Special Care Needed at Any Radiation Exposure Incident

Special Care Needed at Any Radiation Exposure Incident

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The potential increases every day for incidents involving radiation exposure or contamination which must be dealt with by fire departments. There are now 71 nuclear power reactors in operation in the United States¹ and approximately 11 reactors in Canada.² While civilian nuclear power plants are probably the most obvious potential sources of radioactive contamination, there are many more common—although less known—causes of such emergencies located in or passing through every community. Such potential sources include:

• Research reactors. There are currently 69 research reactors in operation in the United States, primarily located in universities and government facilities. These reactors are usually small and produce no commercial power. No detailed emergency planning requirements are currently in force for such reactors.
• Medical facilities. While hospitals and medical facilities have X-ray equipment which could conceiveably cause radiation injuries, the primary threat to fire departments is through associated high-voltage electrical systems. However, such facilities do produce large quantities of low-level ra-
• dioactive waste from their research experiments (animal carcasses, for example) and from discarded needles and syringes from nuclear medicine departments. Fire departments should have a pre-incident plan for the facilities.
• Transportation incidents. Although the transportation of high-level wastes from commercial nuclear plants has been temporarily suspended, the movement of low-level wastes from all sources continues.
• Military weapons. While it is virtually impossible to specifically plan for military nuclear weapons incidents due to security considerations, every emergency service agency must be prepared for such an incident. Any community can become involved in a weapons incident, whether from a nearby base or a weapon in transit via air, surface or water. (The effects of nuclear warfare are beyond the scope of this article.)
• Industrial radiography. X-ray diagnostic tests for quality control are routinely made on industrial equipment, machinery and pipes. Small radioactive sources are transported in large steel and lead containers which are quite secure from damage in transportation accidents. The primary danger is direct whole-body exposure from mishandling the radioactive wastes.

Radiation is simply energy. The injury caused by radiation is an energy transfer from the source to the target (victim). These sources of energy may be external to, in contact with, or deposited inside the human body. Radiation injuries are classified according to the source of the radiation in relationship to the patient. Exposure to radiation and contamination by radioactive material are different matters. Whole-body exposure is when most or all of the body has been exposed to a source of radiation apart from and not in contact with the body. An example would be a person who inadvertently stands too long in the beam of an X-ray unit (medical or industrial). The symptoms are those of acute radiation syndrome (vomiting, diarrhea).^3,4 The patient is not radioactive and does not give off radiation any more than a burned patient gives off heat!

Local exposure involves a similar relation to the energy source as above, except the area involved is much more limited, usually to the extremities. The symptoms may include localized reddening of the skin, blistering and deeper tissue damage.

Internal contamination results from the ingestion, inhalation, absorption or injection of radioactive materials. Symptoms are usually of the long-term variety, including anemia and neoplasia. Miscalculated medically administered isotopes, due to the high dose levels, may produce symptoms of acute radiation syndrome. Although these incorporated isotopes give off radiation from within the patient, the most significant hazards are to the patient and not to emergency personnel.

External contamination involves the presence of radioactive material on the body or clothes of the patient. For the patient, contamination poses the twofold hazard of causing local or wholebody exposure through contact with the skin. For emergency personnel the primary hazard is exposure from the contamination, with the added concern of secondary contamination to the ambulance and hospital.

Initial treatment

The effects of radiation vary widely from patient to patient and from exposure to exposure depending on the type of exposure, the source, the length of the exposure, the body portions exposed, the patient’s age and existing medical condition. The radiation exposure induces chemical reactions in the cells receiving the dose, which can potentially lead to alteration of cellular structure and function. Generally, higher doses, even in a short period of time, cause the most serious and immediate consequences.

The handling of a radiological emergency is similar to that of any hazardous material incident. The initial units on the scene must size up the nature and extent of the hazard, take appropriate actions to protect themselves and the public, perform life-saving rescue and first aid for any victims, and control the hazards.

