Emergency plan for prevention and treatment of sudden human avian influenza in hospital
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Emergency plan for radiation accidents and nuclear accidents
The wide application of ionizing radiation and the development of nuclear energy are of great significance to the development of modern clinical medicine. Nuclear energy is a relatively "clean" energy source. Since Roentgen discovered X-rays, the nuclear industry has maintained a good safety record. However, practice shows that the occurrence of nuclear accidents cannot be completely avoided. Although the probability of nuclear accident is very low, it happens suddenly, sometimes with serious consequences, involving a wide range and a large number of people, which can have great social and psychological impact, and the long-term impact needs long-term observation and evaluation. Therefore, the emergency rescue of nuclear accidents often requires a lot of manpower and material resources, so we must adhere to the principle of putting prevention first, minimize the occurrence of accidents and make preparations.
Emergency response to radiation accidents and nuclear accidents is an important part of the whole emergency work. Its main task is to report and register different types and degrees of accidents, conduct on-site investigation and handling, sort out and analyze data, and make differential diagnosis and first aid principles to ensure the safety and health of employees and the public. Medical observation and evaluation of the consequences of radiation exposure; Carry out necessary publicity and education for relevant personnel and the public, so that they have a scientific and correct understanding of the characteristics, functions, hazards and protective measures of ionizing radiation.
I. Report Registration
1. According to the Regulations of People's Republic of China (PRC) Municipality on the Administration of Radiation Accidents, the state implements the principle of graded management, reporting and filing of radiation accidents, and must report the radiation accidents preliminarily diagnosed as Grade III to the health administrative department and public security department of the State Council within 24 hours. Accidents below Grade II shall be reported to the provincial health administrative department and the public security department.
When orally reporting a 2.3-level accident, you must report the time and place of the accident, the number of people involved, the local treatment and the severity of the patient. And report the mailing address, postal code, telephone number, fax number and mobile phone number of the main contact person.
3. The annual report of radiation accidents shall be submitted in the format of "Statistical Report of Health Supervision of Shenguo" and "Annual Report of Health Supervision and Monitoring Accidents".
4. Report content
(1) Accident report of accident unit and personnel.
(2) Proof materials and evidence collection materials for accident investigation.
(3) Technical data for handling accidents.
(4) Accident hazard impact assessment.
(5) Information about health examination and disease treatment of radiation workers.
(6) Fill in the Radiation Accident Report Form, Radiation Accident Stage Report and Radiation Accident Registration Form.
Second, the investigation and handling
1. After receiving the report, the relevant personnel should arrive at the scene of the accident quickly, and the leaders of the Center for Disease Control and Prevention and related professionals should carry emergency equipment related to handling the accident and arrive at the scene of the accident at the first time.
2. Determine the nature of the accident, whether it is a radiation accident or a nuclear accident, what level of accident it is, and the basic situation of the exposed personnel; At present, the physical injury degree of personnel, etc. , and take corresponding measures.
3. In order to ensure the health and safety of emergency workers in radiation accidents and nuclear accidents, personal dose monitoring should be carried out for emergency workers, and their cumulative dose should be known through direct reading dosimeter.
4. In the accident area, personnel who may be exposed to high-dose radiation who participate in rescue and perform tasks should be equipped with alarm personal dosimeter; For those who may suffer from serious radioactive pollution, the pollution degree of their body surface and eye bags should be continuously monitored at regular intervals to prevent burns. According to the actual needs, emergency workers should wear personal dosimeter with two ranges. Emergency personnel should have special dose monitoring personnel.
5. Rescuers and residents with sudden large-scale Grade 3 nuclear accident should take stable compounds such as iodine or potassium iodate as soon as possible to reduce thyroid damage.
6. For source loss accidents below Grade 2, local radiation protection personnel should be organized as soon as possible to find the lost radioactive source. According to the intensity of radiation sources and the number of people exposed, report to the health administrative department and the public security department step by step.
7. All personnel exposed to radioactive sources must carry out dose estimation and medical examination.
8. Units that have accidents such as radioactive source blockage and accident radiation room of irradiation device shall immediately stop working and organize nuclear physics and protection experts to participate in the whole process of accident treatment. Immediately send the exposed personnel to the hospital for examination. The examination contents include peripheral blood picture, nuclear count under lymphocyte microscope, chromosome analysis of peripheral blood lymphocytes after high dose radiation, dose estimation, etc.
Third, data sorting and analysis.
