Radiation exposure is an unusual occurrence in the ED, and because of this emergency physicians are unfamiliar with management. Below are some quick questions to help you review.

1. Security informs you that the radiation detectors at the ambulance entrance have alarmed after the last patient came through. You should:

A. Immediately flee

B. Don a lead apron

C. Take potassium iodide

D. Ask the patient if they have recently had any medical therapy or imaging studies in the last few days

Answer D – The vast majority of alarms occur due to patients coming through the entrance who have recently had radioactive treatments (implants or etc.) or studies (like a VQ scan) involving radioactive tracers. Our alarms (located at the ambulance entrance, triage entrance to the ED and in the decontamination room in the ceiling) can detect beta or gamma radiation and alarm at levels >200 counts/minute, which is a very low level. There are algorithms in the HAZMAT radiation cupboard for your information if this isn’t the case or doesn’t fit the situation – which would be rare, and would usually imply an unrecognized exposure (legal or illegal) or, if the patient is a former KGB agent, perhaps they are being slowly and silently poisoned.

2. What is the biggest problem with a ‘dirty bomb’?

A. High levels of radiation

B. Increased severity of injuries

C. Effects on providers

D. Tons of people descending on the hospital worried that they have been exposed to radiation