State of Connecticut Radiation Professional Volunteer Program (CT-RPVP) LESSON 1 Principles of Radiation and Radiation Protection.

State of Connecticut Radiation Professional Volunteer Program (CT-RPVP)
LESSON 1 Principles of Radiation and Radiation Protection

Objectives Describe the two forms of radiation and give examples of each Distinguish between radiation exposure and radioactive contamination Describe the relationships between radiation exposure, radiation absorbed dose, and dose equivalent Understand how time, distance and shielding are used to minimize radiation exposure At the end of Lesson 1, you will be able to: 1. describe the two forms of radiation and give examples of each; 2. distinguish between radiation exposure and radioactive contamination; 3. distinguish between radiation exposure and radioactive contamination; and 4. understand how time, distance and shielding are used to minimize radiation exposure

Photon and Particle Radiation
Radiation, as the term is used in this course, consists of: photons and subatomic particles Radiation is emitted from the nuclei of radioactive atoms (or radioisotopes) and is capable of causing the ionization of atoms. For this reason, this type of radiation is often referred to as “ionizing radiation” Photon Radiation Particle Radioactive Atom Radiation or ionizing radiation consists of photons and subatomic particles emitted from the decay process of unstable (radioactive) atoms. These forms (photons and subatomic particle) of radiation have enough energy to eject electrons from other atom they interact with and as such, they are sometimes referred to, collectively, as ionizing radiation

Photon Radiation X- and gamma rays are released from the nuclei of a radioactive atoms as packets of energy, or photons X rays are similar to gamma but have lower energy X- and gamma-rays are packet of pure energy called photons. X rays are similar to gamma but have lower energy 4

Subatomic Particle Radiation
Alpha, and beta radiations are subatomic particles ejected from the nuclei of atoms undergoing radioactive decay Neutron radiation consists of free neutrons produced during nuclear fission, a reaction which takes place in reactors of nuclear power plants and atomic bombs following detonation + Particle radiation is released from the nuclei of unstable atoms as fast moving subatomic particles, and includes alpha, beta and neutron radiation. Alpha radiation consists of alpha particles made up of two protons and two neutron. As such, alpha particles have a charge of +2 A beta radiation consists of beta particles which are high-speed electrons emitted from the nuclei of decaying radioisotopes. Beta particles have an electrical charge of -1 Neutron radiation consists of free neutrons released from the nuclei as a result of nuclear reactions, such as those which occur in nuclear reactors and during the detonation of a nuclear weapon (N) Alpha (α) Beta (β) Neutron (N) 5

Test Your knowledge Which of the following can be used to in place of “radioactive atom” A) Radiation B) Radioisotope C) Photon D) Subatomic Particle Correct answer is A) Radioisotope: Radioisotope is atom that has an unstable nucleus and emits radiation during its decay. The radiations that are emitted during the decay process can be in the form of photons (e.g., gamma rays) or subatomic particles (e.g., alpha and beta particles)

April 6, 2017 Sources of Radiation Man-Made, such as x-rays generated from a medical x-ray machine, and gamma rays from radiation therapy equipment or Naturally-Occurring, such as cosmic rays from space, and gamma radiation from radon gas Exposure to radiation can result from man-made sources of radiation which is generated from medical, commercial and industrial activities, or from naturally-occurring radiation, namely cosmic radiation (from space), and terrestrial radiation (gas and soil). 7 A Small Dose of Toxicology - Overview

[X-, Gamma rays and Neutrons]
Shielding from Radiation Protective shielding varies with the type of radiation α β X, γ and n Skin, paper, 1 to 4 inches of air Less than ¼ inch metal, glass, concrete, 1 to 18 feet air 2 to 12 inches lead, 3 to 18 inches steel, 1 to 6 feet of concrete, tens to hundreds of yards in air [Alpha] [Beta] [X-, Gamma rays and Neutrons] Effective shielding form radiation will depend on the type of radiation. Alpha radiation requires the least shielding, while gamma and neutron radiation requires the thickest shielding. Note that alpha and beta particles are attenuated after traveling relatively short distances in air. Neutrons can travel hundreds of feet in air, and X and gamma radiation can travel hundreds of yards in air. As an external hazard, gamma, X and neutron radiation is the most dangerous. However, if inhaled or ingested, alpha and beta radiation can cause damage to local organs. Beta radiation cane burn the skin, similar to a sunburn, but beta burns may have much greater long-term cancer effects than sunburns. 8

Radiation Detection Cannot be seen Cannot be smelled But, can be
Cannot be felt Cannot be tasted easily detected by instruments Radiation cannot be detected by human senses – it has no odor, taste, or smell, and cannot be felt. However, radiation can easily and quickly detected by the appropriate instruments, including hand-held detectors 9

