vii.baru mejemen resiko radioaktif

7/27/2019 Vii.baru Mejemen Resiko Radioaktif

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RADIOAKTIF Orbit elektron

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MEJEMEN RESIKO RADIOAKTIF

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• Radiasi ionisasi adalah radiasi yangmampu membe rikan energi padabadan atau makluk hidup dan materi lain

dan dapat menyebabkan perubahansecara kimia maupun fisika

• Radiasi ionisasi dipancarkan dari

- Benda beradioaktif Atau alat penghasil sinar X.

Ionizing Radiation



Types of Ionizing Radiation

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Alpha Particles

Dapat dihalangi hanya dengan

lembaran kertas

Beta Particles

Dapat dihentikan selapis kain setebal

1inchi atau kurang, sepeti plastik dll

Gamma Rays

Hanya dapat dihentikan betonsetebal

Satu kaki atau kurang satu inch, (lempeng

Radiation

Source



Radiation Units

4

Measure of

Amount of

radioactive material

Ionization in air

Absorbed energy per

mass

Absorbed dose

weighted by type of

radiation

For most types of radiation 1 R 1 rad 1 rem

Quantity

Activity

Exposure

Absorbed

Dose

Dose

Equivalent

Unit

curie (Ci)

roentgen (R)

rad

rem



Radiation Doses and Dose Limits

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Flight from Los Angeles to London 5 mrem

Annual public dose limit 100mrem

Annual natural background 300 mrem

Fetal dose limit 500 mrem

Barium enema 870 mrem

Annual radiation worker dose limit5,000 mrem

Heart catheterization (skin dose)45,000 mrem

Life saving actions guidance (NCRP-116) 50,000 mrem

Mild acute radiation syndrome 200,000 mrem



Radioactive Material

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• Rad ioact ive material terdiri atomdengan inti yang tidak stabil.

• Atoms secara spontane berubah(decay= atau peluruhan) untuk

menjadi atom yang stabil denganmemancarkan radiasi (tenaga).

• Seseorang yang terkontaminasi RA (contaminated by radioactive material )pada kulitnya atau dalam tubuhnyadengan cara (e.g., inhalation,ingestion or wound contamination)



JENIS Half-Life (HL)• 1.Physical Half-Life

Waktu yang diperlukan dalam (in minutes,hours, days or years) selama peluruhansehingga mencapai 50 % (separo =half) decay(meluruh)

• 2.Biological Half-Life

Waktu yang diperlukan oleh badan (organ)untuk mengeliminsai RA yang berada dalamtubuh keluar dari tubuh sehingga tingga 50%dari jumlag RA. (depends on the chemical

form)• 3.Effective Half-Life

Waktu yang digunakan baik secara fisikamaupun bilogi untuk megeluarkan maupun

memancarkan dalam peluruhan dari badanhingga 50%.Half-lives range from fractions of 7



Materials

Radionuclide Physical

Half-Life

Activity Use

Cesium-137 30 yrs 1.5x106 Ci Food Irradiator

Cobalt-60 5 yrs 15,000 Ci Cancer Therapy

Plutonium-239 24,000 yr 600 Ci Nuclear Weapon

Iridium-192 74 days 100 Ci Industrial Radiography

Hydrogen-3 12 yrs 12 Ci Exit Signs

Strontium-90 29 yrs 0.1 Ci Eye Therapy Device

Iodine-131 8 days 0.015 Ci Nuclear Medicine Therapy

Technetium-99m 6 hrs 0.025 Ci Diagnostic Imaging

Americium-241 432 yrs 0.000005 Ci Smoke Detectors

Radon-222 4 days 1 pCi/l Environmental Level

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Causes of Radiation

Exposure/Contamination

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AccidentsNuclear reactor Medical radiation therapy Industrial irradiator

