How might I be exposed to radiation?
There are two main routes of radiation exposure:
external and
internal.
-
External radiation is emitted by sources
outside the human body.
-
Internal radiation is emitted by sources
inside the human body. This can happen when radioactive materials are inhaled, ingested, or enter the body through a wound. Internal radiation can also come from radioactive materials that have embedded themselves in the body, such as bomb fragments, shrapnel, or debris.
What PPE is appropriate for me?
The correct PPE, when properly used, will prevent internal exposure to radionuclides, prevent external exposure to alpha particles and most beta particles, and reduce the spread of contamination. PPE will not protect personnel from external exposure to gamma and neutron radiation. The appropriate use of PPE should not introduce additional unnecessary risk to the conduct of duties. Conduct a complete risk assessment before implementing these recommendations.
Contamination Zone Responders
Radiological incident (no other hazards)
Level C PPE or Mission-Oriented Protective Posture (MOPP) 4 (such as, the Joint Service Lightweight Integrated Suit Technology (JSLIST)) provides adequate protection during first response, search and rescue, and decontamination (see Table 1).
- Level A with a self-contained breathing apparatus (SCBA) should be worn if the hazards are unknown.
In the presence of
chemical hazards, biological hazards, recent fire, or low-oxygen areas, Level A or Level B PPE may be appropriate. - For rescues involving fire, structural firefighting gear should be worn, including helmet, SCBA, and turnout gear (thermally insulated coat, pants, and boots).
Transporting Contaminated Patients to an MTF
The risk of radiation injury or illness from transporting contaminated patients is extremely low. Appropriate PPE should not restrict movement unnecessarily or increase the risk of an accident when transporting patients. Other factors and universal precautions will most likely dictate the appropriate PPE.
Appropriate PPE can include:
- Disposable gloves
- National Institute for Occupational Safety and Health (NIOSH) N-95/99/100 respiratory mask
- Eye protection or face shield
- Waterproof disposable shoe covers
- Disposable gown
Resuscitation
Other ventilation devices should be used as an alternative to mouth-to-mouth resuscitation.
Pre-MTF Triage Procedures and Perimeter Security PPE
Those performing initial triage and perimeter security that may encounter contaminated patients should wear a minimum of Level C PPE.
Initial MTF Precautions
Emergency treatment or lifesaving measures performed outside the MTF should not be delayed for radiological decontamination of casualties/patients.
Consider all potential victims/casualties/patients of a radiological/nuclear incident as contaminated unless proven otherwise. Standard hospital barrier clothing, as used in universal precautions, is adequate for emergency treatment of radiological-contaminated casualties. If cross-contamination occurs, it may be necessary to declare an area of the MTF as contaminated and to screen any medical personnel leaving that area for contamination. If patients have been adequately decontaminated before entering the MTF, there are no additional PPE requirements for care of the patient inside the MTF.
How should I remove potentially contaminated PPE?
Remove potentially contaminated PPE in the following order:
- outer gloves
- dosimeter
- tape at ankles/wrists coveralls
- head cover
- respiratory protection
- shoe covers
- inner gloves
Bag the removed PPE separately from non-contaminated equipment and waste.
|
Level A
|
Level B
|
Level C
|
JSLIST
|
|---|
Air Supply
| Self-contained breathing apparatus or Supplied Air Respirator; commercial NIOSH CBRN approved | Self-contained breathing apparatus or Supplied Air Respirator; commercial NIOSH CBRN approved | Tight-fitting full-face piece air-purifying respirator with P-100 filter; organic vapor and acid gas cartridges/canister | M-40 or M-50 mask with air purifying cartridges/canister
|
Suit | Fully encapsulating chemical resistant suit and duct tape to seal seams
| Non-gas-tight encapsulating suit | Tyvek or equivalent garments and duct tape to seal seams
| MOPP 4 JSLIST |
Gloves/ Boots | Chemical resistant over- gloves and boot covers | Chemical resistant over- gloves and boot covers | Double gloves and boot covers | Double gloves and overboots |
Situations for Use
| Environments that are immediately dangerous to life and health; working with substances that can be absorbed by or are
hazardous to skin | Environments that are immediately dangerous to life and health; only if substances cannot be absorbed by or are not hazardous to skin | First response, search and rescue, and decontamination | First response, search and rescue, and decontamination |
Note: A complete risk assessment should be conducted before implementing these recommendations.
References
- Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Managing Hazardous Material Incidents: Volume 1 - Emergency Medical Services. https://www.atsdr.cdc.gov/mhmi/index.html#bookmark05
- Armed Forces Radiobiology Research Institute. 2013. Medical Management of Radiological Casualties Handbook, Fourth Edition. https://afrri.usuhs.edu/sites/default/files/2020-07/4edmmrchandbook.pdf
- National Council on Radiation Protection and Measurements. 2008. NCRP Report No. 161, Management of Persons Contaminated With Radionuclides.
- National Council on Radiation Protection and Measurements. 2001. NCRP Report No. 138, Management of Terrorist Events Involving Radioactive Material.
- “Radiation Emergency Medical Management," U.S. Department of Health & Human Services. https://remm.hhs.gov/
- U.S. Army Center for Health Promotion and Preventive Medicine. 2008. Technical Guide 244, The Medical NBC Battlebook. https://ephc.amedd.army.mil/HIPECatalog/viewItem.aspx?id=277
