Serving the “Worried Well” Following a Radiological Emergency

By Dr. Y

In 1987, scrap metal scavengers in Goiania, Brazil, a city of about a million people, found a strange machine in an abandoned cancer clinic. Salvaging and dismantling the device, they found a small and enigmatic metal cylinder that aroused their curiosity – opening it up they found a fine blue powder. What they didn’t know was that the device was a cancer therapy machine, the cylinder was a radioactive source, and the powder was radioactive cesium. When all was said and done four people had received a fatal dose of radiation, over a hundred had received significant doses of radiation, and 249 needed decontamination. When news of the accident got out, about 112,000 people showed up at the soccer stadium to be surveyed – approximately 10% of the population.

Consider that number in terms of our major cities. Ten percent of the daytime population of New York City is a million people. Ten percent of our other major cities is hundreds of thousands of people seeking screening and reassurance that they have not been harmed by radiation or radioactivity. The CDC is promoting the concept of Community Reception Centers (CRCs) – something that has been a part of nuclear power plant emergency response planning for some time. 

Of course this assumes that these hundreds of thousands know to go to CRCs, which may not be the case. Even with CRC plans in place it is still a concern that hospitals might be overwhelmed by uninjured people who are worried about their health. This would not only take attention away from those who may badly need medical attention but can also delay the radiological surveys that the population so desperately wants because most hospitals simply are not set up to perform this level of screening.

For the uninjured person – contaminated or not – hospitals actually have little to offer. The best and fastest way to identify those who have skin contamination, or who have had an uptake of radioactive materials, is to have them scanned by trained responders wielding appropriate radiation survey instruments – exactly the sort of attention they will receive at an operating CRC.

At the same time, hospitals have an obligation to treat those who show up at their doors and many hospitals interpret this to mean that they cannot turn away even healthy people who are asking to be scanned for radiation. Ironically, trying to live up to this admirable interpretation of their obligation serves neither the hospitals nor those who desire screening – what is needed is a way to give hospitals permission in times of radiological emergency to redirect the “worried well” to radiological screening stations. This will free hospitals to carry on their core mission of treating the sick and injured, and will also route the public towards stations that can screen them more rapidly and more thoroughly for both external and internal radioactivity. By so doing both the injured and the concerned are better-served.

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Dr Y is a certified health physicist, trained in nuclear power plant design and operations, with experience in nuclear power, environmental science, and planning for radiological and nuclear emergencies. He has 30 years of experience in the areas of nuclear and radiation safety.

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