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. 190-59-60.
VOL

2 7 1 8

~
- / /
_

/ /

- / /

1992
2
1992

1992

Contents

. . .
. . .,
. ., . .
(
) .

ARTICLES . . . . .
.
Kamyshenko I. D., Kipor G. V..
Nemtsev A. N. Concept of the
state public health system of
the Russian Federation aimed
at the prevention of extreme
situations and rendering emergency medical care (emergency
medical service in extreme situations)

. ,-

-
. . . . .
. .,
. ., . .
MP 8

Yatsenko V. N.
Dosimetry
measurements necessary for the
rendering specialized emergency,
medico-sanitary care to the victims of extreme radiation situations .
. . . . .
.

19

. //.,
. ., . .

29

? . 0

^ ^ ^

12

12

Ryazantsev
E. P., Pavlenko V. /., Egorenkov P. M. Analysis of radiation after-effects
of design accidents and accidents beyond the design basis
at the MR and IR-8 reactors
. 1 9
Phylutov
B. N..
Prosiakishin G. P., Shkodich P. E. General principles of medico-sanitary help system organization
at accidents in chemical industry
. . . . . . .
. ' 29
1

. ., . .


. .
34
. .,
. .


.
39
. .
43
. ., . .
,
.
53
. ., . .,

. .,
. . .
62
. . -8
.
67
. : -
71
.
... . .
. .
75
. ., . ., . . -


. . . .
75
. .,
. .,
. .
.
. . . .
82
.
88
10. .

.
. . . .
88
2

Pankova V. ., Popova . .
Occupational pathology and deontology aspects oi chemical '
accidents in industry . . .
Jsakin A. F., Zaboiotny V. N.
On some peculiarities of the
damages among mine rescueres
due. to sulphur dioxide at dealing with coal mines accidents

34

39

Volovich V. G. A man in
extreme environment . . .

43

Novikov V. S.. Smirnov V. S.


Bioregulating therapy of the
secondary
immunodeficiency
following accidents and disasters . . . . . . .
.

53

SedooA. ., Mikhaylov 0. R.,


Tsutskiridze N. I., lashvily B. P.
The use antimicrobial materials
for the prevention of interhospital infection a m o n g j h e patients
with burns . . . . . .
Artyomov V. N. Trauma of
the Mi-8 helicopter air crews in
air accidents
. . . . .
Yutnatov E. A.
Emotional
stress is a medico-social problem
,
. . . . . . .
CHERNOBYL. CENTURY DISASTER
. . . . . . . .
Davydov B. /.,
Ponomarenko V. A., Ushakov h B. Radiation safety of the helicopter air
crew liquidators of the Chernobyl NPP-accident
. . .

62
67

71
75

75

Klochkov V. N..
Goldsltiein
D. S., Vaskin A. G. Problems of safety clothes decontamination at the Chernobyl NPP
accident after-effects elimination . . .
. . . .
. 8 2
\ OF DISCUSSION
.
88
Musiychuk Yu. I. Some principles of medical aid organization at, chemical accidents- . .

.
88

- . .

601 S1 (. 1) .
. .
96
. .

Keyrim-Markus I. . New recommendations


on radiation :
\
safety in Publications 60 and
61 of ICRS {part 1) . . .
96
LOOKING TO THE PAST . ... 10

: JL . . . . .

V. . Two catastrophes .
. . . ". . . .

110

CONFERENCES, SyMPOSIA,
MEETINGS, EXHIBITIONS
.

114

,
, ,

110

114

0. JI. -
.
. . ,

,

'. . . . . . .

115

[ . 7[
. .

. . . .

115

Serov V. M/- Probable sour-;


ces of extreme
situations,
threatening
the
health
of:
the Moscow region population,
and prognosis of medical consequences of possible accidents 116

. 1. 0
- .
. . . . .
. . .

Gavrilenko .0.. L, Organizetion of sanitary-hygienic and


anticpu'ctr.ica! measures - when
c!i)!iwiiug accident auer-effects
. . . . . . . .

116
Chuvakoaa I. M. On preparation of Kaliningrad zone center
for emergency medical care for the elimination of medical consequences of extreme situations - 119
119

123

. .
. . .

125

1 Yakimenko V. Ya. | Ryabochkin V. M. Communications and


control system when eliminating medical consequences of
accidents in Kaliningrad zone-

:
123.'

