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Title: Development of a statewide hospital plan for radiologic emergencies

Abstract

Although general guidelines have been developed for triage of victims in the field and for hospitals to plan for a radiologic event, specific information for clinicians and administrators is not available for guidance in efficient management of radiation victims during their early encounter in the hospital. A consensus document was developed by staff members of four Connecticut hospitals, two institutions of higher learning, and the State of Connecticut Department of Environmental Protection and Office of Emergency Preparedness, with assistance of the American Society for Therapeutic Radiology and Oncology. The objective was to write a practical manual for clinicians (including radiation oncologists, emergency room physicians, and nursing staff), hospital administrators, radiation safety officers, and other individuals knowledgeable in radiation monitoring that would be useful for evaluation and management of radiation injury. The rationale for and process by which the radiation response plan was developed and implemented in the State of Connecticut are reviewed. Hospital admission pathways are described, based on classification of victims as exposed, contaminated, and/or physically injured. This manual will be of value to those involved in planning the health care response to a radiologic event.

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [6];  [8];  [9];  [10];  [9];  [5];  [11];  [12];  [9];  [10];  [9]
  1. Department of Medicine, Bridgeport Hospital, Bridgeport, CT (United States) and Yale University School of Medicine, New Haven, CT (United States). E-mail: pndain@bpthosp.org
  2. Greenwich Hospital, Greenwich, CT (United States)
  3. Yale-New Haven Hospital, New Haven, CT (United States)
  4. Bridgeport Hospital, Bridgeport, CT (United States)
  5. State of Connecticut Department of Environmental Protection, Hartford, CT (United States)
  6. Yale University School of Medicine, New Haven, CT (United States)
  7. State of Connecticut Office of Emergency Preparedness, Hartford, CT (United States)
  8. American Society for Therapeutic Radiology and Oncology, Alexander, VA (United States)
  9. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States)
  10. Hartford Hospital, Hartford, CT (United States)
  11. University of Connecticut Health Center, Farmington, CT (United States)
  12. Center for Emergency Preparedness and Disaster Response, Yale New Haven Health, New Haven, CT (United States)
Publication Date:
OSTI Identifier:
20793450
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 65; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2005.12.047; PII: S0360-3016(06)00083-6; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; 54 ENVIRONMENTAL SCIENCES; ACCIDENTS; CLASSIFICATION; CONNECTICUT; ENVIRONMENTAL PROTECTION; EVALUATION; HOSPITALS; LEARNING; MANUALS; MEDICAL PERSONNEL; RADIATION INJURIES; RADIATION MONITORING; RADIATION PROTECTION; RADIOLOGY; RECOMMENDATIONS

