Treatment should be planned to optimize the use of the limited health care resources during a nuclear disaster.
Patients exposed to radiation are categorized according to the degree of exposure and the severity of symptoms. Treatment should be carefully planned to optimize the use of limited medical resources as well as staff during a nuclear disaster. Health care workers should follow strict procedures to prevent contamination and should wear protective gear. They should be rotated as often as possible so that they are minimally exposed to radiation.
Patients exposed to radiation should preferably be decontaminated. The patients’ clothes should be changed. Open wounds should be covered before decontamination. Patients with injuries like burns and wounds may need emergency treatment. The skin and hair should be washed. Some blood tests like tests for blood counts, blood group, to assess the degree of exposureand check for chromosomal breakage may be carried out. Urine, stool samples and nasal swabs may be tested for internal contamination.
Patients exposed to radioactive iodine should take potassium iodide tablets to prevent the development of thyroid cancer in the future.
Low blood counts may be treated with cytokines that stimulate the production of white blood cells like granulocyte macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), and the pegylated form of G-CSF (pegylated G-CSF or pegfilgrastim). Antibiotics should be administered to patients with low WBC count to prevent infection. Other treatments like transfusion of specific blood cells like packed red blood cells and platelets, as well as stem cell transplantation may be tried out. Treatment with epoetin and darbepoetin along with iron supplementation may be tried out of cases of anemia (though they have not been proved useful in such cases).
Medications should be administered to treat symptoms like vomiting, diarrhea, pain, infections and burns.
Fluids and electrolytes and nutrition should be maintained.
Psychological support should also be offered to these patients.
Patients who develop multiorgan failure after several days may require critical care.
Comfort measures should be provided to patients exposed to very high doses of radiation in whom there may be no chance of survival. These patients should receive supportive care in the form of painkillers, drugs for nausea and vomiting as well as psychological support.
- Harrison’s Principles of Internal Medicine 17th edition
- Waselenko JK et al. Medical Management of the Acute Radiation Syndrome
- Recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004;140:1037-1051.