Radiation Emergency Medicine

In Fukushima with the nuclear disaster still ongoing, it is necessary that we develop radiation emergency medical systems that can respond to every possible type of incident in the NPP involving radiation exposure/contamination. Fukushima Medical University Hospital regards radiation emergency medicine as an applied general clinical practice, which requires a few radiation emergency specific protocols. Therefore, our radiation emergency medical protocol was developed on the basis of the existing Japan Advanced Trauma Evaluation and Care (JATEC™), incorporating protocols specific to radiation emergency, and making these protocols easy to follow by physicians with no previous experience in radiation emergency medicine. One of our goals is to make the protocol applicable for any type of external threat expressed as chemical, bacterial, radiological, nuclear, or explosive (CBRNE) incidents.

Basic Principles

• Medical care is provided even when the patient is contaminated with radionuclides.
• If contamination is detected, take appropriate radiation safety measures and set up a contamination-controlled area.
• Higher priority is given to normal critical care than radiation emergency medical care.
• Radiation exposure screening and decontamination should be completed as soon as possible, making sure to minimize disadvantages to the patient.
• Undress the patient either before or during an early stage of physical examination.
• Primary survey and resuscitation should be performed in the contamination-controlled area.
• Decontamination should be performed before exiting the contamination-controlled area.
• Measures to prevent the spread of contamination (i.e., covering the contaminated areas with dressings) should be applied before exiting the contamination-controlled area if the surface contamination density is not below the level defined by the hospital.
• Internal and external exposure dose assessment requires careful evaluation of measured doses, as well as history of acute radiation syndrome, particularly, the initial symptoms such as vomiting, fever, diarrhea, and cognitive dysfunction.
• The clinical protocol and standard level of surface contamination density should be determined according to the regulations of the Ordinance on Prevention of Ionizing Radiation Hazards and the current conditions of each institute, as they may vary depending on the severity and urgency of the case, the capability and availability of the medical facilities and resources, and time phase of the disaster.