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First published 1993 by CRC Press
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 ABOUT THE AUTHOR

In twelve years of emergency medical service, Mr. Carder has

come to believe that additional education on the handling of radiation
accident patients should be provided for those persons charged with
the responsibility for the care of victims of accidents. Mr. Carder has
served as a Radiation Safety Officer for a US Nuclear Regulatory
Commission (NRC) 60Co license and has received training and
education in the field of Radiological Health Physics as well as
experience in handling radioactive materials. His education and
experience in radiological health physics and emergency medical
service provide him with the background to write this book. This
book should provide much information and education for any
interested individual or agency, emergency services or otherwise,
thereby replacing most common fears with respect for and knowledge
of the possible hazards surrounding radiological incidents involving
patients. This should enable the student to provide an adequate
service through knowledge.

However comprehensive or extensive this text may be, it is

written in such a manner that the reader does not need to have
previous education or experience in radiological science. All readers
should have no trouble understanding the material within.

H. S. Stocks

Since Mr. Stocks provided comments for the 1981 publication,

Mr. Carder has become a professional Nuclear Emergency Planner at
nuclear power utilities as a consultant, as a utility staff member, and
as a member of the plant emergency response organization.

The Publisher
 ACKNOWLEDGEMENTS

Thanks go to the following who have provided valuable

information and assistance in ensuring the accuracy of particular
points within this text:

Anita M. Barnette, B.S.-Radiological Health Science, Health

Physicist
Debra A. Bookser, Senior Policy Specialist
Russell N. Bookser, Technological Hazards Specialist, with
experience as an E.M.T, a police officer, and a firefighter
Henry C. Briggs, Ph.D.-Engineering, C.H.P.
Jeff B. Burnett, M.S.-Nuclear Engineering, Health Physicist
Gilbert H. Cosnett, E.M.T, M.I.C.P.
W. K. Evans, M.S.-Physics
Shirley A. Fry, M.B., B. Ch., M.P.H.
James F. Hefner ,M.D.
Russell A. Jones, M.D.
Douglas C. Kay, M.S.-Nuclear Engineering, Health Physicist
Perry D. Knowles, M.D.
Roger E. Linnemann, M.D.
Tom Linnemann, B.S.-Nuclear Medicine Technology
Jose A. Luna, Radiation Protection Technician
James A. McGehee, E.M.T.I.
Z. L. Olkowski, M.D., Ph.D.-Radiation Biology
Michel S. Pawlowski, M.S.-Biochemistry
Kedar N. Prasad, Ph.D.-Radiation Biology
Coy M. Rice, Senior Reactor Operator
James M. Stavely, Jr., B.S.-, M.S.-Nuclear Engineering
Hal S. Stocks, Radiological Health Chief
Donald W. Waddell, B.S.-Physics

Special thanks to Mr. Rice, Dr. Hefner, Dr. Briggs, Dr. Fry, and
Dr. Prasad for their patience with my impatience. Special thanks go
also to Debra and Russell Bookser for their level of detail in proof
reading the manuscript.

Mr. Danney R. Rodgers deserves special notice due to his

patience in helping me learn how to use Macintosh computers and
software.
 NOTE

T h s text is a comprehensive "manual" for persons involved in

emergency medical service to radiation accident patients. Although
the material is not highly technical, there are numerous points of
parascientific nature and as such would be difficult to absorb as a
good novel. It is suggested that this text be made readily available to
responding personnel to enable periodic and timely review of the
information within.

With this information and suggested guidelines at your

disposal, you should be better prepared for entering the relatively
new field of emergency services, the

