TRANSCRIPT
Medical Response to Nuclear and Radiological
Terrorism
>>
USE OF TRADE NAMES FOR
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.
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>>>
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
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
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
IT
MIGHT
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
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
WEBSITES
FOR OUR VIEWERS TO
LEARN
MORE IN-DEPTH ABOUT
RADIATION
FUNDAMENTALS WHICH
WE'VE
BEEN ABLE TO
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
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
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
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
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
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
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
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
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
TRANSFERABLE
CONTAMINATION AND
POSES A
HAZARD TO BOTH
RESPONDERS AND TO THE PATIENT.
DECONTAMINATION
PARTIES ARE
FIRST
FOR WOUNDS SINCE THEY POSE
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
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
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
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
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
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
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
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
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
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
SPONSORED TRAINING.
TO JOIN
THIS REGISTRY, VISIT
WWW.BT.CDC.GOV/CLINREG.
AS IN CLINICIANS REGISTRATION.
INFORMATION
ABOUT ORDERING
VIDEOTAPES
CAN BE OBTAINED
BY
SENDING AN E-MAIL
TO RSB@CDC.GOV.
IT HAS
BEEN MY PLEASURE BEING
YOUR
MODERATOR FOR THIS
BROADCAST.
MY
THANKS TO OUR PANELISTS,
DR.
JAMES SMITH AND
DR. FUN
FONG, FOR JOINING US
TODAY.
AND
THANK YOU, OUR VIEWERS,
FOR
PARTICIPATING IN THIS VERY
INFORMATIVE
PROGRAM ON MEDICAL
RESPONSE
TO NUCLEAR
AND RADIOLOGICAL TERRORISM.
ON
BEHALF OF EVERYONE AT CDC
AND THE
PUBLIC HEALTH NETWORK,
I'M
KYSA DANIELS, WISHING
YOU A GOOD DAY FROM
BYE-BYE.
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