Population Monitoring and Radionuclide Decorporation Following a Radiological Or Nuclear Incident

Preface......Page 4 Contents......Page 6 1. Executive Summary......Page 14 2.1 Overview......Page 20 2.2 Purpose of this Report......Page 26 2.4 Scope of this Report......Page 27 3.1 Internal Deposition of Radionuclides......Page 30 3.1.1 Inhalation......Page 31 3.1.2 Ingestion......Page 33 3.1.4 Absorption Through Wounds......Page 34 3.3 Effects of Weather......Page 35 3.4 Complications Due to the Presence of Multiple Agents or Serious Injuries......Page 36 3.6 Proximity to the Incident......Page 39 3.7 Previous Experience with Internal Contamination......Page 40 3.8 Conclusions......Page 41 4.1 Radiological Dispersal Device......Page 42 4.1.2 Nature of Contamination......Page 43 4.2.2 Nature of Contamination......Page 44 4.3.1 Incident Characteristics......Page 45 4.4.1 Incident Characteristics......Page 46 4.5 Nuclear Reactor Incident......Page 48 4.5.1 Incident Characteristics......Page 49 4.6.1 Incident Characteristics......Page 50 4.7 Sealed Radioactive Source Incidents......Page 51 4.7.2 Nature of Contamination......Page 52 4.8 Summary......Page 53 5.1 Introduction......Page 54 5.2 Incident Command System......Page 56 5.3 Hospital Incident Command System......Page 59 5.5 Communicating Information from the Scene to the Hospitals and from the Hospitals to the Scene......Page 61 6.1 General Guidance for Emergency Responders......Page 66 6.1.1 Selecting an Appropriate Radiation Survey Instrument......Page 67 6.1.2 Presurvey Radiation Survey Instrument Checks......Page 68 6.2 Radiological Triage and Screening Procedures......Page 69 6.3 Initial Screening at Scene......Page 70 6.4 Initial Screening at Hospital......Page 73 6.6 Biodosimetry......Page 74 7.1 Clinical Decision Guide Concept......Page 78 7.2.1 Decision-Making Process......Page 81 7.2.2 Use of the CDG Tables......Page 82 7.2.4 Using the CDG with an Intake of Multiple Radionuclides......Page 83 7.2.5 Determining an Intake for Times More than 24 h in the Past......Page 84 7.2.6 Special Considerations for Uranium CDGs......Page 86 7.3 Americium-241: Clinical Decision Guide Fact Sheet......Page 91 7.4 Cesium-137: Clinical Decision Guide Fact Sheet......Page 92 7.5 Cobalt-60: Clinical Decision Guide Fact Sheet......Page 93 7.6 Iodine-131: Clinical Decision Guide Fact Sheet......Page 95 7.7 Iridium-192: Clinical Decision Guide Fact Sheet......Page 97 7.8 Plutonium-238: Clinical Decision Guide Fact Sheet......Page 98 7.9 Plutonium-239: Clinical Decision Guide Fact Sheet......Page 99 7.10 Radium-226: Clinical Decision Guide Fact Sheet......Page 101 7.11 Strontium-90: Clinical Decision Guide Fact Sheet......Page 102 7.12.1 Treatment Based on Radiological Properties of Uranium (CDG)......Page 103 7.12.2 Treatment Based on Nephrotoxic Properties of Uranium......Page 104 7.13.1 Noniodine Radionuclides......Page 106 7.13.3 Uranium Mass and Activity Calculations......Page 107 8. Rapid Determination of Internal Contamination......Page 109 8.1 Rapid Identification of Radionuclide(s) Involved......Page 110 8.2 Screening for External Contamination......Page 111 8.3.1 Detection of Internal Contamination by Direct Measurement......Page 112 8.3.2 Hospital Equipment for the Detection and Quantitation of Radionuclides......Page 116 8.3.3 Measuring Internal Contamination with Hospital Equipment......Page 123 8.3.4 Wound Monitoring......Page 125 8.4.1 Nasal Swabs......Page 126 8.4.2 Urine Samples......Page 127 8.4.3 Blood Samples......Page 128 8.4.5 Analysis of Indirect Bioassay Samples......Page 129 8.5 Rapid Screening of Persons to Identify Radionuclide Intakes that Exceed the Clinical Decision Guide......Page 130 9.1 Introduction......Page 134 9.2 General Clinical Guidance for the Treatment of Internal Contamination......Page 135 9.3 Making Requests for Radiological Countermeasures......Page 137 9.4.1 Triage......Page 138 9.4.2 Prioritizing Children and Pregnant Women......Page 139 9.4.3 Medical Decisions During the Early Phases of a Radiation Incident......Page 140 9.4.4 Choice of Decorporation Therapy for Internally-Deposited Radionuclides......Page 141 9.4.6 Contaminated Wound Management......Page 142 9.4.7 