First-Aid for First Responders
"The fact that accidents are uncommon should not.give grounds for complacency. No radiological accident is acceptable, and one that threatens widespread contamination is bound to alarm a public that has not yet come to terms with radioactivity." - IAEA, The Radiological Incident in Goiânia.
Time is of the essence when treating victims of internal radiological contamination. Patients suspected of being internally contaminated with Cesium-137, radioactive Thallium-201, or non-radioactive Thallium should be treated with Radiogardase® (Prussian blue insoluble capsules) as soon as possible after contamination is suspected. Contamination should be verified through medical examination as soon as possible thereafter. The earlier Radiogardase® is administered, the earlier it can start to work to increase the rate of elimination of any Cesium-137 that might be present and to reduce the patient´s exposure to radiation. Even if treatment cannot be initiated immediately after contamination is suspected, administration of Radiogardase® should be started as soon as possible.
If available locally, Radiogardase® could be administered to rescue workers and medical personnel responding to a suspected Cesium-137 attack before they arrive on the scene. The anticipatory or immediate administration of Prussian blue to first responders and medical personnel will not prevent them from becoming internally contaminated, but will ensure that the drug will be available to start working immediately if they become internally contaminated with Cesium-137, decreasing their total exposure time and providing them with the ability to continue to execute their duties with confidence.
First Responders should consider a few things when taking Radiogardase® (Prussian blue insoluble capsules):
- Radiogardase® should be administered at the dosage of 9 grams (18 capsules) per day for adults if contamination is suspected (and 3 grams or 6 capsules per day for children between the ages of 2 and 12 years).
- Medical examinations conducted after-the-fact will determine whether a first responder has been internally contaminated.
- If internal contamination is confirmed, treatment at 9 grams per day continues for a minimum of 30 days or as determined by treating physicians.
- If medical tests determine that there is no internal contamination, the treatment is discontinued.
There have been no reports of deaths or serious or severe adverse events attributed to the use of Prussian blue. While Prussian blue increases the rate of elimination of radioactive Cesium-137 and Thallium-201 from the body, it does not treat complications of radiation toxicity, such as bone marrow suppression, neutropenia, or thrombocytopenia. Patients suspected of being internally contaminated with Cesium-137 or Thallium-201 should be monitored for radiation toxicity and treated as necessary. Prussian blue might not increase the rates of elimination from the body of radioactive elements other than Cesium-137 and Thallium-201. Patients known or suspected to have been exposed to radioactive elements in addition to Cesium-137 or Thallium-201 may require additional, concomitant treatment with other agents.
Known side effects include constipation and a blue discoloration of the mouth and teeth if the powder from Prussian blue capsules is mixed with food for administration to patients unable to swallow capsules. Prussian blue might bind to electrolytes or other therapeutic drugs in the gastrointestinal tract. Serum electrolyte levels should be monitored during treatment, particularly in patients with pre-existing cardiac arrhythmias or electrolyte imbalances, as should possible clinical responses to critical orally administered products. Prussian blue´s potential effects on pregnancies have not been studied. However, Prussian blue is not absorbed into the bloodstream and therefore effects on the fetus and the possibility that Prussian blue might be passed from mother to infant in breast milk are not expected. Cesium-137 can be transmitted to infants through breast feeding, so women thought to be internally contaminated with the radioactive material should not breast feed. Dosing in neonates and infants (0 to 2 years of age) has not been established.