How would military hospitals cope with a nuclear, biological, or chemical disaster?

In any nuclear, biological, or chemical (NBC) attack, it is clear that the hospitals may be overwhelmed with casualties. In these deliberate accidents, there will be an additional problem of contamination. Military hospitals must be prepared for NBC disasters with a detailed incident plan. Within this plan, decontamination facilities and shower systems are needed primarily to protect the hospital from self-contamination. Physical and collective protection measures of the staff should be taken into account, with evacuation routes under such an attack. Within this conjunction, the required equipment, including protective suits, detection means, drugs, antidotes, and vaccines, should be provided and stored properly. Qualified personnel should be assigned to the NBC first-aid and rescue team organized within the hospital, equipped, and trained according to such a possible task. Medical staff must be aware of the effects of the agents, and must be experienced in decontamination and first-aid to victims exposed to these agents. Therefore, this information must be put into practice by giving attack scenarios and responses to the hospital administration. It can be conclusively pointed out that military hospitals especially should be better prepared than any other civilian health unit to such attacks of weapons of mass destruction.     

Data Bank and Consulting System for Medical Management of Patiens with Acute Radiation Sickness

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生物剂量估算技术在核与辐射事故医学救援中的应用

核与辐射事故医学救援中,对事故人员进行分类诊断可使医疗资源得以充分利用,从而大大提高救援效率。生物剂量估算技术是目前判断外照射放射损伤程度的有效方法。利用生物剂量估算技术进行受照人员的分类诊断,对核与辐射事故医学救援的高效、有序具有重要意义。该文针对现有生物剂量估算技术的特点及其在核与辐射事故医学救援分类诊断中的应用进行了分析讨论。     

A Turkish medical rescue team against nuclear, biological, and chemical weapons

Medical aid is one of the primary responses given in the deliberate release of weapons of mass destruction for both military and terrorist purposes. From this point of view, a nuclear, biological, and chemical (NBC) Medical Rescue Team was established in the structure of Gulhane Military Medical Academy. The staff in the team is composed of physicians, nurses, and paramedics who are assigned in Medical Intervention Units, Medical Nursing Units, and Decontamination Units, respectively. The main aim of this team is to give a medical response including first aid, airway, breathing, and circulation resuscitation, decontamination, and triage under any NBC attack. For this purpose, the communication and coordination between the team members were standardized. Moreover, the team was equipped with the required protective clothing, masks, antidotes, and other drugs and agents used for victims exposed to NBC weapons. Within this concept, the personnel in the team were trained with respect to first aid and treatment of NBC casualties in both theoretical and practical scenario. All of this background information was used in a practical operation held in Gulhane Military Medical Academy under a chemical attack scenario given.     

Learning From Biomarkers in Victims Accidentally Exposed to Ionizing Radiation

Biomarkers,such as chromosome aberration and micronuclei assays,prove to be reliable for facilitating clinical diagnosis in radiation accidents.In a radiation accident in India,chromosomal aberration,γ-H2AX,as well as other blood markers,were detected in accidentally exposed victims.This multi-parametric approach aided in confirming that individuals had been exposed by ionizing radiation.However,doses were impossible to estimate because of a 30-day delay in accident awareness.Exposure dose for victims was estimated using a dose-response curve previously established.Dose estimation,blood cell depletion kinetics,and no appearance of prodromal symptoms suggested that doses of exposure were low.Hematologic investigation,sampling time,and chromosome aberration scoring were all proposed according to data from the victims exposed to 60Co.Finally,knowledge regarding chromosome aberration analysis and the importance of international co-operation and assistance should be shared from this accident.     

How to cope with radiation accidents: the medical management.

A concerted action, termed METREPOL, was accepted by the Commission of the European Communities and was started in December 1997. Its purpose was to develop a new approach to the medical management of radiation accident victims with respect to diagnostic procedures and therapeutic options, based on recognition and evaluation of health impairments after acute radiation exposure. The result of this interdisciplinary project is a manual entitled "Medical management of radiation accidents: manual on the acute radiation syndrome". The manual compiles recommendations for assessing the state and outcome of a radiation accident victim in the shortest possible time. Furthermore, it provides guiding support for the medical management of patients accidentally exposed to ionising radiation, based on a new strategic approach for the diagnosis of the acute radiation syndrome: the response category concept. This commentary outlines the background for the development of such a manual and the realisation of the response category concept.     

