Radiological Weapons

Ionizing radiation and its effects are discussed in detail elsewhere (see Radiation Exposure and Contamination). Mass casualties due to ionizing radiation can result from the detonation of a nuclear (fission) or a thermonuclear (fusion) device, from the contamination of conventional explosives with radioactive material (such a weapon is called a radiation dispersal device, or a dirty bomb), or from placement (eg, under a subway seat) of a concealed point source of radiation (1).

Radiation exposure may involve

• Contamination (external or internal)

• Irradiation

• Both

Contamination is contact with radioactive material, typically as a dust or liquid. Irradiation is exposure to ionizing radiation but not radioactive material.

In cases of the deliberate use of radiation as a weapon, it must be determined whether patients have been exposed (irradiated), contaminated, or both. If contamination has occurred, determination of whether it is external, internal, or both is needed. Use of the ASBESTOS acronym (see table ASBESTOS*: Secondary Assessment of Mass Casualties Due to Chemical or Radiological Weapons) is helpful in making these determinations.

Treatment of damage from exposure is supportive in nature, with focus on the gastrointestinal tract (eg, managing nausea), preventing (isolation may be needed) and managing infections, and treating radiation-induced bone-marrow depletion. Specific antidotes are available to treat internal contamination with selected radioisotopes; therefore, identification of the isotope or isotopes involved is crucial. A clinical resource for the diagnosis and management of radiological casualties is the online and downloadable module, Radiation Emergency Medical Management (REMM).

(See also Overview of Incidents Involving Mass-Casualty Weapons.)