>> USE OF TRADE NAMES FOR

TRANSCRIPT

Medical Response to Nuclear and Radiological Terrorism

February 10, 2004

COMMERCIAL SOURCES ARE FOR

INFORMATIONAL PURPOSES ONLY AND

DOES NOT CONSTITUTE

ABENDORSEMENT BY THE PUBLIC

HEALTH SERVICE OR THE UNITED

STATES DEPARTMENT OF HEALTH AND

HUMAN SERVICES.

VIEWS EXPRESSED BY GUEST

PARTICIPANTS ARE NOT NECESSARILY

THE VIEWS OF THE CDC.

CME, CNE, CEU AND CECH

CONTINUING EDUCATION CREDIT IS

AVAILABLE FOR THIS ACTIVITY

BASED ON ONE HOUR OF

INSTRUCTION.

CDC AND OUR SPEAKERS WISH TO

DISCLOSE THEY HAVE NO FINANCIAL

INTERESTS OR OTHER RELATIONSHIPS

WITH THE MANUFACTURE OF

COMMERCIAL PRODUCT, PROVIDERS OF

COMMERCIAL SERVICES OR

COMMERCIAL SUPPORTERS.

PRESENTATIONS WILL NOT INCLUDE

ANY DISCUSSION OF THE UNLABELED

USE OF COMMERCIAL PRODUCTS OR

PRODUCTS FOR INVESTIGATIONAL USE

WITH THE EXCEPTION OF NEUPOGEN

AND OTHER ACUTE RADIATION

SYNDROME DRUGS WHICH ARE IMD

APPROVED BUT NOT FDA APPROVED.

\M\M

>>> HELLO I'M DR. JULIE

GERBERDING, DIRECTOR FOR THE

CENTERS FOR DISEASE and CONTROL

AND PREVENTION.

THANK YOU FOR TAKING TIME FOR

VIEWING THIS BROADCAST.

WE ALL KNOW NOW THE EVENTS OF

SEPTEMBER 11th 2001 STUNNED AND

SHOCKED OUR NATION.

THOSE EVENTS FOREVER CHANGED OUR

WORLD AND WE NOW LIVE IN A TIME

WHEN TERRORISTS MIGHT USE ANY

MEANS TO TRY TO CAUSE HARM TO

THE AMERICAN PEOPLE, WHETHER

IT'S FLYING A PLANE INTO THE

BUILDING, LACING LETTERS WITH

ANTHRAX OR MOST RECENTLY WITH

RICIN.

WE ARE CONFRONTED WITH THE

CHALLENGE OF PREPARING FOR WHAT

SEEMED JUST A FEW YEARS AGO AS

INCOMPREHENSIBLE, A RADIOLOGIC

ATTACK.

SUCH AN ATTACK COULD BE

DEVASTATING.

NO ONE CAN PREDICT THE

LIKELIHOOD OF A RADIOLOGIC

ATTACK, BUT OUR COUNTRY MUST BE

PREPARED FOR THAT POSSIBILITY.

CDC ASKED FOR YOUR INPUT AND YOU

HAVE VOICED THE NEED FOR

RADIATION.

INCLUDING THE HEALTH EFFECTS

ASSOCIATED WITH EXPOSURE,

DECONTAMINATION PROCEDURE AND

TREATMENTS FOR IMPORTANCE

EXPOSED TO RADIATION.

OVER THE NEXT HOUR YOU'LL BE

HEARING FROM EXPERTS WHO WILL

ADDRESS ALL OF THESE TOPICS.

AS A CLINICIAN I CAN FULLY

APPRECIATE THE DIFFICULTIES WE

FACE IN RESPONDING TO TERRORISM.

I HOPE THIS COURSE WILL HELP

MEET YOUR NEEDS.

CDC WILL DEVELOP OTHER MATERIALS

AS NEW INFORMATION E MERGE.

PLEASE LET US KNOW WHAT WILL BE

MOST USEFUL AS WE TAKE THE

NECESSARY STEPS TO PREPAREDNESS.

THANK YOU FOR ALL YOUR INPUT AND

ALL YOUR HARD WORK.

>> HELLO, I'M KYSA DANIELS.

WELCOME TO "MEDICAL RESPONSE TO

NUCLEAR AND RADIOLOGICAL

TERRORISM."

WE ARE COMING TO YOU LIVE

CONTROL AND PREVENTION IN

ATLANTA, GEORGIA.

THE GOAL OF THIS PROGRAM IS TO

PROVIDE INFORMATION ON

RADIATION,

THE MANAGEMENT OF RADIOLOGICAL

INJURIES,

AND RADIATION PROTECTION FOR

CLINICIANS.

UPON SUCCESSFUL COMPLETION OF

THE PROGRAM, PARTICIPANTS WILL

BE ABLE TO

NUMBER ONE,

DISTINGUISH BETWEEN

RADIATION EXPOSURE AND

CONTAMINATION, RECOGNIZE THE

SIGNS AND

SYMPTOMS OF ACUTE RADIATION SYND

RECOGNIZE THE SYMPTOMS OF

CUTANEOUS RADIATION SYNDROMES

AND HOW TO

DECONTAMINATE A PATIENT.

IF YOU ARE HAVING TECHNICAL

PROBLEMS RECEIVING OUR SIGNAL,

YOU CAN CALL US HERE AT CDC AT

(800)728-8232.

THE TTY NUMBER FOR THIS

BROADCAST IS (800)815-8152.

DURING TODAY'S PROGRAM, WE WILL

HAVE A PHONE-IN QUESTION AND

ANSWER SESSION.

FOR VOICE

CALLS, THE NUMBER IS

(800)793-8598.

YOU CAN ALSO FAX YOUR QUESTION

OR COMMENT TO US AT

(800)553-6323.

AND FINALLY, OUR TTY NUMBER FOR

QUESTIONS IS ALSO (800)815-8152.

WE WILL ANSWER AS MANY

QUESTIONS AS WE CAN ON-AIR.

IF YOU HAVE ANY ADDITIONAL

QUESTIONS AFTER THE BROADCAST,

YOU CAN EMAIL THEM TO

RSB@CDC.GOV.

PLEASE INDICATE "MEDICAL

RESPONSE TO NUCLEAR AND

RADIOLOGICAL TERRORISM" IN THE

SUBJECT LINE.

YOU CAN CHECK FOR ANSWERS TO

YOUR E-MAILED QUESTIONS AT THE

CDC EMERGENCY PREPAREDNESS AND

RESPONSE RADIATION EMERGENCIES

WEBSITE -- WWW.BT.CDC.GOV/RADIAT

CONTINUING EDUCATION CREDIT

WILL BE OFFERED FOR A VARIETY

OF PROFESSIONS, BASED ON ONE HOU

OF INSTRUCTION.

A CERTIFICATE

OF CREDIT OR A CERTIFICATE OF

ATTENDANCE WILL BE AWARDED TO

PARTICIPANTS WHO COMPLETE THE

EVALUATION.

THAT CONTINUING EDUCATION

WEBSITE IS

WWW.PHPPO.CDC.GOV/PHTNONLINE.

I WILL GIVE YOU MORE

REGISTRATION INFORMATION LATER

IN THE BROADCAST.

OUR SPEAKERS WISH TO DISCLOSE

ARE FIRST DR. JANE SMITH, HE IS

ASSISTANT DIRECTOR FOR RADIATION

AND THE DIVISION OF

ENVIRONMENTAL HAZARDS AND HEALTH

EFFECTS NATIONAL CENTER FOR

ENVIRONMENTAL HEALTH HERE AT

CDC.

ALSO DR. FUN FONG WHO IS AN

EMERGENCY PHYSICIAN IN ATLANTA

AND HE'S ALSO THE FORMER

DIRECTOR OF RADIATION MEDICINE

AT THE MEDICAL SCIENCES DIVISION

OF OAK RIDGE ASSOCIATED

UNIVERSITIES.

DR. FONG ALSO IS AUTHOR OF

SEVERAL TEXTBOOK CHAPTERS ON

RADIATION AND NUCLEAR ACCIDENT

MANAGEMENT AND CURRENTLY SERVES

AS THE SENIOR MEDICAL OFFICER OF

THE GEORGIA 3 DISASTER MEDICAL

TEAM.

THANK YOU TO YOU, DR. SMITH AND

DR. FONG, WE APPRECIATE YOU

BEING WITH US TODAY.

DR. SMITH, WE WILL START WITH

YOU FIRST.

GIVE US POSSIBLE RADIOLOGICAL

SCENARIOS WHERE THESE INCIDENTS

COULD RESULT IN EITHER RADIATION

EXPOSURE OR CONTAMINATION.

>> I'D BE HAPPY TO, KYSA PPI IT

WOULD BE MY PLEASURE TO GO OVER

SOME OF THESE ISSUES WITH YOU AS

DR. GERBERDING SAID,

UNFORTUNATELY, TERRORISM IS A

VERY REAL THREAT TO THE U.S. IN

THE 21st CENTURY.

IT'S POSSIBLE THAT RADIATION

COULD BE USED AS AN AGENT OF

HARM AND TO TERRORIZE

COMMUNITIES AND PEOPLE.

SOME OF THESE POTENTIAL

SCENARIOS ARE IN OUR FIRST

GRAPHIC.

FIRST, WE TAKE THE SITUATION OF

A NUCLEAR POWER PLANT, THERE

THERE COULD BE A DIRECT ATTACK

OR SOME TYPE OF SABOTAGE ON A

NUCLEAR POWER PLANT WHICH COULD

RESULT AND RELEASE SOME

RADIOACTIVE MATERIAL OFFSITE

FROM THE POWER PLANT AND PRODUCE

SIGNIFICANT RADIATION EXPOSURE

TO PEOPLE WHO LIVE OFF-SITE.

THERE COULD BE A HIDDEN SOURCE

OF RADIATION THAT IS A SOURCE OF

RADIATION STOLEN FROM AN

INDUSTRIAL FACILITY, FOR EXAMPLE

OR A MEDICAL FACILITY.

IT COULD BE HIDDEN IN A PUBLIC

PLACE LIKE A PARK, A CITY PARK

AND EXPOSE PEOPLE WITHOUT THEIR

KNOWLEDGE.

IT COULD EVEN GIVE POTENTIALLY

LETHAL DOSES OF RADIATION TO

PEOPLE.

A DIRTY BOMB HAS RECEIVED LOT OF

PRESS LATELY.

