Radiation Safety Training

for First Responders

Regional EMS Council
of New York City

Presented by:
Greater New York Chapter
Health Physics Society
 Objectives
 Radiation and Radioactivity
 Biological Effects, Risks, and Limits
 Radiation Sources
 Protection from Radiation and Radioactivity
 Measurements
 Use of Instruments

2
 Part 1:
Radiation and
Radioactivity

3
 What Is Radiation?
The spontaneous emission of “fragments” or “bundles” of
energy from unstable nuclei creating more stable nuclei
Radioactive Atom Energy Release

Emits radiation in the

form of particles and waves

Becomes more stable

5
Helium Atom
–
Neutron (n)

+ +
– Proton (p)

Electron (e)
6
Ionizing Radiation
 Radiation with enough Change a neutral atom
energy to cause or molecule to one with
ionizations. positive or negative
charge.

7
Types of Ionizing Radiation
 Alpha – positively charged
particles that can be stopped by
a sheet of paper.
 Beta – electrons that can be
stopped by plastic.
 Gamma/X – energetic
penetrating rays that can be
reduced by lead.
 Neutron – only during reactor
or accelerator operation, or rare
sources – reduced by water and
other light materials. 8
Distance Helps !
When you double the distance the dose is
decreased by 4 times (or to 1/4)
Good for “Point Sources”

9
Radiation Absorbed Dose (rad)

Definition:
the energy deposited by ionizing radiation
in a unit mass of material

Units:
rad = 100 ergs/gram,
gray (Gy) = 100 rad

10
Dose Equivalent (Rem)
Definition:
A common scale for equating relative
hazard of various types of ionizing
radiation in terms of equivalent risk
Q
Units: Alpha 20
Rem = Q x rad Beta 1
Sievert (Sv) = 100 rem Gamma, X-ray 1
Neutrons – up to 10
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 Radioactive
 A material that contains many unstable nuclei
which emit radiation.

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 Radioactive Contamination
Radioactive material that is in a place where
it is not wanted .

13
 Radioactive Contamination
Can be in the form of:
 Solid (powder, dust, etc.)
 Liquid
 Gas

14
Units of Radioactivity
 Curie (Ci) = 37 billion dis/sec. . . 37,000,000,000
 millicurie (mCi) = 1 / 1000 Ci . . 37,000,000
 microcurie (uCi) = 1 / 1,000,000 Ci . . 37,000
 1 disintegration/sec = 1 Bequerel (Bq)

 1 Bq = 1 dis/sec = 60 dis/min (dpm)

Radioisotopes often come in units of MBq

1 MBq = 1,000,000 Bq = 27 microcurie (uCi)
1 millicurie = 37 MBq
15
 Half - Life
The time required for the radioactivity to
decrease to one-half of its
100
initial value
Initial
Activity
Radioactivity

Decrease in
50
Radioactivity
with Time
% of

0
1 2 3 4 5 6

Number of Half-Lives
16
Radioactivity – Hazardous?
3 Things you should know to find out what
kind of hazards are presented:
What type of radiation is emitted?
Alpha, beta, or gamma
Half-Life – long or short?
Solid or Dispersible?

17
 Part 2:
Effects of
Radiation

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Radiation: Is It Safe???
 Is Fire Safe?
 Is Water Safe?

19
External Vs. Internal Exposure
 External  Internal
 Outside of body  Materials in body
 Add external and  Inhalation or ingestion

internal to give total  Through breaks in skin

dose
 Long term in body
 Material is removed from
body by natural processes

20
 Pathways for Radioactive Material
Entry into the Body
Inhalation Skin
Absorption

Ingestion
Cuts,
wounds,
injections

21
 Acute vs Chronic Dose
 Acute  Chronic
 Large dose in short  Small doses over time
time (300 rem / hr)  May cause delayed effects
 May cause early  Possible for workers (but
not observed)
effects
 Effects known from:  Analogy with Sun
 Bomb victims  Acute exposure gives sun

 Radiography burn, peeling, new skin

 Accidents  Chronic leads to repair

(tan)
 Both may lead to cancer

22
 Chronic Health Effects
from Radiation
 Radiation is a weak carcinogen at low doses
 No unique effects
 Natural incidence of cancer ~ 40%;
mortality ~ 25%
 Risk of fatal cancer is estimated as ~ 4% per
100 rem
 A dose of 5 rem increases the risk of fatal
cancer by ~ 0.2%
 A dose of 25 rem increases the risk of fatal
cancer by ~ 1%
23
Occupational Dose Limits
 Whole body dose - 5 rem / yr
 Organ dose - 50 rem / yr
 Lens of the eye - 15 rem / yr
 Extremities - 50 rem / yr
 Skin (shallow dose) - 50 rem / yr
1 rem = 1000 millirem

