During a particularly bad weather event, a truck departing from a regional transport facility slid off the road and tipped over, rupturing a commercial-grade, encapsulated americium source that was in the cargo bay.  There were three men in the truck – all of whom were able to extricate themselves from the vehicle and were found by emergency responders looking over the contents of the spilled cargo. They were not wearing respiratory protection, and informed the approaching responders that they had been hauling cargo that included a radiation source. As such, they were asked to shed and bag their clothing and wipe themselves off as they were transported to the nearest medical facility for further evaluation.

You are an emergency physician working at the medical facility where these three individuals present. Because responders were made aware of the radiation source, they alerted your team ahead of time so you could take necessary protective actions.

The source at the site was located, and the presence of radiation was detected both around the site, as well as on the worker's clothing. Report is given to your team, and based on information from the transport digest and the initial radiation assessment it is suggested that the radiation source could be americium. 

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The workers provide a verbal exposure history, participate in a more comprehensive radiation assessment, and provide you with urine and blood laboratory samples. Based on their risk for internal contamination with americium, you decide to start all three individuals on DTPA treatment.

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As the workers are waiting to receive their nebulized medication, the shift nurse overhears one of the individuals say to his co-worker that he forgot to mention that he left his albuterol inhaler at home as he left for work, and is going to call his spouse to have her bring it in. After confirming this with the patient, the shift nurse relays this information to you.

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When trying to place the order for Ca-DTPA, you are notified by the pharmacy that due to a loading error, the area's supplier only shipped out the Zn-DTPA portion of their order; the Ca-DTPA portion is being reshipped, but will take two days to arrive and be distributed.

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After adjusting the treatment plan, all three workers received DTPA and had monitoring of their urine and stool for elimination of americium-241. Each patient received a specifically tailored duration of treatment based on these results over several months; the total number of doses of DTPA administered to each patient varied from 6 to 10 doses over that period.  All patients had enhanced elimination of americium-241 from their body during DTPA treatment.