The threat of use of radiological materials or nuclear weapons is at its highest point since the end of the Cold War. This chapter summarizes the environment, dangers, planning recommendations, and response techniques for EMS personnel when involved as providers or victims in a radiological or nuclear event. Selected resources are identified.

Radiation: definition and effects

Radiation consists of subatomic particles and electromagnetic waves that can interact with matter. Non-ionizing radiation causes excitement of atoms and molecular structures, and ionizing radiation can remove electrons from atoms and break interatomic and molecular bonds, including single- and double- strand breaks of DNA chains. Ionizing radiation has the capability to cause gross surface and subsurface damage, and incrementally impairs the ability of the body to repair those injuries. The latter effect, typically called a “radiation burn,” requires a different medical response than is typical for thermal burns [1].

Ionizing radiation materially damages the immune system, with permanence depending on radiation dose and probabilistic long-term effects, and requires a multifaceted care environment for injury and recovery.

Ironically, medical personnel, who have ample scientific training beyond that of the general public, are not immune to fear of the effects of radiation created by the entertainment industry. This was confirmed at a major “dirty-bomb” drill in North Texas in 2004 [2]. In that exercise, a large sports venue held 2,500 volunteers and the number of EMS personnel as would be present for an event with capacity of 275,000. State authorities secreted minor radiation sources, commonly available at sporting goods stores, on “trauma victims” with moulage wounds. When patients arrived at the 35 participating hospitals with varying levels of trauma, and hospital personnel detected the radiation sources, all closed temporarily (went to “divert” status) due to the presence of contamination. The local public health authority made a decision to require “contaminated” hospitals to continue to accept contaminated patients, because the authority had received radiation training a few weeks prior to the exercise. In a real-life scenario, fear of radiation can negatively affect operations due to reluctance of medical personnel to handle exposed or minimally contaminated patients. In addition, emergency facilities are likely to be overwhelmed with terrified but uninjured citizens.

Normal radiation environment

The human species developed in a radioactive world. Ionizing radiation from the sun, rocks, cosmic rays, and from naturally occurring radioisotopes in the environment has continually bathed all life on earth since life began. The background radiation level of the earth is actually less now than at the generally accepted date of Homo sapiens’ first appearance. Approximately 0.03% of the potassium on the earth is potassium-40 (K-40), a radioactive isotope with a half-life of 109 years, which decays while emitting powerful gamma rays. Since K-40 is ubiquitous, any foods that contain potassium are radioactive, and human bodies are radioactive as well. We live in a constant bath of ionizing radiation, and DNA strand breaks and radiation-generated chemically active free radicals result from this radiation. In addition, granite, which is widely found on the earth’s surface and used in buildings, contains small amounts of uranium, which generates many radioisotopes as it decays. Radon, a radioactive inert gas that accounts for over half the background radiation exposure in the United States, is a product of uranium decay. Ionizing radiation is simply everywhere in our existence. Excessive amounts of radiation are problematic because the physical re- pair mechanisms we have developed to cope with the background radiation on planet earth become over- whelmed.