Boston University Medical Campus
Nuclear Accident Preparedness Program

Radiation Injury

	Photograph showing epilation reaction to radioactive emanations sixty-three days after the Nagasaki explosion Reprinted courtesy Eastman Kodak Company
	Typical flash burn of exposed portions of the skin as it appeared sixty-three days after the Nagasaki explosion. Reprinted courtesy Eastman Kodak Company

Radiation accident, Goiania, Brazil, Sept 13, 1987:

Radiation accident, Goiania, Brazil, Sept 13, 1987. External irradiation of hand and thigh. Pictures were taken by Erwin F. Hirsch, M.D., Professor of Surgery of Boston University School of Medicine and IAEA consultant, in December 1987 roughly three months post-exposure.

The radiation accident that took place in Goiania, Brazil, Sept 13, 1987, is the best characterized of radiation accidents giving a clear picture of medical and public health response. A private radiotherapy institute moved to new premises, leaving behind a teletherapy unit containing a Ce-137 source, without notifying authorities and without securing the site. During site demolition, the unit was partly demolished. Two people entered the premises to search for scrap metal and removed the source assembly, taking it home to try to dismantle it. In the attempt, the source capsule ruptured. The source was in the form of pellets of cesium chloride salt, of the size of rice grains, highly soluble and readily dispersible. They sold the remnants of the source assembly to a junkyard owner. Over a period of five days, friends and family, noticing that the pellets glowed in the dark, took them home as trinkets. Some were played with, contaminating hands, and causing the material to be ingested. The people began showing gastrointestinal and flu-like symptoms, hair loss, and general malaise, not initially recognized as due to irradiation. Public health authorities became aware that a radiation accident may have occurred when one of the victims, making a connection between the illnesses and the source capsule, took the source remnants to the municipal public health department; this action set into play the medical response and remedial actions.

Twenty people were identified by medical triage as needing hospitalization. Triage was performed in a soccer stadium in which 112,800 people were monitored from September 30 through December 21, 1987. 249 people were internally or externally contaminated (skin and/or clothing) and 2000 sq m of the environment was contaminated. Four people died within four weeks of hospital admission. Estimated dosages received ranged from 4.5-6.0 Gy (total body dose, independently estimated based on cytogenetics). Two people survived such a dosage.

Medical response: Initially, patients’ skin was decontaminated and clothing discarded. Desquamation from their injuries was cared for. Nursing care, daily medical examinations, and urine/fecal sampling provided the basis for continued therapy. Decorporation using Prussian Blue, for those internally contaminated, continued for more than two months until safe to discharge from hospital. Cytogenetic analysis was used to distinguish severely irradiated victims from those less exposed. Contaminated body fluids and waste were managed.

Remedial actions: Authorities brought all potential sources of contamination under control, first, which took three days, then took actions to bring back normal living conditions, which took until March 1988. Radiation surveys on foot and by car and airplane were conducted to determine and monitor the areas of contamination. Sampling of air, food and fruit, soil, groundwater, sediment, river water, and drinking water took place. Environmental contamination necessitated evacuation of 41 residences, demolition of seven homes, and removal of large amounts of soil by heavy machinery. Waste was placed first into temporary planned waste storage then moved to permanent planned storage. The total volume of waste was 3500 cubic meters, more than 275 truckloads. Heavy rain that fell between Sept 21 and 28 complicated the response by dispersing cesium further into the environment rather than washing it away; radioactive materials were found to be deposited on roof tops after the rainfall instead of washing out.

Lessons learned:

1. Nothing can diminish the civil (and potentially criminal) responsibility of persons liable for the security of a radioactive source.
2. Strong political and public pressures caused authorities to set remedial action levels at substantially restrictive levels. To meet these levels, a substantial economic cost was borne over and above the burden of the accident itself. Authorities had to allocate workers and machinery equivalent to the task. The large volume of waste, and consequent high economic burden, was directly attributable to these restrictive levels. There would have been much less waste and less cost if higher action thresholds had been set.
3. Known therapeutic measures and remedial actions were used and validated. The experience in Goiania confirmed in general the adequacy of existing diagnostic techniques, antibiotics, measures for platelet separation, and transfusion, as well as the efficiency of Prussian Blue in eliminating internal contamination by Ce-137. Once engaged, the response was well-understood, showing the importance of a clear chain of command. Authorities laid out a plan and followed it.
4. On the other hand, medical treatment is complex, long, and varied depending upon the amount and type of radiation exposure. It involves many medical and non-medical disciplines. Care must be rendered by medical staff who are engaged on a daily basis. Generally, medical personnel and hospitals are not prepared for this type of injury, care, or emergency.
5. Ability of the general public to recognize the potential danger of a radiation source is important. Many ways of notifying, communicating, and educating must be employed to increase public awareness.
6. How a source is packaged, its physical and chemical properties, has bearing on the potential danger. In this accident, pellets were insidious in their small size, easy to handle.
7. Documenting an accident, and disseminating lessons learned to the emergency responders and to the public, acts as refresher training, keeping the important points in mind and preventing the facts from being blurred with the passage of time.

Source: The Radiological Accident in Goiania, International Atomic Energy Agency, Vienna, 1988 (permission granted to reproduce).