HANDLING OF RADIATION ACCIDENT PATIENTS

BY PARAMEDICAL AND HOSPITAL PERSONNEL
 PREFACE

Nuclear radiation and radioactive materials of varying potency

and amounts are used in many ways by many types of industry,
research, and commerce. Although under tight controls, radiation
and radioactive materials may be encountered almost anywhere at
any time. For example, some food providers have used radiation to
increase the shelf-life of packaged meats. The reason for this is, as
presented in Chapter 1, that nuclear radiation can destroy the living
bacteria that causes the meat to spoil, but the radiation will not harm
the non-living meat. Since radiation can destroy bacteria, packaged
bandages can be sterilized by exposure to radiation. Some industries
use radiation to measure thickness in metals. Radiation can be used
to study the condition of or treat particular organs or areas of the
human body. An internal "picture" of the human body can be taken
without surgery by using radiation. Energy is produced utilizing
radioactive materials.
The previous paragraph names only a few ways radiation and
radioactive materials are used in everyday life. With so many uses for
radiation and radioactive materials and many other ways not named,
there are bound to be adverse incidents in the handling or use or
abuse of the radiation or radioactive materials, possibly creating a
hazard whether by accident or intent. Either way, special precautions
and consideration may be indicated when responding to such an
incident. A victim of such an incident may have received an exposure
to radiation as well as possible external and internal contamination
with the radioactive materials.
A point worth special notation is that the patient may be a
victim of all three conditions, external exposure, external contamination,
or internal contamination. In any case, you must assume all three
conditions are indicated until a thorough survey can be performed by
other professionals equipped with special instrumentation and
training. Although the patient may be contaminated with radioactive
materials or may have been exposed to nuclear radiation, your
attention to medical emergencies must be foremost. Do not let this
statement alarm you. The remainder of this text will provide greater
understanding into the matters of cross-contamination and
self-exposure.
 vii

COMMENT

My intent in preparing this material is to amplify the training in

the 120-hour Emergency Medical Technician-A (EMT-A) training
course and the "first responder" training courses. I feel the subject
coverage in these courses is not adequate to provide for the
radiological education of responding personnel. Further, I have
learned that some emergency department physicians have not had the
opportunity to obtain what they feel to be adequate training in
handling radiation accident patients. This material should provide
each discipline with an insight and perspective regarding the
handling of radiation accident patients beyond what they may
already have and should provide a good foundation to build upon.
Many sources and much training were called upon to compile
this material in a manner that is understandable and straight-forward.
Many of the texts and books I've seen covering this subject seemed to
have been written for health physicists and scientists: this text is not.
This text is written for you as field and hospital personnel. I have a
great deal of respect for the health physicists and scientists and envy
their perseverance in learning their expertise. However, I have more
respect for the field and hospital people who must implement the
guidance provided by the physicists and scientists, i.e., EMTs,
Paramedics, Fire-fighters, First Aiders, Police, and volunteers who
must get their boots muddy rescuing victims of accidents, radiological
or otherwise. The same respect goes to the good doctor in the
emergency department who must make the most sense of the
nonsense of trauma.
I did not intend to plagiarize anyone's work and I feel I have
not. I believe I've given credit where credit is due. Most of the
materials obtained to perform research were handouts and individual
pages of publications given to me over the years that did not indicate
the publication's name, author, or publisher.
A great number of experts became personally invloved in this
project and I cannot thank them enough. Each of them is listed on the
Acknowledgements page. I tried to list them in order of their level of
support, but each was so personable and willing to help me ensure
the accuracy of particular points within this text that I was forced to
list them alphabetically. Thanks go also to those professionals who
are not listed on the Acknowledgements page and who were not
personally involved but who prepared the source matieral for some of
this project: the References and Suggested Reading lists most of them.
This material includes suggested procedures and guidelines for
handling and decontaminating the radiologically contaminated
patient, for performing radiological surveys, for using protective
 ...
Vlll

clothing, and for other activities, each with a common goal of helping
the EMT, medic, first aider, emergency physician, nurse, police
officer, firefighter, industrial safety officer...the list goes on.. ..provide
quality medical care to the patient-the victim of a radiation accident.
The suggested procedures and techniques are not necessarily to be
performed in the order shown-modification of each procedure and
technique may be necessary to compensate for the case-specific and
facility-specific needs.
Once again I offer my salute to emergency personnel in the field
and the hospital. Often the work of these people is thankless and
unrewarded. A special salute to the volunteers-they are not getting
paid when the wrecked vehicle or smoldering structure they are
crawling into bursts ablaze. I have an idea of what most of them must
deal with because in my own small way I have been there. Finally, let
us not forget the voice on the radio-the dispatcher helps save lives,
too! Thank you-all of you. And may God bless you.