A DIRTY BOMB, OF COURSE, THE

CONVENTIONAL TYPE OF BOMB OR

EXPLOSIVE DEVICE THAT IS LACED

WITH OR CONTAINS RADIOACTIVE

SUBSTANCE, THEN WHEN THE BOMB

WERE TO GO OFF IT WOULD SPREAD

THE RADIO ACTIVE SUBSTANCE OVER

A LARGE AREA, PERHAPS SEVERAL

CITY BLOCKS DEPENDING ON THE

SIZE OF THE BLAST.

THIS WOULD NOT ONLY KILL AND

INJURE PEOPLE, BUT IT WOULD

RADIATE VICTIMS OR EXPOSE PEOPLE

LIKE FIRST RESPONDERS AND IT

WOULD CONTINUE TO EXPOSE PEOPLE

IN THE AFTERMATH OF THE

EXPLOSION.

THE LAST COUPLE OF SCENARIOS

HERE PERHAPS MAY BE HIGHLY

UNLIKELY BUT THEIR CONSEQUENCES

WOULD BE SO DEVASTATING THAT

IT'S JUST SIMPLY PRUDENT OF US

IN THE MEDICAL COMMUNITY AND IN

PUBLIC HEALTH TO TAKE THEM IN

CONSIDERATION AS WE PLAN.

FIRST WOULD BE AN IMPROVISED

NUCLEAR DEVICE.

THIS WOULD BE A DEVICE THAT

PERHAPS A TERRORIST GROUP WITH

KNOWLEDGE OF NUCLEAR WEAPON

DESIGN, ACCESS TO SPECIAL

NUCLEAR MATERIAL COULD ASSEMBLE.

IT WOULD BE, IF SUCCESSFULLY

DETONATED, IT WOULD BE AN ACTUAL

NUCLEAR BLAST SIMM SIMILAR TO

HIROSHIMA AND NAGASAKI.

AND OF COURSE, WE STILL HAVE

NUCLEAR WEAPONS THROUGHOUT THE

WORLD TODAY AND WE CAN'T RULE

OUT THE USE OF A POSSIBILITY OF

USE OF ONE OF THOSE.

IN OUR NEXT GRAPHIC WE SHOW A

PICTURE HERE OF -- THIS IS

SEVERAL YEARS OLD.

IT SHOWS THE CHAIR OF THE HOUSE

SUBCOMMITTEE RESEARCH AND

DEVELOPMENT AND HE'S ACTUALLY

SHOWING A HYPOTHETICAL SUITCASE

BOMB.

THIS WAS A NUCLEAR DEVICE SMALL

ENOUGH TO FIT IN A SUITCASE AND

THE CHAIRMAN MADE THE COMMENT

BEFORE THE HEARING THAT THIS

DEVICE WOULD HAVE THE NUCLEAR

YIELD, ABOUT 1/10 OF THAT OF THE

HIROSHIMA BOMB.

WHEN WE TALK ABOUT RADIATION,

WHAT WE'RE TALKING ABOUT IS

ESSENTIALLY ENERGY THAT'S

TRANSPORTED IN THE FORM OF

PARTICLES OR WAVES.

WHEN WE AND I ALSO WANT YOU TO

KEEP IN MIND THAT THE TYPE OF

RADIATION WE'RE TALKING ABOUT

HERE, IS NUCLEAR IONIZING

RADIATION.

WE'RE NOT TALKING ABOUT

MICROWAVES OR RADIATION FROM

CELL PHONE TOWERS OR ANY OF

THIS.

KEEP THIS IN MIND THROUGHOUT THE

ENTIRE BROADCAST AND WE'RE

TALKING ABOUT IONIZING RADIATION

AND WE CLASSIFY THIS RADIATION

BY DIFFERENT TYPES, DEPENDING

UPON ITS PENETRATION ABILITY.

FOR EXAMPLE, ALPHA PARTICLES.

THEY CAN BE STOPPED VERY EASILY,

NOT PENETRATING AT ALL.

ACTUALLY A DEAD LAYER OF SKIN

WOULD STOP ALPHA PARTICLES.

THEY ARE HARMFUL, IF -- HOWEVER,

THEY ARE BROUGHT INTO THE BODY,

SAY BY WAY OF INHALATION.

AND THEN BETA PARTICLES ARE MORE

PENETRATING, LORE ENERGY BETA

PARTICLES MIGHT BE STOPPED BY A

THICK LAYER OF CLOTHE.

THEY WOULD REQUIRE A SUBSTANCE

OF PLASTIC, AN INCH OR SO OF

THAT.

WITH BETA PARTIC ELSE GETTING ON

THE SKIN THERE COULD BE SEVERE

SKIN DAMAGE IF THEY WERE THERE,

IF THE MATERIAL CONTAINING THE

EMITTING DATA PARTICLES WERE ON

THE SKIN FOR A VERY LONG PERIOD

OF TIME.

GAMMA RAYS AND NEUTRONS

REPRESENT VERY PENETRATING TYPES

OF RADIATION.

THEY MIGHT REQUIRE UP TO A FEW

FEET OF CONCRETE IN ORDER TO

STOP.

ONE POINT I WANT TO MAKE ABOUT

THE -- ALL OF THESE DIFFERENT

TYPES OF RADIATION IS THAT THEY

ACTUALLY OCCUR NATURALLY IN THE

ENVIRONMENT SO WE'RE BEING

EXPOSED TO VERY LOW LEVELS OF

THAT TYPE OF RADIATION

CONSTANTLY.

HOWEVER, WE CAN DO DETECT THE

RAID YAGDS, WHETHER IT'S THE LOW

LEVEL ENVIRONMENTAL BACKGROUND

OR IF IT'S HIGHER LEVELS LIKE WE

MIGHT HAVE IN AN EVENT.

OF COURSE, DETECTING THIS TYPE

OF RADIATION REQUIRES

APPROPRIATE INSTRUMENTATION,

DEMONSTRATED HERE ARE SOME

SURVEY METERS THAT COULD BE USED

FOR THAT.

THEY ARE LIGHTWEIGHT.

THEY'RE RELATIVELY INEXPENSIVE

AND EASY TO USE IF YOU HAVE THE

PROPER TRAINING.

NOW, I WANT TO TALK ABOUT IN THE

NEXT FEW GRAPHICS SOME TERMS

THAT YOU WILL HEAR FREQUENTLY

THIS AFTERNOON.

THEY ARE BASIC CONCEPTS DEALING

WITH RADIATION, BUT SOMETIMES

THEY ARE CONFUSED SO I WANT TO

MAKE SURE THAT YOU DO UNDERSTAND

THEM.

AS WE SAID BEFORE, RADIATION

REPRESENTS THE TRANSPORT OF THE

ENERGY.

ALPHABETTA, GAMMA, NEWT RORNGS

ET CETERA.

A RADIOACTIVE MATERIAL IS A

SUBSTANCE THAT CONTAINS ATOMS

THAT EMIT RADIATION

SPONTANEOUSLY.

WHEN WE LOOK AT EXPOSURE TO RAID

YAGDS, WHAT WE ARE SPEAK OF IS A

RADIATION OF THE BODY.

THAT IS THE BODY'S BEEN EXPOSED

TO A SOURCE OF RADIATION.

THE ENERGY FROM THAT RADIATION

CAN BE ABSORBBED BY THE BODY.

THIS LEADS TO AN ABSORBBED DOSE

WHICH IS MEASURED IN UNITS SUCH

AS GRAY OR RED.

FOR HIGH ABSORBBED DOSES ONE CAN

GET SEVERE EFFECTS AND MOST OF

THE FOCUS THIS ARV WILL BE ON

THESE ACUTE EFFECTS THAT WE GET

FROM HIGH LEVELS OF ABSORBBED

DOSE.

NOW, CONTRAST EXPOSURE WITH

CONTAMINATION.

CONTAMINATION REFERS TO

RADIOACTIVE MATERIAL THAT MIGHT

BE ON SOMEONE, THE PATIENT, FOR

EXAMPLE.

IT MIGHT OB THEIR CLOTHING.

IT MIGHT OB THEIR SKIN.

WE REFER TO THAT AS EXTERNAL

CONTAMINATION.

OR IT CAN BE WITHIN THE PATIENT

IN WHICH CASE IT WOULD BE

INTERNAL CONTAMINATION.

IT MIGHT GET INSIDE THE PATIENT,

FOR EXAMPLE, BY INHALATION.

IT MIGHT GET THERE BY EATING OR

DRINKING A SUBSTANCE OR IT COULD

GET THERE THROUGH A WOUND AND

THE RADIOACTIVE CONTAMINATION

COULD BE DELIVERED BY THE DRUG

BLOODSTREAM THROUGHOUT THE BODY.

IN THE NEXT COUPLE OF GRAPHICS

WE'LL DEMONSTRATE WHAT WE MEAN

HERE.

HERE'S A SOURCE OF RADIATION.

LET'S SAY THIS IS A VERY

PENETRATING GAMMA RADIATION AND

YOU CAN SEE BY THE SQUIGGLY

ARROWS THERE.

THE PERSON IS BEING EXPOSED FROM

THIS RADIATION SOURCE BUT THIS

RADIATION SOURCE ALSO HAS

RADIOACTIVE MATERIAL IN IT.

NOW WE SEE THE PARTICLES THAT

ARE COMING OUT.

THAT MIGHT GET INTO THE AIR.

OFTEN RADIO ACTIVE MATERIAL CAN

BE ATTACHED TO DUST PARTICLES IN

THE AIR, FOR EXAMPLE.

SO NOW THE PERSON IS BEING BOTH,

EXPOSED BY THE SOURCE, BUT ALSO

BEING CONTAMINATED BY THE

RADIOACTIVE MATERIAL.

SO YOU SEE THERE'S A DIFFERENCE

BETWEEN BEING JUST EXPOSED AND

BEING CONTAMINATED.

ONE CAN BE EXPOSED WITHOUT BEING

CONTAMINATED.

IF ONE IS CONTAMINATED AND THIS

SHOWS A PERSON WHO HAS BEEN

CONTAMINATED BY RADIOACTIVE

SUBSTANCE.

THE RADIOACTIVE SUBSTANCE WITH

BE ALPHA, BETA, EMITTING PARTIC

ELSE, FOR EXAMPLE.

IT CAN BE EASILY WASHED OFF,

THIS CONTAMINATION.

DR. FONG WILL TALK MORE ABOUT

THAT LATER.

