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

219 Pages·1980·7.36 MB·English

by  National Council on Radiation Protection and Measurements

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