Cutaneous radiation syndrome in multi-organ failure

The likelihood of an individual being exposed to, and thus the probability of cutaneous injury from, nuclear weapons or dispersed nuclear material has, in contrast to post cold war euphoria, considerably increased during the last 13 years. This is in part due to a temporary loss of control of nuclear material, including uncontrolled deployment, and in part to an increasing capability and apparent willingness of terrorist and other criminal groups to use such material for their purposes. A relatively recent danger emerges from the development of so-called robust nuclear earth penetrators (RNEPs) to destroy very deep bunkers, which may be used in future “conventional” wars, and which without doubt will cause contamination with short-range radioactive nuclides, which will primarily affect the skin. In summary, the probability of local cutaneous radiation exposures to extremely high absorbed doses (<60 Gy), with concomitantly survivable bone marrow doses, has increased.