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Initial Management of Irradiated or Radioactively Contaminated Personnel. Washington, DC: Department of the Navy; 1998. 10A. US Navy Bureau of Medicine and Surgery. Radiation Health Protection Manual. Washington, DC: Department of the Navy; 2001. Publication NAVMED P-5055. html. gov/reacts 40 Federal and State Emergency Contacts 1. html 3. html 4. html 5. shtm 6. html 7. gov/nceh/eehs 8. gov 9. org 10. gov 11. gov 12. gov/homeland 13. mil 14. gov 41 Appendix A: Treatment of Radiation Exposed Patients at General Hospitals Type of Exposure Possible Consequences Initial Laboratory Treatment at a General Hospital External Exposure Localized exposure, most often to hands Total or partial body exposure, with minimal delayed clinical signs Localized erythema with possible development of blisters, ulceration, and necrosis No clinical manifestation for 3 hours or more following exposure Not life-threatening Clinical observation and treatment Securing of medical advice if necessary Clinical observation and symptomatic treatment Sequential hematological investigations Minimal hematological changes Total or partial body exposure, with early prodromal signs Acute radiation syndrome of mild or severe degree depending on dose Treatment as above plus securing of specialized treatment Full blood count and HLA typing before transfer to a specialized center Total or partial body exposure, with thermal, chemical irradiation burns and/or trauma Severe combined injuries, life-threatening Treatment of lifethreatening conditions Treatment as above and early transfer to a specialized center External Contamination Low-level contamination, intact skin that can be cleaned promptly Unlikely, mild radiation burns Decontamination of skin and monitoring Low-level contamination, intact skin where cleaning is delayed Radiation burns Securing of specialist advice Percutaneous intake of radionuclides Low-level contamination, Internal contamination with thermal, chemical, or radiation burns and/or trauma 42 Securing of specialist advice Appendix A continued Type of Exposure Possible Consequences Initial Laboratory Treatment at a General Hospital External Contamination (continued) Extensive contamination, with associated wounds Likely internal contamination Securing of specialist advice Extensive contamination, with thermal, chemical, or radiation burns and/or trauma Severe combined injuries and internal contamination First aid, plus treatment of life-threatening injuries; early transfer to a specialized center Inhalation and ingestion of radionuclides–insignificant quantity (activity) No immediate consequences Securing of specialist advice Inhalation and ingestion of radionuclides–significant quantity(activity) of radionuclide No immediate consequences Nasopharyngeal lavage Absorption through damaged skin (see under external contamination) No immediate consequences Securing of specialist advice Major incorporation, with or without external total, or partial body, or localized irradiation, serious wounds and/or burns Severe combined radiation injury Treatment of lifethreatening conditions and transfer to a specialized center Internal Contamination Early transfer to a specialized center to enhance excretion Source: Planning the Medical Response to Radiological Accidents, International Atomic Energy Agency, Safety Series Report No.
Html 34 Table 10: Radiological Findings Associated with Biological and Chemical Threats to Public Health Adapted from Can you recognize these public health threats in your facility? San Francisco Department of Public Health, 2001. html and Ketai, et al, in press. Syndrome Acute Respiratory with Fever Distress Bioterrorism Threat Disease Description Initial Laboratory and Other Diagnostic Test Results Inhalation anthrax: Abrupt onset of fever; chest pain; respiratory distress without radiographic findings of pneumonia; no history of trauma or chronic disease; progression to shock and death within 24-36 hours Chest X-ray with widened mediastinum Pneumonic plague: Apparent severe community-acquired pneumonia but with hemoptysis, cyanosis, gastrointestinal symptoms, shock Variable CXR findings, most commonly include bilateral parenchymal infiltrates.
If internally deposited radionuclide exposures are also possible, these should be taken into account (NCRP 116, 1993). See NCRP Report No. 138 (NCRP 138, 2001), chapter 8, for a detailed discussion of dose limitation and exposure guidance for terrorist events. 33 XIV. Basic Rules for Handling Contaminated Patients To summarize, the basic rules for handling ill or injured patients contaminated with radioactive material are: 1. Treat life-threatening conditions first without regard to radiation or contamination.