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The rapid responses to Turai et Al’s1 review provide an interesting
thread, which is worthy of further comment. Firstly Benger,2 identifies
the important issue of emergency worker safety with specific mention of
firefighters suffering radiation injury at Chernobyl. In doing so he
challenges Turai’s statement that the management of life threatening
injury should take precedence over decontamination for radioactive
material. While there are undoubtedly situations within radiation
incidents where emergency worker and patient safety could be threatened,
these considerations do need to be separated from the simple management by
appropriately trained and equipped staff of a casualty contaminated with
radioactive material. In this situation, Turai and his colleagues are
correct in asserting that risk assessment determines that life-threatening
injury to the patient predominates, and must be the immediate priority.
This assessment for contamination with radioactive material is of course
spectacularly different from some chemical scenarios, where chemical risk
to casualty or carer determines that immediate decontamination must occur
before any treatment consideration. This difference must be appreciated
by both those who produce decontamination plans, and of equal importance
by those who have to carry them out. Knowledge of the hazard is at least
important as knowledge of how to protect oneself in the delivery of
affective emergency response. I never cease to be surprised how few
health professionals, emergency workers, or members of the public can
explain even the simple difference between radiation and contamination if
asked to do so.
The contamination theme continues in Tidd’s3 comment on the need to
consider alpha and beta radiation. Of course the range of these
radiation’s determine that they only pose a hazard if contamination of the
individual occurs with radioactive material which emits them. For pure
alpha emitters, the contamination needs to be internal (i.e. inside the
body) for a hazard to occur. In fact Turai’s paper does describe skin
injury which could result from heavy beta emitter contamination. Tidd’s
interest however appears to be focussed on the longer-term effects of
radiation in terms of carcinogenisis and he extends the debate into public
counter measures proposing precautionary use of stable iodine prophylaxis.
In my commentary4 I drew attention to the Uk’s well developed and
promulgated system for intervention and early urgent counter measures.
These include the use of stable iodine and are based on defined triggers
of the radiation dose averted by their use. A prerequisite for such a
national policy is of course the availability of expertise able to make
such assessments which in turn is directly relevant to the comments of
Lewis5 in his response.
Considerations of information on hazard is also relevant to
Buscombe’s6 response questioning the actual level of risk of terrorist use
of radioactive material. His assessment I believe, significantly
underplays the importance of induction of panic as a potential terrorist
objective. Such is the media and public profile of radiation issues,
often raised for reasons which are somewhat obscure, by the use in
headlines and articles of the word “nuclear”, there appears little doubt
that terrorist use of radioactive material could produce significant panic
and disruption. Such panic could well be far greater than could be
justified by the actual hazard to health produced. This observation
returns us to a basic conclusion that hazard knowledge and information for
health professionals, emergency workers, the media and the public provide
perhaps the key element in considering defense again such attacks.
1 Turai I Vieress K, Gunalp B, Souchevitch G, Medical response to
radiation incidents and radionuclear threats. BMJ, Mar 2004; 328: 568-572
2 Benger J, Response to radiation incidents and radionuclear
threats. BMJ 2004; 328: 1074
3 Tidd M, Response to radiation incidents and radionuclear threats.
BMJ Rapid response 11 Mar 04
4 Kalman C, How would the UK cope. BMJ 2004 328: 571
5 Lewis N, Response to radiation incidents. BMJ Rapid response 29
Mar 04
6 Buscombe J, Response to radiation incidents and radionuclear
threats. BMJ 2004 328: 1074
Competing interests:
None declared
Competing interests:
No competing interests
20 May 2004
Chris Kalman
Consultant Occupational Physician
Salus Occupational Health, Centrum Park, Hagmill Road, Coatridge, ML5 4TD
KNOWLEDGE OF RADIATION HAZARD
The rapid responses to Turai et Al’s1 review provide an interesting
thread, which is worthy of further comment. Firstly Benger,2 identifies
the important issue of emergency worker safety with specific mention of
firefighters suffering radiation injury at Chernobyl. In doing so he
challenges Turai’s statement that the management of life threatening
injury should take precedence over decontamination for radioactive
material. While there are undoubtedly situations within radiation
incidents where emergency worker and patient safety could be threatened,
these considerations do need to be separated from the simple management by
appropriately trained and equipped staff of a casualty contaminated with
radioactive material. In this situation, Turai and his colleagues are
correct in asserting that risk assessment determines that life-threatening
injury to the patient predominates, and must be the immediate priority.
This assessment for contamination with radioactive material is of course
spectacularly different from some chemical scenarios, where chemical risk
to casualty or carer determines that immediate decontamination must occur
before any treatment consideration. This difference must be appreciated
by both those who produce decontamination plans, and of equal importance
by those who have to carry them out. Knowledge of the hazard is at least
important as knowledge of how to protect oneself in the delivery of
affective emergency response. I never cease to be surprised how few
health professionals, emergency workers, or members of the public can
explain even the simple difference between radiation and contamination if
asked to do so.
The contamination theme continues in Tidd’s3 comment on the need to
consider alpha and beta radiation. Of course the range of these
radiation’s determine that they only pose a hazard if contamination of the
individual occurs with radioactive material which emits them. For pure
alpha emitters, the contamination needs to be internal (i.e. inside the
body) for a hazard to occur. In fact Turai’s paper does describe skin
injury which could result from heavy beta emitter contamination. Tidd’s
interest however appears to be focussed on the longer-term effects of
radiation in terms of carcinogenisis and he extends the debate into public
counter measures proposing precautionary use of stable iodine prophylaxis.
In my commentary4 I drew attention to the Uk’s well developed and
promulgated system for intervention and early urgent counter measures.
These include the use of stable iodine and are based on defined triggers
of the radiation dose averted by their use. A prerequisite for such a
national policy is of course the availability of expertise able to make
such assessments which in turn is directly relevant to the comments of
Lewis5 in his response.
Considerations of information on hazard is also relevant to
Buscombe’s6 response questioning the actual level of risk of terrorist use
of radioactive material. His assessment I believe, significantly
underplays the importance of induction of panic as a potential terrorist
objective. Such is the media and public profile of radiation issues,
often raised for reasons which are somewhat obscure, by the use in
headlines and articles of the word “nuclear”, there appears little doubt
that terrorist use of radioactive material could produce significant panic
and disruption. Such panic could well be far greater than could be
justified by the actual hazard to health produced. This observation
returns us to a basic conclusion that hazard knowledge and information for
health professionals, emergency workers, the media and the public provide
perhaps the key element in considering defense again such attacks.
1 Turai I Vieress K, Gunalp B, Souchevitch G, Medical response to
radiation incidents and radionuclear threats. BMJ, Mar 2004; 328: 568-572
2 Benger J, Response to radiation incidents and radionuclear
threats. BMJ 2004; 328: 1074
3 Tidd M, Response to radiation incidents and radionuclear threats.
BMJ Rapid response 11 Mar 04
4 Kalman C, How would the UK cope. BMJ 2004 328: 571
5 Lewis N, Response to radiation incidents. BMJ Rapid response 29
Mar 04
6 Buscombe J, Response to radiation incidents and radionuclear
threats. BMJ 2004 328: 1074
Competing interests:
None declared
Competing interests: No competing interests