Annals of Disaster Medicine
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ISSN:1684-193X
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Updated
Oct 30, 2003
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Contents:
Volume 2, Supplement 1; October, 2003 |
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Role
of Emergency Medical Technicians on Radiation Accidents |
Yuh-Jeng
Yang MD, Tzong-Luen Wang, MD, PhD |
From the Department of Emergency Medicine (Ma
HP, Lin CM, Wang TL), Shin-Kong Wu Ho-Su Memorial Hospital.
Correspondence to Dr. Tzong-Luen Wang, Department
of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95
Wen Chang Road, Taipei, Taiwan. E-mail M002183@ms.skh.org.tw
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Abstract
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Taiwan is a small island, but she has 4 nuclear power plants (including 3
active nuclear reactors and the other one is building now).
Although the likelihood of a major accident at a nuclear power
plant is low, should such an accident occur, protective and
save actions near the facility would need to be taken to protect
the public.
The emergent medical technicians provide on-site medical assistance
and help direct or transport people to medical facilities. An efficient and systematic delivery
of EMS saves lives, reduces disability, and should contain all
of the following components: rapid, reliable public access to
emergency medical services; dispatch of the appropriate ambulance unit to the scene of injury; appropriate on-scene emergency medical
care; rapid transport to an appropriate emergency care facility;
and continuity of care until the injured person is either admitted
to an acute care facility or discharged.
Key words--- Emergency
Medical Technician; Radiation; Disaster
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Introduction
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In
recent years, accidents at several nuclear power plants have proven
such events can lead to the widespread discharge of radioactive
materials into the environment. Additionally, acts of domestic terrorism
involving chemical and biological weapons have recently occurred,
raising fears about the intentional use of a radioactive device
against a civilian population. Because of these threats, there is
a need for emergency medical technicians (EMT) to become more informed
about the issues that would occur in the case of a significant radiological
event.1,2 |
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History |
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Several historical events have shaped our understanding of the consequences of radiation disasters.3,4
1.
There were come radiation accidents
of unknown origin and late recognition; for example, Goiania, Brazil in 1987; Tammiku, Estonia in 1994; Lilo, Georgia in 1997; Istanbul, Turkey in 1998/99; Samut Prakarn, Thailand in 2000; Meet Halfa, Egypt in 2000.
2.
Accidents of known radiation origin
have ever occurred; for example, Gilan, Iran in 1996, and Yanango, Peru in 1999.
3.
Accidental exposure in medical
applications (e.g., Zarragosa, Spain, 1990; Costa
Rica, 1996; Panorama, 2001)
4.
Criticality accidents (e.g., Sarov, Russia, 1997; Tokaimura, Japan, 1999)
5.
Nuclear accident with transboundary effects (Chernobyl, USSR, 1986)
6.
Nuclear accident with produced
negligible doses among people living nearby. Three Mile
Island (TMI), 1979 ); The TMI accident brought into question the
safety of nuclear power plants and the potential consequences
of a power plant mishap. Immediate administration of potassium
iodide (KI) was recommended for those living
near TMI, but it was not available.5 There were
no biological effects of the exposure but significant psychologic
sequelae occurred. |
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Sources
of Potential Radiation Threat |
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Radiological
threats can be unintentional or intentional. Unintentional threats
include power plant disasters such as Chernobyl
and TMI.4,5 Intentional
threats are associated with military conflict or terrorism.
The major types of radiation disaster threats are nuclear power
plant accidents, nuclear weapons accidents, international incidents
involving radioactive materials, lost (orphaned) radiation source
devices, acts of terrorism involving nuclear materials, and
accidents involving satellites containing radioactive material.
Any of these occurrences could result from human error or terrorist
activity. The most important of these risks is the potential
for release of radioiodines into the
environment. Additionally, spent reactor fuel rods, which are
typically retained by the nuclear power plant for many years,
present a radiation hazard that is distinct from an incident
that releases a radioactive cloud.
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Consequences of a Radiation
Disaster |
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Radiation
Biology |
In nuclear reactor accidents involving the release of radioactive material
into the atmosphere, the following routes resulting in radiation
injury to the population are expected: 6,7
1.
