Transcript Chemical Agents - South Bay Disater Resource Center

Decontamination of Patients
 External


Skin
Wound
 Internal

DHS/NTC
Decorporation agents
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Patient Decontamination
 Remove and bag the patient’s clothing and personal
belongings (this typically removes 80 - 90% of
contamination)
 Handle foreign objects with care until proven nonradioactive with survey meter
 Survey patient and collect samples
-
Survey face, hands and feet
Survey rest of body
Note: Avoid contamination of the probe.
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External Contamination
 Radioactive material (usually in the form of dust
particles) on the body surface and/or clothing
 Radiation dose rate from contamination is usually
low, but while it remains on the patient it will
continue to expose the patient and staff
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External Contamination – Remove
with Showering
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Decontamination Priorities
 Wounds
 Intact skin (areas of highest contamination first)
 Change outer gloves frequently to minimize
spread of contamination
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Decontamination of Wounds
 Contaminated wounds:

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Irrigate and gently scrub with surgical sponge
Debride surgically only as needed
 Contaminated thermal burns:
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Gently rinse
Changing dressings will remove additional contamination
 Avoid overly aggressive decontamination
 Change dressings frequently
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Decontamination of Skin
 Use multiple gentle efforts
 Use a mild soap & water solution
 Cut hair if necessary (do not shave)
 Promote sweating:

Plastic wrap, glove, etc.
 Use survey meter
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Cease Patient Decontamination
 When decontamination efforts produce no significant
reduction in contamination
 When the level of radiation of the contaminated area is
less than twice background
 Before intact skin becomes abraded
 Consider internal contamination
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Internal Contamination
 Radioactive material may enter the body through:
- Inhalation
- Ingestion
- Wounds
 Internal contamination generally does not cause
early signs or symptoms
 Internal contamination will continue to irradiate the
patient
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Treatment of Internal Contamination
 Rare earths
- Plutonium
- Transplutonics
- Yttrium
 Uranium
 Cesium, rubidium, thallium
 Tritium
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Potassium Iodide (KI)
 Only helpful in blocking thyroid gland
 KI saturates the thyroid gland with stable
iodine
 KI must used prior to or within hours of
exposure to radioactive iodine
 See the FDA web site:
www.fda.gov/cder/drugprepare/KI_Q&A.htm
 Decorporation agent
 Provide to Decon Team Members
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Immediate Medical Management of
Radiation Exposed Patients
 Triage

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
Acute Radiation Syndrome (ARS)
localized/cutaneous
combined injury
 Initial stabilization and treatment
 Psychological effects
 Record keeping/Dose assessment
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Management - Priorities of Radiation
Exposed Patients
 Standard medical triage is the
highest priority
 Radiation exposure and
contamination are secondary
considerations
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Management – Protocol of Radiation
Exposed Patients (Cont)
Based on:
 Injuries
 Signs and symptoms
 Patient history
 Contamination survey
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Prenatal Radiation Exposure
 Human embryo and fetus highly sensitive to ionizing
radiation
 At higher doses, effects depend on dose and stage of
gestation
 Pregnant patients should receive special dose
assessments and counseling
 Information on prenatal radiation exposure
www.bt.cdc.gov/radiation/prenatalphysician.asp
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Required Conditions for
Acute Radiation Syndrome
 Large dose
 Penetrating
 Most of body exposed
 Acute
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Acute Radiation Syndrome
Never delay critical care
because a patient is
contaminated
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1986 Chernobyl Accident
“When workers at Chernobyl who were in the
reactor area at the time of the nuclear accident
were decontaminated, the medical personal at
the site received less than 10 mGy of
radiation.”
Mettler and Voelz, New England Journal of Medicine, 2002; 346: 1554-61
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Skin Effects
 Epilation
 Erythema
 Pigmentation
 Dry desquamation,
(Shedding, flaking off)
 Moist desquamation that
heals
NUREG / CR-4214, p II-68
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Treatment of Large External
Exposures
 Treat patients symptomatically
 Prevent and manage infections:

Hematopoietic growth factors, e.g., GM-CSF, G-CSF
(24-48 hr) (Neupogen®)
 Irradiated blood products
 Antibiotics/reverse isolation
 Electrolytes
 More information on ARS:
www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp
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Treatment of Cutaneous Radiation
Syndrome
 Lesions do not appear for days to weeks
 Perform surgical treatments within 48 hrs
 Consult Radiation Emergency Assistance Center/
Training Site (REAC/TS) for advice for further
treatment, 865-576-1005 or www.orau.gov/reacts/
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Dealing With Staff Stress
 Preplanning

Establish information center
 Train staff on radiation basics
 Post Event
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Debrief immediately after event
 Offer counseling
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Bomb Blast - Injury Patterns
 Most survivors suffer
secondary and tertiary blast
effects
 Primary blast injury is
infrequent in survivors
 15% of survivors require
hospital admission
 The remaining are treated
and released from the
emergency department
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Staff Preparedness
 Plan for the needs of the
unaffected population:

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Ratios range from 5-15 to 1
5-15 “worried well” to 1
actual injured patient
This can paralyze your ED
 Prepare to receive large
numbers of casualties
 Rotate staff to avoid
congestion and fatigue
 Monitor staff in chemical
protective clothing &
equipment (CPC&E)
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Logistics/Supplies
 Highest priority: getting the right resources to the
right place at the right time:
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Chemical protective clothing and equipment
Medications / antidotes / vaccines
Mechanical ventilators
Isolation rooms remote from other patients
 Identify current inventory and augment as
necessary
 Develop a procedure to access external assets
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Maximal Utilization of
Hospital Space
 Identify alternative medical
treatment areas
 Planning for use of
available space:

Open areas

Isolated areas
Temporary morgue
Conference room
Cafeteria
Physical Therapy
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Handling of Evidence
 Maintaining evidence is
critical for an
investigation:

Clothing
 Embedded foreign
bodies
 Decontamination
runoff
 Chain of Custody must
be maintained
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Table Top Exercise
Hospital Incident
Management System
(HIMS) Hands-on
Exercise - Overview
Table Top Exercise
Hospital Incident
Management System
(HIMS) Hands-on
Exercise - Report Out