Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-08T04:26:37.718Z Has data issue: false hasContentIssue false

30 - Nuclear and Radiological Events

from SECTION A - CBRNE AND HAZMAT

Published online by Cambridge University Press:  05 August 2011

Kristi L. Koenig
Affiliation:
University of California, Irvine
Carl H. Schultz
Affiliation:
University of California, Irvine
Get access

Summary

OVERVIEW

Large-scale Radiation Events: An Evolving Risk

Mass exposure to radiation does not occur frequently but when it does such events present significant logistical, operational, and medical challenges that may be compounded by the lack of familiarity most first responders and other medical personnel have with the manifestations and management of radiation injury. Because of the proliferation of nuclear states, the occurrence of at least one well-documented case of smuggling of nuclear technology, the widespread availability of radioactive materials, and continuing concerns about the risk of nuclear or radiological terrorism, the risk of deliberate mass exposures to radiation has likely increased in recent years. Additionally, there is an ever-present risk of mass radiation exposures, such as occurred after the Chernobyl accident and the 137Cs dispersion event in Goiânia, Brazil. The recent efforts of the United States and other nations to improve their capabilities to prevent or interdict nuclear smuggling, to enlarge the armamentarium of radiation countermeasures, and to disseminate information about the management of radiation casualties suggest the seriousness with which the threat of deliberate attack is regarded. Numerous authors have summarized the publicly available information related to this threat, and the interested reader is referred to these sources for more detailed accounts.

SCENARIOS OF CONCERN

Mass exposures to radiation may be accidental or deliberate in origin. Heretofore, all such incidents have been the result of accidents, with the notable exceptions of the exposures occurring as a result of the atomic bombings in Hiroshima and Nagasaki and the exposure of more than a hundred people to 210Po in the wake of the Litvinenko poisoning.

Type
Chapter
Information
Koenig and Schultz's Disaster Medicine
Comprehensive Principles and Practices
, pp. 477 - 510
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bennett, B, Repacholi, M, Carr, Z, eds. Health Effects of the Chernobyl Accident and Special Health Care Programmes: Report of the UN Chernobyl Forum Health Expert Group. Geneva: World Health Organization; 2006. Available at: http://www.who.int/ionizing_radiation/chernobyl/WHO%20Report%20on%20Chernobyl%20Health%20Effects%20July%2006.pdf. Accessed February 23, 2009.
Oliveira, AR, Hunt, JG, Valverde, NJ, Brandao-Mello, CE, Farina, R. Medical and related aspects of the Goiânia accident: an overview. Health Physics. 1991;60:17–24.Google Scholar
In the United States, such efforts include but are not limited to the establishment of the Domestic Nuclear Detection Office, a Radiation Countermeasures Program at the National Institute of Allergy and Infectious Diseases, and the Radiation Event Medical Management website available online at www.remm.nlm.gov.
Tenet, G. At the Center of the Storm: My Years at the CIA. New York: Harper Collins; 2006. (See particularly chapters 14 and 15)
Allison, G. Nuclear Terrorism: The Ultimate Preventable Catastrophe. New York: Henry Holt and Co.; 2004.
Williams, PL. Osama's Revenge: The Next 9/11. Amherst, NY: Prometheus Books; 2004.
Ferguson, CD, Potter, WC. The Four Faces of Nuclear Terrorism. Monterey, CA: Monterey Institute for International Studies; 2004.
Lightfoot, N. The polonium 210 incident: lessons identified. Powerpoint presentation, delivered at the Polonium 210: The Public Health Response conference, Royal College of Surgeons, London, UK, March 27, 2007. Accessed online at http://www.hpa-events.org.uk/hpa/templates/sub/titem.csp?pageID=8259&eventID=31 on May 19, 2007.
McLaughlin, TP, Monahan, SP, Pruvost, NL, Frolov, VV, Ryazanov, BG, Sviridov, VI. A Review of Criticality Accidents, 2000 Revision. Los Alamos, NM: Los Alamos National Laboratory; 2000. Available at: http://www.csirc.net/docs/reports/la-13638.pdf. Accessed February 23, 2009.
Andrews, GA. Criticality accidents in Vinca, Yugoslavia, and Oak Ridge, Tennessee. Comparison of radiation injuries and results of therapy. JAMA. 1962;179:191–197.Google Scholar
Tanaka, SI. Summary of the JCO criticality accident in Tokai-mura and a dose assessment. J Radiat Res (Tokyo). 2001;42 Suppl:S1–S9.Google Scholar
Mettler, FA, Voelz, GL, Nenot, J-C, Gusev, IA. Criticality accidents. In: Gusev, IA, Guskova, AK, Mettler, FA, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Guskova, AK, Gusev, IA. Medical aspects of the accident at Chernobyl. In: Gusev, IA, Guskova, AK, Mettler, FA, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Cohen, BL. The Nuclear Energy Option: An Alternative for the 90s. New York: Plenum Publishing; 1990. Available at: http://www.phyast.pitt.edu/~blc/book/BOOK.html. Accessed February 23, 2009.
