202
17 Medical Response
17.3.3 Radiation Safety in the Emergency Department
The primary radiation safety concern in the Emergency Department are contamination control, followed by limiting radiation exposure from embedded source
fragments.
Limiting radiation exposure from embedded source fragments requires, first,
locating the fragments and obtaining an accurate dose rate. Fragments should not
be held with the hands or fingers—only with forceps, hemostats, or the like—and
they should be placed into a shield (colloquially called a “pig”), a shielded safe, or a
related location. If removing an embedded source fragment is expected to require an
extended period of time, those involved in the procedure should take care to utilize
the principles of Time, Distance, and Shielding (discussed below) to reduce their
own radiation exposure and that of others in the trauma bay or operating room in
which the procedure is being performed (Fig. 17.5).
Contamination control is somewhat more challenging because contamination can
spread quite easily from person to person, from person to objects or surfaces, and
from objects or surfaces to workers. The following precautions will help to control
the spread of contamination while a patient is in the Emergency Department [2, 24].
• Medical staff should assume that all patients arriving from and downwind of the
site of the attack are contaminated and should take appropriate precautions.
• Uncontaminated patients should not be put into the same rooms as those who are
contaminated.
• Use disposal equipment (e.g. thermometer covers, blood pressure cuffs, etc.) when
possible.
• Remove patient’s outer clothing if possible and place in a plastic bag.
– Patients’ clothing should be saved for possible forensic purposes; when no
longer needed for that purpose it may be disposed of as radioactive waste.
• This includes taking standard precautions when working with patients as well as
changing PPE and surveying one’s hands after finishing and before moving on to
the next patient.
• If the patient is in an examination room or bay there should be a waste container
at the entry so that staff can place their used (and possibly contaminated) PPE in
the container upon exiting.
• If resources permit there should be contamination survey meters (preferably a
pancake-type GM) in each area so that those exiting a room or bay can survey
their hands and feet for contamination prior to exiting.
• If resources permit, there should be a step-off pad or entry/exit area set up
to provide a location for donning and doffing PPE, conducting contamination
surveys, and performing decontamination (if necessary).
• Establish boundaries between contaminated and uncontaminated areas.
17 Medical Response
17.3.3 Radiation Safety in the Emergency Department
The primary radiation safety concern in the Emergency Department are contamination control, followed by limiting radiation exposure from embedded source
fragments.
Limiting radiation exposure from embedded source fragments requires, first,
locating the fragments and obtaining an accurate dose rate. Fragments should not
be held with the hands or fingers—only with forceps, hemostats, or the like—and
they should be placed into a shield (colloquially called a “pig”), a shielded safe, or a
related location. If removing an embedded source fragment is expected to require an
extended period of time, those involved in the procedure should take care to utilize
the principles of Time, Distance, and Shielding (discussed below) to reduce their
own radiation exposure and that of others in the trauma bay or operating room in
which the procedure is being performed (Fig. 17.5).
Contamination control is somewhat more challenging because contamination can
spread quite easily from person to person, from person to objects or surfaces, and
from objects or surfaces to workers. The following precautions will help to control
the spread of contamination while a patient is in the Emergency Department [2, 24].
• Medical staff should assume that all patients arriving from and downwind of the
site of the attack are contaminated and should take appropriate precautions.
• Uncontaminated patients should not be put into the same rooms as those who are
contaminated.
• Use disposal equipment (e.g. thermometer covers, blood pressure cuffs, etc.) when
possible.
• Remove patient’s outer clothing if possible and place in a plastic bag.
– Patients’ clothing should be saved for possible forensic purposes; when no
longer needed for that purpose it may be disposed of as radioactive waste.
• This includes taking standard precautions when working with patients as well as
changing PPE and surveying one’s hands after finishing and before moving on to
the next patient.
• If the patient is in an examination room or bay there should be a waste container
at the entry so that staff can place their used (and possibly contaminated) PPE in
the container upon exiting.
• If resources permit there should be contamination survey meters (preferably a
pancake-type GM) in each area so that those exiting a room or bay can survey
their hands and feet for contamination prior to exiting.
• If resources permit, there should be a step-off pad or entry/exit area set up
to provide a location for donning and doffing PPE, conducting contamination
surveys, and performing decontamination (if necessary).
• Establish boundaries between contaminated and uncontaminated areas.