? ,.'
~
(for clipping and shaving) Nail clippers, pair 1 l .
- 5:it.' sors , heavy duty HARE, paramedic 1 Medica'. and Radia:icn 5:a:us Card 3 r
T.:s:.: ta:s, asser: en: .
- s.cid de::r ma:er.als af:er usef Tar.s, vi:h vira li f
s- >,
.l
1 ,
=
0 (to indicace concents of con =ainer and bags) Tissde paper, box 1
!!otebook
- Pencils i
6 O e O f e O e e 4 -9 g O O
?.
N
* ,f a
w-
t 7.3 Sample Takine Xit I I I
- 1. Blood Samoling
. Vacu tainers , heparinized, 6 10 m1, s cerile Vacutainers. uncoated, 6 10 ml, sterile vacutainers, oxalated, 6 10 ml, sterile Vacutainers , EDTA 6 10 m1, ster.ile Needle-holder combination, sterile 12 Alcohol wipes, sterile, 12
~
- pre packaged
- 2. 'Jou n 'd Fluid , Nose Swabs Cotton tipped applicato.s, in test tube, sterile F.nve lop e s , (for storate of nose swabs)
Tissue paper, box ( for nose blows) box (1)
- 3. Small Soecimens (hair,. nails, tissue samples, sputum) s-3sceles, wide mouth, 100 ml 5
. Excreta. Irrication Fluids. Vo=itus .
.:r. las:i: f:: feces sa=rles 2
'- i e: see:i::iners. 25?: 5
- : : '.
- s . v :e .ou:h, 5 ' .. f: :
- .'e::ic
. :f irri;a:ien f'.uids
* .*e e e
_ - _ , . - - _ . _ . -. y - __ _
g . ,
***++
(. NUCON _ smear pads, witN envelopes 50
- 6. Miscellaneous Items _
Plastic bags, assorted sized 10 Tats, with wire 20 ' Labels, self-sticking 20 Medical & Radiation Status Card 5 Notebook
. Pencils 1'
i _
- q 1
~
l- . . s . s s i 4 J r. I . i Reviewed: December 1981
e . . SECTION 8 P (OCEDLIREh FOR PATIENT DECONTAMINATION AND SAMPLE TAKING 3.0 Ceneral These procedures cover the use of the Decontamination and Sample Taking Kits. The kits provide all the necessary items for the decontamination of a radioactively contaminated patient and the collection of specimens of this contamination. The collection of specimens is a prerequisite for a thorough evaluation of the medical and radiation status of the patient. ,, It should be performed in conjunction with patient deconta=ination.
. Section 7 provides a parts list for each of the two kits. There
, , is also a parts list in each kit. Following use, the lists should be consulted for replenishment. The intended use of several of the items is indicated on the parts list. This section contains a copy of "?atient Radiation and Medical
. '. Stacus Record Sheet".
This form should be used to record essential i
.s.
data on the satient's medical and radiation status. ma 5 '.
/ A.1 Patient Dec'ontamination Procedures I 8.1.1 Principles
- a. The objectives of decontamination are:
, -(1) to prevent injury caused by the presence of radioactive, substances on the body; (2) to prevent the spread of contamination over and into the patient; (3) to protect attending personnel from becoming contaminated themselves or (in extreme cases) from being exposed to a source of radiation. . _; . . b. Although decontamination should be started as soon as i
possible, primary _ attention should be given to the alleviation
. . of life-threatening conditions created by traumatic injury.
- c. Decontamination is essentially the physical removal of
- 1. .'
radioactive dirt from the skin, vounds, or body orifices.
- M.ost decontaminants contain detergents or other chemical
~.
', agents to facilitate this removal. Therefore, most decontaminants are suitable for decontamination of the intact skin only, i.e., are not appropriate for wound cleansing
. :: irriga:icn of body orifices.
- d. :ecen:aminati:n is perforned: .
s '. , from :he '. oves: level of con:amina: ion :s the hi;hes:: 5-f
r: 9 (2) starting vi,th the simplest procedure (e.g., soap and water) to more complicated procedures; (3) with due regard to contamination of wounds, body orifices, etc. (see below for specific guidelines).
