Since 1978, the US Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has required that all hospitals have an active plan to manage radiation accidents. Casualties from radiation accidents are rare events in comparison with other types of hazardous material accidents. 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 importance is the potential of large numbers of casualties from a terrorist attack employing nuclear weapons. An understanding of basic radiation physics and pathogenesis of injury will aid the emergency physician in the triage and initial management of radiation injuries.
The emergency physician must also be prepared for the potential situation in which an individual has gained possession of a radiation source without being aware of its hazard and the individual develops injury. A significant case of this occurred in 1987 in Guiana, Brazil, when a teletherapy source of Cs-137 was released into the public domain. Two weeks elapsed before the radiation accident was fully discovered. Patients with gastrointestinal symptoms were initially misdiagnosed as having a food allergy. One patient with severe radiation skin injury was referred to a specialty center for suspected tropical disease infection. This incident resulted in over 200 contaminations, 20 significant exposures, and 4 deaths. The ability to recognize signs and symptoms of radiation injury will enable the physician to deliver more prompt and effective treatment to these types of patients.
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