http://www.nbcnews.com/id/43529641/ns/health-

health_care/t/nurses-suicide-highlights-twin-

tragedies-medical-errors/#.WDtQK_krJaQ

1985 1986

STANISLAV

PETROV

LAYING BLAME

AND THE

MYSTERIOUS CASE

OF T25

Rules for Mogwai

1.Don't expose them to sunlight

2.Don't expose them to water

3.Don't feed them after midnight

What if Gremlins Rules

Were Run by a Computer?

1985 1986

• Becqurel(Bq) is a measurement of radioactivity

• Bq is the number of atoms in the material that decay per second

NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.

• gray(Gy) is a measurement of absorbed dose

• Gy doesn’t predict harm because different tissues respond differently to exposure

NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.

NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.

• Radiation Absorbed Dose(rad)

• 1 rad = 0.01Gy

• sievert(Sv) is a measure of the health effect on the body

• Weighted by the type of radiation and exposed tissue

NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.

1985 1986

1985 1986

Linear Accelerator

Isodose Distribution

25MeV X-Ray Beam

Korevaar, E.W., et. al.; Mixing intensity modulated electron and photon beams: Combining a steep dose fall-off at depth with sharp and depth-independent penumbras and flat beam profiles. Physics in Medicine and Biology 44:9, 1999.

3D Conformational Radiotherapy

Intensity-Modulated Radiotherapy

Proton Therapy

Ling, T.C., et. al. Analysis of IMRT, Proton, and 3D-CRT for reducing perioperative cardiopulmonary complications in esophageal cancer patients. Cancers, 6(4), 2014.

Fort Calhoun Incident

https://orise.orau.gov/reacts/guide/care.htm#Team

http://ansnuclearcafe.org/2014/06/13/pathfinder/

#sthash.c2E8XHJa.dpbs

Pathfinder Project

ED Radiation Treatment

● Exposure – Exposed to radioactive particles but

person doesn't emit radiation (no hazard to EMS)

● Contamination –

Radioactive material on skin

or in body

Ask

● How many victims

● Expose or contaminated

● Identity of contaminant

● ETA

● Advise EMS of special entrance / procedure

Contamination

● Set up a controlled area

● Isolation precautions

– Protective clothing

– Double bag clothing

Protective Clothing

• Surgical Clothing including

shoe covers

• Open seams should be

taped

• Tape inside glove to skin

• Apply second glove over gown

and tape

• Lead aprons not recommended

• Won’t stop most gamma rays

Room Preparation

● Sheet or butcher

paper taped to

the floor

● Document

background

radiation level

● Cover equipment and bed with 2 layers of plastic

https://www.remm.nlm.gov/ext_contamination.htm

Decontamination

• Irrigate wounds first,

then intact skin

• Soap and water for

intact skin/hair

• Soap and water for

intact skin/hair

http://hps.org/physicians/documents/Management_of_Radiation_Exposed_or_Contaminated_Patients.ppt

• Radiation survey after each cycle

• Done when contamination is < 2 x background

radiation level

• Promote Sweating (gloves over hands for a few

hours)

Decontamination

Internal Decontamination

• Iodine-125 or -131 Potassium Iodide

• Strontium-90 Calcium

• Americium-241 Diethylenetriamine Pentaacetate

• Plutonium-239• Cobalt-60

Tse, M. Antidotal treatment for radioactive materials, The Hong Koong Medical Diary, 16:4, 2011.

• Cesium-137 Prussian Blue

Exposure Treatment

● Doses > 1Gy

● Prodromal

● Nausea/Vomiting, diarrhea

● Latency

● Manifest Illness

• Loss of cell lines

• Hemorrhage

• Infections

• Vomiting/Diarrhea

• Mental Status Changes

6-8 Gy Whole-body

1-2 Gy Whole-body

Time phases of acute radiation syndrome, U.S. Dept. of HHS. https://www.remm.nlm.gov/ars_timephases2.htm, 2016.