24
Comparison With Other Risks
Risks Expected Life
Lost

Smoking (1 pack a day) 6 yr

Overweight (15%) 2 yr
Alcohol 1 yr
Accidents 1 yr
Motor vehicle 207 days
Home 74 days
Drowning 24 days
Natural hazards (floods, etc) 7 days
Medical radiation 6 days
Occupational exposure
300 mrem/yr (age 18 to 65) 15 days
One time exposure of 10 rem 15 days
25
Assumptions for Safety
 Risks uncertain, therefore
 Assumes that all doses have some effect

 No evidence of effect at low doses

 ALARA (As Low As Reasonably Achievable)

 Margin of safety

 Do better than the limits

26
EPA Emergency Dose
Guidelines
Dose Limit Activity Conditions
5 rem All
10 rem Protection of Where lower dose
major property limit not practical
25 rem Lifesaving or Where lower dose
protect population limit not practical
> 25 rem Lifesaving or Voluntary basis,
protect population person is fully
aware of risks

27
 Treatment of Large External
Exposures
• Estimating the severity of radiation injury is
difficult.
• Treat symptomatically. Prevention and
management of infection is the primary
objective.
• Seek the guidance of experts.
– Radiation Emergency Assistance Center/
Training Site (REAC/TS)
– Medical Radiobiology Advisory Team
(MRAT)

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 Part 3:
Radiation
Sources

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Typical Radiation Exposures
~ 363 mrem/yr

Radon-200
Cosmic-27
Earth-28
Internal-39
Med Xray-39
Nuc Med-14
Cons Prod-10
Occupational-0.2

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Comparing Levels of Radiation
 US Avg Per Year  363 mrem/year
 Chest X-ray  20 mrem
 Radiation Worker  100-500 mrem/year
 GI Series  5,000 mrem (5 rem)
 Cancer Therapy  > 1,000 rem (local)
 Food Irradiation  >100,000 rem to food
 Sterilization (medical  >1,000,000 rem to eqpt
equipment, etc.)

31
 Examples of Radioactive Materials
Physical
Radionuclide Half-Life Activity Use
Cesium-137 30 yrs 1.5x106 Ci Food Irradiator
Cobalt-60 5 yrs 15,000 Ci Cancer Therapy
Plutonium-239 24,000 yrs 600 Ci Nuclear Weapon
Iridium-192 74 days 100 Ci Industrial Radiography
Hydrogen-3 12 yrs 12 Ci Exit Signs
Strontium-90 29 yrs 0.1 Ci Eye Therapy Device
Iodine-131 8 days 0.015 Ci Nuclear Medicine
and Therapy
Technetium-99m 6 hrs 0.025 Ci Diagnostic Imaging
Americium-241 432 yrs 0.000005 Ci Smoke Detectors
Radon-222 4 days 1 pCi/l Environmental Level

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Radiopharmaceuticals

33
Consumer Products

34
Soil Density Gauge

35
Radiography Source

36
Radioactive Waste

37
Radioactive Material
Transportation
Labels on Packages

38
Radioactive Material Transportation
Vehicle Placards and UNID Numbers

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 Part 4:
Protection from
Radiation and
Radioactivity

40
 Radiological Incident Control
Identify the Substance
Consider all potential hazards
Establish Contamination Control Zones
Protect Personnel from Radiation Exposure
Follow EPA Protective Action Guides for
radiation exposure
Time, Distance, Shielding
Personal Protective Equipment
Protect Equipment from contamination

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Radiological Incident Control

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Radiological Incident Control

Protect equipment from

contamination and mark
off hot, warm, and cold
zones.

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Radiological Incident Control

Tool drop before Contamination check

leaving hot zone

Hot area marked off

with tape and stanchions 44
 Patient Handling
Determine type of exposure

Externally Externally Internally

irradiated contaminated contaminated

45
 Patient Handling
Perform gross decontamination:
 If needed
 If it will not interfere with critical care

46
 Patient Handling
Preparing to enter contaminated area

Double blanket, then backboard, then medical

equipment, then suit up for entry

47
 Patient Handling
Enter zone and provide initial care

Put backboard near patient, cut away clothing to

reduce contamination, provide initial care

Important: contamination is not likely to be life-

threatening, but delay of treatment could be

48
 Patient Handling
Prepare patient and transport

VIDEO

49
 Causes of Radiation
Exposure/Contamination
 Accidents
 Transportation
 Lost/stolen medical or industrial
radioactive sources
 Medical radiation therapy

