Thread by @funranium

Medical Emergency vs. Rad is the natural follow up to Fire vs. Rad because the responder priorities are exactly the same: Life, Property, and Environment. Though in some jurisdictions they swap the order of those last two.

Life saving efforts are always top priority though.

https://twitter.com/funranium/status/1311717863569281026

Which is why it is such a dick move at the level of war crime to drop/set off a second bomb 10-20min after the first to make sure you nail all the responders doing life saving efforts.

But I digress.

In general, during contamination incidents that also have injuries we do our best to simultaneously decon and render medical attention as close to the site of the incident as safely possible, with priority on treating the injury.

This comes back to what I yelled at my firefighters about. The latency for most radiological issues, other than certain leukemias, is ~40 years. The latency for arterial bleeding is minutes. The reason medical issues get priority is that you don't have much time to work with.

You don't have long to save the malfunctioning meat colony hanging on a bone reef. But, man, we can spend 80+ years decontaminating spaces, equipment, dirt and water. When we remember to care and find money for it. All the time in the world for inanimate objects & environment!

But the Responder's First Rule always applies: don't become a victim yourself.

If there is a chance for serious radiation exposure or material uptake by the responders, this matters and this is also why you have health physicists to tell you how long you can be in there.

Acute external radiation exposure tends to not be an issue in these cases, but then there's situations like the criticality accidents. Victims are most certainly dead if you don't get them out immediately. The traditional advice of NEVER MOVE INJURED PEOPLE no longer applies.

First responders have dose thresholds where we can ask them to do their jobs, but we don't ask them to jump into the heart of a reactor. In the US, we have limits:

• .05Sv normal annual dose limit
• .1Sv work to save property
• .25Sv for life-saving/disaster mitigation

If things are REALLY BAD, you can ask for volunteers to exceed .25Sv but you can't force them to go in. You reserve this for absolutely critical life saving efforts or things like "Someone needs to go in to flip the switch to stop the pump fueling the crit accident."

All your responders have PPE, even more monitoring than normal, etc. to minimize their uptake of material and make sure they don't overexpose themselves. It's very rude to treat your responders as disposable. Also, you spent a lot of money training them. They're valuable.

And while it's not fun to think about, health physicists also get to do the math to tell first responders NOT to go in. We accept responder dose for life saving; we do not unnecessarily take dose for corpse retrieval.

But in this scenario you have a living, for the moment, contaminated accident victim riddled with glass. The scenario asked you which choice would "best minimize the spread of contamination & help save the patient."

Because while life saving is a priority, we aren't dumb.

The less we have to move the victim, the less likely we are to injure them further AND the less likely we are to spread contamination. Potential contamination does matter, so someone responding to this accident also needs to be taking note of who has gone where. Probably several.

Why does it matter? Because those are areas you're going to have to go back and decon later after the medical part of the response is over. You have more time but man oh man is it easier when you have some notes about where to look.

Ideally, you'd bring your medical responders to a safe area near the the accident to minimize the movement of the patient and spread of contamination. Particularly large facilities, or ones with some "high consequence" materials and operations, often have medical staff on site.

But that's not going to let your doctor do much more than some advanced first aid. Enough to stabilize the victim to get them to the hospital. Perhaps to work with the rad safety people to get the nastier of the contamination off before transport.

What you *aren't* going to do in most case is full decon before transport. If you can get their clothes off, which is where most of the contamination is, that's super. Go for it. But the clock is ticking and time is blood. Decon showers and such aren't happening.

The nice/horrible thing about the shards is that they constitute and internal uptake of radioactive material by injection. Your victim is politely containing that material in themselves and not spreading it as contamination for the time being.

But since shards though clothes into the victim are gonna make it hard get them off, you gently put them in Tyvek suit and load them off for transport to hopefully contaminate the ambulance as little as possible.

But if time is of the essence, you transport without delay.

This is where you probably lose an ambulance for a while afterward. They've got impermeable surfaces and are meant to be cleaned because they transport malfunctioning meat colonies that may be very messy indeed. But, man, there are so many nooks and crannies in those things.

There is a point where you throw your hands up and write it off because the time of labor and expense of disposal exceeds the cost of the ambulance itself. If you're gonna be throwing an ambulance away, chose an old one.

But sometimes you NEED that ambulance. During a mass casualty incident, contaminated victims can seriously wipe out your transport capability when you need it most. Plastic down that you replace every run, a quick meter survey for anything serious, and then you're off again.

Which brings us to the hospital itself. Ideally, you've already got arrangements with the hospital for how to deal with contaminated patients, they're trained for it, and you've all run drills to make sure everyone knows what to do.

[waits patiently for the laughter to die down]

Hospitals do not appreciate SURPRISE CONTAMINATION INCIDENT. Everything I said about ambulance decon applies to operating rooms too, though they're more precious and difficult to clean.

Before transport, you should call ahead to let them know what's coming. So they can prepare.

They will open different doors, slap plastic up, whatever to make a controlled, easily decontaminated corridor to an operating room with the least possible disruption to the rest of hospital operations.

And, if they can, they will do this in the parking lot as triage.

Might not be as sterile as an operating room, but any equipment & supplies they need for the triage tent are conveniently right in the hospital. Rad safety people from the worksite tend to come with the victim and get handed all the contaminated shards. Hospital doesn't want 'em.

Once the victim is no longer in danger of dying of their injuries, now begins the complicated work of trying to determine what their material uptake was. This going to involve pretty much every orifice, including bonus ones like wounds, and everything a human body can excrete.

If the preliminary sampling and math for the internal dosimetry doesn't look good, it's good you're already at the hospital because it may be time to start chelation therapy.

PROTIP: You don't do chelation without medical supervision. It's a really nasty way to die.

In the inspiring event for this scenario, the victim wasn't working with a hot cell, though that certainly has happened in the past, but rather in a glovebox where the exhaust fan had a rather severe hiccup and causing the window to shatter.

On a positive note, this means the victim didn't get a face and torso full of shards but arms and hands instead. Through the gloves.

Considering the actinides this glovebox was normally used for with, that's bad.

It worth noting that the glovebox window going away immediately caused all the continuous air monitoring systems to go off. Odds of a materials uptake by victim = VERY YES

GOOD NEWS: The gloves were thick enough that they caught most of the shards with only a few penetrating deeply.

BAD NEWS: The now exposed gloves were *very contaminated* from handling materials and need to be kept from shedding.

And so, the victim got out of the glovebox room, stood immediately outside of the door while their arms, that were still wearing the gloves with glove ports attached, and had plastic bags taped over their arms. This helped contain contamination and, well, blood.

Took some nasal swabs to see how much of the actinides in question they'd gotten up the snoot and then took them over to the clinic. They were met in parking lot with a cart full of equipment to delicately get those gloves off and into a waste drum.

After plucking the shard, the doctor effectively did bloodletting by letting the wound flow for a bit to hopefully clean and rad materials out before stitching things up. That blood was collected to assess what had been flushed vs. that the Wound Counter saw remaining.

Yes, there is a specialized piece of radiation detection equipment called a Wound Counter.

Patient was conscious and making jokes through all this. Their favorite was "I don't look forward to explaining my new track marks to the clearance investigator."

The best part of it was the punch biopsy they did where they just out right removed all the material in one wound. The bioassay which is actually decontamination is A+ work.

Victim was scarred but fine, with quite the dose assigned over the next 40 years of their life.

~fin~