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Management of Persons Accidentally Contaminated With Radionuclides (N C R P Report) PDF

219 Pages·1980·7.36 MB·English
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NCRP REPORT No. 65 MANAGEMENT OF PERSONS ACCl DENTALLY CONTAMINATED WITH RADIONUCLIDES Recommendations of the NATIONAL COUNCIL ON RADIATION PROTECTION AND MEASUREMENTS Issued April 15, 1980 First Reprinting August 1,1985 Second Reprinting May 15,1987 Third Reprinting May 15,1989 Fourth Reprinting May 30,1992 Fifth Reprinting January 31,1993 - Sixth Reprinting November 1,1994 Seventh Reprinting September 22,1997 ' National Council on Radiation Protection and Mea- suremen ts 7910 WOODMONT AVENUE / BETHESDA, MD 2081 4 LEGAL NOTICE Thie report wae prepared by the National Council on Radiation Protection (NCRP). The Council strivet, to provide accurate, complete and di nformation in ita reporta However, neither the NCRP, the membem of NCRP, other pereons contributing to or tusbting in the preparation of this report, nor any pereon acting on the behalf of any of thew partiea (a) make any warranty or representation, oxpress or implied, with respect to the accuracy, cornpletenesa or usefulness of the information contained in thm report, or that the uee of any information, method or pmceas disclosed in thin report may not infringe on privately owned righte; or (b) assumes any liabiity with respect to the use of, or for damages resulting from the use of, any information, method or pmcena dbcld in this report. Copyright Q National Council on Radiation Protection and Meawvementa 1979 All rights reserved. This publication is protected by copyright. No part of this publication may be reproduced in any form or by any means, including photocopying. or utilized by any information storege and retrieval aystem without written permiseion from the copyright owner, except for brief quotation in critical arLiclea or reviews. Library of Conpem Catalog Card Number 79-81648 Interaational Standard Book Number 0-913392489 Preface With the increased use of radionuclides in all fields of science and technology, the NCRP determined to review the scientific literature and select that body of information which represents the state of the art in the management of contaminated individuals. A committee was eelected that was composed of those individuals who could bring the necessary expertise and experience together to write a manual that would be useful to the physician in the management of accidents involving radionuclides. It was recognized that the subject is not a normal requirement of a medical student's curriculum and that, only by attendance at training courses specifically aimed at the subject of managing radiation accidents, would a physician gain any insight into the problems involved in the treatment of casualties, where the pres- ence of the contaminant was detectable only by use of special equip ment. It is a tribute to the safety record of the industry that there is not a vast amount of experience to draw on. There are scattered incidents that have been reported in the world's literature. This manual is intended to mist individuals faced with the problem of managing an accident involving radioactive contamination to make the decisions necessary in selecting the treatment techniques that have been successful in the past or, in the case of a situation where there is no experience, the treatment techniques that appear to be the most rational. The NCRP wishes to emphasize the fact that this report is intended only as an aid and guide for those called on to manage an accident case in its initial stages and cannot be used as a substitute for the knowledge and judgment of the responsible physician or for the information and advice available from those specialists who have had .actual experience with euch casea and who have pondered d of the potential difficulties that arise in such cases. Responsibility for the management of such cases must, of courae, rest with the physician in charge. The Council has noted the adoption by the 15th General Conference of Weights and Meaeures of special names for some units of the Systeme #Unites International (SI) used in the field of ionizing iii radiation. The gray (symbol Gy) has been adopted as the special name for the SI Unit, of absorbed dose, absorbed dose index, kerma, and specific energy imparted. The becquerel (symbol Bq) has been adopted as the special name for the S1 unit of activity (of a radionuclide). One pay equals one joule per kilogram and one becquerel is equal to one second to the power of minus one. Since the transition from the special units currently employed-rad and curie--to the new special names is expected to take some time, the Council has determined to continue, for the time being, the use of rad and curie. To convert from one set of units to the other, the following relationships pertain. 1 rad = 0.01 J kg-' = 0.01 Gy 1 curie = 3.7 x 10'Os-' = 3.7 x 10" Bq (exactly) Serving on the Committee for the preparation of this report were: George L. Voelz, Chainnun Health Division Leader University of California Los Alamos Scientific Laboratory Los Alamos. New Mexico H. David Bruner Herta Spencer Route 1, Box 3397 Chief, Metabolic Section Bonita Springs, Florida Veterans Administration Edward Hines, Jr. Hospital Thomas k Lincoln Hines. Illinois Medical Director Oak Ridge National Laboratory Niel WaJd Oak Ridge, Tennessee Chairman. Department of Industrial En- viroment. Health Sciences Victor H. Smith Graduate School of Public Health Biology Department Battelle Pacific Northwest Labo- University of Pittsburgh Pittsburgh. Pennsylvania ratories consuuant John W. Healy Health Division University of California Los Alamos Scientific Laboratory Los Alarnos. New Me& NCRP Secretarkt. James A. Spahn, Jr. The Council wishes to express its appreciation to the members and the consultant of the Committee for the time and effort devoted to the preparation of this report. WARREKN. SINCLAIR President, NCRP Bethesda, Maryland October 15, 1979 Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Introduction ........................................ . 2 Quick Reference Information .......................... . 3 Initial Management of the Patient ..................... 3.1 Introduction ...................................... 3.2 Uptake and Clearance Mechanism ................... 3.3 The Contaminating Radionuclide .................... 3.4 Initial Radioactivity Measurement ................... 3.5 On-Site Management ............................. 3.6 Transportation .................................... 3.7 Hospital Management ............................. 3.8 Evaluation of the Contaminated Patient .............. . 3.9 Public Health Considerations ........................ 4 D. iag.n ostic Techniques to Measure Radioactive Contam- rnatron ............................................... 4.1 Surface Contamination Meesurements ................ 4.2 Penetrating (External) Radiation Measurements ....... 4.3 Measurements by Excretion (Bioassay) Sampling ...... . 4.4 In Viuo Measurements .............................. 5 Conceptual Basis for Treatment Decisions ............. 5.1 Timeliness of Data ................................. 5.2 Risk/Benefit Considerations ....................... 5.3 Soluble Versus Insoluble Compounds ................. . 5.4 Multiple Isotope Effects ............................ 6 Resume of Experience With Important Radionuclides . 6.1 Americium ......................................... 6.2 Californium ....................................... 6.3 Cerium ........................................... 6.4 Cesium ........................................... 6.6 Cobalt ............................................ 6.6 Curium ........................................... 6.7 Gold ............................................. 6.8 Iodine ............................................. 6.9 Mercury .......................................... 6.10 Phosphorus ........................................ v ~i / CONTENTS 6.1 1 Plutonium ......................................... 6.12 Polonium .......................................... 6.13 Radium ........................................... 6.14 Strontium ......................................... 6.16 Technetium ....................................... 6.16 Thorium ........................................... 6.17 Tritium (Hydrogen-3) ............................... 6.18 Uranium .......................................... . 7 Therapy Procedures and Drugs ....................... 7.1 Skin Decontamination .............................. 7.2 Treatment of Contaminated Wounds ................. 7.9 Treatment of Internal Contamination ................. 7.4 Lung Lavage ....................................... APPENDIX A Radiological Aseietance Plan (RAP) ....... APPENDIX B Definitions ................................ References ............................................... The NCRP ................................................ NCRP Publications ........................................ ... Index ....................... ......................... Introduction Inrreasing use of radionuclidm in research, medical applications, nuclear power, and industrial proceasea eugeesta that there is also a concomitant increase in the probability of human erpoawea to inter- nally-deposited radionuclides. It is important that such erpoeRves be minimized, especially by preventive means, but good medical manage- ment is important when exposure has occurred. The literature on medical management of such cases is scattered and sparse. Any indi- vidual physician or health physicist probably will have had experience with only a limited number of radionuclides and a limited variety of exposure conditione. Furthermore, the therapeutic dectiveness of some treatmenb has been tested only in animals. Other therapies may be thought to be useful but have not been evaluated for a particular radionuclide or accident situation. This report is a collection of many of these data and ideas into one document to aid those called upon to manage contaminated perao118. Persons who use this report will probably represent a broad spec- trum of professional personnel but the NCRP has directed its atten- tion and recommendations primarily toward the physician who as- sumes responsibility for a case. He may be an occupational physician, emergency room physician, military phyeician, general practitioner, nuclear medicine specdht, physician consultant to the nuclear indus- tries, or a public health physician. Hospital staffs should find this report of sufficient value to make it available in their emergency rooms. Nurses, ambulance attendants, rescue quads, and other para- medical pexsonnel will tind sections relating to their duties. Health physicieta will find useful information that will contribute to their role in the management of accident casee. It is recognized that many aspecte of medical management depend on judgment and evaluation that are difficult to express in wonle. Some portiona of the report present collective opinions that are in- tended to assist in such judgment and evaluation, but it muat be recognized that there ie comiderable latitude in the profdona1j udg- ment of physicians as to the extent and intensity of treatment of a particular case. This report will be a guide and aid in the general management of such cases, but it ie not intended as a model or standard for medical practice. 