Mx overview for a radiation emergency at a hospital in Victoria:
inform ED consultant & nursing supervisor & activate medical DISPLAN if appropriate
ensure DHS & Radiation Safety Program (RSP) is notified ph: 13 22 22
as of Oct 2005, emergency activation of DHS / RSP staff may be via ph: 1300 790 733 while a non-urgent contact number is 1300 767 469.
in addition, a written report must be sent to DHS within 5 days in the event of either:
it is believed that any person has or may have received a radiation dose exceeding 1 millisievert effective dose due to an abnormal or unplanned radiation exposure.
a source of radiation is or has been out of control
a source of radiation is damaged or malfunctioning in a manner which could result in a person receiving a higher dose than under normal circumstances.
there has been an unintentional or accidental release of radioactive substance in excess of the allowed concentration levels
a surface has been significantly contaminated by a radioactive substance.
furthermore, if an irradiating or radioactive source has been lost or stolen, the registered person must report it immediately to the RSP.
ensure adequate supplies such as plastic bags for clothing, waste, warning signs & barrier tape to establish barricades, plastic sheets & tape to cover treatment room floor, toothbrushes and 3% hydrogen peroxide to decontaminate mouth, PPE for staff
establish control areas:
external radiological & medical triage/decontamination area with hot, warm & cold zones
internal medical treatment room - this will need preparing if time allows - radiologically survey everyone & everything that leaves the room for evidence of contamination
treating staff to don protective clothing (PPE) such as waterproof apron/shoe covers, surgical mask, eye protection as well as RADOS personal radiation monitors
management of casualties and potentially contaminated personnel:
if a life threatening problem arises, this must be stabilised before further decontamination or radioactive surveying is performed, even if this means entry into resus. room before it is prepared.
survey casualty for radioactive contamination in external control area if possible:
if no contamination:
if no possible radiation exposure, then Rx as usual
if possible radiation exposure, then in addition to usual Rx, monitor for acute radiation syndrome:
evaluate history & symptoms
baseline FBE, rpt FBE 6hrly for 48hrs total from exposure
if nausea/vomiting or erythema or if absolute lymphocyte count falls by > 25% then admit for further evaluation
if none of the above occur, can discharge home and advise to be reviewed if nausea, vomiting or erythema occur within the next week
if contamination detected:
remove clothing carefully
survey for radiation using Cypher monitor and document sites of high contamination
collect swabs & dressings
decontaminate until contamination reduced to twice background radiation level:
open wounds 1st - drape to limit spread, irrigate with NS or water, blot dry
intact skin - wash under running tepid water with soap for at least 5mins, blot dry
NB. avoid harsh scrubbing as this will increase absorption
NB. pay particular attention to sites of high contamination
once decontaminated, manage as above for possible radiation exposure
in some circumstances such as significant ingestion or absorption, decorporation may be required to remove the radioactive nuclides from the body using “antidotes”.