Preparation for Receiving
• Nuclear reactor
• Medical radiation therapy
• Industrial irradiator
• Lost/stolen radioactive sources
• Terrorist Event
• Radiological dispersal device (dirty
• Attack on or sabotage of a nuclear
• Low-yield nuclear weapon
Scope of Event
Event Number of Deaths Most Deaths Due to
Radiation None/Few Radiation
Radioactive Few/Moderate Blast Trauma
(Depends on size of
Dispersal explosion and proximity
Device of persons)
Low-Yield Large Blast Trauma
(e.g., tens of thousands in
Nuclear Weapon an urban area even from Thermal Burns
0.1 kT weapon) Radiation Exposure
(Depends on Distance)
Medical stabilization is the highest priority.
Contamination control should not delay critical medical
Be prepared for multiple hazards, including
chemical, radiological, and biological.
Be prepared for multiple events, e.g., a 1st event
followed by 2nd event used to take out first
responders if terrorists are involved.
Be prepared for:
Large numbers of potentially contaminated individuals.
Large numbers of uninjured and uncontaminated but
concerned and frightened individuals.
Triage Goals for Mass Casualty
Evaluate and sort patients by immediacy of treatment.
Do the greatest good for the most people.
In mass casualty event, may need to deal with
thousands of persons in need of contamination
and exposure assessment.
Pre-plan to ensure adequate supplies and
survey instruments are available.
Training and drills are essential to competence
• A systematic approach to handling large
numbers of potentially contaminated individuals
• Such an approach should provide for surveying,
mass decontamination, resurveying, advanced
decontamination (if necessary), resurveying,
and additional decontamination or medical care
• Depending on weather, decontamination sites
may have to be established indoors or in a
Contaminated but Uninjured and Worried Well
• An incident caused by nuclear terrorism may
create large numbers of contaminated people
who are not injured and worried people who
may not be injured or contaminated.
• Measures must be taken to prevent these
people from overwhelming the emergency
Controlled Triage Site
• A controlled triage site
should be established
away from the
to intercept the large
who are not injured and
people who are
worried and divert them
to appropriate locations.
Triage Site Control
• Control of movement through the site is
necessary to minimize the potential for
contaminating clean areas of the site.
• The triage site should be staffed with medical
staff, radiation monitors, and security personnel.
• Precautions should be taken so that people
cannot avoid the triage center and go directly to
the emergency department.
• Establish a decontamination center for people who
are contaminated, but not significantly injured.
• Center should provide showers for many people.
• Replacement clothing must be available.
• Provisions to transport or shelter people after
decontamination may be necessary.
• Staff the center with medical staff with a radiological
background, health physicists or other staff trained
in decontamination and use of radiation survey
• Psychological counselors available
Movement Through the Triage/Decontamination
• The path through the
area must be clearly
marked and individuals
assigned to keep traffic
moving in the right
direction and to prevent
individuals from walking photo credits: M. Meehan
into clean areas, except
by the designated route.
• Clear directions (in
necessary to help
understand what is
expected of them.
Handling of Mass Casualties
Near Emergency Hospital
Access for Area for
Self- deceased Ambulance
referred Serious Traffic
patients Injury/Illness Only
Triage for Injury & Emergency
• Perform first aid
Community or treat &
• Activate hospital plan:
• Obtain radiation survey meters.
• Call for additional support: Staff from Nuclear
Medicine, Radiation Oncology, Radiation
Safety (Health Physics).
• Establish area for decontamination of
• Establish triage area.
• Plan to control contamination:
• Instruct staff to use universal precautions and
• Establish multiple receptacles for
• Protect floor with covering if time allows.
• For transport of contaminated patients into the
emergency department, designate separate
entrance, designate one side of corridor, or
transfer to clean gurney before entering, if time
Treatment Area Layout
• Develop prepared information packets
with Media Relations in advance with
message for incidents involving radiation.
• CDC Web site (www.cdc.gov) has
Emergency Instructions for Individuals
Chinese photo credits: CDC
Health Physics Society
Disclaimer: The information contained herein was current as of 13 Aug 2008 and is
intended for educational purposes only. The authors and the Health Physics Society
(HPS) do not assume any responsibility for the accuracy of the information presented
herein. The authors and the HPS are not liable for any legal claims or damages that
arise from acts or omissions that occur based on its use.
*The Health Physics Society is a nonprofit scientific professional organization whose
mission is to promote the practice of radiation safety. Since its formation in 1956, the
Society has grown to approximately 6,000 scientists, physicians, engineers, lawyers,
and other professionals representing academia, industry, government, national
laboratories, the Department of Defense, and other organizations. Society activities
include encouraging research in radiation science, developing standards, and
disseminating radiation safety information. Society members are involved in
understanding, evaluating, and controlling the potential risks from radiation relative to
the benefits. Official position statements are prepared and adopted in accordance
with standard policies and procedures of the Society. The Society may be contacted
at 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101; phone: 703-790-1745;
fax: 703-790-2672; email: HPS@BurkInc.com.