Contamination by low level radioactive substances
Any such patient must be discussed with the EM Consultant on-call
Principles of management
- It is the responsibility of the Gardaí on the site to contact hospital
radiation staff for advice.
- Contaminated casualties will normally be taken to nominated
regional hospitals but seriously ill patients will be taken to the
nearest Emergency Department.
- Life saving treatment is of over-riding importance.
- The emphasis throughout management is to limit the spread
- Low-level contamination presents no immediate hazard to
the ED or hospital staff.
- On receipt of notification by the Emergency Services, a treatment
area in which the patients can be isolated should be set aside. Ideally,
this area should be equipped with a shower and irrigation facilities
but if these are not available, disposable polythene sheeting should
be placed on the floor and other indispensable items which may become
contaminated. Adequate amounts of paper and absorbent material e.g.
cotton wool will be required. Air conditioning equipment should be
switched off. Patients should preferably be admitted through
a separate entrance.
- A controller should be nominated to record details of
all personnel in contact with the contaminated area.
- Contact the Local Radiation Protection Officer who will
be responsible for quantification of the level of radioactive contamination
- Mark out an area where ambulances can be examined after
arrival and decontaminated if necessary.
- All staff who may be exposed to radio-active substances
should be issued with overalls/aprons, boots and gloves.
- On arrival, seriously ill or injured patients should be
directed to appropriate resuscitation facilities. The remainder should
be contained in the decontamination area.
- A senior member of staff should liaise with the hospital
administrator to deal with enquiries.
Techniques for Emergency Decontamination
- Avoid any spread of contaminant
- Patients should be undressed and all items in contact
with the radio-active source should be collected in plastic bags
and sealed for subsequent collection and examination by the Radiation
Protection Officer or his team
- Patients should be gently washed with water, avoiding
any spread of contamination by splashing.
- Exposed areas of skin have priority as other areas
are usually protected by clothing.
- Washing with soap and water is usually adequate.
Nails should be cleaned with brushes.
- Fluid used for washing the casualty should be retained
in suitable containers.
- Open wounds should be irrigated with saline and
if minor, encouraged to bleed.
- Wound debridement, if permissible, will reduce
the level of contamination.
- Nostrils, ears and other orifices should be swabbed
before cleansing and the swabs retained for examination by the Radiation
- Urine and faeces should be collected from patients
who have inhaled or ingested contaminant.
The irradiated patient
- These individuals do not require emergency management except in the case of burns which should be irrigated as above before being treated according to standard practice.
- The development of radiation sickness is a delayed phenomenon and any patient suspected of this should be referred to the nearest Oncology Unit.
Content by Dr Íomhar O' Sullivan 24/02/2004. Reviewed by Dr ÍOS
02/05/2005, 06/01/2007, 05/03/2008. Last review Dr IOS