Population Monitoring and Radionuclide Decorporation Following a Radiological Or Nuclear Incident

Preface......Page 4
Contents......Page 6
1. Executive Summary......Page 14
2.1 Overview......Page 20
2.2 Purpose of this Report......Page 26
2.4 Scope of this Report......Page 27
3.1 Internal Deposition of Radionuclides......Page 30
3.1.1 Inhalation......Page 31
3.1.2 Ingestion......Page 33
3.1.4 Absorption Through Wounds......Page 34
3.3 Effects of Weather......Page 35
3.4 Complications Due to the Presence of Multiple Agents or Serious Injuries......Page 36
3.6 Proximity to the Incident......Page 39
3.7 Previous Experience with Internal Contamination......Page 40
3.8 Conclusions......Page 41
4.1 Radiological Dispersal Device......Page 42
4.1.2 Nature of Contamination......Page 43
4.2.2 Nature of Contamination......Page 44
4.3.1 Incident Characteristics......Page 45
4.4.1 Incident Characteristics......Page 46
4.5 Nuclear Reactor Incident......Page 48
4.5.1 Incident Characteristics......Page 49
4.6.1 Incident Characteristics......Page 50
4.7 Sealed Radioactive Source Incidents......Page 51
4.7.2 Nature of Contamination......Page 52
4.8 Summary......Page 53
5.1 Introduction......Page 54
5.2 Incident Command System......Page 56
5.3 Hospital Incident Command System......Page 59
5.5 Communicating Information from the Scene to the Hospitals and from the Hospitals to the Scene......Page 61
6.1 General Guidance for Emergency Responders......Page 66
6.1.1 Selecting an Appropriate Radiation Survey Instrument......Page 67
6.1.2 Presurvey Radiation Survey Instrument Checks......Page 68
6.2 Radiological Triage and Screening Procedures......Page 69
6.3 Initial Screening at Scene......Page 70
6.4 Initial Screening at Hospital......Page 73
6.6 Biodosimetry......Page 74
7.1 Clinical Decision Guide Concept......Page 78
7.2.1 Decision-Making Process......Page 81
7.2.2 Use of the CDG Tables......Page 82
7.2.4 Using the CDG with an Intake of Multiple Radionuclides......Page 83
7.2.5 Determining an Intake for Times More than 24 h in the Past......Page 84
7.2.6 Special Considerations for Uranium CDGs......Page 86
7.3 Americium-241: Clinical Decision Guide Fact Sheet......Page 91
7.4 Cesium-137: Clinical Decision Guide Fact Sheet......Page 92
7.5 Cobalt-60: Clinical Decision Guide Fact Sheet......Page 93
7.6 Iodine-131: Clinical Decision Guide Fact Sheet......Page 95
7.7 Iridium-192: Clinical Decision Guide Fact Sheet......Page 97
7.8 Plutonium-238: Clinical Decision Guide Fact Sheet......Page 98
7.9 Plutonium-239: Clinical Decision Guide Fact Sheet......Page 99
7.10 Radium-226: Clinical Decision Guide Fact Sheet......Page 101
7.11 Strontium-90: Clinical Decision Guide Fact Sheet......Page 102
7.12.1 Treatment Based on Radiological Properties of Uranium (CDG)......Page 103
7.12.2 Treatment Based on Nephrotoxic Properties of Uranium......Page 104
7.13.1 Noniodine Radionuclides......Page 106
7.13.3 Uranium Mass and Activity Calculations......Page 107
8. Rapid Determination of Internal Contamination......Page 109
8.1 Rapid Identification of Radionuclide(s) Involved......Page 110
8.2 Screening for External Contamination......Page 111
8.3.1 Detection of Internal Contamination by Direct Measurement......Page 112
8.3.2 Hospital Equipment for the Detection and Quantitation of Radionuclides......Page 116
8.3.3 Measuring Internal Contamination with Hospital Equipment......Page 123
8.3.4 Wound Monitoring......Page 125
8.4.1 Nasal Swabs......Page 126
8.4.2 Urine Samples......Page 127
8.4.3 Blood Samples......Page 128
8.4.5 Analysis of Indirect Bioassay Samples......Page 129
8.5 Rapid Screening of Persons to Identify Radionuclide Intakes that Exceed the Clinical Decision Guide......Page 130
9.1 Introduction......Page 134
9.2 General Clinical Guidance for the Treatment of Internal Contamination......Page 135