 Nuclear reactor

 Industrial irradiator
 Terrorist Event
 Radiological dispersal device (dirty
bomb or smoky bomb)
 Low yield nuclear weapon

50
 Scope of Event

Event Number of Deaths Most Deaths Due to

Radiation None/Few Radiation

Accident

Radioactive Few/Moderate Blast Trauma

Dispersal (Depends on
size of explosion &
Device proximity of persons)

Low Yield Large Blast Trauma

Nuclear Weapon (e.g. tens of thousands in Thermal Burns
an urban area even from Radiation Exposure
0.1 kT weapon)
Fallout
(Depends on Distance) 51
 Radiation Protection
Reducing Radiation Exposure
Time
Minimize time spent near radiation
sources
Distance
Maintain maximal
practical distance from
radiation source

Shielding
Place radioactive sources in
a lead container

52
 Protecting Hospital Staff from
Contamination
• Universal precautions
• Survey hands and clothing with
radiation meter
• Replace gloves or clothing
that is contaminated
• Keep the work area free of
contamination
Key Points
• Contamination is easy to detect and most of it can be
removed
• It is very unlikely that ED staff will receive large
radiation doses from treating contaminated patients
53
 Facility Preparation
 Activate hospital plan
 Obtain radiation survey meters
 Call for additional support: Staff from Nuclear Medicine,
Radiation Oncology, Radiation Safety (Health Physics)
 Plan for decontamination of uninjured persons
 Establish triage area
 Plan to control contamination
 Instruct staff to use universal precautions and double glove
 Establish multiple receptacles for contaminated waste
 Protect floor with covering if time allows

54
 Treatment Area Layout
Separate
Entrance
CONTAMINATED ED
Radiation Staff
Survey
AREA
&
Charting

Contaminated Trauma Room

Waste
HOT
LINE
STEP Radiation
Waste
BUFFER

OFF Survey
ZONE

PAD
CLEAN
AREA

Clean
Gloves,
Masks,
Gowns,
Booties
55
 Patient Management - Priorities
Triage
 Medical triage is the highest
priority
 Radiation exposure and
contamination are secondary
considerations
 Degree of decontamination
dictated by number of and
capacity to treat other injured
patients

56
Patient Management - Triage
Triage based on:
 Injuries
 Signs and symptoms -
nausea, vomiting, fatigue,
diarrhea
 History - Where were you
when event occurred?
 Contamination survey

57
 Psychological Casualties
 Terrorist acts involving toxic agents (especially
radiation) are perceived as very threatening
 Mass casualty incidents caused by nuclear
terrorism will create large numbers of worried
people who may not be injured or contaminated
 Provide psychological support to patients and set
up a center in the hospital for staff
 Establish triage (monitoring and counseling)
centers to prevent psychological casualties from
overwhelming health care facilities

58
 Patient Management -
Decontamination
 Carefully remove and bag patient’s clothing
and personal belongings (typically removes
95% of contamination)
 Survey patient and, if practical, collect samples
 Handle foreign objects with care until proven
non-radioactive with survey meter
 Decontamination priorities:
 Decontaminate wounds first, then intact skin

 Start with highest levels of contamination

 Change outer gloves frequently to minimize

spread of contamination

59
Patient Management -
Decontamination (Cont.)
 Protect non-contaminated wounds with waterproof
dressings
 Contaminated wounds:
 Irrigate and gently scrub with surgical sponge

 Avoid overly aggressive decontamination

 Change dressings frequently
 Decontaminate intact skin and hair by washing with soap
& water
 Remove stubborn contamination on hair by
cutting with scissors or electric clippers
 Use survey meter to monitor progress
of decontamination

60
 Patient Management -
Decontamination (Cont.)
 Cease decontamination of skin and wounds
 When the area is less than twice background, or
 When there is no significant reduction between decon
efforts, and
 Before intact skin becomes abraded.
 Contaminated thermal burns
 Gently rinse. Washing may increase severity of injury.
 Additional contamination will be removed when
dressings are changed.
 Do not delay surgery or other necessary medical
procedures or exams…residual contamination can
be controlled.
61
 Key Points
 Medical stabilization is the highest priority
 Train/drill to ensure competence and confidence
 Pre-plan to ensure adequate supplies and survey
instruments are available
 Universal precautions and decontaminating
patients minimizes exposure and contamination
risk
 Early symptoms and their intensity are an
indication of the severity of the radiation injury
 The first 24 hours are the worst; then you will
likely have many additional resources

