Presentation is loading. Please wait.

Presentation is loading. Please wait.

Preparing for an Unplanned Radiation Event. Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear.

Similar presentations

Presentation on theme: "Preparing for an Unplanned Radiation Event. Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear."— Presentation transcript:

1 Preparing for an Unplanned Radiation Event

2 Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear device, dirty bomb Equivalent Experiences: Chernobyl, Goiana 4. Health Management of Affected Population OUTLINE

3 What is Radiation? For the purpose of this presentation, defined as energetic emissions from unstable atoms that can result in ionizing events to target atoms Ionizing radiation is radiation capable of imparting its energy to the body and causing chemical changes Ionizing radiation is emitted by –- Radioactive material – Some devices such as x-ray machines

4 Common Radiation Terms Radioisotope - a generic name for a radioactive element Radionuclide - a specific radioisotope such as Uranium-235 These terms are often used interchangeably

5 Radiation Physics Ionizing Radiation –Radiation with enough energy to cause ionization of atoms by ejecting electrons from their atomic orbits Types of Radiation –Electromagnetic (Photons - No Mass) X-ray, Gamma –Particulate Alpha (helium nucleus), Beta (electron), Proton, Neutron

6 Types of Radiation Emitted from Radioactive Material Particulate –Charged Alpha Radiation Beta Radiation –Uncharged Neutron Radiation Electromagnetic Gamma Radiation

7 Types of Ionizing Radiation Alpha Particles Stopped by a sheet of paper Beta Particles Stopped by a layer of clothing or less than an inch of a substance (e.g. plastic) Gamma Rays Stopped by inches to feet of concrete or less than an inch of lead Radiation Source

8 Alpha and Beta Radiation Alpha –Typically emitted from a heavy element –Most have energies between 4-8 MeV –Particles up to 7.5 MeV stopped by dead skin layer (only a few microns penetration) –Can be shielded by paper –Penetrates a few cm in air –Does not penetrate the dead layer of skin Beta –Travels about 4 meters in air per MeV –Penetrates about 0.5 cm in soft tissue per MeV –Can reach the basal cell layer of skin

9 Pertinent Alpha Emitters

10 Neutron Radiation Neutral particle emitted from the nucleus Can be very penetrating Requires special consideration for shielding Can induce radioactivity when absorbed by stable elements (N, Na, Al, S, Cl, P, etc.)

11 Electromagnetic Radiation Energy = hf Energy expressed typically in KeV or MeV (not joules) Absorption of Electromagnetic Radiation by matter –Photoelectric –Compton Scattering –Pair production (photon energy must exceed 1.02 MeV) Stochastic event Low energy photons more readily absorbed

12 The Electromagnetic Spectrum

13 Gamma Radiation Electromagnetic energy emitted from the nucleus Specific energies can be analyzed to identify source Very penetrating (many meters in air) Difficult to shield, often shielded with lead

14 X-ray Radiation Electromagnetic energy emitted from outside the nucleus May be machine-produced by bombarding high energy electrons on a target May also be emitted from radioactive materials Similar shielding and penetrating powers as gamma radiation

15 Measure of Amount of radioactive material Ionization in air Absorbed energy per mass Absorbed dose weighted by type of radiation Radiation Units For most types of radiation 1 R 1 rad 1 rem Quantity Activity Exposure Absorbed Dose Dose Equivalent Unit curie (Ci) roentgen (R) rad rem

16 Units of Radioactivity Quantity –1 Becquerel (Bq) = 1tps –1 Curie (Ci) = 3.7 x tps Exposure –1 Roentgen (R) = 2.58 x C/Kg air 87.7 ergs/g air Exposure to Dose Relationship –1 R exposure 95 ergs/g absorption in muscle

17 Half-Life The time required for a radioactive substance to loose 1/2 of its radioactivity Each radionuclide has a unique half-life Half-lives range from extremely short (fraction of a second) to billions of years

18 Example of the Effect of Half-Life Assume an initial amount of 32 uCi of TC-99m with a half-life (T 1/2 ) of 6 hours –after 1 half-life (6 h): 16 uCi –after 2 half-lives (12 h): 8 uCi –after 3 half-lives (18 h): 4 uCi –after 4 half-lives (24 h): 2 uCi After 10 half-lives, less than 1/1000 of the original activity remains

