Appropriate radiation accident medical management: necessity of extensive preparatory planning
Tóm tắt
Despite the rareness of radiation accidents, their potential consequences can be very serious, and appropriate medical management requires sufficient preparatory planning. To identify necessary factors for sufficient preparatory planning, three different radiation accidents were analyzed, i.e. the accidents in Goiânia, Brazil, 1987; Lilo, Georgia, 1997; and Tokai-mura, Japan, 1999. These radiation accidents have been chosen specifically because they provide a wide spectrum of potential radiation accident scenarios. After a brief description of the accidents and the following medical management, the measures taken are analyzed in terms of diagnosing radiation-induced health damage, determining the cause, dealing with contamination/incorporation, pathophysiological and therapeutic principles, preparatory planning, national and international cooperation and training. Several important factors are identified that should be considered in preparatory planning, i.e. preventing delayed diagnosis and training of medical personnel. Due to limited national resources, an intensified international cooperation to manage medical radiation accidents is of great importance.
Tài liệu tham khảo
Densow D, Fliedner TM, Arndt D (1992) Übersicht und Kategorisierung von Strahlenunfällen und -katastrophen als Grundlage medizinischer Maßnahmen. In: Der Bundesminister für Umwelt, Naturschutz und Reaktorsicherheit (Ed) Medizinische Maßnahmen bei Strahlenunfällen, Veröffentlichungen der Strahlenschutzkommission, Gustav Fischer Stuttgart Jena New York, 27:9–50
Zimmerman PD, Loeb C (2004) Dirty bombs the threat revisited. Center for Technology and National Security Policy, National Defense University. Defense Horizons 38
Meineke V, van Beuningen D, Sohns T, Fliedner TM (2003) Medical management principles for radiation accidents. Mil Med 168:219–222
Bland SA (2004) Mass casualty management for radiological and nuclear incidents. J R Army Med Corps 150(Suppl 1):27–34
Lubenau JO, Strom DJ (2002) Safety and security of radiation sources in the aftermath of 11 September 2001. Health Phys 83:155–164
Timins JK, Lipoti JA (2003) Radiological terrorism. N J Med 100:14–21
Mettler FA Jr (2005) Medical resources and requirements for responding to radiological terrorism. Health Phys 89:488–493
Smith JM, Ansari A, Harper FT (2005) Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device. Health Phys 89:513–520
International Atomic Energy Agency (1999) Report on the preliminary fact finding mission following the accident at the nuclear fuel processing facility in Tokaimura, Japan. International Atomic Energy Agency, Vienna
Hirama T, Tanosaki S, Kandatsu S, Kuroiwa N, Namada T, Tsuji H, Yamada S, Katoh H, Wamamoto N, Tsuji H, Suzuki G, Akashi M (2003) Initial medical management of patients severely irradiated in the Tokai-mura criticality accident. Br J Radiol 76:246–253
Muramatsu Y, Noda Y, Yonehara H, Ishigure N, Yoshida S, Yukawa M, Tagami K, Ban-Nai T, Uchida S, Hirama T, Akashi M, Nakamura Y (2001) Determination of radionuclides produced by neutrons in heavily exposed workers of the JCO criticality accident in Tokai-mura for estimating an individual’s neutrone fluence. J Radiat Res 42(Suppl):117–128
Hayata I, Kanda R, Minamihisamatsu M, Furukawa A, Sasaki M (2001) Cytological dose estimation for 3 severely exposed patients in the JCO criticality accident in Tokai-Mura. J Radiat Res 42(Suppl):149–155
Hall EJ, Giaccia AJ (2005) Radiobiology for the radiologist. Lippincott Williams & Wilkins, Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo
Farina R, Brandao-Mello CE, Oliveira AR (1991) Medical aspects of 137Cs decorporation: the Goiania radiological accident. Health Phys 60:63–66
International Atomic Energy Agency (1988) The radiological accident in Goiânia. International Atomic Energy Agency, Vienna
International Atomic Energy Agency (2000) The radiological accident in Lilo. International Atomic Energy Agency, Vienna
Gottlöber P, Bezold G, Weber L, Gourmelon P, Cosset JM, Bahren W, Hald HJ, Fliedner TM, Peter RU (2000) The radiation accident in Georgia: clinical appearence and diagnosis of cutaneus radiation syndrome. J Am Acad Dermatol 42:453–458
National Institute of Radiological Sciences (2002) The report of the criticality accident in a uranium conversion test plant in Tokaimura. National Institute of Radiological Sciences (NIRS-M−154), Chiba
Meineke V, Fliedner TM (2005) Radiation-induced multi-organ involvement and failure: challenges for radiation accident medical management and future research. Br J Radiol Suppl 27:196–200
Toohey RE (2003) Internal dose assessment in radiation accidents. Radiat Prot Dosimetry 105:329–331
Salter CA (2001) Psychological effects of nuclear and radiological warfare. Mil Med 166:17–18
Friesecke I, Beyrer K, Fliedner TM (2001) Medical treatment protocols for radiation accident victims as a basis for a computerised guidance system. Br J Radiol 74:121–122
Pieper B, Grossmann HP, Weiss M, Fliedner TM, Akleyev AV (1999) Project RATEMA—one year’s experience. J Telemed Telecare Suppl 1:89–90
Levy K, Aghababian RV, Hirsch EF, Screneci D, Boshyan A, Ricks RC, Samiei M (2000) An internet-based exercise as a component of an overall training program addressing medical aspects of radiation emergency management. Prehospital Disaster Med 15:18–25
Coleman CN, Blakely WF, Fike JR, MacVittie TJ, Metting NF, Mitchell JB, Moulder JE, Preston RJ, Seed TM, Stone HB, Tofilon PJ, Wong RS (2003) Molecular and cellular biology of moderate-dose (1–10 Gy) radiation and potential mechanisms of radiation protection: report of a workshop at Bethesda, Maryland, December 17–18, 2001. Radiat Res 159:812–834
International Atomic Energy Agency (2004) Code of conduct on the safety and security of radioactive sources. International Atomic Energy Agency, Vienna
International Atomic Energy Agency (2005) Guidance on the import and export of radioactive sources. International Atomic Energy Agency, Vienna
Breitenstein BD Jr (2003) The medical management of unintentional radionuclide intakes. Radiat Prot Dosimetry 105:495–497
National Council on Radiation Protection, Measurements, Bethesda MD (2001) Management of terrorist events involving radioactive material. NCRP report, vol 138, pp 1–232
Gonzales AJ (2001) Security of radioactive sources, the evolving of new international dimensions. IAEA Bull 43(4):39–48
Fliedner TM, Dörr HD, Meineke V (2005) Multi-organ involvement as a pathogenetic principle of the radiation syndromes: a study involving 110 case histories documented in SEARCH and classified as the bases of hemopoietic indicators of effect. Br J Radiol Suppl 27:1–8
Friesecke I, Beyrer K, Wedel R, Reimers K, Fiedner TM (2000) SEARCH: a system for evaluation and archiving of radiation accidents based on case histories. Radiat Environ Biophys 39:213–217