DISASTER NURSING WEEK 15

DISASTER CAUSED BY RADIOLOGICALAGENTS Example:

● Radiofrequency (RF) radiation is used in many
● Radiation is a part of our natural environment. broadcast and communications applications
● In large doses, radiation can cause a number of ● Microwaves used in the home kitchen
syndromes, including death. ● Infrared radiation used in heat lamps
● In small doses, radiation is more likely to cause ● Ultraviolet (UV) radiation from the sun and tanning
cancer later in life. beds
● Radioactively contaminated patients (e.g., following a
terrorist attack) pose relatively little risk to healthcare TYPES OF RADIATION
staff.
Alpha Radiation
● Contamination control measures when working with
Emitted by heavy atoms making them the most massive kind
contaminated patients will help limit the spread of
of radiation.
radioactive contamination to medical facilities.
● Example: uranium, polonium, radon, radium,
plutonium
Radiation Basics
● Found in rocks, soil, nuclear weapons, nuclear power
RADIATION
plants, static eliminators, smoke detectors and some
Refers to the emission of energy as electromagnetic waves or
consumer products.
as moving subatomic particles, particularly of high-energy
● Can cause a great deal of damage to cells.
particles that results to ionization.
● Objects and patients exposed to alpha radiation may
become contaminated, but they do not become
IONIZATION
radioactive.
A process by which electrically neutral atoms or molecules are
converted into electrically charged atoms or molecules.
Beta Radiation
Beta particles are lighter than alpha particles and possess a
IONIZING RADIATION
lower electrical charge.
Ionizing radiation can damage our DNA, causing health effects
● Penetrates up to a centimeter into tissue.
in sufficiently high doses.
● Gives a radiation dose only to the skin, unless they
are ingested or inhaled, or enter the body through
RADIOACTIVE CONTAMINATION
open cuts or wounds.
Radioactive contamination is the presence of
● Used in research, some luminous paints, and for both
radiation-emitting substances in a place where it is not
diagnostic and therapeutic medical purposes.
desired.
● Objects and patients exposed to beta radiation may
● A patient may be contaminated with radionuclides,
become contaminated, but they do not become
but that patient will not be inherently radioactive and
radioactive.
can be decontaminated.

Gamma Radiation
Ionizing vs Non-Ionizing Radiation
Gamma rays are energetic photons, similar to x-rays. Gamma
Ionizing radiation radiation is much less damaging than alpha radiation and is
● Is a form of energy that acts by removing electrons about as damaging as beta radiation.
from atoms and molecules of materials that include ● Gamma radiation will penetrate the whole body (as
air, water, and living tissue. x-rays will), so it will deliver radiation doses to internal
● Ionizing radiation can travel unseen and pass through organs as well as to the skin.
these materials. ● Gamma radiation is used for many research,
industrial, and medical purposes. Objects and
Non-ionizing radiation patients exposed to gamma radiation may become
● Radiation that exists all around us from many contaminated, but they do not become radioactive.
sources.
DISASTER NURSING WEEK 15
● Materials scientists misusing x-ray diffraction
equipment
● Industrial employees using linear accelerators
● Radiation oncology patients.
● Severe radiation burns—usually to the
hands—among people who have found and picked
up abandoned radioactive sources.

Radiological Incidence And Emergencies

Examples of Radiological Incidents and Emergencies:

● Traffic accident involving a truck carrying research or
medical radioactive isotopes
● Terrorist attack with an RDD (or “dirty bomb”)
HEALTH EFFECTS OF RADIATION EXPOSURE
● Fire in a hospital or university radioactive waste
2 TYPES OF RADIATION EXPOSURE:
storage facility
● Acute exposure
● Unplanned radioactive release from a commercial
● Chronic exposure
nuclear power station
● Detonation of a nuclear weapon
2 DISTINCT MODES OF EXPOSURE:
● Loss of a radioactive soil-density gauge or
● Radiation exposure
well-logging gauge
● Radioactive exposure

