Perform Lifesaving Tasks Before Managing Radiation Problems

• Managing victims with contamination
• Managing victims with exposure

• Managing victims with contamination
  • General guidance
    • Rescuing victims with contamination should occur only after
      • On-scene management activities have been taken to ensure responder and public safety
    • Minimally contaminated victims do not pose a health risk to rescuers or healthcare providers.
    • Perform life- and limb-saving tasks before managing external or internal radiation contamination.
    • Do not delay life-saving rescue or transport of a seriously injured or contaminated person.
  • Guidance for managing patients with highly radioactive fragments or shrapnel (e.g., Cobalt-60 or Iridium-192)
    • If such radioactive fragments are possible, evaluation should be performed by
      • A healthcare provider who will assess medical status AND
      • A radiation safety professional who will survey the patient with appropriate radiation survey equipment and document survey results
    • Radiation dose to healthcare providers in prolonged, close contact (e.g., CPR teams, surgeons, operating room staff) must be
      • Monitored using personal dosimeters and/or dose rate meters to track radiation dose in real time
      • Minimized by rotating staff to decrease total exposure time
      • Considered in the context of worker exposure guidelines.
    • Removed radioactive shrapnel should be placed in a shielded container and secured.
  • Smith, et al.¹, provide excellent guidance for medical responses to explosive RDD events.
• Managing victims with exposure
  • Rescuing victims with exposure should occur only after
    • On-scene management activities have been taken to ensure responder and public safety
  • Victims who have been exposed but not contaminated do not pose a threat to rescuers or health care providers.
  • After a nuclear detonation, widespread, high radiation levels in the environment may
    • Preclude rescue efforts in certain Zones of Response.
    • Limit work time in other areas, at least initially
  • Radiation safety personnel and incident managers should maximize the health and safety of responders by
    • Ensuring that appropriate personal protective equipment and personal dosimeters are worn.
    • Respecting relevant emergency worker exposure guidelines

References:

1. Smith JM, Ansari A, Harper FT. Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device. Health Phys. 2005 Nov;89(5):513-20. [PubMed Citation]
2. Harper FT, Musolino SV, Wente WB. Realistic radiological dispersal device hazard boundaries and ramifications for early consequence management decisions. Health Phys. 2007 Jul;93(1):1-16. [PubMed Citation]
3. Musolino SV, Harper FT. Emergency Response Guidance for the First 48 Hours after the Outdoor Detonation of an Explosive Radiological Device. Health Physics 2006 Apr;90(4):377-85. [PubMed Citation]
4. Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats)

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