The Not-So-Friendly Atom: An Overview of Radiological and Nuclear Consequence Management 


By Frank G. Rando

Since the discovery of radium by Marie Curie and her husband Pierre, there has been a mystique and fears surrounding nuclear energy. This has been reinforced by many obscure and infamous radiological and nuclear accidents. The return of Cold War fears heightened by pre-existing geopolitical instability and ongoing armed conflicts in Ukraine and in the Middle East have indeed magnified the threat of nuclear war and its devastating consequences.

With this comes the fear and uncertainty experienced by the lay populace and their perceptions. This has been facilitated by misinformation and popular culture inspired by the B-movies of the last several decades. In addition, global nuclear superpowers and the nuclear power industry have left behind a legacy of highly radioactive waste that will remain lethal for thousands of years.   

While we have come far in the areas of counterproliferation, radiological and nuclear safety, environmental remediation, reactor design, and related areas, there is a pressing need and requirement worldwide to do much more. The threats of radiological and nuclear terrorism, accidents, and global thermonuclear warfare remain real and plausible.  

In fact, the #1 U.S. Department of Homeland Security National Planning Scenario concerns the use of an improvised nuclear device (IND), and there have been several international planning sessions and exercises devoted strictly to nuclear-radiological preparedness over several decades. 

These exercises range from local preparedness exercises that test the response to nuclear power plant emergencies and radiological terrorism to international full-scale military exercises addressing tactics, strategies and consequence management of nuclear warfare. 

Most recently, NATO’s Steadfast Noon nuclear warfare exercise, the Vahalia Nuclear Preparedness Exercise held in Romania in conjunction with Norwegian support, the Arctic Radiation Exercise in High North 2023 – known as “Arctic Reihn” – to address nuclear accidents at sea, and the Sixth International Nuclear Emergency Exercise are just a few examples of exercises designed to test emergency preparedness and response to a variety of nuclear and radiological scenarios. 

In the shadow of the 1945 atomic bombings of Hiroshima and Nagasaki, the Chernobyl and Fukushima Daiichi nuclear reactor disasters, Russia’s occupation of Ukraine’s Zaporizhzhia nuclear power plant, the international legacy of radioactive waste and radiological contamination, as well as the possibility of imminent nuclear conflict, there are legitimate concerns regarding nuclear energy harnessed both for weaponry and peaceful use. In addition, the travesty and tragedy of human experimentation utilizing radionuclides accentuates these fears.  

The international community has also been active in the research, development, and stockpiling of medical countermeasures to counter the adverse health effects of ionizing radiation, as well as the overall health effects incurred on populations subjected to nuclear terrorism and warfare (i.e. thermal, blast effects and including ionizing radiation).

The difference between radiation contamination and exposure, © U.S. CDC

Nuclear and Radiological Threats

Nuclear and radiological threats include:  

  1. Nuclear warfare;
  2. Nuclear and radiological terrorism, including cyber attacks against IT assets and the use of RDDs and stationary radiological sources as weapons, intentional environmental dispersal/dissemination of radionuclides;
  3. Nuclear power generation accidents;
  4. Transportation and handling mishaps;
  5. Overexposure to diagnostic and therapeutic radiation;
  6. Criticality accidents.

Consequence Management

The consequence management goals of radiological and nuclear events may be applied across the spectrum of such events, with necessary adjustments made according to the type and magnitude of the event.

The general objectives of consequence management involve: 

  1. The lives and safety of responders and victims;
  2. Incident stabilization, including recognition and mitigation of secondary hazards;
  3. Preservation of property and the environment.

Meanwhile, general and event-specific consequence management should utilize the time-honored principles of mitigation and response: time, distance, and shielding.

Exposure Times  

The exposure times of responding personnel must be minimal and utilize the ALARA principle of “As Low As Reasonably Achievable”. Alarming dosimeters must be worn by all personnel and readings must be recorded by a radiation safety officer. Instruments must also be able to detect the energetic particles and waves of ionizing radiation, i.e. alpha, beta, gamma, neutrons. 


Any ionizing radiation exceeding natural background levels must be given its due respect, and responders and victims must be placed as far as possible from any active sources or contamination.  

The “inverse square law” specifies that the intensity of radiation goes down by the square of the distance from the source. Essentially, if the individual moves twice as far from the source of radiation, the intensity of the radiation will decrease by a factor of 4. 


Effective shielding for ionizing radiation varies with the energetic particles and waves of the radiation being emitted as well as other factors, and serves as a component of the protective countermeasures triad. The particle and wave energy level is an important factor in effective radiation shielding.

