Specific Measures

The ED receiving patients from the exposure zone should be divided into areas to deal with those who are radiation-contaminated and those who are not.

Safe transfer of patients between areas can be achieved by wrapping each patient in a sheet, which limits cross-contamination. When patients arrive, they can be further segregated into those who are externally contaminated only, internally contaminated only, and those with combination injuries and trauma associated with detonation devices such as blast, flash and thermal injuries.

Learning bite

The department should be separated into ‘dirty’ and ‘clean’ areas.

External radiation injuries

Wounds should be rinsed with saline and left open until debrided and decontaminated. Surgical excision of some long half-life materials may be required. After this, wounds should be closed or covered to prevent entry of infection. In addition, the clinical approach is to provide adequate analgesia and antibiotic prophylaxis as well as considering vasodilator therapy and referring the patient for plastic surgery for definitive grafting/amputation as appropriate.

Internal contamination

The aim of internal contamination is to reduce the overall radiation dose by strategies for reduction of absorption, dilution, blocking, displacement by non-radioactive nucleotides, increased elimination from tissues, chelation and decorporation. The particular strategy will depend on the radioactive substance to which the patient has been exposed. For example: decorporation, which is the removal of internal contamination by exploiting the chemical and biological properties of the radioisotope; Prussian blue is used for caesium exposure or bicarbonate for uranium exposure.

Acute radiation sickness

Management of acute radiation sickness is mainly supportive and includes:

• IV fluids
• Antiemetics
• Analgesia
• Nutritional support
• Antibiotics
• Antifungals
• Antivirals
• Blood component substitution
• Reduction of brain oedema (mannitol and ventilation strategies)

The doctors best qualified to look after these patients are usually haematologists as the condition is very similar to aplastic anaemia and haematologists are familiar with the preparation processes for bone marrow transplants.

Long-term management

Potassium iodide or iodate is given to prevent radioiodine in thyroid accumulation.

Options for definitive therapies include stimulation therapies such as:

• Granulocyte-stimulating factor (GSF)
• Granulocyte-macrophage colony-stimulating factor (GM-CSF)
• Bone marrow transplant
• Stem cell therapy
• Definitive surgery
• Cancer surveillance
• Infertility and potential teratogenesis management
• Addressing the psychosocial impact of exposure