Improved Nuclear Device: Accessing Casualties,

Transcription

1 Improved Nuclear Device: Accessing Casualties, Triage, and Treatment By Richard L. Alcorta, MD, FACEP State EMS Medical Director Maryland Institute for Emergency Medical Services Systems

2 Exposure Scenario Acute (explosion) Hiroshima, Kt Killed -- 36,000 Injured -- 40,000

3 WWII s s Lesson: Many Survivors of 15Kt Survivors: miles 13% miles 72% miles 98% 1.6 miles 0.6 mi 13% 72%

4 Fires, Structural Access Exposure/ Emission Rates

5 Radiation Detection Instrumentation G.M. Survey Meter Dose Rate Meter - Ionization Chamber Alpha Meter Neutron Meter Personal Dosimeters Film Badge Thermoluminescent Dosimeter Quarts Fiber Dosimeter Electronic Instantaneous Read Out Dosimeter

6 Radiation Protection/ Reducing Exposure Time Minimize time spent near radiation sources Distance Maintain maximal practical distance from radiation source Shielding Place shielding/ lead between radioactive sources and personnel

7 Particulate Protection Not Radiation Protection Front Back

8 Work Exposure Rates To Limit Caregiver Dose to 5 rem Distance Rate Stay time 1 ft 12.5 R/hr 24 min 2 ft 3.1 R/hr 1.6 hr 5 ft 0.5 R/hr 10 hr 8 ft 0.2 R/hr 25 hr Ld 50/60: The lethal dose for up to 50% of people within 60 days Equates to 450 rads used by military only in absolute critical areas

9 Radiation and Rate Mapping

10 Energy Partition Standard Fission / Fusion Thermal Blast 35% 50% AFRRI, Medical Effects of Nuclear Weapons, Blast and Thermal Effects Lecture, Fallout Initial 10% Radiation 5%

11 Injury Patterns Blindness (depending) Traumatic Injury Thermal and Radiation Burns Combined Trauma, Burns, and Radiation Degree of irradiation injury not apparent initially Early onset of vomiting

12 Dose Related Onset Of Vomiting Vomiting in of incident Estimated dose: Less than 10 minutes > 8Gy min 6-88 Gy Less than 1 hr 4-66 Gy 1-22 hr 2-44 Gy More than 2 hr Less than 2 Gy

13 Distribution of Injuries in a Nuclear Detonation Wounds + Wounds + Burns Irradiation 5% 5% Burns + Wounds + Irradiation 20% Combined Injuries (60% - 70%) Irradiation 15-20% Single Injuries (30% - 40%) Burns 15-20% Wounds < 5% Burns + Irradiation 40% Data from Walker RI, Cerveny TJ Eds., Medical Consequences of Nuclear Warfare, TMM Publications, Falls Church, p 11.

14 Andrew s Lymphocyte Nomogram Can System Run 50,000? Absolute Lymphocyte Count over 48 hours Confirms Significant Radiation Exposure From Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Medical Management of Persons Exposed to High Levels of Radiation. In Personal Dosimetry for Radiation Accidents. Vienna, International Atomic Energy Agency, 1965, pp 3-16

15 Incident Occurs EMRC Notified TIME LINE Pre-9/11/01 Notification Complete Availability to Field Unit Units Arrive Hospital notification begins Radio/Fax Bed Availability Received

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19 EMRC Notified TIME LINE With Facility Emergency Incident Occurs Notification Complete Availability to Field Unit Resources Database (FRED) Units Arrive Bed Availability Received Hospital notification begins FRED

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21 Principles Remove the victim from the radioactive source Direct ambulatory to cold/ Safe zone Perform rapid extraction of non-ambulatory Only life-saving rescues should be performed in a high radiation area Limit time spent in hazardous environment Rotating teams Quickly assess and evacuate

22 Principles Get patients to definitive care Trauma Centers Burn Centers Hospitals Alternate Care Facilities Secondary Care Distribute Patients Across The Nation Burn Care Radiation Consequence Management

23 Summary Principles System Notification, Activation and Response High numbers of combined injury victims Protect Responders (Exposure / Emission Rates mapping) Extrication / Evacuation /Decontamination Definitive Acute Care Radiation and Rehabilitation Care