INCOMING! Is your ED Ready for a Nuclear Bomb?

Transcription

1 INCOMING! Is your ED Ready for a Nuclear Bomb? Katie Tataris MD, MPH Assistant Professor of Medicine, Section of Emergency Medicine EMS Fellowship Director University of Chicago Medical Center EMS Medical Director, Chicago South EMS System

2 Disclosures 1. I have no relevant financial relationships with the manufacturer(s) of any clinical product(s) and/or provider(s) of commercial services discussed in this CME activity 2. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation

3 Objectives At the end of my presentation you (the learner) should be able to: 1. Examine the current state of the ED's capabilities and knowledge of handling victims of a nuclear weapon attack. 2. Operationalize methods of preparing the learner's own ED in the event of a nuclear fall-out. 3. Explain the risks that ED personnel face in treating these patients.

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10 What if this happened on the NEXT shift in your ED?

11 Ask yourself five questions: Does my hospital have a policy to address a nuclear bomb? Does my hospital have a policy to address a radiation incident? What is my mass casualty triage policy? How would we set up decontamination? Where is the best location to shelter in place?

12 Phase 1: Direct Effects from Explosion Nuclear explosion will vaporize everything within certain radius Vaporized particles form characteristic mushroom cloud At ground zero, high mortality Adverse effects of bomb miles away Where are you in relation to the bomb?

13 Phase 1: Direct Effects from Explosion 1) Radiation: Gamma rays emitted upon explosion 2) Fire: rapid rise in temperature and pressure cause fireball 3) Shock wave: pressure wave front moves out 4) Flash blindness: abrupt change in light intensity 5) Electromagnetic Pulse (EMP): burst of electromagnetic radiation that shuts down electronic devices

14 Phase 2: Fallout Radioactive particles fall back down toward earth Emitting radiation Ingested or inhaled Wind may disperse further SEEK SHELTER! Within 5-30 minutes of initial blast Shelter in place for hours

15 Preparing your ED for a Nuclear Bomb What to do if you are in the ED and a Nuclear Blast is nearby

16 Immediate Considerations 1) Where to go? 2) What kind of injuries to expect? 3) Decontamination? 4) Other logistics?

17 You need to find this instrument

18 Radiation Review

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20 REAC/TS Radiation Emergency Assistance Center/Training Site Under Department of Energy 24/7 National and International radiation emergency response capability Physicians, nurses, health physicists Experienced in evaluation, treatment, decontamination Cytogenic Biodosimetry Lab (CBL) Maintains radiation accident registry Manages use of DTPA and Prussian Blue Provides CME

21 Risks for you and your ED staff in a Nuclear Bomb

22 Critical Concept #1 If you can see/feel the blast you are in the danger zone Shelter in place to protect from fallout Communications may be down As patients start to present, decontaminate away from shelter space

23 Critical Concept #2 Radiologically contaminated patients generally pose no danger to healthcare personnel! Address life threats, then contamination issues Standard Universal Precautions for PPE External Contamination Internal Contamination

24 Staff Protection Guidelines Establish a triage area Establish contaminated zone, buffer zone, clean zone Survey your body with a radiation meter when entering and exiting clean zone Remove your contaminated outer garments when leaving contaminated area

25 Decontamination Guidelines Survey the patient with a radiation meter Thorough and consistent technique Involve Radiation Safety Officer in response Note large amounts on surface or embedded radioactive material Handle radioactive objects with forceps and seal in lead containers Record location and level of any contamination found

26 Decontamination Guidelines Remove patient clothing carefully May remove up to 90% of radioactive particles Double bag clothing and follow radioactive waste guidelines Repeat patient survey Cleanse contaminated areas Soap and water to highest contamination area first Resurvey and note levels Cover wounds with waterproof dressing Dispose of water through normal routes

27 Medical Evaluation Patients require prompt diagnosis and treatment of: Medical and surgical conditions Conditions related to radiation exposure and/or radioactive contamination Radiation dose can be estimated post event by: Medical history Serial blood counts Time to emesis Dose confirmed with chromosome-aberration bioassay (gold standard)

28 Acute Radiation Syndrome ARS results from external exposure of radiation doses greater than 1 Gy delivered to whole body or a major portion of it over a short time Radiation damage to cells occurs in seconds of exposure Intestinal cells Stem cells Lymphocytes (large nucleus) Acute illness varies onset from hours to weeks

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30 Medical Management of ARS Focus on support and recovery of the hematologic system CBC with differential and repeat q 6 hours Evaluate lymphocyte kinetics Calculate neutrophil/lymphocyte ratio Serum amylase baseline and q 24 hours Antiemetics Granuolocyte colony stimulating factors (G-CSF) Neutropenic infections

31 Medical Management of Local Injury Cutaneous Radiation Injury (CRI) Hours>days>weeks Transient itching, tingling, erythema, edema Latent period Delayed appearance of lesions Treatment: Pain and infection control

32 Medical Management of Internal Contamination Inhalation, ingestion, absorption from wound Consider if persistently high survey readings after decontamination Depends on isotope Decorporation therapy

33 Psychological Effects Nuclear terrorism and radiation exposure elicits fear Anxiety out of proportion to true medical significance Similar presentation as ARS Lack of understanding or communication Risk for ED staff and patients

34 Clinical Pearls to Take Home 1. While the thought of a nuclear bomb is terrifying, the ED physician needs to understand immediate hazards 2. Direct effects of nuclear bomb include radiation, fire, shock wave, flash blindness, and electromagnetic pulse (EMP) 3. Radioactive fallout increases affected population 4. Healthcare providers should wear standard universal PPE 5. Immediate response to nuclear blast is to shelter in place

35 QUESTIONS??