External gamma irradiation brought
by the passing radioactive cloud;
2.
Internal irradiation from inhaling
radioactive aerosols (inhalation hazard);
3.
Contact radiation due to deposition
of radioactive fallout on the skin and clothes;
4.
Total external gamma irradiation
of the population due to deposition of radioactive fallout on
the soil and local objects (buildings, constructions etc.);
5.
Internal irradiation resulting
from water consumption and local food products contaminated by
radioactive substances.
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Health
Effects |
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Health effects after a radiation exposure will depend greatly
on the circumstances surrounding the release.8
For example, after detonation of a nuclear weapon or radioactive dispersal device, there may be thermal or blast
injury in addition to radiation exposure. In contrast, a nuclear
power plant disaster can produce a radioactive cloud with no associated
blast.
Specific health outcomes after radiation exposure are typically
divided into short-term and long-term; short-term effects appear
within days to weeks after exposure, and long-term effects appear
months to years later. Short-term effects are dependent on the degree
of radiation exposure and the tissue irradiated. The general symptoms
appear after exposures as little as 0.75 to 1.0 Gy
(75-100 rad), like nausea, vomiting, anorexia,
diarrhoea, weakness, headache, dizziness and/or fatigue associated
with lymphopenia appear in combination
(within 2 days following an exposure of large part of the body).
At a later stage (2¡V4 weeks after the accidental exposure to
radiation source), they progress to simultaneous leuko-
and thrombopenia, leading to gingival bleeding, epistaxis and petechiae as well
as infectious complications; a hematopoietic
syndrome (severe lymphoid and bone marrow suppression) typically
appears after 3.0 to 6.0 Gy. |
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Three
Ways to Minimize Radiation Exposure |
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There are three factors that minimize
radiation exposure to human body: time, distance, and shielding.
1. Time--Most radioactivity
loses its strength fairly quickly. Limiting the time spent near
the source of radiation reduces the amount of radiation exposure
a person will receive. Following an accident, local authorities
will monitor any release of radiation and determine the level of
protective actions and when the threat has passed.
2. Distance--The more distance between
a person and the source of the radiation, the less radiation a person
will receive. In the most serious nuclear power plant accident,
local officials will likely call for an evacuation, thereby increasing
the distance between a person and the radiation.
3. Shielding--Like distance, the heavier, dense materials between a person and the
source of the radiation, the better. This is why local officials
could advise a person to remain indoors if an accident occurs. In
some cases, the walls in the home or workplace would be sufficient
shielding to protect a person for a short period of time. |
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Preparing
for a Radiation Disaster |
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Radiological emergencies require a multi-disciplinary team
who can track, contain, and cleanup a radioactive release, while
protecting people and the environment around the emergency site.
Emergency response personnel include scientists and engineers, health
physicists, emergency medical technicians (EMTs),
laboratory staff, and other emergency response specialists.9
The special medical needs of victims make it essential that EMTs
be prepared for radiation disasters, including 1) the detonation
of a nuclear weapon; 2) a nuclear power plant event that unleashes
a radioactive cloud; and 3) the dispersal of radionuclides by conventional explosive or the crash of a
transport vehicle. Any of these events could occur unintentionally
or as an act of terrorism. Nuclear facilities (eg,
power plants, fuel processing centers, and food irradiation facilities)
are often located in highly populated areas, and as they age, the
risk of mechanical failure increases. The EMTs
has an important role in planning for radiation disasters. For example,
potassium iodide is of proven value for thyroid protection but must
be given before or soon after exposure to radioiodines, requiring its placement in ambulances and offers
it to victims on scene. |
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Figure .Assessment of victims suspected with radiation
injury |
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Initial
Emergency Management - Guidelines for
Emergency Medical Tecdhnicians10,11 |
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1. Approach site with caution--look
for evidence of hazardous materials.
2. If radiation hazard is suspected, position personnel, vehicles,
and command post at a safe distance (approx. 150 feet) upwind and
uphill of the site.
3. Notify proper authorities and hospital.
4. Put on protective gear and use dosimeters and survey meters if
immediately available.
5. Determine whether injured victims are present. Do diagnostic
measures to consider in victims of radiation exposure.
