Radiation Emergencies Response and Preparedness workshop_28 Sep 2019.pdfRadiation Emergencies...

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Radiation Emergencies Response and Preparedness

MEFOMP WorkshopOn Medical Physics in Diagnostic Radiology

28- 29 September 2019/ Muscat- Oman

Dr. Huda Al Naemi President of MEFOMPAssistant professor Medical Biophysics Research in Radiology (Weill Cornell Medicine – Qatar)Executive Director of OHS at Hamad Medical Corporation-Doha-Qatar

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• Internal and External exposure

• Radiation Emergency

• Emergency Preparedness

• Classification of Emergency

• Handling of Emergency

• Medical Physicists and radiological emergencies response

Outline

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Radiation, Radioactivity and Radioactive Materials

MEFOMP Workshop On Medical Physics in Diagnostic Radiology- 28- 29 September 2019/ Muscat- Oman

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Exposure Dose from Natural and Artificial Radiation


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Internal and External Exposure


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External Exposure and Skin


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Local injury thresholds


Dose Effect Timing ( Time post exposure )

3 Gy Epilation 14 – 21 days

6 Gy Erythema Early, then 14 – 21 days later

10 – 15 Gy Dry Desquamation 2 – 3 weeks

15 – 25 Gy Wet Desquamation 2 – 3 weeks

> 25 Gy Necrosis Dependent upon dose

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Internal Exposure


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• “Any unintended event including operating errors, equipment failures or

other mishaps, the consequences or potential consequences of which

are not negligible from the radiological protection or safety point of

view”

Radiological event


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International nuclear and radiological event scale (Nuclear Disaster)


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Emergency Preparedness Categories


• GSR Part 7 (2015)

• Categories I-III involve fixed facilities (Example: power/research reactor, irradiation facilities, hospitals

• Category IV: could occur anywhere!

• Category V: means primarily to protect food/water supply

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Emergency Preparedness

• The capability take actions that will

effectively mitigate the consequences of

an emergency for human health and

safety, quality of life, property and the

environment.

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Meet response objectives

QA programme

Organization

Plan and Procedures

Logistical support and

facilities

Training drill and

exercises

Coordination

Authority

Emergency Preparedness Programme

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• To save lives,

• To regain control of the situation and to mitigate consequences,

• To avoid or to minimize severe deterministic effects;

• To render first aid, to provide critical medical treatment and to manage the treatment of radiation injuries;

• To reduce the risk of stochastic effects;

• To keep the public informed and to maintain public trust;

• To mitigate, to the extent practicable, property and the environment;

• To prepare, to the extent practicable, for the resumption of normal social and economic activity.

Goal of the Response

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Radiological Accident: Goiania, Brazil (13 September 1987)


Cs-137: ≈ 51 TBq (1.4 MCi)

Widespread Contamination

IAEA reports 112,800 people monitored

Over a 2.5-month period

249 contaminated

8 with acute radiation syndrome

4 died

Mental health impact

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Radiological Accident: Fukushima, Japan (11 March 2011)


245000 people screened

901 cases, between 13- 100 kcpm

110 cases > 100 kcpm

All cleaned by removal of clothing and wiping

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Effect of reactor accidents (Nuclear Disaster)


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What is Population Monitoring?


The process of identifying, screening, and monitoring people for exposure to radiation or contamination with radioactive materials.

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Plan for a “Large” Population


There is potential for contamination

There is potential for injuries

Some may need immediate medical care

Most may need shelter/temporary housing

All would be stressed

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Controlled Area


Establish controlled/decontamination area

Tape, ropes, signs, floor covering, security

Remove unneeded items

Non-contaminated patients do not enter

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Reception Centers (RC)


Place to conduct population monitoring

Multi-agency effort

Opened 24-48 hours after incident

Located outside of hot zone

May be next to hospital or shelter

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Reception Center

Surrounding Community

Affected Area

Home

Public Shelter

Hospital or Alternate Care Site

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Services include:

Contamination screening

Decontamination

Limited medical care

Main purpose is to prioritize people for further care

Ease burden on hospital

Manage scarce medical resources

Support shelters

Reassure population

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Guiding Principles


The first priority is to save lives: respond to and treat the injured first.

