The gross alpha analysis of nasal smear samples for the radiation emergency and the additional follow-up steps were established. Cotton swab sticks using in local hospitals for nasal smear in Korea were used for the verification. The measurement results of standard samples spiked with certified reference source were well agreed within ${pm}20%$ compared with reference values. The clearance ratio of smear samples conducted with wet smear condition showed higher value. To eliminate the quenching effect of liquid scintillation samples, dry of smear samples should be followed up before counting samples. Based on the measurement results, medical decision levels and internal dose assessment were established for the victims in the beginning of radiation emergency.