Radiological and nuclear terrorism

Carol J. Iddins, Jason E. Davis, Ronald E. Goans, Cullen Case

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

1 Scopus citations

Abstract

Recent world events and political tensions are again bringing attention to the possibility of a nuclear incident, including a detonation. Radiological materials are ubiquitous and are found in most cities throughout the country at academic institutions, hospitals, and many businesses and in industrial settings. Nuclear materials are more difficult to access because of their scarce nature and the security of the settings in which they are found. A significant radiological or nuclear (R/N) incident in the Unites States will require activation of local, state, territory, regional, and national government assets. Initially, ad hoc triage and treatment areas will rise up in the moderately to lightly damaged zones. Patients will undergo mass casualty triage and stabilization before medical evacuation to subsequent higher levels of care. This will require subject matter expert advice and response as the size and circumstances of the incident unfold. Initial mass casualty triage should be done to sort the populations who will require minor interventions, admission to the hospital, and possibly eventual intensive care and those who may have an extremely dire prognosis and may require comfort or hospice care. The hematologist-oncologist will be among those with the expertise to effectively treat those patients who will experience bone marrow aplasia as part of radiation exposure that is higher than 1-2 Gray (Gy). Acute radiation syndrome (ARS) is the complex of organ system injuries that occur from the radiation exposure. The organ systems show a classical clinical prodrome that correlates to radiation exposure dose. This syndrome will affect bone marrow, gastrointestinal, cutaneous, pulmonary, and neurovascular systems. These patients will require the expertise of intensivists and those experienced in managing systemic inflammatory response syndrome (SIRS), multiple organ dysfunction (MOD), and multiple organ failure (MOF) that may result. This chapter provides an overview for the hematologist-oncologist in managing patients who may present after an R/N incident.

Original languageEnglish
Title of host publicationOncologic Emergency Medicine
Subtitle of host publicationPrinciples and Practice: Second Edition
PublisherSpringer International Publishing
Pages543-553
Number of pages11
ISBN (Electronic)9783030671235
ISBN (Print)9783030671228
DOIs
StatePublished - Apr 22 2021
Externally publishedYes

Keywords

  • Acute radiation syndrome
  • Biodosimetry
  • Colony-stimulating factors
  • Cytokines
  • Granulocytopenia
  • Hematopoietic
  • Improvised nuclear device
  • Lymphocyte depletion
  • Nuclear
  • Nuclear power plant
  • Nuclear weapon detonation
  • Radiation
  • Radiation dispersal device
  • Radiation exposure device
  • Radioactivity
  • Radiological
  • Stem cell transplantation
  • Terrorism

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