There are three categories of radiation illness: Acute radiation syndrome (ARS), cutaneous radiation syndrome, and cutaneous radiation injury. ARS occurs when the victim’s entire body has been exposed to high doses of high-energy radiation from an external source over a short period of time. The victim experiences bone marrow destruction and gastrointestinal and cardiovascular/neurological symptoms. There are four stages the victim experiences (i.e., prodromal, latent, manifest, and recovery or death), and nursing care is dependent on which stage the victim presents in (CDC, 2014). Cutaneous radiation syndrome is a new diagnosis recently separated from ARS. In this situation, the victim does not always show typical ARS symptoms or may only have skin damage when exposed to high-energy radiation (CDC, 2018d). Cutaneous radiation injury is caused by exposure to low-energy doses of beta or gamma radiation. Symptoms, which occur hours to days after exposure, generally include itchy skin that may tingle and erythema and edema to the area (CDC, 2018d).
Self-Assessment Quiz Question #5 Which of the following forms of radiation is the most dangerous? a. Alpha. b. Beta.
c. Neutron. d. Gamma. Treatment
Treatment depends on the type of exposure or contamination the victim experiences (i.e., internal vs. external), how long the exposure lasted, and the type of radiation (i.e., alpha, beta, or gamma radiation). The victim’s clothes are removed with external radiation and the victim is washed to remove contaminating material. Internal contamination, in the form of inhaled, ingested, or injected exposure, usually must be monitored and the radiological source allowed to decay without intervention. In all cases, basic nursing care includes maintaining a patent airway; watching physiologic signs and symptoms for adequate blood pressure; monitoring intake and output; maintaining fluid and electrolyte balances; and emotional support. Any burns that may have resulted from the radiation would be treated according
to the degree of the burn. Hematology lab values are also monitored closely (Adelman et al., 2014; CDC, 2018b). PERSONAL PROTECTIVE EQUIPMENT SPECIFIC TO RADIOLOGICAL EXPOSURE
mostly seen in the hospital or clinic setting, where it is used for diagnostic testing. In those locations, it is the healthcare organization’s responsibility to provide the appropriate PPE available to all who may be at risk of exposure to a radiological release. The healthcare organization supplies the healthcare professionals using the radiation with protective equipment made to order for the employee. Table 3 shows the types of PPE used for different types of radiological emergency exposures.
The importance of protecting first responders and healthcare personnel in a radiological disaster means having appropriate personal protective equipment (PPE) specially designed for the type of radiation released (USHHS,2021c). Until the type of radiation is determined, PPE should be immediately employed. When the exposure is from an RDD, it is usually alpha or beta radiation. These lower-energy radiation sources are easier to protect the individual from than gamma radiation that is
Table 3: Personal Protective Equipment Used in Radiological Disasters Emergency Type Response Role Recommended PPE*
Notes, Caveats, & Concerns
● Before incident hazard(s) characterized: Wear PPE that protects from anticipated hazard. ● May need to wear a higher level of PPE than accustomed to until hazard characterization is complete. ● After hazards are confirmed: ● Level C PPE usually provides a sufficient level of respiratory and skin protection. ● Level C PPE should be worn until risk characterization determines that Level D PPE provides sufficient protection. Wear PPE ensembles that protect against identified hazards.
● Higher level PPE is not usually available in hospitals.
Radiation plus chemical and/or biological hazard: "Combined hazard" event.
First responders delivering care to contaminated victims.
● Recommended respiratory PPE includes a full-face air-purifying respirator with a P-100 or high- efficiency particulate air (HEPA) filter. ● Other respiratory protective equipment (e.g., simple surgical facemask, N-95 respirators), non-fit tested respirators, or ad hoc respiratory protection do not offer sufficient respiratory protection. ● Lead aprons do not protect against high-energy, highly penetrating ionizing radiation exposure.
First responders delivering care to victims are likely to be externally contaminated: i.e., pre- decontamination and decontamination.
Radiation only with a high risk of contamination: e.g., Radiological Dispersal Device (RDD).
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