19 Selected Radionuclides with Radiations RadionuclideRadiation(s)Half-LifeEff. Half-Life Hydrogen-3 12 y12 d Cobalt y10 d Strontium y15 y Iodine d8 d Cesium y70 d Iridium d- Radium y44 y From Mettler, Jr., F.A. and Upton, A.C., Medical Effects of Ionizing Radiation 2 nd edition

20 Radiation Dose Absorbed Dose (D) 1 Gray (Gy) = 1 J/Kg 1 rad = 100 ergs/g 100 rad = 1 Gy Dose Equivalent (H T ) [ H T = DQ] 1 Seivert (Sv) = 1 J/Kg 1 rem = 100 ergs/g 100 rem = 1 Sv Note: 1 MeV = 1.6 x Joules Deterministic Acute Effects Stochastic Late Effects

21 Weighting Factors OrganizationNRCICRUNCRPICRP Weighting factorQQQWRWR X &Gamma Rays1111 Beta Rays1111 Thermal Neutrons255 Fast Neutrons Hi Energy Protons1015 Alpha Particles202520

22 Radiation Doses and Dose Limits Flight from Los Angeles to London 5 mrem Annual public dose limit 100 mrem Annual natural background 300 mrem Fetal dose limit 500 mrem Barium enema 870 mrem Annual radiation worker dose limit5,000 mrem Heart catheterization (skin dose) 45,000 mrem Life saving actions guidance (NCRP-116) 50,000 mrem Mild acute radiation syndrome 200,000 mrem LD 50/60 for humans (bone marrow dose) 350,000 mrem Radiation therapy (localized & fractionated) 6,000,000 mrem

23 Radioactive Material Radioactive material consists of atoms with unstable nuclei The atoms spontaneously change (decay) to more stable forms and emit radiation A person who is contaminated has radioactive material on their skin or inside their body (e.g., inhalation, ingestion or wound contamination)

24 Physical Radionuclide Half-Life Activity Use Cesium yrs 1.5x10 6 Ci Food Irradiator Cobalt-60 5 yrs 15,000 Ci Cancer Therapy Plutonium-23924,000 yrs 600 CiNuclear Weapon Iridium days 100 Ci Industrial Radiography Hydrogen-3 12 yrs 12 Ci Exit Signs Strontium-9029 yrs 0.1 CiEye Therapy Device Iodine days Ci Nuclear Medicine Therapy Technetium-99m 6 hrs Ci Diagnostic Imaging Americium yrs Ci Smoke Detectors Radon days 1 pCi/l Environmental Level Examples of Radioactive Materials

25 Radiation vs. Radioactive Material Radioactive Material –Any substance that spontaneously gives off radiation –Can be in various chemical forms –If not contained (sealed source) can lead to contamination - External, Internal or Both Radiation –The energetic emissions of radioactive material –Can be subatomic particles (,, n), photons (X-ray, ) or combinations –Results in ionization of the absorbing material (if living tissue radiation injury)

26 Half-Life (HL) Physical Half-Life Time (in minutes, hours, days or years) required for the activity of a radioactive material to decrease by one half due to radioactive decay Biological Half-Life Time required for the body to eliminate half of the radioactive material (depends on the chemical form) Effective Half-Life The net effect of the combination of the physical & biological half-lives in removing the radioactive material from the body Half-lives range from fractions of seconds to millions of years 1 HL = 50%2 HL = 25%3 HL = 12.5%

27 Criticality Incident Operation Upshot/Knothole, a 1953 test of nuclear artillery projectile at Nevada Test Site

28 Nuclear Fission

29 Fissile Material U-235 –Enriched from 0.7% (Natural) to 3% > 90% –Used: Commercial Reactors Research Reactors Naval Reactors Atomic Bomb Pu-239 –Byproduct of U-235 fission –Used in Breeder Reactor –Also can be weaponized

30 Radionuclides of Concern

31 Causes of Radiation Exposure/Contamination Accidents –Nuclear reactor –Medical radiation therapy –Industrial irradiator –Lost/stolen medical or industrial radioactive sources –Transportation Terrorist Event –Low yield nuclear weapon –Radiological dispersal device (dirty bomb) –Attack on or sabotage of a nuclear facility