,U.S. Nuclear Regulatory Commission. Chernobyl nuclear power plant accident. Available at: http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/chernobyl-bg.html. Accessed February 23, 2009.
Crick, MJ, Linsley, GS. An assessment of the radiological impact of the Windscale reactor fire, October 1957. Int J Radiat Biol Rela Stud Phys Chem Med. 1984;46:479–506.Google Scholar
,U.S. Nuclear Regulatory Commission. Fact Sheet on the Three Mile Island accident. Available at: http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/3mile-isle.html. February 23, 2009.
,United States General Accounting Office. Spent nuclear fuel: options exist to further enhance security. GAO Report No. 03–426; 2003. Available at: www.gao.gov/new.items/d03426.pdf. February 23, 2009.
Pilkey, OH, Pilkey-Jarvis, L. Useless Arithmetic: Why Environmental Scientists Can't Predict the Future. New York: Columbia University Press; 2007.
Peter, RU, Arsin, H, Cosset, J-M, Clough, K, Gourmelon, P, Nenot, J-C. Accident involving abandoned radioactive sources in Georgia, 1997. In: Gusev, IA, Guskova, AK, Mettler, FA, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Oliveira, CN, Melo, DR, Liptzstein, JL. Internal contamination in the Goiânia accident, Brazil, 1987. In: Gusev, IA, Guskova, AK, Mettler, FA, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Guskova, AK. Epidemiological evaluation of populations accidentally exposed near the Techa River, Russia. In: Gusev, IA, Guskova, AK, Mettler, FA, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Mettler, FA, Ortiz-Lopez, P. Accidents in radiation therapy. In: Gusev, IA, Guskova, AK, Mettler, FA, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Mettler, FA. Accidents at industrial irradiation facilities. In: Gusev, IA, Guskova, AK, Mettler, FA, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Zimmerman, PD, Loeb, C. Dirty bombs: the threat revisited. Defense Horizons. 2004;38:1–11.Google Scholar
Bale, JM. The Chechen resistance and radiological terrorism. Nuclear Threat Initiative Issue Brief. Available at: http://www.nti.org/e_research/e3_47a.html. Accessed February 25, 2009.
,The Nunn-Lugar Cooperative Threat Reduction (CTR) Program. Available at: http://www.nti.org/db/nisprofs/russia/forasst/nunn_lug/overview.htm. February 25, 2009.
Langewiesche, W. The Atomic Bazaar: The Rise of the Nuclear Poor. New York: Farrar, Straus and Giroux; 2007.
,CNN Newswire. Bush, Kerry: nukes most serious threat. October 9, 2004. Available at: http://www.cnn.com/2004/ALLPOLITICS/09/30/debate.main/index.html.February 25, 2009.
Glasstone, S, Dolan, P. The Effects of Nuclear Weapons. Department of the Army Pamphlet No. 50–3. Washington, DC: Department of the Army; 1977.
,HOTSPOT Version 2.06 Nuclear Explosion Program. Lawrence Livermore National Laboratory. Available at: http://www.llnl.gov/nhi/hotspot. Accessed February 25, 2009. (Documentation is within the “Help” function of the computer program.)
Martin, JE. Physics for Radiation Protection. New York: John Wiley & Sons; 2000.
Guskova, AK, Barabanova, AV, Baranov, AY, et al. Acute radiation effects in victims of the Chernobyl accident. UNSCEAR 1988 Report, Appendix to Annex G. Available at: http://www.unscear.org/docs/reports/1988annexgappx.pdf. Accessed February 25, 2009.
Cronkite, EP, Bond, VP, Conrad, RA. Medical effects of exposure of human beings to fallout radiation from a thermonuclear explosion. Stem Cells. 1995;13(Suppl 1):49–57.Google Scholar
Hall, EJ. Acute effects of total-body irradiation. In: Hall, EJ, ed. Radiobiology for the Radiologist. Philadelphia: Lippincott Williams & Wilkins; 2000;124–135. Of note, however, only 1 (5%) of the 21 Chernobyl emergency workers receiving doses in excess of 650 cGy survived, despite aggressive supportive care (13 received allogeneic bone marrow transplants). Fifteen (68%) of the 22 emergency responders receiving doses between 420 and 640 cGy survived. See United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and Effects of Ionizing Radiation. Annex J: Exposures and effects of the Chernobyl Accident. United Nations, New York, 2000. Accessed online at http://www.unscear.org/docs/reports/annexj.pdf on 9/5/06.
Rotblat, J. Acute radiation mortality in a nuclear war. In: Soloman, F, Marston, RQ, eds. The Medical Implications of Nuclear War. Washington, DC: Institute of Medicine, National Academy of Sciences; 1986;233–250. (This calculated dose reflected a neutron-dose fraction of <0.06.)