Zaytsev V. I. The problems of


zone center emergency medical
service provision with medical
equipment and. instruments . .

125

128

ABSTRACTS

128

134

ADWISE TO READ

. .
.

136

. . .

OFICIAL DOCUMENTS

. .

134
136

Regulation ensuring trans. portation of technical


and
.. 3' '

- ,
136
,
,
,
.
11, 14, 16, 27, 33,
36, 41, 59, 79, 84

human resource necessary (or


realization of emergency situations after-effects elimination
on the territories of Russian
Federation
136
PROBLEMS,
CONSIDARATIC~S, FAKTS, COMMENTS
.
11, 14, 16, 27, 33,
36, 41, 59, 79. 84

. .
.

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. H.
. . .

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:
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. 190-59-60

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, 1992

2/1992


DISASTER MEDICINE
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CONCEPT OF THE STATE PUBLIC


HEALTH SYSTEM OF THE RUSSIAN
FEDERATION AIMED AT THE
PREVENTION OF EXTREME
SITUATIONS AND RENDERING
EMERGENCY MEDICAL CARE
(EMERGENCY MEDICAL SERVICE
IN EXTREME SITUATIONS)
I. D, Kamushenko, G. V. Kipor,
A. N. Nemtsev

origin are considered. A special attention is given to the structure of


the measures aimed at the prevention
of manmade accidents and the pattern of emergency preparedness. An
attempt is made to formulate the main
principles which may be assumed as
a basis of the concept of the state
public health -system: aimed at the
prevention of. extreme.; situations and
rendering emergency medical tare.

The organizational principles of


emergency medical service in extreme.
situations of natural and m a n - m a d e

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(INES): 2628 1990 . :
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5.
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DOSIMETRY MEASUREMENTS
NECESSARY FOR THE RENDERING
SPECIALIZED EMERGENCY
MEDICO-SANITARY CARE TO THE
VICTIMS OF EXTREME RADIATION
SITUATIONS
V. N. Yatsenko
The results of radiation accident
analysis, classification of radiation
accidents, their types, as well as the
whole complex of problems concerning the unfavourable radiation situations are given.
The estimate is carried out on the
amount of necessary dosimetry measurements and an approach is given on
the analysis of radiation situation
for the rendering of medico-sanitary
care to the victims of different radiation accidents in nuclear and other
branches of national economy.

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: (23182 , . , 5
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19911992 ..

ANALYSIS OF RADIATION
AFTER-EFFECTS OF DESIGN
ACCIDENTS AND ACCIDENTS
BEYOND THE DESIGN BASIS AT
THE MR AND IR-8 REACTORS
E. P. Ryazantsev, V. I. Pavlcnko,
P. M. Egorenkov
Possible accidents at the MR and
IR-8 reactors oF the Russian scientific center Kurchatov Institute" arc
considered, and results of the radia-

.

,
. , , , .

5,
10% ,
, 3,1392

tion accident after-effects are given,


given.
The analysis of the given accidents at the IR-8 reactor shows
that such accidents (besides the cases
of the cladding damage and coolant
flow blocking through fuel assembly)
don't lead to the radionuclide release
in the environment. It is stated that
the predicted radiation doses in ease
of maximum design accident at the
IR-8 reactor don't represent any
real danger for the population.
The results of the accident analysis
at the MR reactor manifest that
27

besides such cases as test fuel rod


Failure, rupture oi loop channel In the
active zone and pipeline rupture of
the first circuit of the reactor cooling
system all the other accidents don't
lead to the fuel rod damage and radionuclide release in the environment.
The radiation after-effects in case of
maximum design accident at the MRreactor don't represent any danger
for the population.

The results of the calculation oi


the radiation aftcr-cfi'ects at the
AIR- reactor accident beyond basis
are represented.
The conclusion is made that the
predicted radiation situation at the
IR-8 and MR reactors in case
of design accidents and accidents
beyond, the design basis doesnt demand implementation of measures
limiting normal human activity.

41

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DISASTER MEDICINE
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2. . .,
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/ / - : . " . . . ., ., 1989, . 3546.
3. Technical guidance for hazazds
analysis. Emergency planning for
extremely hazardous substances.
U. S. Environmentatal
Protection
Agency. U. S. Department of Transportation. Des. 1987,150 P.
4.
.