切尔诺贝利核事故受害者内脏器官病变的发展及治疗特点

本文在介绍切尔诺贝利核事故受害者内脏器官病理发展共同特点的基础上,着重指出心血管系统病变在此人群发病率和死亡率中的主要地位;救援人员中缺血性心脏病发病率高于普通人群,且多见于受照剂量大于0.25Gy者;对此疾病,除了通用的治疗措施外,报告强调要修正公认的一些风险因素,如吸烟、饮食习惯和超体重等.指出救援人员中消化道溃疡病发病率高于普通人群,提示应采取针对性治疗措施.还指出受照者体内照射最大危险来自铯137,提出要服用"婓拉丁"含铁合剂来减少铯137在胃肠道吸收和促排;还介绍了一种以植物提取物为主剂的"植物志群"组方,促排效果明显.在此基础上,提出了对受害者通用的治疗原则.     

Dose estimation by chromosome aberration analysis and micronucleus assays in victims accidentally exposed to 60Co radiation

The objective of this study was to assess the radiation exposure levels in victims of a ⁶⁰Co radiation accident using chromosome aberration analysis and the micronucleus assay. Peripheral blood samples were collected from three victims exposed to ⁶⁰Co 10 days after the accident and were used for the chromosome aberration and micronucleus assays. After in vitro culture of the lymphocytes, the frequencies of dicentric chromosomes and rings (dic+r) and the numbers of cytokinesis blocking micronuclei (CBMN) in the first mitotic division were determined and used to estimate radiation dosimetry. The Poisson distribution of the frequency of dic+r in lymphocytes was used to assess the uniformity of the exposure to ⁶⁰Co radiation. Based on the frequency of dic+r in lymphocytes, estimates of radiation exposure of the three victims were 5.61 Gy (A), 2.48 Gy (B) and 2.68 Gy (C). The values were estimated based on the frequencies of CBMN, which were 5.45 Gy (A), 2.78 Gy (B) and 2.84 Gy (C). The estimated radiation dosimetry demonstrated a critical role in estimating the radiation dose and facilitating an accurate clinical diagnosis. Furthermore, the frequencies of dir+r in victims A and B deviated significantly from a normal Poisson distribution. Chromosome aberration analysis offers a reliable means for estimating biological exposure to radiation. In the present study, the micronucleus assay demonstrated a high correlation with the chromosome aberration analysis in determining the radiation dosimetry 10 days after radiation exposure.As early as the mid-1960s, ionising radiation was known to be capable of inducing chromosome aberrations in the metaphase of human peripheral lymphocytes [1, 2]. Since then, the chromosome aberration assay has been widely used as a sensitive biomarker for dose reconstruction following radiation exposure [3–6]. In particular, the analysis of dicentric chromosomes and rings (dic+r), two aberrations exemplifying inter- and intrachromosomal exchanges, respectively, has been generally considered to be the standard means for estimating biodosimetry based on its well-established dose–response relationship with radiation exposure and its low baseline levels in the general population [7, 8]. However, the utility of the chromosome aberration assay relies heavily on the expertise and experience of individual investigators. As an alternative method for determining radiation biodosimetry, the cytokinesis blocking micronucleus (CBMN) assay is easy to perform and less time-consuming, but its drawbacks include large individual variations in baseline values in the general population [7] and a markedly lower sensitivity when used for estimating low dose exposure compared with the chromosome aberration assay. Therefore, the micronucleus assay is widely used as a supplement to the chromosome aberration analysis [9]. In the present study, we made a comparative estimate of the radiation exposure in three victims of a ⁶⁰Co radiation accident that occurred in 1999 using dose–response curves of γ-ray-induced chromosome aberration and micronuclei, which were previously established in our laboratory. The results provide evidence of the utility of both methods in estimating biological doses of radiation exposure in humans.     

Professional and collegiate team assistance programs: services and utilization patterns

Elite professional and collegiate athletes underuse stress control, mental health, and substance abuse treatment services. Behavioral health services use can be increased by establishing on-site, sports-specific services. Like Employee Assistance Programs of industry and government, Team Assistance Programs (TAPs) address critical issues such as substance abuse prevention, tobacco cessation, stress recognition, mental illness management, injury rehabilitation, performance enhancement, and cultural support. Strong links with the team's medical and conditioning staff can ensure a steady stream of TAP referrals and build trust with players and team staff. This article describes nine years of operation for two professional TAPs and three years for one college TAP. Use patterns and linkage strategies with team physicians, trainers, strength staff, chiropractors, and nutritionists are discussed.     

