Posted in Issue 111 - April 2009 Perspective
In situations of radiological emergencies, rapid, targeted response is essential in order to limit people’s exposure, mitigate the consequences, and restore normal conditions. In such situations, response capacity is not only linked to the availability of physical and human resources, but also to appropriate planning which guarantees quickness and efficiency. The management of patients exposed to ionizing radiation requires multidisciplinary support in which different health specializations are involved.
In Latin America there is a wide diversity in the range of radiological sources and practices. Some countries have nuclear power and research reactors, while all have sources available for medical, industrial, agricultural and research purposes. These uses for ionizing radiation are associated with radiographical, analytical, radiation and measuring techniques and the nuclear combustion cycle, as well as in the use of unsealed sources.
These applications of ionizing radiation can produce different types of accidents and consequences, the nature of which will determine the scale and degree of damage to human health with possible psychological, social and economic impact. In addition, today there is the possibility of the ill-intentioned use of radiation sources for terrorist purposes such as a “dirty bomb” (radiological dispersion device – RDD) or a radiological exposure device (RED).
A radiological emergency, from the medical point of view, can cause:
- solely external radiation, either full, partial or local —in this case, there is no contact with radioactive material, that is to say, there is no radiological contamination;
- radioactive contamination of an internal or external nature;
- both external radiation and contamination;
- conventional trauma wounds and external radiation and/or radioactive contamination (combined wounds.
In Latin America, there are significant differences with regard to radiological protection programs in view of constraints in infrastructure, little availability of qualified human resources and little funding, which increase the possibility of accidents despite the intention to strengthen regulatory structures and the legal framework, as well as the implementation of notification systems, licensing and control of sources.
As a result, the effectiveness of initiatives in the region to cope with and mitigate the consequences of radiological emergencies is dependent on the best possible use of human and material resources, and appropriate planning of actions to be carried out. The inclusion and coordination of factors making up response at different levels are necessary.
A high percentage of Latin American countries lack optimal infrastructure and trained personnel for medical response in radiological emergencies.
In any nuclear or radioactive facility —industrial, medical or for research— it is compulsory to have appropriate planning to ensure help for those involved in radiological accidents. Regulatory and health authorities should also consider the need to respond to radiological emergencies following terrorist acts with radiation sources. In this eventuality, victims will be people from the public, and psychosocial and public communication components will be extremely significant. It has been agreed that a medical-hospital assistance plan should be built on three levels of care:
Level 1 - Relates to assistance provided at the site of the accident or in areas of the facility which have been assigned, by other workers or by the radiological protection team. This stage can also involve assistance in the facility’s medical service.
Level 2 - Relates to “designated hospitals” to which, if necessary, patients who need medical-surgical assistance as a result of fractures, diverse trauma, thermic or chemical burns, etc., but combined with external radiation and/or radiological contamination would be transferred.
Level 3 – Relates to “the referral center for highly complex cases” for highly specialized support. Since this is a referral center, it could be situated at a distance from the radioactive or nuclear facility. This center must have excellent conditions for assistance to those affected by radiation that have bone marrow failure or wounds which need specialized treatment by hematologists, plastic and reparatory surgery, micro surgery and vascular surgery, etc.
Level 4 - Level 4 relates to the possibility of carrying out joint efforts of a transnational nature between several radiopathological centers. This includes the referral of patients, the support of international specialists and materials, mutual counseling and the ability to take advantage of regional response networks, such as that of WHO, PAHO and the International Atomic Energy Agency.
The Pan American Health Organization has begun a project to develop a guide for response to radiological and nuclear emergencies, as well as the establishment of a regional network of knowledge on the subject to facilitate advice between countries through experts in the region. In parallel, the Organization is considering whether it would be appropriate to manage a regional stock of useful elements for response, as well as the creation of networks of laboratories and the identification of experts who can be mobilized to support emergency response of this kind in the region.
In conjunction with the guide, a training workshop for health personnel will be designed, which seeks, in addition to further upgrading and enhancing preparedness in the issue, to review and adapt national contingency plans in this area and to test the process of planning and medical assistance to those involved in radiological accidents. The first meeting of experts involved in this project was held in Buenos Aires in April of this year.
* Written by Dr. Nelson Valverde, consultant in Radiopathology, Rio de Janeiro – Brazil.
Adapted from the Manual for Assistance to victims of radiation accidents , published in the framework of the project ARCAL RLA/9/031 - ARCAL XXXVII.