11. According to the TMT Handbook 2009, washing operations must be stopped if signs of skin irritation appear, if the reduction in contamination through washing becomes less than 10% or if the level of residual contamination is less than 2 times the background radiation. IF THE CLINICAL CONDITION OF THE PATIENT DETERIORATES: STOP THE DECONTAMINATION PROCESS The decontamination operations are long and require the victim to in a stable clinical condition. The decontamination operations must be stopped in order to administer medical-surgical treatment if there is any deterioration in the patient’s condition. i MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 103 SHEET ACTION TO TAKE IN A 1ST LINE HEALTHCARE FACILITY Decontaminating the victims 34 FULL DECONTAMINATION: TREATMENT PROTOCOL CONTAMINATION ON HEALTHY SKIN First-line treatment: wash with tepid water and mild soap or, if available, a product specifically suited to the radionuclides causing the external contamination, working from the periphery towards the centre of the contaminated zone. “Detection – decontamination – drying” sequence to be repeated 2 times if necessary. Case of contamination withstanding two successive washings11 : • Cover the contaminated skin zone with a cotton or osmogel dressing and a light plastic film. In the case of contamination of the hand, use a cotton glove covered with plastic or a rubber glove. • Leave in place for 1 to 2 hours to facilitate perspiration, then wash the zone and repeat the treatment if necessary. Case of contamination by actinides or certain metals: pour directly over the healthy skin one or more vials of Ca-DTPA. With a local treatment, this route can be used as a complement to the IV route. SEE radionuclides handbook Case of risk of contamination by radioactive iodine: apply Lugol’s solution. SEE SHEET 39 + radionuclides handbook (RH 24) Other examples of treatments on the market which show a degree of effectiveness against various targeted radionuclides (actinides, caesium – RH 25, cobalt, etc.) or which show comparable effectiveness in certain utilisation situations: Trait Rouge® cleansing gel and Cevidra® cream (washing and decontaminating cream containing calixarene, a chelator of uranium and other elements). EYE CONTAMINATION Wash with physiological serum (saline solution). In cases of contamination by a radionuclide that can be chelated by Ca-DTPA, this product can be used as a solution diluted to 10%. CONTAMINATED SKIN PUNCTURE, WOUND OR BURN • Immediate action: pour vials of a chelating agent (Ca-DTPA) over the wound or burn in cases of contamination by actinides (this minimises the retention of radionuclides and speeds up their elimination). • Protect the wound with an impermeable dressing made up of sterile compresses attached by an impermeable adhesive or by an occlusive dressing of cream-under-glove type to facilitate transportation of the contaminated person and their treatment in the surgical environment. SEE SHEET 31 Contaminated wound treatment protocol CONTAMINATION OF THE HAIR SYSTEM Possibly treat by shaving, but never use a mechanical razor (they cause micro-lesions of the skin which foster retention of the contamination, decontamination becomes difficult if not impossible if one wants to reduce contamination to a very low level).
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