- e. Usually, the effect of decontamination is greatest in the aarliest stages, i.e. , most of the radioactive material is removed during the f.irst decontamination ef fort. Continued decontamination may show diminishing effectiveness. At some point, a decision has to be made to either accept some
~
residual contamination, or proceed with the use of more potent decontaminants (more specific guidelines below).
'8 .1. 2 Measures to be Taken before Decontamination 1
, . a. Assuming that gross decontamination has been performed at the Nuclear Power Station, it can be expected that the
. ., residual contamination is minor, and/or that serious contamina: ion is localized, e.g. , around and in a wound.
. . Before decontamination, :he following s:eps should be taken:
-.r . .
(1) judge whether the patient's condition requires immediate
'~
. c. . ,c. . A, $ r
,, .,,.. .?;, - . Int e rvention; if so, proceed, covering the contaminated
~,- area with a plastic drape or ,a covel; (2) obtain a briefing from the Na:1 ear Power Station heal:h
?.
physi:is: as to :he con:amina:icn s:atus of :he pa:ien: and as :o :he specifi: naasures :o be :aken by at:ending 5-3
I p'ersonnel dich regard to their protection. Confirm this in consultation with.'the Radiation Protection
. Officer.
(3) monitor the patient with the radiation survey instrument by scanning the entire body (holding the probe about 2 inches from the skin) and record the findings on the
. PATIENT STATUS RECORD SHEET; decide in which order skin decontamination shall be performed; (4) inspect wounds, inquire about their decontaminatien at the site of accident, and decide whether further
.vound decontamination or creatment can safely be postponed until completion of skin decontamination;
__.=- (5) make a decision as to whether certain samples should f be taken (see paragraph 8.2 for further details).
. ~.
- b. In case no decontamination has been performed
..,- ..~
c
~ ~
. , ., (mos: likely because of an urzent need for emergency surgical creatment):
-. . .. " . tas- (1) perform a gross decontamination by removing all clo:hing
.i... - 5.w 4 . . .. , . , ,
< ._ ' and obvious dtrc and debris; if immediate intervention
, is necessary, cover the contaminated area vich a plastic drape and preceed;
. .i a: :he s a=e :i=e, ob:ain a briefine fre: any accompanying personnel as :o :ne =easures ::
be taken by at:ending personnel vi:h regard :o :hei: 3-
e . . proceetion;"
~;. y 4
after the emergency creatment, proceed with the applicable steps described under 8.1.2a(2) to (5) above. 8 .1. 3 Decontamination Technioues
- a. General
. Two general rules apply to the performance of decontamication:
(1) check the effectiveness of the technique applied by monitoring periodically; (2) , avoid the spread of radioactive materials from the area being decontaminated to areas of lesser contamination
=L by covering the adjacent area.
Except when prohibitive degre s of contamination are present on/in any of the locations listed below,
, ,, decontamination is performed in the following order:
(1) wounds and adjacent skin; (2) body orifices and adjacent skin;
.. .., . .1- . . .
'. t;@a. s
~.'27.".
~...:,,. . .
e ~ . ~: (3) other skin areas.
' T.m+ .
. M1
..'ag.'
* . ,[ ,
- b. Decontamination of Wounds (1) use acerture drape
- isolate ene :enta=inated area:
3-5
-(2) take sample' (see paragraph 8.2.la):
(3) decontaminate skin adjacent to wound as described below; (4) depending on surface and depth of wound, irrigate wound with sterile saliae. dab with v gauze pads and sterile saline
. or use applicators to cleanse wound; collect all materials used, and place in labeled containers; (5) remove obviously necrotic and devitalized tissue surgicall'y; keep all tissue specimens removed (see
~
paragraph 8.2);
~
(6] monitor wound; record result ,
.,.~":.
(7) if contamination persists - consult with Radiological Proteccion Officer to determine further course of action; (8) if wound clean - creat wound as indicated.
- c. Decontamination of Body Orifices
. .._3.
(1) take samples of activity in nares, ear canals, and other
- ., ..y .zi.; . ; .g . ..- :
i4. 3. ,. u*. ..,'f.
' I .~- orifices as indicated (see paragraph 8.2.la); .: . p... .' . .. .
c . . . . . -. w.-. .
