At-Risk / Special Needs Populations During Radiation Emergencies
- Definitions
- Managing At-Risk / Special Needs Populations - General
- Elderly
- Immune-suppressed
- Infants and Children
- Pregnant Woman and Fetus
- Persons with Disabilities and Other Special Needs
- Crisis Triage and Disability Rights
Definitions
- HHS definition of At-Risk Individuals plus Tools and Resources
- Populations with Special Needs (PDF - 520 KB) (Oak Ridge National Laboratory, ORNL/TM-2006/559, October 2006)
Managing At-Risk / Special Needs Populations - General
- At-risk / special needs populations require special attention during a radiation incident.
- Health care providers must identify and respect their needs and respond appropriately to them, considering the resources available.
- Selected issues particularly relevant to radiation incidents are discussed below
- General issues are discussed in this CDC document
- US Department of Labor Office of Disability Employment Policy Information about Various Aspects of Emergency Preparedness
Elderly
- Bone marrow reserve diminishes with age
- Predisposition to anemia
- Predisposition to infection
- Predisposition to bleeding
- May have increased risk of bleeding due to medications, poor diet, or other factors
- Increasing number of co-existing diseases and conditions may be associated with
- Inability to tolerate certain drugs
- Lesser ability to tolerate aggressive salvage treatments, such as stem cell transplant for treatment of Acute Radiation Syndrome
- Cognitive issues may need to be addressed
Resources
- Seniors (Ready.gov)
- Emergency Readiness for Older Adults and Caregivers (HHS/Administration on Aging)
Immune-suppressed
- Whole body radiation exposure will exacerbate pre-existing diminished immune functions.
- Countermeasures (e.g., myeloid cytokines) used to enhance blood cell production may be less effective.
- Affected individuals are more susceptible to infection.
- These individuals usually require leuko-reduced, irradiated blood.
- May not be able to tolerate radiation-induced prolonged pancytopenia or stem cell transplant due to underlying condition (e.g., cancer, congenital or acquired immune deficiency).
Infants and Children
At-Risk / Special Needs Populations - Infants and Children
Pregnant Woman and Fetus
- National Council on Radiation Protection and Measurement (NCRP)
- Preconception and Prenatal Radiation Exposure: Health Effects and Protective Guidance, (NCRP Report No. 174), Bethesda, MD, 2013.
- International Committee on Radiation Protection (ICRP)
- Biological effects after prenatal irradiation (embryo and fetus), ICRP Publication 90, Ann. ICRP 33(1-2), 2003.
- Doses to infants from radionuclides ingested in mothers' milk, ICRP Publication 95, Ann. ICRP 34(3-4), 2004. Errata published (PDF - 62 KB)
- Doses to the embryo and fetus from intakes of radionuclides by the mother, ICRP Publication 88, Ann. ICRP 31(1-3), 2001.
- Pregnancy and medical radiation, ICRP Publication 84, Ann. ICRP 30(1), 2000.
- ICRP 84, Pregnancy and medical radiation; Free, downloadable, educational material for teachers, doctors, those in radiological protection. (English and Spanish versions)
- Health Physics Society (HPS)
- Pregnancy and Radiation (PDF - 222 KB) (Health Physics Society)
- Pregnancy and Radiation Exposure (Health Physics Society)
- Radiation Exposure and Pregnancy - Fact Sheet for Patients (PDF - 480 KB) (Health Physics Society)
- Government publications and videos
- Effects of in utero exposure to ionising radiation during the early phases of pregnancy (PDF - 328 KB) (European Commission, Proceedings of a scientific seminar held in Luxembourg in November 2001)
- Prenatal Radiation Exposure: A Fact Sheet for Physicians (HHS/CDC, May 10, 2006)
- Possible Health Effects of Radiation Exposure on Unborn Babies (HHS/CDC, May 10, 2006)
- Prenatal Radiation Exposure (YouTube - 3:33 minutes) (HHS/CDC)
- Public Health England (PHE) (formerly Health Protection Agency [HPA], United Kingdom)
- Protection of pregnant patients during diagnostic medical exposures to ionising radiation, RCE 9 (Public Health England [PHE], formerly Health Protection Agency [HPA], March 2009)
- Guidance on the application of dose coefficients for the embryo, fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Public Health England [PHE], formerly Health Protection Agency [HPA], March 2008)
- Other publications
- Mabuchi K, Fukiwara S, Preston DL, Shimizu Y, Nakamura N, Shore RE. Atomic-bomb survivors: Long-term health effects of radiation, Chapter 8, pp 89-113 in Human Radiation Injury, Shrieve DC, Loeffler JS, eds.: Wolters Kluwer | Lippincott Williams & Wilkins, Philadelphia, PA, 2011.
