Radiation accidents. Examination and treatment of persons exposed to radiation. Helsinki 2008. 47pp. (Publications of the Ministry of Social Affairs and Health, Finland, ISSN 1236-2050, 2008:14) ISBN 978-952-00-2630-1 (pb), ISBN 978-952-00-2605-9 (PDF)

Radiation accidents are very rare, and in Finland there is no experience of treating patients that have been accidentally exposed to ionizing radiation. Still the health care system should be prepared for situations where people have been or may have been exposed to radiation.

An accident can occur in connection with medical or industrial use of radiation, or during transport of radioactive material. An orphan source, which has escaped from control, poses a danger to the public. Even deliberate, malevolent spreading of radioactivity is a possible threat. In case of an accident in a nuclear reactor there may arise radiation injuries inside the building or, in the worst of cases, even outside it. The ultimate scenario is detonation of a nuclear weapon.

Whole-body exposure to strong gamma-radiation may lead to an acute radiation syndrome. If there are many severely exposed persons, it is important to choose the right level of care for everyone. The decision can be taken within two days, based on the clinical picture and estimated dose.

Keeping a strong, sealed source with a bare hand or in a pocket, without knowledge of its character, may cause serious local injury, which may recur in waves during months or even years. For a medical doctor, if the patient is not aware of any exposure, it is a challenge to recognize a radiation injury. Treatment of a serious local radiation injury is extremely difficult.

A radiation accident can cause external exposure, radioactive contamination of clothes and skin, internal contamination, and also conventional trauma. The first priority in an accident is to stop any further exposure. Medical first aid will not have any influence on the further course of a radiation injury. If there are mechanical injuries, they should be treated in the first place in accordance with their urgency, regardless of radiation exposure.

Spreading of radioactive contamination in hospital surroundings should be prevented by designing a separate area for the contaminated patients. Removing clothes and washing with soap and warm water will remove 95% of the external contamination. For treatment of internal contamination there are only limited possibilities.

After an accident with possible exposure of the public there will be an immense demand for information and advice. Medical personnel should notice that many patients might ascribe diverse symptoms to radiation exposure, even if they have not been exposed at all or have only been exposed to insignificant doses. In such situations there will be an urgent need for basic knowledge of potential radiation doses and corresponding symptoms.

Key words

accidents, exposure, health care, radiation, radioactive material