Contamination with radioactive materials is not immediately life-threatening

Flexibility are an important part of the planning process

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Reception Centers (RC): 7 stations:


Initial sorting

First Aid

Contamination Screening

Wash

Registration

Radiation Dose Assessment

Discharge

Clean Zone

Contamination Control Zone

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Initial Sorting (Contamination Control Zone)


Staff identify people who have:

• Urgent medical needs

• High levels of contamination

• Special needs

• Decontaminated coming to the CRC

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First Aid (Contamination Control Zone)


• Medical staff care for and/or transport patients with urgent medical needs

• Life saving care takes priority • Do not delay transport for

decontamination

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Contamination screening (Contamination Control Zone)


Staff screen people for external contamination

Radiation detection Equipment

Full-Body Contamination Screening

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Contamination screening (Contamination Control Zone)


Staff screen people for external contamination

Radiation detection Equipment

Partial-Body Contamination Screening

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Survey Meter- Contamination


Instrument Description:

• Geiger-Mueller/Pancake Probe

• off

• battery Check

• Scale

• Multiplier

• Audio

• Reset

• Alpha, Beta, and Gamma

• Survey: patient, Personnel, Area

• Units- counts/minute (cpm) or (cps)

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Personnel Contamination Surveys


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Personnel Contamination Surveys (Patients)


Measurement can be made during patient treatment.

Order to survey

Wounds

Face/Body Orifices

Skin

Survey all area of the patient (sides, back, etc..)

Survey SLOWLEY and carefully

First, nose and mouth, detect potential for internal contamination early

Take into account religious and cultural considerations

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Wash Station (Contamination Control Zone)


Staff monitor and facilitate showering

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Post-Decontamination Screening (Contamination Control Zone)


• Screening staff in the Wash Station will check people for contamination after they clean themselves. If contamination is still present after two showers, that person may be internally contaminated and will require additional screening at the Radiation Dose Assessment Station.

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Registration (Clean Zone)


Staff use epidemiological tools to: • Establish a registry• Determine need for immediate

follow-up at Radiation Dose Assessment Station

Information collected includes:• Demographic information• Destination• Proximity to event • Time in affected area

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Radiation Dose Assessment (Clean Zone)


Clinical and Health physics staff:

Screen for internal contamination

Assess radiation exposure

Assess need for bioassay (blood/urine)

Assess need for treatment

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Discharge (Clean Zone)


Staff provide information for people discharged:

Assess need for counseling

Discharge to home or shelter

Provide referral for further care

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It all started with a simple question …


• Do Medical physicists have a role in case of a nuclear or radiological emergency?

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Roles and Responsibilities of Medical Physicists


• International Basic Safety Standards (GSR Part 3, 2014)

• International Basic Safety Standards (GSR Part 7, 2015)

• IOMP: Policy Statements 1-3 (2012, 2013)

• IAEA: Roles and Responsibilities, and education and Training Requirements for Clinically Qualified Medical Physicists (HHS 2013)

• ILO: International Standard Classification of Occupations (ISCO-08, 2008)

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Where is the Medical Physicist in the chain ..?


The Medical Physicist is a member of a multidisciplinary team involved in the diagnosis and treatment of patients

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Medical Physicists act as Qualified Experts in radiation protection


• The Medical Physicists are trained in medical radiation physics, dosimetry and biological effects of radiation.

• Medical Physicists are Qualified Experts (QE) in dose measurement of medical radiation exposure

• Medical Physicist have legal responsibilities for radiation protection of patients, workers and public.

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Why should MPs contribute to nuclear and radiological emergencies response?


• Medical Physicists have expertise and experience with radiological issues:

1- Radiation safety and protection of patients, staff and the public

2- Radiation dose assessment:

- Medical management purposes

- Responder safety

3- Radiation risk assessment and communication

4- Education, training and associated planning

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The potential roles of medical physicists in nuclear or radiological emergency situations


• Advice on appropriate personal protective equipment

• Delineation of radiation and contamination control zones

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As an expert in radiation dosimetry:

• Advises on dose measurement and reconstruction

• Conducts or participates in dosimetry measurements and dose reconstructions

• Communicates associated risks

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As a trainer:

• Advises the medical staff and other emergency response staff in the evaluation and understanding of the significance of the levels of radioactivity with which they are dealing

• Contributes to the development and implementation of training programs to different groups at hospitals

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As a stakeholder:

• Participates in the planning of radiation emergency response, as requested by appropriate authorities

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Summary of Key Points


Medical Physicists play roles as Radiological Assessor on the scene, supporting multiple on-site teams including decontamination teams.

Reception center are where population screening and decontamination take place

The first priority is to save lives

Initial radioactive monitoring/ decontamination efforts should focus on preventing deterministic effects

Developing plans and exercising those plans are key to preparedness

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