The least difficult radiation emergencies for the emergency medical service and community hospitals to deal with—because of their rarity—are those involving fixed nuclear facilities (fuel manufacturing and reprocessing plants, research reactors, medical facilities) and commercial nuclear power plants. Commercial nuclear power plants, for example, average far less than one radiological medical emergency requiring off-site assistance annually. Another factor in such emergencies is that fixed sites have expert personnel highly trained in dealing with emergencies. In addition, nuclear power plants are required to provide annual training to nearby fire, emergency medical service and hospital personnel.

When dealing with incidents at fixed facilities the emergency medical services crew will routinely find the patient decontaminated, with at least immediately life-threatening injuries already treated. A radiation protection expert from the facility usually will accompany the patient to the hospital to provide both constant radiological monitoring and expert advice in medical treatment and decontamination. The ambulance crew will usually only be expected to provide supportive transportation and take responsibility for contamination control.

Transportation emergencies

The most difficult problems facing emergency personnel are those involving transportation emergencies, including military weapons incidents. Transportation incidents are often in isolated areas, and a lack of information concerning the nature of the radiological hazard is the biggest consideration of the first-responder. The problems with military weapons include the security constraints that prevent most detailed planning and the fear of a catastrophic explosion from a nuclear weapon detonation. (Such fears concerning nuclear weapons detonations are apparently unfounded, although nuclear weapons have broken open and caused local contamination.)

Since fire and emergency medical service personnel are often first at the scene of a transportation incident, and most units do not have readily available radiological monitoring equipment, the rescuers usually do not know for certain the extent of the radiation and contamination present. If a “radioactive material” placard is present, or there is other indication that the vehicle is transporting nuclear materials, the emergency personnel must assume that some radiation is present. However, it must also be kept in mind that due to the stringent packing requirements for transporting radioactive materials, most accidents actually involve little or no release of radioactive matter. There have been several incidents in which the drivers of such vehicles have been badly injured and have not been given prompt medical care due to fears relating to the “radioactive material” placard on the vehicle.⁵

Protective gear

Emergency medical service personnel should undertake necessary rescue and life-saving functions. Of course, due care must be taken to avoid the usual hazards present in any transportation incident: spilled fuel, downed electric lines and other vehicles. All rescue personnel should be wearing full turnout gear (cuffs and collars closed with tape) and SCBA, which will prevent most radiation exposure and direct contamination.

Personnel providing medical care should wear surgeons gloves. Also, if available, all personnel should be equipped with self-reading dosimeters, film badges or TLD badges. A safety zone of 20 years should be established around the vehicle to avoid any unnecessary personnel exposure and contamination, with only the minimum personnel necessary to carry out the rescue within the zone.⁶ The area should be roped off, and any equipment or personnel leaving the zone must be monitored for contamination.

Harvey Grant and Robert Murray in “Emergency Care” recommend that emergency teams not directly involved in the rescue should remain upwind and stay behind vehicles, concrete walls or earth banks.⁷ Such precautions are probably not necessary in most accidents where the materials are known to be of the low-level type (medical supplies, most waste products and industrial radiography equipment), where the shipping containers are intact, and where no fire is directly impinging on the containers.

To avoid unnecessary exposure of rescue personnel if the rescue is an extended one, teams should only work in 15-to-20-minute intervals and then be replaced by a new team.

Move to safety zone

Unless there is an overriding reason, the patient should be moved outside of the 20-yard danger zone as soon as the rescue is complete. There, medical personnel should carry out any necessary basic and advanced life support. No extra precautions are required when starting I Vs or drawing blood of an exposure victim, because the patient’s blood will be neither contaminated nor radioactive.

Medical care must always take priority over decontamination procedures. If the patient’s condition permits, his outer clothing should be removed, placed in a plastic bag and left at the scene for later disposal. This simple procedure will usually remove up to 90 percent of surface contamination.⁸ Any other decontamination procedures or definitive treatment for the radiation exposure should not be undertaken in the field.

