Exposure + Contamination (Text Version)

Management Modifiers Burns Trauma Mass casualty Timing of surgery Blood products use At-risk/special needs populations

1. Assess External Contamination
   • Contact radiation safety officer
   • Assess contamination pattern with radiation survey meter
   • Evaluate for radioactive shrapnel
   • Document contamination pattern on a body diagram (PDF - 49 KB)
   • Swab each nostril separately to help estimate level of internal (lung) contamination
2. Decontaminate Whole Body
   • Decontaminate either on-site or at other designated areas
   • Follow decontamination procedures
   • Re-scan patient with radiation survey meter
   • Repeat decontamination until successful (Understand target levels for decon)
   • Do not exceed 3 attempts (decon cycles)
   • Special issues for infants and children
3. Evaluate if All Are True
   • Decontamination successful (Understand target levels for decon)
   • Absent or minimal physical injury
   • Whole/partial body dose from exposure likely to be < 2 Gy
4. If All Are True:
   • Send home with follow-up instructions
   • Register in event database
5. Otherwise: Evaluate at Medical Facility
   • Treat life- or limb-threatening injuries first
   • Obtain serial CBCs with differential to evaluate possibility of exposure and ARS
   • Remove any remaining radioactive shrapnel and shield it safely
   • Surgical window of about 36-48 hours, depends on rate of dropping blood counts
   • Treat non-life-threatening problems
6. Assess Internal Contamination
   • Scan patient with radiation survey meter (caveat)
   • Event responders or radiation safety officer will identify the isotope(s)
   • Swab each nostril separately to help estimate level of internal (lung) contamination
   • Collect ≥70 mL spot urine sample for isotope measurement
     • Instructions for sample collection, labeling, packaging and shipping (HHS/CDC)
   • Consider total body radiation survey with modified hospital nuclear medicine equipment
7. Treat Internal Contamination of Specific Isotope
   • Isotopes of Interest Table
   • Countermeasures Table
   • Decision to treat will depend on
     • Level of internal contamination
     • Size of radiation event
     • Availability of resources/personnel
     • Likelihood that patient will survive
8. Diagnose/Manage Exposure - Acute Radiation Syndrome
9. For Deceased
   • Management of decedents with contamination
   • Register decedent in incident database
10. For Survivors
    • Discharge with appropriate follow-up instructions
    • Register patient in incident database
    • Radiation follow-up considerations
      • Whole body dose
      • Immune status
      • Risk of cancer
      • Risk of specific organ dysfunction