Lost/stolen medical or industrialradioactive sourcesTransportation

Terrorist Event

Radiological dispersal device(dirty bomb) Attack on or sabotage of a

nuclear facilityLow yield nuclear weapon



Types of Radiation Hazards

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• External Exposu re -whole-body or partial-body (no radiationhazard to EMS staff)

• Contaminated -

– external radioactivematerial: on theskin

– internal radioactivematerial: inhaled,swallowed,absorbed through

skin or wounds

External

Exposure

Internal

Contamination

External

Contamination



Scope of Event

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Event Number of Deaths Most Deaths Due to

RadiationAccident

None/Few Radiation

Radioactive

Dispersal

Device

Few/Moderate (Depends on

size of explosion & proximity of persons)

Blast Trauma

Low Yield

Nuclear Weapon

Large (e.g. tens of thousands in an urban area even from

0.1 kT weapon) Radiation Exposure

Blast Trauma Thermal Burns

Fallout

(Depends on Distance)



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Time

Minimize time spent near radiation sources

Radiation Protection

Reducing Radiation Exposure

Distance

Maintain maximalpractical distance fromradiation source

Shielding

Place radioactive sources in alead container

To Limit Caregiver Dose to 5

rem

Distance Rate Stay time

1 ft 12.5 R/hr 24 min

2 ft 3.1 R/hr 1.6 hr

5 ft 0.5 R/hr 10 hr

8 ft 0.2 R/hr 25 hr



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Key Points

• Contamination is easy to detect and most of it can beremoved

• It is very unlikely that ED staff will receive large radiation

doses from treating contaminated patients

Protecting Staff from Contamination • Universal precautions

• Survey hands and clothing with

radiation meter

• Replace gloves or clothing

that is contaminated

• Keep the work area free of contamination



Mass Casualties, Contaminated but

Uninjured People, and Worried Well

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An incident caused by nuclear terrorism may createlarge numbers of contaminated people who are notinjured and worried people who may not be injured or contaminated

Measures must be taken to prevent these people fromoverwhelming the emergency department

A triage site should be established outside the ED tointercept such people and divert them to appropriatelocations. Triage site should be staffed with medical staff and

security personnel Precautions should be taken so

that people cannot avoid the triagecenter and reach the ED



Decontamination Center

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Establish a decontamination center for peoplewho are contaminated, but not significantlyinjured.Center should provide showers for many

people.Replacement clothing must be available.Provisions to transport or shelter people after

decontamination may be necessary.

Staff decontamination center with medicalstaff with a radiological background, healthphysicists or other staff trained indecontamination and use of radiation surveymeters, and psychological counselors



Psychological Casualties

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Terrorist acts involving toxic agents (especiallyradiation) are perceived as very threatening

Mass casualty incidents caused by nuclear terrorism will create large numbers of worriedpeople who may not be injured or contaminated

Establish a center to provide psychologicalsupport to such people

Set up a center in the hospital to provide

psychological support for staff



Activate hospital plan

Obtain radiation survey meters Call for additional support: Staff from Nuclear

Medicine, Radiation Oncology, Radiation Safety(Health Physics)

Establish area for decontamination of uninjuredpersons

Establish triage area

Plan to control contamination

Instruct staff to use universal precautions anddouble glove

Establish multiple receptacles for contaminatedwaste

Protect floor with covering if time allows

Facility Preparation

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Contaminated

Waste

Waste

Treatment Area Layout

Radiation

Survey

HOT

LINE STEP

OFF

PAD

C O N T A M I N A T

E D

A R E A

B U F F E R

Z O N E

C L E A N

A R E A

Radiation

Survey

&

Charting

ED Staff

Clean

Gloves, Masks,

Gowns, Booties

Separate

Entrance

Trauma Room



Detecting and Measuring

Radiation

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Instruments Locate contamination - GM Survey Meter (Geiger

counter) Measure exposure rate - Ion Chamber

Personal Dosimeters - measure doses to staff Radiation Badge - Film/TLD Self reading dosimeter

(analog & digital)



Patient Management - Priorities

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Triage

Medical triage is the highest priority

Radiation exposure and

contamination aresecondary considerations

Degree of decontamination dictatedby number of and capacity to treatother injured patients

Triage" is a French word meaning

"sorting, selection, choice



Patient Management - Triage

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Triage based on:

Injuries

Signs and symptoms - nausea,vomiting, fatigue, diarrhea

History - Where were you whenthe bomb exploded?

