Initial hospital management of irradiated and radio-contaminated victims in case of accidental exposure of populations

The current risk of radiologic exposure of the population occurs in many circumstances. The industrial accident is remarkably illustrated by the Tchernobyl event. Another kind is still virtual but the international situation does not allow to turn this hypothesis down. It is terrorist utilization of radioactive material. In these situations, medical problems are specific and require particular knowledge about the two forms of exposure which are external irradiation and external and internal contamination. Pathophysiological mechanisms of radiation effects concerning biological tissues are similar in these situations but care actions are dedicated. These elements are mandatory for the elaboration of procedures for the reception of irradiated or contaminated victims, being wounded or not, in a first-aid department. These procedures must comprise two aspects: the recognition of the radiologic exposition and the therapeutic actions taking into account the severity of associated injuries. Diagnosis of a radioactive contamination is rather simple by external detection. Conversely, to estimate the reality of an external irradiation is much more difficult but necessary for dosimetric evaluation. This latter is of the highest importance for the prevision of delayed clinical manifestations. At the hospital level, despite the training effort for first aid departments staff, the nuclear medicine physician, specialist for radioactive contamination, can play a specific role for the preparation of the equipment, the procedures and during intervention after a radiologic event has happened. This emphasizes the obligation for him to update his knowledge about this subject. (author)