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Emergency Department Management of Radiation Casualties. CAUTION. This presentation, "Emergency Department Management of Radiation Casualties,” was prepared as a public service by the Health Physics Society for hospital staff training.
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Stopped by a sheet of paper
Stopped by a layer of clothing
or less than an inch of a substance
Stopped by inches to feet of concrete
or less than an inch of lead
Ionization in air
Absorbed energy per mass
weighted by type of radiation
For most types of radiation 1 R 1 rad 1 rem
Flight from Los Angeles to London 5 mrem
Annual public dose limit 100 mrem
Annual natural background 300 mrem
Fetal dose limit 500 mrem
Barium enema 870 mrem
Annual radiation worker dose limit 5,000 mrem
Heart catheterization (skin dose) 26,000 mrem
Life-saving actions guidance (NCRP-116) 50,000 mrem
Mild acute radiation syndrome 200,000 mrem
LD50/60 for humans (bone marrow dose) 350,000 mrem
Radiation therapy (localized & fractionated) 6,000,000 mrem
Time (in minutes, hours, days, or years) required for the activity of a radioactive material to decrease by one half due to radioactive decay
Time required for the body to eliminate half of the radioactive material (depends on the chemical form)
The net effect of the combination of the physical and biological half-lives in removing the radioactive material from the body
Cesium-137* 30 yrs 1.5 x 106 Ci Blood Irradiator
Cobalt-60 5 yrs 15,000 Ci Cancer Therapy
Plutonium-23924,000 yrs 600 Ci Nuclear Weapon
Iridium-192 74 days 100 Ci Industrial Radiography
Hydrogen-3 12 yrs 12 Ci Exit Signs
Strontium-90 29 yrs 0.1 Ci Eye Therapy Device
Iodine-131 8 days 0.015 Ci Nuclear Medicine Therapy
Technetium-99m 6 hrs 0.025 Ci Diagnostic Imaging
Americium-241 432 yrs 0.000005 Ci Smoke Detectors
Radon-222 4 days 1 pCi/l Environmental Level
*Potential use in radiological dispersion device
Number of Deaths
Most Deaths Due to
size of explosion and
proximity of persons)
(e.g., tens of thousands in an urban area even from 0.1 kT weapon)
(Depends on Distance)
To Limit Caregiver Dose to 5 rem
Distance Rate Stay time
1 ft 12.5 R/hr 24 min
2 ft 3.1 R/hr 1.6 hr
5 ft 0.5 R/hr 10 hr
8 ft 0.2 R/hr 25 hr
Treatment Area Layout
Triage based on:
Cesium-137 Prussian blue Oral
Iodine-125/131 Potassium iodide Oral
Strontium-90 Aluminum phosphate Oral
Americium-241/ Ca- and Zn-DTPA IV infusion,
Transport injured, contaminated patient into or from the ED:
Time of Onset
Severity of Effect
Acute Radiation Syndrome (Cont.)Hematopoietic Component - latent period from weeks to days
~3 MonthsSpecial Considerations
Prepared by the Medical Response Subcommittee of the National Health Physics Society Homeland Security Committee.
Jerrold T. Bushberg, PhD, ChairKenneth L. Miller, MS
Marcia Hartman, MS
Robert Derlet, MDVictoria Ritter, RN, MBA
Edwin M. Leidholdt, Jr., PhD
ConsultantsFred A. Mettler, Jr., MD
Niel Wald, MD
William E. Dickerson, MD
Appreciation to Linda Kroger, MS, who assisted in this effort.
Disclaimer: The information contained herein was current as of May 9, 2009, and is intended for educational purposes only. The authors and the Health Physics Society (HPS) do not assume any responsibility for the accuracy of the information presented herein. The authors and the HPS are not liable for any legal claims or damages that arise from acts or omissions that occur based on its use.
*The Health Physics Society is a non profit scientific professional organization whose mission is to promote the practice of radiation safety. Since its formation in 1956, the Society has grown to approximately 6,000 scientists, physicians, engineers, lawyers, and other professionals representing academia, industry, government, national laboratories, the department of defense, and other organizations. Society activities include encouraging research in radiation science, developing standards, and disseminating radiation safety information. Society members are involved in understanding, evaluating, and controlling the potential risks from radiation relative to the benefits. Official position statements are prepared and adopted in accordance with standard policies and procedures of the Society. The Society may be contacted at: 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101; phone: 703-790-1745; FAX: 703-790-2672; email: HPS@BurkInc.com.