When a nuclear radiation accident occurs, the radiation dose of personnel should be estimated reasonably and reliably. The purpose and significance of accident dose estimation is to find out whether the radiation dose of accident victims exceeds the dose equivalent limit, and if it exceeds this limit, whether to give corresponding medical treatment. According to the radiation dose, the possible influence and degree of illness can be predicted, which can provide reference for determining the treatment scheme, sum up the experience and lessons of accidents, improve the ability of accident handling, and reduce and prevent accidents.
1. In a general nuclear accident, according to ICRP publication No.28, Principles and General Degree of Handling Radiation Workers in Emergency and Accident, when estimating the personal dose of radiation outside the accident, it is generally divided into three grades according to the radiation dose. When the radiation dose is low, the process of dose estimation can be greatly simplified; Only when the dose is likely to exceed 5 times the annual dose equivalent, it is necessary to start three program stages.
(1) stage 1 (0~6h after irradiation)
(1) Take back and deal with the accident radiation personnel and all personal dosimeter present.
② Check and register the data of fixed or recording instruments near the accident site.
(3) If personal dosimeter doesn't wear it at last, we should collect measurable accident dose samples as soon as possible, such as biological samples, human clothes, substances at the scene of the accident, etc.
(4) Understand the cause, process and radiation of the accident, listen to the descriptions of the accident victims and people present in detail, and simulate the radiation of the accident.
⑤ Make a preliminary dose estimation, and preliminarily evaluate the radiation uniformity and the parts of the population exposed to high dose local irradiation.
⑥ During the accident investigation, detailed records should be made, recording and photographing can be made when necessary, and the scene of the accident should be protected as much as possible to obtain relevant evidence for dose estimation.
(2) the second stage (7~7 1h)
① Further analyze the investigation data and all dose data of 1 stage, recheck the unclear, omitted or contradictory points, and conduct accident simulation when necessary.
② Carry out post-accident measurement when conditions permit.
③ Compare whether the physical dose, biological dose and clinical manifestations are basically the same. For the dose range of acute radiation sickness of bone marrow with uneven irradiation, it is best to give the preliminary results of equivalent dose of hematopoietic stem cell live share counting.
(4) Give the data of local high-dose radiation and pay close attention to the skin reaction after radiation.
⑤ Make necessary corrections to the preliminary report of physical dose, and give the reevaluation dose level and preliminary dose distribution data.
(3) Stage 3 (after 72 hours of radiation)
① The physical dose was compared with the estimated dose by chromosome aberration analysis, lymphocyte micronucleus analysis, biochemical index analysis, hemogram changes and clinical manifestations.
(2) If necessary, further accident simulation measurement shall be carried out.
③ Processing and analysis of dose measurement of human model. Compare the dose report of the second stage with the dose results of the manikin, and check and reinspect if necessary.
(4) Give the final report of the irradiated person, including the dose distribution in vivo, the average absorbed dose of major organs, the effective dose equivalent, the equivalent dose of hematopoietic stem cell survival count, etc. , and give a detailed report on the scene of the accident.
⑤ Combined with physical dose work, evaluate the reliability of dose estimation.
2. Large-scale accidents should quickly find out the way of holding and releasing the accident, the activity and composition of the released radionuclides, etc. According to the pre-established procedure, the preliminary results of environmental dose should be reported within 2 ~ 4 hours.
(1) Quickly monitor the cause of the accident and the radiation level of the external environment according to the emergency plan.
(1) According to various monitoring results, the preliminary dose report is revised, and a reliable dose report and a forecast of future dose changes are put forward within 24 hours.
② Before the release is terminated, the dose report should be revised continuously.
③ Physical dose work of classified diagnosis.
(4) The personnel at the scene of the accident should wear personal dosimeter, and the dose measurers should monitor the dose at the scene.
(2) The personnel leaving the scene of the accident should ask about the radiation situation one by one, carry out pollution measurement, recover personal dosimeter and measure it in time. For those who have not worn personal dosimeter and those who have worn it but the dose has exceeded its range, the dose should be estimated according to the operating conditions of the working environment. Try to collect on-site articles and samples that can be used for dose measurement, register, save and measure them in time.
① Physical measurement after the accident.
② Patients admitted to the medical department can make dose estimation according to the general nuclear accident treatment procedures.
③ Physical measurement after the accident.
④ Continue to monitor the environmental dose, and expand the measurement scope and content when necessary.
(3) Provide dose information of radioactive pollution inside and outside the accident site.
① Collect environmental data and articles for dose measurement to estimate the radiation dose of workers and the public.
(2) Estimate the individual dose and collective dose equivalent given by the staff inside and outside the accident site and the public.