HAD YOU EVER, EACH AFTER BEING

WASHED OFF THE PERSON CAN STILL

HAVE INTERNAL CONTAMINATION

WITHIN HIM.

THIS PERSON, FOR EXAMPLE HAS

INHALED A LARGE AMOUNT OF

MATERIAL LIKE DUST OR DEBRIS

THAT WAS RADIOACTIVE, HAD

RADIOACTIVE MATERIAL IN IT AND

THIS HAS GOTTEN INSIDE HIS

LUNGS.

SO THIS, OBVIOUSLY, CANNOT BE

WASHED OFF, BUT IT'S SOMETHING

THAT WE HAVE TO TAKE INTO

CONSIDERATION AS WE MANAGE

PATIENTS WHO HAVE BEEN EXPOSED

TO AND CONTAMINATED WITH RAID YO

YATION, RADIO ACTIVE MATERIAL.

ONE IMPORTANT POINT I'D LIKE TO

MAKE WITH SERVE THAT THE

IMPORTANCE OF WORKING WITH

PARTNERS WHO ARE RADIATION

EXPERTS, BOTH AS WE PREPARE FOR

RADIATION EMERGENCIES AND IF AN

EVENT HAPPENS ITSELF, THESE

RADIATION EXPERTS ARE INVAL

AUBLE IN WORKING WITH THE

MEDICAL COMMUNITY.

RADIATION SAFETY OFFICERS IN

YOUR LOCAL FACILITY OR AT AYE

YOUR NEARBY FACILITY LIKE AN

ACADEMIC CENTER COULD BE

AVAILABLE.

THEY HAVE SOME MINIMUM LEVEL OF

TRAINING AND OFTEN THEY ARE

HEALTH PHYSICISTS OR MEDICAL

PHYSICISTS THEMSELVES.

HEALTH PHYSICISTS AND MEDICAL

PHYSICISTS IN A LARGE

METROPOLITAN AREA ARE USUALLY

AVAILABLE.

IF YOU LIVE IN AN AREA WHERE YOU

MAY NOT KNOW OF ANY MEDICAL

PHYSICISTS THAT YOU MIGHT

PARTNER WITH, WE WOULD RECOMMEND

ONE OF OUR PARTNERS THE

CONFERENCE OF RADIATION CONTROL

DIRECTORS.

THIS IS A NON-PROFIT

ORGANIZATION OF SPECIALISTS AND

RADIATION PROTECTION.

THEY WORK IN STATE AND LOCAL

GOVERNMENTS, FOR THE MOST PART,

AND THEIR WEBSITE, WHICH WE HAVE

THERE, WWW.CRCPD.ORG PROVIDES

CONTACTS SO THAT YOU CAN FIND

OUT MORE ABOUT WHERE TO GET HELP

P. SOME OF THE THINGS THESE

EXPERTS CAN HELP YOU WITH IS

DETERMINING AND DOCUMENTING THE

PRESENCE OF RADIOACTIVE ACTIVITY

ACTIVITY LEVELS AND RADIATION

DOSE, COLLECTING SAMPLES TO

DOCUMENT CONTAMINATION,

ASSISTING IN DECONTAMINATION

PROCEDURE, PROVIDING ADVICE AND

COUNSEL ON THAT IN PARTICULAR

AND HELPING OUT WITH PROVIDING

COUNSEL AND GUIDANCE ON THE

DISPOSAL OF RADIOACTIVE WASTE.

THIS HAS BEEN A VERY QUICK

OVERVIEW OF SOME OF THE BASIC

CONTENTS -- CONCEPTS OF

RADIATION WHICH DR. FONG WILL

USE IN HIS MORE E TENSIVE TALK

THAT FOLLOWS, THE LAST FEW

GRAPHICS AT END OF THE BROADCAST

WILL PROVIDE A NOON NUMBER OF

WEBSITES FOR OUR VIEWERS TO

LEARN MORE IN-DEPTH ABOUT

RADIATION FUNDAMENTALS WHICH

WE'VE BEEN ABLE TO TOUCH ON

HERE.

>> IT WAS COMPREHENSIVE ON

EXPOSURE AND CONTAMINATION.

>> THANK YOU, DR. SMITH.

NEXT, DR. FONG WILL BE

DISCUSSING THE CLINICAL ASPECTS

OF RADIOLOGICAL INCIDENTS.

DR. FONG.

>> THANK YOU, KYSA.

THIS WILL BE THE BRIEFEST OF

INTRODUCTIONS, FOR THE AUDIENCE

IT WILL GIVE PEOPLE A REAL

UNDERSTANDING OF WHAT WE'RE

GETTING AT WHEN WE TALK ABOUT

RADIATION FOR INSTANCE, WITH

REGARD TO, IN PARTICULAR,

WEAPONS OF MASS DESTRUCTION.

I'D LIKE TO TALK ABOUT IS FIRST

OF ALL, NUMBER ONE, HOW DO WE

PROTECT THE PATIENTS AND STAFF

FROM RADIATION.

HOW DO WE DEAL WITH INITIAL

MANAGEMENT OF THE PATIENT?

TALK ABOUT ACUTE RADIATION

SYNDROME.

TALK ABOUT EXTERNAL AND LOCAL

EFFECTS OF RADIATION AND TALK

ABOUT INTERNAL CONTAMINATION AND

HOPEFULLY THAT WILL GIVE THE

AUDIENCE A FAIR IDEA OF WHAT I

WILL BE TALKING ABOUT.

IF I CAN HAVE THE FIRST GRAPHIC.

WHAT TYPE OF INJURE REESE ARE WE

TALKING ABOUT WITH RADIOLOGICAL

INCIDENTS.

WE'RE THE SYSTEMIC EFFECTS OF

RADIATION.

WE CAN HAVE LOCALIZED RADIATION

INJURIES ALSO KNOWN AS THE

CUTANEOUS RADIATION SYNDROME.

IT CAN HAVE EXTERNAL AND

INTERNAL CONTAMINATION AND

COMBINED INJURIES THAT IS A

RADIATION INJURY COMBINED WITH

TRAUMA OR BURNS WHICH ARE MORE

CONVENTIONAL INJURIES AND WE CAN

ALSO HAVE FETAL EFFECT WHICH IS

COULD OCCUR WITH RADIOLOGICAL

INCIDENTS.

WE SHOULD MENTION HERE ALONG

WITH BASIC DISASTER MEDICINE

PRINCIPLES THAT AS THESE EVENTS

MAY OR MAY NOT BE RELATED TO

TRUE DISASTER EVENTS, THAT THERE

IS PROBABLY SOME CLOSE LINKAGE,

PERHAPS, AND THERE WILL BE A

SIGNIFICANT PSYCHOLOGICAL EFFECT

PARTICULARLY IF THERE WERE A

TERRORIST SITUATION.

ALSO WITH DISASTER SITUATIONS,

THERE WILL BE A VICTIM AND

HEALTH CARE PROFESSIONALS THAT

CAN BE UNDER TREMENDOUS

PSYCHOLOGICAL STRESS.

WE HAVE REPORTS COMMONLY OF

POST-TRAUMATIC STRESS DISORDER

AND THIS SHOULD BE OBSERVED AND

NOTED AND PLANNERS SHOULD BE

AWARE OF THIS.

AND THIS TYPE OF EVENT W

POTENTIAL WMD EVENT, THE COMMON

LINKAGE IS THAT THERE MAY BE

LARGE NUMBERS OF PEOPLE THAT ARE

CONCERNED WITH THEIR HEALTH

WITHOUT ANY APPARENT INJURIES

AND THAT MAY BE A VERY

SIGNIFICANT PART OF WHAT MEDICAL

PERSONNEL WILL HAVE TO DEAL

WITH.

ALSO ANOTHER ISSUE IS EXPOSURE

OF RADIATION IN THE CASE OF

PREGNANCY.

AND FOR THAT, WE HAVE MORE

INFORMATION AT THE CDC WEBSITE

THAT YOU SEE BELOW.

HOW SHOULD WE TALK ABOUT DEALING

WITH RADIATION PRINCIPLES WITH

CLINICAL STAFF?

WE SHOULD GO BACK TO THE

PRINCIPLES THAT RADIATION

WORKERS HAVE USED AND THAT IS

TIME, DISTANCE AND SHIELDING.

MEDICAL PERSONNEL CAN USE AND

TAKE ADVANTAGE OF THE FIRST, TWO

TIME AND DISTANCE.

WE CAN REDUCE THE AMOUNT OF TIME

THAT WE WORK WITH CONTAMINATED

PATIENTS AND INCREASE THE

DISTANCE WHENEVER ALLOWABLE TO

DEAL WITH CONTAMINATED PATIENTS.

THE SHIELDING ASPECT IS A LITTLE

BIT DIFFERENT HERE.

GAMMA RADIATION IS MORE

PENETRATING THAN THAT OF OUR

COMMON X-RAY RADIATION WHICH WE

MEDICAL PERSONNEL WORK WITH ALL

OF THE TIME AND AS SUCH THE LEAD

APRONS AND LEAD SHIELDING THAT

WE NORMALLY USE, IS NOT THOUGHT

TO BE VERY EFFECTIVE IN THE CASE

OF RADIATION RESPONSE.

THEREFORE, SHIELDING IS NOT OF

MUCH SIGNIFICANT USE.

HOWEVER, PERSONAL PROTECTIVE

EQUIPMENT IS VERY USEFUL AND TO

RELIEF MEDICAL PERSONNEL'S MINDS

IT CAN BE SIMPLY THOUGHT OF AS

USING THE SAME GEAR THAT YOU

WOULD BE USING FOR A TRAUMA

RESPONSE.

THAT IS, BODY FLUID ISOLATION,

BARRIER PROTECTIONS AND IF

PARTICULARS ARE CONCERNED, ONE

CAN USE IN 95 MATH.

ADDITIONALLY, THE THIRD FEATURE

THAT WE SHOULD USE IN THE

MEDICAL PERSONNEL ARMAMENT IS

CONTAMINATION CONTROL.

AND WE SHOULD SHOW AN EXAMPLE OF

BASIC, BASIC CONTAMINATION

CONTROL THAT ONE -- THAT HEALTH

CARE PERSONNEL CAN FOLLOW.

SO ONCE AGAIN, USE STANDARD

PRECAUTIONS.

YOU WANT TO USE THE STANDARD

TRAUMA GEAR, WATERPROOF

PROTECTION, TRAUMA APE RONCE ARE

ACCEPTABLE.

