6.3 Special Considerations for Those Near an Explosion
55
6.3.2 Radioactive Embedded Objects and Contaminated
Wounds
Embedded fragments of radioactive material might be as simple as micron-sized
particles driven into the skin by the force of an explosion or they might be higheractivity pieces from a radioactive source shattered by the force of an explosion.
The former offers little risk to the patient or to medical personnel caring for them;
depending on the activity included in the latter, there might be a degree of risk to
the patient or to those caring for them depending on the amount of radioactivity
contained in the fragments. For example, a relatively low-activity source fragment
containing 37 GBq (1 Ci) of radioactivity will produce a radiation dose rate of only
about 10 mSv hr
−1 (1 R hr
−1 ) at arm’s length (about 1 m) and a dose rate as high
as 1000 Sv hr
−1 (10
5 R hr
−1 to tissues in contact with the fragment. Dose rates this
high can cause tissue damage in the patient and to the unwary surgeon who might
handle the fragment when removing it from the patient.
In addition to radiation damage from embedded fragments, they can cause physical
trauma as they pass through tissues; these fragments can also begin to dissolve into
body fluids and enter the bloodstream, where the radioactivity can be carried to
internal organs (where it can remain for days, months, even years) or to the kidneys
to be excreted from the body.
Radioactive contamination can also enter the body through open cuts, wounds,
and other injuries that can result from being in proximity to an explosion. Sweat, rain,
water used for fire-fighting, even liquids used for decontamination can wash contamination into open cuts or wounds where the radionuclides can enter the bloodstream
with the results noted earlier.
6.3.3 Blast-Related Injuries
Any medical responder—emergency medical technicians, paramedics, nurses, physicians, and others—must be able to prioritize the severity of various medical issues
facing their patients so that they can properly perform triage. Many injuries—broken
bones, lacerations, burns, and so forth—can be relatively easily seen and triaged in
the field; explosives, however, have the potential to cause injuries that are not as
easily seen. Thus, it seems reasonable to briefly discuss some blast-related injuries
that might not be obvious during an initial examination. This is an overview only;
for a more thorough discussion the reader should refer to the references noted in this
section as an introduction to this subject.
Horrocks [2] describes four categories of blast injuries, Primary, Secondary,
Tertiary, and Quaternary—each with its own set of characteristics.
Primary
Interaction of the blast wave with the body. Gas-containing structures
(ear, lungs, gastro-intestinal tract) are particularly at risk.
55
6.3.2 Radioactive Embedded Objects and Contaminated
Wounds
Embedded fragments of radioactive material might be as simple as micron-sized
particles driven into the skin by the force of an explosion or they might be higheractivity pieces from a radioactive source shattered by the force of an explosion.
The former offers little risk to the patient or to medical personnel caring for them;
depending on the activity included in the latter, there might be a degree of risk to
the patient or to those caring for them depending on the amount of radioactivity
contained in the fragments. For example, a relatively low-activity source fragment
containing 37 GBq (1 Ci) of radioactivity will produce a radiation dose rate of only
about 10 mSv hr
−1 (1 R hr
−1 ) at arm’s length (about 1 m) and a dose rate as high
as 1000 Sv hr
−1 (10
5 R hr
−1 to tissues in contact with the fragment. Dose rates this
high can cause tissue damage in the patient and to the unwary surgeon who might
handle the fragment when removing it from the patient.
In addition to radiation damage from embedded fragments, they can cause physical
trauma as they pass through tissues; these fragments can also begin to dissolve into
body fluids and enter the bloodstream, where the radioactivity can be carried to
internal organs (where it can remain for days, months, even years) or to the kidneys
to be excreted from the body.
Radioactive contamination can also enter the body through open cuts, wounds,
and other injuries that can result from being in proximity to an explosion. Sweat, rain,
water used for fire-fighting, even liquids used for decontamination can wash contamination into open cuts or wounds where the radionuclides can enter the bloodstream
with the results noted earlier.
6.3.3 Blast-Related Injuries
Any medical responder—emergency medical technicians, paramedics, nurses, physicians, and others—must be able to prioritize the severity of various medical issues
facing their patients so that they can properly perform triage. Many injuries—broken
bones, lacerations, burns, and so forth—can be relatively easily seen and triaged in
the field; explosives, however, have the potential to cause injuries that are not as
easily seen. Thus, it seems reasonable to briefly discuss some blast-related injuries
that might not be obvious during an initial examination. This is an overview only;
for a more thorough discussion the reader should refer to the references noted in this
section as an introduction to this subject.
Horrocks [2] describes four categories of blast injuries, Primary, Secondary,
Tertiary, and Quaternary—each with its own set of characteristics.
Primary
Interaction of the blast wave with the body. Gas-containing structures
(ear, lungs, gastro-intestinal tract) are particularly at risk.