Exposure vs. Contamination
Exposure to radiation occurs after entering an area in which there is a radiation source After leaving the area, the exposure no longer happens Contamination occurs when radioactive material is on the body surface (external contamination) or is in the body (internal contamination) Decontamination of external areas is accomplished by removing clothing and washing the affected areas Exposure to radiation occurs after entering an area in which there is a radiation source. The individual is exposed to radiation up until such time as the source id removed from the area, or the individual leaves the are. Exposure does not make the individual radioactive, just like a hand x-ray does not make a patient radioactive or contaminated with radioactive material Contamination occurs when radioactive material is present on the body surface of an individual, or when the individual has inhaled, ingested or internalized radioactive materials through the skin. If radioactive contaminants are present on the surface of the body, an individual is said to be externally contaminated; if radioactive contaminated are in the body, the individuals is said to be internally contaminated. 10

Measuring Radiation Exposure to radiation results in the absorption of a radiation dose The unit for exposure is the roentgens (R) The unit for absorbed dose is the Radiation Absorbed Dose (rad) The unit for dose equivalent is the Roentgen equivalent man (rem) For practical purposes, 1 R (exposure) = 1 rad (absorbed dose) = 1 rem or mrem (dose equivalent) Because radiation can damage biological tissues, detecting its presence and quantifying its levels in the environment is important. For these purposes, several units are used. Here, why describe three: the roentgen (R), radiation absorbed dose (rad), and the roentgen equivalent man (rem) Exposure describes the amount of radiation traveling through the air. Many radiation monitors measure exposure. The common unit for exposure is R Absorbed dose describes the amount of radiation absorbed by an individual. The common unit for absorbed dose is rad Dose equivalent is the amount of absorbed dose modified by the ability of the radiation to cause biological damage; it describes the physiological effects of a given radiation type (i.e., gamma, neutron, alpha and beta) in relation to the amount of the type of radiation absorbed. For beta and gamma radiation, the dose equivalent is the same as the absorbed dose. So, 1 rad = 1 rem. By contrast, the dose equivalent is larger than the absorbed dose for alpha and neutron radiation, because these types of radiation are more damaging to the human body. The common unit for dose equivalent is rem 11

Daily sources of radiation
Normal annual exposure from natural radiation Approx. 0.3 rem/yr Radon gas rem Human body rem Rocks, soil rem Cosmic rays rem Normal annual exposure from man-made radiation Between rem/yr 1 chest X-ray rem Consumer products rem Air travel round trip (NY-LA) rem Watching color TV rem Nuclear industry < rem The average contributions from various natural and man-made sources of radiation to which the average U.S. citizen is exposed during his or her lifetime varies between 0.33 – rem, or 330 – 370 millirem. Approximately 82% of the radiation dose is from natural sources: 55% from radon 11% from internal sources (radioactive materials, primarily potassium-40, from food and water consumed in the daily diet) 8% from terrestrial sources (radioactive material in rocks and soil), and 8% from cosmic radiation (from space) The remaining 18% of the dose comes from anthropogenic (man-made) sources: 11% medical x ray exposure 3% consumer products, and 4% other sources 12

Test You knowledge Radon gas can enter homes from surrounding soil. Radon cannot be seen and has no odor, but at elevated levels, radon in homes presents a serious health risks. Radiation emitted by radon in homes is an example of: A) Man-made radiation B) Naturally occurring radiation Correct answer is B. Radon is a naturally occurring, radioactive gas released in rock, soil, and water formed from the breakdown of uranium.

Minimizing Radiation Doses - ALARA
ALARA stands for As Low As is Reasonably Achievable The purpose of ALARA is to minimize risk as a result of exposure to radiation or radioactive material to a level that is As Low As is Reasonably Achievable ALARA is a radiation safety principle for minimizing radiation doses and releases of radioactive materials by employing all reasonable methods

Mitigating External Radiation Doses
Minimize Time Maximize Distance There are three basic rules of thumb to assist with maintaining doses ALARA. They are: 1. Time - minimizing the time of exposure directly, 2. Distance – doubling the distance between your body and the radiation source will reduce the radiation exposure by a factor of 4 and 3. Shielding - using the thickest possible shielding between you and the radiation source Maximize Shielding 15

Dose Limits for Responders Performing Emergency Services
Dose Limit (rem) Activity Condition 5 All 10 Protecting valuable property lower dose not practicable 25 Life-saving or protection of large populations > 25 Only on a voluntary basis to persons fully aware of the risks involved The Table summarizes the guidance on dose limits for workers performing emergency services. Responders may receive exposure under a variety of circumstances in order to assure protection of others and of valuable property. These limits apply to doses incurred over the duration of a radiological emergency ICRP (1991), NCRP Report No. 116 and NCRP Report No. 138, DHS (2007)

