Treatment Criteria-when to Treat

DOE-STD-1121-98

Guidance for actions, evaluations, work restriction

Management approval by significant parties involved.

A common point of tension in combined medical emergency and radioactivity intake event is a

question of priority of treatment. The general guidance is that medical treatment takes priority.

Decontamination is of little immediate value in a major trauma emergency and is certainly of secondary

concern to lifesaving activities. However, in many of the combined medical and radioactivity intake

event, both insults are relatively minor. Under these circumstances, it is a good practice for both the

health physicist and the physician to discuss their respective concerns with the potential intake and the

injury and prioritize the treatment for the particular case at hand. Ultimately, the physician has

responsibility for the treatment of the victim.

10.2 ROLE OF THE HEALTH PHYSICIST IN MEDICAL TREATMENT

Radiation protection and health physics expertise is rare in occupational medicine physicians and

medical staff. Thus the health physicist will likely need to work closely with medical staff in dose

reduction therapy. The decision to commence therapy for dose reduction is a medical decision which

cannot be delegated to the health physicist. However, the health physicist can identify the circumstances

under which therapy would seem appropriate, and advise the medical staff on the likely efficacies of

treatment alternatives. Once therapy has commenced, bioassay measurements are required to determine

the efficacy of therapy. The interpretation of those bioassay measurements will likely fall to the health

physicist.

DOE facility health physics staff should establish contact with the cognizant medical staff prior to an

emergency. Once a significant potential intake event occurs, the administrative and technical pressures

associated with response and case management can become intense. Prior efforts to establish good

communications will pay dividends.

10.3 TREATMENT CRITERIA WHEN TO TREAT

Deciding when medical response is needed poses some real challenges. Guidance has been offered

in the volume edited by Gerber and Thomas (Bhattacharyya et al. 1992). This guidance, summarized in

Table XII, is expressed in terms of ALIs. However, these ALIs are based on the 20-mSv (2 rems) per ALI

concept of ICRP-60, rather than the 5-rem limit of 10 CFR 835).

While Table XII can provide philosophical guidance on when therapy is needed, it does not fulfill

the practical need for field-identifiable criteria which can be interpreted as action points for initiating

medical response. Such criteria may include DAC-h exposure to airborne radioactivity, nasal smear

activity levels, personal skin contamination levels, wounds caused by contaminated objects, or special

bioassay measurement results.

Developing specific field criteria to identify the need for medical response can be challenging.

Inhalation intake estimates based on DAC-h exposure are straightforward and discussed earlier in this

document. Early bioassay measurement levels corresponding to the action levels have been calculated at

Hanford and are summarized in Table XIII and Table XIV. Another method is to develop field

observation criteria (e.g., nasal smear or skin contamination criteria) which might indicate an action level

has been exceeded. This latter approach is highly subjective with any number chosen likely to be

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