62
 Part 5:
Measuring
Radiation and
Radioactivity

63
 Geiger Counters
• Indicate gamma radiation dose rate
•Some models also indicate beta dose rate
•Generally rugged field instruments, but window can
be damaged, and then instrument is out of service
•Can be “maxed out” and will under-respond
•UltraRadiac Personal Radiation Meter OK up to 500
rem per hour

64
 Friskers
• Friskers are a type of Geiger counter with a pancake (flat
round) probe, with a thin window for beta measurements.
• Friskers are used to check contamination on personnel and
equipment
•They are affected by background radiation sources

65
 Survey meters
 Geiger Counters – good overall field use
 Ion Chambers – more accurate, generally
less rugged
 Scintillation counters – very sensitive; ideal
for looking for sources or low levels of
radiation; not good in high radiation field

Ion Chamber
66
Meters and Probes
 Generally, there are two parts to a survey
instrument – the meter and the probe
 Some instruments have internal probes, so
there is not external probe visible

67
Reading the meter
Note battery
check and
multiplier scale

Some instruments
have multiple
scales for
different probes

68
 Self-reading Dosimeters and
Electronic Dosimeters

Electronic
dosimeter – used as
an alarming
Self-reading dosimeter and dose
dosimeter – used rate meter
for immediate
indication of dose 69
 Personnel Dosimetry
Devices such as TLD – Thermoluminescent Dosimeters, are
used to provide a permanent record of radiation dose.
TLDs are sent to processor periodically for readout.

70
 Laboratory Tests
Alpha isotopic analysis: a detailed and complicated analysis
where the chemicals are added to the sample to chemically
separate elements. The result is available in a period of
days to weeks.
Specific radionuclide analysis – If not a gamma emitter,
certain radionuclides (e.g. Sr-90) must be chemically
separated, similar to the alpha isotopic method. The result
is available in days to weeks.

71
 Laboratory Tests
Liquid Scintillation Counter – a swipe of an area for
contamination is placed in a vial, and it is counted in a
liquid scintillation counter – results available in a few
minutes to a few hours. Good for all energies of beta and
for alpha emitters.
Gamma Spectrometer, GeLi (pronounced Jelly), or Sodium
Iodide – this provides a readout of the specific isotopes that
are gamma emitters (most) – results available in a few
hours.
Gross Alpha and gross beta – simple analysis, where a
swipe or air sample is placed into a counting chamber –
results available in a few minutes.
72
 Canberra Ultra-Radiac

 Personal Dosimeter Distributed To NYC Based EMS

Agencies as Part of a Citywide Radiation Detection
Program.
 Also Utilized by FDNY-Fire, OEM & Hospital ER’s.

73
 From US Army to First Responders
 Military AN/UDR-13...
 MIL-STD 810 qualified personal radiation

detector designed for nuclear battlefield

applications
 Designed for extreme physical conditions

 ...Evolves to Ultra-Radiac for First Responders to

the current Ultra-Radiac
 Remove prompt gamma/neutron detection

 Add vibration alarm

 Increase alarm volume to 90dBA

 Same operability

 Same dynamic range

 Multiple colors and radiation units

74
 CabberraUltra-Radiac
 Features
 Detects Gamma/Neutron Radiation
 98% of radioactive materials emit Gamma/Neutron
Rays
 Backlit Display (large font)
 Audible Alarm (90 dBA at one foot)
 Vibrating Alarm (Optional)
 2 LEDs under the display turn green on alarm of either
rate (on the left) or cumulative dose (on right)
 Rugged buttons
 Not Susceptible to Electromagnetic Interference (EMI)

75
 Canberra Ultra-Radiac
 Features Cont.
 Operates on 4 AAA Batteries (150 hours life normally).
 Battery compartment located on lower left side of device.
 6 easy buttons
 Aluminum Housing for ruggedness.
 4 Alarm Settings
 Low Dose Alert

 High Dose Alarm

 Low Rate Alert

 High Rate Alarm

76
 Two Modes of Detection
 Radiation Dose
 Measures the accumulated
amount of radiation that has
been absorbed.
 It is the primary parameter
used to determine the health
risk of remaining in a
radioactive environment.
 Default reading on the
Ultra-Radiac.
 Rate of Exposure
 Measures the rate at which
individual is being exposed
to radiation.
 Measures the rate at unit of
radiation per hour.
 Example 5R/hr
 Primarily used to determine
the strength of a radioactive
source.
77
 Dose Setting on Radiac
 The Ultra-Radiac automatically adjust
the display and units to accommodate
data (μR, mR, R)
 Dose Visual Alarm LED located on right
side, underneath the display.
 By pressing DOSE, can toggle display to
Cumulative Dose since “reset” (10-sec
toggle)
 Start cumulative dose period by
depressing DOSE and CLR/TEST
simultaneously for about 5 seconds
 Cumulative dose will ONLY be clear via Manual
Reset, will NOT clear upon turning off device.

