radiation emergencies response and preparedness workshop_28 sep 2019.pdfradiation emergencies...
TRANSCRIPT
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Radiation Emergencies Response and Preparedness
MEFOMP WorkshopOn Medical Physics in Diagnostic Radiology
28- 29 September 2019/ Muscat- Oman
Dr. Huda Al Naemi President of MEFOMPAssistant professor Medical Biophysics Research in Radiology (Weill Cornell Medicine – Qatar)Executive Director of OHS at Hamad Medical Corporation-Doha-Qatar
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• Internal and External exposure
• Radiation Emergency
• Emergency Preparedness
• Classification of Emergency
• Handling of Emergency
• Medical Physicists and radiological emergencies response
Outline
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Radiation, Radioactivity and Radioactive Materials
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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Exposure Dose from Natural and Artificial Radiation
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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Internal and External Exposure
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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External Exposure and Skin
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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Local injury thresholds
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Dose Effect Timing ( Time post exposure )
3 Gy Epilation 14 – 21 days
6 Gy Erythema Early, then 14 – 21 days later
10 – 15 Gy Dry Desquamation 2 – 3 weeks
15 – 25 Gy Wet Desquamation 2 – 3 weeks
> 25 Gy Necrosis Dependent upon dose
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Internal Exposure
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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• “Any unintended event including operating errors, equipment failures or
other mishaps, the consequences or potential consequences of which
are not negligible from the radiological protection or safety point of
view”
Radiological event
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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International nuclear and radiological event scale (Nuclear Disaster)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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Emergency Preparedness Categories
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• GSR Part 7 (2015)
• Categories I-III involve fixed facilities (Example: power/research reactor, irradiation facilities, hospitals
• Category IV: could occur anywhere!
• Category V: means primarily to protect food/water supply
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Emergency Preparedness
• The capability take actions that will
effectively mitigate the consequences of
an emergency for human health and
safety, quality of life, property and the
environment.
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Meet response objectives
QA programme
Organization
Plan and Procedures
Logistical support and
facilities
Training drill and
exercises
Coordination
Authority
Emergency Preparedness Programme
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• To save lives,
• To regain control of the situation and to mitigate consequences,
• To avoid or to minimize severe deterministic effects;
• To render first aid, to provide critical medical treatment and to manage the treatment of radiation injuries;
• To reduce the risk of stochastic effects;
• To keep the public informed and to maintain public trust;
• To mitigate, to the extent practicable, property and the environment;
• To prepare, to the extent practicable, for the resumption of normal social and economic activity.
Goal of the Response
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Radiological Accident: Goiania, Brazil (13 September 1987)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Cs-137: ≈ 51 TBq (1.4 MCi)
Widespread Contamination
IAEA reports 112,800 people monitored
Over a 2.5-month period
249 contaminated
8 with acute radiation syndrome
4 died
Mental health impact
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Radiological Accident: Fukushima, Japan (11 March 2011)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
245000 people screened
901 cases, between 13- 100 kcpm
110 cases > 100 kcpm
All cleaned by removal of clothing and wiping
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Effect of reactor accidents (Nuclear Disaster)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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What is Population Monitoring?
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
The process of identifying, screening, and monitoring people for exposure to radiation or contamination with radioactive materials.
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Plan for a “Large” Population
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
There is potential for contamination
There is potential for injuries
Some may need immediate medical care
Most may need shelter/temporary housing
All would be stressed
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Controlled Area
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Establish controlled/decontamination area
Tape, ropes, signs, floor covering, security
Remove unneeded items
Non-contaminated patients do not enter
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Reception Centers (RC)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Place to conduct population monitoring
Multi-agency effort
Opened 24-48 hours after incident
Located outside of hot zone
May be next to hospital or shelter
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Reception Centers (RC)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Reception Center
Surrounding Community
Affected Area
Home
Public Shelter
Hospital or Alternate Care Site
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Reception Centers (RC)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Services include:
Contamination screening
Decontamination
Limited medical care
Main purpose is to prioritize people for further care
Ease burden on hospital
Manage scarce medical resources
Support shelters
Reassure population
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Guiding Principles
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
The first priority is to save lives: respond to and treat the injured first.
