OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see ionising radiation, radiation emergencies - details, disaster medicine

• DON'T PANIC

• 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

• 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 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

• 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
  • orifices 2nd - flush eyes repeatedly from inner to outer aspect, brush teeth & rinse repeatedly, 3% hydrogen peroxide gargles, ear syringe, ?gastric lavage
  • 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”.