● All radiological cases will require some sampling to

UNITS OF RADIATION DOSE
confirm the level of exposure and to help determine a
● The unit that is used to measure the amount of
treatment plan.
energy deposition is the gray (Gy)—a unit of radiation
● Samples must be treated as potentially radioactive
absorbed dose that is equal to the deposition of 1 J
until proven otherwise.
of energy in 1 kg of material.
● Analytical equipment and areas may become
● A Joule is the amount of energy required to
contaminated, precluding their use for
accelerate a 1 kg object to a speed of 2 m/s, or to lift
non-radiological patients until decontaminated
a 1 kg object about 10 cm vertically.
● Medical personnel should take all possible
● The U.S. unit for absorbed dose is the rad, which
precautions to avoid accidental uptake of RAM.
results from the deposition of 100 ergs of energy per
These include:
gram of absorber (1 Gy = 100 rad).
○ Not eating, drinking, or smoking in
contamination zones;
○ Promptly irrigating and covering open
wounds;
○ Thoroughly swabbing patients’ skin before
giving injections, drawing blood, or suturing

● All persons entering a contaminated area should take

standard precautions; when working with
radiologically contaminated patients or in
contaminated areas, they should wear:
○ protective gloves,
○ shoe covers,
Acute radiation injury to limited parts of the body can
○ outer protective clothing,
include:
○ eye covering
● Patients receiving excessive fluoroscopy
● Mineralogists
DISASTER NURSING WEEK 15
● All persons leaving a contamination area should ○ Patients with sprains, contusions, or
remove their protective clothing (including gloves and noncompound broken bones
shoe covers) before exiting the area.
● All equipment exiting the area should also be MEDICAL RESPONSE TO ARADIATION-EMITING DEVICE
surveyed prior to release or should be sealed in ATTACK (RED)
plastic bags for later survey, possible ● Terrorists may simply set a high-activity radioactive
decontamination, and release. source in a public place-this is referred to as a
radiation-emitting device (RED)
Medical Response To Nuclear And Radiological Terrorism ● Small number of people may be suffering from
anxiety rather than radiation sickness
MEDICAL RESPONSE TO RRD (“DIRTY BOMB”)
● Attack of this type will likely not be associated with
● An RDD (Radiological Dispersal device. “dirty bomb”)
an
is a chemical explosive laced with radioactivity.
● explosion, it is prudent to assume that skin burns are
● An RDD attack will probably lead to widespread
radiation burns and to treat them accordingly
contamination, but will likely not result in widespread
● Regardless of the severity of a patient’s injuries,
radiation injury or illness.
patients pose absolutely no threat to medical
● Those close to the RDD may have radioactive
personnel.
shrapnel embedded in their bodies, contaminated
● Radiation burns from exposure to high levels of
wounds, and may have inhaled radioactive dust and
radiation are not radioactive.
smoke.
● The patients will likely be frightened, anxious, and in
● Set up a triage and decontamination station outside
pain; this should not be exacerbated by medical staff
the emergency room
taking unnecessary and elaborate precautions
● Medical staff working with contaminated patients
should wear anticontamination clothing.
MEDICAL RESPONSE TO NUCLEAR ATTACK
● Their clothing should be changed after treating each
● A nuclear attack is devastating.
patient to reduce the chance of having skin
● Many people will be killed and injured
contamination.
● Many more will be traumatized
● Shower after each shift.
● A city’s infrastructure may be severely damaged.
● The medical response to RDD use should focus on
● Radioactive fallout can be present in dangerous
injuries from the blast—
concentrations up to 10 miles downwind.
○ thermal burns
● People can suffer from thermal and radiation burns as
○ broken bones
well as inhalation of fallout
○ Shock
● Medical personnel should be prepared to also treat
○ lacerations,
injuries from:
○ internal injury
○ flying (or falling) glass
○ crushing, and so forth.
○ temporary or permanent blindness
● Lightly injured patients may be decontaminated prior
○ injuries from traffic accidents when drivers
to arrival at the hospital, and may simply be
are suddenly and unexpectedly unable to
decontaminated, treated, and released at the scene.
see.
● Instruct patients who are sent home to change their
● There will also be thermal damage—prompt burns
clothes, shower, and wash their hair (although
from the thermal radiation emitted by the explosion
conditioners should not be used as these can
itself as well as burns from the mass fires ignited by
actually trap contamination on the hair) when they get
the blast’s thermal pulse.
home
● Medical personnel should expect to see a very large
● More seriously injured patients may be
number of burn victims, and for these victims to
decontaminated prior to treatment if their injuries
continue arriving for days after the attack as they are
permit—these may include:
rescued or make their way to safety
○ patients with lacerations requiring suturing,
but that are not life-threatening.
DISASTER NURSING WEEK 15
Effects of a nuclear terrorist attack ● Were contamination/radiation levels measured on the
● People closest to the weapon will be killed patient’s skin? If so, what were the results?
immediately and those somewhat further away might ● Was the patient exposed to radiation or radioactive
receive a fatal dose of radiation. contamination?
● There will be the presence of physical ● Is the patient still emitting radiation following
trauma—broken bones, thermal burns, crushing, decontamination? If so, the patient might have
lacerations, and so forth. internal contamination from inhalation, ingestion, or
contamination of open wounds.
GUIDELINES FOR MEDICAL PERSONNEL ● Are there any dosimetric measurements or
● Part of the triage process should include an estimates?
assessment of radiation exposure received. ● Have any therapeutic methods been attempted
Example: (blocking agents, isotopic dilution, chelation, etc.)?
● If a patient is vomiting or has diarrhea on ● What are the chemical and radiological properties of
arrival, there is a good chance the patient the contaminants?
was exposed to a lethal dose of radiation
● Accept that the emergency room will become 3. Follow-up
contaminated and will require decontamination after ● Has the patient’s clothing been saved (if removed at
the crisis has passed. the site)?
● Contingency plans should include the loss of potable ● Have any physical samples (blood, urine, feces) been
water, electricity, and/or heat. collected? If so, where are they?
● Radioactive fallout can include “hot” particles that ● What further laboratory work is planned or
can burn very localized parts of the skin. recommended?
● Fall out distribution can be very patchy, depending
on peculiarities of terrain, weather, weapon Patients can be assessed for internal radioactivity via any
characteristics, and other factors. of the following methods:
● Medical personnel must expect to be confronted with
1. External counting using radiation detectors can be
situations for which their experience and training give
used to detect internal gamma-emitting radionuclides
them no appropriate tools—technical or emotional.
only. (Cannot detect internal alpha or beta emitters).
● Painkillers and antibiotics can help to make patients
2. Nasal and oral swabs
comfortable and to help them survive until their family
3. Urine samples
can be found.
● Contamination of the face or head can indicate the
potential for a patient to have been exposed to
Caring for Patients Exposed to High Levels of Radiation
elevated levels of radioactivity.
Questions to ask when receiving and caring for Radiological
Patients
Emergency Department Contamination Control
1. About the Incident
● When did it occur? 1. Wrap patients in blankets to contain contamination
● What was the nature of the incident? and reduce contamination of facilities.
● What other medical problems might we see? 2. Establish dedicated routes for transporting
● What isotopes are involved and at what levels? contaminated patients.
● What on-site measurements have been made and 3. Establish dedicated rooms for decontamination and
what were the results? care of contaminated patients.
● Are other contaminants (biological, chemical) 4. Line dedicated routes and rooms with plastic to
expected? reduce contamination of fixed surfaces.

