9.3. EFFECT OF RADIATION

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Absent.

Purpose of assistance

1. Priority in identifying and treating life-threatening conditions and injuries over any injury caused by radiation exposure.
2. Recognition and proper treatment of acute radiation injuries.
3. Reduce the risk of infection of EMD personnel who provide care to patients who are infected or suspected of being infected with radioactive substances.

Inclusion criteria

1. Patients with significant contamination due to the action of ionized radiation released from the place of storage of radioactive substances as a result of accidents.
2. Patients with significant contamination due to the action of ionized radiation released from the place of storage of radioactive substances as a result of a certain event.
3. Patients with infection due to contact with materials emitting ionizing radiation.

Exclusion criteria

1. Patients who received a small dose of ionizing radiation during a medical examination.
2. Patients who received a small dose of ionizing radiation during therapeutic procedures.

Management of the patient

Status assessment

1. Identification and treatment of emergencies has a higher priority than decontamination.
2. Use personal protective equipment that protects the skin from contact with liquids and solid objects (suit and gloves), protects the mucous membranes from liquids and particles (face mask and glasses), and also protects the respiratory tract from particles (mask No. 95 or a respirator).
3. Do not consume liquids or food while caring for patients until testing for contamination and decontamination has been completed.
4. Be careful and prevent the distribution of infected materials.
5. Provide patient-specific care for any emergencies or medical problems.

Treatment and intervention

1. If the patient has nausea, vomiting and/or diarrhea:

a) provide assistance according to the Nausea/Vomiting guideline;
b) document the time of onset of gastrointestinal symptoms.

2. When a seizure occurs:

a) suspect the presence of a medical root cause or exposure to other chemicals in the absence of other indicators of contamination with a large dose of whole-body radiation (more than 20 Gray) such as, for example, vomiting;< br />b) treat according to the instruction “Convulsions”.

Patient safety

Treat emergencies and injuries before evaluating and treating radiation damage or decontamination.

Useful information for training

Key points

1. Irradiated patients do not pose a threat to EMD specialists.

2. Infected patients do not pose a threat to EMD workers if proper personal protective equipment is used, including masks or respirators, gloves, gowns, and face and eye protection.

3. Sources of radiation:

a) legal:

• • • • industrial enterprises;
      • healthcare institutions providing radiology services;
      • nuclear power plants;
      • mobile engineering means (for example – building structures for pouring cement);

b) illegal:

• • • • weapons of mass destruction;
      • “dirty bombs”, the purpose of which is to pollute large areas.

4. Physiology of radiological contamination:

a) contamination – poisoning as a result of direct contact with a source of radiation, contaminated objects, liquids or clothing on which there are active radioactive particles;
b) exposure – poisoning as a result of action of radioactive rays penetrating through body tissues.

5. Types of radioactive poisoning:

a) gamma rays:

• • • • the highest frequency of ionizing rays;
      • penetrates deeply through the skin;
      • causes the strongest intoxication;

b) beta rays – penetrate to a depth of 1 cm under the skin;
c) alpha rays:

• • • • lowest frequency of ionizing rays;
      • short range of absorption;
      • dangerous only if inhaled or consumed;

d) daughter radionuclides:

• • • • decay products of primary radioactive substances;
      • can produce gamma and beta rays (for example, uranium decays into a series of daughter products of radon).

6. In general, trauma patients with radioactive contamination or exposure should be triaged and treated based on the severity of their usual injuries.

7. A patient infected with radioactive substances (for example, as a result of radioactive particles falling on clothing) carries a minimal risk of infection for EMD workers.

8. Emergency responders may be tasked by health services to distribute potassium iodide in mass trauma situations due to radiation release or exposure.

Corresponding evaluation results

1. Treatment of life-threatening injuries or emergencies takes priority over assessment of contamination or initiation of decontamination.
2. The time of onset of nausea and vomiting is a reliable indicator of the received dose of ionizing radiation. The faster vomiting occurs, the greater the total radiation dose.
3. Tissue burns are usually detected in the late stages after exposure. If the burns appear suddenly, they are caused by a thermal or chemical mechanism.
4. Convulsions may indicate the presence of acute radiation syndrome if they are accompanied by vomiting. If other clinical indicators do not indicate exposure to the whole body with a dose higher than 20 Gray, consider other causes of the seizure.
5. Late symptoms (days or weeks after exposure or infection):

a) skin burns due to direct contact with a radioactive source;
b) skin burns or erythema due to ionizing radiation;
c) fever;
d) suppression of the bone marrow in the form of:

• • • • immunosuppression;
      • petechiae;

g) spontaneous internal and external bleeding.

Key elements of documentation

1. Duration of exposure to a radiation source or radiation environment.
2. Distance (if it is possible to determine) to the source of infection (if known).
3. Time of onset of nausea, vomiting.

Criteria for the effectiveness of aid provision

1. Using appropriate means of personal protection.
2. Use of dosimetry by EMD workers.
3. Measurements of the radiation background at the scene.