(
) / /

. .:
, 1991, . 5 . - 9 6 .
5. . ., . .
. //.
. . - . . . ,1990,. 35, 1, . 125
128.

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. ..
. . . / / . - 4. . 440
447.

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510.
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45'i.

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, / / . . 447452.
11. . N.. . .,
10. . .
^ // : . . .. 1990. . 69;
12. . .,
. . / / .
. 112.
13. . .. . 10.
/ / . . .
- . . . . 1991.
. 33. 1, . 9495.
14. . ., . .
-

/ / :
. . -,
1990, . 104.
16. . .. . ..
li. IL, . .
/ / : - . nav4. . ., 1991.
. 51.
GENERAL PRINCIPLES OF
.MEDICO-SANITARY HELP SYSTEM
ORGANIZATION AT ACCIDENTS
IN CHEMICAL INDUSTRY :
B. N. Phylatou, G. P. Prostakishin,
P. E. Shkodych
The data on the accidents in chemical industry in this country and
abroad are given. The status of medical help at such accidents is given.
is emphasised thai for anefficient
elimination of chemical accident aftereffects it is necessary to organize a
qualitative system of medico-sanitary
prediction, prevention and quick response. The methodological and organization aspects of this problem are
discussed.

, , , .-..

. ,
I 1992 ... , , 1/6. 3 1982
-

(). or 200 400 .

, 7700 .


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33


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V, B. Pankova, . B. Popova
Deontological and clinical aspects
of mass chemical accidents and catastrophes
in industry, connected
with disorders in human health arc
given. When analysing sanitary-hygienic situation in industry the incompetence of medical personnel in estimating the influence of different
chemical substanccs on a human
being is emphasized. The difficulties
connected with the systematical aspects of the diagnosis are enumerated. The social aspects of the aftereffects of the inadequate solution of
the diagnostic and expert problems
in chemical accidents in industry are
considered.

2425 1993


,

100 ,
.
:
.
.

OCCUPATIONAL PATHOLOGY
AND DEONTOLOGY ASPECTS
OF CHEMICAL ACCIDENTS
IN INDUSTRY

. 400600 .


:
125167 , .,
4

. . (. 212-44-43)


DISASTER MEDHHNE
2 1992



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169

ON SOME PECULIARITIES OF
THE DAMAGES AMONG MINE
RESCUERES DUE TO SULPHUR
DIOXIDE AT DEALING WITH
COAL MINES ACCIDENTS
A. F. Isakin, V. N.

Zabolotny

The peculiarities of the damages in


mine rescuercs groups due to sulphur
dioxide and hydrogen sulphide resulted from the isolation of respiratory
organs following the usage of protective oxygen respiratory devices are
described. The skin damages of different intensity in the form of dermatitis and eczematous effects, especially at the sites covered with moist
clothes, as well as general intoxication
effects due to the skin absorption of
toxic substances are observed. The
toxic effect mechanisms and damages
protective measures are represented.


DISASTER MEDICINE
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1. Deaton J. . The Psychology of


Survival Approach. 1981,Vol. 27.
N 5. P. 38.
2. Alexander S. E.,
Fraser J. G.
RCAF Arctic Survival T r a i n i n g / / E s cape and Survival.Pergamon Press,
1961. P. 3940.
3. Tyhurst J. S. Individual Reactions
to Community Disaster. The Natural
Hystory of Psychiatric Phenomena / /
Am. J. Psychiatry. 1957. N 107.
P. 764769.

52,

4. McLaughlin
D. R. Survival:
Thinking Cool Aerospace Safety.
1931. Vol. 36. N 2. P. 1619.
5. Nicholson J. E. Survival Stresses
Flying". 1968. Vol. 83. N 2.
P. 4647.
6. . . : , // . .:
, 1987. . 1421.
7. Torrance

P.

Psychological

Aspects of Survival I1GORL Report,


1953. N

35.

8. . . .
.: . . -, 1978.
271 .
9. . .
. .: , 1976, 332 .
10. Gakill G. F. Starvation in Man
/ / N e w . Engl. J. Med., 1970.
Vol. 282. N 12. P. 668675.
11. 10. .
/ / . .: ,
1969, . 1948.
12. Young V. R., Scrimshaw N. The
Physiology of Starvalion//Scientific
American, 1971. Vol. 225. N 4.
P. 1421.
13. . .

