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Radiological accidents and disasters can have a huge and lasting impact on public health. Hospitals should be prepared to respond to potential radiation emergencies as determined by risk assessments based on local and regional radioactive hazards, threats and vulnerabilities. Approach to hospital management of multiple combined radiation injury victims require attention to casualty triage, decontamination and prevention of secondary contamination, healthcare personnel radiation safety, trauma care system, medical staff knowledge of radiation related injuries and availability of pharmaco-therapeutic options. Considering surge science, preparedness strategies are described according to the key components of the “3 S” system.