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SYMPOSIUM
Year : 2010  |  Volume : 2  |  Issue : 3  |  Page : 159-160 Table of Contents     

Undeclared disaster: Radiation episode in New Delhi - Medical overview and hard lessons to learn!


Department of Emergency Medicine, James Paget University Hospital, NHS Foundation Trust, Lowestoft Road, Gorleston, Great Yarmouth,Norfolk, NR31 6LA, United Kingdom

Date of Web Publication16-Aug-2010

Correspondence Address:
Vivek Chhabra
Department of Emergency Medicine, James Paget University Hospital, NHS Foundation Trust, Lowestoft Road, Gorleston, Great Yarmouth,Norfolk, NR31 6LA
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.68495

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How to cite this article:
Chhabra V. Undeclared disaster: Radiation episode in New Delhi - Medical overview and hard lessons to learn!. J Pharm Bioall Sci 2010;2:159-60

How to cite this URL:
Chhabra V. Undeclared disaster: Radiation episode in New Delhi - Medical overview and hard lessons to learn!. J Pharm Bioall Sci [serial online] 2010 [cited 2019 Dec 6];2:159-60. Available from: http://www.jpbsonline.org/text.asp?2010/2/3/159/68495

The episode of spread of radioactive source in North India from New Delhi to Rewari, a distance range of 60 km, has reckoned the dangers of invisible, impalpable and odorless radiation hazard, again. An evaluation of recent history brings forth knowledge of chilling recurrence, albeit in similar fashion and common roots, across the globe. Various such similar episodes have happened in Goiania, Brazil (1987), Ankara, Turkey (1993), France/China (2000) and Samut Prakarn, Thailand (2000), where scrap industry and institutional or hospital teletherapy units were more or less involved, with Cobalt 60 being the commonest culprit. [1]

In this particular incidence at New Delhi, a lot of pitfalls and perils about administrative issues have already been published in the newspapers. But what went amiss is a formal review of gaps and strengths of the medical framework ranging from disaster health, emergency medicine, medical transportation, acute medicine and hemato-oncological services across the government, corporate and military medical sector. By this publication, some interesting facts are documented about unfolding of events while the episode was evolving.

It was a pride moment to realize that the team at apex trauma centre, AIIMS, was fully geared up with a specially controlled and isolated area to triage and decontaminate the radiation victims from the very first day of reporting of the incidence. This preparedness was also covered and lauded by responsible and constructive electronic and press media. However, the chinks appeared in less than 24 hours, when patients reported or moved to the lesser equipped and unprepared facility of emergency department at AIIMS and another corporate hospital in west Delhi. This exposed the robustness of communication mechanisms in place at national capital level and also at intramural levels in reputed institutes of the country.

It was heartening to note that various organizations, government, private and army, working from day one of the incident, with emergency meetings at short notice for setting up interim guidelines for handling suspected victims, if reporting to a hospital. But, again, it was a case of right hand not knowing what was being done by the left and vice-versa. This got further complicated by remarks of certain officials who gave "all clear" signal in the very first 24 hours of first reported case which obviously was not the fact and has never been the fact, if one sees the history of similar episodes in the past.

The edifying strengths of National Disaster Management Authority (NDMA), Government of India, got appropriately reflected when a major corporate group hospital (MAX Health Care) raised the Incident Command Officer (ICO) with pre-defined roles of stakeholders. It also assigned a controlled isolation area in case of need, and raised interim guidelines for management of radiation victims by the hospital team under the leadership of Emergency Medicine, on the very first day. However, intra-mural communication deficits to the entire chain of the healthcare group and extramural partners deprived benefits to affected parties, of the carried exercise.

Another important role deserving praise was that of Radiation Safety Officers (RSOs) who were well utilized and did some real heroic jobs, very silently. One of them lived through the literal nightmare and did not succumb to pressures of administration suggesting placing the radiation source in the open public area, and used innovative measures to control the radiation till advance help from the development of atomic energy of India arrived. It was sad to realize that Safdarjung Hospital, flagship institute of Ministry of Health, Government of India, was found lacking on the aspect of numbers of RSOs employed with them.

A good job done during H1N1 pandemic, from the Division of Emergency Medical Relief, Directorate General of Health Services, Ministry of Health and Family Welfare, raised very high expectations for this serious issue as well. However, it was extremely difficult to find if anything during the radiation episode was done by them.

An issue of transporting canisters which safely hold radioactive source needs to be revealed. Given the emergency in view of people getting exposed in west Delhi to radioactive pencil found in patient's wallet, a quick aerial transport of canisters, both during day or night, was the best option. However, this was not feasible in view of pitiable policies for heli-transport, even during a national emergency, which this surely was. The traffic jams ensured the delay in the delivery of canisters, which may be avoided in the future, if responsible officials take appropriate stance to set up process and systems, and also, if the authorities permit blue-light ambulance to transport such materials, as the current policy allows blue light only if there is a patient in the ambulance.

Another strength worth citing is the meeting of management committee of a major corporate health group which set the ball rolling for production of clinical flowchart for management of such patients [Figure 1]. This was also shared with Disaster Cell, Government of NCT of Delhi and NDMA, Government of India.
Figure 1 :Management of radiation victim

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With lot of water already gone above the bridge, time is still not lost regarding the medical preparedness at a community level for which following suggestions may be utilized.

Scrap dealers and common public may be educated about the universal trifoliate symbol [Figure 2] warning of radiation hazard. Even the best international literature backs this recommendation as well. This may also be incorporated in the induction program for all the staff working in institutes where radiation hazards do exist.
Figure 2 :Trifoliate symbols for radiation hazard

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Dos and Don'ts for radiation related issues, for example, if one has handled radioactive source, then the simple act of placing it down safely, distancing oneself off, washing hands or body part with tap water and soap and informing relevant authorities, will take care of major issues. Washing with cold or hot water, either, may worsen the exposure by radioactive particles. [2]

It will also be good if an institutional committee of qualified and dynamic medical professionals is established by the Government of India to deliver a white paper over the medical aspects of the whole episode. The same may help strengthen our medical preparedness and resilience and mitigate effects of such occult and silent disasters besides fortifying activities undertaken by NDMA.

 
   References Top

1.Reducing the risk from radioactive sources. Carolyn Mac Kenzie. IAEA Bulletin 47/2; 2006. p. 61-3. Available from: http://www.iaea.org/Publications/Magazines/Bulletin/Bull472/pdfs/srs_toolkit.pdf . [Last accessed on 2010 Jun 19].List of Civilian Radiation Incidents: Wikipedia; Available from: http://en.wikipedia.org/wiki/List_of_civilian_radiation_accidents [Last accessed on 2010 Jun 19].  Back to cited text no. 1      
2.Guidance Manual: Medical Management of Individuals involved in Radiation Accidents; Part 3 of 3 Appendix A6; Technical Report Series No 131: Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). Available from: http://www.orau.gov/reacts [Last accessed on 2010 Jun 19].  Back to cited text no. 2      


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 RADIOLOGICAL AND NUCLEAR EMERGENCIES: MEDICAL MANAGEMENT OF RADIATION INJURIES
L. Ravi Shankar
Defence Science Journal. 2011; 61(2)
[Pubmed] | [PDF]



 

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