An incident involving even a single casualty from an incident involving radiological materials is likely to trigger widespread community concern. Significant numbers of individuals may seek assessment and reassurance about potential health effects, from hospitals and other clinical providers.

The nature of radiation is frequently poorly understood, and this may create anxiety even amongst health professionals. The principles of ionising radiation, its health effects and treatment should be included in clinical education to address knowledge deficits. Enhanced understanding is relevant, not just in preparedness for radiological incidents, but also to the concept of justification in the use of diagnostic radiology. Justification is the principle of minimising exposure to ionising radiation unless the benefit outweighs the risk of harm.

Organisationally, a structured approach to the management of radiological incidents is essential to ensure occupational safety of personnel, and appropriate allocation of resources. Preparedness for radiological events is a component of the all hazards approach that ambulance and hospitals must address as part of emergency planning. Planning must consider both mass casualties and the hazardous nature of radioactive substances. Procedures should be documented as part of emergency response plans, taught and exercised.

The Australian Health Protection Principal Committee (AHPPC) commissioned a comprehensive technical guide for clinicians and public health professionals to provide a reference for education and planning for the management of radiation incidents. The document also needed to provide specific therapeutic indications and protocols for the use of decorporation agents used to treat radiation injuries. The Guidelines were developed to complement existing national guidelines on Anthrax, Smallpox and Chemical Agents.

The ARPANSA Technical Report Series number 131, Medical Management of Individuals Involved in Radiation Accidents, 2000 formed the starting point for development of the Australian Radiological Clinical Guidelines. At times, content in these Guidelines is based on ICRP 60 rather than the updated ICRP 103, 2007 Recommendations of the International Commission on Radiological Protection. Whilst these are likely to be adopted within Australia in the near future, they have not been endorsed at the time of writing.

The Guidelines aim to provide:

  • A plain language, practical manual written for clinicians to address basic knowledge gaps
  • Sufficient information to contribute to realistic risk assessment
  • Technical content consistent with contemporary evidence-based clinical practice
  • Health professionals with resources to facilitate the administration of clinical care in a mass casualty radiation event.

The Guidelines do not include laboratory methodology, as this is beyond the scope of this document.

Contributors to this document include:
Dr Stephen Solomon, ARPANSA
Cmdr Alison McLaren, RAN
Dr Andrew Pengilley, ACT Department of Health
Jon Byrne, Ambulance Victoria
Dr Jane Canestra, Victoria Department of Health

Special thanks go to Dr Lindsay Murray, University of WA, Sir Charles Gardiner Hospital, and Poisons Information Centres WA/NSW/Qld, and Mr Jeff Robinson, Victorian Poisons Information Centre for their assistance in reviewing the toxicological content of these guidelines.

Dr Jane Canestra
Chair of the Writing Group for National Clinical Guidelines for Radiological Emergencies