32 Size of Event EventNo. of Deaths Most Deaths Due to Radiation Accident None/Few Radiation Radioactive Dispersal Device Few/Moderate (Depends on size of explosion & proximity of persons) Blast Trauma Low Yield Nuclear Weapon Large (e.g. tens of thousands in an urban area even from 0.1 kT weapon) Radiation Exposure Blast Trauma Thermal Burns Fallout (Depends on Distance)

33 Dose Limits - ICRP 60 ApplicationOccupationalPublic Whole Body20 mSv/year Effective dose averaged over 5 years, max: 50 mSv/yr 1 mSv in 1 year Annual Equiv. Dose: Lens of eye150 mSv15 mSv Skin500 mSv50 mSv Hands & Feet500 mSv _

34 Emergency Exposure Guidelines - ICRP 60 Dose Limit (Whole Body)Activity PerformedConditions 5 remsAll…..……. 10 remsProtecting major propertyWhere lower dose limit not practicable. 25 remsLifesaving or protection of large populations Where lower dose limit not practicable >25 remsLifesaving or protection of large populations Only on a voluntary basis to personnel fully aware of the risks involved

35 Radiography Source

36 Sealed Source Accident 13 Curie Cs-137 Radiography Source Found by a man at an Argentina construction site Carried in front pockets for 18 hours

37 Accident Dose Calculation Cs-137 Gamma Constant = R-m 2 /hr-Ci R-m 2 x (18hr)(13Ci) = 755,820 R hr-Ci (0.01m) 2

38 Accident Isodose Curves

39 Basic Radiobiology Atom Ionization in Water or Cell Molecules Molecule Chemical Damage Bond Breakage DNA Chromosomal Aberration Cell Death Mutation

40 Radiosensitivity (most to least): Lymphocytes Erythroblasts Myeloblasts Epithelial Cells –Intestinal crypts –Testis –Ovary –Skin –Secretory glands –Lungs and bile ducts Endothelial Cells Connective Tissue Cells Tubular Cells of Kidneys Bone Cells Nerve Cells Brain Cells Muscle Cells 19-A

41 Classification of Medical Radiation Problems Anxiety Acute Radiation Syndrome Local Radiation Injury External Radionuclide Contamination Local Trauma with Radionuclide Contamination Internal Radionuclide Contamination

42 Radiation Injuries External exposure to penetrating radiation –Criticality Incident (,N) –Sealed Source (, ) –External Contamination (, ) –Beam Generator (,N) Internal contamination with radionuclides –Wound Contamination (,, ) –Injection (,, ) –Inhalation (,, ) –Ingestion (,, )

43 Late Health Effects from Radiation Radiation is a weak carcinogen at low doses No unique effects (type, latency, pathology) Natural incidence of cancer ~ 40%; mortality ~ 25% Risk of fatal cancer is estimated as ~ 4% per 100 rem A dose of 5 rem increases the risk of fatal cancer by ~ 0.2% A dose of 25 rem increases the risk of fatal cancer by ~ 1%

44 What are the Risks to Future Children? Hereditary Effects Magnitude of hereditary risk per rem is 10% that of fatal cancer risk Risk to caregivers who would likely receive low doses is very small - 5 rem increases the risk of severe hereditary effects by ~ 0.02% Risk of severe hereditary effects to a patient population receiving high doses is estimated as ~ 0.4% per 100 rem

45 Fetal Irradiation No significant risk of adverse developmental effects below 10 rem Little chance of malformation. Most probable effect, if any, is death of embryo. Reduced lethal effects. Teratogenic effects. Growth retardation. Impaired mental ability. Growth retardation with higher doses. Increased childhood cancer risk. (~ 0.6% per 10 rem) < All Pre-implantation Organogenesis Fetal Weeks After Fertilization Period of Development Effects

46 Types of Radiation Hazards External Exposure - whole-body or partial- body (no radiation hazard to EMS staff) Contaminated - –external radioactive material: on the skin –internal radioactive material: inhaled, swallowed, absorbed through skin or wounds External Exposure Internal Contamination External Contamination

47 Radioactive Contamination Contamination is simply the presence of radioactive material where it is not wanted Persons may be contaminated either externally, internally or both Exposure does not necessarily imply contamination

48 In order to limit the amount of radiation you are exposed to, think about: SHIELDING, DISTANCE and TIME Shielding: If you have a thick shield between yourself and the radioactive materials more of the radiation will be absorbed, and you will be exposed to less. Distance: The farther away from the blast and the fallout the lower your exposure. Time: Minimizing time spent exposed will also reduce your risk.