/ / , 1983. 6.
. 4960.
14. Davenport R. Spaide J. .,
Hodges . . An Evaluation of Various Survival
Ration//Amer.
J.
Chin. Nutr., 1971. Vol. 24. N 5.
P. 513523.
15. Volovich V. Survival medicine:
tasks and perspectives //Journal of
Wilderness Medicine. 1992,Vol. 3.
P. 256259.

_ _ _


DISASTER MEDICINE
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10 , , 18 .
1 710 . , , .

,
.


.

1. . ., . .,
. ., . . -
/ / ' - :
. .,
1990. . 1928.
2. . . . .: .
. -, 1976.
60

3. Luster . I., Blank 1. A.. Dean J. . Molecular and cellular basis


of chemically induccd immunotoxicilv! I Ann. Rev. Pharmacol. Toxicol.
'19S7. Vol. 27. P . 2349.
4. , ., . .,
. ., . .

/ / . . . . 1983. . 95.
95, . 3435.
5. . ., . ..
. . . THMvea. : >'- 1989. 150 ."
6. . . :
, , 11 .
. . 1988.. 23.
. 6890.
7. . ., . .,
. . . . .: ,
1992.
47 .
8. . ., . X.
11
, .
1983, . 9, . 3(6). . 339.
9. . ., . .,
. X. , ,
. .:
. .
-, 1990, 238 .
10. . ., . .

/ / . .: ,
1989. . 141143.
11. . ., . .
1''-
/ / .-. . 1990. 7.
. 2124.
12. Anderson R. ., Warner N. L.,
Ionizihg radiation and the immune
respoonce / / Adv. Immunol. 1976.
Vol. 24. P. 215335.
13. Sado T. Late effccts of radiation
on immunosystem: A rewiev / / Radiat.
Res. Proc. 6th Lntern. Congr. Radiat.
Res. Tokio, 1979, P. 688697.

BIOREGULATING THERAPY OF
THE SECONDARY
IMMUNODEFICIENCY FOLLOWING
ACCIDENTS AND DISASTERS
V. S. Novikov, V. S. Smirnov
The extreme status due to the health
effects associated with adverse factors of industrial and environmental
disasters yields the development of
secondary immunodeficiency with different subsequent complications. The




.
'
5 ;
,
, , .
,
.

.
.

. , , , .
.

peptide bioregulators intake by persons "with severe mechanical traumata,


prolonged
compression
syndrome,
burns and acute radiation disease is
accompanied by the restoration of
suppressed i;:::nunc system rates and
considerable
improvement of the
victims general status. Regulatory
thymus peptides of high effectiveness
ior the treatment of post-traumatic
complications can be used as therapeutic bioregulators at industrial disasters, radiation accidents and natural calamities.


30 2 4 ,

.
. : 0,305 30 . : 1 ( 11,5 ); 2 ( 2
3 ); 4 ( 6 ).


50 0,002 .


.
.
.
:
123424 . , ,
. 4. (.
)
.: (095) 491-08-91

61


DISASTER MEDICINE
2 - 1992

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S. aureus (82,3%),
S. epiaermidis (56,2%), . svibtilis
(47,8%), P. aeruginosa (17,3%)
E. coii (13,0%).
- : S. aureus42,71,
Proteus 17,56, P. aerugenosa5,09,
S. epidermidis 3,09, E. coli 1,39%.
.
129 , 3 : I
30 % ; II 3060 % 10%
; III ,
20%
.

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58,78,7*

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138,38,1

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37,34,5*

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* (<0,05).

64

POOR QUALITY
ORIGINAL

(t ). II III

:
7885.
5857
44
46%.

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.


. 2.
. 2, , , 5

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( 10 )

. .

.

5 . .V?

1. . ., .
. . . / /
. ., 1987.
192 .
2. . .. . .

//. . 1988.
-Vs 8. . 3 1 - 3 4 .
3. . . . / / . . 1984. .V 10.
. 1720.
4. . ., . .,
ffoputu .. . .
-
// .
1985. 5. . 8284.
65

THE USE OF ANTIMICROBIAL


MATERIALS FOR THE
PREVENTION OF INTERHOSP1TAL
INFECTION AMONG THE
PATIENTS WITH BURNS
. V. Sedov, O. P. Mikhaylov,
N. I. Tsutskiridze, B. P. lashvily
As a result of clinical investigations
the use antimicrobial underwear
for the prevention of interhospital


:

()

,
, , ,
.
: ,
;
;
; ;
.
1,52
.