Contamination with radioactive materials is not immediately life-threatening
Flexibility are an important part of the planning process
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Reception Centers (RC): 7 stations:
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Initial sorting
First Aid
Contamination Screening
Wash
Registration
Radiation Dose Assessment
Discharge
Clean Zone
Contamination Control Zone
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Initial Sorting (Contamination Control Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Staff identify people who have:
• Urgent medical needs
• High levels of contamination
• Special needs
• Decontaminated coming to the CRC
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First Aid (Contamination Control Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• Medical staff care for and/or transport patients with urgent medical needs
• Life saving care takes priority • Do not delay transport for
decontamination
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Contamination screening (Contamination Control Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Staff screen people for external contamination
Radiation detection Equipment
Full-Body Contamination Screening
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Contamination screening (Contamination Control Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Staff screen people for external contamination
Radiation detection Equipment
Partial-Body Contamination Screening
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Survey Meter- Contamination
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Instrument Description:
• Geiger-Mueller/Pancake Probe
• off
• battery Check
• Scale
• Multiplier
• Audio
• Reset
• Alpha, Beta, and Gamma
• Survey: patient, Personnel, Area
• Units- counts/minute (cpm) or (cps)
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Personnel Contamination Surveys
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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Personnel Contamination Surveys (Patients)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Measurement can be made during patient treatment.
Order to survey
Wounds
Face/Body Orifices
Skin
Survey all area of the patient (sides, back, etc..)
Survey SLOWLEY and carefully
First, nose and mouth, detect potential for internal contamination early
Take into account religious and cultural considerations
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Wash Station (Contamination Control Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Staff monitor and facilitate showering
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Post-Decontamination Screening (Contamination Control Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• Screening staff in the Wash Station will check people for contamination after they clean themselves. If contamination is still present after two showers, that person may be internally contaminated and will require additional screening at the Radiation Dose Assessment Station.
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Registration (Clean Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Staff use epidemiological tools to: • Establish a registry• Determine need for immediate
follow-up at Radiation Dose Assessment Station
Information collected includes:• Demographic information• Destination• Proximity to event • Time in affected area
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Radiation Dose Assessment (Clean Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Clinical and Health physics staff:
Screen for internal contamination
Assess radiation exposure
Assess need for bioassay (blood/urine)
Assess need for treatment
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Discharge (Clean Zone)
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Staff provide information for people discharged:
Assess need for counseling
Discharge to home or shelter
Provide referral for further care
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It all started with a simple question …
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• Do Medical physicists have a role in case of a nuclear or radiological emergency?
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Roles and Responsibilities of Medical Physicists
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• International Basic Safety Standards (GSR Part 3, 2014)
• International Basic Safety Standards (GSR Part 7, 2015)
• IOMP: Policy Statements 1-3 (2012, 2013)
• IAEA: Roles and Responsibilities, and education and Training Requirements for Clinically Qualified Medical Physicists (HHS 2013)
• ILO: International Standard Classification of Occupations (ISCO-08, 2008)
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Where is the Medical Physicist in the chain ..?
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
The Medical Physicist is a member of a multidisciplinary team involved in the diagnosis and treatment of patients
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Medical Physicists act as Qualified Experts in radiation protection
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• The Medical Physicists are trained in medical radiation physics, dosimetry and biological effects of radiation.
• Medical Physicists are Qualified Experts (QE) in dose measurement of medical radiation exposure
• Medical Physicist have legal responsibilities for radiation protection of patients, workers and public.
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Why should MPs contribute to nuclear and radiological emergencies response?
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• Medical Physicists have expertise and experience with radiological issues:
1- Radiation safety and protection of patients, staff and the public
2- Radiation dose assessment:
- Medical management purposes
- Responder safety
3- Radiation risk assessment and communication
4- Education, training and associated planning
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The potential roles of medical physicists in nuclear or radiological emergency situations
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
• Advice on appropriate personal protective equipment
• Delineation of radiation and contamination control zones
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The potential roles of medical physicists in nuclear or radiological emergency situations
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
As an expert in radiation dosimetry:
• Advises on dose measurement and reconstruction
• Conducts or participates in dosimetry measurements and dose reconstructions
• Communicates associated risks
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The potential roles of medical physicists in nuclear or radiological emergency situations
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
As a trainer:
• Advises the medical staff and other emergency response staff in the evaluation and understanding of the significance of the levels of radioactivity with which they are dealing
• Contributes to the development and implementation of training programs to different groups at hospitals
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The potential roles of medical physicists in nuclear or radiological emergency situations
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
As a stakeholder:
• Participates in the planning of radiation emergency response, as requested by appropriate authorities
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Summary of Key Points
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
Medical Physicists play roles as Radiological Assessor on the scene, supporting multiple on-site teams including decontamination teams.
Reception center are where population screening and decontamination take place
The first priority is to save lives
Initial radioactive monitoring/ decontamination efforts should focus on preventing deterministic effects
Developing plans and exercising those plans are key to preparedness
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Other Resources
MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman
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