Summary Radiation is composed of subatomic particles or high-energy photons Contamination results form the presence of radioactive material on or in the body, whereas radiation exposure results form being in the presence of a radiation source R, rad and rem are units used to measure radiation exposure, absorbed dose and dose equivalent ALARA is a radiation safety principle for minimizing radiation doses and releases of radioactive materials by employing all reasonable methods Three basic rules of thumb for minimizing radiation exposure are time, distance and shielding

Lesson 2 Radiation and Nuclear Threats and Vulnerabilities 18

Objectives Describe the radiological and nuclear threats faced by the U.S. Understand the risks of contamination and exposure to volunteers when screening individuals involved in a radiological or nuclear incident By the end of Lesson 2, you will be able to: Describe the radiological and nuclear threats faced by the U.S.; and Understand the risks of contamination and exposure to volunteers when screening individuals involved in a radiological or nuclear incident

Intentional Nuclear/Radiological Threats to the US
Nuclear Weapon, IND Likelihood Less More Impact/Damage Dirty Bomb RED Radiation Emission Device (RED) “Dirty” Conventional Bomb (RDD) Improvised Nuclear Device (IND) 1kT “Suitcase Nuke” Ballistic Missile Attack 250 kT Nuclear Weapon – “City Killer” While attacks by terrorists have not involved the use of radioactive materials, concerns over the possibility that these materials can be use for making and deploying radiation emission device or RED, or a dirty bomb (RDD) have increased. These deployment of an IND is also within a terrorist's ability to employ. The use of ballistic missiles and larger nuclear weapons would produce the greatest impact, however, the likelihood they would be used is far smaller than that for REDs, RDDs and INDs. 20 20

Possible Terrorist-Related Scenario
Radiation Emission Device (RED) - concealed at high-traffic area: ~ 60 to 250 deaths and ~ 130 cases of radiation sickness requiring public health follow-up for 30 years; psychological trauma Community recovery timeline: Months to years Source: Tofani A, Bartolozzi M. Ranking nuclear and radiological terrorism scenarios: The Italian case. Risk Analysis 2008;28(Oct): An RED employs a stationary radioactive source to expose victims to high levels of radiation. It is possible that placing such a source in a high-traffic area could cause radiation injuries and death of individuals who become exposed to significant levels of radiation emitted from the device. Such an act could results in psychological trauma for affected individuals, their family members and the community. Tracking the health effects could last for as long as 30 years.

Radiation Dispersal Device (RDD) - explodes at busy street corner: ~ 30 to 180 deaths Few in any radiation-related injuries Decontamination efforts for people and objects Significant financial cost for decontamination of property in the affected area Source: Tofani A, Bartolozzi M. Ranking nuclear and radiological terrorism scenarios: The Italian case. Risk Analysis 2008;28(Oct): The use of an RDD would likely be more impactful than an RED, creating instantaneous, community-wide panic. The most probable means for spreading radioactive materials, using an RDD is to employ dynamite or other chemical explosives. Although radiation injuries are unlikely following the detonation of an RDD, the blast form the bomb could result in tens or in upwards of 100 deaths. Significant efforts and money would be required for screening and subsequent decontamination of people and property

Improvised nuclear device (IND) - explosion of 10 kilotons, in center of a city, such as Coleman Dock, Seattle, WA Approximately 50,000 deaths Infrastructure damage out to 1 mile Contamination ~3,000 sq. miles $100+ billion in costs Community recovery time: Years Source: Tofani A, Bartolozzi M. Ranking nuclear and radiological terrorism scenarios: The Italian case. Risk Analysis 2008;28(Oct): Unlike an RED, which uses conventional explosives to disperse radioactive material, an IND is in fact a nuclear weapon. A successful IND detonation of similar magnitude to that detonated in Nagaski, Japan, in 1945, would result in catastrophic loss of life, destruction of infrastructure, and nuclear contamination of a very large area. The economic costs would be in the trillions of dollars and the community would be affected for many decades

Risk to Volunteers from Screening Individuals of a Radiological or Nuclear Incident
What is the risk of exposure or contamination to volunteers performing radiological surveys of people involved in a radiological or nuclear event? Depends on the nature of the event: Contamination for RED: None Exposure only (such as in an RED incident) Acute radiation syndrome in exposed individuals No risk of exposure or contamination to volunteers Risk of radiation exposure or contamination to radiation professional volunteers who will screen victims depends on the type of the incident. For RED, there is zero risk of radiation exposure or contamination to volunteers. The only risks are to the victims who have been exposed to the radiation emitted by the device. If radiation doses received by victims are significant, victims will incur radiation injuries.

