emergency medical management of radiation causalties in hospital module xvii
TRANSCRIPT
EMERGENCY MEDICAL MANAGEMENTEMERGENCY MEDICAL MANAGEMENTOF RADIATION CAUSALTIESOF RADIATION CAUSALTIES
IN HOSPITALIN HOSPITAL
Module XVII
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Hospital management of Hospital management of radiation accident victimsradiation accident victims
PotentialPotential problem of admitting victims of radiation accident
Plan & protocolPlan & protocol for emergency department needed to deliver prompt and appropriate medical care to victim
Slight potentialSlight potential for radioactive contamination of hospital team, equipment and facility
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Preparation for hospital care Preparation for hospital care of radiation accident victims of radiation accident victims
Organization of hospital radiological emergency response team
Facility preparation and staff training Patient reception and triage
Decontamination and decorporation procedures
Radiological monitoring & contamination control
Bioassay sampling Post-emergency activities
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Meet victims at ambulance or other transport vehicle at hospital entrance
Instruct ambulance personnel to stay with vehicle until surveyed and released by radiation safety officer (RSO)
Arrival of radiation accidentArrival of radiation accident victims at hospital victims at hospital
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Extended triage and reception of Extended triage and reception of victim at hospitalvictim at hospital
Lifesaving measuresLifesaving measures
Extended triageExtended triage If victim’s condition allows, perform brief radiological survey to check for contamination
Remove victim’s contaminated clothing in or near the ambulance
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Area Selection ConsiderationsArea Selection Considerations Outside entrance with easy access Away from main hospital traffic flow Availability of and storage capacity for
equipment and supplies Sufficient rooms of suitable size for
decontamination and treatment
Establishing radiation Establishing radiation emergency area (REA)emergency area (REA)
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Triage Area
Dec
on
tam
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ion
R
oo
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No
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vict
ims
control control lineline
Plan of hospital reception area Plan of hospital reception area for radiation casualtiesfor radiation casualties
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Procedures for handling contaminated accident victims similar to strict reverse strict reverse isolation precautions and to protocol for isolation precautions and to protocol for “septic” surgical cases“septic” surgical cases
Prevents spread of radioactive contaminants and simplifies clean up
Preparation of radiation Preparation of radiation emergency area (REA) - Iemergency area (REA) - I
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Victim considered contaminated until proven otherwise
Remove patients, uncontaminated casualties, and non-essential personnel from REA before using it
Designate separated part of REA for patient decontamination
Preparation of REA - IIPreparation of REA - II
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Cover route from ambulance entrance to decontamination room, and floor of room and treatment area with wide strong rolled paper
Roped off route and mark “radiation area” Establish control linecontrol line at entrance to
decontamination room
Preparation of REA - IIIPreparation of REA - III
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Life support and other essential medical Life support and other essential medical equipment and supplies should be equipment and supplies should be available immediately and ready for use available immediately and ready for use
Prepare decontamination table and Prepare decontamination table and materials materials
Cover door handles and light switches to reduce contamination that might be spread by hand
Preparation of REA - IVPreparation of REA - IV
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• Prior to patient arrival, check radiation monitors
• Cover probe of contamination monitor
• Check and record background radiation level in decontamination room
Preparation for Preparation for radiological monitoringradiological monitoring
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1. Set up and equip controlled area
2. Restrict access
3. Use strict isolation precautions, including protective clothing and double
bagging
4. Monitor anyone/anything leaving controlled area
Procedures for Procedures for contamination controlcontamination control
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Necessary supply: Surgical gown and suit, mask, head cover, gloves, waterproof apron and shoe covers
Tape all clothing sleeves and cuffs Splash protection for eyes Double gloving procedures Issue personal dosimeters
Response team preparation forResponse team preparation forreceiving potentially contaminated receiving potentially contaminated
radiation victimsradiation victims
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Assessment and treatment of Assessment and treatment of non-contaminated patientnon-contaminated patient
Care for non-contaminated patientsnon-contaminated patients like any other emergency case
Victim of external exposure without contamination poses no radiological hazard
If exposure known or suspected, order blood cell count in particular to determine absolute lymphocyte count. Record time blood sample taken
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SumSummmary: assessment and ary: assessment and treatment of contaminated patienttreatment of contaminated patient
Contaminated patients can have radioactive material deposited on clothes, hair, skin, in wounds, or internally (ingested, inhaled, or absorbed)
Assess level of consciousness and vital signs on arrival
Reassess contaminated patient’s airway, breathing and Reassess contaminated patient’s airway, breathing and circulationcirculation first and stabilize condition After examining patient and identifying all injuries, conduct complete radiological survey (incl. nasal swabs and skin smears)