Any emergency situation can be a high stress, fast paced environment where time is of the essence. Scene safety, medical treatment and patient transport all take well trained professionals who are quick to act, and are and knowledgeable about the impacts of their decisions.
Emergencies involving radiation are often seen as more complicated events, but most radiation-related incidents bring little risk to those providing patient care and transport. Knowledge of the real radiation risk is crucial when dealing with radiation related injuries.
In these events, the key is that emergency medical care of the patient takes precedence over decontamination. Unlike with chemical contamination, medical stabilization for patients with a radiological contamination takes priority. Irradiation occurs when all or part of the body is exposed to radiation from a source.
Irradiated patients are not contaminated, and irradiation does not make a person radioactive. These irradiated, or exposure only, patients are analogous to those who have had an X-ray, and therefore pose no radiological threat to the care provider.
Contaminated patients are those who have transferable radiological material anyplace it is not desired. A person is externally contaminated if radioactive material is on the skin. A person is internally contaminated if radioactive material is inhaled, ingested or absorbed through wounds. A person contaminated with radioactive materials will be irradiated until the radioactive material, the source of the radiation, is removed.
The vast majority of external radiological contamination can be detected with a basic survey meter.
Radiological contamination can be readily detected, pinpointed and addressed, and the area can be decontaminated with simple cleaning methods such as mild soap and water. Basic radiological instrumentation is used to understand risk and assess effectiveness of contamination control techniques.
It is important to remember that contamination can be mitigated and contained with appropriate measures. Doing so makes the transport of a contaminated patient safer for ground ambulance and aeromedical crews, which helps expedite patient transport to definitive care.
Providers can mitigate the radiation contamination risk by wearing available personal protective equipment. Various examples can be seen here.
The following steps will help emergency personnel provide high quality patient care while mitigating radiological contamination risk:
- Assess and treat life threatening injuries, do not delay life saving measures in order to assess radiological contamination status.
- Perform routine emergency care during extrication procedures.
- Move the patient away from the radiation hazard area using proper patient transfer techniques to prevent further injury.
- Patients should be monitored for possible contamination only after they are medically stable.
- Radiation levels above background indicate the presence of contamination.
- With an external radiological contamination event, outer garments typically retain a large percentage of the contamination. Removing the patient’s outerwear helps control the spread of this contamination.
For example, if a patient is extricated from a radiologically contaminated area in an occupational setting, the removal of personal protective equipment in a controlled manner should be done expeditiously, provided removal can be accomplished without causing further injury or delaying necessary care.
If possible, before removing clothing, the patient’s airway should be protected from airborne contaminants. This can be accomplished with an oxygen mask, a simple surgical mask, an N95 mask, or an inverted face shield. As with any intervention, the patient’s respiratory status should be continuously monitored.
In some situations, a three-sheet method is used to help control the spread of contamination from the patient and from surfaces. The bottom sheet protects the providers and the medical equipment from contamination on the ground. The top sheet is used as a surface to provide initial patient care, and will be left behind with the patient’s contaminated clothing. The middle sheet is used to cocoon the patient, thus containing any residual contaminants.
Based on medical necessity, a limb or other body part may be exposed to facilitate acquisition of vital signs or intravenous access. With the patient appropriately packaged to contain any contamination and mitigate its spread, the patient may now be placed on a covered stretcher at the control line, if one has been established, and prepared for transport by securing them in the appropriate manner. Do not remove the patient from the spine board if one was used for medical purposes.
If possible, the patient should be transported by personnel who have not entered the control area. In a setting where the patient is wearing only personal clothing, the same concepts and approach apply.
Variations to this cocooning method include using plastic sheets, tarps or garbage bags. Isolated contamination may also be fixed in place by using a pre-made bioclusive dressing or plastic wrap.
If aeromedical transport is warranted, the landing zone should be upwind and away from the contaminated site, which may require intermediate transport from the incident site. The patient may be placed onto the helicopter via a cold or hot load, based on medical priority and local protocols.
The patient should be transported to the most appropriate facility based on their medical or trauma needs. During transport, the concepts of time, distance and shielding can be used to minimize risk. During transport, a standard medical history should be obtained.
Depending on the type of radiological incident, other questions that might provide useful information include about where the patient was in relation to the event, how long the patient was in that location, and any recent nuclear medicine tests. The patient may have anxiety related to the event, and psychological support should be offered.
If the ground or air ambulance is needed for another medical trauma emergency, especially if returning to the same radiologically contaminated scene, it may be used prior to surveying and decontamination. If radiological instrumentation is available, it can be used to identify any areas of contamination, and those areas may be covered or decontaminated as time allows.
Medical care takes priority for all patients, and therefore response to another emergency call should not be delayed, otherwise the ambulance and crew should not return to regular service until the crew, vehicle, and equipment have undergone monitoring and any necessary decontamination. Consider common areas touched by medical personnel as a priority for survey, such as oxygen regulators, monitoring equipment, medical cabinets or bags, and radios.
Understanding contamination control can provide for the safety of emergency responders and medical providers, and lead to better patient outcomes.