The medical response to the Goiânia cesium-137 accident tested Brazil’s healthcare system in ways no one had prepared for. Between September 29 and October 3, 1987, physicians, physicists, and technicians set up a radiological triage at the Olympic stadium, treated patients with acute radiation syndrome, and administered Prussian Blue (Radiogardase®) on a scale never before attempted in the history of radiological accidents. Four people died.
Radiological Triage at Goiânia’s Olympic Stadium
On the evening of September 29, 1987, Goiânia’s authorities mobilized police, firefighters, and civil defense forces. By 20:00, the Olympic stadium had been designated as a staging area for isolating patients and screening others for contamination. The two known contamination sites — the Vigilância Sanitária on Rua 16A and Junkyard I — were resurveyed using monitoring equipment from the Goiás Institute of Radiotherapy (IGR). Nearby residents were evacuated and access was restricted.
Those possibly contaminated were directed to the stadium. But the situation quickly overwhelmed the available resources. Overnight, rumors spread. By morning, residents found cordoned-off streets with no coherent explanation. Hundreds rushed to the stadium seeking reassurance, straining the limited monitoring capacity.
What stands out in the IAEA report is this: despite having no local plans for radiological emergencies of this scale, the improvised strategy worked. When CNEN personnel began arriving, they found the situation minimally under control — allowing them to focus on recovery rather than initial containment. For the full accident chronology, see our comprehensive guide to the Goiânia radiological accident.
At the stadium, the CNEN team found that no decontamination had been attempted on the affected individuals. The local authorities had feared contaminating the water supply. CNEN physicists immediately directed all contaminated persons to take decontamination showers. Clothes were collected in bags. This simple but critical procedure significantly reduced the ongoing dose received by dozens of people.
CNEN Mobilization and Evacuation Criteria
CNEN’s emergency arrangements were activated through its Executive Group for Emergency Control (GECE). The director of GEDIN was appointed coordinator for Goiânia and carried out the Emergency Plan. The Institute of Radiation Protection and Dosimetry (IRD) in Rio de Janeiro was tasked with mobilizing technical and human resources on demand.
The nuclear emergency coordinator (NEC) left Rio at 18:00 on September 29 and arrived in Goiânia just after midnight on September 30. Two technicians from IPEN in São Paulo joined him en route, bringing suitable monitoring equipment based on preliminary information from physicist W.F. — the professional who had discovered the contamination.
The lead team first visited the derelict IGR clinic. Finding no contamination, they proceeded to the Vigilância Sanitária, where they confirmed the source remnants in a bag on a chair in the front courtyard. The dose rate 1 meter from the source was 0.4 Sv/h, indicating residual activity of approximately 4.5 TBq (120 Ci) — less than 10% of the original teletherapy source.
The 2.5 µSv/h evacuation criterion
W.F. and the CNEN team adopted an evacuation criterion based on a dose rate of 2.5 µSv/h. The reasoning was straightforward: the internationally recommended occupational dose limit of 50 mSv per year is maintained if the dose rate on the external surface of a barrier stays below 25 µSv/h. Since public dose limits were ten times lower than occupational limits, the criterion became 2.5 µSv/h.
The CNEN team reached a similar conclusion from different considerations. They deemed it politically unacceptable for residents to exceed 5 mSv in the year. They recognized that residential occupancy factors exceeded those for occupational exposure. And they estimated cleanup would take about three months — one quarter of the year. These latter two factors roughly cancelled out, supporting the simplified criterion. It was later refined as the response matured.
On the morning of September 30, the team neutralized the source remnants: a section of sewer pipe was lifted by crane over the two-meter courtyard wall of the Vigilância Sanitária, lowered over the chair, and filled with pumped concrete. Dose rates in the surrounding area dropped significantly, and much of the cordoned zone was reopened.
The Medical Team and First Diagnoses
A CNEN-IRD physician arrived by air at 06:30 on September 30, accompanied by two IRD physicists. At the stadium, he found the Tropical Diseases Hospital physician who had spent the night screening patients — the first doctor to recognize that the symptoms were caused by radiation exposure, not tropical disease.
The initial toll was serious: 22 persons showed symptoms of overexposure. Eleven had already been sent to the Tropical Diseases Hospital. Over the course of that day, the two physicians examined another 50 to 70 contaminated individuals — a 12-hour triage marathon.
A critical insight came from the former IRD Director. Analyzing how the material had dispersed, he deduced the source could not be metallic cobalt — it would not have spread so easily. He concluded it was caesium chloride (CsCl), a highly soluble, hygroscopic salt. Tracing confirmatory information proved difficult, but the deduction was correct and reshaped the entire decontamination and treatment approach. Our article on the discovery of cesium-137 and initial response in Goiânia covers this phase in detail.
Treating the Most Severely Affected Patients
The 11 most seriously affected patients were consolidated on the entire third floor of one wing of the Goiânia General Hospital, creating a radiologically and biologically controllable location. Concentrating all contaminated patients in a single area was a sound decision, though it was driven by necessity rather than planning.
