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Exposure + Contamination (Text Version)

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Algorithm guideline modifications will be required in
mass casualty events.


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  1. Assess External Contamination
  2. Decontaminate Whole Body
  3. Evaluate if All Are True
  4. If All Are True:
  5. Otherwise: Evaluate at Medical Facility
    • Treat life- or limb-threatening injuries first
    • Obtain serial CBCs with differential to evaluate possibility of exposure and ARS
    • Remove any remaining radioactive shrapnel and shield it safely
    • Surgical window of about 36-48 hours, depends on rate of dropping blood counts
    • Treat non-life-threatening problems
  6. 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
  7. Treat Internal Contamination of Specific Isotope
  8. Diagnose/Manage Exposure - Acute Radiation Syndrome
  9. If No Recovery:
  10. For Patient Making a Recovery: Arrange for continuing and long-term follow-up
 

US Department of Health & Human Services     
U.S. Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response National Library of Medicine