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	You are here: Home > Exposure + Contamination > Text Version		Planning Guidance for Response to a Nuclear Detonation, 1/2009 (Homeland Security Council) Key Response Planning Factors for the Aftermath of Nuclear Terrorism, 8/2009 (Lawrence Livermore National Laboratory) Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners, 8/2007 (HHS/CDC)    New Users: Where Do I Start? What's New on REMM Patient Management Algorithms Print Algorithms & Tables Isotopes of Interest Countermeasures Decontamination Procedures Dose Estimator for Exposure Manage ARS Subsyndromes Multi-organ Dysfunction Syndrome Hematopoietic Subsyndrome Cutaneous Radiation Syndrome Time/Dose Effects in ARS Time Phases of ARS Strategic National Stockpile Animations, Illustrations, Photos Dictionary Emergency Contacts Download REMM (6/2009) Download Mobile REMM (6/2009)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS HPS   IAEA ICRP NCRP NRC OSHA REAC/TS RERF RITN UNSCEAR WHO
	Exposure + Contamination (Text Version) Management Modifiers Burns Trauma Mass casualty Timing of surgery Blood products use Specific populations 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 either 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 Whole/partial body dose from exposure likely to be < 2 Gy 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 serial CBCs with differential to evaluate possibility of exposure and ARS Remove any remaining radioactive shrapnel and shield it safely Surgical window of about 36-48 hours, depends on rate of dropping blood counts Treat non-life-threatening problems 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 24-hr stool for isotope measurement (baseline and sequential after management) Collect 24-hr urine for isotope measurement Label all specimens with time, date, and name 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 Diagnose/Manage Exposure - Acute Radiation Syndrome If No Recovery: Management of the deceased Register data into event database For Patient Making a Recovery: Arrange for continuing and long-term follow-up Send home with follow-up instructions Register patient in long-term follow-up database

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