Download Chemical Agents - South Bay Disater Resource Center

Decontamination of Patients
 External


Skin
Wound
 Internal

DHS/NTC
Decorporation agents
B461 Course
1
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.
DHS/NTC
B461 Course
2
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
DHS/NTC
B461 Course
3
External Contamination – Remove
with Showering
DHS/NTC
B461 Course
4
Decontamination Priorities
 Wounds
 Intact skin (areas of highest contamination first)
 Change outer gloves frequently to minimize
spread of contamination
DHS/NTC
B461 Course
5
Decontamination of Wounds
 Contaminated wounds:


Irrigate and gently scrub with surgical sponge
Debride surgically only as needed
 Contaminated thermal burns:


Gently rinse
Changing dressings will remove additional contamination
 Avoid overly aggressive decontamination
 Change dressings frequently
DHS/NTC
B461 Course
6
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
DHS/NTC
B461 Course
7
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
DHS/NTC
B461 Course
8
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
DHS/NTC
B461 Course
9
Treatment of Internal Contamination
 Rare earths
- Plutonium
- Transplutonics
- Yttrium
 Uranium
 Cesium, rubidium, thallium
 Tritium
DHS/NTC
B461 Course
10
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
DHS/NTC
B461 Course
11
Immediate Medical Management of
Radiation Exposed Patients
 Triage



Acute Radiation Syndrome (ARS)
localized/cutaneous
combined injury
 Initial stabilization and treatment
 Psychological effects
 Record keeping/Dose assessment
DHS/NTC
B461 Course
12
Management - Priorities of Radiation
Exposed Patients
 Standard medical triage is the
highest priority
 Radiation exposure and
contamination are secondary
considerations
DHS/NTC
B461 Course
13
Management – Protocol of Radiation
Exposed Patients (Cont)
Based on:
 Injuries
 Signs and symptoms
 Patient history
 Contamination survey
DHS/NTC
B461 Course
14
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
DHS/NTC
B461 Course
15
Required Conditions for
Acute Radiation Syndrome
 Large dose
 Penetrating
 Most of body exposed
 Acute
DHS/NTC
B461 Course
16
Acute Radiation Syndrome
Never delay critical care
because a patient is
contaminated
DHS/NTC
B461 Course
17
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
DHS/NTC
B461 Course
18
Skin Effects
 Epilation
 Erythema
 Pigmentation
 Dry desquamation,
(Shedding, flaking off)
 Moist desquamation that
heals
NUREG / CR-4214, p II-68
DHS/NTC
B461 Course
19
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
DHS/NTC
B461 Course
20
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/
DHS/NTC
B461 Course
21
Dealing With Staff Stress
 Preplanning

Establish information center
 Train staff on radiation basics
 Post Event

Debrief immediately after event
 Offer counseling
DHS/NTC
B461 Course
22
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
DHS/NTC
B461 Course
23
Staff Preparedness
 Plan for the needs of the
unaffected population:



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)
DHS/NTC
B461 Course
24
Logistics/Supplies
 Highest priority: getting the right resources to the
right place at the right time:




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
DHS/NTC
B461 Course
25
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




DHS/NTC
B461 Course
26
Handling of Evidence
 Maintaining evidence is
critical for an
investigation:

Clothing
 Embedded foreign
bodies
 Decontamination
runoff
 Chain of Custody must
be maintained
DHS/NTC
B461 Course
27
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