Contamination (Radiation Dispersal Device ) Individual’s person, articles of clothing, other belongings may be contaminated Removing contaminated clothing will eliminate % of contamination Individuals may be internally contaminated Individuals with minor injuries may self-refer to screening centers Relatively low risk for contamination to volunteers; very low level exposures possible (varies with degree of individuals’ levels of contamination) The risk of contamination or exposure to radiation to volunteers screening victims of an RDD incident are low. The exposure levels will vary according to the quantity of contaminants present on victims during the time of screening. Removing the victims clothing will reduce contamination by %.

Contamination (Nuclear Power Plant Incident) Individual’s person, articles of clothing, other belongings may be contaminated Individuals may be internally contaminated Relatively low risk for contamination to volunteers; very low level exposures possible (varies with degree of individuals’ levels of contamination) The risk of contamination or exposure to radiation to volunteers screening victims of a nuclear power plant accident are low. The exposure levels will vary according to the quantity of contaminants present on victims during the time of screening. Removing the victims clothing will reduce contamination by %. Victims may be internally contaminated as a result of inhaling or ingesting radiologic materials released from the power plant.

Contamination from Fall-Out, and High-Level Exposures (Nuclear detonation) Individuals’ persons, articles of clothing, and other belongings may be contaminated Individuals may be internally contaminated Individuals may incur radiation doses up to several hundred rads are possible (acute radiation syndrome) Individuals with minor injuries may self-refer Relatively low risk for contamination to volunteers; very low level exposures possible (varies with degree of individuals’ levels of contamination) Incident-related psychological stress/trauma among volunteers The risk of contamination or exposure to radiation to volunteers screening victims of a nuclear incident e.g. IND are low. Removal of the victims’ clothing will eliminate 80 – 90% of external contamination. Volunteers should be monitored for psychological stress and trauma which may manifest during such a large-scale event. Individuals may be externally and/or internally contaminated from fallout. It is also possible that some victims may have received significant doses of radiation and will suffer from radiation injuries (acute radiation syndrome)

Test your knowledge Which of the following are the most likely terrorist-related threats to the U.S are: A) 250 kT nuclear weapon and an IND detonation B) Ballistic missile attack and an IND detonation C) Dirty bomb detonation and deployment of an RED D) Detonation of a RDD and IND E) No threat The most likely threats from terrorists are the deployment of an RED (radiation emission device) or detonation of a dirty bomb (RED). While IND are within the capability of terrorists’ use, IND detonations represents a lower probability than the deployments of REDs and explosions of RDDs

Test your knowledge Which of the following is true:
A) The impact of an IND is greater than that of a 250 kT bomb B) With respect to a terrorist attack, the probability of an RDD detonation is greater than that of a IND detonation C) A dirty bomb detonation is likely to cause radiation injury, deaths and contamination of a small area D) The risk of radiation exposure and contamination to volunteers who may be called upon to screen victims of an RED is zero E) The risk of radiation exposure and contamination to volunteers who may be called upon to screen victims of an RDD is zero Correct answer is D. Volunteers who screen victims of a radiation emission device have zero risk of radiation exposure or contamination.

Summary Threats to the U.S. involving the release of radiation and radioactive materials are the use of REDs, RDDs, INDs, and nuclear weapons with yields varying from 1 – 250 kT Volunteers screening individuals impacted by an RDD have no risk of exposure or contamination Volunteers screening individuals impacted by a dirty bomb or a nuclear weapon, including an IND, have a low risk of contamination, or radiation exposure

Lesson 3 Biological and Clinical features of Radiation injuries

Objectives Distinguish between acute and chronic radiation exposure
State three types of DNA changes resulting from radiation exposure Identify symptoms of acute radiation syndrome

Acute Radiation Exposure
Acute radiation exposure is exposure to a large, single dose of radiation, over a short period of time (seconds) A large acute exposure to radiation may result in immediate clinical effects (e.g., acute radiation syndrome) as well as long-term effects (e.g., cancer) An exposure received within a short period of time is called acute exposure. A large acute exposure can result in immediately observable clinical effects, such as radiation sickness, and long-term effects, such as cancer The probability of developing long-term effects depends on the amount of radiation dose that was delivered

Chronic Radiation Exposure
Chronic radiation exposure involves exposure to low levels of radiation over a long period of time (months – years) Chronic radiation exposure may result in increased risk of developing cancer Exposure to radiation emitted by radon gas present in many homes is an example of chronic radiation exposure Exposures to low levels of radiation over a long period of time are termed chronic exposures. Unlike acute radiation exposures, chronic radiation exposures have no immediate observable clinical effects. However, over a protracted time, the health effects may be the same those linked with the long-term effects of acute radiation exposure. An example of chronic exposure is exposure to radon gas present in homes

Test your knowledge True or False: Unlike acute radiation exposure, chronic radiation exposure may result in the development of cancer A) True B) False The correct answer is B) False. Both acute and chronic radiation exposures can result in the development of cancer.