SURGICAL CARPS VERY PERMISSIBLE.

FACE SHIELDS ARE VERY ADEQUATE

HERE IN THIS CASE AND IN 95,

IT'S PREFERRED.

IT'S AVAILABLE.

WE WANT TO SERVE A HAND AND

CLOTHING FREQUENTLY.

WE TOP OF THE PLACE CONTAMINATED

GLOVES OR CLOTHING AS THEY GET

CONTAMINATED IF TIME ALLOWS AND

ALSO IF TIME ALLOWS IT'S A GOOD

IDEA TO KEEP THE WORK AREA FREE

OF CONTAMINATION BECAUSE IT

REDUCES THE BACKGROUND OF

RADIATION IN THE AREA AND

REDUCES HEALTHCARE PERSONALEL TO

LESS EXPOSURE.

HERE IS A DIAGRAM OF THE TYPICAL

CONTAMINATION CONTROL AREA.

THIS IS KNOWN AS A RADIATION

EMERGENCY AREA.

THIS IS AN AD HOC OR IMPROVISED

AREA WHERE WE -- OUR HEALTHCARE

PERSONNEL DECIDED THIS IS WHERE

WE WILL TAKE CARE OF A

CONTAMINATED PATIENT.

YOU CAN SEE THERE'S A LINE DRAWN

HERE, A HOT LINE DELINEATING

WHERE RADIATION IS TO BE DEALT

WITH AND TO BE CONFINED.

YOU CAN SEE AT THE BUFFER ZONE,

THERE'S A STEP OFF ANDAD THERE'S

A CHECKPOINT HERE WHERE PEOPLE

WITH RADIATION SURVEY METERS

WOULD USE TO MAKE SURE THAT NO

RADIATION LEAVES THAT HOT AREA.

AND YOU CAN SEE IN THE CLEAN

AREA THERE'S PLENTY OF EQUIPMENT

FOR MORE PERSONNEL PROTECTIVE

EQUIPMENT FOR PEOPLE TO DON IN

THE EVENT THAT MORE PERSONNEL

NEEDED TO BE ROTATED IN OR OUT

OR PEOPLE NEEDED TO CHANGE

CLOTHING.

FOR PREGNANT STAFF THERE IS A

LIMIT FOR WORKING WITH

RADIATION.

THAT IS .5 RAD OR 5 MILLIRAY AND

THAT'S APPROXIMATELY A LITTLE

MORE THAN WHAT WE NORMALLY

RECEIVE DURING THE FULL YEARS OF

EXPOSURE.

HOWEVER IT'S PROBABLY EASIEST TO

REASSIGN PREGNANT STAFF TO

CONTACT AREAS WHERE CONTAMINATED

PATIENTS ARE NOT ASSIGNED WHERE

RADIATION EXPOSURE LEVELS MAY

NOT BE PRECISELY KNOWN.

THERE IS ALSO ONCE AGAIN A

PRENATAL RADIATION EXPOSURE FACT

SHEET AT THE WEBSITE THAT YOU

SEE BELOW.

DEALING WITH STAFF STREP.

AS WE SAY THIS CAN BE A DISASTER

RESPONSE OR MULTIPLE CASUALTY

INCIDENT RESPONSE AND A LITTLE

PREPLANNING GOES A LONG WAY.

IT WOULD BE IMPORTANT TO

ESTABLISH AN INFORMATION CENTER

BOTH FOR MEDICAL PERSONEL AND

FOR VICTIMS.

VICTIMS' RELATIVES WILL WANT TO

KNOW WHERE THEIR RELATIVE IS AND

WHERE AND HOW THE PROGRESS IS

BEING CON TA DUCTED AND HEALTH

CARE PERSONNEL WILL ALSO WANT TO

KNOW ABOUT WHERE THEIR

PARTICULAR LOVED ONCE ARE AND IF

THERE ARE ANY NEEDS THAT THEY

HAVE AS WELL.

IT'S IMPORTANT TO TRAIN THE

STAFF ON RADIATION BASICS AND

GIVE STAFF AN IDEA OF THOU DEAL

WITH RADIATION EVENT.

IT'S IMPORTANT TO TRAIN

REGULARLY, IF POSSIBLE.

AFTER THE EVENT.

THESE EVENT CBS QUITE STRESSFUL

AS WE SAID BEFORE.

PARTICULARLY IF THERE ARE

SERIOUS INJURIES INVOLVED AND

IT'S IMPORTANT TO DEBRIEF

PERSONNEL IMMEDIATELY AFTER THE

EVENT.

IT'S IMPORTANT TO IDENTIFY

PEOPLE THAT MIGHT NEED COUNSEL

ANDGING AND OFFER COUNSELING TO

THOSE WHO NEED -- WHO NEED

COUNSELING HERE.

IT'S WELL KNOWN IN DISASTER

MEDICINE HISTORY THAT ORDINARY

PEOPLE CAUGHT IN EXTRAORDINARY

SITUATIONS THAT ARE STRESSFUL

CAN DEVELOP POST-TRAUMATIC

STRESS DISORDER.

THIS MUST BE RECOGNIZED AND

IDENTIFIED.

IN REGARDS TO THE MOST SERIOUS

SCENARIO THAT WE'VE EVER SEEN IN

THE HISTORY OF RADIATION

RESPONSE WE CAN THINK OF IN 1986

CHERNOBYL ACCIDENT.

IN THIS CASE IT WOULD BE OF

INTEREST TO RESPONDERS TO KNOW

THAT THE MEDICAL PERSONNEL AT

THE SITE RECEIVED LESS THAN 10

MILLIGRAY OF RADIATION, THAT

WOULD BE APPROXIMATELY ONE RAD

OR THE EQUIVALENT OF ONE CT TO

THE HEAD.

AND THAT'S THE WORST-CASE

SCENARIO THAT WE'VE SEEN IN

MEDICAL CARE HISTORY IN RESPONSE

TO RADIATION EVENTS.

OKAY.

LET'S SHIFT GEARS A LITTLE BIT

AND TALK A BIT ABOUT PATIENT

CARE.

THE PRIMARY THING, THE MOST KEY

POINT I CAN GIVE YOU IS NEVER,

NEVER DELAY CRITICAL CARE JUST

BECAUSE A PATIENT IS

CONTAMINATED.

THAT IS THE SOURCE OF EXTRA

MORBIDITY OR MORTALITY RATHER

THAN DELAY OR ATTENTION TO THE

RADIOLOGICAL COMPONENT OF THE

PATIENT'S INJURY.

IT'S VERY IMPORTANT TO MAKE SURE

THAT A PATIENT HAS COMPLETELY

MEDICAL STABLED BEFORE WE

ADDRESS THE RADIATION ISSUE.

AND IT'S A VERY IMPORTANT TO

REMEMBER THAT.

IF NOTHING ELSE.

IMMEDIATE MEDICAL MANAGEMENT

WOULD CONSIST OF TRIAGE.

WOULD CONSIST OF CHECKING FOR

ACUTE RADIATION CENTER, THAT

WOULD BE THE ONSET OF NAUSEA AND

VOMITING, TO TRIAGE FOR THAT.

TO CHECK FOR LOCALIZED AND

CUTANEOUS INJURY WHICH MIGHT BE

DIFFICULT AT FIRST.

YOU MIGHT ONLY SEE A LITTLE E

RITH MIA OR DISPROPORTIONATE

PAIN INITIALLY ASK WE WANT TO

CHECK FOR COMBINED INJURY, THE

POSSIBLE RADIATION ALONG WITH

CONVENTIONAL INJURY.

WE WANT TO PROVIDE INITIAL

STABILIZATION OF TREATMENT.

WE WANT TO IDENTIFY ANY

PSYCHOLOGICAL ISSUES THAT MAY

COME UP DURING PATIENT CARE.

AND WE WANT TO BE GOOD

RECORDKEEPERS.

WE WANT TO SURVEY PATIENTS.

WE WANT TO GET AN IDEA OF THEIR

CONTAMINATION LEVELS.

WE WANT TO BEGIN THE WORK OF OB

TAKE THE DOSE ASSESSMENT WHICH

WILL USUALLY TAKE SOME TIME AND

USUALLY MUCH MORE TIME THAN THE

TIME THAT IS THERE IN THE

EMERGENCY SETTING.

OKAY.

SO ONCE AGAIN, MEDICAL TRIAGE,

THE HIGHEST PRIORITY, RAID YAGDS

ASSESSMENT AND CONTAMINATION

ISSUES ARE SECONDARY

CONSIDERATIONS.

THE MAIN THING THAT YOU NEED TO

KNOW IS -- IS THAT PATIENT

DOES, THAT PATIENT HAVE SERIOUS

CONSIDERATION TO BEING

CONTAMINATED OR NOT.

IF SO, THEN WE APPROACH THE

PATIENT WITH STANDARD

PRECAUTIONS AND OUR STANDARD

TRAUMA GEAR.

THERE SHOULD BE NO UNDUE DELAY

IN THIS TYPE OF RESPONSE.

SO WE ARE THERE BASED ON THE

PATIENT INJURY THAT THEY HAVE

OCCURRED, SIGNS AND SYMPTOMS

THAT THEY OBTAINED BOTH

CONVENTIONAL AND RADIOLOGICAL.

WE WANT TO OBTAIN A PATIENT

HISTORY OF WHERE THEY WERE, WHAT

THEY WERE DOING, THE POINT OF

TRUE RADIATION EXPOSURE AND TO

DO A CONTAMINATION SURVEY.

AND I SHOULD GO AHEAD AND DO A

MINI DEMO AT THIS POINT WITH THE

CONTAMINATION SURVEY HERE.

HERE HAVE A RADIATION SURVEY

METER AND THIS IS A GOOD MODEL

FOR MEDICAL PERSONNEL TO BE

USING A METER THAT HAS A PANCAKE

HEAD.

IT CAN DETECT ALPHABETA AND

GAMMA.

AND TO SOME DEGREE AND YOU CAN

FIRST -- THE FIRST THING TO

NOTICE ABOUT A RADIATION SURVEY

METER IS THAT YOU HEAR

BACKGROUND RADIATION.

WE ALWAYS HEAR BACKGROUND

RADIATION AND PROBABLY ONE OF

THE MOST COMMON MISTAKES IS TO

TRY TO SURVEY SOMEONE AND

MISTAKE BACKGROUND RADIATION FOR

TRUE CONTAMINATION.

POINT NUMBER ONE.

