Ionizing radiation is more dangerous than nonionizing radiation because such reactions lead to breaks in both DNA and RNA.
There are two categories of radiation injuries with which the emergency physician should be familiar:
Exposure injury, which generally represents no threat to emergency care providers.
Contamination, which may represent a risk to emergency personnel.
Acute radiation syndrome may develop following a whole-body exposure of 100 rad or more that occurs over a relatively short period of time.
Total-body irradiation with >1000 rad results in a neurovascular syndrome.
In the presence of contamination, if the patient’s condition permits, decontamination should begin in the prehospital setting.
Radiation accidents involving discarded medical and industrial sources get little attention compared to problems at nuclear power plants or weapon facilities. Unfortunately, these accidents occur around the world with surprising regularity, and in some instances prove deadly.
According to the Radiation Emergency Assistance Center/Training Site (REAC/TS) Radiation Accident Registry, between 1944 and March 2017, there have been 462 accidents worldwide. These accidents resulted in significant radiation exposure to 2985 individuals and in 129 deaths (Table 143-1).
TABLE 143-1Major Radiation Accidents Worldwide: Human Experience—1944 through March 2017 ||Download (.pdf) TABLE 143-1 Major Radiation Accidents Worldwide: Human Experience—1944 through March 2017
|Location ||Number of Accidents ||Number of Persons Involved ||Significant Exposuresa ||Fatalities |
|United States ||271 ||1,405 ||802 ||26 |
|Non-United States ||191 ||132,467 ||2,183 ||103 |
|Total ||462 ||133,872 ||2,985 ||129 |
Despite the relatively rare incidence of medically significant pediatric radiation accidents, our dependence on nuclear energy makes it necessary for today’s emergency physician to understand its potential for disaster. Most obvious are the threats of sophisticated nuclear weaponry to individuals of all ages. However, the near disaster of Three Mile Island in Pennsylvania in 1979, the Chernobyl Nuclear Power Station catastrophe in the former Soviet Union in 1986, and the Fukushima Dai-ichi Nuclear Disaster as a result of the March 2011 tsunami in Japan serve as potent reminders of the severe underlying hazards to children and adults, even in peaceful nuclear energy utilization. A more probable predicament, however, is an isolated or limited exposure in a medical, industrial, or research accident, or during the transport of radionucleotides. Basic preparation for radiation emergencies is not difficult, but a thorough understanding of the pathophysiology and clinical presentation is necessary in order to successfully handle all aspects of these complex problems and minimize the risk to providers.
All individuals are susceptible to radiation injury if the exposure is of significant dose and duration. Children, however, may suffer greater short-, and long-term consequences of a significant radiation exposure for several reasons. Children are more susceptible to relatively greater internal exposure to inhaled radioactive gases given their ...