To the Editor:

We would like to thank Dr Steven Becker and Sarah Middleton for their insightful report on preparedness for radiological terrorism.Reference Becker and Middleton1 Becker and Middleton’s focus group research confirmed that emergency departments are not prepared to handle a radiation disaster.

The September 11, 2001, terrorist attacks reaffirmed the urgent need to have disaster plans in place. Hospital plans typically address natural, biological, chemical, explosive, and to a lesser extent radiological disasters. It is imperative for emergency physicians to recognize radiological disasters as a potential threat and possess a working knowledge of the standard evaluation and treatment of radiation emergencies. The US Department of Homeland Security now includes radiation disaster training in their Homeland Security Exercise and Evaluation Program,2 but hospital preparedness for radiation disasters remains poor. Hsu et alReference Hsu, Casani and Romanosky3 noted in a 2007 report that hospitals prepare the least for radiation emergencies among all types of disaster threats.

Three points raised by Becker and Middleton’s research were alarming to our group, including the participants’ lack of familiarity with radiation principles, inadequate preparedness training, and insufficient hospital preparedness. Becker and Middleton note that hospital-based disaster preparedness training typically focuses on natural, chemical, biological, and blast terrorism and devotes far less time to radiation disasters. Almost one-third of their subjects reported that they had not received focused radiation preparedness training. A physician stated, “I don’t think we have a protocol” for radiation evaluation and treatment. Even worse, a nurse noted that his or her department did not have 24-hour access to a Geiger counter. These gaps in preparedness are likely common in urban and suburban hospitals in the United States and must be addressed.

As emergency physicians and medical toxicologists with training in the evaluation and treatment of radiation emergencies, we recently surveyed 28 of the 40 Philadelphia-area physician emergency department (ED) directors to assess the preparedness of EDs for the evaluation and treatment of radiation emergencies, and found that their staff are undertrained and inadequately prepared to handle these emergencies.Reference D’Orazio, Wilson and Greenberg4 Sixteen of the directors surveyed (57%) indicated that their hospital did not have specific training in radiation emergencies. Ten (36%) stated that either their ED did not have a radiation-specific disaster protocol or they were unaware of one. Only 10.5% noted that a Geiger counter was present in the ED. Although 57% reported receiving training in the past 5 years, none felt “very capable” of handling radiation emergencies.

Becker and Middleton’s findings suggest that these findings are not isolated to the Philadelphia area. We hope that studies such as theirs will provide an impetus for increased awareness and better training for emergency physicians regarding radiation emergencies.

Joseph L. D’Orazio, MD

Michael I. Greenberg, MD, MPH

Department of Emergency Medicine, Division of Medical

Toxicology, Drexel University College of Medicine