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