MEDICAL PREPAREDNESS AND MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RESPONSE IN NUCLEAR OR

RADIOLOGICAL EMERGENCY RADIOLOGICAL EMERGENCY

MEDICAL PREPAREDNESS AND MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RESPONSE IN NUCLEAR OR

RADIOLOGICAL EMERGENCY RADIOLOGICAL EMERGENCY

Module IIModule II

Module II - 2

SyllabusSyllabus

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

Module II - 3

IntroductionIntroduction

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 Objectives of emergency medical emergency medical

preparedness and responsepreparedness 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

Module II - 5

Medical aspects Medical aspects of radiation accidentsof radiation accidents

AlphaLungPu - weapons damage or manufacture

GammaBeta

Whole body (bone marrow) Skin

Industrial and medical gamma sources (damaged, unsealed)

GammaGamma

Whole body (bone marrow)

SkinIndustrial and medical gamma sources (sealed)

GammaWhole body (bone marrow) Spent reactor fuel storage or reprocessing

GammaBetaRadioiodine

Whole body (bone marrow)

SkinThyroid

Reactors (power, research, ship)

Major source of dose

Critical organAccident

Module II - 6

What do we need What do we need to know ?to know ?

They are usually connected with radiological accidents

involving lost or stolen sources manifest in radiation burns

…. about the most frequent medical consequences of the radiological accidents

Module II - 7

What do we need to What do we need to know?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

Module II - 8

Requirements for Requirements for medical preparednessmedical 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

Module II - 9

Requirements for emergency Requirements for emergency preparedness and response preparedness and response

Infrastructure Functional

Common Specific

Co-operative

Module II - 10

Infrastructure Infrastructure requirementsrequirements

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

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Functional requirementsFunctional 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 requirements:Functional requirements:medical assistancemedical 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 Minimum information required for medical preparednessfor 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

Module II - 14

Planning stage:Planning stage:prepare listsprepare 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

Module II - 15

Response stageResponse 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: Emergency response: medical personnel medical personnel

On site Emergency medical responders

Off site Medical specialists in general hospitals and

specialized medical centres

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On-site response:On-site response:generic organizationgeneric organization

RESPONSE INITIATORFirst official being informed of

an emergency with authority to initiate a response plan

FIRST RESPONDERFirst person or team to arrive at the scene of an accident

with an official role to play in the accident response

EMERGENCY MANAGERAppointed official in charge of overall emergency response

RADIOLOGICAL ASSESSORUsually senior member of a

radiological assessment team sent to the scene of an

accident

ON-SCENE CONTROLLER

Usually senior member of First Responder

team

Fire service

Police

Facility responder

Emergency medical

responder

Module II - 18

Medical assistance in Medical assistance in radiation emergencies: radiation emergencies: interfaces and activitiesinterfaces and activities

Radiological support

Physical and biological dosimetry

Environmental survey

Environmental and metabolic models

Accident reconstruction and

dose estimationClinical evaluation

Health prognosis

Acute effects

Adopted therapies

Hospital support(Therapy unit)

Module II - 19

Tasks of emergency Tasks of emergency medical responders on sitemedical 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

Module II - 20

Tasks of medical responders: Tasks of medical responders: search and rescue 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: Tasks of medical responders: radiological triage 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.

Module II - 22

Tasks of medical responders: Tasks of medical responders: establish contacts 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

Module II - 23

Tasks of medical responders: Tasks of medical responders: checking contamination 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

Module II - 24

Step 7 Step 7 (cont’d)(cont’d)

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

Module II - 25

Emergency medical Emergency medical response off siteresponse 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

Module II - 26

Emergency medical Emergency medical response off siteresponse 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

Module II - 27

Minimum requirement for Minimum requirement for equipment and supply for initial equipment and supply for initial

hospital treatmenthospital treatment

Radiation survey instruments Personal protective equipment Supplies Supporting documentation Transport

Module II - 28

Responsibilities of responding Responsibilities of responding medical facilitymedical 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

Module II - 29

SummarySummary

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