Radiation and Radiation Injury

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Is it safe to treat patients who have been exposed or contaminated during a radioactive disaster?

This is the first question because it is the most important. Like any other situation in the field, safe is a relative term. There are three primary sources of danger: the origin of the radiation, the hazards of the disaster environment, and the patient. By maintaining vigilance about the environment and wearing the proper personal protective equipment (PPE), it is safe to treat patients during a radiation event. Well, as safe as one can be in the field during any disaster.

Do not let the myths surrounding radiation prevent you from doing your job. We have seen this occur during mock disasters. In the words of the Greek poet Archilochus, “We don’t rise to the level of our expectations, we fall to the level of our training.”

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What is the difference between exposure and contamination?

There are three methods by which individuals will be affected by radiation:

• A.

  Irradiation (or exposure): radiation from the field passing through the body.

• B.

  External contamination: radioactive materials outside the body.

• C.

  Internal contamination: radioactive materials that have entered the body (usually from inhalation or ingestion).

While it is important to understand the difference, it is not a focus for providers in the field retrieving patients; it is more of an academic point. Every patient should be approached as if they are contaminated until proven otherwise.

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What is the concern about radiation?

The radiation to be concerned about in a radiological event is ionizing radiation. Every person has constant exposure to background radiation, but it is usually nonionizing. Ionizing radiation causes more damage as it has the power to penetrate tissues and remove electrons from atoms or molecules, generating free radicals that are highly reactive. Although the body has cellular repair mechanisms, these are generally operating at capacity just dealing with background radiation.

When human cells are exposed to ionizing radiation, three things can happen: they repair themselves, they die, or they mutate. Low levels of ionizing radiation do not have any immediate health effects but might cause a small increase in the possible risk of cancer. High doses can cause acute radiation syndrome (ARS), which can be fatal.

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