MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY

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MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR
RADIOLOGICAL EMERGENCY

• Module II

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Syllabus

• Introduction
• Medical aspects of radiation accidents
• Most frequent medical consequences
• Medical preparedness and response
• Infrastructure and functional requirements
• On- and off-site medical response
• Summary

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Introduction

• General objectives of emergency response
• To reduce risk or mitigate consequences of
  accident at source
• To prevent or reduce deterministic health effects
  
• To reasonably reduce risk of stochastic effects
• Clear understanding by each member of emergency
  response organization of basic radiation medicine
  
• Clear understanding of role of each emergency
  response team and organization

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Objectives of emergency medical preparedness and
response

• To treat life threatening injuries
• To implement actions needed to meet general
  objectives of emergency response
• To participate in training, drills, and exercises
  to update and enhance basic knowledge and skills
  necessary to meet general objectives of emergency
  response

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Medical aspects of radiation accidents
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What do we need to know ?
. about the most frequent medical consequences
of the radiological accidents

• They are usually
• connected with radiological accidents involving
  lost or stolen sources
• manifest in radiation burns

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What do we need to know?

• They are often
• combined with contamination of the body
• result of inadequate public knowledge about
  radiation
• recognized late because of poor awareness of
  general practitioners of medical consequences of
  radiation

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Requirements for medical preparedness

• Infrastructure
• must be in place to ensure that functional
  requirements of response can be performed when
  needed
• Functional
• should be fulfilled to achieve the response
  objectives

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Requirements for emergency preparedness and
response
Infrastructure
Functional
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Infrastructure requirements

• Infrastructure
• Authority, command and control
• Organizational responsibilities
• Response co-ordination
• Plans and procedures
• Logistical support
• Training, drills and exercises

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Functional requirements

• Initial accident assessment and classification
• Notification and activation
• Accident condition mitigation
• Urgent protective action
• Public education and instruction
• Emergency worker protection
• Medical, fire fighting and police assistance
• Media relations
• Longer term protective action
• Psychological impact mitigation

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Functional requirementsmedical assistance

• Establish a capability to provide immediate
  on-site first aid during an emergency
• Develop guidelines for decontamination
• Provide means to transport and initially treat
  contaminated, exposed and injured people
• Develop agreement to treat highly exposed people
  at an existing institution with capability to
  provide required specialized treatment
• Make plans to triage and treat radiation exposed
  persons using existing medical facilities most
  effectively

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Minimum information required for medical
preparedness

• Locations where radiation or radioactive
  materials are used
• Types and activities of radioactive source
• Types of radiation generating device
• Information on transportation of radioactive
  materials through area in question
• Spectrum of possible accidents
• Estimated number of people potentially affected
  in severe radiation accident

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Planning stageprepare lists

• Telephone numbers and addresses of medical and
  support staff in each location
• Medical facilities at local, regional and
  national levels
• Specialized national medical centres for treating
  radiation induced skin lesions or
  immunosuppression
• Specialized medical facilities in other countries
• Equipment and supplies needed for emergency
  response
• Agreements with ambulance transport services

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Response stage

• Basic principles of medical care of exposed
  persons
• General methods
• Specific methods for possible health effects of
  radiation and contamination
• Medical care
• On site (on the scene of an accident)
• Off site (in medical institutions)

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Emergency response medical personnel

• On site
• Emergency medical responders
• Off site
• Medical specialists in general hospitals and
  specialized medical centres

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On-site responsegeneric organization
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Medical assistance in radiation emergencies
interfaces and activities
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Tasks of emergency medical responders on site

• Procedure C4 of the IAEA-TECDOC-1162 Generic
  procedures for assessment and response during a
  radiological emergency suggests seven steps
• Step 1
• If you are first at the scene assume the role of
  on-scene controller until relieved
• If not, get briefed by on-scene controller
• Step 2
• If you have personal dosimeters wear them
• Wear protective clothing as required

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Tasks of medical responders search and rescue

• Step 3
• Search for and rescue injured people as soon as
  possible
• Perform medical triage. Assess and treat
  life-threatening injuries immediately
• DO NOT DELAY LIFE SAVING ACTIONS DUE TO THE
  PRESENCE OF RADIATION
• Provide routine emergency care during extrication
  procedures
• Remove injured people from the hazard area as
  soon as possible
• If necessary, request additional medical help

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Tasks of medical responders radiological triage

• Step 4
• With support of decontamination team, perform
  radiological triage and isolate contaminated
  people
• Remove all contaminated clothing unless medically
  contraindicated
• Isolate (bag and secure) clothing, shoes, and
  personal belongings
• Cover wounds with sterile dressings and prepare
  injured people for transport to hospital
• Transport in a manner suitable to prevent further
  contamination of victims, ambulance, and
  attending personnel.

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Tasks of medical responders establish contacts

• Step 5
• Establish contact with police to obtain names and
  addresses of the involved population for further
  interview
• Step 6
• Inform receiving hospital about nature of
  conventional injuries and any known or suspected
  radioactive exposure or contamination
• Identify radioactive material if known
• If not known, ask radiological assessor to
  identify radioactive materials involved

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Tasks of medical responders checking
contamination

• Step 7
• With support of decontamination team, check
  personal and equipment for contamination or
  request assistance from radiological assessor
• When medical conditions do not require urgent
  hospitalization, DO NOT leave the scene of
  accident before being checked for personal
  contamination

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Step 7 (contd)

• DO NOT take any equipment out of area before
  having it checked for contamination
• If you have to leave the scene urgently,
  contamination control procedures should be
  carried out as soon as reasonable

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Emergency medical response off site

• Dressing order
• Shoe covers
• Trousers
• Surgical gown
• Tape gown opening
• Tag both sides of gown
• Surgical cap and mask
• Inner gloves
• Seal gloves and gown sleeves with tape
• Dosimeter
• Outer gloves

• Undressing order
• Remove tape from gown, then shoe covers
• Outer gloves
• Remove tape from inner gloves
• Dosimeter
• Gown
• Lower trousers to below knee
• Sit on chair placed on clean side of border line
• Take off trousers
• Splash protector
• Mask
• Shoe covers
• Inner gloves

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Emergency medical response off site

• Treatment in reception area
• Priorities
• Life threatening injuries
• If internal contamination is suspected, quickly
  assess nature and degree
• Assess extent and magnitude of contamination,
  and decontaminate as necessary

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Minimum requirement for equipment and supply for
initial hospital treatment

• Radiation survey instruments
• Personal protective equipment
• Supplies
• Supporting documentation
• Transport

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Responsibilities of responding medical facility

• Designate appropriate staff
• Further train staff if necessary
• Develop detailed emergency plan and procedures
• Indicate space where reception and treatment can
  take place
• Provide and properly maintain special equipment
  and all necessary material

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Summary

• Medical response is a component and important
  part of the overall emergency response
• Infrastructure and functional requirements of
  emergency planning are valid for medical planning
• On-site and off-site medical response what
  should be done in accordance with priorities