سال انتشار: ۱۳۸۵

محل انتشار: سومین کنگره بین المللی بهداشت، درمان و مدیریت بحران در حوادث غیرمترقبه

تعداد صفحات: ۱

نویسنده(ها):

Tol Azar – Shariati Hospita

چکیده:

This text" Emergency Department Management of Radiation Casualties,” was prepared as a public service by the Health Physics Society for hospital staff training.Types of Radiation HazardsExternal Exposure -Whole-body or partial-body (no radiation hazard to EMS staff)Contaminated -External radioactive material: on the skin, Internal radioactive material: inhaled, swallowed, absorbed through skin or woundsCauses of Radiation Exposure/ContaminationAccidentsNuclear reactor, Medical radiation therapy, Industrial irradiatorLost/stolen medical or industrial radioactive sources, TransportationTerrorist EventRadiological dispersal device (dirty bomb), Attack on or sabotage of a nuclear facility, Low yield nuclear weapon Protecting Staff from Contamination Universal precautions, Survey hands and clothing with radiation meter, Replace gloves or clothing, that is contaminated, Keep the work area free of contamination, Contamination is easy to detect and most of it can be removed, It is very unlikely that ED staff will receive Decontamination Center Establish a decontamination center for people who are contaminated, but not significantly injured, Replacement clothing must be available. Provisions to transport or shelter people after decontamination,. May be necessary, Staff decontamination center with medical staff with a radiological background, health physicists or other staff trained in decontamination and use of radiation survey meters, and psychological counselorsPsychological Casualties Terrorist acts involving toxic agents (especially radiation) are perceived as very threatening, Mass casualty incidents caused by nuclear terrorism will create large numbers of worried people who may not be injured or contaminated Establish a center to provide psychological support to such people set up a center in the hospital to provide psychological support for staff Facility Preparation Activate hospital plan, Obtain radiation survey meters, Call for additional support: Staff from Nuclear Medicine, Radiation Oncology, Radiation Safety (Health Physics) ,Establish area for decontamination of uninjured persons, Establish triage area Plan to control contamination, Instruct staff to use universal precautions and double glove, protect floor with covering if time allows, for transport of contaminated patients into ED, designate separate entrance, designate one side of corridor, or transfer to clean gurney before entering, if time allows Patient Management – PrioritiesTriageMedical triage is the highest priority; Radiation exposure and contamination are secondary considerations, Degree of decontamination dictated by number of and capacity to treat other injured patients Patient Management – TriageTriage based on:Injuries, Signs and symptoms – nausea, vomiting, fatigue, diarrhea History – Where were you when the bomb exploded?Contamination survey Patient Management – Decontamination Carefully remove and bag patient’s clothing and personal belongings (typically removes 95% of contamination), Survey patient and, if practical, collect samples, Handle foreign objects with care until proven non-radioactive with survey meter, Decontamination priorities: Decontaminate wounds first, then intact skin, Contaminated wounds:Irrigate and gently scrub with surgical sponge,Avoid overly aggressive decontamination Extend wound debridement for removal of contamination only in extreme cases and upon expert advice, Change dressings frequently, Decontaminate intact skin and hair by washing with soap & water, Promote sweating Remove stubborn contamination on hair by cutting with scissors or electric clippers, Use survey meter to monitor progress of ovens frequently to minimize spread of contamination, Cease decontamination of skin and wounds, When the area is less than twice background, or When there is no significant reduction between deacon efforts, and, When the area is less than twice background, orBefore intact skin gently rinse. Washing may increase severity of injury. Becomes abraded, Gently rinse. Washing may increase severity of injury,.Additional contamination will be removed when dressings are changed. Do not delay surgery or other necessary medical procedures or exams…residual contamination can be controlled.Patient Management – Patient TransferTransport injured, contaminated patient into or from the ED:Clean gurney covered with2 sheets, Lift patient onto clean gurney Wrap sheets over patient Roll gurney ED or out of treatment room Facility Recovery Remove waste from the Emergency Department and triage area, Survey facility for contamination, Decontaminate as necessary, Normal cleaning routines (mop, strip waxed floors) typically very effective, Periodically reassess contamination levels.