1 Several problems exist concerning the me of some medications that are effective in the treatment of persons internally contaminated with radionuclidea Experimental studiea have shown eome mat8riala to be useful, but they have not been considered for approval as a drug by the Food and Drug A ' ' ' ' tion, or they are available only as an Investigational New Drug under approved study conditions. Informa- tion demonstrating the experimental effectiveness of such compounds in reducing expomw to intend radionuclides h ed along ' with the available information on toxicity of such compounds. The report is written so that wful advice can be rapidly obtained by consulting the "Quick Reference Section," pages 3 to 19. The firet four tables in this ~ectiona re check lists that will guide the gathering of information MI as to f mth e early efforts to deal with the particular problem. Table 2.5 ia a fmmumqy of treatment considerations for selected radionuclidee and an index to the appropriate sections of the report. Table 2.6 providea information on selected radionuclidee that can be used in preliminary assesement of the consequences of an exposure. More deetive d m e stimates must be made using the specific d e a o f the exposure, including the chemical and physical form of the nuclides involved, and the latest data on these radionu- clidea It is important to emphasize that management of these cases requires a team effort by many apecidkts. The evaluation and management of such accident casee should utilize the help of profdona1 health physicists, analytical chemists, and dosimetry (internal and external) specialists, as well as medical specialists. This NCRP report ia intended aa an aid and guide for those called to manage an accident case in its initial stages and cannot passibly substitute for the information, advice, and judgment available from the above epecialieta 2. Quick Reference Information TABL2E1 4-sitee mergency check list Note. The eequence and priority of these actions will my with difhmt accident conditions. Provide emergency 'medical care immediately for eerioue injwiea and preserve vital hctione. Minor injuries can wait until nfter initial radiation m y haa been com- pleted. Remove individual &om contaminated radiation erea Individual dotea up to 100 rems may be permitted for liFe saving purposea or up to 26 rem for ieas urgent needs (NCRP, 1971). Teams miy be used in relays to remove injured peraone from very high radiation are= Sweyi ndividual for dacec ontaminntion levala Get nasal smears. Do this before ahowering (Sectione 3.4.1 aml4.1.4); Remove contaminated clothes and replace with clean coveralls or wrap in Met. Take individual to an area where akin decontaminntion or showering can be done. Deconhnhte skh. Remove all transferde contamination if poseible (Sections 3.7.4 nnd 7.1.5) by cl- contaminated skin area snd showering. Cover contaminated wounds with sterile dmdnp before and aRer decontaminatim efforts (Section 7.25). Alert hospital and call for nmbdmce service M emn M it is &temined that it is needed Apprise them of situation if their help ie required (Section 3.6.7). Identify radionuclide(a) involved in tbe accident and, ifpogaible, ascertain ib chemical form, eohrbility, and presumed pnrticle t3iae. Send personnel radiation doshetern for pmxuaing. Get complete history of accident (Section 3.8.I), especially an it relates to the activities of the individual. Where wae he? What w ah e doing? Exit path? Symptoms? Evaluate possibility of penetrating radiation erposure (Section 36.6). Advise individual on coWon of dl excreta (Section 3.5.8). Provide containers. Save other contaminated materials (Section 3.5.9). Be sure someone has asnumed mpomibiity for management of the ddenta rea. In radiological mahmce needed? Who will request it? hom whom? &port your initial reeponeea and evaluation to the plant -82 (Section 3.6.4). Get names of supervieory and health physics pereonael who will r e do n call in caae additional information is needed (Section 3.6.7). Take individual to the Wital if injuries require surgical care not available at plant or If further medical or dosimetric evaluation and treatment is requird Take precautions to prevent spread of contambation during traMport and movement of the patient (Section 3.6). Have tmnaport vehicles, attendank., and equipment checked for residual radioactive contaminntion before release fmm hospital area. If environmental coatamination outside the plant ha.9 ocnu7ed, notify public health authorities (Section 3.9). Advise family and ne& of kin on the extent of injuries and exposum (Section 3.6.4). Plant management pemnnel and the medical department parsonael ehould agree on the proper procedure. Find out where to wnd bioassay specimens nnd longth of time tequirad for anal* Specify who will receive the d t a 3 / 2 QUICK INPORWTION a. Nuasof patisat, empbyar, oompny Illlmko. b. Physial injrnies and mntunnt. c. Sldo~aam~tiwxita&nmtkm,domnte.ad/orewntnte~tm initLllyudafterdeamtunin8~and~ofdeam~tknrsetbocb .ndagmtod d. Internal wntamhtioa (1) Radionuclide. ita ehcaniclll fonn, probable SolUbiIity, and podble putide charrct41'. (2) S u s p e c b d m u t e o f ~ (3) N dco rrnk (4) Wound counts (5) Whole body colmta (6) BiiaampIea-colbeted (7) Treetalent initiathd e. Extemaleqammtopmetnhgrrdi.tba (1) hecisebcatiundpaitkadtbep.tieatraktivetotbs~ofndiath attkaedarpoeun. (2) Eucttimeaadduntiondexpoewu (3) Wn doeilnetsr bhjJa an? whom? what typeB? (4) Hae dosiwter beem edlactsd? By whom? Whom & it am locatad? (5) Symptom type rrad time of oecurrsacc. (6) Describe other dmhehk studies mdemay. (7) -t. f. Nameandphomnumberof~prrY~ptOrlidrLorpbydehnfkodditional info~tion

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