12.1 Public Health
113
a hematologist who has an understanding in this area to manage those aspects of
treatment. Every Group III patient will develop severe radiation sickness, some
may suffer from radiation burns, and a high percentage are likely to die from their
radiation exposure, especially at the higher levels of exposure.
• Group IV patients will have received a dose in excess of 10 Gy and they will
not survive their exposure. Thus, caring for Group IV patients should consist
of supportive care and treating symptoms as they arise. If resources permit,
these patients can be accorded additional care, up the level provided to Group
III patients.
In addition to the whole-body effects of radiation exposure, many patients in
Groups II, III, and IV might also develop radiation injury to the skin, although many
of these effects do not appear for several weeks after exposure. These effects include
erythema (skin burns) at a skin dose of approximately 3 Gy with dry desquamation
(peeling) at a dose of about 10 Gy to the skin and wet desquamation (blistering) at
20 Gy to the skin. If this skin exposure is received from penetrating (gamma and
neutron) radiation the patient will likely die of radiation sickness; if the skin exposure
is the result of contamination with beta-emitting fallout then the patient might survive
the exposure [3].
Patients in all exposure groups might experience nausea, vomiting, and diarrhea
and these will worsen as the exposure increases. Thus, dehydration and electrolyte
depletion should be expected and monitored, and appropriate antiemetics and/or antidiarrheal medications considered. Flynn and Goans do not recommend any except
for the most necessary surgery until the patient is past the worst of the radiation
sickness.
For American cities and hospitals that lack the expertise and resources to address
the number of radiation injury patients they are confronted with, the Radiation
Injury Treatment Network can provide facilities and expertise, including transporting
patients to member hospitals in other cities for care and treatment. In addition, the
Radiation Emergency Assistance Center and Training Site (REAC/TS) can provide
medical advice and assistance.
12.1.2 Burns, Lacerations, and Other Injuries
As noted in Chap. 11, those with non-radiological injuries are likely to be quite
numerous. In particular, thermal burns from the detonation are likely to affect tens
of thousands of people with burns from the mass fires injuring still more. It is likely
that the number of serious burns will outstrip the ability of the city to care for burn
victims and many patients—possibly the majority of burn victims—will need to be
transported to a facility that can treat them properly or will have to be treated in ad
hoc burn units.
In addition, blast injuries, lacerations from broken glass, broken bones, and other
physical injuries are almost certain to overwhelm available resources; many with light
113
a hematologist who has an understanding in this area to manage those aspects of
treatment. Every Group III patient will develop severe radiation sickness, some
may suffer from radiation burns, and a high percentage are likely to die from their
radiation exposure, especially at the higher levels of exposure.
• Group IV patients will have received a dose in excess of 10 Gy and they will
not survive their exposure. Thus, caring for Group IV patients should consist
of supportive care and treating symptoms as they arise. If resources permit,
these patients can be accorded additional care, up the level provided to Group
III patients.
In addition to the whole-body effects of radiation exposure, many patients in
Groups II, III, and IV might also develop radiation injury to the skin, although many
of these effects do not appear for several weeks after exposure. These effects include
erythema (skin burns) at a skin dose of approximately 3 Gy with dry desquamation
(peeling) at a dose of about 10 Gy to the skin and wet desquamation (blistering) at
20 Gy to the skin. If this skin exposure is received from penetrating (gamma and
neutron) radiation the patient will likely die of radiation sickness; if the skin exposure
is the result of contamination with beta-emitting fallout then the patient might survive
the exposure [3].
Patients in all exposure groups might experience nausea, vomiting, and diarrhea
and these will worsen as the exposure increases. Thus, dehydration and electrolyte
depletion should be expected and monitored, and appropriate antiemetics and/or antidiarrheal medications considered. Flynn and Goans do not recommend any except
for the most necessary surgery until the patient is past the worst of the radiation
sickness.
For American cities and hospitals that lack the expertise and resources to address
the number of radiation injury patients they are confronted with, the Radiation
Injury Treatment Network can provide facilities and expertise, including transporting
patients to member hospitals in other cities for care and treatment. In addition, the
Radiation Emergency Assistance Center and Training Site (REAC/TS) can provide
medical advice and assistance.
12.1.2 Burns, Lacerations, and Other Injuries
As noted in Chap. 11, those with non-radiological injuries are likely to be quite
numerous. In particular, thermal burns from the detonation are likely to affect tens
of thousands of people with burns from the mass fires injuring still more. It is likely
that the number of serious burns will outstrip the ability of the city to care for burn
victims and many patients—possibly the majority of burn victims—will need to be
transported to a facility that can treat them properly or will have to be treated in ad
hoc burn units.
In addition, blast injuries, lacerations from broken glass, broken bones, and other
physical injuries are almost certain to overwhelm available resources; many with light