Radiological Incidents

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 Objectives
• To identify 4 radiation protection
principles
• To describe differences between
radiological exposure and
contamination
• To identify key hospital contacts in
the event of radiologically
contaminated patients

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 Nuclear and Radiological Risks
• Radiological Dispersal Device
– Aka: Dirty Bomb
• Greatest risk
• Simple radiological sources
– Transportation of radioactive material,
– Likely-Not expected to be mass casualty event
• Nuclear irradiation
– Bomb (terrorism)
– Leak (reactor)

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 Radiation Basics
• Ionizing radiation is electromagnetic energy, or
energy containing particles emitted from a
source.

• In living systems, this causes damage to cells

and interrupt normal biological processes.

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 Radiological Detection
• Detecting Radiation
– Cannot be sensed by humans
• Taste, smell, sight etc.
– Detectors needed
• Geiger counters
• Dosimeters
• Alpha meters
• Ionizing chambers

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 Radiation Measurements
Measurements:
• counts per minute
• rads: measure of energy absorbed
• rems: measure of potential biological damage

International Units:
• 1 gray (Gy) = 100 rads
• 1 sievert (Sv) = 100 rems

Typical Range:
• 1 mrad = 10 μGy
• 1 mrem = 10 μSv
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 Radiation Experts
Hospitals are well prepared for a radiological event
• Experts abound
– Radiologists, Nuclear Med, Radiation Safety Officers, etc.
• Detection methods already in place & they know how to
use them!

• LA Co MAC 24/7 (866) 940-4401

• Contact LA Co Radiation Mgmt
Office (213) 351-7897
• State (800) 852-7550

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 Radiation Surrounds Us
Natural background and manmade radiation (year) 360 mrem
Flight from LA to Paris 4.8 mrem
Diagnostic chest x-ray 10 mrem
Occupation exposure limit, annual 5,000 mrem
Smoking 1.5 ppd - 1 year dose 16,000 mrem
Heart catheterization 45,000 mrem
Lifesaving exposure guideline 50,000 mrem
Mild acute radiation sickness 200,000 mrem
Lethal dose for irradiation (approx) 450,000 mrem

mrem = millirem = 1/1000 of a rem

Protection against ALL radiation

follows 4 basic guidelines:
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 Radiation Protection Principles
• Time • Shielding

• Distance • Quantity

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 Time

12

9 3 Result Dose
25 mrem
Source
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100 mrem per hour x 15 minutes (.25 hour) = 25 mrem

Limit time of treatment based on Radiation Safety

Officers recommendations
 Distance

1 meter 1 meter

Dose Rate

Source

100 mrem/hr 25 mrem/hr

A little distance means a lot

 Shielding

• Alpha Particle
•Stopped by thin paper or clothing
•Travels several cm. In air with
few microns in tissue

• Beta Particle
•Some protection by PPE
•Travels up to a few meters in air,
millimeters in tissue

• Gamma Rays
•PPE will not protect against
•Very difficult to shield against, very penetrating
 Quantity

2 mrem/hr 100 mrem/hr

Contaminated
Clothing from 1
Victim
Contaminated Clothing
13 from 50 Victims
 Radiation Protection Principles
• Practical applications of the 4 principles
– If standard working PPE is inadequate as shielding,
use the following to make a bad situation safer
– Limit time in area
• Decrease time dealing with the disaster
– Increase working distances
• Use long handled tools and grabbers
– Don’t allow contaminated clothing bags to accumulate
in quantity
• Spread out contained materials over a large area

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 Exposure Vs. Contamination
• Exposure to radiation does NOT necessarily
make victims contaminated or radioactive!

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 Contamination
• External Contamination
– Material deposited on skin, clothes, hair
• Dirty bomb – material exploded into air
– Decontamination necessary
– Victims are NOT radioactive, but the ‘dust’ is

• Internal Contamination
– Material becomes integral part of the body
• Ingestion-DO NOT lick lips
• Absorption from mucous membrane
– DO NOT touch eyes, mouth nose

16 – Nuclear imaging or therapy

Management of Radiation Victims
• Immediately
– Secure hospital entrances and perimeter
– Establish triage area outside of hospital if possible
– Control ventilation
– Issue protective clothing & dosimeters to staff
– Establish area for contaminated waste/clothes