Test your knowledge Of the following, which is a example of acute radiation exposure A) Radiation incurred on a round-trip flight from New York City to Los Angles B) Radiation incurred from a one-time chest x-ray C) Eating foods over one’s lifetime that contain high levels of potassium-40 (radioactive isotope) D) Living in high-altitude areas The correct answer is B) Radiation incurred from a one-time chest x-ray. A), C), and D) represent activities which involve radiation exposures over long period of time. Although in A) Radiation incurred on a round trip flight from New York City to Los Angles, the flight is of relatively short duration, compared to activates in C) and D), exposure to cosmic radiation does not ceases once the trip has ended.

Radiation Targets All Cellular Components
Radiation damages all biological molecule found in cells. The cell can repair certain levels of cell damage. At low doses, such as that received every day from background radiation, cellular damage is rapidly repaired. At higher levels, cell death results. At extremely high doses, cells cannot be replaced quickly enough, and tissues and organs fail.

Types of DNA Damage Caused by Radiation
Deoxyribonucleic Acid - Radiation can damage DNA resulting in: DNA mutations and DNA breaks Gross structural rearrangements or chromosomal aberrations, to the DNA can also occur Radiation can cause DNA alterations including DNA mutations, DNA breaks, and gross structural rearrangements in the DNA. Gross Structural rearrangements to the DNA result in cell death, as do DNA breaks that are not repaired by the cells. Janice Brock University RPO

DNA Damage Caused By Radiation
Deoxyribonucleic Acid - Radiation damages DNA may result in: DNA mutations may not kill the cell; however over time, these mutations may transform the cell into a cancerous cell This transformation is random (stochastic) and take place over several years The higher the radiation dose, the greater the chance of developing cancer Relatively low does of radiation or chronic exposure to rradiation may cause mutations in cells’ DNA that, over a protracted period of time, may lead to the development of cancer. Such an event occurs by chance, however, the probability of cancer increases with increasing radiation dose. Janice Brock University RPO

DNA is the most important Target of Radiation
Deoxyribonucleic Acid - Radiation damages DNA which result in: Unrepaired DNA breaks and gross structural changes to the DNA almost always lead to cell death High radiation doses, delivered quickly (seconds) and to a large area of the body, result in widespread cell death, causing: Tissue and organ failure which manifest as acute radiation syndrome (ASR) The occurrence of these biological events and clinical manifestations are predictable (or non-stochastic) and take place relatively quickly Gross alterations in the structure of DNA, also known as chromosomal aberrations, results in cell death If the dose of radiation is high, and delivered quickly to a large area of the body, vast numbers of cells die. As cells die, tissues and organs begin to fail and without medical attention, the individual dies. Under these condition (high radiation doses), the sequence of biological and clinical events (acute radiation syndrome) are not random, but rather fairly predictable, and take place in a short period of time, relative to random effects such as the development of cancer. At very high doses, many more cells die, and the extent of tissue and organ damage may be too much for an individual to survive, despite medical attention. Janice Brock University RPO

Effects of Acute Radiation Exposure (High Dose, High Dose Rate)
25 – 50 rads 100 rads 250 rads 650 rads 1000 rads Severe Vomiting (100%) Diarrhea Cramps Bleeding - mouth, kidneys WBC Nausea Vomiting WBC Acute radiation syndrome (ARS) is a series of illnesses that evolve over time. The signs and symptoms, and their severity correlate with radiation dose, when the dose is delivered acutely (within seconds) and to a large portion of the body (whole-body or torso) Early manifestations of symptoms indicate exposure to higher doses of radiation First signs of ARS, a drop in white blood cell count, begin at 25 – 50 rads From 100 – 250 rads, nausea and vomiting occur, and there is a more profound drop in white blood cell count At 450 rads, 50% of individuals will die within 60 days, without medical care Above 650 rads, there is severe vomiting, diarrhea, abdominal cramping, and bleeding in the mouth and kidneys

Test your knowledge Which is true of acute radiation syndrome:
A. Affects more males than females B. Varies in severity according to the absorbed dose of radiation C. Can be treated with potassium iodide D. All of the above Answer B. Varies in severity according to the absorbed dose of radiation, is correct. The severity of symptoms and extent of injury caused by radiation correlates with radiation dose.