I ALSO HAVE A BIT OF -- SLIGHTLY

RADIOACTIVE EARTHENWARE AND

ANOTHER POINT HERE IS THAT THIS

IS ONLY SLIGHTLY RADIOACTIVE.

YOU CAN HEAR THAT THE SURVEY

METER IS REALLY BEING VERY

ACTIVE HERE AT THIS POINT AND

THE BOTTOM LINE IS IT'S

IMPOSSIBLE TO REALLY TELL HOW

MUCH RADIATION IS BEING RELEASED

BY JUST LISTENING TO A SURVEY

METER.

ONLY THE PERSON OPERATING THE

SURVEY METER, KNOWING WHAT THE

SCALE IS AND WHAT THE READINGS

ARE, CAN TELL WHAT IT IS.

ALL YOU CAN TELL WITH THE SURVEY

METER BY HEARING IS JUST

PRESENCE OR ABSENCE OF RAID

YAGDS.

THIS CAN CAUSE SIGNIFICANT

PSYCHOLOGICAL CONSEQUENCES FOR

THE PATIENT AND MAYBE UNDUE

WORRY WITH HAVING THE AUDIO ON.

SO IT MIGHT BE BETTER JUST TO

USE AUDIO OFF AND JUST RELY ON

THE DIAL TO MAKE YOUR SURVEY

MEASUREMENTS.

WITH THE LITTLE POINT FOR PEOPLE

THAT ARE NOT FAMILIAR WITH

RADIATION SURVEY EQUIPMENT.

IF I CAN HAVE THE NEXT GRAPHIC

NOW.

BACK TO PRENATAL EXPOSURE.

PRENATAL EXPOSURE IS OF CONCERN

AS THE HUMAN EMBRYO AND FETUS

ARE HIGHLY SENSES IONIZING

RADIATION AT HIGHER DOSES, THE

EFFECTS CAN BE PREDICTED BASED

ON THE DOSE IN THE GESTATION AND

PREGNANT PATIENTS SHOULD BE

IDENTIFIED EARLY AND SHOULD

RECEIVE DOSE ASSESSMENTS AS

NEEDED.

ALSO THERE'S MORE INFORMATION ON

PRENATAL RADIATION EXPOSURE AT

THE CDC WEBSITE THAT YOU SEE

BELOW.

OKAY.

LET'S SHIFT GEARS AND TOPICS AND

TALK ABOUT ACUTE RADIATION

SYNDROME.

WHAT IS REQUIRED FOR ACUTE

RADIATION SYNDROME?

IT HAS TO BE A RELATIVELY LARGE

DOSE.

IT HAS TO BE ABOVE A CERTAIN

THRESHOLD AND A CERTAIN ORGAN

SYSTEM OF SOME SORT.

IT MUST BE PENETRATING BECAUSE

IT IS A FACT.

SO THINGS SUCH AS ALPHA AND BETA

RAISE YATION ARE TYPICALLY NOT

GOING TO CAUSE ACUTE RADIATION

SYNDROME AM OF.

FOR ACUTE RADIATION SYNDROME TO

OCCUR MOST OF THE BODY NEEDS TO

BE EXPOSED TO ORD ARE TO OBTAIN

SYSTEMIC EFFECTS.

SINCE WE'RE TALKING ABOUT AN

ACUTE EXPOSURE TIMEFRAME.

SO ACUTE RADIATION SYNDROME IS A

SPECTRUM OF DISEASE AT LOWER

DOSES.

WE HAVE SUB CLINICAL EFFECTS AND

THESE SUB CLINICAL EFFECTS ARE

THOUGHT TO BE BELOW THRESHOLD.

THIS THRESHOLD WILL BE THIS

THRESHOLD IS COMMONLY CALLED

OVEREXPOSURE.

AROUND 25 TO RADS OR .25 GRAY TO

5 GRAY GETS INTO BONE MARROW

DEPRESSION AND ONE COULD GET

DEPRESSION OF THE WHITE CELL

ELEMENTS AND TO THE THROM

THROMBOCYTES AS WELL.

sty IT WOULD BE NEWT RO BEANIA

AND THROM BO SIGHTPENIA AND WITH

THAT, THE CHANCES FOR SEPSIS AND

BLEEDING.

AT HIGHER DOSE RANGES, ONE CAN

START HAVING EFFECTS WITH SKIN

AT THE FELIAL TISSUES.

SUCH AS IN THE GASTROINTESTINAL

TRACT, IN THE PULMONARY SYSTEM,

IN THE MOUTH.

THESE MUCOSA WILL START TO

THROUV OFF BECAUSE THERE IS NO

FURTHER PRODUCTION OF THE

CELLULAREL AMS AND AFTER THE

MATURE CELLS LIVE OUT THEIR

NORMAL LIFE SPAN AND DIE IS

THEIR NORMAL PROCESS.

THEY ARE NOT REPLACED BY ANY

OTHER CELLS AND ONE WOULD START

GETTING PROBLEMS WITH

NONABSORPTION AND ELECTROLIGHTS

ABOVE THE GASTROINTESTINAL

TRACT.

THEY WANT TO HAVE ELECTROLIGHT

PROBLEMS BECAUSE THEY CAN

INVOLVE THE CARDIOVASCULAR

SYSTEM.

WITH PERSISTENT SHOCK EFFECTS

AND AT HIGHER RANGE E YOU CAN

HAVE A CENTRAL NERVOUS EFFECT

WHICH IS CAN OCCUR FAIRLY

RAPIDLY AFTER EXPOSH YOU ARE AND

IT'S REALLY METRIC SYSTEM IS NOT

THAT DIFFICULT TO USE IN THIS

CASE WHERE AS BEGINNING OF ACUTE

RADIATION SYNDROME BEGINS WHERE

A QUARTER OF A GRAY TO ONE GRAY

OF ALMOST CERTAIN 100% MORTALITY

OCCURS AT 9 GRAY, 10 GRAY.

IT IS ACTUALLY A CONVENIENT

MEASUREMENT SCALE TO BE USING

FOR ACUTE RADIATION SYNDROME.

ANOTHER TOOL FOR ASSESSING DOSE

IS THE BYOASSESSMENT TOOL WHICH

IS AVAILABLE AT THE ARMS FORCES

RADIO BIOLOGIC RESOURCE TOOL.

THIS TOOL WILL HELP QUANT EIGHT

THE ONSET OF NEWS AND

VOMITING.

THE ONSET OF NEWSA AND VOMITING

IS SOMETHING THAT CORRELATES

WITH DOSE TO SOME DEGREE AND WE

MIGHT BE ABLE TO GET A DOSE

ESTIMATE OF HIGH DOSE EXPOSURE

BY KNOWING THE ONSET OF NAU

NAUSEA AND VOMITING.

WE HAVE ANOTHER INSTRUMENT WHICH

IS USEFUL.

THE ONSET OF NAUSEA AND VOMITING

IS A USEFUL SCREENING TOOL.

HOWEVER, IT'S IMPORTANT TO

CONFIRM SYSTEMIC RADIATION

EXPOSURE THROUGH OTHER MEANS AND

THE LIMB TO SITE MAMMOGRAM WEB

USED TO DO THAT CONVINCINGLY.

WE CAN MEASURE THE PROGRESSION

OF THE ABSOLUTE LIMB TO SIGHT

COUNT OVER SEVERAL HOURS

DEPENDING ON THE CLINICAL

SITUATION, WE CAN DETERMINE NOT

JUST BY THE AM ABSOLUTE

LYMPHOCYTE COUNT, BUT BY

DETERMINING THE RISE AND FALL OF

THE PROGNOSIS OF THE PATIENT IN

DETERMINING THE DEGREE OF

HEMATOLLOGICAL ENVIRONMENT.

THIS IS AN IMPORTANT TOOL FOR

CLINICIANS TO USE IN DETERMINING

WHETHER OR NOT PATIENTS HAVE

TRULY BEEN EXPOSED TO SYSTEMIC

AMENTS OF RADIATION.

ACUTE RADIATION SM SYNDROME

FOLLOWS FOUR PHASES, WHY YOU

HAVE ARE R, NAUSEA, VOMITING AND

DIARRHEA AND THIS OCCURS OVER A

PERIOD OF A FEW HOURS TO AS

POSSIBLY A FEW MINUTES AFTER

EXPOSURE.

THE MORE SEVERE THE DOSE, THE

SOUTHEASTERN THE ONSET OF THE

PRODRUM AND THAT'S IMPORTANT BIT

OF KNOWLEDGE TO KNOW.

AFTER THAT THE INDIVIDUAL MIGHT

EXPERIENCE A PERIOD OF RELATIVE

WELL-BEING.

AT THIS POINT THE STEM CELLS

HAVE EITHER BEEN INHINTED OR

KILLED AND THERE IS NO FURTHER

OR REDUCED PRODUCTION OF CELLS

THAT CONSTANTLY RENEW WHICH IS

TYPICALLY EPITHELIAL CELL LINES.

THERE WILL NOT BE OBVIOUS

DISEASE AT THIS POINT AND THE

PATIENT WILL FEEL RELATIVELY

WELL.

DURING ILLNESS, ALL OF THE

ELEMENTS WILL COME AND BE

OBVIOUS AND THE MATURE CELLS, AS

WE SAID, WILL LIVE OUT THEIR

LIVES NORMALLY, DIE AS EXPECTED

AND THEN THERE ARE NEW CELLS TO

REPLACE THEM.

WE HAVE THE PERIOD OF MANIFEST

ILLNESS.

IF THE SKIN CELLS WERE ABLE TO

RECONSTITUTE AND START

DEVELOPING, PRODUCING EPITHELIAL

CELLS ONCE AGAIN AND THE BONE

MARROW IS ABLE TO REGENERATE

THEN WE MIGHT HAVE RECOVERY.

IF THE CELL LINES DO WANT

REGENERATE OR IF THERE IS A

CHANCE FOR INFECTION OR OTHER

COMPLICATIONS RELATED TO THE

MANIFEST ILLNESS, THEN THE

INDIVIDUAL WOULD EXPIRE.

THIS COULDOR OCK FRUR A PERIOD

OF DAYS TO YEARS.

SPECIAL CONSIDERINGS, RADIO

TRAUMA COULD AFFECT

SYNERGISTICLY.

THEY INCREASE MORBIDITY AND

MORTALITY AND THAT SHOULD BE

REMEMBER WHD WHENEVER TRIAGE IS

BEING PERFORMED.