10例 60 Co源辐射事故受照者眼晶状体的随访观察

目的 观察 ⁶⁰Co源辐射事故对受照者眼晶状体的远后效应。方法 对河南省1986年至2000年期间发生的4起⁶⁰Co源辐射事故共10例受照者进行眼晶状体远期医学观察。用复方托吡卡胺充分散瞳后在裂隙灯下检查眼晶状体,记录病变特征。结果 开封事故中"亮"、新乡事故中"梅"分别于照后2、3年出现典型放射性白内障;许昌事故中"许",照后6年出现典型放射性白内障;开封事故中"燕"、郑州事故中"杰"、新乡事故中"天"、"勇"、"义"照后随访观察仅出现双眼晶状体后囊下少量点状、颗粒状浑浊等放射性白内障的初期改变,未观察到典型放射性白内障的形态特点;新乡事故中"旺"、"民"则未观察到晶状体后囊下的浑浊。结论 眼晶状体是辐射事故受照者远期随访观察应重点关注的靶器官。电离辐射致眼晶状体浑浊的发展程度与照射剂量密切相关。     

Radiation disaster response: preparation and simulation experience at an academic medical center

OBJECTIVES: A mass casualty disaster drill involving the simulated explosion of a radiation dispersal device (dirty bomb) was performed with the participation of multiple hospitals, emergency responders, and governmental agencies. The exercise was designed to stress trauma service capacities, communications, safety, and logistic functions. We report our experience and critique of the planning, training, and execution of the exercise, with special attention to the integrated response of the Departments of Nuclear Medicine, Health Physics, and Emergency Medicine. METHODS: The Health Physics Department presented multiple training sessions to the Emergency Medicine Department, Operating Room, and ancillary staff; reviewing basics of radiation biology and risk, protection standards, and detection of radiocontamination. Competency-based simulations using Geiger-Müller detectors and sealed sources were performed. Two nuclear medicine technologists played an important role in radiation discrimination-that is, assessment of radioactive contamination with survey meters and radionuclide identification based on gamma-spectroscopy of wipe smears from patients' clothing, skin, and orifices. Three Health Physics personnel and one senior Nuclear Medicine staff member were designated the radiation control officers for assigned teams triaging or treating patients. Patients were triaged and, when indicated, decontaminated. RESULTS: Within a 2-h period, 21 simulated victims arrived at our institution's Emergency Room. Of these, 11 were randomized as noncontaminated, with 10 as contaminated. Decontamination procedures were implemented in a hazardous materials (HAZMAT) decontamination trailer and, for the 5 patients with simulated serious injuries, in a designated trauma room. A full debriefing took place at the conclusion of the exercise. Staff largely complied with appropriate radiation protection protocols, although decontamination areas were not effectively controlled. The encountered limitations included significant lapses in communications and logistics, lack of coordination in the flow of patients through the HAZMAT trailer, insufficient staff to treat acute patients in a radiation control area, additional personnel needed for transport, and insufficient radiation safety personnel to control each decontamination room. CONCLUSION: Nuclear Medicine personnel are particularly well qualified to assist Health Physics and Emergency Medicine personnel in the preparation for, and management of, mass casualty radiation emergencies. Simulation exercises, though resource intensive, are essential to an institution's determination of response capability, performance, and coordination with outside agencies.     

从病理学角度看切尔诺贝利核事故的医学生物学后果

本文根据病理形态学特征提出了对切尔诺贝利事故所致小剂量/剂量率受害者疾病分类的方法,指出了尸检研究中应注意的问题,从8个方面的症状表现核事故中青年救援者多器官疾病对加速机体老化的证明及指出了它在生物医学上的意义,提出了小剂量/剂量率技术事故殃及的三种组织或细胞成分的可能机制及其后果,重点分析了基辅地区居民甲状腺小泡性滤泡瘤的病理学形态改变的特点.     

