epr-method (2003) - IAEA Publications - International Atomic Energy ...

A8 - MANAGING THE MEDICAL RESPONSE Threat category Responsibility
Elements I II III IV V O L N
facilities and brief the medical staff on the limited risks from treating contaminated and exposed patients,
precautions they should take, contamination control, and handling of contaminated waste or samples. See
information for Element A10.6 on how to characterize risk. Ensure that medical staff will not let fear
interfere with treatment of contaminated patients. Establish a procedure and system of organization and
notification of appropriate medical staff and support personnel. Diagnosis and treatment guidelines
should be consistent with Refs. [28,29]. Attempt to minimize psychological suffering (for example, by
treating the patient near home if possible). Consult experienced physicians on the treatment of severe
deterministic health effects through the IAEA or WHO using the procedures in Ref. [23]. See the first
information item under Element A8.2 on the information to be gathered to estimate dose.
Be prepared for three waves of people arriving at a hospital from a radiation emergency with masscasualties:
1) Wave 1: worried-well, who are not injured but worried and get to the hospital on their own
and fast. If the staff is not prepared for them, they can clog the hospital and interfere with the treatment of
the truly injured that will arrive later. 2) Wave 2: the injured that are rescued by the public – bystanders.
These arrive next and, while injured, they may not be the most severely injured and 3) Wave 3: the injured
that are rescued by the emergency response personnel. These will be the last to arrive and will typically
be the most severely injured. Note Wave 1 and 2 could contain people who have not been monitored or
decontaminated.
Have arrangements to dispatch an emergency medical response team to co-ordinate the medical response
to a radiological emergency at any location. This team should be prepared to prepare and use local
medical resources. (see Appendix 7 for typical responsibilities)
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A8.5 Arrange for identification, tracking and long term medical follow-up and treatment of the health
effects of people in those groups that are at risk of sustaining a detectable increased incidence of cancer
from radiation exposure or in effects from prenatal exposure (e.g. mental retardation). The criteria for
determining who should receive long term medical follow-up should have the aim of detection of
radiation induced cancers or mental retardation at an early stage to allow more effective treatment (4.81).
A registry should be established of persons to be tracked and to receive long term medical follow-up.
These arrangements should include identification of the responsible organization, criteria for inclusion in