Contamination survey



Patient Management -

Decontamination

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• Carefully remove and bag patient’s clothing and personal belongings (typically removes 95% of contamination)

• Survey patient and, if practical, collect samples

• Handle foreign objects with care until provennon-radioactive with survey meter

• Decontamination priorities:

– Decontaminate wounds first, then intact skin – Start with highest levels of contamination

• Change outer gloves frequently to minimizespread of contamination

P ti t M t D t i ti



Patient Management - Decontamination

(Cont.)

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Protect non-contaminated wounds with waterproof

dressings Contaminated wounds:

Irrigate and gently scrub with surgical sponge Extend wound debridement for removal of contamination

only in extreme cases and upon expert advice

Avoid overly aggressive decontamination Change dressings frequently

Decontaminate intact skin and hair by washing with soap& water

Remove stubborn contamination on hair by cutting withscissors or electric clippers

Promote sweating

Use survey meter to monitor progress of decontamination



Patien t Management - Decon tam inat ion

(Cont.)

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Cease decontamination of skin and wounds When the area is less than twice background, or

When there is no significant reduction between deconefforts, and

Before intact skin becomes abraded. Contaminated thermal burns

Gently rinse. Washing may increase severity of injury.

Additional contamination will be removed when

dressings are changed. Do not delay surgery or other necessary medical

procedures or exams…residual contamination canbe controlled.



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• Radionuclide-specific

• Most effective when administered early

• May need to act on preliminary information

• NCRP Report No. 65, Management of Persons

Accidentally Contaminated with Radionuclides

Treatment of Internal Contamination

Radionuclide Treatment

Route

Cesium-137 Prussian blue Oral

Iodine-125/131 Potassium iodide Oral

Strontium-90 Aluminum phosphate OralAmericium-241/ Ca- and Zn-DTPA IVinfusion,

Plutonium-239/ nebulizer

Cobalt-60



Patient Management - Patient Transfer

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Transport injured, contaminatedpatient into or from the ED:

Clean gurney covered with2 sheets

Lift patient onto clean gurney Wrap sheets over patient

Roll gurney into ED or out of treatment room



Facility Recovery

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Remove waste from the Emergency Department andtriage area

Survey facility for contamination

Decontaminate as necessary Normal cleaning routines (mop, strip waxed floors)

typically very effective Periodically reassess contamination levels Replace furniture, floor tiles, etc. that cannot

be adequately decontaminated

Decontamination Goal: Less than twice normal

background…higher levels may be acceptable



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• Occurs only in patients who have received very highradiation doses (greater than approximately 100 rem)to most of the body

• Dose ~ 15 rem – no symptoms, possible chromosomal aberrations

• Dose ~ 50 rem

– no symptoms, minor decreases in white cells and platelets

Radiation Sickness

Acute Radiation Syndrome



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• Prodromal stage

– nausea, vomiting, diarrhea and fatigue

– higher doses produce more rapid onset and greater severity

• Latent period (Interval)

– patient appears to recover

– decreases with increasing dose

• Manifest Illness Stage

– Hematopoietic

– Gastrointestinal

– CNS

Acute Radiation Syndrome (Cont.)

For Doses > 100 rem

Time of Onset

Severity of Effect



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Skin - No visible injuries < 100 rem Main erythema, epilation >500 rem

Moist desquamation >1,800 rem

Ulceration/Necrosis >2,400 rem

Cataracts Acute exposure >200 rem

Chronic exposure >600 rem

Permanent Sterility

Female >250 rem Male >350 rem

Localized Radiation Effects - Organ

System Threshold Effects

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