38 SHEET INTERNAL CONTAMINATION MEASUREMENTS AND TREATMENTS Internal contamination: initial treatment Reminder: the indication for an internal contamination treatment depends on the dose that would be received if no treatment was administered and the effectiveness of the treatment. This dose can be: • calculated from the individual internal contamination measurements SEE SHEET 37 ; • or estimated from atmospheric measurements or from the calculations of dispersion of a radioactive source or nuclear releases. Administration of the treatment: points requiring vigilance • Persons present near the event, who could have been significantly contaminated: administer the treatment as early as possible without waiting for the dosimetric evaluation. The treatment depends on the identified potential contaminating radionuclides. For example, potassium iodide tablets for radioactive iodines, Radiogardase® for caesium or Ca-DTPA for actinides. • Potassium iodide tablets: it is very important to start the treatment rapidly. The tablets prevent the build-up of radioactive iodine in the thyroid, but their effectiveness decreases rapidly (if they are administered more than one hour after contamination). • The potassium iodide tablets predistributed to the population for administration in the event of a radiological or nuclear (RN) accident, must only be taken when formally instructed to do so by the competent authorities (Prefect or high command in a military environment). • In the event of contamination by radionuclides that do not figure in the radionuclide handbook incorporated in the last part of this guide: contact the Regional Health Agency which will call upon the crisis centre of the Minister responsible for health. The emergency therapies proposed in this guide, which are based on the current state of knowledge, use medicines that have a marketing authorisation (MA) or are undergoing studies with a view to obtaining this authorisation issued by the French Health Products Safety Agency (ANSM). Furthermore, stocks of some of these products have been acquired insofar as possible and distributed nationally for use in the pre-hospital and hospital environments. i Subsequent treatments After the first 24 hours, the treatment is adapted according to the patient and the level of contamination. The subsequent treatments are decided by the specialist physicians according to the precise data concerning the event and, if applicable, the first internal contamination measurement results. The Institute of Radiation Protection and Nuclear Safety (IRSN) can carry out a dosimetric evaluation based on the quantity of radionuclide liable to have been incorporated or the internal contamination measurement results. © Pharmacie centrale des armées © McGuff Company, Inc. MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 111
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