You are here: Home > Contamination: Diagnose/Manage > Text Version		Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners, 8/2007 (HHS/CDC) HHS Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Strategy and Implementation Plan (HHS) Medical Countermeasures Against Radiological and Nuclear Threats (NIH/NIAID)    New Users: Where Do I Start? Use REMM: Earn CME Patient Management Algorithms Print Algorithms & Tables Isotopes of Interest Countermeasures Decontamination Procedures Dose Estimator for Exposure Manage ARS Subsyndromes Hematopoietic Subsyndrome Cutaneous Radiation Syndrome  New! Time/Dose Effects in ARS Time Phases of ARS  New! Strategic National Stockpile Animations, Illustrations, Photos Dictionary Emergency Contacts Download REMM (7/2008) Download Mobile REMM (12/2008)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS   HPS IAEA ICRP NCRP NRC OSHA REAC/TS RITN WHO
	Contamination: Diagnose/Manage (Text Version) CAUTION Algorithm guideline modifications will be required in mass casualty events. Contact radiation safety officer Assess External Contamination Assess contamination pattern with radiation survey meter Evaluate for radioactive shrapnel Document contamination pattern on a body diagram (PDF - 49 KB) Obtain nasal swabs for radioactivity assay if significant internal contamination suspected (survey meter shows head/neck contamination) Decontaminate Whole Body Decontaminate onsite or at other designated area Follow decontamination procedures Re-scan patient with radiation survey meter Repeat decontamination until radiation reading is < 2 times background radiation level Do not exceed 3 attempts Special issues for infants and children Evaluate if All Are True: Decontamination successful (< 2 times background radiation) Absent or minimal physical injury If All Are True: Send home with follow-up instructions Register in event database Otherwise: Evaluate at Medical Facility Treat life- or limb-threatening injuries first Obtain sequential CBCs with differential to rule out whole-body exposure and ARS Remove any remaining radioactive shrapnel and shield it safely Assess Internal Contamination Scan patient with radiation survey meter (caveat) Event responders or radiation safety officer will identify the isotope(s) Swab body orifices (e.g., nostrils, ears, mouth, rectum) to help estimate body burden of isotope Collect 24-hr stool for isotope measurement (baseline and sequential after management) Collect 24-hr urine for isotope measurement Label all specimens with time, date, and name Perform total body count if available; consider hospital nuclear medicine equipment Treat Internal Contamination of Specific Isotope Isotope Table Countermeasures Table Decision to treat will depend on Size of radiation event Availability of resources/personnel Likelihood that patient will survive If No Recovery: Management of the deceased Register data into event database For Patient Making a Recovery: Arrange for Continuing and Long-Term Follow-up Send home with follow-up instructions Register patient in long-term follow-up database

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