Once the patient’s injuries are treated and he is ready for transport, the following steps should be taken:

1. Spread a large clean blanket or sheet on the ground away from the area of contamination. (Do not use plastic, canvas or salvage covers because they will overheat the patient.)
2. Place the stretcher on top of the blanket, and place the patient on the stretcher. (If a scoop stretcher is available, place it and the victim on the blanket, which will leave the stretcher free to roll and elevate.)
3. Fold the blanket over the patient, completely enclosing him to prevent the spread of contamination. Place a towel over his head to prevent any contamination spread from that area.
4. If only small areas of contamination are involved, such as extremities, these areas may be enclosed in plastic bags secured with tape, leaving the rest of the body exposed.
5. It is critical that the receiving hospital have as much advance notification as possible to begin its own procedures. These include covering all floors with plastic, preparing personnel with dosimeters and surgical clothing, and establishing other strict contamination control measures.
6. The patient should be closely monitored during transport, with special notice given to any nausea or vomiting, redness or blistering of the skin, or diarrhea.
7. After delivering the patient, the ambulance crew should remove its outer garments and wash exposed skin with soap and lukewarm water. Do not use brushes which may abrade the skin. Once these procedures are complete, the crew will be thoroughly checked for any contamination by the hospital staff.
8. The ambulance must be completely checked inside and out for contamination before departing the hospital. Decontamination can readily be accomplished using water and soap.
9. Any rescue and ambulance personnel thought to have received significant exposures will probably have blood samples drawn for CBC and differential, chromosome analysis and electrolytes. In addition, any other exposed personnel experiencing nausea, vomiting, skin reddening or blistering, localized deep pain, or diarrhea should immediately report to the hospital.
10. All materials used in the rescue—such as blankets, bandages, surgeons gloves, etc.—as well as any of the patient’s excretions must be collected and brought to the hospital for disposal. All equipment remaining at the scene must be completely checked and decontaminated, if necessary, before leaving the area.

Outside expertise

Emergency medical service and hospital personnel may receive additional information and training in the techniques of handling and caring for radiation accident victims from the Radiation Emergency Assistance Center/ Training Site (REAC/TS), United States Department of Energy, at the Oak Ridge, Tenn., Community Hospital. The unit may be contacted 24 hours a day for expert advice, and in certain cases, admissions of patients. The emergency telephone number is 615482-2441 (Beeper 241).

In summary, emergency medical and fire service personnel should keep the following in mind when dealing with radiation emergencies:

• Due to stringent packaging and shipping requirements, very few transportation accidents result in significant releases of radioactive material.
• The patient’s medical injuries always receive priority in treatment over any radiation problems.
• Rescue personnel are best protected by using standard procedures for any hazardous material incidents. Stay upwind, establish a safety zone, minimize personnel exposure and use full protective turnout gear.
• Aside from preliminary decontamination and the treatment of other injuries at the scene, any definitive treatment and cure will be undertaken at the hospital.

References

1. U.S. Nuclear Regulatory Commission NUREG-0020, Vol. 5, No. 4, April 1981.
2. Nuclear News, “World List of Nuclear Power Plants,” August 1980, Vol. 23, No. 10, p. 89.
3. “Diagnosis and Treatment of Acute Radiation Injury.” Proceedings of Scientific Meeting, IAEA, Geneva, Switzerland, October 1960, International Documents Service, 1961.
4. Thomas, G.E., and Wald, N., “The Diagnosis and Management of Accidental Radiation Injury,” Journal of Occupational Medicine, 1:421, 1959.
5. Mettler, Jr., Fred A., et al, “The Role of EMTs in Radiation Accidents,” Emergency Medical Services, May/June 1977, p. 23.
6. Ibid., p. 24.
7. Grant, Harvey and Murray, Robert, Emergency Care Second Edition (Bowie, Md.: Robert J. Brady Co., 1978, p. 388).
8. Mettler, “The Role of EMTS in Radiation Accidents,” p. 24.