RADIATION EXPOSURE INCIDENTS: INTERPROFESSIONAL APPROACHES TO DETECTION, DECONTAMINATION, PHARMACOLOGIC PROTECTION, AND EMERGENCY RESPONSE WITH NURSING AND FAMILY MEDICINE PHYSICIANS ROLE

Abstract

Radiation exposure incidents represent a critical public health emergency demanding a coordinated interprofessional response from healthcare systems globally. These incidents, which can arise from nuclear accidents, radiological dispersal devices (dirty bombs), or occupational mishaps, pose unique challenges because radiation exposure produces no immediate sensory warning. The consequences can range from mild symptoms to fatal Acute Radiation Syndrome (ARS), which involves multi-system damage (hematopoietic, gastrointestinal, cutaneous, and neurovascular systems) depending on the dose received. Historical events, including Chernobyl and Fukushima Daiichi, underscore the critical importance of organized emergency response protocols.

The purpose of this review is to comprehensively examine radiation exposure incidents, focusing on the necessary interprofessional approaches for effective detection, decontamination, pharmacologic protection, and emergency response. Detection in the absence of facility alarms often relies on high clinical suspicion when patients present with non-specific prodromal symptoms such as early nausea and vomiting. Healthcare providers can utilize the Andrews Lymphocyte Nomogram as an early biologic indicator to estimate the absorbed radiation dose based on the rate of lymphocyte depletion within the first 24 hours. Decontamination protocols emphasize the principle of "life before decontamination," ensuring that acute medical emergencies are addressed first. The most effective single measure is emergency disrobing, which removes approximately 80 to 90 percent of external contamination, followed by a combined approach of dry and wet decontamination for superior contaminant removal.

The clinical progression of ARS involves a prodromal phase (early symptoms) followed by a latent phase lasting one to three weeks, during which patients appear relatively well despite progressive bone marrow suppression, posing a diagnostic challenge in primary care. Pharmacologic protection involves targeted medical countermeasures. Potassium Iodide (KI) is the most established intervention, effectively blocking thyroid uptake of radioactive iodine, with maximum effectiveness when administered within two hours of exposure. Other agents include Prussian Blue, which enhances the fecal excretion of cesium and thallium, and DTPA (diethylenetriaminepentaacetic acid), a chelating agent used for internal contamination with transuranium elements like plutonium and americium.

Nursing professionals are critical frontline responders, essential for initial assessment, triage, decontamination oversight, and providing supportive care. However, current evidence consistently reveals substantial knowledge gaps among emergency nurses regarding radiation protection and appropriate decontamination procedures. Family medicine physicians are vital for initial recognition during the non-specific prodromal or latent phases in community settings, coordinating specialist consultation, and providing essential longitudinal care for survivors. Effective management requires mandatory, standardized, competency-based education for all healthcare professionals, integrating high-fidelity simulation-based training and streamlined interprofessional communication, guided by collaborative frameworks such as the CBRN chain of survival.