P erhaps no other words in the English language evoke as many emotions as the words "nuclear" and "radiation." Visions of mushroom clouds with massive death and destruction lead to strong opinions about the nuclear age---and in many cases, fear. In reality, however, radiation is all around you and I, and uses for it abound in modern society.

In addition to the defense and power industries, radiation has a variety of applications in both medicine and industry. Unfortunately, these uses, along with transportation of the materials involved can pose a risk to EMS personnel and others who may be called to respond to a radiation emergency. But with minimum training and equipment, these risks can be minimized while still allowing effective patient care to be delivered.

Case Presentation

Police, fire and EMS personnel are dispatched to a reported traffic accident with injuries a few blocks from a local hospital. Upon arrival, responders find a collision in which a small utility truck has been broadsided by a tractor-trailer. The driver of the tractor-trailer is unhurt, but the driver of the demolished pickup is pinned in the wreckage, severely injured and unconscious.

During extrication, the EMS team is able to partially access the patient. The caregivers discover that he has a closed head injury and flail chest in addition to significant soft tissue wounds around the face. Vital signs are: blood pressure?158/96; respirations?14 and irregular; and pulse?66. They suction the patient, place an oropharyngeal airway and deliver oxygen via a non-rebreather mask. The providers also attempt to establish an IV but are unsuccessful due to limited access. After approximately 30 minutes, they free the patient and quickly place him on a long spine board and prepare him for transport to a nearby Level 1 trauma center.

Just prior to transport, fire/rescue personnel point out that the patient had been lying on a cardboard box, which they now note is marked with a hazardous materials (hazmat) label indicating it contained radioactive substances. The box is smashed, and the container inside is broken. Due to the patient's location during extrication, it is assumed that much of his facial trauma may have been caused by contact with the smashed box and container.

Glossary of Terms

• Alpha Particles ? the nuclei of helium atoms that are given up when struck by ionizing radiation.
• Beta Particles ?- particle given up by an atom when struck by ionizing radiation, usually electrons.
• Contamination -- the condition in which radioactive particles may be found in or on a patient's body, presenting a continued risk to the patient and to those who may come in contact with the patient.
• Decontamination -- the process by which contaminants are cleaned off a patient or piece of equipment.
• Exposure ? the result of radioactive energy being transmitted through the air.
• Gamma Wave ? an electromagnetic wave, similar to X-rays.
• Geiger Counter ? a device used to measure radiation emanations.
• Ionizing Radiation ? a form of radiation that occurs when the radiation that occurs when the radiation striking an object has sufficient energy to cause atoms in that object to gain or lose electrons.