49 ALARA Techniques Work quickly and efficiently (TIME) Rotate personnel if qualified replacements are available (TIME) When not involved in patient care, remain a few feet away from the patient (DISTANCE) Use long-handled forceps to remove contaminated particles, contaminated dressings, etc. (DISTANCE) Remove contaminated materials from the treatment area (DISTANCE & QUANTITY) Put contaminated metal or glass in lead in lead pigs obtained from nuclear medicine department (SHIELDING)

50 Time Minimize time spent near radiation sources Radiation Protection: Reducing Radiation Exposure Distance Maintain maximal practical distance from radiation source Shielding Place radioactive sources in a lead container To Limit Caregiver Dose to 5 rem Distance Rate Stay time 1 ft 12.5 R/hr 24 min 2 ft 3.1 R/hr 1.6 hr 5 ft 0.5 R/hr 10 hr 8 ft 0.2 R/hr 25 hr

51 Risk to Contaminated Patient ARS, local radiation injury or contamination (both internal & external) never demands immediate medical attention. Priority 1: True medical emergencies –ABCs –Bleeding assessment –Trauma assessment –Wound assessment Remove contaminated clothing as soon as reasonably possible (removes 80% of external contamination) Proceed with decontamination procedures after patient stabilized

52 Risk to Healthcare Provider Minimal if using proper precautions Remember ALARA techniques Worst case - 15 mSv/hr close to contaminated wound At 1 foot ( 30 cm) mSv/hr NCRP public monthly equivalent dose to embryo/fetus: 0.5 mSv

53 Healthcare Provider - Controlling the Spread of Contamination Goal: Minimize and control contamination Use proper protective clothing Do not eat drink or smoke in contamination areas Check yourself for contamination prior to leaving a potentially contaminated area Limit access to treatment area to necessary personnel only

54 Putting It All Together

55 OUTLINE Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear device, dirty bomb Equivalent Experiences: Chernobyl, Goiana 4. Health Management of Affected Population

56 Mass Exposure Events Criticality Events –Improvised Nuclear Device (IND) –Reactor Release Nuclide Contamination –Radiological Dispersal Device (RDD) aka: Dirty Bomb –Intentional Contamination of Resources External Radiation Source -- Industrial or Medical Source

57 Injury Sources From Nuclear Device Detonation Terrorist Event Low yield nuclear weapon Energy Distribution –50% Blast –35% Thermal Radiation –15% Ionizing Radiation Health Consequences –Injury –Burns –Penetrating Ionizing Radiation Prompt (1/3) Delayed (2/3) –Fallout Contamination Penetrating Ionizing Radiation

58 A nuclear weapon is expected to cause many deaths and injuries: radiation is not the primary hazard Blast and thermal effect comprise of the majority of effects/casualties Radiation lethality out-distances thermal and blast damage only in low yield weapons ( 1 kiloton)

59 Thermal: 35% of the energy 1 st flash Pulse 2 nd pulse (99% of the energy) The pattern is from the dark colored areas on her kimono

60 Long distance visual effects Flash Blindness, also referred to as "dazzle," is a temporary impairment of vision. Victim does not have to be looking directly at the source for this to occur. Nighttime greatly increases distance of effect Retinal burn: visual capacity is permanently lost in the burned area. Retinal burns can be produced at great distances from the nuclear detonation because the probability of occurrence does not follow the inverse square law as is true of many other types of nuclear radiation.

61 Fallout: important for surface bursts A nuclear detonation results in a fireball with a temperature estimated to be several tens of millions of degrees. The radioactive particles resulting from nuclear fission and activation of surrounding materials are carried up by the fireball and then drift downwind to later settle on the ground.