78
 Rate Setting on Radiac
 The Ultra-Radiac automatically adjust
the display and units to accommodate
data (Μr/hr, mR/hr, R/hr)
 Dose Visual Alarm LED located on left
side, underneath the display.
 Works in unison with Source Finder
(Chirper) Mode to find and measure
strength of a source.
79
 Chirper Mode
 Depress RATE until a 1 shows on display.
 Chirper will be enabled

 Depress RATE again until a 0 shows on display

 Chirper will be disabled

 Chirper mode also referred to as source locator

mode to search for and pinpoint radioactive
source location
80
Dual Level Alarms - Dose and Rate
 Two alarms (Dose Rate and Dose) with two levels
each (low and high) for flexibility
 Rate
 Low threshold - set at a level above background to serve as a “first
warning” of the presence of radiation
 High threshold - set at a level indicating danger (evacuate)
 Dose (accumulated since last “reset”)
 Low threshold - set at a warning level
 High threshold - set at an absolute limit (must evacuate)
 “Stay time” display feature - shows time in minutes the user can
remain at current dose rate until high dose threshold reached

81
 Ultra-Radiac Alarms
High Dose Alarm Lights
High Rate Alarm Lights Red, Flashes and Alarms
Red, Flashes, and Alarms at faster interval
at faster interval

Low Rate Alarm Lights Low Dose Alarm Lights

Green, Flashes, and Alarms Green, Flashes, and Alarms
at slower interval at slower interval

82
 ALARMS
 There are four alarms available to be set
 Low Dose Rate (Dose rate can fluctuate up or down)
 High Dose Rate (Dose rate can fluctuate up or down)
 Low Dose (Accumulated dose, cannot decrease)
 High Dose (Accumulated dose, cannot decrease)
 In addition to the word ALARM plus either RATE or DOSE in the
display, there are Three Alarm Mechanisms available for each alarm
setting:
 Audible (Aud in display window)
 Visual (Vis in display window)
 Vibrate (Scrolling Bar - - - in display window)
 NYREMS and FDNY are activating all three alarm mechanisms for
each of the four alarms
83
NYC Regional EMS Council Settings
 Low Dose Rate: 1 mR/hr green light left
 Indicates the presence of radiation for awareness
 You should not encounter radiation routinely
 High Dose Rate: 50 R/hr red light left
 Will need to evacuate in under 15 minutes at this
rate
 Accumulating nearly 1 R every minute (0.83 R)
 Dose Rate rarely stays steady and can change
often / significantly

84
NYC Regional EMS Council Settings
 Low Dose (Total): 1R green
light right
 Check stay time frequently by pressing
the |ALARM| button
 High Dose (Total): 12 R red
light right
 EVACUATE!
 Cannot Acknowledge

85
Basic Use by the First Responder
4 Simple Steps…
 1. Turn on the Ultra-Radiac by pressing the |ON/OFF| button
 When the default RATE display is shown, proper
performance has been automatically checked
 2. Reset the total accumulated dose to zero
 Depress the |DOSE| button to display total DOSE
 Depress the |DOSE| and |CLR/TEST| buttons for about 5
seconds
 The new DOSE display value will then show total
accumulated dose since time of last reset
86
 4 Simple Steps, continued…
 3. If “BAT” is blinking on display, the 4 AAA batteries have less than 10
hours of life and should be replaced with fresh batteries at the earliest
opportunity
 To check remaining battery life (possible only when “BAT” is
blinking and RATE is displayed): press the |CLR/TEST| button – the
value displayed represents battery lifetime in minutes (< 600)
 4. If device alarms, move away and upwind from the primary radiation
source, and evaluate best response options (considering the dose hazard)
 NOTE: Alarm limits for dose RATE and total DOSE should be
properly pre-set by a supervisor
 To acknowledge/silence alarm: press |CLR/TEST|
Press the | ALARM | button to display the stay time remaining in
minutes (999 is approximately 16.5 hours). Check this value frequently
when responding to radiation incident as it will change (sometimes 87
rapidly) with dose rate.
Questions?