Notes – Radiation Exposure

Radiation Exposure

Patient Safety Considerations

Treat life-threatening medical problems and traumatic injuries prior to assessing for and treating radiation injuries or performing decontamination

Notes/Educational Pearls

Key Considerations

  1. Irradiated/Exposed patients pose no threat to medical providers
  2. Contaminated patients pose very little threat to medical providers who use appropriate PPE including N95 masks or respirators, gloves, gowns, and face and eye protection
  3. Sources of radiation
    1. Legal
      1. Industrial plants
      2. Healthcare facilities that provide radiologic services
      3. Nuclear power plants
      4. Mobile engineering sources (e.g. construction sites that are installing cement)
    2. Illegal
      1. Weapons of mass destruction
      2. “Dirty bomb” design to contaminate widespread areas
  4. Physiology of radiation poisoning
    1. Contamination – Poisoning from direct exposure to a radioactive source, contaminated debris, liquids, or clothing where radiation continues to be emitted from particles on surface
    2. Exposure – Poisoning from radioactivity, in the form of ionizing rays, penetrating through the bodily tissues of the patient
  5. Common types of radioactivity that cause poisoning
    1. Gamma rays
      1. Highest frequency of ionizing rays
      2. Penetrates the skin deeply
      3. Causes the most severe radiation toxicity
    2. Beta rays – can penetrate up to 1 cm of the skin’s thickness
    3. Alpha rays
      1. Lowest frequency of ionizing rays
      2. Short range of absorption
      3. Dangerous only if ingested or inhaled
    4. Radioactive daughters
      1. Products of decay of the original radioactive substance
      2. Can produce gamma and beta rays (e.g. uranium decays into a series of radon daughters)
  6. In general, trauma patients who have been exposed to or contaminated by radiation should be triaged and treated on the basis of the severity of their conventional injuries
  7. A patient who is contaminated with radioactive material (e.g. flecks of radioactive material embedded in their clothing and skin) generally poses a minimal exposure risk to medical personnel
  8. EMS providers may be asked to assist public health agencies in the distribution and administration of potassium iodide in a mass casualty incident involving radiation release or exposure

Pertinent Assessment Findings

  1. Treatment of life-threatening injuries or medical conditions takes priority over assessment for contamination or initiation of decontamination
  2. Time to nausea and vomiting is a reliable indicator of the received dose of ionizing radiation. The more rapid the onset of vomiting, the higher the whole-body dose of radiation
  3. Tissue burns are a late finding (weeks following exposure) of ionizing radiation injury. If burns are present acutely, they are from a thermal or chemical mechanism
  4. Seizures may suggest acute radiation syndrome if accompanied by early vomiting. If other clinical indicators do not suggest a whole-body dose of greater than 20Gy, consider other causes of seizure
  5. Delayed symptoms (days to weeks after exposure or contamination)
    1. Skin burns with direct contact with radioactive source
    2. Skin burns or erythema from ionizing rays
    3. Fever
    4. Bone marrow suppression presenting as:
      1. Immunosuppression
      2. Petechiae
    5. Spontaneous internal and external bleeding

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914049 – Exposure-Radiologic Agents

Key Documentation Elements

  • Duration of exposure to the radioactive source or environment
  • Distance (if able to be determined) from the radioactive source (if known)
  • Time of onset of vomiting

Performance Measures

  • Use of appropriate PPE
  • Use of dosimetry by EMS provider
  • Scene measurements of radioactivity

References

  1. Center for Disease Control and Prevention, Emergency Preparedness and Response, Specific Hazards: Radiation, 2013
  2. Cone DC, Koenig KL. Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med;12(6):287–302.
  3. Marx JA et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 2010 1937-1939
  4. The Medical Aspects of Radiation Incidents. https://orise.orau.gov/reacts/documents/medical-aspects-of-radiation-incidents.pdf. Revised January 2017. Accessed August 28, 2017.
  5. Radiation Emergency Assistance Center/Training Site (REAC/TS) Training Site. Orise.orau.gov. https://orise.orau.gov/reacts/. Accessed August 28, 2017.