Wall Street Journal columnist Peggy Noonan, who appeared on NBC’s “Meet the Press” the Sunday following the Boston bombing attacks, voiced what many Americans must have been thinking: “and my first thought, I’m, I guess embarrassed to say, is radiological dirty bombs… I have to tell you, there was a certain relief in finding out it was a crude jerk bomb… That for a long time, we’ve been waiting for something more terrible than this.”
Her reaction was understandable, as we tend to fear hazards that we cannot easily detect, such as would be unleashed by a radiological, biological or chemical weapon. This fear is shared by citizens and first responders alike, and highlights the need for specialized training for responders who care for victims of an event.
As with many hazards, such as chemicals, routine exposures to low levels of radiation do not prove to be harmful. Many people do not realize that we are constantly exposed to naturally-occurring radiation which is measured in the units of “millirem”. In fact, over the course of a year, we are exposed to an average 620 millirem of radiation which includes both cosmic radiation and radioactive materials in the earth. This is known as background radiation. Background radiation does not require special safety controls as it is part of our normal life.
A radiological dispersal device (RDD) is a mix of explosives, such as dynamite, with radioactive powder or pellets. When the dynamite or other explosives are set off, the blast carries radioactive material into the surrounding area. In the case of the Boston Marathon attack where the two bombs were made from common household pressure cookers, the actual amount of radioactive materials dispersed by those devices would have presented an isolated threat to the people near-by. It is most likely that the injury from radiation exposure would be much less significant when compared to the physical damage caused by the blast itself. It would be the panic and chaos that ensued following an RDD attack that would disrupt triage and victim care which is critically time-sensitive to reduce the number of fatalities.
Training is imperative for emergency and hospital personnel to coordinate the transportation of victims and to mitigate their risks while performing life-saving activities at the hospital. Proper radiological training benefits staffers not just in the event of a dirty bomb attack, but in the more likely event of an industrial accident or a traffic accident that results in the dispersal of radioactive materials.
Training to prepare for a radiological incident should comprise of a range of topics including: the basic fundamentals of radioactive materials and their hazards, the proper use of radiation detection equipment, and methods to reduce exposure and control radioactive contamination. Training must cover what are normal “background” radiation readings as opposed to elevated readings that indicate that radioactive materials are present. A key objective of training is to develop a clear understanding of how to safely treat victims who could have been exposed to radiation or contaminated with radioactive materials, and how to safely transport them to other areas of the hospital.
It is critical that the right type of instrument is used to assess the situation. Since there are different types of radiation that could be encountered, first responders and ER staff need to be trained to understand the types of radiation and the instruments used to detect them when responding to a radiological event. The routine maintenance of instruments should be covered, including routinely calibrating instruments to verify the accuracy of their readings. Calibration of radiation detection devices should be done on an annual basis by an appropriate licensed facility. During a response, checking the calibration via a field check can ensure that the devices are working properly. Use of a small radioactive “check source” verifies detector performance and is a common best-practice to guarantee optimum instrument operation.
Basic protective measures required to safely triage victims of an event, both at the scene, in the ambulance, and at the hospital should be emphasized. Training should reinforce effective methods to reduce exposure and limit the spread of contamination.
If and when a call comes in that may involve radiological materials, the basic steps to prepare the hospital should include:
• Preparing the entrance for the hospital and the emergency room. Having contamination control materials readily available, such as plastic to place on the floor and cordoning off the treatment area will prevent the spread of radioactive contamination.
• Providing gloves and protective clothing so staffers can interact and treat patients without becoming contaminated.
• Lining gurneys and stretchers used to receive contaminated patients with protective materials will minimize the risk that hospital equipment will be contaminated and require cleaning after the incident.
• Proceeding with treatment regardless of potential contamination. Hospitals should always put top priority on providing life saving measures, examining wounds and preventing infection. Hospital staff should never stop treatment because of contamination. The risks posed by serious wounds far outweigh the risks posed by radiological contamination and hospital workers will receive minimal, if any, exposure from contaminated patients if properly trained.
Preparing for a RDD blast, or other radiological event should be built around two foundations: education and equipment. Classes on the fundamentals of radiation are a necessity. Understanding where radioactive materials come from, what levels of exposure are hazardous, and the types of materials responders may encounter will help responders make educated decisions when faced with an event. Training on the use of the equipment necessary to detect radioactive materials should be provided to all responders. This equipment should be properly maintained and carried by first responders and available to hospital staff at all times.
Drills on the use of equipment and the basic protective measures to take when triaging victims are critical. If properly prepared, the impact on emergency room operations will be minimized. Following the response to contaminated patients, it is also important for ER staff to practice the methods to dispose of protective coverings, conduct decontamination, and perform and document clearance surveys to return to normal operations.
Responders are already well trained on how to safely rescue and treat the injured and coordinate their transfer to hospitals. However, proper training is also important for responders and ER staff to minimize panic when they hear the word “radioactive.” The ER staff needs a basic understanding of how to survey for radioactive materials, and how to communicate effectively with the paramedics bringing patients to them. The most important goal of training is to reinforce that triage is the highest priority. Do not allow the presence of radioactive contamination to affect the treatment of victims, as this care is paramount.