,_' (2) deconta=inate area surrounding orifices as described be low;
' 3 '. ;ently c'.ean erifice using wetted swabs * .
s a) if nose swab indicates significant radioactivity in "6
nasal cavic'y, irrigate _. ( 5 )' collect all materials used, and label containers.
- d. Decontamination of Skin p
(1) take smear sample of area (see paragraph 8.2.la);
- (2) protect ad jacent area by covering with plastic drape or towels; (3) cleanse skin area:
around wounds and orifices: tepid water, using large absorbent balls. cover entire contaminated surface with a good lather, repeatedly renewing cotton balls.
~
remove lather after 2-3 minutes by wiping repeatedly
. '.,- with wetted cotton balls; monitor; record result, other skia areas: wash thoroughly with Turco decon ~.
u.. ' ... . 1
. ' . ~. . . . . . -
soaps- - . 'and tepid water, using either cotton
. .l ..
., _ y..
- .a ; .. : . 7 . .. - ,. ,
~
*" * ~"
. balls, _ . . _ , pre-op sponges, or hand brushes;
- f. j -
. . cover area vtch a good lather; rinse off ate 2-3 minutes with unning water; =onitor; record result. .
'. ;. if centa=inati n persists: repeat step (3) once; 5-7
1 ( . . (5) if contamination still persists: try gentle application of clorox or hydrogen peroxide NOTE: (avoid any of these entering wound or body openings); repeat a few times using new cotton balls; remove
? decontaminants with water; monitor; record result P
(6) af ter complete decontamination: dry skin and apply skin cream (7) if residu'al contamination is present: consult with the Radiation Protection Officer to decide whether further efforts are indicated; if it is decided to accept residual contamination, dry the skin and apply collodion, mark area involved, record,
. (8) collect all materials used and label containers:
NOTES: 8 in case of serious contamination around a wound, rapid removal of the bulk of radioactivity can be obtained
< =:- . : .
3'- . . . by shaving ,_ the adjacent skin;
...~
in case of serious conta=ination of hair, or undernails:
.?
clip
-.: ?recedures for Sa=cle Takint -
. . . Princioles e-S
- a. The objectives of collecting specimens from a radiation acci' dent victim are:
(1) to evaluate crA amount and composition of the radioactive contami..- a and in the body; (2) to obtain-data,vich regard to the patient's exposure to external, and internal radiation. (3) to supply information on the biological injury inflicted by the irradiation.
. b. To me e t these objectives, the following types of specimens are c"ollected routinely: ,
(1) materials containing the external contaminant (swabs, smears, tissue samples, contaminated cleansing fluids,
. etc.);
(2) specimens containing internal contaminant (feces, stools,
~
~
sputum, etc.): Collect all samples. Remember an initial negative result does not indicated-no internal cont:=in.
.. . . cion..(eg.. material may not be in ur in e , etc. yet).
in case of neutron irradiation: materials in which (3)
\ @- *
.. . - :, - ~~
*'
- neutron induced radioactivity may be present
, f, .,
. - .-.... . ./" ..~ .. .
j '..g ,;j.7, . +2. . 1 (hatr, nati citppings); j '. . f. , . . . . - . g. ._ :. - i j .:. -e.: ., e. ..w. . .
's ( !. ) he=atological specimens (whole blood in heparinited,
! :xalated, and uncoated t'ubes; blood s= ears, leukocyte a counts?.
- t. As the analysis of radioactive samples with regard to their l
50 Y l L-
composition is only possible in samples with a relatively high radioactivic'y, care should be taken to collect and store these samples separately from the usually bulky samoles wich' rather low radioactivity (such as cleansing fluids, drapes. towe ls , e tc. ) . i
- d. A sample which is not identifiable as to its source (locstion, time taken) may h e practically worthless: therefore, take care to properly collect, store, and mark all san.ples.
R.2.2 Samole Taking Technioues and Indications
. a. External Contamination Sefore decontamination, the following samol'es shall be obtained: -
(1) skin smears: use smear pads: moisten with a few drops of water, smear a skin area of about 100 cm2 (4
~
x4 in.), if possible. by allowing sticky side of the
..,. ..~ ,
- - - smear to' adhere to sloves, and rub the smear nad over
..'--. the surface to be sam: led; place smear on record nacer,
. *f.
