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08 February 2012

Answer to Question #1671 Submitted to "Ask the Experts"

Category: Homeland Security

The following question was answered by an expert in the appropriate field:

What should medical radiology departments have in place for stocking a radiation-disaster cart? If, during a transportation accident involving radioactive materials used for diagnostic imaging studies (^99MTc, ¹²³I, ⁶⁷Ga, ¹³¹I, ²⁰¹Tl), contaminated victims arrive for treatment, what equipment should a facility have on this disaster cart? Any suggestions, references, or informational websites would be appreciated.

It depends on whether the medical radiology department would be called upon to respond in such a situation. Most hospital emergency rooms have plans to respond to emergent situations and, in the case of radioactively contaminated victims, would likely rely on individuals from their nuclear medicine department or radiation safety section. In any event, items that might commonly be found on carts would include:

survey meters (which do have to be calibrated annually).
radiation dosimeters to be worn by staff working with contaminated victims (these have to be replaced regularly).
swabs, baggies to put them in and containers for specimen collection (these are specimens to be analyzed for radioactivity content).
plastic-backed paper for covering walls/floors, etc.
gowns to be worn while working around the contaminated patient.
tape and labels with the radiation symbol on them.
containers for contaminated disposable equipment and for nondisposable equipment.
rope to cordon off area where contaminated victims will be triaged and where they will be treated.
waterproof shoe covers.
large plastic bags for x-ray plates.

This list is not complete and will vary significantly with the scenario. Staff must be appropriately trained and, for hospitals who are JCAHO (Joint Commission on Accreditation of Healthcare Organizations) accredited, must document the training and emergency drills performed to maintain accreditation. There are a couple of websites that might have some useful information. The first is from the Armed Forces Radiobiology Research Institute. They have a document available on the site (as a downloadable pdf file) that discusses response to radiation incidents. Also, two reports by the National Council on Radiation Protection and Measurements would be useful. They are Report 65, "Management of Persons Accidentally Contaminated With Radionuclides," and Report 138, "Management of Terrorist Events Involving Radioactive Material." Both of these are available for a nominal fee. Kelly Classic Certified Medical Health Physicist Editor's Note: Another source for training is the Radiation Emergency Assistance Center/Training Site (REAC/TS).

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