Kallman, RF. The effect of dose rate on mode of acute radiation death of C57BL and BALB/c mice. Radiat Res. 1962;16:796–810.Google Scholar
Neal, FE. Variation of acute mortality with dose-rate in mice exposed to single large doses of whole-body x-irradiation. Int J Radiat Biol. 1960;2:295–300.Google Scholar
Broyles, AA. The effect of dose rate on radiation injury. Health Physics. 1989;56:933–937.Google Scholar
MacVittie, TJ, Monroy, R, Vigneulle, RM, Zeman, GH, Jackson, WE. The relative biological effectiveness of mixed fission-neutron-gamma radiation on the hematopoietic syndrome in the canine: effect of therapy on survival. Radiat Res. 1991;128(1 Suppl):S29–36.Google Scholar
Wang, J, Wang, BQ, Chen, D, Luo, YS. The response of dogs to mixed neutron-gamma radiation with different neutron/gamma ratios. Radiat Res. 1991;128(1 Suppl):S42–46. (In this study, the WBC nadir after a 90% neutron exposure of 265 cGy occurred at 5 days while the WBC nadir at the same dose with 15% neutrons occurred at 15–17 days.)Google Scholar
Ledney, GD, Madonna, GS, McChesney, DG, Elliott, TB, Brook, I. Complications of combined injury: radiation damage and skin wound trauma in mouse models. In: Browne, D, Weiss, JF, MacVittie, TJ, Pillai, MV, eds. Treatment of Radiation Injuries. New York: Plenum Press; 1990.
Ledney, GD, Jackson, WE, Elliott, TB, Bhatt, R. Relative biological effectiveness (RBE) of reactor-produced mixed-field neutron/gamma radiations: dependence on neutron dose fraction and associated tissue injury. Poster B-8, presented at USUHS research day 4/10–4/11/01.
Kataoka, Y, Basic, I, Perrin, J, Grdina, DJ. Antimutagenic effects of radioprotector WR-2721 against fission-spectrum neutrons and 60Co gamma rays in mice. Int J Radiat Biol. 1992;61:387–392.Google Scholar
Su, Y, Swift, M. Mortality rates among carriers of ataxia-telangiectasia mutant alleles. Ann Intern Med. 2000;133:770–778.Google Scholar
Carlomagno, F, Chang-Claude, J, Dunning, AM, Ponder, BA. Determination of the frequency of the common 657Del5 Nijmegen breakage syndrome mutation in the German population: no association with risk of breast cancer. Genes Chromosomes Cancer. 1999;25:393–395.Google Scholar
Thomson, JF, Tourtellotte, WW, Carttar, MS, Cox, RS, Wilson, JE. Studies on the effects of continuous exposure of animals to gamma radiation from cobalt 60 sources. Am J Roentgenol Radium Ther Nucl Med. 1953;69:830–838.Google Scholar
Garner, RJ, Phemister, RD, Angleton, GM, Lee, AC, Thomassen, RW. Effect of age on the acute lethal response of the beagle to cobalt-60 gamma radiation. Radiat Res. 1974;58:190–195.Google Scholar
Casarett, AP. Modification of radiation injury. In: Radiation Biology. Englewood Cliffs, NJ: Prentice-Hall, Inc.; 1968;236–265.
Alexander, GA, Swartz, HM, Amundson, SA, et al. BiodosEPR-2006 Meeting: acute dosimetry consensus committee recommendations on biodosimetry applications in events involving uses of radiation by terrorists and radiation accidents. Radiat Meas. 2007;42:972–996.Google Scholar
Anno, GH, Young, RW, Bloom, RM, Mercier JR. Dose response relationships for acute radiation lethality. Health Physics. 2003;84:565–575.Google Scholar
Goans, RE. Clinical care of the radiation patient. In Ricks, RC, Berger, ME, O, FM, eds. The Medical Basis for Radiation-Accident Preparedness: The Clinical Care of Victims. Nashville, TN: Parthenon Publishing; 2002.
Goans, RE, Waselenko, JK. Medical management of radiation casualties. Health Physics. 2005;89:505–512.Google Scholar
Blakely, WF, Salter, CA, Prasanna, PG. Early-response biological dosimetry – recommended countermeasure enhancements for mass-casualty radiological accidents and terrorism. Health Physics. 2005;89:494–504.Google Scholar
Pantelias, GE, Maillie, HD. The use of peripheral blood mononuclear cell prematurely condensed chromosomes for biological dosimetry. Radiat Res. 1984;99:140–150.Google Scholar
Evans, JW, Chang, JA, Giaccia, AJ, Pinkel, D, Brown, JM. The use of fluorescence in situ hybridization combined with premature chromosome condensation for the identification of chromosome damage. Br J Cancer. 1991;63:517–521.Google Scholar
Prasanna, PGS, Kolanko, CJ, Gerstenberg, HM, Blakely, WF. Premature condensation assay for biodosimetry: studies with fission neutrons. Health Physics. 1997;72:594–600.Google Scholar
Lloyd, DC, Edwards, AA, Moquet, JE, Guerrero-Carbajal, YC. The role of cytogenetics in triage of radiation casualties. Appl Radiat Isot. 2000;52:1107–1112.Google Scholar
Voisin, P, Benderitter, M, Claraz, M, et al. The cytogenetic dosimetry of recent accidental overexposure. Cell Mol Biol. 2001;47:557–564.Google Scholar
Prassanna, PGS, Subramanian, U, Greenhill, RG, Jacocks, JM, Jackson, WE, Blakely, WF. Proceedings of the 36th Health Physics Society Topical Meeting: Radiation Safety Aspects of Homeland Security. San Antonio, TX; 2003;218–222.