Citation Formats

Dainiak, Nicholas, Delli Carpini, Domenico, Bohan, Michael, Werdmann, Michael, Wilds, Edward, Barlow, Agnus, Beck, Charles, Cheng, David, Daly, Nancy, Glazer, Peter, Mas, Peter, Nath, Ravinder, Piontek, Gregory, Price, Kenneth, Albanese, Joseph, Roberts, Kenneth, Salner, Andrew L., and Rockwell, Sara. Development of a statewide hospital plan for radiologic emergencies. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.1.
Dainiak, Nicholas, Delli Carpini, Domenico, Bohan, Michael, Werdmann, Michael, Wilds, Edward, Barlow, Agnus, Beck, Charles, Cheng, David, Daly, Nancy, Glazer, Peter, Mas, Peter, Nath, Ravinder, Piontek, Gregory, Price, Kenneth, Albanese, Joseph, Roberts, Kenneth, Salner, Andrew L., & Rockwell, Sara. Development of a statewide hospital plan for radiologic emergencies. United States. doi:10.1016/J.IJROBP.2005.1.
Dainiak, Nicholas, Delli Carpini, Domenico, Bohan, Michael, Werdmann, Michael, Wilds, Edward, Barlow, Agnus, Beck, Charles, Cheng, David, Daly, Nancy, Glazer, Peter, Mas, Peter, Nath, Ravinder, Piontek, Gregory, Price, Kenneth, Albanese, Joseph, Roberts, Kenneth, Salner, Andrew L., and Rockwell, Sara. Mon . "Development of a statewide hospital plan for radiologic emergencies". United States. doi:10.1016/J.IJROBP.2005.1.
@article{osti_20793450,
title = {Development of a statewide hospital plan for radiologic emergencies},
author = {Dainiak, Nicholas and Delli Carpini, Domenico and Bohan, Michael and Werdmann, Michael and Wilds, Edward and Barlow, Agnus and Beck, Charles and Cheng, David and Daly, Nancy and Glazer, Peter and Mas, Peter and Nath, Ravinder and Piontek, Gregory and Price, Kenneth and Albanese, Joseph and Roberts, Kenneth and Salner, Andrew L. and Rockwell, Sara},
abstractNote = {Although general guidelines have been developed for triage of victims in the field and for hospitals to plan for a radiologic event, specific information for clinicians and administrators is not available for guidance in efficient management of radiation victims during their early encounter in the hospital. A consensus document was developed by staff members of four Connecticut hospitals, two institutions of higher learning, and the State of Connecticut Department of Environmental Protection and Office of Emergency Preparedness, with assistance of the American Society for Therapeutic Radiology and Oncology. The objective was to write a practical manual for clinicians (including radiation oncologists, emergency room physicians, and nursing staff), hospital administrators, radiation safety officers, and other individuals knowledgeable in radiation monitoring that would be useful for evaluation and management of radiation injury. The rationale for and process by which the radiation response plan was developed and implemented in the State of Connecticut are reviewed. Hospital admission pathways are described, based on classification of victims as exposed, contaminated, and/or physically injured. This manual will be of value to those involved in planning the health care response to a radiologic event.},
doi = {10.1016/J.IJROBP.2005.1},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 65,
place = {United States},
year = {Mon May 01 00:00:00 EDT 2006},
month = {Mon May 01 00:00:00 EDT 2006}
}
  • In 1961 the Medical Division of the Union County Civil Defense and Disastor Control organization in cooperation with the Radiology Department of St. Elizabeth Hospital in Elizabeth, N. J., developed a Hospital Decontamination Center. In addition to being a decontamination center, St. Elizabeth Hospital has become a fallout monitor station for Union County. According to the proposed procedure, upon entering the hospital, the contaminated individual would be taken to a reception room where he would be disrobed. His body would be completely checked for radiation. Clothes would be placed in a covered metal can and then taken to a storagemore » room. The floor of the reception room should be coated with a peelable pairt so that if heavily contaminated, it can be readily removed. A floor drain should be installed to aid in decontamination, leaving the stripping of the paint as a last resort. Emergency surgical instruments, drugs, plasma, and parenteral fluids should be available in this room for treatment of any injury. From the reception area, the patient would be taken to a special shower room containing a bathtub and shower combination in a glass enclosure. After this, the radioactive patient would be taken to a specially located hospital room for observation and treatment. Heating, air conditioning, or ventilation ducts should be completely separate from those of the rest of the hospital to prevent the spread of airborne radioactivity. The radiologic treatment team may consist of 2 radiologic safety officers from the Radiology Department, 2 internists, 1 hematologist, and 1 general surgeon. (TCO)« less
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  • The Chemical Mixture Methodology (CMM) is used for emergency response and safety planning by the U.S. Department of Energy, its contractors, and other private and public sector organizations. The CMM estimates potential health impacts on individuals and their ability to take protective actions as a result of exposure to airborne chemical mixtures. They are based on the concentration of each chemical in the mixture at a designated receptor location, the protective action criteria (PAC) providing chemical-specific exposure limit values, and the health code numbers (HCNs) that identify the target organ groupings that may be impacted by exposure to each chemicalmore » in a mixture. The CMM has been significantly improved since its introduction more than 10 years ago. Major enhancements involve the expansion of the number of HCNs from 44 to 60 and inclusion of updated PAC values based on an improved development methodology and updates in the data used to derive the PAC values. Comparisons between the 1999 and 2009 versions of the CMM show potentially substantial changes in the assessment results for selected sets of chemical mixtures. In particular, the toxic mode hazard indices (HIs) and target organ HIs are based on more refined acute HCNs, thereby improving the quality of chemical consequence assessment, emergency planning, and emergency response decision making. Seven hypothetical chemical storage and processing scenarios are used to demonstrate how the CMM is applied in emergency planning and hazard assessment.« less
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