Answer to Question #3420 Submitted to "Ask the Experts"

In general, Universal Precautions are universal and they will provide fairly good protection against radioactive contamination. As with chemicals, you want to try to avoid direct skin contact with radioactive contamination, so gloves, some sort of respiratory protection (such as an N-95 mask), and possibly a Tyvek suit (or something similar) will suffice to protect emergency responders from a contaminated victim.

In the event of skin contamination, simple decontamination materials are usually sufficient. For me, mild soap and cool to warm water has always worked quite well.

If the patient's injuries permit, it's not a bad idea to try some decontamination so that your ambulance or hospital will not be contaminated. Gently wiping contaminated areas will help, as will removing contaminated clothing. If the hair is contaminated, you may try to cut it or simply cover it. If there is no time (or ability) to decontaminate a patient, you can wrap the patient in clean sheets or blankets, or you can dress the patient in Tyvek or similar suit. The goal of this is to contain the contamination. However, if the patient needs immediate care and/or transportation, take care of the patient first. You can always decontaminate yourself and your equipment later if necessary.

Finally, you may need some radiation survey equipment to understand what the risks (if any) are. Remember, however, that it's not enough to simply have the equipment—you also have to know what the readings are and what they mean. For contamination surveys, a Geiger counter will help out. A relatively small, rugged, and reliable unit is the Ludlum 2401P, but there are others (Ludlum is a Health Physics Society affiliate). This will tell you how much contamination is present. Remember, however, to first obtain background levels so that you can tell how far above background the contaminated area is—it's not a lot of fun to find out that you have spent a lot of time worrying about (or decontaminating) a "clean" area. In addition, you may also wish to purchase a radiation dose-rate meter that will tell you the radiation levels in an area. Contamination tells you how "dirty" something is, but that is no indication of health risk. Health risk comes from radiation levels. Also, although many Geiger counters will read out in dose-rate units (for example, mR/hr), they are not designed for dose-rate measurements and it is usually not appropriate to use a Geiger counter for anything other than contamination levels (for example, cpm). So, for instruments, you should have a Geiger counter for contamination levels (read in cpm) AND a small ion chamber or micro-R meter to measure radiation levels (for example, mR/hr).

One thing to remember, too, is that working with a contaminated victim is not likely to harm an emergency responder. Radiation and contamination levels simply are not high enough to cause a health risk—what you are looking at is a possible decontamination problem, but not a health problem. So you want to do what you can to avoid contaminating yourself, but not at the risk of delaying (or denying) care for a badly injured patient.

So, for supplies in a response kit for radiological accidents or emergencies, here's what we're looking at:

• Geiger counter (preferrably with a "pancake" probe)
• Ion chamber or micro-R meter
• N-95 mask or equivalent respiratory protection
• Gloves (such as surgical gloves)
• Shoe covers
• Tyvek suit (or equivalent)
• Mild soap, cool to warm water, and decontamination wipes
• Sheets or blankets for wrapping contaminated victims
• Boundary materials
• Pencil or pen and paper (for maps of contaminated area and/or victims)
• Plastic bags (for holding decontamination materials)

For more information on this sort of thing, you may wish to visit the Web site for the Oak Ridge REACT/S program. It has a wealth of information for emergency responders and also offers classes for medical and emergency-response personnel.

Andrew Karam, CHP, PhD