EMERGENCY DEPARTMENT CHECKLIST
EMERGENCY CARE OF THE RADIATION ACCIDENT PATIENT
1. DETERMINE
· MEDICAL STATUS
· TYPE OF ACCIDENT
· IRRADIATED and/or
· CONTAMINATED (use radiation survey meter to determine)
· EXTERNAL (radioactive contamination on skin and/or clothing)
· INTERNAL (radioactive material in body)
2. PREPARE FOR PATIENT ARRIVAL
· OBTAIN & TEST RADIATION SURVEY METERS. COVER PROBES (if external contamination expected)
· SUMMON ADDITIONAL STAFF PER RADIATION ACCIDENT PLAN
· DON PROTECTIVE CLOTHING (Use Universal Precautions if external contamination expected)
· PROVIDE PERSONNEL DOSIMETERS AS CALLED FOR IN PLAN
· LABEL WASTE CONTAINERS FOR RADIOACTIVE WASTE (if external contamination expected)
· COVER FLOOR OF TREATMENT ROOM (if sufficient time and if external contamination expected)
· GURNEY(S) COVERED WITH TWO SHEETS AND STAFF MEMBER WITH SURVEY METER
PREPARE TO MEET AMBULANCE (if external contamination expected)
· IF LARGE SCALE ACCIDENT, ARRANGE FOR RECEPTION OF “WORRIED WELL” AND CONTAMINATED BUT UNINJURED PATIENTS AT LOCATION OTHER THAN EMERGENCY DEPARTMENT (ED)
3. MEDICAL STABILIZATION UPON PATIENT ARRIVAL
· ALWAYS TAKES PRIORITY OVER RADIOLOGICAL ASPECTS
· AIRWAY, BREATHING, CIRCULATION
· WOUND/PAIN MANAGEMENT
· QUICKLY SURVEY PATIENT, OUTSIDE ED, WITH RADIATION SURVEY METER FOR EXTERNAL CONTAMINATION
· IF SIGNIFICANT CONTAMINATION AND MEDICAL CONDITION PERMITS, TRANSFER TO CLEAN GURNEY
AND FOLD SHEETS OVER PATIENT FOR TRANSPORT INTO ED
4. IF EXTERNAL CONTAMINATION, PERFORM DECONTAMINATION
· REMOVE AND BAG CLOTHING (Carefully remove to prevent spread of contamination)
· SURVEY (Record time, cpm at one inch, location)
· COLLECT SAMPLES (Label, bag, transfer to buffer zone)
· COVER UNCONTAMINATED WOUNDS WITH WATERPROOF DRESSINGS
· DECONTAMINATE SKIN (Carefully clean with soap and tepid water,
wiping toward highest contamination to limit spread. Do not abrade skin)
· CLEAN CONTAMINATED WOUNDS (Irrigate with saline at
room temperature and gently scrub with surgical sponge)
· GENTLY RINSE CONTAMINATED BURNS (Do not scrub)
· CONTROL CONTAMINATION (Place all potentially contaminated
material in radioactive waste containers)
· CHANGE OUTER GLOVES FREQUENTLY
· STOP DECONTAMINATION OF SKIN AND WOUNDS WHEN
· Contamination is less than twice background, or
· Attempts are not significantly reducing contamination
· PERFORM AND RECORD FINAL SURVEY
5. IF LARGE DOSES (> 100 RAD) TO MOST OF THE BODY ARE SUSPECTED
· MAY EXHIBIT NAUSEA, VOMITING, DIARRHEA, FATIGUE
· Greater severity and prompter onset indicate larger dose
· OBTAIN BLOOD SAMPLES
· CBC with differential (Initially and every 6 hours)
· DRAW BLOOD FOR CHROMOSOMAL ANALYSIS (Dark green, sodium heparin tube)
6. IF INTERNAL CONTAMINATION
· Take action specific to radiochemical as described in NCRP Report No. 65
· TREATMENT May not be AS effective WHEN delayed – may need to act on preliminary information
7. IF NEEDED, OBTAIN EXPERT CONSULTATION
· REAC/TS (865) 576-3131 (Monday-Friday, 8:00 a.m. to 4:30 p.m EST)
Off-hours: (865) 576-1005, ask for REAC/TS (24-hour call)
· AFRRI MEDICAL RADIOBIOLOGY ADVISORY TEAM (301) 295-0530
8. PATIENT TRANSFER
· SURVEY MEDICAL ATTENDANTS (Change gloves and outer apron)
· ROLL IN SEPARATE CLEAN FLOOR COVERING AND A CLEAN GURNEY
9. STAFF EXIT FROM CONTAMINATION AREA
· REMOVE PROTECTIVE CLOTHING IN THE FOLLOWING ORDER:
Outer gloves, mask, apron, isolation gown, cap, shoe covers, inner gloves.
· PLACE IN DESIGNATED RADIOACTIVE WASTE CONTAINERS
· SURVEY STAFF FOR CONTAMINATION & COLLECT PERSONNEL DOSIMETERS.
10. AREA CLEAN-UP: Environmental Services and Radiation Safety Staff Will Assist
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