Radiation sickness, known as acute radiation syndrome (ARS), is a serious illness that occurs when the entire body (or most of it) receives a high dose of radiation, usually over a short period of time. Many survivors of the Hiroshima and Nagasaki atomic bombs in the 1940s and many of the firefighters who first responded after the Chernobyl Nuclear Power Plant accident in 1986 became ill with ARS.
During recent years, the threat of nuclear attack on U.S. soil has increased. The lack of efficient post-exposure treatments for victims experiencing acute radiation toxicity presents a serious problem should an attack with a radiological device occur.
Immediately after exposure, the most critical components of acute radiation syndrome are the hematopoietic (bone marrow) and early-onset of acute radiation syndrome (GI-ARS) because symptoms begin very quickly and can be lethal. However, depending on the level and location of radiation exposure, much of the lethality of both hematopoietic and early-onset gastrointestinal syndromes are potentially avoidable with proper treatment, including supportive care (fluids and antibiotics) and Neupogen, leaving complications to later responding tissues subsequently becoming a major problem.
In situations of accidental exposure, it was initially assumed that a whole-body dose exceeding 10 Gy was inevitably fatal. However, experience with nuclear accident victims suggests that when patients survive gastrointestinal and bone marrow syndromes, respiratory failure becomes the major cause of death. This effect is known as a delayed effect of acute radiation exposure (“DEARE”).
Research has shown that damage associated with the exposure to upper half body irradiation or total body irradiation is an acute, but delayed, onset of radiation pneumonitis (inflammation of lung tissue) followed by lung fibrosis. The incidence of radiation pneumonitis rises very steeply at relatively low radiation doses. A nuclear incident is likely to result in a wide, inhomogeneous distribution of radiation doses to the body that allows hematological recovery. But a higher exposure to the thorax leaves open the risk of serious pulmonary complications.
For the government, interested in saving as many citizens’ lives as possible, it makes little sense to provide care to allow people to survive the short-term effects of radiation exposure following an event, to merely have them die several weeks or months later due to the delayed effects of radiation exposure.
People exposed to radiation will get ARS only if:
• The radiation dose was high (doses from medical procedures such as chest X-rays are too low to cause ARS; however, doses from radiation therapy to treat cancer may be high enough to cause some ARS symptoms),
• The radiation was penetrating (that is, able to reach internal organs),
• The person’s entire body, or most of it, received the dose, and
• The radiation was received in a short time, usually within minutes.
The first symptoms of ARS typically are nausea, vomiting, and diarrhea. These symptoms will start within minutes to days after the exposure, will last for minutes up to several days, and may come and go. Then the person usually looks and feels healthy for a short time, after which he or she will become sick again with loss of appetite, fatigue, fever, nausea, vomiting, diarrhea, and possibly even seizures and coma. This seriously ill stage may last from a few hours up to several months.
People with ARS typically also have some skin damage. This damage can start to show within a few hours after exposure and can include swelling, itching, and redness of the skin (like a bad sunburn). There also can be hair loss. As with the other symptoms, the skin may heal for a short time, followed by the return of swelling, itching, and redness days or weeks later. Complete healing of the skin may take from several weeks up to a few years depending on the radiation dose the person’s skin received.
The chance of survival for people with ARS decreases with increasing radiation dose. Most people who do not recover from ARS will die within several months of exposure. The cause of death in most cases is the destruction of the person’s bone marrow, which results in infections and internal bleeding. For the survivors, the recovery process may last from several weeks up to 2 years.
If a radiation emergency occurs that exposes people to high doses of radiation in a short period of time, they should immediately seek medical care from their doctor or local hospital.
More Information
For more information about radiation and emergency response, see the Centers for Disease Control and Prevention’s Emergency Preparedness and Response website at www.bt.cdc.gov or contact the following organizations:
• The CDC Public Response Source at 1-888-246-2675
• Conference of Radiation Control Program Directors (CRCPD) at www.crcpd.org or 502-227-4543
• U.S. Environmental Protection Agency (EPA) at www.epa.gov/radiation/rert
• Nuclear Regulatory Commission (NRC) at www.nrc.gov or 301-415-8200
• Federal Emergency Management Agency (FEMA) at www.fema.gov or 202-646-4600
• Radiation Emergency Assistance Center/Training Site (REAC/TS) at www.orau.gov/reacts or 865-576-3131
• U.S. National Response Team (NRT) at www.nrt.org
• U.S. Department of Energy (DOE) at www.energy.gov or 1-800-dial-DOE