Summary Acute radiation exposure is exposure to a large, single dose of radiation, over a short period of time Chronic radiation exposure involves exposure to low levels of radiation over a long period of time Both, acute and chronic radiation exposures can result in cancer The most important cellular target of radiation is DNA. Radiation-induced damage to DNA include DNA mutations and chromosomal aberrations The severity of ARS is directly proportional to dose

Lesson 3 External Decontamination

Objectives of this Section
Describe the purpose and goal of decontamination List some key concepts of decontamination Provide an overview of the decontamination process for removing radioactive contaminants present on body surfaces, including hair

Decontamination Concepts
The purpose of the external decontamination is to remove or reduce radioactive contaminants from the surfaces of individuals and pets Skin Hair Goal is < 2 times background or 2 decontamination attempts Removing radioactive material from a person, object, or place is called decontamination. The goal of whole body external decontamination is to decrease external contamination to a level of no more than 2 times background level

Decontamination Concepts for Reception Centers Decontamination
Decontamination, if required or advisable, follows immediately after the screening process If survey readings are: > 2 - 3x background, decontamination is advisable (EPA/NCRP) > x background, decontamination is required (EPA/NCRP) The first step in external decontamination is to check if people have contamination on their bodies and clothing. As such, it take place after individuals have been screened for the presence of contamination. The EPA recommends decontamination if levels exceed 2 time background, and requires it if levels exceed 20 times background readings

Test your knowledge Decontamination of individuals should continue until survey readings indicate levels below 2 times background True False Correct answer is B) False. Ideally decontamination should continue until levels are at least 2x background or below; however, even after several rounds of decontamination, it may not be possible to reduce radioactive reading to levels below 2x background. In such cases, the decontamination process should be stopped even readings no longer decrease after additional decontamination

Decontamination Concepts for Reception Centers
Individuals (and pets) with contamination levels > 2x background, as per GM survey Decontamination is repeated until survey readings are < 2x background or until additional rounds of decontamination do not reduce contamination levels by more than 10% (CDC) After each round of decontamination, individuals are resurveyed Decontamination at a reception center applies to individuals and pets with external levels of contamination are twice background or higher. Individuals (and pets) are decontaminated until levels are no more than twice background or until the decontamination process no longer reduces the levels of contamination.

Decontamination Process for Reception Centers
All contaminated clothing and valuables are placed in a plastic bag Removing clothing will eliminate 80 – 90% of contamination Items that cannot be decontaminated (e.g., porous materials) should be discarded in waste bins for contaminated items Prior to showering, individuals should be asked to place contaminated clothing and valuables in a plastic bag. Removal of clothing typically eliminates % of radioactive contaminant. Items that cannot be decontaminated, are placed in a separate plastic bag and disposed of in appropriate containers.

Decontamination Process for Local Surface Contamination
If contamination is limited to a small body surface (e.g., hand, face) it may be possible to decontaminate the area without showering Cover wounds with bandages Wash with warm water Begin with the least aggressive techniques and mildest agents (e.g., soap and water) If survey readings indicate that contamination is localized to small areas of the body, such as hands or face, it may be possible to decontaminate the areas without showering. In such cases, warm water and mild detergent are used to remove the contamination. If necessary, gently scrubbing of the area with a cloth or a soft brush can be employed to remove the contamination. Be sure to cover wounds during washing to prevent the introduction of radioactive material. Dainiak, N., Delli Carpini, D., Bohan, M., Werdmann, M., Wilds, E., Barlow, A., et al. (2006). Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys, 65(1),

Decontamination Process for Local Surface Contamination
Use the mechanical action of flushing or friction of cloth, sponge, or soft brush Keep materials out of eyes, nose, and mouth, Avoid causing mechanical, chemical, or thermal damage to skin Scrubbing may be firm but should not abrade the skin. If washing the facial area, close eyes, nose and mouth to prevent internalizing water run-off. Dainiak, N., Delli Carpini, D., Bohan, M., Werdmann, M., Wilds, E., Barlow, A., et al. (2006). Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys, 65(1),

Decontamination Process for Extensive Body Contamination
If contamination is present on the majority of the body surface contamination may be removed by showering Shower with warm water and mild soap Begin with the head, bending it forward to direct wash-water away from body Keep water out of eyes, nose, mouth, and wounds Use mechanical action of a cloth or sponge but avoid abrading the skin

Considerations for Decontamination Process
Separate male and female decontamination showers If possible, parent(s) should assist children with washing Keep families together Decontaminate pets in an area separate

Considerations for Decontamination Process
Have on-hand replacement clothing or disposable gowns For large-scale events, it may not be feasible to collect contamination from runoff Provide for the security of items of personal value Individuals with medical dependencies or with other special needs, older adults and children will require additional help with decontamination Medical care for life-threatening injuries must not be delayed in favor of decontamination To the extent possible, implement measures to contain the spread of contamination from runoff or solid waste generated by decontamination activities. This may be impractical in large-scale events. Provisions must be made to assist individuals with special needs, medical dependencies, older adults and children during the decontamination process. Perhaps most importantly, people in need of medical care must be directed to a medical treatment facility without consideration to contamination status

Test your Knowledge All of the following statements are true except:
a. Radioactive contamination may be removed, or reduced to acceptable levels simply by washing the contaminated areas with warm water and mild soap b. Removing a contaminated individual’s clothing eliminates 80 – 90% of radioactive contamination c. Treatment of minor cuts or abrasions should never be delayed in favor of decontaminated d. To the extent possible, family members should not be separated during the decontamination process The correct answer is c. Treatment of minor cuts or abrasions should never be delayed in favor of decontaminated. Treatment of life-threatening injuries and conditions should not be delayed in favor of decontamination; however, prior to receiving treatment for minor cuts and abrasions, individuals should be decontaminated to minimize the possibility to spreading contaminants to clean areas.

