Could your lab deal with a nuclear accident?
The phone rings. It's the emergency room with chilling news: A patient exposed to radiation just came in, and they're following the emergency policy for nuclear accidents.
If you had answered this call, would you be ready? Could the nuclear medicine specialists in your laboratory deal effectively with the health care demands brought on by a nuclear power plant accident? Check your emergency policy manual before the call comes. You will probably be surprised at what you find--or don't find.
Guidance at our 250-bed hospital was meager. This was discovered when supervisors began reading and rewriting policies in preparation for an annual city inspection. In the ER, a new director of emergency medicine and a new nursing supervisor looked at the emergency nursing manual with a fresh sense of involvement. Finding no mention of radiation accident patients, they called me for assistance.
When I pulled out the nuclear medicine division's radiation safety manual, I was dismayed at how little there was on the subject. The manual had not been updated in several years and ignored the advent of nuclear power plants. In place of a single, obsolete page in the manual, we researched and wrote a 15-page chapter on emergency handling of radiation accident cases. Figure I presents an excerpt of the new procedures.
If you think your lab doesn't need written procedures for managing radiation accident victims, think again. Even if you just handle RIAs, and no imaging, you may well be the hospital's only experts on radioactive materials. Putting the expertise to work becomes a grave responsibility in the event of a nuclear disaster in your community. One hopes the bomb is too remote a possibility to discuss--we will focus on the much greater threat of radiation exposure posed by the approximately 100 nuclear power plants currently operating in the U.S.
There is a 45 per cent chance of a major American power plant accident within the next 20 years, the Nuclear Regulatory Commission (NRC) estimated during Congressional hearings last year. That could mean a catastrophe like the nuclear reactor breakdown at Chernobyl in the Soviet Union, which dwarfed our own Three-Mile Island accident in extent of damage.
Nuclear power plant accidents can be caused by anything from faulty construction to human error. Indeed, studies have shown that human error is a significant risk factor, with the risk increasing during early morning hours. In 1985, for example, such accidents were reported at the Davis-Besse nuclear plant near Toledo, Ohio (June 9, 4:14 a.m.) and at California's Rancho-Seco plant, 25 miles southeast of Sacramento (Dec. 26, 1:35 a.m.).
Inadequate materials are a factor in construction-related problems, but even the best concrete--although far safer than lead for reactors--cannot outlive uranium, which has a half-life of 7.13 X 10.sup.8 years.
With these dangers in mind, perhaps it's time to take stock of what your laboratory manual currently covers. Does it include procedures for handling nuclear accident cases, and if so, is the material up to date?
If you don't have any set procedures and don't know where to begin, you might contact a health physicist to clarify any technical questions, such as how to dispose of radioactive waste. A health physicist specializes in the physiological effects of radiation. Any hospital that performs x-rays has a health physicist on staff or available as a consultant.
The idea of being exposed to radiation is very frightening to most people, including those in health care. The lab can help allay the fear that the word "radiation" induces by describing the various types of exposure, along with the treatment for each. We did just that in our revised manual, helping nurses to understand the scope of any particular radiation case and reassure their patients.
In another key change, emergency treatment starts sooner. The original procedures began with the patient arriving at the hospital. Now emergency measures are implemented as soon as the ambulance squad informs the hospital that a patient with possible radiation exposure is en route. (The ambulance squad is also responsible for assessing the level of exposure.) This alert triggers a set of standing orders that prepares the emergency room for the patient's arrival. The ER notifies the hospital's radiation safety officer, the nuclear medical division, and clinicians, so all will be on site to manage the crisis.
Arrival decontamination procedures at some hospitals call for the use of hoses in a shower stall outside the building or the use of an indoor shower. Our protocol designates the morgue table as the decontamination site.
Thay may sound a bit morbid, but it's a logical choice. Some patients are too ill or severely injured to stand up in a shower stall. The morgue is usually unoccupied, and the table allows for plenty of rinsing and dilution of contaminated water. Ours is located out of the way--in the basement, one floor below the emergency room--thus reducing the likelihood of exposing other staff members and patients.