Prasanna, PGS, Muderhwa, JM, Miller, AC, Grace, MB, Salter, CA, Blakely, WF. Diagnostic biodosimetry for radiation disasters: current research and service activities at AFRRI. In: NATO Medical Surveillance and Response: Research and Technology Opportunities and Options. Neuilly-Sur-Seine, France: North Atlantic Treaty Organization; 2004.
Littlefield, LG, Joiner, EE, Sayer, AM. Cytogenetic analysis of the Juarez radiation accident. In: Mettler, FA, Kelsey, CA, Ricks, RC, eds. Medical Management of Radiation Accidents. Boca Raton, FL: CRC Press; 2001.
Sevan'kaev, AV. Results of cytogenetic studies of the consequence of the Chernobyl accident. Radiat Biol Radioecol. 2000;40:589–595.Google Scholar
Ramalho, AT, Nascimento, AC. The fate of chromosomal aberrations in 137Cs-exposed individuals in the Goiânia radiation accident. Health Physics. 1991;60:67–70.Google Scholar
Roy, L, Gregoire, E, Durand, V, et al. Study of the tools available in biological dosimetry to estimate the dose in cases of accidental complex exposure to ionizing radiation: the Lilo accident. Int J Radiat Biol. 2006;82:39–48.Google Scholar
Lindholm, C, Romm, H, Stephan, G, Schmid, E, Moquet, J, Edwards, A. Intercomparison of translocation and dicentric frequencies between laboratories in a follow-up of the radiological accident in Estonia. Int J Radiat Biol. 2002;78:883–890.Google Scholar
Koksal, G, Pala, FS, Dalci, . In vitro dose response curve for chromosome aberrations induced in human lymphocytes by 60Co irradiation. Mutat Res. 1995;329:57–61.Google Scholar
Hayata, I, Kanda, R, Minamihisamatsu, M, Furukawa, M, Sasaki, MS. Cytogenetic dose estimation for 3 severely exposed patients in the JCO criticality accident in Tokai-mura. J Radiat Res (Tokyo). 2001;42:S149–155.Google Scholar
Sasaki, MS, Hayata, I, Kamada, N, Kodama, Y, Kodama, S. Chromosome aberration analysis in persons exposed to low-level radiation from the JCO criticality accident in Tokai-mura. J Radiat Res (Tokyo). 2001;42:S107–116.Google Scholar
Kanda, R, Minamihisamatsu, M, Hayata, I. Dynamic analysis of chromosome aberrations in three victims of the Tokai-mura criticality accident. Int J Radiat Biol. 2002;78:857–862.Google Scholar
El-Naggar, AM, Mohammad, MHM, Gomaa, MA. The radiological accident at Meet Halfa, Qaluobiya, Egypt. In Ricks, RC, Berger, ME, O, FM, eds. The Medical Basis for Radiation-Accident Preparedness: The Clinical Care of Victims. Nashville, TN: Parthenon Publishing; 2002.
Jinaratana, V. The radiological accident in Thailand. In Ricks, RC, Berger, ME, O'Hara, FM, eds. The Medical Basis for Radiation-Accident Preparedness: The Clinical Care of Victims. Nashville, TN: Parthenon Publishing; 2002.
Thierens, H, Ruyck, K, Vral, A, et al. Cytogenetic biodosimetry of an accidental exposure of a radiological worker using multiple assays. Radiat Prot Dosimetry. 2005;113:408–414.Google Scholar
Lloyd, DC, Edwards, AA, Moquet, JA, Hone, PA, Szluinska, M. Doses in radiation accidents investigated by chromosome aberration analysis. XXIV. In: Center for Radiation, Chemical and Environmental Hazards, Review of Cases Investigated, 2003–2005. London: Health Protection Agency; 2006.
Tsujii, N, Akashi, M, eds. Proceedings of an International Symposium on the Criticality Accident in Tokai-mura: Medical Aspects of Radiation Emergency. Chiba, Japan: National Institute of Radiological Sciences; 2001.