62 Same type of nuclear warhead was used in a small artillery round, called Davy Crockett. Real-World Example Similar to Russian Suitcase Nukes

63 Davy Crockett Fallout – NYC Results from Davy Crockett overlaid on New York City map Building that houses detonation device is destroyed Adjoining buildings damaged People within 1200 feet receive lethal dose of radiation (650,000 mrem or higher) from blast (not fallout) 1~50,000 fatalities in estimation 1~200,000 casualties 10,000 mrem/hr Point of Detonation 10,000 mrem/hr FOR TRAINING PURPOSES ONLY 1,000 mrem/hr Lethal Dose Area

64 Atomic Weapon NuclideYields NuclideHalf-lifeMCi 89 Sr 90 Sr 95 Zr 103 Ru 106 Ru 131 I 137 Cs 131 Ce 144 Ce 53 d 28 y 65 d 40 d 1 y 8 d 30 y 1 y 33 d 20.0 b 0.1 b 25.0 b 18.5 b 0.29 b c 0.16 b 39.0 b 3.7 b Approximate Yields of the Principal Nuclides per Megaton of Fission b From Klement (1965) c From Knapp (1963) Environmental Radioactivity 4 th Ed., Eisenbud M (1997)

65 The Chernobyl Accident

66 Chernobyl: Healthcare Resources Used Local medical facilities 400 special medical brigades –M.D., H.P., etc. 15,000 health workers –2,000 M.D.s, 4,000 nurses, med students, etc 213 mobile laboratories Special hospitals (Kiev, Moscow)

67 Chernobyl: Healthcare Procedures Medical Examinations 1,000,000 persons Dosimetric & lab tests 700,000 (216,000 children) Inpatient care32,000 persons (12,000 children) Iodine prophylaxis 5,400,000 persons (1,700,000 children)

68 Chernobyl: Aftermath 31 deaths –1 from roof collapse –1 severe burns –21 of 22 with ARS and skin burns ( r) –7 of 23 ( r) Estimate additional 300 cases of thyroid cancer in exposed children and 100 cases in exposed adults. 135,000 persons from 176 communities evacuated out to 30 km from plant Dose to public (3-15 km zone): estimate 43 rem (50 year commited dose)

69 Lessons Learned In the USSR highly organized Civil Defense, Health system, Military and other government resources were quickly mobilized. In the US less centralized resources might currently have more difficulties, although the maturation of the Homeland Security Agency should facilitate such a response.

70 OUTLINE Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear device, dirty bomb Equivalent Experiences: Chernobyl, Goiana 4. Health Management of Affected Population

71 What Is a Radiation Threat? A radiation threat or "Dirty Bomb" is the use of common explosives to spread radioactive materials. It is not a nuclear blast. The force of the explosion and radioactive contamination will be more localized. In order to limit the amount of radiation you are exposed to, think about shielding, distance and time. Local authorities may not be able to immediately provide information on what is happening and what you should do. However, you should watch TV, listen to the radio, or check the Internet often for official news and information as it becomes available.

72 84 of 132 devices are missing We do not know what the status of the other devices is, we just could not locate them… Russian General Lebed, 1998 No direct evidence that any have been stolen. US Assistant Sec of Defense of Nuclear Chemical Biological Programs, January 2003 Russian Nuclear SuitcaseDevices

73 Black Market Smuggling Total Number of Material Seizures (April 2001) 217 low-grade nuclear material 14 weapons usable material 299 Radioactive Sources

74 Sophisticated RDD May not be recognized before it is exploded

75 Probability of RDD Simple to build Widely available materials Ease of building simple explosives More than 200 naturally-occurring and man-made radionuclides can be potentially used for RDD Terrorist Event Radiological dispersal device (dirty bomb) Health Consequences: Injury Burns Single Nuclide Contamination(?) Much higher probability than the use of a nuclear weapon:

76 Background After the 1991 Gulf War Iraqis disclosed they had worked on an RDD made of iron bombs packed with zirconium oxide irradiated in a research reactor. (USAF SAB, 1998 and IAEA documentation) ~ 200 of the 2 million regulated radioactive sources and devices are lost, stolen, or abandoned each year in the USA. Cesium-137, the most commonly lost radiation source has a 33 year half-life emits Beta (0.510, 1.17 MeV), and Gamma (~0.662 KeV) and substitutes for Potassium in the body.

