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Update (11/11): Status of patients from the JCO Criticality
According to INEEL/MIS-1999-1139, 30 SEPTEMBER 1999 CRITICALITY ACCIDENT,
SUMMARY TO DATE (991109), Prepared by Valerie L. Putman (vputman@inel.gov),
initially estimated doses were 17, 10, and 3 Sv [Gy?]. Apparently based on
fission yield estimates, a later presentation (Soda 91026) indicates doses were
18, 10, and 2.5 Gy respectively.
I'll make the changes.
Albuquerque Journal had an article about the JCO accident victims [Thanks to
Mike Russell of San Onofre Nuclear Generating Station]. See
[http://www.abqjournal.com/news/2news11-07-99.htm] , Sunday, November 7, 1999,
Physician Advises On Radiation, By Jackie Jadrnak, Journal Staff Writer. Here's
some excerpts:
" An Albuquerque physician was one of five international experts invited to
Japan late last month to advise on treatment of three men seriously injured by
radiation in a nuclear accident there. Fred Mettler, professor and chairman of
the radiology department at the University of New Mexico, said the experts were
stymied in offering a solid prognosis for the most serious injuries. Two of the
men already have lived longer than anyone else previously exposed to such high
levels of radiation, he said. "It's unique. They (Japanese physicians) have
been able to keep them (the victims) alive longer than anybody would have
expected at this point," Mettler said in a telephone interview. "The patients
are of a type and situation that haven't been seen before."
<snip>
"They're using very sophisticated technology," he said. An entire intensive
care unit was cleared out for the most seriously injured man because he must be
in sterile surroundings, and a team of 40 people is working on him, Mettler
said.
<snip>
The most seriously injured man was holding the funnel for the uranium as it was
being poured into the tank, getting hit by about 1,700 rads, a measure of
absorbed radiation, Mettler said. The second most serious injuries occurred to
the man pouring the uranium; he absorbed about 800 to 900 rads, Mettler said.
The third, standing about 15 feet away, received about 100 to 200 rads, he said.
In comparison, about 70 other people who may have been affected by the accident
got doses from 1 to 10 rads, he said.
<snip>
The man with the least exposure in the accident experienced problems with his
bone marrow, but it recovered and resumed producing the needed blood cells,
Mettler said. That man was about to be released from the hospital late last
month, he said. However, he probably will develop cataracts in later years and
is at higher risk for leukemia and other cancers because of the genetic damage,
Mettler said. The two more seriously injured men received stem cell
transplants, an alternative to bone marrow transplants that has been developed
in the last two or three years, Mettler said. Stem cells are the precursor cells
that are transformed into all the other needed blood cells. The international
team's report called the most seriously injured man's prognosis "very guarded,"
he said. The second man's condition also was too uncertain to predict survival,
Mettler said. "He's still seriously ill. It could go either way," he said."
Tosh Ushino
ICN Dosimetry
==========================================================================
RBC = Red Blood Cell WBC = White Blood Cell BP = Blood Pressure
Temp = Temperature Pulse = Pulse Rate Resp = Respiration rate
CRP = C-reactive protein
Mr. A: 18 Sv
------------------------------------------------------------------------------
11/05/99 17:00
BP: 168/88 mm Hg, Pulse: 108/min., Resp: 18/min., Temp: 37.5 C
Continuing with sedative and ventilation. No major change to respiratory and
renal functions. WBC count in small blood vessels is 13,600/mm^3. Damage to skin
and mucous membrane of area thought to have received highest dose is a major
problem. Affected area has expanded to back area. Myoglobin level in blood from
muscle deterioration increasing little at a time. Compared to the previous day,
the quantity of stool in diarrhea decreased (480 gram from midnight to 4:00 PM).
As before, no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: With severe radiation burn present over large area, damage to function
of several organs has become major problem, requiring continued vigilance.
11/06/99 17:00
BP: 167/77 mm Hg, Pulse: 112/min., Resp: 20/min., Temp: 38.5 C
Continuing with sedative and ventilation. No major change to respiratory and
renal functions. WBC count in small blood vessels is 15,800/mm^3. Injuries due
to radiation burn appears to have settled down. The quantity of stool in
diarrhea decreased substantially due as result of tissue regeneration hormone
(2,440 gram from midnight to 4:00 PM ). As before, no clear indication of
infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: With severe radiation burn present over large area, damage to function
of several organs has become major problem, requiring continued vigilance.
11/07/99 17:00
BP: 160/75 mm Hg, Pulse: 120/min., Resp: 22/min., Temp: 38.2 C
Continuing with sedative and ventilation. No major change to respiratory
function. Some renal function recovery. WBC count in small blood vessels is
15,200/mm^3. Injuries due to radiation burn appears to have settled down.
Radiation damage to internal organs still is a major problem. The quantity of
stool in diarrhea increased (2,440 gram from midnight to 4:00 PM )., and
(???fluid from stomach though a tube inserted through nose???) also increased.