9.3 Making Requests for Radiological Countermeasures......Page 137
9.4.1 Triage......Page 138
9.4.2 Prioritizing Children and Pregnant Women......Page 139
9.4.3 Medical Decisions During the Early Phases of a Radiation Incident......Page 140
9.4.4 Choice of Decorporation Therapy for Internally-Deposited Radionuclides......Page 141
9.4.6 Contaminated Wound Management......Page 142
9.4.7 Using DTPA on Radionuclide-Contaminated Wounds......Page 143
9.5.2 Treatment......Page 144
9.6.1 Overview......Page 147
9.7.1 Overview......Page 148
9.8.1 Overview......Page 151
9.9.1 Overview......Page 153
9.10.1 Overview......Page 158
9.11.1 Overview......Page 159
9.12.2 Treatment......Page 160
9.13.1 Overview......Page 163
9.13.3 Medical Follow-Up After Treatment......Page 166
10.1 Introduction......Page 168
10.4 Enlisting the Public as a Partner......Page 169
10.6 Proactive Approach......Page 170
10.7 Information Hotlines......Page 171
10.8 Special Services, Approaches and Materials for Children......Page 172
10.9 Persons with Reproductive and Fertility Concerns......Page 173
10.11 Addressing Staff Concerns and Information Needs......Page 174
10.13 Training Exercises......Page 175
10.14 Understanding and Addressing Responder Concerns and Information Needs......Page 176
11.1 Identification of the Population to be Followed......Page 178
11.2 Classification of Persons to be Monitored or Followed......Page 181
11.3 Follow-Up Procedures......Page 184
12. Scalability......Page 185
13. Assessment of Current Capacity in the United States to Perform Population Screening, Decontamination and Monitoring for Internal Contamination......Page 193
13.1 Availability of Equipment and Resources......Page 194
13.2 Laboratory Capabilities......Page 195
13.3 Training Needs on Use of Equipment......Page 196
13.4 Radiation Volunteers to Support Population Screening......Page 198
13.5 Biodosimetry......Page 199
13.6 Conclusions......Page 200
14.1 Recommendations for Planning......Page 201
14.2 Recommendations Related to Screening and Treatment of a Population for Internal Contamination......Page 202
14.3 Recommendations for Additional Work......Page 203
Appendix A. Radiological Properties of Radionuclides Considered in this Report......Page 205
B.1 Screening Survey......Page 215
B.2 Complete Whole-Body Survey......Page 216
B.3 Most Common Mistakes Made During the Survey......Page 217
Appendix C. How to Distinguish Between Alpha, Beta and Gamma Radiation Using a Geiger-Muller Survey Meter......Page 218
C.2 Determining the Presence of Strontium-90 (or other pure beta emitters) Using a Pancake Geiger-Muller Survey Meter......Page 219
D.1 Contamination Survey Sheet......Page 221
D.2 Registry Form......Page 224
D.3 ATSDR Rapid Response Registry Survey Form......Page 227
Appendix E. How to Perform Decontamination at Home......Page 229
Appendix F Using Geiger-Muller Survey Meters to Assess Internal Contamination for Selected Gamma-Emitting Radionuclides......Page 231
G.2 Main Collection Issues......Page 241
H.2 Regulatory Information: Brief Summary......Page 244
H.4 General Shipping Guidelines for Clinical, Diagnostic and Exempt Biological Samples......Page 245
H.6 Website Links for Some Commercial Shippers......Page 247
I.1 Background......Page 248
I.2.2 London, United Kingdom......Page 249
Appendix J. Pregnancy Categories for Drug Use......Page 251
Appendix K. Emergency Phone Numbers for Government Officials to Request Assistance Following a Radiological or Nuclear Incident......Page 252
Glossary......Page 253
Abbreviations and Acronyms......Page 260
References......Page 261
Officers......Page 277
Distinguished Emeritus Members......Page 278
NCRP Reports......Page 286
NCRP Commentaries......Page 291
Proceedings of the Annual Meeting......Page 292
Lauriston S. Taylor Lectures......Page 294
NCRP Statements......Page 296
Other Documents......Page 297