Radiological emergency preparedness and response are increasingly acknowledged as vital components of both emergency readiness and public health. Previous studies have shown that medical providers feel unprepared to respond to radiation incidents. The existing level of knowledge, attitudes, and awareness held by emergency medicine residents and physicians in Oman, remain unexplored. This study aims to evaluate the knowledge, attitude, and awareness level of emergency residents and physicians in Oman regarding the management of radiation emergencies.

An electronic survey was distributed to 44 emergency residents and 57 emergency physicians.

The response rate was 62.7% (N = 69/110). Notably, 62% reported no prior engagement in radiation emergency training. The majority of participants had neither employed nor received training in operating radiation detection devices. A significant gap in knowledge emerged, with the median self-reported knowledge score of 50/100. The majority of participants (59%) expressed a need for educational programs and materials.

Our findings underscore the imperative for enhanced training in radiological incident preparedness for emergency medicine residents and physicians in Oman. The study reveals a clear necessity to bridge the existing gaps in knowledge and attitudes to bolster the readiness of health-care professionals to respond effectively to radiation emergencies.

To summarize presentations and discussions from the 2022 trans-agency workshop titled “Overlapping science in radiation and sulfur mustard (SM) exposures of skin and lung: Consideration of models, mechanisms, organ systems, and medical countermeasures.”

Summary on topics includes: (1) an overview of the radiation and chemical countermeasure development programs and missions; (2) regulatory and industry perspectives for drugs and devices; 3) pathophysiology of skin and lung following radiation or SM exposure; 4) mechanisms of action/targets, biomarkers of injury; and 5) animal models that simulate anticipated clinical responses.

There are striking similarities between injuries caused by radiation and SM exposures. Primary outcomes from both types of exposure include acute injuries, while late complications comprise chronic inflammation, oxidative stress, and vascular dysfunction, which can culminate in fibrosis in both skin and lung organ systems. This workshop brought together academic and industrial researchers, medical practitioners, US Government program officials, and regulators to discuss lung-, and skin- specific animal models and biomarkers, novel pathways of injury and recovery, and paths to licensure for products to address radiation or SM injuries.

Regular communications between the radiological and chemical injury research communities can enhance the state-of-the-science, provide a unique perspective on novel therapeutic strategies, and improve overall US Government emergency preparedness.

Radiation dermatitis (RD) occurs in 95% of patients receiving radiation therapy (RT) for cancer treatment, affecting 800 million patients annually. We aimed to demonstrate the feasibility of developing a historical RD cohort, Radiation Induced Skin Reactions (RISREAC) cohort.

This retrospective study evaluated RD-related clinical documentation for 245 breast cancer patients who received RT at the University of Rochester Medical Center, to understand the RD progression, scoring, and management. All statistical analyses were performed at 0.05 level of significance.

Clinician-documented RD severity was observed for 169 (69%) patients with a mean severity of 1.57 [1.46, 1.68]. The mean descriptor-based severity score of 2.31 [2.18, 2.45] moderately correlated (r = 0.532, P < 0.0001) with documented RD grade. Most patients (91.8%) received skin care treatment during RT, with 66.7% receiving more than 2 modalities.

The RISREAC cohort is the first retrospective cohort established from clinical documentation of radiation-induced skin changes for the study of RD and cutaneous radiation injury (CRI). RD symptom descriptors were more reliably documented and suitable for all skin types compared to Radiation Therapy Oncology Group (RTOG) or Common Toxicity Criteria for Adverse Events (CTCAE) grades. A new descriptor-based scoring tool would be useful for RD and CRI.

The on-going Russo-Ukrainian war has resulted in a renewed global interest in the safety and security of nuclear installations and the possibility of nuclear disasters caused by warfare and terrorism.

The objective of this study was to identify and characterize all documented terrorist attacks against nuclear transport, nuclear facilities, and nuclear scientists as reported to the Global Terrorism Database (GTD) over a 50-year period.

The GTD was searched for all terrorist attacks against nuclear facilities, nuclear scientists, nuclear transport, and other nuclear industry-related targets in the period from 1970-2020. Analyses were performed on temporal factors, location, target type, attack and weapon type, perpetrator type, number of casualties, and property value loss.

Ninety-one incidents that occurred from 1970 through 2020 were included. Incidents took place in 25 countries and nine world regions, with most (42; 46.1%) occurring in Western Europe.

During these 50 years, 91 incidents resulted in 19 fatalities and 117 injuries. One perpetrator was killed during an incident and one other assailant was injured.

Bombings and explosions were the most frequently identified attack type (n = 40; 44.0%), followed by facility/infrastructure damage (n = 24; 26.4%) and armed assaults and assassinations (both n = 7; 7.7%).

Nuclear power plants and reactors under construction were targeted in 13 (14.3%) and eight (8.8%) incidents, respectively. Most of the attacks took place on other nuclear industry-related sites.

Terrorist attacks carried out by non-state perpetrators against nuclear facilities, nuclear scientists, nuclear transport, and other nuclear industry-related targets are rare, with only 91 incidents in a 50-year period. None of the attacks resulted in radioactive fallout or environmental contamination. Most of the attacks took place outside a nuclear power plant.

Beta radiation from nuclear weapons fallout could pose a risk of cutaneous radiation injury (CRI) to evacuating populations but has been investigated only cursorily. This work examines 2 components of CRI necessary for estimating the potential public health consequences of exposure to fallout: dose protraction and depth of dose.

Dose protraction for dry and moist desquamation was examined by adapting the biological effective dose (BED) calculation to a hazard function calculation similar to those recommended by the National Council on Radiation Protection and Measurements for other acute radiation injuries. Depth of burn was examined using Monte Carlo neutral Particle version 5 to model the penetration of beta radiation from fallout to different skin tissues.

Nonlinear least squares analysis of the BED calculation estimated the hazard function parameter θ1 (dose rate effectiveness factors) as 25.5 and 74.5 (Gy-eq)2 h−1 for dry and moist desquamation, respectively. Depth of dose models revealed that beta radiation is primarily absorbed in the dead skin layers and basal layer and that dose to underlying tissues is small (<5% of dose to basal layer).

The low relative dose to tissues below the basal layer suggests that radiation-induced necrosis or deep skin burns are unlikely from direct skin contamination with fallout. These results enable future modeling studies to better examine CRI risk and facilitate effectively managing and treating populations with specialized injuries from a nuclear detonation. (Disaster Med Public Health Preparedness. 2019;13:463-469)

A radiological disaster could result in a large number of patients potentially exposed to harmful levels of radiation. Currently, early triage of patients for radiation exposure relies heavily on a clinical evaluation of signs and symptoms. However, detailed clinical assessment takes significant time and requires specialized training to accurately interpret the results.

During planning of a recent exercise, SMEs estimated that it would take up to 15 minutes per patient. Patient load would quickly overwhelm the number of qualified clinicians providing treatment. In this exercise organized by the NATO RTG HFM 222, we examined using automated translation of clinical data to facilitate clinic evaluations. We used two triage evaluation approaches; REAC/TS and METREPOL. These approaches allowed us to translate tabulated clinical data, first into categorical data for grouping patients, and then into recommendations for follow-up diagnostics and care.

The organizers provided clinical evaluations of 191 case studies that were estimated to require up to 50 total hours for completion. However, using our application, we were able to evaluate all cases in less than 2 minutes.

This study clearly demonstrates the need for automated tools to help translate clinical data for effective patient triage after a nuclear or radiological incident. (Disaster Med Public Health Preparedness. 2018;12:569–573)