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	You are here: Home > Contamination: Diagnose/Manage > Text Version		Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166, 2011) NEW! Nuclear Detonation Scarce Resources Working Group Publications, 3/2011 (HHS/ASPR) NEW! Response to a Nuclear Detonation: State and Local Medical Planners Playbook, 3/2011 (HHS/ASPR) NEW! Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (NCRP Report No. 165, 2010) Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Vol. I, 2008)    New Users: Where Do I Start? What's New on REMM? Emergency Contacts Patient Management Algorithms Dose Estimator for Exposure Dictionary Isotopes of Interest Countermeasures: Internal Contamination Countermeasures: Exposure Decontamination Procedures Acute Radiation Syndrome (ARS) Hematopoietic Subsyndrome Cutaneous Radiation Syndrome Manage ARS Subsyndromes Time/Dose Effects in ARS Time Phases of ARS Strategic National Stockpile Scarce Resources Triage Tool Multimedia Library Print Algorithms & Tables Download REMM (1/2012) Download Mobile REMM (1/2012)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS HPS   IAEA ICRP NCRP NRC OSHA REAC/TS RERF RITN UNSCEAR WHO
	Contamination: Diagnose/Manage (Text Version) Management Modifiers Burns Trauma Mass casualty Timing of surgery Blood products use At-risk/special needs populations Contact radiation safety officer Assess External Contamination Contact radiation safety officer Assess contamination pattern with radiation survey meter Evaluate for radioactive shrapnel Document contamination pattern on a body diagram (PDF - 49 KB) Swab each nostril separately to help estimate level of internal (lung) contamination Decontaminate Whole Body Decontaminate onsite or at other designated area Follow decontamination procedures Re-scan patient with radiation survey meter Repeat decontamination until radiation reading is < 2 times background radiation level Do not exceed 3 attempts Special issues for infants and children Evaluate if All Are True: Decontamination successful (< 2 times background radiation) Absent or minimal physical injury If All Are True: Send home with follow-up instructions Register in event database Otherwise: Evaluate at Medical Facility Treat life- or limb-threatening injuries first Obtain sequential CBCs with differential to rule out whole-body exposure and ARS Remove any remaining radioactive shrapnel and shield it safely Assess Internal Contamination Scan patient with radiation survey meter (caveat) Event responders or radiation safety officer will identify the isotope(s) Swab each nostril separately to help estimate level of internal (lung) contamination Collect ≥70 mL spot urine sample for isotope measurement Instructions for sample collection, labeling, packaging and shipping (HHS/CDC) Consider total body radiation survey with modified hospital nuclear medicine equipment Treat Internal Contamination of Specific Isotope Isotopes of Interest Table Countermeasures Table Decision to treat will depend on Level of internal contamination Size of radiation event Availability of resources/personnel Likelihood that patient will survive For Deceased: Management of decedents with contamination Register decedent in incident database For Survivors: Discharge with appropriate follow-up instructions Register patient in incident database Radiation follow-up considerations Whole body dose Immune status Risk of cancer Risk of specific organ dysfunction

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