Radiation Emergency Information
What to do in case of Emergencies
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Emergency Contact Information for Radiation Safety
Emergency (24/7): Dial 911 and Request the Duke Radiation Safety On-call Responder.
Nuclear Medicine Patient Care Issue: 984-209-3349 (Radiation Safety Patient Team)
- From the Duke campus, dial 911 and ask for the Radiation Safety on-call responder. If offcampus, dial the Duke Police directly (919-684-2444). This option is available 24/7.
- Duke Police will put you in touch with the oncall responder. The on-call responder will assist you. Depending on the nature of your emergency, the responder may put you in touch with the appropriate Radiation Safety Division staff.
- If the emergency involves a nuclear medicine patient care issue, you may call the Radiation Safety Patient Team (984-209-3349).
- Do NOT call 919-684-2794 (OESO) or 919-684-2194 (Radiation Safety). These are administrative numbers. Calling these numbers will delay an appropriate response.
- Do NOT leave voicemail on any Radiation Safety Division staff phone. Instead, dial 911 or call the Duke Police directly.
- For general information, consult the options on this Web site.
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Medical Emergency (Code Blue)
What You Should Do Immediately
- Code procedures should be performed so as NOT to compromise the patient's chances for recovery. Radiation exposure should NOT be a consideration during the initial critical minutes of the code. As the code progresses and becomes more organized, measures can be taken to reduce personnel exposure.
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The patient should be BAGGED ONLY. Mouth-to-mouth breathing assistance should be avoided if at all possible.
- Face protection should be used by those at risk for splash exposure by saliva, respiratory secretions or vomitus. Gloves and gowns should be employed as usual. Universal precautions should be employed as usual.
- If time permits, portable shields may be employed. They can reduce the gonadal exposure of people who are in close. Lead aprons should NOT be sought out or worn. They are ineffective.
- Personnel assisting in procedures should maintain the maximum distance consistent with effective care.
- After the situation has resolved, staff should dispose of gowns, gloves, etc. in the box on the patient's room. Such materials should not be removed from the room. Other equipment (defibrillators, etc.) should be checked for contamination by Radiation Safety before they are removed from the room, unless they need to accompany the patient to an intensive care unit. Personnel should perform thorough handwashing.
- Contact Radiation Safety personnel when the situation stabilizes to assist in transfer of the patient to intensive care, or Duke Police at 911). Transfer to the intensive care unit should be performed irregardless of whether the patient has been removed from "radiation precautions", if medically indicated. It may be necessary to transfer other patients in Intensive Care to minimize their exposure.
- Personnel who experienced exposure to blood or body fluids should contact Radiation Safety within 24 hours to have thyroid monitoring performed.
How Radiation Safety Will Respond
Radiation Safety Staff are available for consultation regarding personnel surveys (including assistance with thyroid bioassays) and dose reconstruction.
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Radioactive Patients: Inpatients or Incoming Patients
As a physician, nurse or ancillary care-giver, you may hear or believe that an in-patient you are caring for is 'radioactive'. Or, you may hear from the news media that people who were exposed to radiation by a nuclear accident or terrorist attack are coming to Duke.
What You Should Do:
- In all cases, report to work and carry on as usual. If required, Duke Radiation Safety will issue special procedures for you to follow.
- Patients who have been involved in nuclear accidents or terrorist attacks may be sent to Duke for specialized treatment such as intensive care or bone marrow transplants. Most patients will have been decontaminated (cleansed of radioactive materials or chemicals) before they get to Duke. In no case will a person exposed to radiation be a significant risk to your health. Follow any instructions issued by Duke Radiation Safety.
- Inpatients and outpatients who have had diagnostic scans in PET or Nuclear Medicine do contain small amount of radioactive drugs but present negligible risk to you, even if you are pregnant. Consult Duke Radiation Safety if you have concerns.
- Patients who have been to Radiation Oncology for linear accelerator treatments or high-dose-rate (HDR) implant treatments are not radioactive at all when they return to your Division. They present no risk to you.
- Patients who have had radioactive implants for prostate cancer or certain types of eye cancer present negligible risk to you. Follow the special "Radiation Precautions" issued by Duke Radiation Safety.
How Radiation Safety Will Respond
If necessary, Duke Radiation Safety Staff will issue special instructions, and are always available for consultation.
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Death of Patient Containing Radioactive Material
What You Should Do Immediately
(1) Contact Radiation Safety personnel on call, or call the Duke Police.
(2) Do not remove the patient from the room until cleared to do so by the Radiation Safety Staff.
(3) For brachytherapy (implant) patients, notify the Radiation Oncology resident on call.
(4) Secure the room and do not permit entry to persons other than Radiation Oncology or Radiation Safety staff.
How Radiation Safety Will Respond
(1) Survey the patient to determine the hazard level.
(2) Assist in the removal of radioactive implants.