Summary The goal of the decontamination process is to reduce or remove contamination from body surfaces Ideally decontamination is performed until survey readings indicate levels below those of 2 times background Removing clothing eliminates 80 – 90% of contamination It may not be possible to decontaminate all personal belongings External contamination may be removed by washing with warm water and mild soap

Summary Do not abrading skin, and avoid internalizing water runoff during showering Do not separate families, particularly, children from parents Make provisions to assist individuals with medical dependencies or other special needs as well as older adults with decontamination Never delay the delivery of emergency care in favor of decontamination

Lesson 4 Behavioral Responses to Radiological/Nuclear Incidents

Objectives Define psychological stress
Present the range of psychological responses elicited by radiation and nuclear incidents Describe elements for managing psychological stress produced by radiation and nuclear incidents The objectives of this lesson are to 1. define the term, psychological stress; 2. present the range of psychological responses elicited by radiation and nuclear incidents; and 3. describe elements for managing psychological stress produced by radiation and nuclear incidents.

What is Psychological Stress?
For this lesson, psychological stress is the individual's response when demands go beyond coping resources to deal with a radiological or nuclear incident For the purpose of this lesson, we will define “psychological stress” as a person's psychological responses to a radiological or nuclear incident.

Reactions Following Radiation Incidents
Radiation and nuclear incidents may cause psychological stress, with both short and long-term effects Extend beyond the individuals directly affected Situations with a high degree of uncertainty, regarding potential future health effects, may be more psychologically traumatic than others Past radiation and nuclear incidents have shown that radiation and nuclear disasters may cause psychological stress, with both short and long-term effects. Individuals need not be directly affected by the incident to experience the same psychological effects as those who are. Because of the high degree of uncertainty about the potential future adverse health effects associated with radiation and nuclear incidents, these incidents tend to illicit more profound psychological effects than other disaster incidents.

Fear Is the Initial Response
Tasteless Odorless Colorless Association to malignant disease Visuals of Hiroshima and Nagasaki Osteosarcoma in a radium dial factory worker (circa 1920) The manifestation of fear is the first response. What is it about radiation that makes people irrationally fearful of it? The answer lies partly in the fact that it cannot be perceived by human senses: it is invisible, cannot be tasted, seen or smelled. As such, people do not feel in control of it. In addition, radiation has the dreaded quality of causing cancer and visuals of the atomic bomb victims only serve to remind the public of the tremendous dangers associated with radiation. Hiroshima: A boy who received radiation burns on his whole body following the atomic bomb explosion

Reactions Following Radiation Incidents
“When people are confused about their actual health risks, some will assume incorrectly that they have been exposed and will develop physical reactions.” National Child Traumatic Stress Network (NCTSN) 2010 Reactions to past radiation accidents have shown that the psychological stress responses to these incidents are often exaggerated to the extent that people misjudge their actual medical risks. Unfortunately, when people are confused about their actual health risks, some will assume incorrectly that they have been exposed and will develop physical reactions.

Stress Reactions Mimic Physical Injury or Illness
A Cesium-137 capsule was stolen from a discarded radiation therapy instrument and opened 250 people came in contact with Cs-137 Fear caused 112,000 people to request screening for contamination Of the first 60,000 screened, 5,000 individuals had psychosomatic symptoms that mimicked those of radiological exposure Goiania, Brazil (1987) In 1987, an abandoned radioactive source of cesium chloride was removed from a closed hospital in Goiania, Brazil. Although 250 people came in direct contact with the cesium chloride, fear caused 112, 000 “worried well” people to seek screening for contamination. Of the first 60,000 screened, 5,000 individuals exhibited somatically-based symptoms that were consistent with radiation exposure, including nausea and vomiting.

