Medical Management of Radiological Casualties. Online Third Edition

This handbook addresses medical management of casualties in the first 72 hours of a radiation event. The most important consideration in the medical evaluation of a radiation event is the relative magnitude of the situation and the resources needed to address the emergency. In many cases, order of magnitude estimates of the scale of the event will be sufficient for emergency response. Small-scale events are those occurring in laboratories, hospitals, nuclear power plants, etc., involving small amounts of radionuclides with the potential exposure andor contamination of one or a few individuals. Large-scale events are those involving relatively large quantities of radionuclides and the potential exposure or contamination of large numbers of people, e.g., terrorist attacks with radiological weapons, nuclear weapons detonation, and large-scale nuclear power plant disasters. High-level external ionizing radiation poses the greatest danger to living organisms. Low levels of internal or external contamination generally pose very low risk. A site known to be radiologically contaminated should be surveyed before entering and responders should be advised to limit their time in high dose-rate areas. There is generally no hazard associated with handling a radiologically contaminated casualty. See the topic Decontamination Techniques. U.S. military planning. The U.S. military has established a system for mission-specific risk-based dose limits that includes life-saving activities. In current doctrine, U.S. military personnel become restricted from engaging in operational radiologicalnuclear missions once they have exceeded a 125-cGy dose accumulation. Military commanders set their Operational Exposure Guidance OEG i.e., dose limits to U.S. troops in nuclear war. For operations other than war, military commanders generally limit OEG levels to 75-cGy. For guidance see JP 3-11, Operations in Chemical, Biological, Radiological, and Nuclear CBRN Environments, 26 August 200