12FICHE Decontamination and internal contamination treatment procedures MEDICAL RESPONSE STRATEGY Medical-surgical urgencies take priority over the treatment of contamination and irradiation. In the event of a large-scale accident with numerous casualties, decontamination is carried out in two stages: first emergency decontamination, then full decontamination. Internal contamination is treated as early as possible. Emergency decontamination Emergency decontamination begins by protecting the upper airways (to prevent external contamination from leading to internal contamination) by putting an FFP3 mask or, failing this, an FFP2 mask on the victim after cleaning the face. If the contamination takes the form of dust, spraying lightly with water prevents the dispersion of the dust deposited on clothing. The skin must not be bare or be wet, to avoid letting contamination of clothing lead to skin contamination. Particular attention must be paid to potentially contaminated run-offs. Whenever possible, emergency decontamination continues with removal of the outer layers of clothing and putting on a surgical cap. Full decontamination Full decontamination follows on from and supplements emergency decontamination (showering in an appropriate mobile or fixed structure with collection of the effluents). Its purpose is to remove all traces of residual contamination. The aim is to enable the victims to be treated without the responders having to take special protection measures and to prevent the transfer of contamination within the healthcare facility to the patients, the hospital personnel and the equipment. A decontamination check is mandatory. If contamination persists, further decontamination is necessary. After two full decontamination passes, the residual contamination is considered to be fixed. Consequently there is no longer any risk of transmission to the healthcare personnel. The decontamination procedure by type of victim is detailed in the following table. Internal contamination treatment If possible, the treatment must be administered within two hours following contamination: as early as possible once the potential contaminating radionuclide(s) has/have been identified. A radionuclide incorporated within an organism irradiates the tissues. The duration of irradiation varies depending on the half-life of the radionuclide and its biological retention in the organs. The therapy aims to speed up the natural elimination of the contaminant. It reduces the quantity of radioactivity retained in the organism and hence the dose received by the tissues/organs and the risk of radiation-induced cancer. Principal dose reduction mechanisms: 1. Increase the excretion of the radionuclide: increase by isotopic dilution (e.g. tritium diluted by water), mobilisation (e.g. strontium mobilised by stable calcium), blocking of storage (e.g. radioactive iodine) or chelation (e.g. with plutonium). 2. Reduce the gastrointestinal or pulmonary absorption (e.g. with caesium, indium or thallium with Prussian blue). SEE SHEETS 27 + 38 to 40 07 SHEET 28 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY
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