Medical Management of Persons Internally Contaminated with Radionuclides in a Nuclear or

119 Pages·2017·5.03 MB·English

EPR-INTERNAL EPR-INTERNAL
CONTAMINATION CONTAMINATION
2 0 1 8 2 0 1 8
Medical Management of
Persons Internally
Contaminated with
Radionuclides in a Nuclear
or Radiological Emergency
A Manual for Medical Personnel
Jointly sponsored by the
Endorsed by
A M E R I C A N S O C I E T Y F O R R A D I A T I O N O N C O L O G Y
I N T E R N AT I O N A L AT O M I C E N E R G Y A G E N C Y
V I E N N A
I S S N 2 5 1 8 – 6 8 5 X @
E ME RG E NCY PRE PARE DNE S S
AND RE SP ON SE
EPR-INTERNAL
CONTAMINATION 2018 Medical Management of Persons Internally Contaminated with Radionuclides in a Nuclear or Radiological Emergency
IAEA SAFETY STANDARDS AND RELATED PUBLICATIONS
IAEA SAFETY STANDARDS
Under the terms of Article III of its Statute, the IAEA is authorized to establish or adopt
standards of safety for protection of health and minimization of danger to life and property, and
to provide for the application of these standards.
The publications by means of which the IAEA establishes standards are issued in the
IAEA Safety Standards Series. This series covers nuclear safety, radiation safety, transport
safety and waste safety. The publication categories in the series are Safety Fundamentals,
Safety Requirements and Safety Guides.
Information on the IAEA’s safety standards programme is available on the IAEA Internet
site
http://www-ns.iaea.org/standards/
The site provides the texts in English of published and draft safety standards. The texts
of safety standards issued in Arabic, Chinese, French, Russian and Spanish, the IAEA Safety
Glossary and a status report for safety standards under development are also available. For
further information, please contact the IAEA at: Vienna International Centre, PO Box 100,
1400 Vienna, Austria.
All users of IAEA safety standards are invited to inform the IAEA of experience in their
use (e.g. as a basis for national regulations, for safety reviews and for training courses) for the
purpose of ensuring that they continue to meet users’ needs. Information may be provided via
the IAEA Internet site or by post, as above, or by email to Offi
MEDICAL MANAGEMENT OF PERSONS
INTERNALLY CONTAMINATED WITH
RADIONUCLIDES IN A NUCLEAR
OR RADIOLOGICAL EMERGENCY
The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the
IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The
Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the
contribution of atomic energy to peace, health and prosperity throughout the world’’.
EPR-INTERNAL CONTAMINATION (2018)
MEDICAL MANAGEMENT OF PERSONS
INTERNALLY CONTAMINATED WITH
RADIONUCLIDES IN A NUCLEAR
OR RADIOLOGICAL EMERGENCY
A MANUAL FOR MEDICAL PERSONNEL
JOINTLY SPONSORED BY THE
INTERNATIONAL ATOMIC ENERGY AGENCY,
INTERNATIONAL FEDERATION OF RED CROSS
AND RED CRESCENT SOCIETIES
AND PAN AMERICAN HEALTH ORGANIZATION
ENDORSED BY THE
AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE,
AMERICAN SOCIETY FOR RADIATION ONCOLOGY,
EUROPEAN ASSOCIATION OF NUCLEAR MEDICINE,
LATIN AMERICAN ASSOCIATION OF SOCIETIES OF
NUCLEAR MEDICINE AND BIOLOGY
AND SOCIETY OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
INTERNATIONAL ATOMIC ENERGY AGENCY
VIENNA, 2018
COPYRIGHT NOTICE
All IAEA scientific and technical publications are protected by the terms of
the Universal Copyright Convention as adopted in 1952 (Berne) and as revised
in 1972 (Paris). The copyright has since been extended by the World Intellectual
Property Organization (Geneva) to include electronic and virtual intellectual
property. Permission to use whole or parts of texts contained in IAEA publications
in printed or electronic form must be obtained and is usually subject to royalty
agreements. Proposals for non-commercial reproductions and translations are
welcomed and considered on a case-by-case basis. Enquiries should be addressed
to the IAEA Publishing Section at:
Marketing and Sales Unit, Publishing Section
International Atomic Energy Agency
Vienna International Centre
PO Box 100
1400 Vienna, Austria
fax: [phone]
tel.: [phone]
email:
FOREWORD
This manual covers the specific measures to be taken in the medical management of individuals
who have been internally contaminated through inhalation, ingestion or absorption of
radionuclides in a nuclear or radiological emergency. It includes a number of exposure
scenarios, risk models and dosimetric data which can be used during the response to a nuclear
or radiological emergency or for other purposes. However, it may be necessary to adapt some
of the concepts discussed in this manual to reflect the prevailing national, regional or local
medical conditions and capabilities.