The immediate problem: no medical staff at the hospital had any training in handling radiologically contaminated patients. The patients were effectively left unattended until the two medical specialists arrived. A labour strike at the hospital compounded matters further.
The physicians and radiation protection staff arrived equipped with monitoring instruments and standard protective clothing — caps, gloves, and overalls. They established a contamination control area following USNCRP Report No. 65 (Management of Persons Accidentally Contaminated with Radionuclides, 1980). Physical examinations, laboratory tests, blood sampling, and symptom treatment began immediately.
Transfer to the Marcílio Dias Naval Hospital
At 18:30 on September 30, a physician from FURNAS in Rio joined the team. After the 12-hour triage, the doctors decided to transfer six of the 11 patients to the Marcílio Dias Naval Hospital in Rio de Janeiro. Selection was based on relative symptom severity and the need for better treatment equipment.
On October 1 at 09:00, the FURNAS physician and six patients were flown to Rio and admitted to Marcílio Dias at 12:30. Four more patients were transferred on October 3.
| Date | Medical Event | Numbers |
|---|---|---|
| Sep 29, 1987 | Olympic stadium designated as triage area | Hundreds screened |
| Sep 30, 1987 | CNEN-IRD physician arrives; 12-hour triage | 22 with overexposure; 50-70 examined |
| Sep 30, 1987 | Source remnants encased in concrete | Dose rates reduced |
| Oct 1, 1987 | Transfer to Marcílio Dias Naval Hospital (Rio) | 6 critical patients |
| Oct 3, 1987 | Second transfer and end of initial phase | 4 patients + 249 contaminated detected |
Source: The Radiological Accident in Goiânia (IAEA, 1988)
Internal Contamination and the Pioneering Use of Prussian Blue
What set Goiânia apart from every previous radiological accident was the severity of both external and internal contamination with cesium-137. For the first time ever, hexacyanoferrate — Prussian Blue, marketed as Radiogardase® — was used extensively to accelerate the elimination of the internally deposited radionuclide.
The clinical scenario was unique: victims suffered initial acute whole-body external exposure followed by chronic whole-body exposure at low dose rates from internally deposited cesium-137. Each case varied depending on time spent near the source and the amount of cesium incorporated. No direct precedent existed to guide the protocol.
Dosimetric interpretation was complicated by several factors. Exposure histories were incomplete. No one knew exactly when individual exposures had begun. Many external exposures were fractionated by the victims’ daily routines. The most severely overexposed individuals suffered acute local skin injuries from beta irradiation and deep tissue damage from penetrating gamma radiation. This variation introduced significant uncertainties into cytogenetic dose estimates, which were based on dose-response curves derived from high dose rates.
Triage Numbers and Transition to Long-Term Control
By Saturday, October 3, the situation was under control. The monitoring team at the stadium had identified 249 people with detectable contamination. Those with external contamination only were readily decontaminated. However, 129 people were found to also have internal contamination and were referred for medical care.
The main contamination sites had been identified. Although teams continued checking for additional hotspots, this effectively marked the end of the emergency containment phase. From this point, the focus shifted to continued treatment of the injured and environmental decontamination at a more deliberate pace.
Formal record-keeping only became possible on the third day. In the first two days, workers were overwhelmed by surveying and training others in contamination screening. When the need for administrative support was recognized and headquarters moved to the OSEGO facility, the process became progressively organized: secretarial services, telex, photocopying, and an information coordinator were assigned. Daily oral and written reports on every decontamination action were required and formed the basis for revising the overall strategy.
Resource organization followed a clear operational logic. Initially, only five people handled health physics aspects, including W.F. and the IGR physicist. On October 1, fifteen additional workers arrived. The twenty available were divided into three groups: management, area verification, and decontamination. The decontamination group was further split into four subgroups, one for each main contamination area.
Weather conditions added another layer of difficulty. A violent storm knocked down the tents housing people at the stadium, hindering operations for a considerable period. It was a foretaste of the adverse conditions that would accompany some of the decontamination work in the following weeks. Maps of affected areas were requested on September 30 but not received until October 2 — once available, all hotspots were marked and residents in areas with dose rates exceeding 2.5 µSv/h were evacuated by October 3.
Parallels with Previous Radiological Accidents
The IAEA report draws striking parallels between Goiânia and four earlier accidents: Mexico City (1962), Algeria (1978), Morocco (1983), and Ciudad Juárez, Mexico (1983). All shared significant whole-body irradiation with acute radiation syndrome, combined with severe local radiation burns in some individuals.
The Ciudad Juárez accident resulted in external contamination of several individuals with cobalt-60, but levels were low and no significant internal contamination occurred. Goiânia stood apart precisely because of the massive internal contamination with cesium-137 and the need for a chelation protocol — Prussian Blue — that had never been tested at real scale.
With four deaths, the outcome in Goiânia could have been far worse. The medical response, though improvised in its earliest days, showed that a small but qualified team — backed by adequate logistics — can contain damage that initially seemed unmanageable. The lessons from this operation directly informed the radiological emergency protocols adopted by Brazil and the international community in the following decades. For the complete picture, see our comprehensive guide to the Goiânia radiological accident.
