17.1 Medical Care at the Scene
195
distance must increase by a factor of
√
4.5, or by a factor of 2.1—moving the
victim to a distance of 2.1 m will reduce radiation dose rates sufficiently to
stabilize the victim to make it safe to remove them the rest of the way to the
perimeter.
Realizing that it is not easy to calculate square roots without a calculator
under such circumstances, one can also simply realize that the dose rate at a
distance of 2 m will be ¼ the dose rate at 1 m (about 2.25 Gy h
−1 ) and at 3 m
the dose rate will be lower by a factor of 9 (1 Gy h
−1 ). Moving the victim 2 m
further from the source will get them to a dose rate that will make it possible
to safely stabilize them.
Emergency responders at the scene should use their judgement to apply as much
contamination control as possible without affecting the person’s medical condition.
For example, a person who is gravely injured should be transported to the hospital
without delay; a person with relatively minor injuries should be decontaminated prior
to transportation to avoid needlessly contaminating an ambulance and emergency
room.
In all operations in the Hot Zone emergency responders must be careful to keep
their exposures low enough to keep from becoming ill themselves—less than 1 Sv—if
at all possible. This means that individual responders need to monitor their dosimetry
(or the total dose feature of their radiation instruments), and the Incident Commander
and/or the Health and Safety Officer must remind those in the Hot Zone to check their
dosimeters frequently and to exit when they reach a dose limit (actually, somewhat
sooner as it will take time to exit the area).
The NCRP [24] and REAC/TS [28] have each developed very similar flowcharts
for the triage, evaluation, stabilization, and radiological assessment of those injured
during a radiological event. As noted elsewhere in this book, the primary consideration must be attending to urgent medical needs and stabilizing the patient; evaluating
the person’s exposures to internal and external radiation and contamination is a
secondary consideration as even a fatal dose of radiation is unlikely to prove fatal in
less than several days or weeks while medical concerns (e.g. arterial bleeding) can
be fatal in minutes or hours.
Critically injured patients should be taken through the entry/exit corridor and
directly to the hospital. All others should be brought out of the area and taken to a
triage area for medical and radiological evaluation. Once out of the area, medical
personnel at the scene (e.g. paramedics and emergency medical technicians) should
provide what treatment they can, including collecting information that can be used
for radiological dose assessment at the hospital or at a Community Reception Center
(Fig. 17.2).
Among the tasks that should be performed if the patient’s condition permits are
performing and recording a whole-body radiological survey to determine levels of
skin contamination and the presence of any embedded source fragments. Survey
195
distance must increase by a factor of
√
4.5, or by a factor of 2.1—moving the
victim to a distance of 2.1 m will reduce radiation dose rates sufficiently to
stabilize the victim to make it safe to remove them the rest of the way to the
perimeter.
Realizing that it is not easy to calculate square roots without a calculator
under such circumstances, one can also simply realize that the dose rate at a
distance of 2 m will be ¼ the dose rate at 1 m (about 2.25 Gy h
−1 ) and at 3 m
the dose rate will be lower by a factor of 9 (1 Gy h
−1 ). Moving the victim 2 m
further from the source will get them to a dose rate that will make it possible
to safely stabilize them.
Emergency responders at the scene should use their judgement to apply as much
contamination control as possible without affecting the person’s medical condition.
For example, a person who is gravely injured should be transported to the hospital
without delay; a person with relatively minor injuries should be decontaminated prior
to transportation to avoid needlessly contaminating an ambulance and emergency
room.
In all operations in the Hot Zone emergency responders must be careful to keep
their exposures low enough to keep from becoming ill themselves—less than 1 Sv—if
at all possible. This means that individual responders need to monitor their dosimetry
(or the total dose feature of their radiation instruments), and the Incident Commander
and/or the Health and Safety Officer must remind those in the Hot Zone to check their
dosimeters frequently and to exit when they reach a dose limit (actually, somewhat
sooner as it will take time to exit the area).
The NCRP [24] and REAC/TS [28] have each developed very similar flowcharts
for the triage, evaluation, stabilization, and radiological assessment of those injured
during a radiological event. As noted elsewhere in this book, the primary consideration must be attending to urgent medical needs and stabilizing the patient; evaluating
the person’s exposures to internal and external radiation and contamination is a
secondary consideration as even a fatal dose of radiation is unlikely to prove fatal in
less than several days or weeks while medical concerns (e.g. arterial bleeding) can
be fatal in minutes or hours.
Critically injured patients should be taken through the entry/exit corridor and
directly to the hospital. All others should be brought out of the area and taken to a
triage area for medical and radiological evaluation. Once out of the area, medical
personnel at the scene (e.g. paramedics and emergency medical technicians) should
provide what treatment they can, including collecting information that can be used
for radiological dose assessment at the hospital or at a Community Reception Center
(Fig. 17.2).
Among the tasks that should be performed if the patient’s condition permits are
performing and recording a whole-body radiological survey to determine levels of
skin contamination and the presence of any embedded source fragments. Survey