ACTION TO TAKE IN THE EVENT OF EXTERNAL IRRADIATION Confirming and characterising the irradiation Accidental exposure to an external source of ionising radiation (from a radioactive source which has been lost or discarded, or from an industrial irradiator, etc.) usually leads to acute or chronic irradiation. The exposure must be confirmed and characterised, and its severity must be evaluated as quickly as possible. Responders Medical teams: physicians and paramedical personnel1 Places VAA, AMP, healthcare facility + Two accident situations • Small- or medium-scale accident: number of victims2 < 10. • Large-scale accident: number of victims2 > 10. The persons stop being irradiated as soon as they are taken away from the radiation source. When at a distance from the site of the accident, treating an irradiated person involves no risk for the medical personnel. 13SHEET Administering the questionnaires and determining the anamnesis without delay This diagnostic approach serves to confirm whether there has been exposure or not and whether the irradiation of the body is total (risk of acute radiation syndrome) or partial (risk of acute localised radiation syndrome). • Look for the investigative elements (circumstances of the event, dosimetric survey). They are to be looked for at the scene of the accident, otherwise they risk being lost definitively: ‒ event circumstance and all useful information; ‒ samples of materials useful for the dosimetric survey if necessary. • Fill out the questionnaires necessary for the overall evaluation of the irradiation and the medical management of each victim: ‒ describe and detail the circumstances of the accident; ‒ record the physical parameters of the accident: nature of the source, type of radiation, dose, dose rate, exposure duration, distance and position with respect to the source and the shields; ‒ collect any complementary dosimetric information (passive and/or operational dosimeters). This information will enable a physical dosimetry to be determined. IN PRACTICE If there are associated medical-surgical issues to address: the conventional emergency takes priority From the radiological aspect, the urgency is to assess the received dose and the associated biological damage. The therapeutic response and the prognosis depend on this. The evaluation is based on three types of dosimetry: physical, biological and clinical dosimetry (clinical signs and how they evolve over time). SEE SHEET 15 WHICH DOCUMENT? WHEN? WHERE? Triage questionnaire Triage of the victims At the Victim Assembly Area (VAA) or the healthcare facility Detailed questionnaire If irradiation is suspected At the Advanced Medical Post (AMP) or the healthcare facility Medical examination questionnaire Medical management questionnaire Medical management by a physician or nurse At the AMP or healthcare facility These questionnaires are to be filled out by a physician or, if need be, a nurse. SEE SHEET 5 1. Depending on the number of victims, under the responsibility of a physician. 2. Guideline figure. The scale of the event will be evaluated in terms of the balance between the number of victims and the medical management capacities. If there is a mismatch, the principles of disaster medicine shall be applied. MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 47
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