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 of contamination
- 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 and advice.
- 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 Protection Officer.
- 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.