用蒙特卡罗方法估算~(60)Co辐射源事故患者的辐射剂量

目的　计算河南6 0 Co放射源事故中事故患者“梅”受到的辐射剂量。方法　基于MIRD的成人数学模型用蒙特卡罗随机模型方法计算事故患者的辐射剂量 ,并编制了一个用于此计算实用计算机程序。结果　模拟事故患者的具体情况 ,计算了人体主要器官剂量和全身剂量。结论　这种理论模拟的方法与用体模的实验模拟测量结果较为一致 ,说明用这种算法算出的各个器官剂量和全身剂量 ,对于临床治疗有参考价值 ,而且模拟方便 ,快速 ,适用于核事故医学应急中的患者器官剂量估算。     

核事故剂量的顺磁分析方法研究与应用

目的建立电离辐射事故剂量的实际测量方法。方法用电子自旋共振（ＥＳＲ）技术，在人体骨髓型急性放射病阈剂量以上范围，对人体生物样品及可能的随身佩带材料的剂量响应特性，信号稳定性，本底均一性，可测剂量下限及辐射条件和环境影响因素等基本剂量学特性进行了实验研究。结果建立了多项适于实际事故剂量测量的顺磁剂量测量指标和方法，并在包括切尔诺贝利事故在内的三起辐射事故剂量评估中得到了成功的应用。结论这项工作进一步证实了ＥＳＲ在事故剂量评估中的重要作用。     

Rays as weapons

PURPOSE: Ionizing radiation is being regarded as life threatening. Therefore, accidents in nuclear power plants are considered equal threatening as nuclear bomb explosions, and attacks with dirty bombs are thought as dangerous as nuclear weapon explosions. However, there are differences between a nuclear bomb explosion, the largest imaginable accident in a nuclear power plant, and an attack with a dirty bomb. It is intended to point them out. METHOD: The processes are described, which damage in a nuclear bomb explosion, in the largest imaginable accident in a nuclear power plant, and in an attack with a dirty bomb. Their effects are compared with each other, i.e. explosion, heat, shock wave (blast), ionizing radiation, and fallout. RESULTS: In the center of the explosion of a nuclear bomb, the temperature rises to 100Mio degrees C, this induces damaging heat radiation and shock wave. In the largest imaginable accident in a nuclear power plant and in the conventional explosion of a dirty bomb, the temperature may rise up to 3000 degrees C, heat radiation and blast are limited to a short distance. In nuclear power plants, explosions due to oxyhydrogen gas or steam may occur. In nuclear explosions the dispersed radioactive material (fall out) consists mainly of isotopes with short half-life, in nuclear power plants and in dirty bomb attacks with longer half-life. The amount of fall out is comparable in nuclear bomb explosions with that in the largest imaginable accident in a nuclear power plant, it is smaller in attacks with dirty bombs. An explosion in a nuclear power plant even in the largest imaginable accident is not a nuclear explosion. In Hiroshima and Nagasaki, there were 200,000 victims nearly all by heat and blast, some 300 died by ionizing radiation. In Chernobyl, there have been less than 100 victims due to ionizing radiation up till now. A dirty bomb kills possibly with the explosion of conventional explosive, the dispersed radioactive material may damage individuals. The incorporation of irradiating substances may kill and be difficult to detect (Litvinenko). A new form of (government supported) terrorism/crime appears possible. CONCLUSION: The differences are important between a nuclear weapon explosion, the largest imaginable accident in a nuclear power plant, and an attack with a dirty bomb. Nuclear weapons kill by heat and blast; in the largest imaginable accident in a nuclear power plant, they are less strong and limited to the plant; an attack with a dirty bomb is as life threatening as an ("ordinary") bomb attack, dispersed radiating material may be a risk for individuals.     

Initial medical management of patients severely irradiated in the Tokai-mura criticality accident

A nuclear criticality accident occurred in Japan on September 30, 1999, which resulted in severe exposure of three victims to mixed flux of neutrons and gamma-rays. Estimated average doses for the three victims were 5.4 Gy of neutrons and 8.5 Gy of gamma-rays for Patient A, 2.9 Gy of neutrons and 4.5 Gy of gamma-rays for Patient B, and 0.81 Gy of neutrons and 1.3 Gy of gamma-rays for Patient C. They then suffered the consequences of the effects of ionizing radiation resulting in acute radiation syndrome. In Patients A and B, bone marrow failure was so severe that they received haematopoietic stem cell transplantation. The graft initially took successfully in both patients, although in Patient B it was later taken over by his own haematopoietic cells. They also suffered from severe skin lesions, later exhibited gastrointestinal bleeding and eventually died of multiple organ failure 82 and 210 days after the accident, respectively. The survival of these patients beyond the period of agranulocytosis means that bone marrow failure per se caused by exposure to ionizing radiation may now be overcome. Patient C also developed bone marrow failure and was treated with granulocyte colony-stimulating factor as well as supportive care. He recovered without major complications and is now under periodical follow-up. Remarkably, during the prodromal phase, all the patients exhibited hypoxaemia, two of whom also showed interstitial oedema of the lungs. In Patient C these manifestations improved within a week. The circumstances of the accident and the initial medical treatment of the victims are described.     