IF ONE ENCOUNTERS CONVENTIONAL

WOUNDS ON PATIENTS, EVEN IF

THEY'VE BEEN I RADIATED THEY

PROBABLY SHOULD BE CLOSED.

THIRD, IF SIGNIFICANT SURGERY IS

REQUIRED TO BE DONE T SHOULD BE

DONE BEFORE THE HEMATOPEOTIC

DEPRESSION OCCUR WHICH IS

THOUGHT TO BE DURING THE FIRST

48 HOURS.

AFTER THE DEPRESSION, NO

RECONSTRUCTIVE SURGERY SHOULD BE

A TEMPED.

AFTER THE HEMATOPEOTIC ELEMENTS

ARE RECONSTITUTED, THEN SURGERY

IS ALLOWABLE.

THAT COULD ANYWHERE FROM TWO TO

THREE MONTHS LATER.

SKIN EFFECTS.

WHEN THE BASE OF THE SKIN LAYER,

THE SKIN IS DAMAGED BY RADIATION

INSULATION, AND DRY OR MOISTNESS

CAN OCCUR.

HAIR FOLLICLES COULD BE DAMAGED.

WITHIN A FEW HOURS OF

IRRADIATION, PARTICULARLY HIGH

DOSE IRRADIATION OR AN

INCONSISTENT EDEMA WHICH IS

ASSOCIATED WITH ITCHING AND

SOMETIMES PAIN CAN OCCUR.

THEN THERE COULD BE A LATER

PHASE THAT CAN LAST FROM A FEW

DAYS TO SEVERAL WEEKS WHEN

INTENSE REDDENING AND BLISTERING

AND ULCERATION OF THE IRRADIATED

SITE IS VISIBLE.

THIS AREA IS DEVOID RELATIVELY

DEVOID OF VASCULAREL AMS AND IT

ALSO PRESENTS CHALLENGES AND

HEALING.

SO THIS CYCLE OF HEALING, AND

THEN

A RETURN OF SYMPTOMS MAY RECUR

SEVERAL TIMES, WITH SYMPTOMS

OFTEN WORSENING EACH TIME.

BECAUSE OF THE POOR, VASCULAR

CONDITION AND THE FACT THAT

THERE WERE PROBABLY REDUCED STEM

CELLS IN THE AREA.

IN MOST CASES, HEALING OCCURS

BY REGENERATIVE MEANS.

HOWEVER, VERY LARGE SKIN DOSES

CAN CAUSE PERMANENT HAIR LOSS,

DAMAGED SEBACEOUS AND SWEAT

GLANDS, ATROPHY, FIBROSIS,

DECREASED OR INCREASED SKIN

PIGMENTATION, AND ULCERATION

OR NECROSIS OF THE EXPOSED

TISSUE.

THIS PHOTO IS FROM A PATIENT WHO

HAD THREE ANGIOPLASTY PROCEDURES

UNDER FLUOROSCOPIC GUIDANCE.

ACCIDENTALLY, THIS PATIENT

RECEIVED AN EXPOSURE OF 2,000

RAD OR 20 GRAY.

THIS LESION SHOWS DEEP NECROSIS

OF THE SKIN 22 MONTHS AFTER

AN EXPOSURE OF APPROXIMATELY

2,000 RAD.

SO THAT IS THE SKIN EFFECTS

HERE.

FOR LARGE HIGH DOSE EXPOSURES

PATIENTS SHOULD BE TREATED

SYMPTOMATICLY AT FIRST AND THEN

CONSIDERATION MAY BE NEEDED

TOWARDS MANAGING POSSIBLE

INFECTIOUS RELATED TO

NUTROPENNIA, WE WANT TO CONSIDER

HEM ATO POETIC EXPOSURE.

CDC HAS DETERMINED THAT THE GLUS

THIS SITUATION OF NEUPOGEN WOULD

BE AN OFF-LABEL USE, HOWEVER I

THINK THAT HEMOTOLOGISTS WOULD

BE COMFORTABLE IN USING NEUPOGEN

IN THIS SCENARIO.

HOWEVER IT BEING AN IMD TYPE OF

USE IN THIS SITUATION CDC WOULD

PROVIDE IMPORTANT SITUATIONS

SHOULD NEUPOGEN SHOULD BE

DETERMINED TO BE NEEDED.

AND IRRADIATED BLOOD PRODUCTS

WOULD BE GIVEN TO PREVENT GRAPH

VERSUS HOST REACTION IN A

PATIENT AND ANTIBIOTICS AND

REVERSE ISOLATION SHOULD BE

CONSIDERED IF THE PATIENT IS

NEWT RO BEANIC OR THOUGHT TO BE

BECOMING SEPTIC.

ELECTROLITE BALANCE SHOULD BE

CONSIDERED AS WELL.

FOR MORE INFORMATION ABOUT ACUTE

RADIATION SYNDROME THERE IS ONCE

AGAIN ANOTHER WEB PAGE THAT CDC

HAS DISPLAYED FOR YOU.

OKAY.

WE SHOULD TALK ABOUT THE

CUTANEOUS RADIATION SYNDROME.

WE SORT OF TOUCHED ON THAT A

LITTLE BIT AND THE MAIN THING

ABOUT THE CUTANEOUS RAID YAGDS

SYNDROME IS IF YOU SEE A SKIN

LESION ON A PATIENT WHO WAS

THOUGHT TO BE EXPOSED TO

RADIATION, THAT WILL BE A

CONVENTIONAL LESION FOR THE MOST

PART.

RADIATION LESIONS DO NOT APPEAR

FOR DAYS OR MORE USUALLY UP TO

WEEKS AND ONCE AGAIN, CUTANEOUS

RADIATION SYNDROME MAY REQUIRE

RESTORE TIFF RECONSTRUCTIVE

SURGERY, PERHAPS.

ONE MAY WANT TO CONSULT THE

RADIATION EMERGENCY ASSISTANCE

CENTER TRAINING SITE FOR 24/7

ADVICE FOR FURTHER TREATMENT.

YOU CAN CONTACT THEM AT THE

PHONE NUMBER THERE THROUGH THE

DEPARTMENT OF ENERGY OAK RIDGE

OPERATIONS OR AT THE REDCIDE

THAT YOU SEE BELOW.

FOR DECONTAMINATION OF PATIENT,

WE'LL SWITCH GEARS ONCE AGAIN.

WE SHOULD TALK ABOUT EXTERNAL

CONTAMINATION AND INTERNAL

CONTAMINATION.

EXTERNAL CONTAMINATION CAN

INVOLVE EITHER SKIN OR WOUNDS

AND WE SHOULD TALK ABOUT THEM IN

SOMEWHAT DIFFERENT FASHIONS.

PATIENT DECONTAMINATION, IF ONE

ONLY REMOVED AND BAGGED THE

PATIENT'S CLOTHING AND PERSONAL

BELONGINGS AT THE SCENE, THAT

WOULD TYPICALLY REMOVE ABOUT 80

TO 90% OF THE CONTAMINATION AND

THE REMAINING CONTAMINATION

WOULD USUALLY BE ON THE HEAD,

HANDS AND FEET.

AND THAT'S BEEN SHOWN IN MANY

RADIATION ACCIDENT CASES THAT WE

HAVE SEEN IN THE PAST.

THAT SEEMS TO BE SOMETHING THAT

IS A FAIRLY RELIABLE CLINICAL

INFORMATION.

WE WANT TO HANDLE FOREIGN

OBJECTS WITH CARE UNTIL THEY'VE

BEEN PROVEN NONRADIOACTIVE.

EITHER THAT THEY MIGHT BE

CONTAMINATED OR IN THE RARE CASE

OF A NUCLEAR EVENT WHERE THERE'S

A DETONATION.

THAT'S THE RARE SITUATION WHERE

RADIO ACTIVITY COULD BE INDUCED.

SO IT'S IMPORTANT TO HANDLE

THESE OBJECTS WITH CARE.

ONE WANTS TO SURVEY THE PATIENT

AND COLLECT SAMPLES,

PARTICULARLY THE FACE, HANDS AND

FEET AND, OF COURSE, THE REST OF

THED ABOUTY.

WE WANT TO SURVEY THE PATIENT'S

BODY COMPLETELY EXTERNAL

CONTAMINATION, WE SAID THAT WAS

RADIOACTIVE MATERIAL.

THAT'S USUALLY IN THE FORM OF A

PARTICULAR FISCAL CONDITION

THAT'S ON THE BODY SURFACE OR

CLOTHING AND USUALLY THE

RADIATION DOSE RATE FROM MOST

CONTAMINATION IS A VERY LOW DOSE

RATE, BUT WHILE IT REMAINOS ON

THE PATIENT IT WILL CONTINUE TO

EXPOSE THE PATIENT AND STAFF AND

IT'S A THORET CAL HAZARD FOR

TRANSFERABLE CONTAMINATION AND

POSES A HAZARD TO BOTH

RESPONDERS AND TO THE PATIENT.

DECONTAMINATION PARTIES ARE

FIRST FOR WOUNDS SINCE THEY POSE

A THORET CAL AVENUE FOR INTERNAL

CONTAMINATION.

AND ONCE WE HAVE DEALT WITH THE

WOUNDS THEN WE TURN OUR

ATTENTION TO INTACT SKIN AND TO

AREAS OF HIGHEST CONTAMINATION

FIRST.

ONCE AGAIN, WE WANT TO CHANGE

OUTER GLOVES FREQUENTLY TO MINE

MYSELF THE SPREAD OF

CONTAMINATION.

DECONTAMINATION OF WOUNDS.

YOU WANT TO DECONTAMINATE WOUNDS

MUCH THE SAME WAY YOU WOULD

DECONTAMINATE ANY OTHER SURGICAL

WOUND OR ANY TRAUMATIC WOUND,

SDWLAUST ONE MAY WANT TO DO

SURVEYS IN BETWEEN ATTEMPTS AND

IRRIGATION ATTEMPTS.

WE WANT TO DEBRIEF SURGICALLY AS

NEEDED.

IT'S NOT NECESSARY TO REMOVE THE

LAST LITTLE BIT OF RADIATION

FROM A WOUND.

IT'S IMPORTANT NOT TO MUTILATE

TISSUES.

OR CONTAMINATE THERMAL BURNS.

IT'S IMPORTANT TO RINSE THESE

BURNS AND GENTLY DECONTAMINATE

THESE WOUNDS.

IT'S ALSO IMPORTANT TO CHANGE

THE DRESSING.

