EMERGENCY DEPARTMENT CHECKLIST
EMERGENCY CARE OF THE RADIATION ACCIDENT PATIENT
1. DETERMINE
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MEDICAL STATUS
TYPE OF ACCIDENT
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IRRADIATED and/or
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CONTAMINATED (use radiation survey meter to determine)
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EXTERNAL (radioactive contamination on skin and/or clothing)
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INTERNAL (radioactive material in body)
2. PREPARE FOR PATIENT ARRIVAL
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OBTAIN & TEST RADIATION SURVEY METERS. COVER PROBES (if external contamination expected)
SUMMON ADDITIONAL STAFF PER RADIATION ACCIDENT PLAN
DON PROTECTIVE CLOTHING (Use Universal Precautions if external contamination expected)
PROVIDE PERSONNEL DOSIMETERS AS CALLED FOR IN PLAN
LABEL WASTE CONTAINERS FOR RADIOACTIVE WASTE (if external contamination expected)
COVER FLOOR OF TREATMENT ROOM (if sufficient time and if external contamination expected)
GURNEY(S) COVERED WITH TWO SHEETS AND STAFF MEMBER WITH SURVEY METER
PREPARE TO MEET AMBULANCE (if external contamination expected)
IF LARGE SCALE ACCIDENT, ARRANGE FOR RECEPTION OF “WORRIED WELL” AND CONTAMINATED BUT
UNINJURED PATIENTS AT LOCATION OTHER THAN EMERGENCY DEPARTMENT (ED)
3. MEDICAL STABILIZATION UPON PATIENT ARRIVAL
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ALWAYS TAKES PRIORITY OVER RADIOLOGICAL ASPECTS
AIRWAY, BREATHING, CIRCULATION
WOUND/PAIN MANAGEMENT
QUICKLY SURVEY PATIENT, OUTSIDE ED, WITH RADIATION SURVEY METER FOR EXTERNAL CONTAMINATION
IF SIGNIFICANT CONTAMINATION AND MEDICAL CONDITION PERMITS, TRANSFER TO CLEAN GURNEY
AND FOLD SHEETS OVER PATIENT FOR TRANSPORT INTO ED
4. IF EXTERNAL CONTAMINATION, PERFORM DECONTAMINATION
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REMOVE AND BAG CLOTHING (Carefully remove to prevent spread of contamination)
SURVEY (Record time, cpm at one inch, location)
COLLECT SAMPLES (Label, bag, transfer to buffer zone)
COVER UNCONTAMINATED WOUNDS WITH WATERPROOF DRESSINGS
DECONTAMINATE SKIN (Carefully clean with soap and tepid water,
wiping toward highest contamination to limit spread. Do not abrade skin)
CLEAN CONTAMINATED WOUNDS (Irrigate with saline at
room temperature and gently scrub with surgical sponge)
SAVE & LABEL ALL SAMPLES
GENTLY RINSE CONTAMINATED BURNS (Do not scrub)
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NASAL SWABS
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BLOOD
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EAR SWABS
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URINE
CONTROL CONTAMINATION (Place all potentially contaminated
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ORAL SWABS
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FECES
material in radioactive waste containers)
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SKIN WIPES
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WOUND EXUDATE
CHANGE OUTER GLOVES FREQUENTLY
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HAIR
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TISSUE
STOP DECONTAMINATION OF SKIN AND WOUNDS WHEN
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NAILS
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VOMITUS
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METALLIC
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IRRIGATION
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Contamination is less than twice background, or
OBJECTS
FLUIDS
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Attempts are not significantly reducing contamination
PERFORM AND RECORD FINAL SURVEY
5. IF LARGE DOSES (> 100 RAD) TO MOST OF THE BODY ARE SUSPECTED
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MAY EXHIBIT NAUSEA, VOMITING, DIARRHEA, FATIGUE
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Greater severity and prompter onset indicate larger dose
OBTAIN BLOOD SAMPLES
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CBC with differential (Initially and every 6 hours)
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DRAW BLOOD FOR CHROMOSOMAL ANALYSIS (Dark green, sodium heparin tube)
6. IF INTERNAL CONTAMINATION
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TAKE ACTION SPECIFIC TO RADIOCHEMICAL AS DESCRIBED IN NCRP REPORT NO. 65
TREATMENT MAY NOT BE AS EFFECTIVE WHEN DELAYED – MAY NEED TO ACT ON PRELIMINARY INFORMATION
7. IF NEEDED, OBTAIN EXPERT CONSULTATION
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REAC/TS
(865) 576-3131 (Monday-Friday, 8:00 a.m. to 4:30 p.m EST)
Off-hours: (865) 576-1005, ask for REAC/TS (24-hour call)
AFRRI MEDICAL RADIOBIOLOGY ADVISORY TEAM (301) 295-0530
8. PATIENT TRANSFER
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SURVEY MEDICAL ATTENDANTS (Change gloves and outer apron)
ROLL IN SEPARATE CLEAN FLOOR COVERING AND A CLEAN GURNEY
9. STAFF EXIT FROM CONTAMINATION AREA
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REMOVE PROTECTIVE CLOTHING IN THE FOLLOWING ORDER:
Outer gloves, mask, apron, isolation gown, cap, shoe covers, inner gloves.
PLACE IN DESIGNATED RADIOACTIVE WASTE CONTAINERS
SURVEY STAFF FOR CONTAMINATION & COLLECT PERSONNEL DOSIMETERS.
10. AREA CLEAN-UP: Environmental Services and Radiation Safety Staff Will Assist
S:\EHS\Health\EMERGMED\RADIATIONACCIDENTCHECKLIST.doc