Radiation Sickness: Prevention, Identification, and Treatment in a Collapsed Society

Radiation sickness, also known as acute radiation syndrome, can be prevented and treated, if necessary, in most people, even in a collapsed society, providing that preparations have been made. 

Radiation sickness is that damage to the body caused by a large dose of radiation in a short period of time.  The degree of sickness depends on the dosage.  Radiation sickness does not arise from low-dose imaging tests like X-rays or CT scans.  Excluding the bombings of Hiroshima and Nagasaki in WWII, most cases of radiation sickness have occurred after industrial nuclear accidents like Chernobyl in 1986 and Fukushima in 2011.  Those close to the scene of the blast or accident may receive doses that are quickly fatal and there will be little we can do to help them.  We can, however, help those who receive lower doses. 

Preventing and Reducing Radiation Exposure

• Relocate so that you are not living in or near a potential nuclear target such as a big city or a military base.  An ounce of prevention is worth a pound of cure.
• If, however, the bomb has already exploded, immediately decide whether to evacuate or take shelter.  After arriving at your shelter but before entering, or evacuating and arriving at a safe location, remove contaminated clothing and leave it far clear of yourself and others.  Shower and shampoo well. 
• Cresson Kearney’s Nuclear War Survival Skills manual (link below) contains detailed information on constructing an emergency shelter to reduce radiation exposure.  Dr. Alton’s Survival Medicine Handbook (3^rd and 4^th editions are identical) addresses this issue to the extent of decreasing exposure, including taking potassium iodide tablets, and symptoms of those who receive excessive doses.  Survival and Austere Medicine, 3^rd Edition, presents more detailed information for roughly identifying the degree of radiation exposure.

Identifying the Extent of Radiation Exposure

The severity of signs and symptoms depends on several factors:

• The strength of radiated energy[1] [2]
• Exposure time[3] [4]
• The distance between the person and the radiation source[5]
  
• How sensitive the affected tissue is (bone marrow, gastrointestinal, cerebral, and vascular tissues are more sensitive)[6]
• Total or partial body exposure[7] [8]

Initial signs of treatable radiation sickness:

Nausea and vomiting[9]

The amount of time between exposure and presentation of symptoms indicates how much radiation was absorbed. [10]

• Mild:  hours to weeks before symptoms present[11]
• Serious: Minutes to days after exposure[12]

After the first round of radiation sickness there may follow a period without any symptoms, which is then followed by new symptoms. [13]

• Diarrhea[14]
• Headache[15]
• Fever[16]
• Dizziness and disorientation[17]
• Weakness and fatigue[18]
• Hair loss[19]
• Bloody vomit and stools from internal bleeding[20]
• Infections[21]
• Low blood pressure[22]
  

Acute Radiation Syndrome[23] Whole Body Radiation from Eternal Radiation or Internal Absorption
Phase	Feature	Subclinical range		Sublethal range		Lethal range
		0-100 rad (cGy)	100-200 rad (cGy)	200-600 rad (cGy)	600-800 rad (cGy)	600-3000 rad (cGy)	>3000 rad (cGy)
Prodromal phase	Nausea and vomiting	None	5-50%	50-100%	75-100%	90-100%	100%
	Onset		3-6 hours	2-4 hours	1-2 hours	<1 hour	<1 hour
	Duration		<24 hours	<24 hours	<48 hours	<48 hours	<48 hours
	Lymphocytes			<100 @ 24 hours	<500 @ 24 hours	<500 @ 24 hours	<500 @ 24 hours
Latent phase	Duration	>2 weeks	7-15 days	0-7 days	0-2 days	None
Illness phase	Signs and symptoms	None	Moderate leukopenia	Severe leukopenia, purpura, hemorrhage, infection		Diarrhea, fever, electrolyte disturbance	Convulsions, ataxia, tremor, lethargy
	Onset		>2 weeks	2 days – 2 weeks		2-3 days	1-48 hours
	Organ system	None		Hematopoietic and respiratory (mucosal) systems		GI tract, mucosal systems	CNS
	Hospitalization	0	<5% 45-60 days	90% 60-90 days		100% 90+ days	100% 2 weeks
	Fatality	0%	0%	0-80%	90-100%	90-100%
	Time of death			3 weeks-3 months		1-2 weeks	1-2 days

(I'm sorry this table is such a disaster.  It looks fine on my screen.  No matter how I try to manipulate it, it will not appear correctly for you.  I apologize. 

Treatment:

The advantage of the table above is that if you’ve got patients with radiation sickness, you can roughly estimate the extent of exposure and likelihood of survival.  Those with rapid onset symptoms and minimal or absent symptom-free period, particularly if they display cardiovascular and central nervous system signs, are going to die regardless of what you do.  Treatment and supplies need to be conserved for those who have better chances for living—those with only gastrointestinal and marrow suppression symptoms, delayed onset, and a long asymptomatic period may benefit from IV fluids and antibiotic treatment (if you have enough to spare).[24]

Unfortunately, most of us will not be able to store the large quantities of IV antibiotics and fluids necessary to manage radiation sickness.  Potassium iodide tablets will prevent the body from absorbing radioactive iodine, but what about radioactive cesium and strontium?  Other substances that prevent radiation uptake and eliminate it from the body were addressed in an article two years ago (link below).  The most significant, in my opinion, were calcium and pectin, and again, as always, I’m thinking I should order some more.  Do we know how effective they would be in treating more serious cases of acute radiation syndrome?  Nope.  

According to the table above, patients who receive less than 150-200 rads will display only minimal symptoms.   The greater risk is for cancer in the years ahead.  As the exposure reaches 450 rads, the death rate increases to 50%.  As the exposure approaches 800 rads, the mortality rate nears 100%.

And now you might be thinking it would be a good idea to have a dosimeter or Geiger counter for checking radiation levels.  (Remember, Cresson Kearney’s book provides instructions on building one at home with stuff you probably already have on hand.)  After all, it would be really helpful to have a handheld device just tell you how much radiation you’ve been blasted with. 

Unfortunately, the vast majority of dosimeters available—and all the ones I found on Amazon—only measure in the range of 0-1 rad, and the levels we are concerned with are tens to hundreds of rads.[25]  So while a dosimeter or Geiger counter will be handy for monitoring radiation levels after an event, neither one will do anything to help manage a patient with radiation sickness.

References:

https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

https://www.cdc.gov/nceh/radiation/emergencies/arsphysicianfactsheet.htm

https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

https://medlineplus.gov/ency/article/000026.htm

Links to related posts:

Do You Really Need Potassium Iodide Tablets?

Nuclear Events:  Making a Potassium Iodide Liquid Mixture for Children  

Eleven Substances that Prevent Radiation Uptake and Eliminate Radiation from the Body  

Nuclear War Survival Skills  

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[1] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[2] https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

[3] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[4] https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

[5] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[6] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[7] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[8] https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness

[9] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[10] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[11] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[12] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[13] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[14] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[15] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[16] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[17] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[18] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[19] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[20] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[21] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[22] https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058

[23] Survival and Austere Medicine, 3^rd Edition, 2017, 365.

[24] Survival and Austere Medicine, 3^rd Edition, 2017, 365.

[25] Survival and Austere Medicine, 3^rd Edition, 2017, 364.