6. Assess and treat life-threatening injuries immediately (Figure).
Do not delay advanced life support if victims cannot be moved or
to assess contamination status. Perform routine emergency care during
extrication procedures (eg. Neck collar, long-back board).
7. Move victims away from the radiation hazard area, using proper
patient transfer techniques to prevent further injury. Stay within
the controlled zone if contamination is suspected.
8. If trauma is present, treat. Expose wounds and cover with sterile
dressings.
9. Victims should be monitored at the control line for possible
contamination only after they are medically stable. Radiation levels
above background indicate the presence of contamination. Remove
the contaminated accident victims' clothing, provided removal can
be accomplished without causing further injury.
10. Move the ambulance cot to
the clean side of the control line and unfold a clean sheet or blanket
over it. Place the victim on the covered cot and package for transport.
Do not remove the victim from the backboard if one was used.
11. Package the victim by folding the stretcher sheet or blanket
over and securing them in the appropriate manner.
12. Before leaving the controlled area, rescuers should remove protective
gear at the control line. If possible, the victim should be transported
by personnel who have not entered the controlled area. Ambulance
personnel attending victims should wear gloves.
13. Transport the victims to the hospital emergency department.
The hospital should be given additional appropriate information,
and the ambulance crew should
ask for any special instructions the hospital may have.
14. Follow the hospital's radiological protocol upon arrival.
15. The ambulance and crew
should not return to regular service until the crew, vehicle, and
equipment have undergone monitoring and necessary decontamination
by the radiation safety officer.
16. Personnel should not eat drink, smoke, etc., at the accident
site, in the ambulance, or at
the hospital until they have been released by the radiation safety
officer.
17. Contamination control to prevent the spread of radioactive materials
from: 11,12
- The patient: In most circumstances the victim will be the source
of the contamination; however, in rescue and extrication, some
contamination may have been transferred to others.
- The rescue personnel
- The gurney and equipment used in patient
care (stethoscope, BP cuff, etc.)
- The ambulance
18. This contamination can be transferred to:
- Care providers as they touch or move
the patient to correct the medical problem
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The equipment used to assess the patient's
condition and to treat the medical emergency
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The surrounding area (treatment gurney,
floor, etc.)
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In rare cases where dust or powders are
present, the air could contain radioactive particles12
From the above discussion, the
recommendations for EMTs on radiation
accident are as follows:
1.
EMTs should increase their knowledge about emergency medical aspects of
radiation exposure.
2.
EMTs should become familiar with local preparedness and evacuation protocols
and work with public health agencies on their development.
3.
EMTs should assist local schools and community in developing protocols
to reunite people in the event a disaster.
4.
All EMTs
at risk should receive Potassium Iodide
( KI ) before exposure, if possible, or immediately afterward. This will
require that KI be available in place located within 10 miles of
a nuclear power plant. Facilities within 10 miles of a nuclear power
plant should plan to stockpile the agent. It may be prudent to consider
stockpiling KI within a larger radius because of more distant windborne
fallout, as occurred after Chernobyl; this will be determined by local
and national public health authorities.5,13
5.
The risks and benefits of using
KI should be understood and discussed with patients. KI is available
without a prescription, and families should be cautioned against
using the medication before consulting with authorities.14
6.
The EMTs
should recognize and respond to the physical and psychosocial consequences
of disasters on victims. |
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Conclusion |
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There is a low
chance for most of the EMTs to meet a
patient with symptoms of acute radiation injury during their professional
career. However, in case of observation of the above described non-specific
symptoms and signs, it is necessary to bear in mind ¡V besides
the usually diagnosed intestinal infection, food poisoning, allergy,
or insect bite ¡V their radiation origin as an alternative
cause. It can be suspected independently of the unawareness of the
accidental exposure by the patient. Radiation injury should not
be ruled out today when improper registration, loss of control,
unauthorised possession, smuggling or
even criminal and terrorist use of radiation sources might, and
occasionally does, occur.
Hence, each EMT has to be prepared to recognize and initially respond
to radiation injuries. Specialists of radiohygiene,
radiation medicine and public health must take the lead in conducting
regular postgraduate training and medical education to successfully
compete with this task.15 |
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References |
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