James Smith, PhD
Associate Director for Radiation
Division of Environmental Hazards and Health Effects (EHHE)
National Center for Environmental Health (NCEH)
Centers for Disease Control and Prevention (CDC)
Let’s review a few key principles of decontamination.
First, radioactive contamination is easy to detect and most of it can be readily removed. It is also highly unlikely that this contamination poses a significant risk to health care providers.
An important principle to keep in mind is that provision of life-saving treatment should take priority over radiological decontamination. For these cases, hospitals should have a policy and procedure for performing decontamination inside the facility. On the other hand, patients without life-threatening injuries should be decontaminated prior to treatment.
Segmentation of patients during the decontamination process is an important consideration. For example, dealing with those who are ambulatory vs. non-ambulatory, segregating male and female, and having a procedure to keep families together as much as possible throughout the process.
In protecting staff from contamination use standard precaution personal protective equipment and, if available, N95 masks. Change outer gloves frequently. It’s recommended to have personal dosimeters for keeping track of radiation exposures to individual staff due to contamination on patients or in the facility. Also, it is recommended to have a full-body radiological survey when exiting any warm zone.
Although highly unlikely, for those scenarios where an explosion has occurred, metallic shrapnel from a radioactive source may become embedded in wounds. In those cases, a radiation survey can identify highly radioactive fragments present. These fragments should be removed with forceps and sealed in a lead container. This is another instance when cooperation with the radiation safety officer or other radiation experts is very important.
Where practical, use additional protective measures in dealing with any highly radioactive fragment or source. Think of it in terms of time, distance, and shielding. That is, decrease the time spent near the radioactive source. And where practical, increase the distance and the amount of physical shielding between you and the source.
Finally, it is important to decontaminate the facility in the recovery phase of the emergency. Always coordinate this with the radiation safety officer. Remove waste from the emergency department and triage area. And survey the facility for contamination and decontaminate as necessary.
Now, let’s summarize. Radioactive contamination is easy to detect and most of it can be readily removed. Provision of life-saving treatment should take priority over decontamination. Complete a radiation survey to rule out highly radioactive fragments that may be embedded in the patient for those scenarios involving explosions.