Editor's Choice

“Doctor, come quickly. There's been a nuclear incident”

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7439.0-g (Published 04 March 2004) Cite this as: BMJ 2004;328:0-g
  1. Richard Smith (rsmith{at}bmj.com), editor

    A friend of mine was recently late for the opera because he was preparing south London's plan for a nuclear attack. Despite living south of the Thames I don't think the plan justified missing the first bars of Turandot. But imagine the phone going in the middle of the night and a voice saying: “Doctor, can you come quickly? There's been a nuclear incident.” Would you have any idea how to respond? The evidence suggests you wouldn't, which is why it might be a good idea to read our clinical review on the subject (p 568).

    Unintentional and unexpected radiation incidents have so far been rare, with 134 deaths from 420 incidents worldwide between 1944 and 2002. Typically people find shiny metallic objects, put them in their pocket, and take them home—failing to realise that the objects are radioactive. The fear now is of a terrorist attack—the explosion of a “dirty bomb” or the dispersal of high activity radioactive sources through air conditioning, subways, drinking water, or food. Hundreds or thousands might die.

    Symptoms of radiation sickness come in phases. With higher doses the phases come more quickly and last for a shorter time. Nausea, vomiting, weakness, and fatigue are followed by infection, bleeding (from gums and nose), and gastrointestinal symptoms. Doctors may misdiagnose radiation sickness as food poisoning or infection. Radiation may also cause injuries to skin, but these may evolve over months.

    Doctors who identify a radiation incident should start by controlling the spread of radioactivity. A differential blood count will help assess the severity of exposure. Contaminated clothing should be removed, and the patient might be showered. If after exposure the patient doesn't vomit then outpatient surveillance may be enough. Vomiting within one or two hours probably requires admission to a haematology ward, while vomiting within an hour accompanied by other symptoms means care in a centre of radiopathology.

    We are, of course, much more used to radiation as a useful diagnostic tool, and medical tests are the largest manmade source of radiation exposure. In most affluent countries medical sources of radiation were one fifth of natural radiation in 1987 but equal to it by 1997. We are, argues Eugenio Picano, overdoing it (p 579): “long term risks are not being weighed against the immediate short term benefits.”

    Several letters attempt to weigh the importance of a paper on the the long term effects on cognitive function of infants who had skin haemangiomas treated with radiation (p 581). The findings are probably relevant to computed tomography. One paediatrician told me that this was the most important paper in paediatrics in five years, while others don't think the findings relevant to today. A letter from authors at the National Radiological Protection Board suggests that the brain dose from computed tomography may be as high as those seen in the study. We are seeking further guidance for readers.


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