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 Management of Radiation Victims
• At patient arrival
– Treat life-threatening conditions first!
– Consider irradiation/contamination second
– Survey patient for radiation ASAP
– Use usual triage methods based on complaints
– Remove and bag victim’s clothing

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 Management of Radiation Victims
• Decontamination
– If there is an open wound decontaminate first, then
rest of skin
– Cover wound with sterile dressing
– Soap/water decon (including hair)
– Re-survey patient for radiation
• If radiation present, send back through decon
– Refer for needed surgery

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Management of Internal Contamination
• Various medications available for limiting uptake
or facilitate removal of radioactive material
– KI
– Radiogardase (Prussian blue)
– DTPA
– Bicarbonate
• Now part of response stockpiles

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 Why Radiation Makes You Sick
• Some cells in your body have a short life cycle
(they reproduce and die rapidly).
• Radiation most affects the rapidly reproducing
cells which are in the gut, bone marrow and
skin/hair.
• Once these cells are damaged by radiation, they
are unable to reproduce.

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Acute Radiation Syndrome (ARS)
• Follows a predictable course over a few hours to
several weeks
• Group of symptoms that develop after total body
irradiation (> 100 rems)
• Patients are classified in three categories based
on signs and symptoms:
– Survival probable: < 100 rems
– Survival possible: 200 - 800 rems
– Survival improbable: > 800 rems

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 ARS - Phases
Prodromal Phase - occurs in the first 48 to 72 hours post-
exposure and is characterized by nausea, vomiting, and
anorexia. At doses below about 500 rems this lasts 2 to
4 days.

Latent Phase - follows the prodromal phase and lasts for

approximately 2 to 2 1/2 weeks. During this time,
predisposed to infection due to decrease of infection
fighting cells.

Illness Phase - period when overt illness develop such as

infection, electrolyte imbalances, diarrhea and shock.

Recovery or Death Phase - may take weeks or months

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Phases of Rad Syndrome & Trauma
• Radiation + Trauma =  Mortality
• Surgical procedures that are not done in the first
48 hours generally are delayed for 2 to 3 months
• Major use of hospital resources due to increased
risk for infection, bleeding and time in the
hospital
Emergency No Surgery
Surgery Surgery Permitted

24 - 48 3 Months After 3 Months

Hours
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 ARS - Hemopoietic Syndrome
• Radiation dose > 100 rems
• Nausea, vomiting and anorexia start within12
hrs & lasts 1-2 days.
• Bone marrow depression - lymphocyte count at
48 hours indicates severity
• Complications - sepsis, hemorrhage, anemia,
impaired wound healing

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ARS - Gastrointestinal Syndrome
• Radiation dose > 600 rems
• Damages intestinal lining
• Nausea and vomiting within
the first 2 - 4 hours
• May develop diarrhea
• Associated with severe
infections
• Bloody diarrhea and
persistent high fever are an
ominous sign

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 ARS - Central Nervous System
• Radiation dose > 1,000 rems
• Brain bleeding and swelling
• Very disoriented or
unconsciousness
• Death within hours

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 ARS - Skin

Black and crunchy

Weeping skin
Response

300 600 1000 >1500 >5000

Dose

Onset varies from hours to weeks.

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 Hospital Considerations
• Utilize radiation experts in your facility
• Call MAC if you suspect a radiologically
contaminated patient has arrived at hospital
– Phone 24/7 (866) 940-4401
• Contact LA County Radiation Management
Office (213) 351-7897
• State (800) 852-7550

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 Hospital Considerations
• Time-Distance-Shielding-Dose
• Do not delay treatment for life threatening
injuries or illnesses for decontamination
• Universal fear of radiation can lead to panic &
misunderstandings
– Accurate public information essential!

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 Hospital Considerations
• Long-term care and resources may be needed
to care for these patients
• Internally contaminated victims may need to be
isolated from other patients
• Most victims will be able to be decontaminated,
treated and sent home

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 Additional Resources
• H&HS: Radiation Event Medical Management:
remm.nlm.gov
• Oak Ridge Institute for Science and Education
orise.orau.gov
• CDC
bt.cdc.gov/radiation
• Los Angeles County:
MARRP
(Multi-Agency Radiation Response Plan)

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 Summary
• Radiation Protection:
Time. Distance, Shielding, Quantity
• Radiation exposure alone does not usually
result in contamination.
• Do not delay life-saving treatment to
decontaminate radiologically contaminated
victims.
• Identify your local radiological experts.
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 Questions

?
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