If a patient is grossly contaminated but has no open wounds or symptoms that require immediate attention, he or she goes directly to the morgue for decontamination. If the patient's condition is deemed life-threatening, however, contamination becomes a secondary concern, and treatment begins at once in the ER.
Among tests that may be performed, a white blood cell count is particularly important. The cound frequently drops in radiation accident patients, rendering them susceptible to infections. In patients who may have ingested radioactive materials, urine and stool specimens are also analyzed for the amount of radionuclide excreted. This can guide therapy.
Radiation victims may develop one of three syndromes, depending on the level of exposure. Lab testing in cases of hemopoietic syndrome include a bone marrow biopsy and CBS. A bone marrow biopsy can also be performed on patients who evidence a gastrointestinal syndrom, which involves the small intestine. However, testing is probably futile in these cases, as there have been no documented recoveries. The prognosis has been similarly discouraging for patients who develop a central nervous system syndrome, which affects the brain.
Procedures should also spell out th eproper disposal of all contaminated materials. The emergency room staff must be instructed to place gauze, sponges, and dressings in separate containers for monitoring, storage, and decay. We use disposable plastic bags in lead waste cans or lead-lined containers and keep the sealed bags well away from the rest of the trash. The bags are monitored periodically with a Geiger counter. For example, if a radioactive substance is short-lived and decays in six hours, we will check it for a full 72 hours. When the substance reaches normal background levels, it goes out with the rest of the trash.
The manual should list phone numbers of Federal, state, and local agencies that you would want to notify or consult. You should include the number for the regional office of the NRC--ours is in King of Prussia, Pa., and serves the East Coast from Maine to Maryland--as well as the Department of Energy's regional coordinating office for radiological emergency assistance. The point is that a crisis is no time to be thumbing through the telephone book.
Once your procedures are complete, make sure you have the necessary equipment and supplies. Does the ER have its own survey meter or Geiger counter? Does the lab have one? More important, have the meters been checked and calibrated recently? The Joint Commission on Accreditation of Hospitals requires annual calibration, but it doesn't hurt to check more often. (NRC recommends quarterly calibration.) Whenever you do it, make sure the batteries haven't corroded.
The survey meter should be part of a portable radiation response kit. You can purchase a prepackaged kit for about $1,000 or you can easily assemble your own for less money (many of the supplies are already available in the hospital). Figure II shows the components and typical prices.
We store our kit in the emergency room, where the patient is likely to need it and where nuclear medicine personnel will be in the event of an accident.
If you work near a nuclear power plant, develop a good rapport with plant officials. Tell them about your emergency plan, discuss theirs, and solicit suggestions. Find out what radionuclides are used, which ones could be released, and how they would notify the various emergency squads. We are located less than 20 miles from the Calvert Cliffs power plant in Annapolis, Md. Our nuclear medicine director plans to meet with the officials there and discuss our protocol.
It's also a good idea to conduct in-services for hospital staff members who will responsd to a radiation accident. Explain the types of exposure, outline procedures for waste disposal, and try to allay their fears about radiation. So far, we have concentrated our efforts on the nursing staff, and we have made the point that they are exposed to radiation every day.
"The National Institutes of Health Radiation Guide" notes that the possible annual radiation dose for those who work eight hours a day near the granite walls at New York City's Grand Central Station is 0.2 rem. American television sets, other consumer products, and air travel deliver an average annual dose of 0.0026 rem. We live in a nuclear society.
Our hospital's nuclear crises have so far been limited to semi-annual accident drills. But we're ready if the real thing comes along, and you should be, too.
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|Title Annotation:||procedures, equipment and training; includes excerpts of the radiation accident procedures|
|Author:||Woodrum, Christine E.|
|Publication:||Medical Laboratory Observer|
|Date:||Mar 1, 1987|
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