(3) Supervise the removal of the patient from the room.
(4) Assist Pathology Department staff and/or Decedent Care staff in completing their tasks.
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Exposure to Radiation While Pregnant
What You Should Do Immediately
(1) Do not panic. Most radiation exposures encountered in a campus research environment will not result in significant exposure to the fetus.
(2) Contact Employee Health (684-3136) and ask for a formal "Declaration of Pregnancy", if you have not already done so. You will receive an Occupational Medicine Consult. Occupational Medicine physicians will work with Radiation Safety Staff to perform the appropriate radiation dose reconstruction.
(3) If the exposure was to a patient during the course of a diagnostic or therapeutic procedure, inform the physician responsible for conducting the procedure.
How Radiation Safety Will Respond
Radiation Safety Division Staff will work with employees, Occupational Medicine physicians and individual physicians in Radiology, Cardiology or Radiation Oncology in performing dose reconstructions and risk assessments. Radiation Safety will provide appropriate radiation dosimeters to pregnant employees on a case-by-case basis.
Preventative Measures
(1) If you learn that you are pregnant, Declare your pregnancy to Employee Health (684-3136) as soon as possible. This confidential process assures you of maximum protection if you work with radioactive materials, hazardous chemicals (including chemotherapy drugs) or biohazards.
(2) Always use proper laboratory techniques when working with radioactive materials, whether or not you know you are pregnant.
(3) When interviewing patients who are being considered for elective diagnostic studies, obtain an age-appropriate history of sexual activity, birth control measures, last menstrual period and so forth to assess the need for further testing to rule out pregnancy.
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Contamination or Spill Involving Radioactive Material
What You Should Do Immediately
(1) Prevent access to the spill to prevent personnel exposure and the spread of radioactive contamination. Cordon off the area. Put on a lab coat or disposable gown, shoe covers and protective gloves.
(2) DO NOT activate the HEICS 'Code Orange' process before consulting Radiation Safety.
(3) Notify the Radiation Safety Division, using any of the means on the "Contact Us" link on the Main Page.
(4) Contain the spill. Cover copiously with absorbent paper; do not wipe up.
How Radiation Safety Will Respond
(1) Assist in cleaning up the spill and decontamination procedures.
(2) Assist in surveying the area to ensure that residual contamination levels are acceptable.
(3) Notify State authorities if required.
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Radioactive Seed Localization: Loss or Damage to Seed
What You Should Do Immediately
FOR SEED LOSS:
(1) Prevent access to the area to prevent inadvertent transport of the seed into unrestricted areas on shoes or clothing.
(2) Notify the Radiation Safety Division, using any of the means on the "Contact Us" link on the Main Page.
(3) Attempt to locate the seed using the radiation detection equipment normally used for the excision procedure, or a GM detector if in Mammography or Surgical Pathology. In Mammography, check implantation needles, operator's shoes, clothing, pants cuff's, etc. and re-survey the patient. In Surgery and Surgical Pathology, check specimen containers, waste receptables, staff clothing, surgical instruments and re-survey the patient.
(4) If the seed is located, do not handle it with bare fingers, even if gloved. Use forceps (preferably "reverse-action" type) to grasp seed and place in the shielded wrapper or other shielded container.
FOR SEED TRANSECTION AND/OR LEAKAGE:
(1) If a seed has been transected in the Operative Suite or Surgical Pathology with a release of the encapsulated radioactive material, prevent access to the spill to prevent personnel exposure and the spread of radioactive contamination.
(2) Using an appropriate radiation detection instrument, determine the extent of the spill.
(3) Contain the spill. If the spilled material is on the patient, cover liberally with sterile gauze. If on another surface, use absorbent paper. Do not wipe up; let the absorbent material contain the material.
(4) DO NOT activate the HEICS 'Code Orange' process before consulting Radiation Safety.
(5) Notify the Radiation Safety Division, using any of the means on the "Contact Us" link on the Main Page.
(6) In consultation with the Radiation Safety Division and the Radiopharmacy Director, consider oral administration of SSKI to the patient if the tissue absorption of radioactive iodine is likely.
How Radiation Safety Will Respond
(1) Assist in locating the seed and performing any required decontamination procedures.
(2) Assist in surveying the area to ensure that residual contamination levels are acceptable.
(3) Notify State authorities if required.
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Trash Monitor Alarms
What You Should Do Immediately
(1) Take the cart to the designated room in Duke Hospital North or Duke Hospital South.
(2) Label the cart with a sign reading "For Radiation Safety".
(3) Lock the room.
(4) Notify your supervisor, who will in turn notify Radiation Safety.
How Radiation Safety Will Respond
(1) Locate the radioactive material in the cart and remove it.
(2) Identify the material and dispose of it properly.
(3) Verify that the remaining trash in the cart is non-radioactive.