Blakely, WF, Brooks, AL, Lofts, RS, Schans, GP, Voisin, P. Overview of low-level exposure assessment. Mil Med. 2002;167(2 Suppl):20–24.Google Scholar
Voisin, P, Barquinero, R, Blakely, B, et al. Towards a standardization of biological dosimetry by cytogenetics. Cell Mol Biol.2002;48:501–504.Google Scholar
Schauer, DA, Coursey, DM, Dick, CE, et al. A radiation accident at an industrial accelerator facility. Health Physics. 1993;65:131–140.Google Scholar
Schauer, DA, Desrosiers, MF, Le, FG, Seltzer, FM, Links, JM. EPR dosimetry of cortical bone of tooth enamel irradiated with X and gamma rays: study of energy dependence. Radiat Res. 1994;138:1–8.Google Scholar
Schauer, DA, Desrosiers, MF, Kuppusamy, P, Zwier, JL. Radiation dosimetry of an accidental overexposure using EPR spectrometry and imaging of human bone. Appl Radiat Isot. 1996;47:1345–1350.Google Scholar
Romanyukha, AA, Schaur, AA, Thomas, JA, Regulla, DF. Parameters affecting EPR dose reconstruction in teeth. Appl Radiat Isot. 2005;62:147–154.Google Scholar
Desrosiers, ME. In vivo assessment of radiation exposure. Health Physics. 1991;61:859–861.Google Scholar
Clairand, I, Trompier, F, Bottollier-Depois, JF, Gourmelon, P. Ex vivo ESR measurements associated with Monte Carlo calculations for accident dosimetry: application to the 2001 Georgian accident. Radiat Prot Dosimetry. 2006;119:500–505.Google Scholar
Lindholm, C, Salomaa, S, Tekkel, M, Paile, W, Koivistoinen, A, Ilus, T, Veidebaum, T. Biodosimetry after accidental radiation exposure by conventional chromosome analysis and FISH. Int J Radiat Biol. 1996;70:647–656.Google Scholar
Hutt, G, Brodski, L, Polyakov, V. Gamma ray assessment after the 1994 radiation accident in Kiisa (Estonia): preliminary results. Appl Radiat Isot. 1996;45:1329–1334.Google Scholar
Swartz, HM, Iwasaki, A, Tazeusz, W, et al. Measurements of clinically significant doses using non-invasive EPR spectroscopy of teeth in situ. Appl Radiat Isot. 2005;62:293–299.Google Scholar
Trompier, F, Tikunov, DD, Ivannikov, A, Clairand, I. ESR investigation of joint use of dentin and tooth enamel to estimate photon and neutron dose components of a mixed field. Radiat Prot Dosimetry. 2006;120:191–196.Google Scholar
Kleinerman, RA, Romanyukha, AA, Schauer, DA, Tucker, JD. Retrospective assessment of radiation exposure using biological dosimetry: chromosome painting, electron paramagnetic resonance, and the glycophorin A mutation assay. Radiat Res. 2006;166:287–302.Google Scholar
Waselenko, JK, MacVittie, TJ, Blakely, WF, 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.Google Scholar
Hogan, , Kellison, T. Nuclear terrorism. Am J Med Sci. 2002;323:341–349.Google Scholar
Barnett, DJ, Parker, CL, Blodgett, DW, Wierezba, RK, Links, JM. Understanding radiologic and nuclear terrorism as public health threats: preparedness and response perspectives. J Nucl Med. 2006;47:1653–1661.Google Scholar
,U.S. Centers for Disease Control and Prevention. Acute Radiation Syndrome: Fact Sheet for Physicians. Available at: http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp. Accessed February 26, 2009.
Hall, EJ. Acute effects of total-body irradiation. In: Hall, EJ, ed. Radiobiology for the Radiologist. Philadelphia: Lippincott Williams & Wilkins; 2000.
Leikin, JB, McFee, RB, Walter, FG, Edsall, K. A primer for nuclear terrorism. Dis Mon. 2003;49:485–516.Google Scholar
Berger, ME, Christensen, DM, Lowry, PC, Jones, OW, Wiley, AL. Medical management of radiation injuries: current approaches. Occup Med (Lond). 2006;56:162–172.Google Scholar
Dainiak, N, Waselenko, JK, Armitage, JO, MacVittie, TJ, Farese, AM. The hematologist and radiation casualties. Hematology Am Soc Hematol Educ Program. 2003;473–496.Google Scholar
Bekkum, DW. Radiation sensitivity of the hemopoietic stem cell. Radiat Res. 1991;128(1 Suppl):S4–8.Google Scholar
Koenig, KL, Goans, RE, Hatchett, RJ, et al. Medical treatment of radiological casualties: current concepts. Ann Emerg Med. 2005;45:643–652.Google Scholar
Walker, RJ, Willemze, R. Neutrophil kinetics and the regulation of granulopoiesis. Rev Infect Dis. 1980;2:282–292.Google Scholar
Chao, NJ. Accidental or intentional exposure to ionizing radiation: biodosimetry and treatment options. Exp Hematol. 2007;35(4 Suppl 1):24–27.Google Scholar
Paris, F, Fuks, Z, Kang, A, et al. Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science. 2001;293:293–297.Google Scholar
Maj, JG, Paris, F, Haimovitz-Friedman, A, Venkatraman, E, Kolesnick, R, Fuks, Z. Microvascular function regulates intestinal crypt response to radiation. Cancer Res. 2003;22:5897–5906.Google Scholar
Schuller, BW, Rogers, AB, Cormier, KS, et al. No significant endothelial apoptosis in the radiation–induced gastrointestinal syndrome. Int J Radiat Oncol Biol Phys. 2007;68:205–210.Google Scholar
Seegenschmiedt, H. Management of skin and related reactions to radiotherapy. Front Radiat Ther Oncol. 2006;39:102–119.Google Scholar
Hymes, SR, Strom, EA, Fife, C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006;54:28–46.Google Scholar
Barabanova, AV. Acute radiation syndrome with cutaneous syndrome. In Ricks, RC, Berger, ME, O'Hara, FM, eds. The Medical Basis for Radiation-Accident Preparedness: The Clinical Care of Victims. Nashville, TN: Parthenon Publishing; 2002.