The manual is published as part of the IAEA’s Emergency Preparedness and Response (EPR)
series. It supports several other publications issued on this overall topic, including IAEA Safety
Standards Series No. GSR Part 7, Preparedness and Response for a Nuclear or Radiological
Emergency, and EPR-Medical 2005, Generic Procedures for Medical Response during a
Nuclear or Radiological Emergency.
This publication has been co-sponsored by the International Federation of Red Cross and Red
Crescent Societies and the Pan American Health Organization, and endorsed by the American
Association of Physicists in Medicine (AAPM), the American Society for Radiation
Oncology (ASTRO), the European Association of Nuclear Medicine (EANM), the Latin
American Association of Societies of Nuclear Medicine and Biology (ALASBIMN), and the
Society of Nuclear Medicine and Molecular Imaging (SNMMI). The IAEA wishes to
acknowledge the boards of all the organizations that have co-sponsored and endorsed this
publication.
The IAEA is grateful for the contributions made by numerous experts from Member States to
the development of this publication. It also wishes to thank the many specialists from national
and international organizations for their important input. The IAEA is particularly grateful to
N. Valverde (Brazil) and A. Wiley (United States of America) for their valuable contributions
to this manual. The IAEA officer responsible for this publication was E.D. Herrera Reyes of
the Incident and Emergency Centre, Department of Nuclear Safety and Security.
EDITORIAL NOTE
This publication (including the figures, tables and references) has undergone only the minimum copy editing considered necessary for
the reader’s assistance.
The views expressed remain the responsibility of the contributors and do not necessarily reflect those of the IAEA or the governments
of its Member States.
Neither the IAEA nor its Member States assume any responsibility for consequences which may arise from the use of this publication.
This publication does not address questions of responsibility, legal or otherwise, for acts or omissions on the part of any person.
The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal
status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries.
The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to
infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA.
The IAEA has no responsibility for the persistence or accuracy of URLs for external or third party Internet web sites referred to in this
publication and does not guarantee that any content on such web sites is, or will remain, accurate or appropriate.
CONTENTS
1. INTRODUCTION ............................................................................................................. 1
1.1. BACKGROUND ................................................................................................. 1
1.2. OBJECTIVE ........................................................................................................ 2
1.3. SCOPE ................................................................................................................ 2
1.4. STRUCTURE ...................................................................................................... 2
2. CONSIDERATIONS IN THE MEDICAL MANAGEMENT OF
INTERNALLY CONTAMINATED PATIENTS ............................................................. 4
2.1. GENERAL CONSIDERATIONS IN THE MEDICAL
MANAGEMENT OF INTERNAL CONTAMINATION .................................. 4
2.2. MEDICAL MANAGEMENT AT THE SCENE AND
TRANSPORTATION ......................................................................................... 5
2.3. MEDICAL MANAGEMENT AT THE HOSPITAL ......................................... 7
2.4. INITIAL DECISIONS FOR THE TREATMENT OF PATIENTS .................. 10
3. DOSIMETRIC CONSIDERATIONS IN THE ASSESSMENT OF
INTERNALLY CONTAMINATED PATIENTS ........................................................... 13
3.1. ASSESSMENT OF INTERNAL CONTAMINATION WITH
RADIONUCLIDES .......................................................................................... 13
3.2. BASIS FOR DECORPORATION DECISIONS .............................................. 13
3.3. BASIS FOR THE USE OF OILs FOR DECORPORATION ........................... 14
4. CONTAMINATION PATHWAYS, METABOLIC PHASES AND
METHODS FOR THE TREATMENT OF INTERNALLY
CONTAMINATED PATIENTS (DECORPORATION METHODS) ........................... 22
4.1. GENERAL PROCEDURES ............................................................................. 25
4.2. BLOCKING ...................................................................................................... 25
4.3. ISOTOPIC DILUTION ..................................................................................... 26
4.4. DISPLACEMENT ............................................................................................ 26