Thomas A. Carder
Table of Contents ix

CHAPTER ONE
BASIC RADIOLOGICAL SCIENCE........................................................ 1
Preview ........................................................................................................... 1
Section 1 . Introduction to Radiological Science .................................... 2
Section 2 . Matter ........................................................................................ 3
Section 3 . Radiation Production............................................................ 13
Section 4 . Biological Effects of Ionizing Nuclear Radiation ..............18
Section 5 . Relative Penetration of Nuclear Radiation......................... 24
Section 6 . Radiation from Electron Shells............................................26
Section 7 . When Radiation is Stopped.................................................. 28
Section 8 - Neutron Radiation ................................................................. 30
Section 9 - "Can Radiation and Radioactivity Be Destroyed?"........... 31
Section 10- Natural Background Radiation ............................................ 32

CHAPTER TWO
EXPOSURE AND CONTAMINATION................................................35
Preview......................................................................................................... 35
Section 1 . Introduction to Exposure and Contamination .................. 36
Section 2 . Exposure and Dose ................................................................ 36
Section 3 . External Exposure and Exposure Controls:
Time, Distance. Shielding ..................................................... 41
Time as an Exposure Control Technique.................... 42
Distance as an Exposure Control Technique ..............43
Shielding as an Exposure Control 'Technique............46
Section 4 . External Contamination with Radioactive Materials.......48
Section 5 . Internal Contamination with Radioactive Materials ........51
Section 6 . PersonnelJPatient Protective Measures: Protective
Clothing. Contamination Control. Decontamination
Techniques. ALARA .............................................................. 53
Protective Clothing .........................................................53
Contamination Control.................................................. 54
DecontaminationTechniques....................................... 60
ALARA............................................................................. 62

CHAPTER THREE
RADIATION INJURIES...........................................................................63
Preview......................................................................................................... 63
Section 1 . Radiation Accident History.................................................. 64
Section 2 . Distribution. Duration. and Effects of Exposure to
Ionizing Radiation ................................................................. 66
Section 3 . Acute Radiation Syndromes................................................. 72
Hematologic (Bone Marrow) Syndrome..................... 72
X Table of Contents

CHAPTER THREE (cont'd)

Gastrointestinal (GI) Tract Syndrome......................... 74

Neurovascular Syndrome............................................. 74
Other Syndromes and Tissue Damage ........................ 75
Section 4 . 1994 Changes to the Methodology of Dose
Determination ........................................................................ 78
Section 5 . Late Effects of Radiation Exposure................................ 82
Leukemia......................................................................... 82
Life-span Shortening...................................................... 82
Sterility.............................................................................83
Cataracts........................................................................... 83
Section 6 . Chernobyl ....................................................................,...........S4

CHAPTER FOUR
RADIATION DETECTION..................................................................... 89
Preview .........................................................................................................
89
Section 1 . Principles of Radiation Detection ........................................ 90
Section 2 . Survey Rate Meter Radiation Detection Principles...........95
Section 3 . Dosimeter Radiation Detection Principles......................... 96
Section 4 . Instrument Examples .......................................................... 101
Survey Rate Meters (Survey Meters)......................... 102
CDV-700 Survey Meter ................................................ 102
CDV-715 Survey Meter ................................................109
Self-reading Dosimeters (SRDs)................................. 111
Section 5 .Instrument Training ............................................................116

CHAITER FIVE
RECOGNITION OF RADIOACTIVE MATERIALS........................ 125
Preview .......................................................................................................
125
Section 1 . Package Labels..................................................................... 126
Section 2 . Vehicle Placarding. Room/ Area Signs. Transport
Packaging ..............................................................................129
Section 3 - "What is This Stuff? How Much is There?"..................... 132

CHAPTER SIX
EXTRICATION AND TREATMENT ...................................................135
Preview ....................................................................................................... 135
Section 1 . Field Extrication of Radiation Accident Patients ............136
Equipment..................................................................... 136
Procedures..................................................................... 137
Table of Contents xi

CHAPTER SIX (cont'd)

Classroom Training ..................................................... 140

Drills ............................................................................... 140
Section 2 . Treatment Basics.................................................................. 141
Section 3 . Emergency Department Handling of Radiation
Accident Patients................................................................. 145
Radiation Safety Officer ...............................................145
Decontamination Team ................................................ 146
Decontamination/TreatmentRoom ..........................147
After Receiving Notification .......................................151
Before Patient Arrival .................................................. 151
Upon Patient Arrival .................................................... 153
Patient Decontamination............................................. 155
Patient Removal from the REA/Decon Room ......... 158
Section 4 - Response to Nuclear Power Facility Incidents ................161

