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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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