Pellmar, TC, Ledney, GD. Combined injury: radiation in combination with trauma, infectious disease, or chemical exposures. Presented at the Human Factors and Medicine Panel Research Task Group 099 (NATO RTG-099 2005), Radiation and Bioeffects and Countermeasures Meeting held in Bethesda, MD on 21–23 June 2005. Published in Armed Forces Radiobiology Research Institute (AFRRI)-CD-05–2, p19–1–19–9, 2005. Available at: http://stinet.dtic.mil/oai/oai?&verb=getRecord&metadataPrefix=html&identifier=ADA438764. Accessed February 26, 2009.
Pellmar, T. Overview of combined injury: radiation in combination with trauma, infectious disease, or chemical exposure. Medical Countermeasures for Combined Injury: Radiation with Burn, Blast, Trauma, and/or Sepsis Meeting (March 26, 2007). Accessed online at http://www3.niaid.nih.gov/research/topics/radnuc/Meeting_Slides.htm on 7/21/07.
Cervany, TJ, MacVittie, TJ, Young, RW. Acute radiation syndrome in humans. In: Walker, RI, Cervany, TJ, eds. Textbook of Military Medicine: Medical Consequences of Nuclear Warfare. Falls Church, VA: TMM Publications Office of the Surgeon General; 1989.
Brush, J, Lipnick, SL, Phillips, T, Sitko, J, McDonald, JT, McBride, WH. Molecular mechanisms of late normal tissue injury. Semin Radiat Oncol. 2007;17:121–130.Google Scholar
Moulder, JE, Cohen, EP. Future strategies for mitigation and treatment of chronic radiation-induced normal tissue injury. Semin Radiat Oncol. 2007;17:141–148.Google Scholar
Robbins, ME, Diz, DI. Pathogenic role of the renin-angiotensin system in modulating radiation-induced late effects. Int J Radiat Oncol Biol Phys. 2006;64:6–12.Google Scholar
Weisdorf, D, Chao, N, Waselenko, JK, et al. Acute radiation injury: contingency planning for triage, supportive care, and transplantation. Biol Blood Marrow Transplant. 2006;12:672–682.Google Scholar
Flynn, DF, Goans, RE. Nuclear terrorism: triage and medical management of radiation and combined-injury casualties. Surg Clin North Am. 2006;86:601–636.Google Scholar
Bolderston, A, Lloyd, NS, Wong, RK, Holden, L, Robb-Blenderman, L. Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-Based Care. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer. 2006;14:802–817.Google Scholar
Barbour, SY, Crawford, J. Hematopoietic growth factors. In: Pazdur, R, Coia, LR, Hoskins, WJ, Wagman, L, eds. Cancer Management: A Multidisciplinary Approach. New York: CMP Healthcare Media; 2006.
Huber, M, personal communication, 2007.
Herodin, F, Drouet, M. Cytokine-based treatment of accidentally irradiated victims and new approaches. Exp Hematol. 2005;33:1071–1080.Google Scholar
Tigue, CC, McKoy, JM, Evens, AM, Trifilio, SM, Tallman, MS, Bennett, CL. Granulocyte-colony stimulating factor administration to healthy individuals and persons with chronic neutropenia or cancer: an overview of safety considerations from the Research on Adverse Drug Events and Reports project. Bone Marrow Transplant. 2007;40:185–192. Epub 2007 Jun 11. Available at: http://www.nature.com/bmt/journal/v40/n3/full/1705722a.html. February 26, 2009.Google Scholar
Gafter-Gvili, A, Fraser, A, Paul, M, Wetering, M, Kremer, L, Leibovici, L. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev. 2005;(4):CD004386.Google Scholar
Abdelsayed, GG. Management of radiation-induced nausea and vomiting. Exp Hematol. 2007;35:34–36.Google Scholar
Schneider, SB, Nishimura, RD, Zimmerman, RP, et al. Filgrastim (r-metHuG-CSF) and its potential use in the reduction of radiation-induced oropharyngeal mucositis: an interim look at a randomized, double-blind, placebo-controlled trial. Cytokines Cell Mol Ther. 1999;5:175–180.Google Scholar
Saarilahti, K, Kajanti, M, Joensuu, T, Kouri, M, Joensuu, H. Comparison of granulocyte-macrophage colony-stimulating factor and sucralfate mouthwashes in the prevention of radiation-induced mucositis: a double-blind prospective randomized phase III study. Int J Radiat Oncol Biol Phys. 2002;54:479–485.Google Scholar
Brook, I, Ledney, GD. Use of selective decontamination in the prevention of infection after accidental irradiation. A review. Prehosp Disaster Med. 1993;8:85–88.Google Scholar
Coghlin Dickson, TM, Wong, RM, et al. Effect of oral glutamine supplementation during bone marrow transplantation. J Parenter Enteral Nutr. 2000;24:61–66.Google Scholar
Spirt, MJ Stress-related mucosal disease: risk factors and prophylactic therapy. Clin Ther. 2004;26:197–213.Google Scholar
Ozturk, B, Egehan, I, Atavci, S, Kitapci, M. Pentoxifylline in prevention of radiation-induced lung toxicity with breast and lung cancer: a double-blind randomized trial. Int J Radiat Oncol Biol Phys. 2004;58:213–219.Google Scholar
Delanian, S, Porcher, R, Rudant, J, Lefaix, JL. Kinetics of response to long-term treatment combining pentoxifylline and tocopherol in patients with superficial radiation-induced fibrosis. J Clin Oncol. 2005;23:8570–8579.Google Scholar
Cohen, EP, Hussain, S, Moulder, JE. Successful treatment of radiation nephropathy with angiotensin II blockade. Int J Radiat Oncol Biol Phys. 2003;55:190–193.Google Scholar
Goans, RE. Update on the Treatment of internal contamination. In Ricks, RC, Berger, ME, O'Hara, FM, eds. The Medical Basis for Radiation-Accident Preparedness: The Clinical Care of Victims. Nashville, TN: Parthenon Publishing; 2002.