CHAPTER SEVEN
DISROBING THE RADIOACTIVELY CONTAMINATED
PATIENT AND RADIOLOGICAL SURVEY TECHNIQUES ........169
Preview....................................................................................................... 169
Section 1 . Disrobing the Radioactively Contaminated Patient .....170
Section 2 . Instrument Selection ........................................................... 175
Section 3 . Patient Radiological Surveys.............................................. 178
Patient Radiological Contamination Survey
in the Ambulance .......................................................... 180
Patient Radiological Contamination Survey
at the Hospital............................................................... 181
Section 4 . The Contribution of Natural Background Radiation
During Patient Radiological Surveys................................ 183

REFERENCES AND SUGGESTED READING .................................185

GLOSSARY ............................................................................................... 191

INDEX.........................................................................................................203

FIGURES

Figure 1.1 . Atoms and Molecules........................................................ 4

Figure 1.2 . Helium Atom ...................................................................... 5
Figure 1.3 . Coulombic Law of Charges............................................... 9
Figure 1.4 - Electron Shells/Levels....................................................... 9
xii Table of Contents

FIGURES (cont'd)

Figure 1.5 . Ionization...........................................................................12

Figure 1.6 . Neutron ..............................................................................
14
Figure 1.7 . Neutron Decay .................................................................. 15
Figure 1.8 . Alpha Particle....................................................................18
Figure 1.9 . Radiolysis of Water.......................................................... 20
Figure 1.10 . Relative Radiation Penetration....................................... 25
Figure 1.11 . Electron Excitation ........................................................... 27
Figure 2.1 . Radiation and Distance.................................................... 44
Figure 2.2 . Inverse Square Law .......................................................... 45
Figure 2.3 . Radiological Half-life....................................................... 48
Figure 4.1 . Ion Pair Production.......................................................... 90
Figure 4.2 . Wave MotionlPropagation..............................................91
Figure 4.3 . Electromagnetic Radiation Spectrum............................ 93
Figure 4.4 . Geiger-Mueller Radiation Detection.............................. 95
Figure 4.5 . Electroscope Radiation Detection............................... 97
Figure 4.6 . Self-reading Dosimeter.................................................... 99
Figure 4.7 . CDV-700 Survey Meter.................................................. l04
Figure 4.8 . CDV-700 Operational Check ........................................ 107
Figure 4.9 . CDV-715 Survey Meter.................................................. 109
Figure4.10 . Dosimeter Viewfield ...................................................... 112
Figure4.11 . Dosimeter Charger......................................................... 113
Figure4.12 . Matrix Survey Exercise..................................................118
Figure4.13 . CDV-715 Survey Meter Exercise................................ 122
Figure 5.1 . Radioactive Materials Package Labels........................ 126
Figure 5.2 . Radioactive White I Label ............................................. 127
Figure 5.3 . Radioactive Yellow I1 Label...................................127
Figure 5.4 . Radioactive Yellow I11 Label......................................... 128
Figure 5.5 . Vehicle Placard ............................................................... 130
Figure5.6 . Room or Area Sign......................................................... 130
Figure 5.7 . Package Contents and Activity ................................ 133
Figure 6.1 . Example Radiation Emergency Area (REA)............... 160
Figure 6.2 . Example Nuclear Power Facility Layout .................... 163

TABLES

Table 1.1 . Examples of Elements and Compounds ........................... 3

Table 1.2 . Neutron, Proton, Electron ................................................... 7
Table 2.1 . Radiation Exposure and Dose Units............................... 38
Table 2.2 . Accumulated Dose............................................................. 41
Table 2.3 . Exposure Controls.............................................................. 42
Table of Contents xiii

TABLES (cont'd)

Table 2.4 Recommended Donning and Removal of

Protective Clothing............................................................ 55
Table 3.1 Radiation Accident History. 1944 to 1991....................... 64
Table 3.2 Distribution and Duration of Exposure.......................... 68
Table 3.3 Effects of Exposure............................................................. 69
Table 3.4 Dose versus Signs and Symptoms................................ 70
Table 3.5 Acute Radiation Syndromes............................................. 76
Table 3.6 Organ Weighting Factors. Wf...................................... 80
Table 3.7 Terms of Dose Determination..........................................81
Table 3.8 Exposure Groupings ..........................................................85
Table 6.1 Evaluation Procedures..................................................... 142
Table 6.2 Radiation Injury Evaluation Procedures and Their
Results in Relation to Time and Magnitude of
Radiation Exposure.......................................................... 142
Table 6.3 Human Dose Indicators.................................................. 143
xiv

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