Emergency Department

Preparation for Receiving Radiation

Exposed/Contaminated Patients

Radiation Exposure/Contamination

• Accidents• Nuclear reactor• Medical radiation therapy• Industrial irradiator• Lost/stolen radioactive sources• Transportation

• Terrorist Event• Radiological dispersal device (dirty

bomb)• Attack on or sabotage of a nuclear

facility• Low-yield nuclear weapon

Scope of Event

Event Number of Deaths Most Deaths Due to

RadiationAccident

None/Few Radiation

RadioactiveDispersalDevice

Few/Moderate(Depends on size of

explosion and proximity of persons)

Blast Trauma

Low-YieldNuclear Weapon

Large(e.g., tens of thousands in an urban area even from

0.1 kT weapon) Radiation Exposure

Blast Trauma Thermal Burns

(Depends on Distance)

Emergency Preparedness

Medical stabilization is the highest priority. Contamination control should not delay critical medical

care.

Be prepared for multiple hazards, including chemical, radiological, and biological.

Be prepared for multiple events, e.g., a 1st event followed by 2nd event used to take out first responders if terrorists are involved.

Be prepared for: Large numbers of potentially contaminated individuals.

Large numbers of uninjured and uncontaminated but concerned and frightened individuals.

Emergency Preparedness

Triage Goals for Mass Casualty Evaluate and sort patients by immediacy of treatment.

Do the greatest good for the most people.

In mass casualty event, may need to deal with thousands of persons in need of contamination and exposure assessment.

Pre-plan to ensure adequate supplies and survey instruments are available.

Training and drills are essential to competence and confidence.

Systematic Approach

• A systematic approach to handling large numbers of potentially contaminated individuals is necessary.

• Such an approach should provide for surveying, mass decontamination, resurveying, advanced decontamination (if necessary), resurveying, and additional decontamination or medical care as indicated.

• Depending on weather, decontamination sites may have to be established indoors or in a temporary shelter.

Contaminated but Uninjured and Worried Well

• An incident caused by nuclear terrorism may create large numbers of contaminated people who are not injured and worried people who may not be injured or contaminated.

• Measures must be taken to prevent these people from overwhelming the emergency department.

Controlled Triage Site

• A controlled triage site should be established away from the emergency department to intercept the large numbers of contaminated people who are not injured and people who are uncontaminated but worried and divert them to appropriate locations.

Triage Site Control

• Control of movement through the site is necessary to minimize the potential for contaminating clean areas of the site.

• The triage site should be staffed with medical staff, radiation monitors, and security personnel.

• Precautions should be taken so that people cannot avoid the triage center and go directly to the emergency department.

Decontamination Center

• Establish a decontamination center for people who are contaminated, but not significantly injured.

• Center should provide showers for many people.• Replacement clothing must be available. • Provisions to transport or shelter people after

decontamination may be necessary.• Staff the center with medical staff with a radiological

background, health physicists or other staff trained in decontamination and use of radiation survey meters.

• Psychological counselors available

Movement Through the Triage/Decontamination Areas

• The path through the triage/decontamination area must be clearly marked and individuals assigned to keep traffic moving in the right direction and to prevent potentially contaminated individuals from walking into clean areas, except by the designated route.

photo credits: M. Meehan

Directions

• Clear directions (in appropriate languages) are necessary to help individuals understand what is expected of them.

Handling of Mass Casualties

Near Emergency Department

Community

Controlled Triage

Site Triage for Injury &

Contamination

EmergencyDepartment

• Perform first aid• Perform

decontamination

AmbulanceTraffic

Only

Area for deceased

Admit patients

or treat & discharge

Access forSelf-referred patients

Access forStaff, Press,Officials

Main Hospital

Serious Injury/Illness

Facility Preparation

• Activate hospital plan:• Obtain radiation survey meters.• Call for additional support: Staff from Nuclear

Medicine, Radiation Oncology, Radiation Safety (Health Physics).

• Establish area for decontamination of uninjured persons.

• Establish triage area.

Facility Preparation

• Plan to control contamination:• Instruct staff to use universal precautions and

double glove.• Establish multiple receptacles for

contaminated waste.• Protect floor with covering if time allows.• For transport of contaminated patients into the

emergency department, designate separate entrance, designate one side of corridor, or transfer to clean gurney before entering, if time allows.

ContaminatedWaste

Waste

Treatment Area Layout

RadiationSurvey

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Radiation Survey

& Charting

ED Staff

Clean Gloves, Masks,Gowns, Booties

Separate Entrance

Trauma Room

Additional Considerations

• Develop prepared information packets with Media Relations in advance with message for incidents involving radiation.

• CDC Web site (www.cdc.gov) has Emergency Instructions for Individuals and Families

Available in EnglishEspañolDeutschFrançaisTagalogChinese photo credits: CDC

Health Physics SocietyDisclaimer: The information contained herein was current as of 13 Aug 2008 and is intended for educational purposes only. The authors and the Health Physics Society (HPS) do not assume any responsibility for the accuracy of the information presented herein. The authors and the HPS are not liable for any legal claims or damages that

arise from acts or omissions that occur based on its use.

*The Health Physics Society is a nonprofit scientific professional organization whose mission is to promote the practice of radiation safety. Since its formation in 1956, the Society has grown to approximately 6,000 scientists, physicians, engineers, lawyers, and other professionals representing academia, industry, government, national laboratories, the Department of Defense, and other organizations. Society activities include encouraging research in radiation science, developing standards, and disseminating radiation safety information. Society members are involved in understanding, evaluating, and controlling the potential risks from radiation relative to the benefits. Official position statements are prepared and adopted in accordance with standard policies and procedures of the Society. The Society may be contacted at 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101; phone: 703-790-1745; fax: 703-790-2672; email: HPS@BurkInc.com.