medical preparedness and response in nuclear or radiological emergency
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MEDICAL PREPAREDNESS AND RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY. Module II. Syllabus. Introduction Medical aspects of radiation accidents Most frequent medical consequences Medical preparedness and response Infrastructure and functional requirements - PowerPoint PPT PresentationTRANSCRIPT
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
Module II - 4
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
Module II - 11
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
Module II - 12
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
Module II - 13
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
Module II - 21
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