With nuclear instability still threatening Japan after the earthquake and tsunami in March, many Americans are concerned about how prepared U.S. healthcare networks are to handle similar nuclear disasters. New York and New Jersey are among the states formulating their own disaster plans, including strategies for caring for the youngest victims those most susceptible to the effects of radiation.
Signs and symptoms
Because children are growing, more cells are repeatedly dividing in their bodies, and there is a greater opportunity for radiation to disrupt this process. The small size of their bodies also can make them more vulnerable.
Children have a disproportionately higher minute ventilation, leading to greater internal exposure to radioactive gases, according to the National Institutes of Health. They also may have special psychological needs from the circumstances of the event, such as possible separation from their families.
In the case of a nuclear disaster, hospital emergency care providers will work to determine the amount of exposure to radiation, but a patients other injuries will get the attention first if, for example, the exposure followed an explosion or earthquake. If they have surface radiation and they have a life-threatening injury, the life-threatening injury gets treated before the radiation because the radiation is going to kill them a lot slower, said Bonnie Arquilla, DO, director of disaster preparedness for the State University of New York Downstate Medical Center in Brooklyn, N.Y.Bonnie Arquilla, DO
Most initial radiation exposure alone will not be life-threatening for children, Arquilla said. The bigger concern for children comes later if radioactive fallout enters the food and water supply.
Over time, exposure to radiation has been proven a risk factor for thyroid cancer, according to the American Cancer Society, which notes many studies have pointed to an increased incidence of thyroid cancer in children because of radioactive fallout from nuclear weapons or power plant accidents. It cites studies that found cancer is more common in children living near Chernobyl, the site of a 1986 nuclear reactor meltdown in the Ukraine that exposed millions to radioactivity.
One of the signs healthcare workers would look for after a nuclear event would be whether a patient vomits and how soon vomiting occurred after exposure. Thats a very baseline indicator of acute radiation sickness, said Kathe Conlon, RN, BSN, CEM, MSHS, burn disaster education coordinator at Saint Barnabas Health Care System in New Jersey. And that would be an indicator that the person actually has absorbed such a high dosage that the chances of survival are minimal. Especially if we see vomiting within the first hour.
Different systems of the body can be affected by radiation exposure, and damage is directly related to how fast those cells reproduce, she said.
Since the bone marrow has fast replicating cells, one of the things wed see would be abnormalities in their white and red blood cell counts. The gastrointestinal system is another area because the lining of the GI tract those cells tend to slough off and replicate, so heres where youd start to see nausea, vomiting and diarrhea, Conlon said.
Conlon said burn centers would play a key role in the event of a nuclear emergency because radiation can affect all body systems, especially the skin.
In New Jersey, if an event produced radiation burns or other burns, the state would engage its system of determining which hospitals would receive which patients based on severity of the injuries and age of the patient, said Chris Ruhren, RN, BSN, CCRN, MAS, who works with the state of New Jersey on disaster preparedness for burns. In dealing with burns, having good communication throughout the hospital network is vital, she said.Chris Ruhren, RN
There are only 1,800 burn beds in the entire country. On the East Coast we have around 328. There are some hospitals that dont take children. There are some that only take children. This is why it was so important to establish partnerships, said Ruhren, assistant vice president of patient care services at Saint Barnabas and director of the only burn center in New Jersey.
New York has disaster plans at the state, city and individual hospital level that include radiation exposure, said Arquilla, who also oversees Kings County Hospital Center in Brooklyn, N.Y. She said New York Citys Pediatric Disaster Coalition has been working on how best to distribute children among hospitals in the case of disaster.
Burn training also is part of the disaster plan, and a burn plan in New York City is waiting to be adopted by the state, but as of press time had not been accepted. What theyre doing is extending out the burn centers [in the New York City area] so that all the trauma centers will be burn centers for a short period of time [during a disaster], Arquilla said.
Disaster plans include a system for tracking patients over time to monitor future effects, Arquilla said.
Many healthcare professionals are monitoring the Japan disaster and looking for lessons in dealing with any potential nuclear emergency in the U.S. They already have learned much about disaster training from Sept. 11.
Lessons also have been learned in establishing identity when there are mass casualties, especially for children, because they generally dont carry identification. That can be a problem if they cant give their name, especially because they may be given fluids which can cause generalized edema and distortion of facial features, Ruhren said. At Saint Barnabas, pictures are taken when patients come in and information on each patient is entered into a database about any unique characteristics, such as piercings, moles, eye color, hair color and tattoos.