Management of persons contaminated with radionuclides : handbook : recommendations of the National Council on Radiation Protection and Measurements, December 20, 2008

Preface......Page 4 Contents......Page 7 1. Executive Summary......Page 23 2. Introduction......Page 33 2.1 Purpose of this Report......Page 34 2.3 Organization of this Report......Page 37 2.3.1 Management of Persons Contaminated with Radionuclides: Handbook......Page 38 2.3.3 Part B: Onsite and Prehospital Actions......Page 41 2.3.5 Part D: Patient Management Post-Hospital......Page 42 2.3.6 Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases......Page 43 3.1.1 Organizations Offering Radiological Incident Assistance......Page 47 3.1.2 Terminology......Page 48 3.2.1 Radiation Types and Recommended Personnel Protection......Page 52 3.2.2 Identifying Radiation Types Using a Pancake or Other Thin End-Window Geiger-Mueller Probe Survey Meter......Page 53 3.2.3 Radiation Energy and Radioactive Decay Facts......Page 54 3.3.1 Incidents......Page 55 3.3.2 Roles and Responsibilities (Section 18)......Page 56 3.4 Guidance for Professionals at Incident Site......Page 57 3.4.1 Radiation Readings and Their Significance (dose-rate meters)......Page 58 3.4.2 Surface Radiation Readings and Their Significance (contamination survey meters)......Page 59 3.5.2 Stages in Management of Exposed Persons......Page 60 3.6.2 Neutron-Radiation Dose from Criticality Accident (based on 24Na activation in body)......Page 64 3.6.3 Exposures from Sealed Radioactive Sources......Page 67 3.7.1 Intervention Levels for Skin Contamination......Page 68 3.8.1 Health Effects from Internal Radionuclide Contamination......Page 71 3.8.2 Inhalation Intakes......Page 76 3.9.1 Clinical Decision Guides......Page 78 3.10 Radiation Dose Limitation......Page 85 4.1 Introduction......Page 94 4.2 General Instructions for First Responders......Page 95 4.3 Guidance for First Responders......Page 96 4.3.2 Immediate Goals for Protection of Exposed Individuals......Page 97 4.3.3 Control Areas......Page 98 4.3.4 Protection of First Responders......Page 100 5.1 Contamination Surveys......Page 102 5.1.1 How to Perform Surveys of Individuals, Clothing, Samples and Surfaces......Page 103 5.1.3 How to Perform an Alpha-Radiation Survey of Contaminated Areas, Individuals and Samples......Page 104 5.2.2 Personal Protection Equipment Inspection......Page 105 5.2.4 Removing Personal Protection Equipment......Page 108 5.3.2 Contamination Control of Exposed People......Page 110 5.3.4 Radiologically-Controlled Areas (further defined in Sections 4.3.3 and 18)......Page 111 5.3.5 Decontamination of Equipment......Page 114 6. Stage 1: Medical Assessment (onsite triage area)......Page 115 6.2 Potential Life-Threatening Problems......Page 116 6.4 Assessment of External Irradiation......Page 118 6.5.2 Internal Contamination......Page 123 6.8 Documenting a Radionuclide Contamination Incident......Page 126 7.1 External Contamination Assessment Procedures......Page 129 7.2 Dose Assessment......Page 131 7.4 Treatment Guidance......Page 133 8.1 Decontamination of Persons......Page 135 8.1.1 Decontamination Objectives......Page 136 8.1.2 Decontamination Procedures......Page 137 8.2 Guidance for Those Performing Decontamination Procedures......Page 139 8.3 Decontamination Facilities......Page 140 8.5 Management of Individuals After Contamination Assessment and Decontamination of Skin and Wounds......Page 142 8.6 Documentation......Page 143 9. Stage 4: Patient Evaluation and Emergency Care (hospital)......Page 145 9.1.1 Medical Evaluation of Persons with Internal Contamination......Page 146 9.1.2 Psychological and Behavioral Consequence Management After Radiation Incidents......Page 147 9.2 General Instructions for Emergency Department Medical Staff......Page 149 9.3.2 Caring for Lightly Injured and Uninjured Contaminated Exposed Persons......Page 150 9.3.3 Caring for Persons Suffering from Radiation Injury......Page 151 9.3.4 Caring for Persons Suffering from Radiation Burns......Page 153 9.4.1 Radionuclides in a Wound......Page 154 9.4.2 Radionuclide Inhalation......Page 155 9.4.3 Radionuclide Ingestion......Page 156 9.5 Medical Information Checklist......Page 158 10.1 Preliminary Assessment Activities......Page 160 10.2.1 Location of the Individual and Time of Exposure......Page 162 10.2.2 Establishing the Route of Exposure......Page 163 10.2.3 Radionuclide Identification and Physical and Chemical Form......Page 164 10.3 Bioassay......Page 165 10.3.1 Indirect (in vitro) Bioassay Monitoring......Page 166 10.3.2 Direct (in vivo) Monitoring......Page 173 10.4 Intake and Dose Assessment......Page 175 11.2 Clinical Decision Guides......Page 180 11.4 Extrapolation of Data for Spot Urine Sample to 24 h Values......Page 191 11.5 Worked Examples with Bioassay Data......Page 193 12. Stage 7: Medical Management (hospital)......Page 198 12.1 Introduction......Page 199 12.2 Decorporation Therapy for Internally-Deposited Radionuclides......Page 201 12.3.1 Deferoxamine Treatment......Page 209 12.3.2 Dimercaprol Treatment......Page 211 12.3.3 DTPA Treatment......Page 213 12.3.4 Ethylenediaminetetraacetic Acid Treatment......Page 220 12.3.5 Penicillamine Treatment......Page 221 12.3.6 Prussian Blue Insoluble Treatment......Page 223 12.3.7 Succimer Treatment......Page 231 12.4.1 Medical Treatment for Barium and Calcium Radionuclides......Page 232 12.4.3 Medical Treatment for Iodine Radionuclides......Page 234 12.4.5 Medical Treatment for Radium and Strontium Radionuclides......Page 243 12.4.7 Medical Treatment for Uranium Isotopes......Page 250 12.5 Lung Lavage......Page 255 13.1 Introduction......Page 259 13.2 Late-Occurring Health Effects......Page 260 13.3 Preventive Medicine Approaches......Page 261 13.4 Psychosocial Issues......Page 262 14.1 Introduction......Page 266 14.2.1 Field Activities......Page 267 14.2.2 Autopsy......Page 269 14.3 Guidelines for Mortuary Personnel......Page 273 14.4 Final Disposition of the Decedent......Page 274 14.5 Religious and Cultural Considerations......Page 275 15.2 Standard Precautions......Page 277 15.3 Contamination Control Actions in the Emergency Department for Highly-Contaminated Patients......Page 278 15.5 Hospital Emergency Department Contamination Controls......Page 279 15.7 Patient Decontamination (Section 8)......Page 281 15.9 Hospital Decontamination Procedures for Protection of Personnel and Facilities......Page 282 References......Page 285 Index......Page 299