200
17 Medical Response
a single source pellet of, say, a few tens of GBq can cause the entire patient to appear
to be contaminated and can even cause instruments to overload due to dead time.
Contaminated and radioactive materials should be removed from the body when
found. However, it might not be immediately evident which fragments are radioactive and which are not; accordingly, each object removed from the body should
be removed using forceps, hemostats, or similar tools and should be surveyed and
placed in a shielded container if contaminated or radioactive. Similarly, wipes and
fluids used for decontamination or that are used to flush injuries or burns should be
collected for later disposal as radioactive waste.
Internal radioactivity can remain in the body for weeks, months…even decades,
depending on the radionuclide(s) and their chemical form. Treatment goals, then,
must include cleaning wounds to prevent contamination from entering the body
through breaches in the skin or from being absorbed through the skin into the body.
For the most part, radioactive contamination can be cleaned from wounds and the
skin the same as any other contaminants; flushing with saline solution, using cleaning
wipes, debridement, and so forth. When cleaning non-injured parts of the body, care
must be taken to not let contaminated liquids flow over injuries, contaminating them
[24]. Wounds and burns can also be flushed with DTPA or other chelating agents to
remove metals such as cesium, cobalt, americium, and so forth [13].
If contamination becomes fixed to the skin, medical personnel (possibly in
conjunction with radiation safety professionals) must determine if the contamination
levels are sufficiently high as to require further decontamination and, if so, what sort
of decontamination is called for. Minor levels of contamination, for example, might
not cause enough radiation exposure and might not pose a sufficiently high risk of
absorption to require any further efforts. In the aftermath of the Fukushima accident,
for example, persons with up to about 100,000 counts per minute were released from
survey stations without any further decontamination requirements, as were patients
admitted to local hospitals [1].
If contamination levels and/or the potential dose to the skin (or to internal organs
if the contamination is absorbed into the blood) are high enough to require further
decontamination, options include:
• Continued use of cleaning solutions and/or chelating agents until contamination
levels are acceptable
• Skin abrasion
• Chemical removal using a compound appropriate for the contaminating element
(see, e.g. [13])
• Excision and/or debridement
• Administration of decorporation agents to treat materials absorbed into the body.
Any patients with embedded fragments or contaminated wounds or burns should
be assessed for internal contamination as described in Chap. 18. If an intake is found
to have occurred, decorporation should be considered if the amount of uptake is
greater than one clinical decision guideline—CDG—NCRP [24].
17 Medical Response
a single source pellet of, say, a few tens of GBq can cause the entire patient to appear
to be contaminated and can even cause instruments to overload due to dead time.
Contaminated and radioactive materials should be removed from the body when
found. However, it might not be immediately evident which fragments are radioactive and which are not; accordingly, each object removed from the body should
be removed using forceps, hemostats, or similar tools and should be surveyed and
placed in a shielded container if contaminated or radioactive. Similarly, wipes and
fluids used for decontamination or that are used to flush injuries or burns should be
collected for later disposal as radioactive waste.
Internal radioactivity can remain in the body for weeks, months…even decades,
depending on the radionuclide(s) and their chemical form. Treatment goals, then,
must include cleaning wounds to prevent contamination from entering the body
through breaches in the skin or from being absorbed through the skin into the body.
For the most part, radioactive contamination can be cleaned from wounds and the
skin the same as any other contaminants; flushing with saline solution, using cleaning
wipes, debridement, and so forth. When cleaning non-injured parts of the body, care
must be taken to not let contaminated liquids flow over injuries, contaminating them
[24]. Wounds and burns can also be flushed with DTPA or other chelating agents to
remove metals such as cesium, cobalt, americium, and so forth [13].
If contamination becomes fixed to the skin, medical personnel (possibly in
conjunction with radiation safety professionals) must determine if the contamination
levels are sufficiently high as to require further decontamination and, if so, what sort
of decontamination is called for. Minor levels of contamination, for example, might
not cause enough radiation exposure and might not pose a sufficiently high risk of
absorption to require any further efforts. In the aftermath of the Fukushima accident,
for example, persons with up to about 100,000 counts per minute were released from
survey stations without any further decontamination requirements, as were patients
admitted to local hospitals [1].
If contamination levels and/or the potential dose to the skin (or to internal organs
if the contamination is absorbed into the blood) are high enough to require further
decontamination, options include:
• Continued use of cleaning solutions and/or chelating agents until contamination
levels are acceptable
• Skin abrasion
• Chemical removal using a compound appropriate for the contaminating element
(see, e.g. [13])
• Excision and/or debridement
• Administration of decorporation agents to treat materials absorbed into the body.
Any patients with embedded fragments or contaminated wounds or burns should
be assessed for internal contamination as described in Chap. 18. If an intake is found
to have occurred, decorporation should be considered if the amount of uptake is
greater than one clinical decision guideline—CDG—NCRP [24].