66

infection among the patients with


burns was scientifically grounded.
The underwear made of fabrics containing furagin and metacide facilitates the decrease of purulentseptic
complications, reduction of a number
of autodermotransplant lysis cases
and time shortening of the patient's
slaying in a burning center. The underwear made of the fabric containing
furagin and metacide is recommended
for the prevention of interhospital
infection among the patients with
burns.

, -
, ,
.
34- .
:
;
,
13 .



( 6 20 1991 .).
:
129301 , . ,
. .
. 324-12-46


DISASTER MEDICINE
2 - 1992
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.


.
.
,
,
,

.
TRAUMA OF THE MJ-8
HELICOPTER AIR CREWS
IN AIR ACCIDENTS
V. N. Ariyomov
The analysis of localization and
character of traumatic injures of the
MI-8 helicopter air crews in air accidents is carried out. The most frequent injures sections of the body
of the crow members are apper ana
low extremities and inguinal region
(up to 80% of injures). Head trauma,
especially among pilots (more than
30%) is often observed. In these conditions traumas impeding the fast
evacuation from the helicopter cockpit
may promote a lethal outcamc. On
the" basis of the conducted analysis
the recommendations on the personal
protection of the crewpilots, flight
engineer and navigatorare grounded. Besides, the recommendations on
the improvement of crgonomic characteristics of the working places of
the crew (deck chairs, control handles etc.) are given.


DISASTER MEDICINE
2 - 1992

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7. . .
1991 . .
/ /
. . -
- . . 1982. 2.
, . 6369.

-8. Levi L. Society stress and disea . se. N. Y. Toronto: Oxford Univ.

Press, 1981, Vol. 4. 300 p.
, , 9. . . , , . .: , 1950. 496 .
- .
- EMOTIONAL STRESS IS
, MEDICO-SOCIAL
PROBLEM

-
, -
E. A. Yumatov
,
The paper is devoted to the role
.
of emotions, and in particular, to the
role of emotional stress in the life
- of modern society. It is stated that

increasing rate of life, sophisticated


, - social relations, destruction "of the
. - environment, appearance of a great
. .
number of chemical and physical factors producing unfavourable effects
on a human body, the necessary quick
adaptation to these factors in supre.

mely short terms all these phenomena play the role of risk factors in
. . - the development of human emotional
. .: stresses. It is noted that the problem
of emotional stress has outgrown
, 1981. 229 .
2. . .
from a medical to a social one. A
- - short review is given of the tasks of
//. . 1975. the International Regional Center on
stress prevention which was estab 8. . 38.
lished in 1991.
3. . .
//. . .
. 1980. . 30. 4.
. 860-^864.
4. . ., . .
. .:
, 1983. 301 .
5. . . . .: , 1987. - 253 .
6. . . .
.: , 1968. 547 .
74


DISASTER MEDICINE
2 1992
.



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,

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10 57,7 %.



10 39,7 % (
78 ).

4
27 1 1986 .
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B. //. . , . . . . . , . . , . .
.

1. Langham W. ., Brooks F.
Grahn D. Radiation biology and space
environmental parameters in mannen
spacecrafts dosing and operations J J
Aerospace Med. 1965. Ne 2.
P. 1441.
2. . ., . .,
. . -'
/ / . 1968. . 6.
. 3. . 450470.
3. . ..
.
.: , 1975. 253 .
4. . ., . .

. .: , 1983. 152 .
5. . .,
. .
/1. . .

19861987 . / /
. . 1991. * 2.. 33
11.
6.
//. .
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110 .

7. . ., . .,
. .
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. 9 . - 2 5 9 .
8. . ., . .

..: , 1975. 224 .
9. . .,
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: , 19S9. 264 .
10. . . : . :
11- , 1S90.
161 .
11. . . . .: , 1991.-
160 .
12. . ., . ..
. . . .: . 1976.
256 .
13. . .,
.., . ., . .

. .:
,
1989. 88 .
. 14. . . -137, , . .: , 1985.120 .
15. JI. ., . .,
. !, .