CHANGING THE DRESSINGS

FREQUENTLY WILL REMOVE

ADDITIONAL CONTAMINATION, IF IT

IS NOT REMOVABLE INITIALLY.

WE IN GENERAL WANT TO SEE OVERLY

AGGRESSIVE AND ONCE AGAIN,

CHANGE DRESSING FREQUENTLY.

DECONTAMINATION OF SKIN.

YOU WANT TO CHANGE MULTIPLE

GENTLE EFFORTS.

THEY WILL FREQUENTLY SUCCEED

IN -- INSTEAD OF A SINGLE

AGGRESSIVE ATTEMPT.

ONE WANTS TO USE SOAP AND WATER

AS THE MAIN DECONTAMINATION

AGENT AND IF HAIR NEEDS TO BE

REMOVED MORE IMPORTANT TO CUT

THE HAIR IF NECESSARY.

IT'S IMPORTANT TO NOT SHAVE THE

AREA.

SHAVING CAN CAUSE AN INCREASED

CHANCE OF DEVELOPING INFECTION

LATER ON.

IF THE CONTAMINATION IS

PARTICULARLY STUCK OR PERCEIVED

TO BE STUCK AROUND THE HAIR

PORES AND SKIN -- HAIR FOLLICLE,

IT MIGHT BE USEFUL TO DO SOME

TYPES OF MANEUVERS SUCH AS

PUTTING, COVERING THAT EXPOSED

AREA WITH PLASTIC, IF IT'S THE

CASE OF A HAND, THEN SOMETIMES

THE LATEX OR VINYL GLOVE, IT'S

IMPORTANT TO PUT IT ON THE

GLOVE.

KEEP IT ON OVERNIGHT AND THE

SWEATING CAN PROMOTE

DECONTAMINATION AND THE SURVEY

METER IS THE MAJOR INSTRUMENT TO

USE IN DETERMINING WHETHER OR

NOT SKIN HAS BEEN

DECONTAMINATED.

WHEN DO WE STOP DECONTAMINATING

A PATIENT?

WELL, WHEN NO MORE CONTAMINATION

COMES OFF, BASICALLY, WHEN THE

DECONTAMINATION EFFORTS ARE NOT

PRODUCTIVE.

THE OTHER STOP LEVEL WHICH IS

EASY TO REMEMBER, THERE ARE

SEVERAL GUIDELINES THAT ONE CAN

USE AND SOME CAN BE FOUND IN

NCRP 65 IN THE BACK THAT'S THE

REFERENCE NOTED IN THE BACK OF

THE PROGRAM.

BUT AN EASY RULE OF THUMB COULD

BE THAT ONE CAN STOP WHEN THE

CONTAMINATED AREA IS LESS THAN

TWICE THE BACKGROUND LEVEL OF

RADIATION AND WE WANT TO STOP

BEFORE THE INTACT SKIN BECOMES

DAMAGED OR BRAIDED.

IN THAT CASE YOU MAY WANT TO

CONSIDER INTERNAL CONTAMINATION.

INTERNAL CONTAMINATION MAY ENTER

THE BODY BY INHALATION, INJETION

OR WOUNDS.

AN INTERNAL CONTAMINATION

GENERALLY DOES NOT CAUSE EARLY

SIGNS OR SYMPTOMS.

IT'S VERY RARE FOR INTERNAL

CONTAMINATION TO CAUSE ACUTE

RADIATION SYNDROME.

HOWEVER T MAY CONTINUE TO

RADIATE THE PATIENT AND MAY

CAUSE CONCERNS FOR INCREASING

THE RISK OF CANCER LATER ON IN

YOUR LIFE.

TYPICALLY.

THE TREATMENT OF INTERNAL

CONTAMINATION.

WE CAN REDUCE THE AMOUNT OF

INTERNAL CONTAMINATION IN AN

INDIVIDUAL SOMETIMES BY, IN BEST

CASE SITUATIONS, BY A QUARTER TO

PERHAPS A THIRD OR SO.

AND WE ACTUALLY HAVE SPECIFIC

AGENTS THAT CAN BE USED FOR

INTERNAL CONTAMINATION.

OR RARER INCLUDING PLUTONIUM AND

THE TRANSPLU TONIC ELEMENTS.

WE CAN USE DTPA.

DTPA IS AN INVESTIGATIONAL NEW

DRUG WHICH IS AVAILABLE FROM

REACTS AND IT IS AVAILABLE

WITHIN THE NATIONAL

PHARMACEUTICAL STOCKPILE THAT

THE CDC MANAGES.

THIS WOULD BE AVAILABLE IN THE

EVENT OF A RADIO LOGIC EVENT.

WE LIKE TO AND EXCRETE THE

URANIUM FROM THE BODY AND IT

SEEMS TO WORK WELL.

THERE'S ANOTHER INVESTIGATIONAL

NEW DRUG AGENT KNOWN AS SOLUBLE

PRESSURE BLUE AS WELL AS DTPA

ARE THOUGHT TO BE HAVE A FAIRLY

GOOD PATIENT PROFILE IN THE

LIMITED NUMBER OF PATIENTS IN

THE CASE OF DTPA.

IT'S APPROXIMATELY 2,000 DOSES

AND ABOUT 800 PATIENTS.

AND IT IS LESS.

PRETION BLUE IS NOT ABSORBBED

AND IS THOUGHT TO HAVE MINIMAL

SIDE EFFECTS.

PRID YUM IS COMMONLY FOUND AS A

CONTAMINANT IN THE PHYSICAL FORM

OF WATER AND IT BEING AYE IN THE

FORM OF WATER DILUTION IN THE

STABLE WATER, HAVING PEOPLE

DRINK LARGE AAMES OF WATER IS

THOUGHT TO BE HELPFUL IN

ACCELERATING THE ELIMINATION OF

IT FROM THE BODY.

FOR IO DINE.

IO DINE IS A SPECIAL CASE AND A

LOT HAS BEEN MADE ABOUT IODINE

CONTAMINATION AND PAT AS YUM

USE.

POTASSIUM IODIED IS USED ONLY IN

SPECIAL CASES.

THE ONLY THING IT WOULD DO WOULD

BE TO PROTECT THE THYROID DPLAND

AND KEEP IT FROM BEING AFFECTED

BY FALLOUT OR OTHER ISOTOPES.

POTASSIUM STOPS THE UPTAKE OF

RADIOACTIVE IODIDE IF IT IS

GIVEN IN A TIMELY FASHION AND

THAT'S THE KEY BOARD.

IT MUST BE GIVEN IN A TIMELY

FASHION.

IT MUST BE EITHER USED PRIOR OR

WITHIN A FEW HOURS OF EXPOSURE

TO THE RADIO ACTIVE IODIDE AND

FOR SPECIFIC GUIDANCE IN HOW TO

ADMINSTER POTASSIUM IODID I

DIRECT YOU TO THE WEBSITE YOU

SEE BELOW.

LONGER TERM CONSIDERATIONS

FOLLOWING RADIATION INJURY IS

NEWT ROPENNIA.

PAIN MANAGEMENT THIS WHICH CAN

BE SIGNIFICANT ALONG WITH

NECROSIS ISSUES AND REPLACING

SURGERY.

WE TALKED ABOUT THE

PSYCHOLOGICAL EFFECTS AND WE

TALKED ABOUT THE NEED FOR

COUNSELING BOTH IN AFFECTED

VICTIMS AND HEALTH CARE

PROVIDERS AND TO PROVIDE DOSE

ASSESSMENTS AS POSSIBLE AND TO

GIVE PEOPLE A -- COUNSELING ON

THEIR POSSIBILITY FOR INCREASED

RISK OF DEVELOPING CANCER LATER

IN LIFE.

IN SUMMATION, MEDICAL

STABILIZATION IS THE HIGHEST

PRIORITY.

RADIATION EXPERTS SUCH AS HEALTH

OR MEDICAL PHYSICISTS, RADIATION

CYSTY OFFICERS OR OTHER

RADIATION EXPERTS SHOULD BE

CONSULTED PARTICULARLY IN

PREPLANNING.

IT'S IMPORTANT TO PREPLAN THESE

RESPONSES AND GET THEM INVOLVED

WITH YOUR PLANNING ATTEMPT.

RADIATION AND TRAINING AND THE

STAFF SHOULD BE GIVEN ADEQUATE

SUPPLIES AND SURVEY INSTRUMENTS

IN THEIR CARE AREAS THERE AND

THAT'S ANOTHER IMPORTANT

EMPOWERING TOOL.

FINALLY, STANDARD PRECAUTIONS

SHOULD BE USED TO APPROACH A

POSSIBLY CONTAMINATED PATIENT

AND THE SYMPTOMS INDICATE THE

SEVERITY OF THE RADIATION

INJURY.

FIRST 24 HOURS ARE THE MOST

CRITICAL.

AFTER YOUR HEALTH CARE PROVIDERS

START WORKING WITH THE RESPONSE,

AFTER 24 HOURS, THERE WILL BE A

LARGE, LOCAL SDPAT FEDERAL

RESPONSE THAT WILL ASSIST YOU IN

DEALING WITH PATIENTS THERE.

AND THANK YOU VERY MUCH.

>> THANK YOU, DR. FONG.

YOU'VE GIVEN US A LOT TO

CONSIDER.

RIGHT NOW OUR DOCTORS, DR. FONG

AND DR. SMITH WILL ANSWER

QUESTIONS FROM YOU, OUR VIEWERS.

WE HAVE RECEIVED GOOD RESPONSE,

BUT IN THE INTEREST OF TIME, IT

APPEARS WE ARE RUNNING JUST A

LITTLE LONGER TODAY.

I'M GOING TO ASK THAT THE

DOCTORS WILL KEEP THEIR

RESPONSES AS BRIEF AS POSSIBLE.

DR. SMITH, FIRST FOR YOU, IRIS

FROM ALABAMA.

UNDER WHICH RISKS WOULD WE

EXPECT LARGE NUMBERS OF PATIENTS

WITH SIGNIFICANT DOSES OF

EXPOSURE AND SUBSEQUENT HOSPITAL

ADMISSION FOR ACUTE RADIATION

SYNDROME?

>> CERTAINLY IN THE EVENT THAT

THERE IS A NUCLEAR DETONATION.

WE TALKED ABOUT THE IMPROVISED

NUCLEAR DEVICE AND TALKED ABOUT

A NUCLEAR WEAPON, BY FAR IN THAT

CASE.