3.. . . + -v; . - record location and time, and area smeared L: otner v..., ... .*-:'.y3~4
.u a. _ ..:: ~g -
t* .
...e..+.,. .
than 100 cm,.-
- 7. .y......a.,.
. (2) wound samples: use either one of the following methods:
7 latte vcunds with risible blood or scund fluii: i ? ebtiin a few :: 's usinc d:::per. . ::ansfer *
- bottle and lacel:
.: -10
superficial wounds: rub gently with cotton swab -
. return -to tube, label;
- wounds with visible di.rt or debris: remove with applicscor SWN1 or use tweezers, and transfer sample to samil glass vial, label.
- b. Internal contaminac. ion
. in all cases where internal contamination is suspected:
' collect all urine and feces in containers supplied and
.._ .. - . . . s.__.
record time of voiding.'
.__/ ..
- c. External Exoosure ~ ~
In all cases where a whole body dose of more than 10 rads
. . '. is known or susoected:
. .' (1) obtain a blood smear for differential:
. ; .n. . .y
.. . g-
. . . re,q[zp.. .
, ..y. ..;. . .wlTF.. .. ..
(2) obtain a leukocyte count;
- ,~ .
r (.... , s . , . t. .
. ... wi--> -
.~o M (3) obtain 30 ml of blood in vacutainers (green, red, gray
. -r _ - _ . -.
"~~T ' and lavender scopo j ab.m gm G
8.ecord date and ti :e :5ese ra rles we e taken. c_;- i i
cesa==- =
. =e===sIMIENT lW)lATIO!! A!O IfDIG1L-SIRIU3 IMEM EHLw (ni sump.iny paacent;9 ~ '
= yt e = a c e.:c a n e = = = '
~ i 1 ' I ME"'# 0 ~E - :
~
!!aa.c of patients- -
A90: J_ Location, date,~and time of>locilent:- f - . . , Su :nry description of indjd,en,li . d r: .-
.. :. 6 p: . . . ,- -
========================c=====d=,===============h,==========;===============u =___ ____==TG= G I:= E====u= .: 2=u G .b.f
,F. . E. L P .0 r ?
?S U '{l. 5 [ I N .i U R Y i%I*h?$.CI:
..,y r, a r, .or , it; f :
IDtH)S
.,R,..C. D'M. E.w.g g@n py;' SKlH {0NDUlmT10N lillEIVBl. COMN111RT10f1 ye:;/no -
; ; eyes /no {,. ,y - yes7ifo~ yes/qo uhcre?'.ir;dicate overicaf
~' ' r nherc? iu:dicata onceleaf hou? axii:nda/ingantion/inini.
how serious? where? $shole body how much? indicato meter how much?
!t readinga overleaf '
I E M10cai wha t? what? '
general condition? hou much?% ' rons mixe:1 fission' products? mixed fission products'? (likely/ other(describc): other(describc): __ what? 8 l7 lpossible) ,ncutr- , .
..=========================o =======================, === =========- ======================u=====u=====uuuusu.
MEAS il R R S TAXEN tuna: tima: time: time: f trst aid: synptoms? nausca +/- decon: nose blow: umicing f/- technique: '- sample kept? ' skin erythema +/- other? effect: decon of orifices; medical: symptomatic treatmentT ' Where? (indicate decontaminated hou? blood samples taken? areas overleaf) residual contamination decon fluids kept? badge tal:en? at time of' transfer? (describe; mark on skin): other samples taken; uound decon: IIEUTRON IRRADIATION ONE,Y:_ urinc? . , hou: ving taken? icces? . other? buttons, hair, nait clip-cffect: pinga taken? Course / follow-up: 1 . o I q;;
--_______.__._W
Irl0!CATE C0!! tai 1111 ATE 0 AREAS AS TO LOCATI0tl, DECREE OF CONTAf4IfMTION, DEC0tl EFFORT IttDICATE LOCATIOr! CF k'0Utl0S (use additioncL sheets if neccsscry) 6
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