At-Risk / Special Needs Populations During Radiation Emergencies
- Managing At-Risk / Special Needs Populations - General
- Infants and Children
- Pregnant Woman and Fetus
- Persons with Disabilities and Other Special Needs
- Crisis Triage and Disability Rights
- HHS definition of At-Risk Individuals plus Tools and Resources
- Populations with Special Needs (PDF - 520 KB) (Oak Ridge National Laboratory, ORNL/TM-2006/559, October 2006)
Managing At-Risk / Special Needs Populations - General
- At-risk / special needs populations require special attention during a radiation incident.
- Health care providers must identify and respect their needs and respond appropriately to them, considering the resources available.
- Selected issues particularly relevant to radiation incidents are discussed below
- General issues are discussed in this CDC document
- US Department of Labor Office of Disability Employment Policy Information about Various Aspects of Emergency Preparedness
- Bone marrow reserve diminishes with age
- Predisposition to anemia
- Predisposition to infection
- Predisposition to bleeding
- May have increased risk of bleeding due to medications, poor diet, or other factors
- Increasing number of co-existing diseases and conditions may be associated with
- Inability to tolerate certain drugs
- Lesser ability to tolerate aggressive salvage treatments, such as stem cell transplant for treatment of Acute Radiation Syndrome
- Cognitive issues may need to be addressed
- Seniors (Ready.gov)
- Emergency Readiness for Older Adults and Caregivers (HHS/Administration on Aging)
- Whole body radiation exposure will exacerbate pre-existing diminished immune functions.
- Countermeasures (e.g., myeloid cytokines) used to enhance blood cell production may be less effective.
- Affected individuals are more susceptible to infection.
- These individuals usually require leuko-reduced, irradiated blood.
- May not be able to tolerate radiation-induced prolonged pancytopenia or stem cell transplant due to underlying condition (e.g., cancer, congenital or acquired immune deficiency).
Infants and Children
Pregnant Woman and Fetus
- National Council on Radiation Protection and Measurement (NCRP)
- Preconception and Prenatal Radiation Exposure: Health Effects and Protective Guidance, (NCRP Report No. 174), Bethesda, MD, 2013.
- International Committee on Radiation Protection (ICRP)
- Biological effects after prenatal irradiation (embryo and fetus), ICRP Publication 90, Ann. ICRP 33(1-2), 2003.
- Doses to infants from radionuclides ingested in mothers' milk, ICRP Publication 95, Ann. ICRP 34(3-4), 2004. Errata published (PDF - 62 KB)
- Doses to the embryo and fetus from intakes of radionuclides by the mother, ICRP Publication 88, Ann. ICRP 31(1-3), 2001.
- Pregnancy and medical radiation, ICRP Publication 84, Ann. ICRP 30(1), 2000.
- ICRP 84, Pregnancy and medical radiation; Free, downloadable, educational material for teachers, doctors, those in radiological protection. (English and Spanish versions)
- Health Physics Society (HPS)
- Pregnancy and Radiation (PDF - 222 KB) (Health Physics Society)
- Pregnancy and Radiation Exposure (Health Physics Society)
- Radiation Exposure and Pregnancy - Fact Sheet for Patients (PDF - 480 KB) (Health Physics Society)
- Government publications and videos
- Effects of in utero exposure to ionising radiation during the early phases of pregnancy (PDF - 328 KB) (European Commission, Proceedings of a scientific seminar held in Luxembourg in November 2001)
- Prenatal Radiation Exposure: A Fact Sheet for Physicians (HHS/CDC, May 10, 2006)
- Possible Health Effects of Radiation Exposure on Unborn Babies (HHS/CDC, May 10, 2006)
- Prenatal Radiation Exposure (YouTube - 3:33 minutes) (HHS/CDC)
- Public Health England (PHE) (formerly Health Protection Agency [HPA], United Kingdom)
- Protection of pregnant patients during diagnostic medical exposures to ionising radiation, RCE 9 (Public Health England [PHE], formerly Health Protection Agency [HPA], March 2009)
- Guidance on the application of dose coefficients for the embryo, fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Public Health England [PHE], formerly Health Protection Agency [HPA], March 2008)
- Other publications
- Mabuchi K, Fukiwara S, Preston DL, Shimizu Y, Nakamura N, Shore RE. Atomic-bomb survivors: Long-term health effects of radiation, Chapter 8, pp 89-113 in Human Radiation Injury, Shrieve DC, Loeffler JS, eds.: Wolters Kluwer | Lippincott Williams & Wilkins, Philadelphia, PA, 2011.
