Radiation Contamination: Diagnose and Manage

Decontaminate Whole Body

• Decontaminate on-site or at other designated areas
• Follow decontamination procedures
• Re-scan patient with radiation survey meter
• Repeat decontamination until successful (Understand target levels for decon)
• Do not exceed 3 attempts (decon cycles)
• Special issues for infants and children

Evaluate if All Are True:

• Decontamination successful (Understand target levels for decon)
• Absent or minimal physical injury

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)
• Incident 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
• 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
  • Risk/benefit (toxicity) profile of the countermeasure
  • Size of radiation event
  • Availability of resources/personnel
  • Likelihood that patient will survive