2. ENVIRONMENTAL EMERGENCIES
2.5 RADIATION INJURIES
Exposure to radiation can occur through two mechanisms: the first mechanism is from a strong radioactive source such as uranium; the second mechanism is contamination by dust, debris and fluid that contain radioactive material. Factors that determine severity of exposure include: duration of time exposure, distance from radioactive source, and shielding from radioactive exposure. The three types of radiation exposure include alpha, beta and gamma. The most severe exposure is gamma (x-ray radiation).
In general, radiation exposure does not present with any immediate side effects unless exposure is severe. Most commonly, serious medical problems occur years after the exposure. Acute symptoms include nausea, vomiting and malaise. Severe exposure may present with burns, severe illness and death (beta or gamma).
Scene safety is of utmost importance for the patient(s), bystander(s) and rescuers.
ASSESSMENT / TREATMENT PRIORITIES
1. Assure scene safety, i.e. by ascertaining that the source of radiation is removed from the patient and the rescue area. Call appropriate public service agencies in order to properly stabilize the scene and rescue any victims that may be in the "hot zone". The patient will need to be removed from scene and properly decontaminated (radioactive liquid and/or dust). Rescuers will need to place patient in a safe environment so the rescuers may administer care.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs. Treat all life threatening conditions as they become identified.
6. Obtain appropriate history related to event (alpha, beta and gamma exposure, duration of time exposure, distance from radioactive source, and shielding from radioactive exposure). Obtain Past Medical History, Medications, Drug Allergies, Substance abuse.
TREATMENT
BASIC PROCEDURES
1. Assure scene safety, i.e. by ascertaining that the source of radiation is removed from the patient and the rescue area. Call appropriate public service agencies (HAZMAT TEAM) in order to properly stabilize the scene and rescue any victims that may be in the "hot zone". The patient will need to be removed from scene and decontaminated by appropriate personnel with the necessary protective gear. The patient then will need to be brought to a safe environment so the rescuers may administer care.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Manage burn injuries as indicated in the severely exposed patient.
6. Activate ALS intercept if deemed necessary and if available.
7. Initiate transport as soon as possible with or without ALS.
8. Notify receiving hospital. If severe radiation burns are noted, consider appropriate Point-of-Entry as defined by Regional capabilities, i.e., Burn Center.
INTERMEDIATE PROCEDURES
1. Assure scene safety, i.e. by ascertaining that the source of radiation is removed from the patient and the rescue area. Call appropriate public service agencies (HAZMAT TEAM) in order to properly stabilize the scene and rescue any victims that may be in the "hot zone". The patient will need to be removed from scene and decontaminated by appropriate personnel with the necessary protective gear. The patient then will need to be brought to a safe environment so the rescuers may administer care.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Manage burn injuries as indicated in the severely exposed patient.
6. ALS STANDING ORDERS
a. Provide advanced airway management, if indicated.
b. Initiate IV Normal Saline (KVO). Titrate IV to patient's hemodynamic status as necessary.
7. Contact Paramedic intercept, if deemed necessary and if available.
8. Initiate transport as soon as possible with or without Paramedics.
9. Notify receiving hospital. If severe radiation burns are noted, consider appropriate Point-of-Entry as defined by Regional capabilities, i.e., Burn Center.
PARAMEDIC PROCEDURES
1. Assure scene safety, i.e. by ascertaining that the source of radiation is removed from the patient and the rescue area. Call appropriate public service agencies (HAZMAT TEAM) in order to properly stabilize the scene and rescue any victims that may be in the "hot zone". The patient will need to be removed from scene and decontaminated by appropriate personnel with the necessary protective gear. The patient then will need to be brought to a safe environment so the rescuers may administer care.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Manage burn injuries as indicated in the severely exposed patient.
6. ALS STANDING ORDERS
a. Provide advanced airway management, if indicated.
b. Initiate IV Normal Saline (KVO). Titrate IV to patient's hemodynamic status as necessary.
7. Initiate transport as soon as possible.
8. Notify receiving hospital. If severe radiation burns are noted, consider appropriate Point-of-Entry as defined by Regional capabilities, i.e., Burn Center.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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