1957 . / / . .1990, 12. . 1115.
13. . ., . .,
. . : ,
( ).//. .
1990, 12, . 311.

RADIATION SAFETY OF THE


HELICOPTER AIR CREW
LIQUIDATORS OF THE
CHERNOBYL NPP ACCIDENT
. I. Davydov. V. A. Ponomarenko,
I. B. Ushakov
Three aspects of the radiation safety of the helicopter air crew who took
part in the elimination of the Chernobyl
NPP
accident aftcr-effects
during the period from the 27-th of
April to July 193> were considered:
dosimetry, physical protection and
radioprotector use. 1125 subjects from
the flight and engineer personnel were
irradiated: 6% 2,5 mSv and more,
32% 2,12,5 mSv
and
about
60% up to 2,0 mSv. It is stated
that the use of physical protection
(local screening of a pilot seat and
use oi special antiradiation belts)
makes irradiation dose 23 times
less. In the intense conditions of flight
activity the pilots preferred the radioprotector indralin to cystamin. Alimentary aids in the earlier and later periods after' the accident influenced
favourably somatic and psychic states.

81


DISASTER MEDICINE
2 - 1992
.




. . ,

. . , . .




. , 1986 .


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3. , ,
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. 97126.
4. . .,
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. .: , 1981.
248 .
5.
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. 343390.

PROBLEMS OF SAFETY CLOTHES


DECONTAMINATI ON AT THE
CHERNOBYL N P P ACCIDENT
AFTER-EFFECTS ELIMINATION
N. Klochkov. D. 5. Goldshteln.
A. G. Vaskin
The problems are analysed arising
at the organization of decontamination of safety clothes and personal
protective equipment of the personnel
working in Ihe conditions of the high
level radioactivity in the Chernobyl
N P P zone.
It is shown that for further increase of decontamination efficiency it is
necessary to apply in the specialized
laundries modern automatic technological equipment capable of realising
the most effective technologic conditions and first of all, of washing/wringing machines. The test results are
given
of
the washing
machine

PAC-91 (made in. Czesho-Slovakia),


conducted in Smolensk N P P specialized laundry. The results manifested
the incontestable advantages of the
PAC-91 in comparison with washing
machines used in the specialized
laundries.
On the whole, in the course of
accident
alter-effects
elimination
the elaborated system of the equipment decontamination stimulated the
ensuring of ihe timely cleaning up
to the established level of the great
amount of the safety clothes and other
protectiive equipment.
Taking into account the experience
in the safety clothes decontamination
in the course of accident after-effects elimination a new version of
The hygienic rules for industrial and
municipal specialized laundries on the
decontamination of the safety Clothes
and other personal protective equipment" was worked out.

!
1993 . - .

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3. 1CRP Publication 61. Annual
limits on intake of radionuclides by
workers based on the lf!00 Recommendations// Ann. ICRP. 1991.
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1981.Vol. 40. N 6. P . 488-494.
11. Raabe O. G. Comparison of the
carcinogenecity of radium and boneseeking actinides / / Ibid. 1984.
Vol. 46. N 6. P. 12411258.

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/1.,
Tanooka H.
One hundred percent tumor induction
in mouse skin after repealed p-irrad:ation in a limited dose r a n g e / / R a d i a t .
Res. 1988. Vol. 5. N 3.
P. 488494.
13. Ootsuyama A.,
Tanooka 11.
Threshold-like dose of local P-irrndialion repeated throyghout the lifespan of mice fcr induction of skin
and hone ioumors / / Ibid. 1991.
Vol. 125. N 1. P. 98101.
14. . .
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Mahaffey F. A. Lung tumor response
to inhaled Pu and its implication
For radiation protection//Heal Hi Phvs.
1988. Vol. 65. N 2. '
P. 455462.
16. . . . : , 1974:
17. A summary third stage investigations on cancer mortality in
high background radiation a r e a ' / H e
W e i h u i o t a 1//Chin. J. Radiol.
Med. Protect. 1985. Vol. 5.
N 2. P. 109-113.
18. NCRP USA. Report N 61. Influence of dose and distribution in
time on dose response relationship's
for low LET radiations. Bcthesda.:
Md. NCRP, 1980.
19. . '
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20. - . . . .: , 1980.-191 .
21. .
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exposure to low level of ionizing "radiation. BEIR V Report: Wash."
Ntl Acad..Press, 1990.


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