Medical Effects of Ionizing Radiation (MEIR) Course

SCENARIOS

Scenario 1 – Destroyed aircraft factory

A soldier was part of a reconnaissance patrol that sought shelter at 2200 hours last night in the ruins of a
destroyed aircraft factory. He had onset of vomiting approximately 0500 today which lasted until 1200
hours. The time is now 1600 and the soldier just returned from patrol. He feels better but is fatigued and
still has nausea. He has had 3 episodes of watery diarrhea. The soldier has no wounds, drank only
bottled water, ate MRE’s and consumed no local food. On examination, the soldier has normal vital signs
and an unremarkable physical exam.

Three other members of the patrol also experienced nausea, but no vomiting. No one consumed
anything other than MRE’s and bottled water.

Slide 38 of Radiation, at 6-15 Gy (600-1500 rem), gastrointestinal effects are present.

a. What is your differential diagnosis? [Determination of which one of two or more diseases with
similar symptoms is the one from which the patient is suffering. Also called differentiation]

Acute Gasteorentis Syndrome (GI) & ARS

Radiation vs Contamination
Hematopoietic 1-5 Gy
Gastrointestinal syndrome generally begins with doses >5 Gy
Cerebrovascular syndrome is observed at dose >20-30 Gy
A whole-body or significant partial body dose >10 Gy is lethal
Actually no one has been known to survive a whole body dose greater than about 8 Gray

GOOD PROGNOSIS ARS

• Vomiting starts > 4 hours after incident
• No significant change in serial lymphocyte counts within 48 hours after an incident
• No other significant injuries
POOR PROGNOSIS ARS
• Coma, Seizures
• Vomiting less than 4 hours after incident
• Serial Lymphocyte counts drop more than 50% within 48 hours
• Bloody vomitus or stool
• Other serious injuries

• Stochastic
– Effects that occur by chance (not unequivocally related to exposure)
– Increase in probability proportional to increase in dose
– Cancer and hereditary effects
• Deterministic
– Minimum dose required to produce effect - threshold
– Magnitude of effect increases with dose
– Clear, unambiguous causal relationship between exposure and effect
• Acute Radiation Syndrome
• Cutaneous injury
• Ocular injury
• Sterility
• Chronic Radiation Disease

b. What lab work will you request at a field hospital?

CBC, UA, CRP, Serum Amylae, FH3 Ligrad (Hemotology, biodosimetry assay)
Radioactive materials used in the laboratory to perform “in-vitro” or test-tube studies on blood, urine, or
cells for the diagnosis of diseases.

c. How can you confirm or exclude the presence of a radiological or chemical hazard at the site
of the abandoned factory as a cause for this condition?

CAMS, M256, Gelger counter, M8 paper (chemical agent testing at the aircraft factory)

Chernobyl disaster - This capability still needed to be confirmed experimentally, and previous tests had
ended unsuccessfully. An initial test carried out in 1982 showed that the excitation voltage of the turbine-

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 Medical Effects of Ionizing Radiation (MEIR) Course
SCENARIOS
generator was insufficient; it did not maintain the desired magnetic field after the turbine trip. The system
was modified, and the test was repeated in 1984 but again proved unsuccessful. In 1985, the tests were
attempted a third time but also yielded negative results. The test procedure was to be repeated again in
1986, and it was scheduled to take place during the maintenance shutdown of Reactor Four.

d. Given that the patient has ARS affecting the hematologic system: discuss what clinical
features and laboratory findings you’ll find during the prodromal, latency, and clinical stages.

Vomiting, diarrhea, nausea, mostly asymptomatic – mild weakness, bone marrow atrophy –
infection and hemorrhage (2 days, hair lost) person not ready to work

e. What treatment modalities will you use?

Basic support care – fluid membrane, transfusion support, surgery, biodosimetry (due to higher
CBC count)
Burn due to sleeping near the radioactive source – treat like normal burns (good basic care), fluid,
anti-biotic, consider interim feeding (or higher echlon for better care)
Colony stimulating factors!!

f. What long-term follow-up will you recommend?

Shield around the source, freeze, robot pick up, bury/waste procedures.
Follow up the rest of his career/life
Skin care follow up – depends on the burn (size & severe)

Cancer follow up – Leukemia / cataract (2Gy)

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