Initial medical diagnosis of patients severely irradiated in the accident with 60Co in Bulgaria

: A severe radiation accident occurred on Tuesday, 14 June 2011 in an industrial irradiation facility. Five people were exposed for 5-10 min to (60)Co source (137 TBq-3710 Ci). This accident was the first one in Bulgaria, in which the whole-body irradiation doses exceeded 1 Gy and suggested the development of acute radiation syndrome (ARS). This report discusses the diagnostic features of ARS and the use of the METREPOL concept and its diagnostic criteria in assessing the severity of radiation damage. The results used in this study show that injury assessment based only on prodromal symptoms is burdened with a serious error. The probable reasons are at least two: one is the unwillingness of victims to be diagnosed as involved in radiation emergency, which could reflect on their working status, and the other is the slight manifestation of symptoms due to the specific geometry of irradiation. The European Guideline for Medical Management of ARS is a good basis for an early diagnosis of radiation injury.