For example, a sheet of paper can stop an alpha particle, as can human skin. However, alpha emitters can be inhaled, swallowed, and deposited in the lungs, causing internal contamination and irradiation of local tissues such as the respiratory and gastrointestinal mucosa.  

Beta particles are more energetic and can cause extensive radiation burns. These “beta burns” were seen frequently in radiation incidents in the former Soviet Union such as the specialized radiological casualty facility known as Hospital #1 in Moscow. Extensive beta burns were also encountered by emergency medical services and healthcare personnel in the aftermath of the Chernobyl reactor disaster. 

Beta particle radiation can be mitigated by shielding consisting of materials such as lead, aluminum and plexiglass. Gamma, x-ray radiation, and fast neutrons can be stopped by lead, concrete and hydrogen containing materials such as water and plastics. Gamma, x-ray, and neuron radiation can induce devastating biological effects that impact tissues composed of rapidly dividing cells such as hematopoietic (blood forming), gastrointestinal, reproductive and fetal cells. Long term effects include autonomic regulation disorders, and various genetic and cancer somatic mutations.

Cherenkov radiation is present, among others, in the water that surrounds the fuel in nuclear reactors, © International Atomic Energy Association

Mitigating Radiological and Nuclear Events

In mitigating radiological and nuclear events these specific actions must be taken: 

  • Establishing a law enforcement or military cordon for access, egress, and crowd control;  
  • Establishing Incident Command as per established policy and planning; 
  • Establishing hot, warm and cold (clean) zones utilizing radiological surveys, meterological and other data; 
  • Ongoing and decisive public protective countermeasures such as evidence-based shelter near the event location or evacuation orders; 
  • Mustering local, state, regional and national radiological, medical and emergency management expertise; 
  • Activating local, state, regional and national radiological and nuclear emergency operations and response plans; 
  • Providing essential and adequate personal protective equipment (PPE) to all levels of response assets, including personal dosimeters; 
  • Establishing decontamination areas in a warm zone with assets to provide responder, victim, and equipment decontamination, as well as teams to provide triage and lifesaving medical intervention; 
  • Establishing Casualty Collection Points (CCPs) and Ambulance Exchange and Transport Areas for decontaminated casualties;  
  • In terrorist scenarios, providing armed tactical support and tactical overwatch of disaster operations;  
  • In nuclear power emergencies, utilizing protective guidelines stipulated by the revelant agencies and authorities; 
  • Being prepared to request national stockpile medical assets, including radiation-specific medical countermeasures such as colony-stimulating factors, antibiotics, antifungals, decorporation agents; 
  • In criminal and terroristic acts, trying to preserve evidentiary materials and not moving the obviously deceased. Nuclear forensics assets must be deployed; 
  • Providing accurate public information and risk communications; 
  • In the U.S., advanced radiological injury assessment such as cytogenetic testing and whole body burden analysis should be part of the medical and public health response under national Emergency Support Function #8, Public Health and Medical of the National Response Framework.  
  • Assessing the environmental impacts of a radiological/nuclear event by public health and radiological assessment teams. Testing of environmental media such as crops, soil, livestock, milk, and the overall food chain must take place.
  • Conducting fallout and meteorological assessments early on along with airborne assessment capabilities, as well as conducting radiochemical characterization and identification of radionuclides.

Healthcare delivery systems need to be prepared to accept and treat contaminated casualties, including “walking wounded” who self-present. It is also important to consider that psychological casualties may exceed actual physical casualties. Meanwhile, accredited and licensed mental health counselors must be placed to assess and treat these casualties. Volunteer staging, management, and accountability must be integrated into the response. 


In closing, preparedness, planning, and consequence management for radiological and nuclear events are very complex multifactorial and evolving endeavors. Furthermore, with radiation as part of the equation, these events are unique as we cannot detect radiation with our senses. However, while the threat of injury or death by radiation is real, it is often exaggerated.

Strict adherence to the concepts and techniques of radiation safety and a solid comprehension of the facts will do much to dispel fears among the public and responders. Like any other crisis, emergency or disaster, these events have common denominators as well as their own specific resources, tactics and strategies.

Frank G. Rando currently serves as an allied health programs educator/lead instructor and healthcare emergency preparedness/medical readiness/public health preparedness and tactical, operational, disaster medicine and homeland security Subject Matter Expert, educator, instructor, and curriculum designer. He has served in instructional, guest speaker and consultative roles for DHS-FEMA, various components of the National Domestic Preparedness Consortium, DoD, industry, academia, health, safety and regulatory entities, emergency services organizations and healthcare.

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