- Brent RL. The effects of embryonic and fetal exposure to x-rays and isotopes. in: Barron WM, Lindheimer MD, eds. Medical disorders during pregnancy. 3rd ed. St. Louis: Mosby Yearbook; 2000, pp. 586-610.
- Brent RL. Utilization of developmental basic science principles in the evaluation of reproductive risks from pre- and postconception environmental radiation exposures. Teratology. 1999 Apr;59(4):182-204. Review. [PubMed Citation]
- Brent RL. Counseling patients exposed to ionizing radiation during pregnancy. Rev Panam Salud Publica. 2006; 20(2/3): 198-204. [PubMed Citation]
- Boice JD, Miller RW. Childhood and adult cancer after intrauterine exposure to ionizing radiation. Teratology 1999;59:227-233. [PubMed Citation]
- Donnelly EH, Smith JM, Farfan EB, Ozcan I. Prenatal Radiation Exposure: Background Material for Counseling Pregnant Patients Following Exposure to Radiation. Disaster Med Public Health Prep. 2011 Mar;5(1):62-8. [PubMed Citation]
- Izumi S, Suyama, A, Koyama K. Radiation-related mortality among offspring of atomic bomb survivors: a half-century of follow-up. Int J Cancer. 2003 Nov 1;107(2):292-7. [PubMed Citation]
- Schull WJ, The children of atomic bomb survivors: a synopsis. J Radiol Prot. 2003 Dec;23(4):369-84. [PubMed Citation]
- Brent RL and Mettler FA, Pregnancy Policy. AJR Am J Roentgenol. 2004 Mar;182(3):819-22. [PubMed Citation]
- Prasad KN, Cole WC, Haase GM. Health risks of low dose ionizing radiation in humans: a review. Exp Biol Med (Maywood). 2004 May;229(5):378-82. Review. [PubMed Citation]
Persons with Disabilities and Other Special Needs
- Patients with diminished mobility may not be able to
- Evacuate the radiation scene as directed
- Tolerate the austere environments required during the emergency
- Mobilize without assistance for transportation or decontamination
- Transportation issues may need to be arranged to accommodate special needs.
- Patients with diminished mental capacity may not be able to follow directions.
- Patients with limited language proficiency or non-English speakers may not be able to follow directions.
- Patients with medical disabilities may not be able to tolerate standard radiation rescue treatments and may be disconnected from chronic treatments such as dialysis, oxygen, insulin, and other chronic medications.
- Individuals with Disabilities — Special Preparedness Information for the Disabled (DHS)
- Preparing for disaster for people with disabilities and other special needs (DHS/FEMA, American Red Cross)
Crisis Triage and Disability Rights
- Crisis Triage and Disability Rights – these papers about the Covid-19 pandemic present issues that could be relevant for large radiation incidents
- Mello MM, Persad G, White DB. Respecting Disability Rights - Toward Improved Crisis Standards of Care [published online ahead of print, 2020 May 19]. N Engl J Med. 2020;10.1056/NEJMp2011997. [PubMed Citation]
- Solomon MZ, Wynia MK, Gostin LO. Covid-19 Crisis Triage - Optimizing Health Outcomes and Disability Rights [published online ahead of print, 2020 May 19]. N Engl J Med. 2020;10.1056/NEJMp2008300. [PubMed Citation]
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