Treatment The type of treatment depends on the type of exposure. If the toxin has been inhaled or affects the respiratory system, ventilator support may be needed. Aggressive intensive care support is needed in many cases. Blistering agents must be washed from the skin. Nerve agents and pesticides also need to be washed off immediately to increase survival rates (Worek et al., 2016). The patient may be immunocompromised and the risk for infections on the third day must be closely monitored. High airway resistance may be treated by atropine. Blood pressure and vital signs must be monitored closely. The blood pressure may have a biphasic effect where it is elevated initially and then drops precipitously. Skin lesions are painful and may result in blistering. Pain medication may be necessary and
treatment of the blisters may need to follow burn protocols. One must be mindful of open lesions that may have resulted from trauma and the consequences of treatment; these areas may concern further entry of the toxins. Intravenous benzodiazepine may be used to control seizures. The healthcare provider should implement seizure precautions. One must remember that even the most severe cases can result in total recovery with the correct medical care (Madsen, 2020). Triage protocols, organ failure assessments, and severity indices are provided by the Crisis Standard of Care Plan (The National Academy of Sciences, Engineering, Medicine, 2018). Chemical and biological exposures may create panic in patients and healthcare providers, so calm reassurance and containment procedures are needed.
RADIOLOGICAL TERRORISM
There is a recent concern of widespread nuclear detonations that could cover the 60 largest cities in the United States. This concern is the result of threats by North Korea. Federal agencies are shifting planning for small nuclear devices to a thermonuclear blast that could kill millions of US citizens and tax medical professionals and first responders. Several of the concerns include getting healthcare professionals and food and medical supplies to areas where victims need treatment without contaminating the disaster responders (Vergano, 2018). Healthcare Consideration : A widespread nuclear detonation would result in massive amounts of radiation dispersed in the atmosphere. This may spread to areas rapidly, depending on wind and water currents. Sheltering in place is a concept that protects against acute radiation effects. demand for rescue of false casualties, which further strains healthcare resources. Medical consequences Healthcare staff receiving victims of a radiologic disaster or terrorist attack must consider that some victims may already be decontaminated at the scene, and others who have not received prior care or decontamination may present to the receiving site, whether in the field or at a hospital or clinic. To treat these victims properly, healthcare staff must understand the types of contamination the victims have been exposed to (e.g., alpha, beta, or gamma radiation). Alpha radiation is a large or heavy type of radiation that consists of two protons and two neutrons. Because this type of radiation is heavy and has a significant charge, it does not travel far and can be stopped by clothing and even paper. This type of radiation will not penetrate the skin and can be washed off the victim with water. However, if inhaled, alpha radiation can destroy lung tissue; this mode of absorption is considered very dangerous for the victim (USNRC, 2020). Beta radiation is more serious for both the victim and healthcare professional. Beta radiation consists of a single electron traveling at high speeds and is very light with a negative charge. Beta radiation does not travel much further than alpha radiation, but the rays do penetrate paper and cloth and penetrate the skin to some degree. Beta radiation is used mostly for medical imaging purposes and is injected into the body or used for cancer treatment, being placed within the tumor, usually in pellets. Gamma rays, also known as X-rays , are very dangerous forms of radiation and can penetrate the human body. They are most familiarly known through their use as a diagnostic technique to examine a person for broken bones or to find some types of metallic objects that may be in the body. Protection from gamma rays requires heavy shielding in the form of protective aprons and metal shielding within walls or free-standing screens (USNRC, 2020).
Radiologic disasters and radiological terrorism are infrequent, but they can be daunting when they occur. The first responders and emergency department staff must be prepared to handle such a disaster or terrorist attack. Examples of radiological disasters include the Fukushima power plant in Japan, which was damaged by a tsunami in March 2011. The worst nuclear disaster in US history was the Three Mile Island accident in 1979 that resulted in a partial core meltdown of the reactor core. Because of the Three Mile accident, over 140,000 people in central Pennsylvania were evacuated. Only a small amount of radiation was released. Still, there was a delay in communication and evacuation, where 5 days after the meltdown pregnant women and children were asked to evacuate the area. There were no deaths directly attributed to this accident, but there was an increase in cancer-related deaths, especially thyroid cancer (National Public Radio, 2018). Radiologic and nuclear terrorism Radiologic disasters fall within the following six categories: 1. Explosive detonations containing radiologic materials. 2. Exposure to radiation materials in public places. 3. Terrorist attacks at nuclear-related sites or that will result in a release of radiation from a power plant. 4. Multiple vehicular accidents involving the transport of radioactive isotopes. While each category originates from a different type of disaster, the key result is the release of radioactive materials, referred to as ionizing radiation . Nuclear or radiological terrorism can be considered part of a weapons of mass destruction classification, complicating matters in responding because different agencies at different response levels would be involved depending on the category and source of the release of ionizing radiation. Dirty bombs, also called radiological dispersal devices (RDD), are a type of bomb used to disperse radiological materials in terrorist attacks. They have the added result of explosive damage resulting from the conventional explosive device used, which may also contain shrapnel-producing effects. Dirty bombs are not nuclear bombs and do not have the same intended results as a nuclear bomb. Nuclear weapons have millions of times the energy and radiation that RDD do and are meant to destroy thousands, if not millions, of people and hundreds of miles of land. Generally, an RDD does not disperse enough radiation to kill a person, though the explosive device or added shrapnel used to disperse the radiation could do so. The impact of the radiation depends on the type of radiation contained in the RDD (i.e., alpha, beta, or gamma radiation), how far a person is from the RDD, how the person was exposed (e.g., skin vs. inhalation), and how much radiation the person absorbed (U. S. Nuclear Regulatory Commission [USNRC], 2018). Panic resulting from this type of terrorism also contributes to injuries and the 5. Water or food source contamination. 6. Nuclear explosive device detonation. (Adelman et al., 2014)
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