Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

status?
4. Conduct an initial survey with RADIACs.
5. Collect samples – external swabs/swipes (orifices, wounds, “hot” areas).
6. Begin external decontamination.
History. Diagnosis of external contamination is usually revealed by medical history. A
history of some exposure event, together with suspicion of contamination, should lead
medical personnel to check the patient with detection instruments. External
contamination would probably be asymptomatic at this time, unless the presenting
complaint is a skin lesion occurring a considerable time after the incident.
Initial survey and samples. External monitoring and sample collection should begin at
the accident scene if possible. This use of monitoring equipment to search for
radioactivity is termed a radiological survey. This readily detects external contamination
and guides decontamination efforts. First responders can be quickly taught basic survey
techniques from health physicists, who are experienced users of survey equipment.
The initial survey involves passing a RADIAC slowly over the entire body, using both
alpha- and beta-gamma detectors. The RADIAC should be moved slowly from head-totoe
and side to side, at a rate of about 2–3 cm/sec, and the number of counts/minute
should be recorded frequently. At any site that has a high count (i.e., “hot”), a smear
sample should be collected, or the area should be “swiped” using gauze or filter paper.
These samples should be saved individually in suitable specimen containers for later
laboratory analysis (see also the section on medical treatment later in this chapter).
Evaluation of wounds and orifices. Wounds and orifices should also be surveyed to see
if decontamination of these sites is indicated. All wounds should be surveyed with
RADIAC, because wounds are more likely to be contaminated than intact skin. A
“swipe” sample should be collected from any wound with a high count. Wounds should
be uncovered and exudates removed/collected before the survey, because dressings and
exudates can block alpha particles and low-energy beta particles. Wounds should be dried
by application of absorbent material, rather than by rubbing with gauze, which can force
contaminants into the tissue.
Contaminants can be naturally cleared from the mouth and nose within about an hour.
Therefore, nasal and oral swabs must be collected in the first hour. These should be
collected at the accident scene if possible but certainly before the patient is washed or
showered. Both nostrils should be swabbed and activity on the swab measured with the
RADIAC. The swabs should be saved. Contamination of only one nostril means that the
patient has touched his nose with contaminated hands, or that there is unilateral nasal
obstruction. Samples of saliva, sputum, and vomitus should also be collected if available.
After each decontamination, all the above RADIAC surveys should be repeated, taking
additional samples if there is residual radioactivity. Each sample should be labeled with
the patient’s identification, the sample site, and the date and time of sample collection.
169