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Records Associated With Bioassay Measurements
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Internal Dosimetry - index
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Treatment Criteria-when to Treat


DOE-STD-1121-98
10.0 MEDICAL RESPONSE
10.1 NEED FOR MEDICAL RESPONSE
Medical intervention may be needed to reduce the committed doses from significant intakes of
radionuclides. This intervention can take the form of prophylactic treatment (therapy administered before
an intake has occurred or been confirmed) or treatment in direct response to identified intakes. Examples
of prophylactic treatment include administration of potassium iodide to emergency response workers for
prevention of radioiodine uptake, and immediate administration of a chelating agent following a
suspected actinide intake but before any confirming bioassay measurements. Treatment in response to
identified intakes includes diuretics following tritium exposure, and use of adsorption agents to prevent
gastro-intestinal tract uptake from ingestion or inhalation exposures.
Example 10.1 provides three situations where medical treatment and associated internal dosimetry
concerns occur simultaneously. These examples are intended to show the kinds of circumstances which
should be addressed by the medical response action plan of Section 3.5.
Example 10.1. Situations Where Internal Dosimetry Actions and Medical Treatment
Occur Simultaneously
1.
A chemical (or steam) explosion results in severe contaminated lacerations, imbedded
contaminated particles, and chemical (or thermal) burns. The worker requires emergency
room medical treatment for physical trauma injuries. Contamination may be significant and
raises some concerns for treatment staff.
2.
While working in a plutonium glove box, a worker incurs a contaminated puncture wound in
the index finger. Initial surveys of the wound site and blood smears indicate potential doses
could exceed several times the allowable occupational limits. The worker has no other
injuries and the wound itself is quite small (suitable for an adhesive bandage and a tetanus
shot). However, dose therapy should consider tissue excision and DTPA chelation by
appropriate medical staff.
3.
Following exposure to tritium gas, a single void urine sample indicates a significant tritium
oxide intake warranting diuresis as a therapeutic action. There are no physical injuries.
Diuresis involves administration of diuretics and medical monitoring of blood chemistry for
electrolyte control.
Each of these examples poses different questions for resolution in an action plan for medical
response. Key points the action plan should address may include the following:
Identification of parties involved in response (facility, health physics support, initial medical
response, emergency medical dispatch, hospital, etc.)
Statement of authority & responsibilities for each party
Identification of action levels, or reference to documentation of action levels
Identification of policies, manuals, or procedures providing key details of response
Notification and communication chains
105


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