Using DTPA on Radionuclide-Contaminated Wounds......Page 143 9.5.2 Treatment......Page 144 9.6.1 Overview......Page 147 9.7.1 Overview......Page 148 9.8.1 Overview......Page 151 9.9.1 Overview......Page 153 9.10.1 Overview......Page 158 9.11.1 Overview......Page 159 9.12.2 Treatment......Page 160 9.13.1 Overview......Page 163 9.13.3 Medical Follow-Up After Treatment......Page 166 10.1 Introduction......Page 168 10.4 Enlisting the Public as a Partner......Page 169 10.6 Proactive Approach......Page 170 10.7 Information Hotlines......Page 171 10.8 Special Services, Approaches and Materials for Children......Page 172 10.9 Persons with Reproductive and Fertility Concerns......Page 173 10.11 Addressing Staff Concerns and Information Needs......Page 174 10.13 Training Exercises......Page 175 10.14 Understanding and Addressing Responder Concerns and Information Needs......Page 176 11.1 Identification of the Population to be Followed......Page 178 11.2 Classification of Persons to be Monitored or Followed......Page 181 11.3 Follow-Up Procedures......Page 184 12. Scalability......Page 185 13. Assessment of Current Capacity in the United States to Perform Population Screening, Decontamination and Monitoring for Internal Contamination......Page 193 13.1 Availability of Equipment and Resources......Page 194 13.2 Laboratory Capabilities......Page 195 13.3 Training Needs on Use of Equipment......Page 196 13.4 Radiation Volunteers to Support Population Screening......Page 198 13.5 Biodosimetry......Page 199 13.6 Conclusions......Page 200 14.1 Recommendations for Planning......Page 201 14.2 Recommendations Related to Screening and Treatment of a Population for Internal Contamination......Page 202 14.3 Recommendations for Additional Work......Page 203 Appendix A. Radiological Properties of Radionuclides Considered in this Report......Page 205 B.1 Screening Survey......Page 215 B.2 Complete Whole-Body Survey......Page 216 B.3 Most Common Mistakes Made During the Survey......Page 217 Appendix C. How to Distinguish Between Alpha, Beta and Gamma Radiation Using a Geiger-Muller Survey Meter......Page 218 C.2 Determining the Presence of Strontium-90 (or other pure beta emitters) Using a Pancake Geiger-Muller Survey Meter......Page 219 D.1 Contamination Survey Sheet......Page 221 D.2 Registry Form......Page 224 D.3 ATSDR Rapid Response Registry Survey Form......Page 227 Appendix E. How to Perform Decontamination at Home......Page 229 Appendix F Using Geiger-Muller Survey Meters to Assess Internal Contamination for Selected Gamma-Emitting Radionuclides......Page 231 G.2 Main Collection Issues......Page 241 H.2 Regulatory Information: Brief Summary......Page 244 H.4 General Shipping Guidelines for Clinical, Diagnostic and Exempt Biological Samples......Page 245 H.6 Website Links for Some Commercial Shippers......Page 247 I.1 Background......Page 248 I.2.2 London, United Kingdom......Page 249 Appendix J. Pregnancy Categories for Drug Use......Page 251 Appendix K. Emergency Phone Numbers for Government Officials to Request Assistance Following a Radiological or Nuclear Incident......Page 252 Glossary......Page 253 Abbreviations and Acronyms......Page 260 References......Page 261 Officers......Page 277 Distinguished Emeritus Members......Page 278 NCRP Reports......Page 286 NCRP Commentaries......Page 291 Proceedings of the Annual Meeting......Page 292 Lauriston S. Taylor Lectures......Page 294 NCRP Statements......Page 296 Other Documents......Page 297 This Report is the second of two reports by the National Council on Radiation Protection and Measurements (NCRP) that focus on measurement of radionuclides deposited internally in a population exposed in a radiological or nuclear incident. The first report, NCRP Report No. 161, entitled Management of Persons Contaminated with Radionuclides (NCRP, 2008a), is an update and expansion of NCRP Report No. 65, Management of Persons Accidentally Contaminated with Radionuclides (NCRP, 1980) that provides detailed guidance for many radionuclides in a much broader range of exposure scenarios. The present Report focuses on screening a population exposed to one or more radionuclides that may be involved in a radiological or nuclear incident