Strahlentherapeutische Beteiligung an interdisziplinären palliativmedizinischen Einrichtungen

BACKGROUND: In Germany, a sufficient system of palliative care does not exist. Possibilities for participation of radiooncologists in the further development of this promising part of medical action are reported. MATERIAL AND METHODS: Experiences from interdisciplinary work in the field of palliative care are described. This experience is communicated for use in the actual discussion about the future of palliative care in Germany, especially in the field of radiooncology. RESULTS: A palliative care unit can only work in a team of different professions, which means different physicians, but also nurses, social workers, psychologists or pastors. A palliative care unit will benefit from working with radiooncologists as well as radiooncologists will do from working in the field of palliative care. CONCLUSION: In times of growing interest in and need for palliative care, radiooncologists should actively participate in the development of palliative care units in Germany. The aim of this participation should be to reasonably arrange the treatment of incurably ill patients with the chances of modern radiotherapy. Another aim should be to improve the treatment of "classic" radiation oncology patients by ideas of palliative care. The further development of palliative care in Germany should not take place without the participation of radiooncologists. This will meet the interests of palliative care and radiotherapy and-most importantly-the patients' interests.     

用蒙特卡罗方法估算60Co辐射源事故患者的辐射剂量

目的：计算河南^60Co放射源事故中事故患者“梅”受到的辐射剂量,方法：基于MIRD的成人数学模型蒙特卡罗随机模型方法计算故忠患者的辐射剂量,并编制了一个用用此计算实用计算机程序,结果：模拟事故患者的具体情况,计算了人体主要器官剂量和全身剂量,结论：这种理论模拟的方法与用模的实验模拟测量结果较为一致,说明用这种算法算出的各个器官剂量和全身剂量,对于临床治疗有参考价值,而且模拟方便,快速,适用于核事故医学应急中的患者器官剂量估算。     

胞质分裂阻滞微核法对辐射事故受照射人员的生物剂量估算

目的 探讨胞质分裂阻滞微核(CBMN)分析在估算辐射事故受照射者的生物剂量中的应用价值.方法 2008年山西太原辐射事故发生后16 h收集5名受照射者(1、2、3、4和5号)的外周血及I号的骨髓,进行CBMN分析,以微核(MN)频率估算生物剂量.对较严重的受照射者(1号)结合体外"co 1射线大剂量照射实验获得的核分裂...     

Perception of Radiation Exposure and Risk Among Patients,Medical Students,and Referring Physicians at a Tertiary Care Community Hospital

Background

It is important for physicians to be aware of the radiation doses as well as the risks associated with diagnostic imaging procedures that they are ordering.

Methods

A survey was administered to patients, medical students, and referring physicians from a number of specialties to determine background knowledge regarding radiation exposure and risk associated with commonly ordered medical imaging tests.

Results

A total of 127 patients, 32 referring physicians, and 30 medical students completed the survey. The majority of patients (92%) were not informed of the radiation risks associated with tests that they were scheduled to receive and had false perceptions about the use of radiation and its associated risks. Physicians and medical students had misconceptions about the use of ionizing radiation in a number of radiologic examinations; for example, 25% and 43% of physicians and medical students, respectively, were unaware that interventional procedures used ionizing radiation, and 28% of physicians were unaware that mammography used ionizing radiation. Computed tomographies and barium studies were thought to be associated with the least ionizing radiation among physicians.

Conclusion

There is a need for educating the public, medical students, and referring physicians about radiation exposure and associated risk so that (1) patients receiving multiple medical imaging tests are aware of the radiation that they are receiving and (2) physicians and future physicians will make informed decisions when ordering such tests to limit the amount of radiation that patients receive and to promote informed consent among patients.