2. About the Patient? Medical Staff Contamination Control

● Was the patient contaminated? Is the patient now 1. Follow standard precautions-wear gloves, lab coats,
decontaminated? shoe covers, and so forth, to reduce personnel
DISASTER NURSING WEEK 15
contamination and to cover all exposed skin to the
maximum extent possible.
2. Wear surgical masks or N95 masks to reduce the
chance of contamination inhalation.
3. Securely bandage or cover all open cuts, scrapes,
and other wounds.
4. Change gloves after treating each patient.
5. Remove shoe covers before leaving any
contaminated area.
6. Wash hands and exposed skin thoroughly after
treating each patient.
7. Change clothes and shower at the end of the shift or
when leaving patient decontamination or treatment
areas.
8. Medical personnel working with highly contaminated
patients should consider performing a urine bioassay
24 to 72 hours after exposure to check for evidence
of radionuclide uptake. About 20 mL of urine is
required, of which 1 mL will be counted in a liquid
scintillation counter.

Emergency Care for Badly Injured, Contaminated Patients

1. If the patient requires immediate attention, treat the

patient first and worry about radiological controls
when the patient’s condition has stabilized.
● Rooms and medical staff can be
decontaminated later.
2. Even badly contaminated patients pose no health risk
to medical or emergency personnel.