Bhattacharyya, MH, Breitenstein, BD, Metivier, H, Muggenburg, BA, Stradling, GN, Volf, V. Guidebook for the Treatment of Accidental Internal Radionuclide Contamination of Workers. eds. Gerber, GB, and Thomas, RG. A Joint Publication for the Commission of the Commission of the European Communities and the US DOE Office of Health and Environmental Research. Radiat Proton Dosim. 1992;41:1–49.
Mansfield, WG. Nuclear Emergency and Radiological Decision Handbook. Livermore, CA: Lawrence Livermore National Laboratory; 1997.
National Council on Radiation Protection and Measurements. Management of Persons Accidentally Contaminated with Radionuclides. NCRP Report No. 65.Bethesda: National Council on Radiation Protection and Measurements; 1980.
Mettler, F, personal communication, 2007.
Goans, RE, Dickerson, WE, Wiley, AL. Unpublished compilation of current medical practice in radionuclide decorporation therapy, 2007.
Potassium iodide as a thyroid blocking agent in radiation emergencies. FDA Center for Drug Evaluation and Research Procedural, Rockville, MD, December 2001. Available at: http://www.fda.gov/Cder/guidance/4825fnl.pdf. Accessed February 26, 2009.
Norwood, AE, Ursano, RJ, Fullerton, CS. Disaster psychiatry: principles and practice. Psychiatr Q. 2000;71:207–226.Google Scholar
Boudreaux, E, Kilpatrick, DG, Resnick, HS, Best, CL, Saunders, BE. Criminal victimization, posttraumatic stress disorder, and comorbid psychopathology among a community sample of women. J Trauma Stress. 1998;11:665–678.Google Scholar
Grieger, TA, Waldrep, DA, Lovasz, MM, Ursano, RJ. Follow-up of Pentagon employees two years after the terrorist attack of September 11, 2001. Psychiatr Serv. 2005;56:1374–1378.Google Scholar
Koenig, KL, Hatchett, R, Crail, S, et al. Report of the Department of Homeland Security Working Group on Radiological Dispersal Device (RDD) Preparedness. Medical Preparedness and Response Sub-Group. Washington, DC: Department of Homeland Security; 2003. Available at: http://www.va.gov/emshg/docs/Radiologic_Medical_Countermeasures_051403.pdf. Accessed February 26, 2009.
International Atomic Energy Agency. The Radiation Accident in Goiânia. STI/PUB/815. Vienna, Austria: IAEA; 1988.
International Atomic Energy Agency. Dosimetric and Medical Aspects of the Radiological Accident in Goiânia in 1987. IAEA-TECDOC-1009. Vienna, Austria: IAEA; 1998.
International Atomic Energy Agency. The Radiation Accident in Tammiku. STI/PUB/1053. Vienna, Austria: IAEA; 1998.
Goans, RE, Wald, N. Radiation accidents with multi-organ failure in the United States. BJR Suppl. 2005;27:41–46.Google Scholar
McLaughlin, TP, Monahas, SP, Pruvost, NL, Frolov, VV, Ryazanov, BG, Sviridov, VI. A Review of Criticality Accidents: 2000 Revision. LA-13638 (2000; Los Alamos National Laboratory, Los Alamos, New Mexico). Accessed online at http://www.orau.org/ptp/Library/accidents/la-13638.pdf on 7/22/07.