No apparent blockage of intestine. As before, no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: Continue vigilance.
11/08/99 17:00
BP: 164/82 mm Hg, Pulse: 130/min., Resp: 20/min., Temp: 38.7 C
Continuing with sedative and ventilation. No major change to respiratory
function. More renal function recovery. WBC count in small blood vessels is
16,700/mm^3. Injuries due to radiation burn appears to be settling down.
Radiation damage to intestine still is a major problem. The quantity of stool in
diarrhea increased (2,535 gram from midnight to 4:00 PM ). Evaluating suspected
lung infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: Continue vigilance.
11/09/99 17:00
BP: 150/75 mm Hg, Pulse: 125/min., Resp: 21/min., Temp: 37.7 C
Continuing with sedative and ventilation. No major change to respiratory
function. More renal function recovery. WBC count in small blood vessels is
15,000/mm^3. No major change to injuries due to radiation burn. Continuing
problem with radiation damage to intestine. Volume of stool in diarrhea
decreased (1,850 gram from midnight to 4:00 PM ).
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: Continue vigilance.
11/10/99 17:00
BP: 145/80 mm Hg, Pulse: 126/min., Resp: 25/min., Temp: 38.7 C
Continuing with sedative and ventilation. No major change to respiratory
function. Renal function recovering little at a time. WBC count in small blood
vessels is 16,700/mm^3. Areas of injuries due to radiation burn has expanded
more. Continuing problem with radiation damage to intestine. Volume of stool in
diarrhea increased again (2,255 gram from midnight to 4:00 PM ). No clear
indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: Continue vigilance.
11/11/99 17:00
BP: 150/90 mm Hg, Pulse: 132/min., Resp: 25/min., Temp: 38.8 C
Continuing with sedative and ventilation. No major change to respiratory
function. Renal function recovering little at a time. WBC count in small blood
vessels is 17,100/mm^3. No major change to areas of injuries due to radiation
burn. Continuing problem with radiation damage to intestine (Volume of stool in
diarrhea was 2,255 gram from midnight to 4:00 PM ). No clear indication of
infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: Continue vigilance.
Mr. B 10 Sv
-------------------------------------------------------------------------
11/05/99
As reported at the 3:00 PM press conference today, blood forming functions (RBC,
WBC, and platelet) is on way to recovery. The recovery is thought to be the
result of transplanted stem cells from umbilical cord blood cells and powerful
tissue regeneration hormone. Result is chimera consisting of transplanted stem
cells and recovery of patient's own stem cells. There is substantial damage to
skin of hands, feet, face, and back of neck, and lately there peeling of skin on
localized spots on face. Sharp pain to hands and feet continuing. No clear
indication of infection. Conscious, lucid. Strong sharp pain.
BP: 120/80 Pulse: 108/min. Temp (peak): 37.9 C
Blood oxygen level: 99% WBC count: 15,250/mm^3
Hemoglobin level: 9.4 g/dl, Platelet count: 80,000/mm^3
CRP: 3.59 mg/dl
11/06/99
No major change to overall condition, skin damage, and examination. Conscious,
lucid.
BP: 132/82 Temp (peak): 37.7 C WBC count: 15,150/mm^3
11/07/99
No major change to overall condition, skin damage, and examination. Conscious,
lucid, but drowsy.
BP: 128/68 Temp (peak): 38.0 C WBC count: 12,500/mm^3
11/08/99
Fever in 38 C range. Increase in CRP. No other major change to overall
condition, skin damage, and examination. Conscious, lucid, but drowsy.
BP: 122/78 Temp (peak): 38.7 C WBC count: 12,900/mm^3
11/09/99
No major change.
BP: 130/78 Pulse: 98/min Temp (peak): 37.4 C WBC count:
15,150/mm^3
11/10/99
Vomited small amount yesterday and today. No other change to overall condition,
skin condition, or examination result. Conscious, lucid, but nauseated.
BP: 136/70 Temp (peak): 37.8 C WBC count: 19,240/mm^3
11/11/99
No major change to overall condition, skin condition, or examination result.
Unconscious, lucid but drowsy.
BP: 148/92 Temp (peak): 38.1 C WBC count: 19,460/mm^3
Mr. C: 2.5 Sv
------------------------------------------------------------------------
11/05/99: Stable. Temp: 35.6 C, BP: 110/70 mm Hg
11/06/99: Stable. Temp: 36.5 C, BP: 108/80 mm Hg
11/07/99: Stable. Temp: 36.0 C, BP: 111/66 mm Hg
11/08/99: Stable. Temp: 36.2 C, BP: 125/90 mm Hg
-------------------------------------------------------------------------
Toshihide "Tosh" Ushino, CHP Tel: (800) 548-5100 x2413
Product Development Manager Fax: (714) 668-3149
Dosimetry Div., ICN Biomedicals, Inc. Email: tushino@icnpharm.com
3300 Hyland Ave., Costa Mesa, CA USA 92626 tushino@hotmail.com
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