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Preparing for the Patient and Decontamination. Wm. Mark Hart MS RN EMT-P REAC/TS Nurse/Paramedic & Education Coordinator 24/7 Emergency Phone: 865-576-1005 (DOE Oak Ridge Operations) Developed in cooperation with Rob Beauchamp RN NREMTP REAC/TS Nurse/Paramedic. - PowerPoint PPT Presentation
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Preparing for the Patient and DecontaminationWm. Mark Hart MS RN EMT-PREAC/TS Nurse/Paramedic & Education Coordinator
24/7 Emergency Phone: 865-576-1005 (DOE Oak Ridge Operations)
Developed in cooperation with Rob Beauchamp RN NREMTP REAC/TS Nurse/Paramedic
FRS radio, safe separation device, 6v btryexplosives, blasting caps
450 Ci Cobalt 60 source from Mexico. The source contained 6000 pellets with magnetic properties. Each pellet contained~75 mCi with an exposure rate at 50cm of 0.4 R/h
137 Cesium Chloride
ED Protocol for Radiation AccidentsActivation & Notification (Alert Process)Information SynthesisED PreparationPatient ProcessingDecontaminationED DischargeClean-up & Recovery
Information SynthesisScene communicationsIncident commander/POC/designeeLocation & Time of accidentMechanism of injuryNumber of patients & condition (Medical & Radiological)Identification of radioactive materialType(s) of radiation injuryIn-house or outside expertise
REAC/TS Radiation Patient Treatment algorithm. Used by permission.
Preparing the Area
The areas readytime to get dressed.
Dressing Out
The Finished Product!!!
Patient Care(rememberMEDICAL CARE FIRST!)
treat life threatening problems first when medically stable, remove clothing approximately 80% of contamination is removed by disrobing patient
cut clothes from the head towards the feet
roll clothes outward keep contamination away from patient
log roll protect cervical spine, if necessary fold sheet over clothing
Complete log roll Roll sheet from head to feet Keep contaminated material away from patient's skin and airway
Remove contaminated material from immediate area Survey patient's back for contamination
Double bag contaminated linens and clothes Remove from immediate area Keep in designated holding area
Medical problems come first Treat life threatening problems immediately If patient is stable, remove clothing and survey for radioactive contamination
when possible, use distance to lower exposure rate
bag wound dressing label with name, date, time and meter reading in cpm double bag and remove from immediate area
survey and define area of contamination at wound site document initial reading in cpm
drape area with water proof drapes
tape edges of drapes to skin
direct run off into lined garbage can
pads help protect from splashing
wash and irrigate wound avoid high pressure flushing
only blot wound one time with each 4x4 do not spread contamination
cover and protect wound remove drapes and pads
place clean chucks or pads remove contaminated trash from immediate patient area
repeat survey compare current readings to initial survey repeat washings as long as they produce a decrease in survey readings reasonable goal - less than three times background level
draping and washing process is repeated for each decontamination effort stop when no longer getting lower survey readings
bandage and wrap decontaminated wound
Stitches??? Surgery??? Make decisions based on medical needs, NOT contamination concerns REAC/TS 865-576-3131
Lets get out of here!
EgressTime to go!
And now youre free!
Clean-up & RecoveryExit procedure of decon teamRadiological surveyspersonnelroomequipmentHandling of contaminated wastedisposalownershipmonitoringsecurity
QUESTIONS????
Now, lets talk about what needs to be done when it is known that a radiological or nuclear incident has occurred and what needs to be done in the hospital to receive and manage the victims. The REAC/TS Radiation Patient Treatment algorithm is meant to provide decision-support to providers. It is lacking a lot of detail but contains all of the essentials needed to manage radiological patients effectively and efficiently.
Talking points - some to be discussed in more detail throughout the presentation.
The emergency management of victims from radiological and nuclear (R/N) incidents follows some very logical and quite simple pathways. 2) How to deal with staff and patient concerns for radiation exposure needs to be managed IN ADVANCE of an incident. These issues must be addressed and taught in planning and preparation stages. 3) Radiation protection and contamination control need attention but are actually not that much different than management of biological and chemical hazards. There are only a few additional considerations.
Protection of personnel and patients can be accomplished with:
a) Universal precautions; b) Appropriate personal protective equipment and anti-contamination clothing; and c) Following the principles of ALARA (As Low As Reasonably Achievable) to be discussed later.