One of the most commonly overlooked areas of preparation is the communication that occurs with the immediate responders (paramedics, EMT’s) prior to their arrival with the patient. The common language of medicine is helpful in communicating to the emergency room staff, via radio or telephone, the clinical status of the patient and the nature of the wounds. Emergency responders understand the importance of respiration, pulse, blood pressure, skin color, pupillary response, and other signs and symptoms. The average emergency responder however is not versed in the communication of radiological data. A description by a radiation technologist at the scene of the accident stating that there is “ten thousand DPM of contamination at the hand wound and two thousand at the scalp” may be met with fear and reluctance to care for the patient.
If a hospital is located near a facility that uses radioactive materials, it is imperative that both the emergency responders and the hospital staff understand the language of radiation. Drills are an important part of preparedness and should be conducted in conjunction with the radiation user, emergency responders, and emergency room staff on at least an annual basis.
As in any hazardous material situation, it is helpful to have a knowledge of the materials that caused the contamination, the amount of exposure, and the body areas affected. If the accident involves transportation of radioactive materials, the contents and activity are clearly labeled on the package.
Pre-arrival communication preparation should involve all parties. Common language should be decided upon. Rads or Gray of radiation are not easily calculated at the scene. Contamination is more easily expressed in either disintigrations per minute (DPM) or counts per minutes (CPM.) Input should also come from a radiation technologist or radiation physicist as part of disaster preparedness. The hospital radiation safety officer (RSO) is a good choice. Data not only about the contamination, if present, but the type of accident, materials if known, and the areas involved are imporant pieces of information.
On arrival of the patient at the hospital the ambulance or helicopter and its personnel must be considered to be contaminated. The patient cannot simply be wheeled through the hospital on a potentially contaminated ambulance gourney by potentially contaminated personnel. Contamination may be spread throughout the hospital quickly by an unknowing staff.
Video of clean team transfer at heliport.
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Video of clean team transfer at ambulance bay.
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The simplest method to avoid this problem is to perform a clean team transfer. Such a transfer is performed by defining a zone of potential contamination around the arriving vehicle. An ambulance can back up to a piece of Herculite that will serve as the contaminated zone. Ambulance staff should not leave the area. The ambulance staff is met by the hospital staff at the edge of this zone. The ambulance gourney and the hospital cart are placed side by side at the edge of the zone. Ambulance personnel stay on one side, hospital staff stay on the other. The patient is then transferred to the clean gourney to be transported anywhere in the hospital. The cart and wheels are not contaminated so the hospital remains clean. Radiation will not “jump” off the patient to contaminate the surroundings.
Similar procedures can be performed with helicopter staff. Herculite is not a good choice for a landing zone as it may be blown up and become caught in the rotors of the helicopter. The landing zone however usually has a painted circle or square. The interior of this area can be considered to be potentially contaminated, and the clean team transfer can occur at the border.
In this manner, the patient can be taken directly to the emergency care area, operating room, CT scanner, or any other place in the hospital with complete assurance that contamination will not be spread throughout the facility.
The emergency responders should be checked by a radiation technologist that is experienced in detecting contamination. Nuclear medicine technologists who routinely survey areas for contamination are a good choice. While waiting, the emergency responders should not be allowed to drink, eat or smoke. If there is contamination, these actions may result in converting a more easily treated external contamination to a more difficult to manage internal contamination.
Total body surveys of the responders and the interior of the vehicle should be performed according to routine procedures. Again, an RSO is often helpful in directing activities. Once the emergency responders and the vehicle are determined to be clear of contamination, or the contaminated areas have been cleaned, they are free to go.