Preventative Measures
Nuclear Medicine staff and Nursing staff should ascertain that all trash associated with diagnostic or therapeutic radiation patients is disposed of properly. For diagnostic patients, trash may consist of IV tubing or discontinued central lines. For therapy patients, all shoe covers, gloves, syringes, urine containers, kleenex, eating utensils, food trays, etc. should be disposed of in specially-marked containers in the patient's room.
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Injury Involving Radioactive Material
What You Should Do Immediately
(1) For minor injuries (scalpel cuts, needle-sticks, splash to eyes, etc.): Flush the wound with copious amounts of water and dress it. Contact Occupational Medicine for a consult. If the cut or needle-stick involved contact with human blood, immediately dial 115 to contact the "Blood-Borne Pathogens" hotline. This takes precedence over any radiation considerations. The risk associated with hepatitis (B or C) and HIV is far higher than that of radiation. For splashes to the eyes, flush with water using a chemical eye-wash station. For splashes to bare skin, flush with copious amounts of water, then wash with soap and water. Survey the skin using a pancake GM detector; repeat if radioactivity is still present. Do not use a scrub-brush or solvents to clean skin.
(2) For major contamination (explosions, accidental ingestions, etc): Dial 911 and arrange for immediate transport to the Duke Emergency Department.
How Radiation Safety Will Respond
Radiation Safety Staff are available for consultation regarding personnel surveys and dose reconstruction.
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Fire Involving Radioactive Material
What You Should Do Immediately
(1) Remove all persons in immediate danger.
(2) Alert the authorities by activating the fire alarm.
(3) Close doors to contain the fire.
(4) Extinguish the fire if it is safe to do so.Advise Duke Fire Safety personnel and/or Fire Department that the fire may involve radioactive materials.
How Radiation Safety Will Respond
Radiation Safety Staff will assist the authorities with investigation and clean-up.
Preventative Measures
(1) Do not store radioactive materials near solvents or other fire accelerants. Radioactive materials and brachytherapy sources should be used and stored only in climate-controlled areas that have a low probability of fire.
(2) If using potentially flammable reagents, work in a fume hood.
(3) Use "biodegradable" liquid scintillation counting fluids whenever possible, since these have higher flashpoints than the xylene- or toluene-based fluids.
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Loss / Theft of Radioactive Material
What You Should Do Immediately
(1) Use a survey meter (pancake GM or ionization chamber) to attempt to locate the radioactive material. Check lab coats, trash cans, waste barrels, bed linens, food trays, etc. Visually check what you think may be "empty" lead pigs or shipping cartons.
(2) If the material cannot be located, notify Radiation Safety by dialing 911 from the Duke campus and requesting assistance with a radiological emergency.
(3) If theft is suspected, notify the Duke Police.
How Radiation Safety Will Respond
(1) Assist in locating the material in your laboratory or patient room.
(2) Survey the Laundry Facilities, trash carts, dumpsters, etc. to locate material.
(3) Report incidents to appropriate State authorities if required.
Preventative Measures
(1) Secure your radioactive materials. Keep them in lock-boxes, locked refrigerators or locked cabinets. Lock your laboratory doors if you must leave during experiments. Do not leave radioactive materials unattended.
(2) Be vigilant. Do not throw away newly received shipments of radioactive laboratory reagents. Do not allow unauthorized persons access to your laboratory areas. Keep proper inventory of radioactive materials and brachytherapy sources.
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Duke Comprehensive Cancer Center Irradiator Emergency
What You Should Do Immediately
(1) If the radiation monitor on the wall gives an audible alarm, LEAVE THE ROOM, close the door and notify Radiation Safety (dial "911" and request assistance with a radiological emergency).
(2) The manufacturer of the irradiator has identified four additional conditions that they consider to be emergency conditions:
(a) source does not raise or lower smoothly;
(b) source fails to return to shielded position automatically;
(c) able to open cavity door without pressing "Door Release" button;
(d) unable to raise source with door closed.If any of these conditions occurs, suspend operations immediately and notify the Authorized User of the irradiator. DO NOT USE THE IRRADIATOR IF IT IS MALFUNCTIONING.
How Radiation Safety Will Respond
(1) Assess hazard in the event that radiation monitor sounds.
(2) Direct any emergency procedures required if high radiation levels exist, in conjunction with Duke Police and other emergency facilities.
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Transfusion Services Irradiator
What You Should Do Immediately
(1) If the radiation monitor next to the irradiator sounds (loud, continuous tone), instruct all persons in the Blood Bank to leave the room IMMEDIATELY. When the facility has been evacuated, secure the doors to prevent access and dial 911 (Duke Police) to declare a Radioloical Emergency.
(2) Do not re-enter the facility until instructed to do so by Radiation Safety personnel.
How Radiation Safety Will Respond
(1) Assess the radiation hazard and determine the reason that the alarm was activated.
(2) Advise Duke Police and other emergency personnel regarding the need for further evacuation.