In the last 50 years, the public’s concern with radiation
injuries centered around nuclear power plant accidents and the threat
of nuclear warfare. However, with today’s widespread use
of radiation technology in medicine, research, industry, power production,
and national defense, there is a growing potential for radiation
injuries. Of further concern is the potential for large numbers
of casualties from a terrorist attack using a nuclear weapon or
radioactive material. The emergency physician must be prepared to
recognize and treat signs and symptoms of radiation injury.
Radiation events may be accidental or intentional. Accidents
may occur at any facility using a radioactive source or during transport
of radioactive materials. Accidents can occur in the medical setting,
involving erroneous dosing of radiotherapy. In 2006, polonium-210
was used in the intentional poisoning and assassination of Russian
dissident Alexander Litvinenko.
“Orphan” radioactive sources
are a growing concern and can result in accidental exposure to radiation.
Sealed medical and industrial sources, such as cobalt-60, cesium-137,
strontium-90, and iridium-192, can be abandoned, lost, or stolen,
thereby ending up in the wrong or unsuspecting hands. Four major
cases of this occurred in Thailand (2000), Egypt (2000), Estonia
(1994), and Brazil (1987), in which unsuspecting villagers gained
possession of lost or abandoned radioactive sources (scavenging
scrap metal in two of the incidents) and were exposed to radiation. The
average time from first exposure to diagnosis for these four events was
22 days.1 A radiation event could result from use
of a “dirty bomb.” A “dirty bomb” is
one in which radioactive materials are combined with conventional
explosives to disperse radioactive particles over a large area.
In addition to radiation injuries, the ensuing panic and psychological distress
could be devastating. An attack upon a nuclear installation (such as
a power plant or waste repository) or use of nuclear weapons can
cause large-scale radiation disasters.
The U.S. Department of Energy, the Radiation Emergency Assistance Center/Training
Site (REAC/TS) maintains an international registry of radiation
accidents. Since the inception of the registry in 1944, 432 radiation
accidents have been recorded worldwide (250 within the U.S.). Of the
133,811 victims, 3082 had significant exposure, and there were 127 fatalities
(26 in the U.S.). The 1986 Chernobyl accident accounted for 116,500
individuals and 28 acute fatalities. The most frequent radiation accident
is one of high-dose local exposure, usually to the hands, from a radiation
device. The majority of these accidents have occurred in the industrial
setting with inadvertent exposure from radiation devices used in radiography
to verify integrity of metals such as pipe welds.2,3
An understanding of basic radiation physics and pathogenesis
of injury is needed to properly recognize and triage radiation injuries.
and Ionizing Radiation
Radiation is energy emitted from a source. The electromagnetic
radiation spectrum includes long-wavelength, low-frequency, low-energy forms
of nonionizing radiation and progresses to short-wavelength, high-frequency,
and high-energy forms of ionizing radiation. ...