Medical Reponse

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

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.

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.

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

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