Lack of Accurate Information Fuels Fear
Inaccurate or insufficient information Fear Myths Knowledge Facts Fear, in response to a radiological or nuclear incident may be the most debilitating of the psychological reactions. Fear is driven by ambiguity, fragmented information, hype and miscommunication, and left unchecked, individuals may act in extreme and sometimes irrational ways to avoid the perceived or real threat. Without accurate or sufficient information, fear leads to myths and misconception. In the aftermath of a radiological and nuclear incident, dissemination of accurate information at the local level, by credible sources, will help dispel myths, provide facts, and provide the knowledge necessary to alleviate fear. One of the roles of radiation professional volunteers will be to reassure individuals by providing accurate information about radiation and its risks Accurate information at a local level Fear and anxiety of radiation exposure are as debilitating as the actual physical health effects One role of population monitoring volunteers is to reassure individuals by providing accurate information about radiation

Test Your Knowledge Which fact about radiation contributes to its fear? A. Causes severe sunburns and other skin rashes B. Damages cellphones C. Cannot be detected by the human senses D. Leads to birth defects such as two-headed cows The answer is C. Cannot be detected by the human senses. As such, people do not feel in control of it.

Responders’ Concerns to Radiation Incidents
Responders’ Concerns and Emotional Reactions Medical professionals, First Responders and Volunteers Have limited experience in managing casualties from radiation events May experience fear, shock, anger, helplessness and worry May be concerned about exposing family/friends Psychological support services, education and training may mitigate the psychological stress exhibited by emergency responders Emergency responders are not immune to the psychological effects of radiation or nuclear incidents. Medical professionals, first responders and volunteers may exhibit the same psychological stress as the general public: fear, shock, anger, helplessness and may be concerned about harming family members and friends as a result of contamination incurred while caring for victims.

Range of Psychological Stress
shock, fear, grief, anger, guilt, shame, feeling helpless, feeling numb, sadness indecisiveness, worry, confusion, reduced attention span, trouble concentrating distrust, conflict, work/school problems, irritability, loss of intimacy, feeling abandoned, withdrawn Emotional Cognitive Behavioral tension, fatigue, edginess, insomnia, bodily aches pain, startling easily, racing heartbeat, nausea, change in appetite Physical Spiritual changes in one’s belief in God, changes in assumptions about good and evil In addition to fear, other psychological stresses include alterations in emotional, cognitive behavioral, physical and spiritual reactions. For example, affected individuals may experience shock, sadness, and an inability to concentrate or sleep; they may be left with a sense of distrust, and changes in their beliefs about God. Personal exposure, personality characteristics, age, gender, socioeconomic status, and culture and ethnicity all influence the duration and severity of the psychological stress responses.

Prompt, safe and dignified provision of assistance
Managing the Psychological Responses to a radiological or Nuclear Incident Prompt, safe and dignified provision of assistance Medical care Screening and decontamination of affected individuals Clear and credible information pertinent to: Incident status Protective actions Public health follow-up Tracking of chronic health effects Education on health risks Providing immediate assistance to affected individuals, such as medical care, screening and decontamination, will help alleviate psychological effects. The dissemination of frequency, consistent and clear information from authoritative sources, for example, the CT Department of Public Health and the CT Department of Energy and Environmental Protection, on protective actions such as sheltering-in-place and showering, will also help to offset psychological effects. Public health follow-up is required to provide up-to-date information for health protection, track long-term effects of radiation exposure and contamination, and alleviate fears that may well be unfounded.

Test Your Knowledge Which of these is not a strategy for mitigating psychological stress during a radiological or nuclear incident? A. Provide clear and credible information about the incident B. Minimize the incident as not to worry the community C. Provide education on the health risk of radiation D. Provide medical assistance to those affected by the incident The answer is B. Minimize the incident as not to worry the community.

Summary Radiological and nuclear incidents cause psychological stress to people directly and indirectly affected by the incidents. Fear is the first psychological response to a radiological or nuclear incidents, and perhaps the debilitating of the psychological reactions Fear may cause individuals to exhibit symptoms which resemble those of radiation exposure, and act in extreme and sometimes irrational ways to avoid the perceived or real threat Medical professionals, first responders and volunteers may also experience the same psychological stresses as those experienced by the general public

Summary Individuals impacted by radiological or nuclear incidents may exhibit alterations in emotional, cognitive behavioral, physical and spiritual reactions Strategies for managing psychological stress in the after math of a radiological or nuclear incident are to provide prompt assistance to the affected population, disseminate clear information by credible sources about the status of the situation and instructions for protecting the public, and ensure that governmental agencies establish a means for tracking the effects of the event and provide health risk management information.

Roles and Responsibility of Local, State and Federal Agencies
State of Connecticut Radiation Professional Volunteer Program (CT-RPVP) Lesson 5 Roles and Responsibility of Local, State and Federal Agencies

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State of Connecticut Radiation Professional Volunteer Program (CT-RPVP) LESSON 1 Principles of Radiation and Radiation Protection.

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State of Connecticut Radiation Professional Volunteer Program (CT-RPVP) LESSON 1 Principles of Radiation and Radiation Protection.

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Presentation on theme: "State of Connecticut Radiation Professional Volunteer Program (CT-RPVP) LESSON 1 Principles of Radiation and Radiation Protection."— Presentation transcript:

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