WHERE WE HAVE THE HIDDEN SOURCE,

IF WE HAVE A VERY HIGH STRENGTH

SOURCE HIDDEN IN A PUBLIC PLACE

THAT'S EXPOSING PEOPLE TO

PENETRATING RADIATION, WE MIGHT

GET A NUMBER OF CASUALTIES

THERE.

NOT AS LARGE AS WHEN THE NUCLEAR

DETONATION CASE, BUT THEY WOULD

HAVE PRESENTED THE HOSPITAL

PERHAPS WITH SEVERE LEVELS OF

RADIATION DOSE.

WE WOULD NOT EXPECT IN THE CASE

OF THE DIRTY BOMB TO SEE SO MANY

PEOPLE WITH ACUTE EXPOSURES OF

RADIATION, PERHAPS A HANDFUL WHO

WERE VERY CLOSE TO THE ANDOERS

SURVIVED THE BOMB BLASTS.

>> ARKS APPRECIATE YOUR

QUESTION.

IRIS AND THIS IS FOR YOU,

DR. FONG.

IT'S FROM ELIZABETH FROM NEW

YORK.

HOW DO I DISTINGUISH CUTANEOUS

RADIATION EFFECTS FROM THERMAL

BURN?

>> THAT'S IMPORTANT TO KNOW.

AS WE SAID EARLIER.

IF YOU SEE A SKIN LESION

IMMEDIATELY AFTER WHAT IS

THOUGHT TO BE A RADIATION EVENT.

THAT IS GOING TO BE A

CONVENTIONAL SKIN LESION AT

FIRST.

THE ONLY THING THAT RADIATION

COULD POSSIBLY DO AND THAT WOULD

BE IN HIGH DOSES AND IN THIS

CASE ONE WOULD HAVE NOT ONLY THE

LOCAL EXPOSURE, BUT ONE WOULD

ALSO HAVE SYSTEMIC EFFECTS OF

THE SYMPTOM OF NAUSH A VOMITING

AND DIARRHEA, ONE WOULD HAVE

DISPROPORTIONAL PAIN TO WHAT THE

CLINICIAN'S ACTUALLY LOOKING AT,

BUT IF YOU SEE A SKIN LESION

RIGHT AFTER AN EVENT, THAT IS A

CONVENTIONAL INJURY.

>> OKAY, WE WILL PING-PONG,

DR. SMITH,.

ITS FROM BOB IN FLORIDA.

HE ASKED HOW DO WE KNOW A DOSE A

PATIENT HAS RECEIVED IF WHEN

THEY ARRIVED AT OUR EMERGENCY

DEPARTMENT?

>> GOOD QUESTION PHOTOCOPY WE

DON'T NECESSARILY KNOW WHAT THAT

DOSE IS THAT THE PATIENT'S

RECEIVED.

WE CAN ESTIMATE IT IF WE KNOW

SOMETHING ABOUT THE LOCATION OF

THE VICTIM, THE PATIENT RELATIVE

TO WHERE THE BLAST OCCURRED OR

WHERE THE EXPOSURES WERE

OCCURRING.

TIMED ONSET OF NAUSEA AND

VOMITING WOULD BE IMPORTANT

ADJUNCT HERE.

BOTH OF THESE WOULD BE SCREENING

TOOLS TO ESTIMATE THE DOSE, BUT

AS DR. FONG POINTED OUT, THE

LIMB POCYTE COUNT WOULD BE MORE

CRITICAL THAN GETTING AN EXACT

DOSE.

>> DR. FONG, THIS ONE IS FROM

YOU.

ARMAND FROM TENNESSEE, WANTS TO

KNOW SHOULD ABENTIRE BODY SURVEY

BE DONE WITH EVERY PATIENT IN A

MASS CASUALTY SITUATION TO

ASSESS CONTAMINATION.

IT SOUNDS LIKE IT'S A SLOW

PROCESS THAT MIGHT INCREASE OUR

TRIAGE AND THROUGHPUT TIME.

I'M ALSO CONCERNED ABOUT HOW

MANY RADIATION METERS AND

TRAINED STAFF THAT WE VARKS

VEILABLE TO DO THE SURVEY.

>> THAT IS A SIGNIFICANT

LOGISTICAL POTENTIAL PROBLEM

THERE.

ONE MIGHT YUS USE THINGS SUCH AS

DOOR FRAME, TO BE ABLE TO SURVEY

PEOPLE, SCREEN THEM RATHER

QUICKLY.

THOSE OTHER PEOPLE THAT ARE

FOUND TO BE SOMEWHAT POSITIVE

MAY REQUIRE MORE IN-DEPTH SURVEY

THERE.

SO IDEALLY IT WOULD BE NICE TO

SURVEY ABSOLUTELY EVERYBODY.

WE HAVE IN MEDICINE -- A QUICK

LOOK AROUND THE ROOM TO SEE IF

SOMEONE IS DYING, HONEST.

IN A SIMILAR FASHION WE CAN LOOK

QUICKLY WITH A SURVEY METER, IN

DEALING WITH A SIGNIFICANT

RADIATION LEVEL THAT WE MIGHT

NOT BE AS CONCERNED ABOUT AND

CAN WAIT A LITTLE BIT TO DO A

MORE THOROUGH EXAM.

I THINK SOMETIMES RADIATION

SURVEYS SHOULD BE DONE IN TWO

STAGES SOMETIMES.

>> DR. FONG, ALSO FROM YOU FROM

ROBERT IN GEORGIA.

IF A CONTAMINATED PATIENT IS

TRIAGED FOR IMMEDIATE SURGERY,

BUT DECONTAMINATION HAS NOT BEEN

DONE, SHOULD WE DECONTAMINATE

THEM BEFORE TRANSPORTING THEM TO

THE OPERATING ROOM?

>> OKAY.

THAT'S A GOOD QUESTION HERE.

WHAT WE DIDN'T COVER EARLIER WAS

THE FACT THAT YOU CAN DELAY

DECONTAMINATION EFFORTS AND THAT

IS ISOLATING THE CONTAMINATED

AREAS WITH EITHER PLASTIC WRAP,

SURGE RAL -- -- PLAFERTSIC

SURGICAL DRAPE, THINGS OF THAT

SORT AND THAT CAN RERND THE

CONTAMINATION NONTRANSFERABLE

AND BUY YOU TIME TO BE ABLE TO

DO THOSE LIFE-SAVE PROG SEED YOU

ARES THAT MIGHT NEED TO BE DONE.

THAT MIGHT BE A GOOD TEMP RISING

THING.

THEN YOU CAN GO AHEAD AND SEND

THEM TO THE CT SCANNER OR

WHATEVER.

>> AGAIN, DR. FONG, FROMMANCE

INY IN NEVADA, AFTER

DECONTAMINATION CLOTHING IS

DOUBLE BAGGED.

WHAT SHOULD BE DONE TO THE

CLOTHING OR WITH IT?

>> THAT CLOTHING SHOULD BE

IDENTIFIED FIRST TO BELONG TO

WHICH VICTIM IT DID AND IT

SHOULD BE GONE OVER WITH THE

HEALTH FISIST TO DETERMINE

WHETHER OR NOT IT'S TRULY

CONTAMINATED.

IF IT'S NOT CONTAMINATED IT

COULD BE RETURNED TO THE

PATIENT.

>> OKAY.

DR. FONG, CERTAINLY THANK YOU

FOR YOUR EXPERTISE.

>> LIKEWISE, DR. SMITH,

APPRECIATE YOU.

WE ARE OUT OF TIME FOR

QUESTIONS.

IF YOU HAVE ANY

RADIATION-RELATED QUESTIONS

AFTER THIS BROADCAST YOU CAN

E-MAIL THEM

TO RSB@CDC.GOV.

PLEASE INDICATE "MEDICAL

RESPONSE TO NUCLEAR

AND RADIOLOGICAL TERRORISM"

IN THE SUBJECT LINE.

AND DON'T FORGET, YOU CAN CHECK

FOR ANSWERS TO YOUR E-MAILED

QUESTIONS AND FIND ADDITIONAL

INFORMATION AT THE CDC'S

EMERGENCY PREPAREDNESS

AND RESPONSE-RADIATION

EMERGENCIES WEBSITE --

THE ADDRESS IS

WWW.BT.CDC.GOV/RADIATION.

YOU MAY ALSO WANT TO VISIT THESE

WEB SITES FOR INFORMATION.

THE OAK RIDGE INSTITUTE

FOR SCIENCE AND EDUCATION

RADIATION EMERGENCY ASSISTANCE

CENTER TRAINING SITE, AND ARMED

FORCES RADIOBIOLOGY RESEARCH

INSTITUTE.

PARTICIPANTS OF THIS BROADCAST

ARE ENCOURAGED BUT NOT REQUIRED

TO REGISTER AND EVALUATE

THE PROGRAM ON THE CDC TRAINING

AND CONTINUING EDUCATION ONLINE

SYSTEM.

THAT ADDRESS IS

WWW.PHPPO.CDC.GOV/PHTNONLINE.

PARTICIPANT REGISTRATION

AND EVALUATION WILL BEGIN TODAY,

FEBRUARY 10th, AND END ON MARCH

12th, 2004.

HERE ARE THE COURSE NUMBERS

YOU WILL NEED.

THE NUMBER FOR THE SATELLITE

BROADCAST IS SB-0150.

THE WEBCAST NUMBER IS WC-0050.

WEB-ON-DEMAND, WD-0037, BEGINS

MARCH 15th, 2004, AND ENDS

FEBRUARY 10th, 2007.

PLEASE TAKE A MOMENT NOW

TO WRITE DOWN THESE IMPORTANT

NUMBERS.

QUESTIONS ABOUT REGISTRATION

SHOULD BE DIRECTED

TO 800-41-TRAIN, T-R-A-I-N,

OR E-MAIL AT CE@CDC.GOV.

WHEN E-MAILING A REQUEST, PLEASE

INDICATE "MEDICAL RESPONSE

TO NUCLEAR AND RADIOLOGICAL

TERRORISM" IN THE SUBJECT LINE.

I WANT TO MAKE SURE CLINICIANS

WHO WATCH OUR PROGRAM ARE AWARE

OF THE CLINICIANS' REGISTRY.

CLINICIANS THAT REGISTER AT THIS

SITE WILL RECEIVE ALERTS

AND UPDATES ON PUBLIC HEALTH

THREATS AND INFORMATION ON CDC