MEDICAL RESPONSE STRATEGY Questioning and description of the circumstances of an event If irradiation is suspected The detailed questionnaire and the medical examination questionnaire supplement the triage questionnaire. They concern all victims identified as being exposed to a risk of irradiation. Detailed questionnaire The detailed questionnaire serves to evaluate the received dose if irradiation is suspected. Part 1: The circumstances of the accident 1 • Were you in a building? Which building? 2 • Were other people present and close to you? How many people? Who were they? (Names) 3 • Can you estimate how far away from you they were? How long did they remain beside you? What were their respective positions? Standing, sitting, lying down, other? 4 • Describe precisely what you were doing at the time of the accident. What was the duration of each task you did following the accident? 5 • What route did you take to reach the assembly area ? How long did you take to reach the assembly area? 6 • Describe your near environment. Distance and position with respect to the source and the shielding: were you close to structures situated between yourself and the site of the incident? Made of concrete? Another material? Can you indicate their size and approximate thickness? 7 • What position were you in? Standing, sitting, lying down, other? 8 • Do you have a telephone or any other electronic object on your person? Do you have a watch, spectacles, a packet of cigarettes, sweets, medication, sugar or sweeteners? Indicate their location at the time of the accident (for example, in which pocket). These objects can be useful for the dosimetric reconstruction. 9 • For the workers: do you know the nature and activity of the radioactive source? The type of radiation, the dose, the dose rate? Were you wearing a dosimeter? Active or passive? The questionnaire is supplemented by an accurate diagram: illustrate the places where the victim was situated at the time of the event, locate their position on the ground, in the area and with respect to the initial point of the event, and the position of any people present around the victim (markings on the ground). To position the various elements as accurately as possible, while observing the proper distances, you can for example use the grid shown below (1 square = 0.50 metres x 0.50 metres). SHEET 05 Download the detailed questionnaire Word file MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 21
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