In September 1987, a radiological accident occurred in the city of Goiania, Brazil. A radiotherapy unit was disassembled by individuals who intended to sell it; this exposed the unit's radioactive source material. As a result, radioactive cesium-137 was spread across portions of the city over several days before the accident was discovered. Approximately 112,000 residents of the city were monitored for radioactive contamination and 249 people were contaminated internally or externally. Four people died from radiation injuries. Forty-six of the contaminated patients were treated with Prussian blue to hasten elimination of Cs-137 and limit radiation doses. Treatment with Prussian blue was found to shorten the elimination half-life of Cs-137 in contaminated patients and reduced the absorbed radiation dose by an average of 71%.
The following scenario is constructed to test concepts and is based on, but not in total alignment with, the chronological flow of events during the incident in Goiania, Brazil.
You are the physician on the initial three person team that is in transit to Goiania, Brazil in late September 1987, to respond to reports of a number of potential radiological exposure cases. Accompanying you are two radiation health professionals.
You arrive at Olympic Stadium to find basic monitoring and triage stations set up, as report is given you learn that some individuals with more serious symptoms had been triaged to Santa Maria Hospital. As you are receiving this report, you are flagged to assess a patient who has just vomited on the floor in the stadium.
The young man tells you that he thinks he may have food poisoning, since he has been nauseated and increasingly tired, and he heard from a neighbor that there was a medical station being set up here. Preliminary screening of the individual and the vomitus indicate radioactivity, and based on measurements and medical history taken so far the assumption is that he is part of the larger Cesium-137 contamination emergency.
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Your team rapidly evaluates the remaining individuals waiting in the stadium. During this time, local officials arrange for both the young man and some others the team identifies as having moderate exposure risk to be transported to the Santa Maria Hospital in Goiania for further evaluation. You anticipate they will need medical treatment with Prussian blue, and prepare to be able to provide guidance to local staff and to educate patients.
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Over the next few days you address the immediate needs of admitted patients at the Santa Maria Hospital, and transfer out patients to the tertiary care center at Marcilio Dias Naval Hospital as needed. By Saturday, October 3rd, the extent of population exposure is clearer, and you volunteer to help the hospital with scaling up medical response operations in anticipation of high patient volumes.
The next day is particularly busy, and half-way through an individual is prioritized based on preliminary radiation screening. A quick verbal history reveals that he did come in contact with the source, but he was just now presenting one week later at the urging of his family. He was intentionally avoiding medical staff out of fear of what being contaminated would mean, and who would support his family if he were unable to return.
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You recommend Prussian blue with monitoring of stool and urine output to assess elimination of radioactive cesium. Before the patient is transitioned to another hospital wing, you note education points in his chart that should be discussed with him.
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