(Reprinted from Department of Homeland Security Working Group on Radiological Dispersal Device (RDD) Preparedness: Medical Preparedness and Response Sub-Group (5/1/03 Version))
- All patients should be medically stabilized from their traumatic injuries before radiation injuries are considered. Patients are then evaluated for either external radiation exposure or radioactive contamination.
- An external radiation source with enough intensity and energy can cause tissue damage (eg, skin burns or marrow depression). This exposure from a source outside the person does notmake the person radioactive. Even such lethally exposed patients are no hazard to medical staff.
- Nausea, vomiting, diarrhea, and skin erythema within four hours may indicate very high (but treatable) external radiation exposures. Such patients will show obvious lymphopenia within 8-24 hours. Evaluate with serial CBCs. Primary systems involved will be skin, intestinal tract, and bone marrow. Treatment is supportive with fluids, antibiotics, and transfusions stimulating factors. If there are early CNS findings of unexplained hypotension, survival is unlikely.
- Radioactive material may have been deposited on or in the person (contamination). More than 90% of surface radioactive contamination is removed by removal of the clothing. Most remaining contamination will be on exposed skin and is effectively removed with soap, warm water, and a washcloth. Do not damage skin by scrubbing.
- Protect yourself from radioactive contamination by observing standard universal precautions, including protective clothing, gloves, and a mask.
- Radioactive contamination in wound or burns should be handled as if it were simple dirt. If an unknown metallic object is encountered, it should only be handled with instruments such as forceps and should be placed in a protected or shielded area.
- In a terrorist incident, there may be continuing exposure of the public that is essential to evaluate. Evacuation may be necessary. Administration of potassium iodine (KI) is only indicated when there has been a release of radioiodine.
- When there is any type of radiation incident many persons will want to know whether they have been exposed or are contaminated. Provisions need to be made to potentially deal with thousands of such persons.
- The principle of time/distance/shielding is key. Even in treatment of Chernobyl workers, doses to the medical staff were about 10 mgray or 10 msievert [20% annual occupational limit]. Doses to first responders at the scene, however, can be much higher and appropriate dose rate meters must be available for evaluation. Radiation dose is reduced by reducing time spent in the radiation area (moderately effective), increasing distance from a radiation source (very effective), or using metal or concrete shielding (less practical).
