In view of public concern about health impairment from accidental radiation exposure, the record of forty years experience in the utilization of nuclear energy was reviewed. All reported exposure incidents producing health effects from external radiation sources and internal radionuclide contamination in the United States and some in other countries have been included. Preparations for the management of such accidents will be considered briefly. The relationship of this actual accident experience to the unresolved problems in management planning and professional and public education for future accidents like that at the Three Mile Island nuclear power station in Middletown, Pennsylvania, March 1979, but with potential associated health impairment, was discussed. The complete paper is published in the Proceedings of the 3rd World Congress for Emergency and Disaster Medicine, organized by the “Club of Mainz” in Rome, Italy, 1983 (see Manni, C and Magalini, S, Springer Publ, Heidelberg, 1984).