3. Determination of accident radiation conditions According to the source of the accident, internal irradiation, external irradiation or both can be determined, and the types of ionizing radiation should also be identified. When estimating the personal dose of external exposure accidents, the following relevant information should be mastered.
Properties of (1) radiation field.
(2) Radiation situation of personnel.
(3) Geometric conditions of radiation, including the distance from the source, posture, personnel activities, shielding and scattering of surrounding objects, etc.
(4) The ways of human body irradiation should be divided into whole body or local, uniform or non-uniform, one time or multiple times, acute irradiation with large dose and high dose rate, chronic irradiation with small dose and low dose rate, etc.
(5) Radiation exposure time, generally speaking, should be based on the severity of radiation exposure, ask the subject or check the time records on the instrument, or ask people who work together with low radiation dose. It is very important to estimate the timeliness of radiation accident dose and try to be accurate.
4. The diagnosis of acute radiation sickness generally refers to systemic diseases caused by large doses of ionizing radiation in a short time. Clinical diagnosis is not difficult. Differential diagnosis is a big problem. First of all, symptoms of systemic diseases will appear, especially acute radiation sickness, which is difficult to classify. Generally, acute radiation sickness is divided into three types and four stages, namely, bone marrow type, intestinal type and brain type, and its course is generally divided into four stages: initial stage, false recovery stage, extreme stage and recovery stage.
(1) The injury time is short, and the disease develops continuously: after human body is irradiated, symptoms of digestive tract and nervous system may appear, but the disease will not stop because of the termination of future irradiation. The occurrence, development and prognosis of diseases are affected by radiation conditions (such as dose size, dose year and uniformity), patients' condition (such as age, health and radiation release) and whether the treatment measures are timely and appropriate.
(2) The lesions are extensive and the development of the disease is complicated: acute radiation sickness involves many systems, organs and tissues besides shielding or local injury, and different radiation doses can highlight the damage of a certain system. For example, people with bone marrow type are mainly injured in hematopoietic system. The white blood cells in peripheral blood increased at the initial stage, but decreased quickly. The symptoms of nervous system indicate that the radiation dose is large and the prognosis of patients is poor.
(3) Time course or stage of disease: After human body is irradiated, it shows a definite time course within a certain dose range. The stages of bone marrow type can generally be divided into initial stage, false recovery stage, extreme stage and recovery stage. If the treatment measures are improper or not timely, the bone marrow type above the medium level can be fatal. With the increase of radiation dose, the stage becomes inconspicuous. The radiation symptoms of intestinal type are not as obvious as those of bone marrow type, and the radiation symptoms of brain type span all stages horizontally, and then turn sharply in the later stage.
(4) Radiation-sensitive tissues dominate the course of disease: after human body is irradiated, the symptoms appear sooner or later and the severity is related to the radiation energy of tissues, organs and cells. Because of the different energy of tissues and cells, their damage changes play a great role in clinical manifestations. Hemorrhagic infection and metabolic disorder caused by hematopoietic dysfunction of bone marrow radiation sickness are its main clinical symptoms. In intestinal radiation sickness, severe gastrointestinal injury and electrolyte disorder are the main clinical manifestations.
(5) Principles to be followed in the treatment of all acute radiation injuries: ① Collect the medical history after radiation and estimate the physical dose of radiation; ② According to radiation dose and clinical manifestations, diseases can be diagnosed and eliminated; ③ Estimation of radiation dose according to body surface reaction; (4) According to the blood changes after radiation, estimate the dose and judge the condition.
5. The treatment principle pays attention to the early stage and takes into account the extreme stage.
(1) Symptomatic treatment and intensive nursing are generally used in the early stage, mainly including: ① early application of anti-radiation drugs; ② Measures to improve microcirculation and hematopoiesis microcirculation at early stage; ③ If the radiation dose exceeds a certain dose range, hematopoietic stem cell transplantation should be prepared as soon as possible to change the course of disease.
(2) Symptomatic comprehensive treatment: ① Anti-infection principles and measures; ② Anti-bleeding principles and measures; (3) supplementing nutrition, keeping water, electrolyte and acid-base balance, and preventing complications; ④ Treatment by stages.
Differential diagnosis of radiation sickness is not difficult, and there is usually a history of exposure. All the systemic symptoms caused by radiation should be attributed to radiation sickness, and the diagnosis should be made separately without considering the pathological changes of each system. However, the early clinical changes of acute skin radiation injury are similar to those of general burns and some skin changes, which should be differentiated.