- Brent RL. The effects of embryonic and fetal exposure to x-rays and isotopes. in: Barron WM, Lindheimer MD, eds. Medical disorders during pregnancy. 3rd ed. St. Louis: Mosby Yearbook; 2000, pp. 586-610.
- Brent RL. Utilization of developmental basic science principles in the evaluation of reproductive risks from pre- and postconception environmental radiation exposures. Teratology. 1999 Apr;59(4):182-204. Review. [PubMed Citation]
- Brent RL. Counseling patients exposed to ionizing radiation during pregnancy. Rev Panam Salud Publica. 2006; 20(2/3): 198-204. [PubMed Citation]
- Boice JD, Miller RW. Childhood and adult cancer after intrauterine exposure to ionizing radiation. Teratology 1999;59:227-233. [PubMed Citation]
- Donnelly EH, Smith JM, Farfan EB, Ozcan I. Prenatal Radiation Exposure: Background Material for Counseling Pregnant Patients Following Exposure to Radiation. Disaster Med Public Health Prep. 2011 Mar;5(1):62-8. [PubMed Citation]
- Izumi S, Suyama, A, Koyama K. Radiation-related mortality among offspring of atomic bomb survivors: a half-century of follow-up. Int J Cancer. 2003 Nov 1;107(2):292-7. [PubMed Citation]
- Schull WJ, The children of atomic bomb survivors: a synopsis. J Radiol Prot. 2003 Dec;23(4):369-84. [PubMed Citation]
- Brent RL and Mettler FA, Pregnancy Policy. AJR Am J Roentgenol. 2004 Mar;182(3):819-22. [PubMed Citation]
- Prasad KN, Cole WC, Haase GM. Health risks of low dose ionizing radiation in humans: a review. Exp Biol Med (Maywood). 2004 May;229(5):378-82. Review. [PubMed Citation]
Persons with Disabilities and Other Special Needs
- Patients with diminished mobility may not be able to
- Evacuate the radiation scene as directed
- Tolerate the austere environments required during the emergency
- Mobilize without assistance for transportation or decontamination
- Transportation issues may need to be arranged to accommodate special needs.
- Patients with diminished mental capacity may not be able to follow directions.
- Patients with limited language proficiency or non-English speakers may not be able to follow directions.
- Patients with medical disabilities may not be able to tolerate standard radiation rescue treatments and may be disconnected from chronic treatments such as dialysis, oxygen, insulin, and other chronic medications.
Resources
- Individuals with Disabilities — Special Preparedness Information for the Disabled (DHS)
- Preparing for disaster for people with disabilities and other special needs (DHS/FEMA, American Red Cross)
Crisis Triage and Disability Rights
- Crisis Triage and Disability Rights – these papers about the Covid-19 pandemic present issues that could be relevant for large radiation incidents
- Mello MM, Persad G, White DB. Respecting Disability Rights - Toward Improved Crisis Standards of Care [published online ahead of print, 2020 May 19]. N Engl J Med. 2020;10.1056/NEJMp2011997. [PubMed Citation]
- Solomon MZ, Wynia MK, Gostin LO. Covid-19 Crisis Triage - Optimizing Health Outcomes and Disability Rights [published online ahead of print, 2020 May 19]. N Engl J Med. 2020;10.1056/NEJMp2008300. [PubMed Citation]
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