4.5. ION EXCHANGE ............................................................................................. 26
4.6. MOBILIZATION .............................................................................................. 26
4.7. CHELATION .................................................................................................... 27
4.8. EXCISION ........................................................................................................ 28
4.9. LUNG LAVAGE .............................................................................................. 28
5. BASIC INFORMATION ON SELECTED RADIONUCLIDES AND
POSSIBLE DECORPORATION THERAPY ................................................................ 29
5.1. AMERICIUM (AM) ......................................................................................... 29
5.2. CAESIUM (CS) ................................................................................................ 31
5.3. COBALT (CO) .................................................................................................. 34
5.4. IODINE (I) ........................................................................................................ 37
5.5. PLUTONIUM (PU) ........................................................................................... 39
5.6. POLONIUM (PO) ............................................................................................. 42
5.7. STRONTIUM (SR) ........................................................................................... 43
5.8. TRITIUM .......................................................................................................... 46
5.9. URANIUM (U) ................................................................................................. 47
5.10. SUMMARY OF POSSIBLE DECORPORATION THERAPIES
FOR OTHER RADIONUCLIDES ................................................................... 49
6. SCREENING A LARGE NUMBER OF PEOPLE FOR INTERNAL
CONTAMINATION ....................................................................................................... 52
6.1. INTRODUCTION AND HEALTH CONSIDERATIONS .............................. 52
6.2. RADIATION MONITORING UNITS ............................................................. 53
6.3. CONSIDERATIONS FOR SCREENING AND MONITORING.................... 56
6.4. PEOPLE MANAGEMENT AND INFORMATION ........................................ 59
6.5. BASIC DECONTAMINATION AND WASTE MANAGEMENT ................ 60
7. HANDLING OF DECEASED BODIES WITH RADIONUCLIDE
CONTAMINATION ....................................................................................................... 61
7.1. GENERAL COMMENTS................................................................................. 61
7.2. PROCEDURES FOR THE SAFE HANDLING OF DECEDENTS ................ 61
7.3. ON-THE-SCENE RECOVERY OF DECEDENTS ......................................... 63
7.4. FIELD MORGUE NEAR THE SCENE ........................................................... 64
7.5. BASIC PROCEDURES IN THE MORGUE AND RELEASE OF
BODIES ............................................................................................................ 64
8. CASE REPORTS ............................................................................................................ 67
8.1. CAESIUM-137: INTERNAL/EXTERNAL CONTAMINATION .................. 67
8.2. POLONIUM-210: A LETHAL INDUSTRIAL INHALATION
ACCIDENT ....................................................................................................... 69
8.3. PLUTONIUM-239: THREE CASES OF OCCUPATIONAL
CONTAMINATION ......................................................................................... 70
8.4. YTTRIUM-90: THERAPEUTIC RADIOPHARMACEUTICAL
ACCIDENT ....................................................................................................... 75
8.5. AUTOPSIES ON CONTAMINATED BODIES .............................................. 75
APPENDIX I: DRUGS THAT MAY BE USED FOR DECORPORATION
TREATMENT ........................................................................................... 77
APPENDIX II: PROTECTION OF HEALTH CARE PROVIDERS AND
PREPARATION OF THE EMERGENCY DEPARTMENT
AT THE HOSPITAL ................................................................................. 86
APPENDIX III: DIFFERENCES BETWEEN RADIOACTIVE AND
CHEMICAL OR BIOLOGICAL HAZARDS ...................................... 90
REFERENCES ......................................................................................................................... 92
DEFINITIONS .......................................................................................................................... 99
ABBREVIATIONS ................................................................................................................ 104
CONTRIBUTORS TO DRAFTING AND REVIEW ............................................................ 105