Hempelmann, LH, Lisko, L, Hoffman, JG. The acute radiation syndrome: a study of nine cases and a review of the problem. Ann Intern Med. 1952;36:279–510.Google Scholar
Shipman, TL, Lushbaugh, LL, Peterson, DF, Langham, WH, Harris, PS, Lawrence, JNP. Acute radiation death resulting from an accidental nuclear critical excursion. J Occup Med. 1961; Special Supplement:145–192.Google Scholar
Karas, JS, Stanbury, JB. Fatal radiation syndrome from an accidental nuclear excursion. N Engl J Med. 1965;272:755–761.Google Scholar
Farrell, CL, Bready, JV, Rex, KL, et al. Keratinocyte growth factor protects mice from chemotherapy and radiation-induced gastrointestinal injury and mortality. Cancer Res. 1998;58:933–939.Google Scholar
Dörr, W, Noack, R, Spekl, K, Farrell, CL. Modification of oral mucositis by keratinocyte growth factor: single radiation exposure. Int J Radiat Biol. 2001;77:341–347.Google Scholar
Hérodin, F, Grenier, N, Drouet, M. Revisiting therapeutic strategies in radiation casualties. Exp Hematol. 2007;35(4 Suppl 1):28–33.Google Scholar
Miller, MC, Nanchahal, J. Advances in the modulation of cutaneous wound healing and scarring. BioDrugs. 2005;19:363–381.Google Scholar
Jurjus, A, Atiyeh, BS, Abdallah, IM, et al. Pharmacological modulation of wound healing in experimental burns. Burns. 2007;33:892–907.Google Scholar
Denham, JW, Hauer-Jensen, M. The radiotherapeutic injury–a complex ‘wound.’ Radiother Oncol. 2002;63:129–145.Google Scholar
Mustoe, TA, Purdy, J, Gramates, P, Deuel, TF, Thomason, A, Pierce, GF. Reversal of impaired wound healing in irradiated rats by platelet-derived growth factor-BB. Am J Surg. 1989;158:345–350.Google Scholar
Amendt, C, Mann, A, Schirmacher, P, Blessing, M. Resistance of keratinocytes to TGFβ-mediated growth restriction and apoptosis induction accelerates re-epithelialization in skin wounds. J Cell Sci. 2002;115:2189–2198.Google Scholar
Anand, P, Terenghi, G, Warner, G, Kopelman, P, Williams-Chestnut, RE, Sinicropi, DV. The role of endogenous nerve growth factor in human diabetic neuropathy. Nat Med. 1996;2:703–707.Google Scholar
Kanaan, SA, Saadé, NE, Karam, M, Khansa, H, Jabbur, SJ, Jurjus, AR. Hyperalgesia and upregulation of cytokines and nerve growth factor by cutaneous leishmaniasis in mice. Pain. 2000;85:477–482.Google Scholar
Hérodin, F, Roy, L, Grenier, N, et al. Antiapoptotic cytokines in combination with pegfilgrastim soon after irradiation mitigates myelosuppression in nonhuman primates exposed to high irradiation dose. Exp Hematol. 2007;35:1172–1181.Google Scholar
Candan, F, Alaqözlü, H. Captopril inhibits the pulmonary toxicity of paraquat in rats. Hum Exp Toxicol. 2001;20:637–641.Google Scholar
He, X, Han, B, Mura, M, et al. Angiotensin-converting enzyme inhibitor captopril prevents oleic acid-induced severe acute lung injury in rats. Shock. 2007;28:106–111.Google Scholar
Jiang, JS, Wang, LF, Chou, HC, Chen, CM. Angiotensin-converting enzyme inhibitor captopril attenuates ventilator-induced lung injury in rats. J Appl Physiol. 2007;102:2098–2103.Google Scholar
Moulder, JE, Fish, BL, Cohen, EP. Treatment of radiation nephropathy with ACE inhibitors and AII type-1 and type-2 receptor antagonists. Curr Pharm Des. 2007;13:1317–1325.Google Scholar
Robbins, ME, Diz, DI. Pathogenic role of the renin-angiotensin system in modulating radiation-induced late effects. Int J Radiat Oncol Biol Phys. 2006;64:6–12.Google Scholar
Dovi, JV, He, LK, DiPietro, . Accelerated wound closure in neutrophil-depleted mice. J Leukoc Biol. 2003;73:448–455.Google Scholar
Martin, P, Leibovich, SJ. Inflammatory cells during wound repair: the good, the bad and the ugly. Trends Cell Biol. 2005;15:599–607.Google Scholar
Brenner, DJ, Hall, EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284.Google Scholar
French Academy of Medicine. Medical Irradiation, Radioactivity Releases, and Disinformation: An Opinion by the Academy of Medicine, 4 December 2001. Available at: http://www.radscihealth.org/rsh/docs/academy_of_medicine_of_france.htm. Accessed February 26, 2009.
International Agency for Research on Cancer. Ionizing radiation, part I: x- and gamma (γ) radiation and neutrons. IARC Monographs on the evaluation of carcinogenic risks to humans, Vol. 75. Lyon: International Agency for Research on Cancer; 2000.
,National Research Council, Board on Radiation Effects Research. Distribution and Administration of Potassium Iodide in the Event of a Nuclear Accident. Washington, DC: National Academies Press; 2004.
Koenig, KL, Bey, T, Bradley, D, Kahn, CA, Schultz, C. The RADPACK: a new concept for stockpiling medical countermeasures for a radiation disaster at the local level. West J Emerg Med. 2008;9(1): Article Available at: http://repositories.cdlib.org/uciem/westjem/vol9/iss1/art49. Accessed February 26, 2009.Google Scholar
Adapted from Glasstone S, Dolan P. The Effects of Nuclear Weapons. Department of the Army Pamphlet No. 50–3 (1977; Department of the Army, Washington, DC.
Adapted from Glasstone S, Dolan P. The Effects of Nuclear Weapons. Department of the Army Pamphlet No. 50–3 (1977; Department of the Army, Washington, DC.

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×