Immediate Medical Care

DOE-STD-1136-2004

Guide of Good Practices for Occupational Radiological Protection in Uranium Facilities

management of the contamination incident. Care should be taken to limit the spread of radioactive

contamination.

The health physicist should immediately begin to gather data on the time and extent of the incident.

Contamination survey results should be recorded. Radionuclide identity, chemical form, and solubility

classification should be determined. Nasal smears should be obtained immediately if an intake by

inhalation is suspected. When action levels are exceeded, all urine and feces should be collected and

labeled for analysis. Decontamination should proceed with the assistance of the medical staff.

Contaminated clothing and other objects should be saved for later analysis.

5.10.4 Immediate Medical Care

The medical staff should provide immediate emergency medical care for serious injuries to preserve

the life and well-being of the affected worker. Minor injuries may await medical treatment until after an

initial radiation survey is completed and the spread of contamination is controlled. However, the individual

should be removed from the contaminated radiation area as soon as possible. Chemical contamination and

acids should be washed immediately from the skin to prevent serious burns and reactions.

A chelating agent should be administered immediately following an accidental intake of uranium.

Sodium bicarbonate should be available for treating internal uranium contamination. The worker to be

treated must first be informed of the proposed use of a chelating agent, instructed on the purpose of

administering the chelating agent, and warned about the possible side-effects. The worker must then give

signed consent before chelation therapy may be initiated. Even though sodium bicarbonate therapy is the

only method available for reducing the quantity of uranium retained in the body, the affected worker has

the right to refuse its use.

The recommended therapy for decorporation is a systemic administration of 250 mL of isotonic

(1.4%) solution of sodium bicarbonate by slow intravenous injection (Gerber and Thomas, 1992). The

sodium bicarbonate reacts with uranyl ions, UO2 ++, in body fluids to form an anionic complex, probably

UO2(CO3)3, which is rapidly excreted in urine. Treatment may be continued if bioassay indicates that

decorporation therapy continues to enhance the urinary excretion of uranium. However, if treatment is

extended over the days following the incident, the dosage should be adapted to prevent contraindications

of alkalosis (bicarbonate solution is alkaline) and respiratory acidosis (Gerber and Thomas 1992).

5.10.5 Contaminated Wounds

Medical treatment for contaminated wounds may include flushing with saline and decorporating

solutions, debridement, and surgical excision of the wound. These measures are all the responsibility of

trained medical staff operating under the direction of a physician. Radiological control personnel can

provide valuable assistance by prompt assessment of materials removed from the wound and identification

of magnitude of residual activity as decontamination proceeds. Decontamination should continue until all

radioactivity has been removed or until risk of permanent physical impairment is

reached.

5-42