77 The principal type of dirty bomb, or Radiological Dispersal Device (RDD), combines a conventional explosive, such as dynamite, with radioactive material. In most instances, the conventional explosive itself would have more immediate lethality than the radioactive material. At the levels created by most probable sources, not enough radiation would be present in a dirty bomb to kill people or cause severe illness. However, certain other radioactive materials, dispersed in the air, could contaminate up to several city blocks, creating fear and possibly panic and requiring potentially costly cleanup. Prompt, accurate, non-emotional public information might prevent the panic sought by terrorists. A second type of RDD might involve a powerful radioactive source hidden in a public place, such as a trash receptacle in a busy train or subway station, where people passing close to the source might get a significant dose of radiation. A dirty bomb is in no way similar to a nuclear weapon. The presumed purpose of its use would be therefore not as a Weapon of Mass Destruction but rather as a Weapon of Mass Disruption. Radiation exposure from most RDDs in urban areas would expose many, kill few Good reference:

78 Concerns Immediate radiation injuryvery few Cancersmall (if any) increase on overall 25% probability of dying from cancer Exceptions: iodine and childrens thyroid cancer Birth defectsonly a concern for a few (if any), has been dramatically overestimated in the past

79 Goiania Contamination Accident 454-2

80 Location of Goiania, Brazil 451-1

81 Goiania Accident Source 137 Cs teletherapy source capsule: Physical form: CsCl hygroscopic powder with blue fluorescence as it absorbed moisture. Radioactivity: 50.9 TBq (1375Ci) Dose m:4.56 Gy/hr (456 rad/hr)

82 Goiania Event Sequence 451-3

83 Goiania Medical Disposition 580-9

84 Goiania Casualty Burial

85 Goiania Local Injury 454-5

86 Goiania Contaminated Areas 451-2

87 Goiania Population Screening 55-3

88 Goiania Accident Magnitude People monitored: 112,000 Chromosome analyses: 110 Roads monitored: 2,000 Km Remediation workers: 755 Above DL: 38 (Highest: 10 mSv CDE) Homes contaminated: 85 Demolished: 7 Vehicles contaminated: 50 Radwaste created: 3, L drums

89 Lessons Learned Lack of awareness of the detrimental health effects of radiation exposure can impede its recognition on the part of patients and medical practitioners until much damage is done. The alert M.D. who faces an unusual public health problem must find a collaborating H.P. to evaluate its possible radiogenic origin and if confirmed, to help deal with it.

90 Shelter if you cant evacuate Use the Shelter to Shield and Distance yourself from the fallout contamination.

91 Particle Filtering Factors Filtration Efficiencies –Mans cotton handkerchief, 16 thick.94% –Mans cotton handkerchief, 8 thick.88% –Toilet paper, 3 thick.91% –Bath towel, 2 thick.85% –Cotton Shirt, 2 thick.65% Turn off ventilation

92 Recommended Accumulated Dose Levels at which to Consider Evacuation and/or Relocation

93 Fallout: The 7-10 Rule of Thumb Time (hours) Relative Fallout Dose Rates H + 1 * 100% H + 7 (1 7) 10 % H+49 (7 7) 1% H+343 (7 7 7) ~14 Days 0.1% H+2401 (7 4 ) ~100 Days 0.01% * Prior to H+1, the dose rates from fall out is significantly higher Shelter as long as possible before evacuating across fallout contamination. Waiting 2 days will reduce exposure by a factor of 100!

94 Decontamination: important for nuclear weapons and radiation dispersal devices

95 Evacuate the Fallout Path Although dose rates are highest within the first few hours, this only represents a relatively small area Evacuating the fallout area before fallout arrival will save the most lives

96 If there is a radiation or a dirty bomb threat 1.If you are outside and there is an explosion or authorities warn of a radiation release nearby, cover your nose and mouth and quickly go inside a building that has not been damaged. If you are already inside check to see if your building has been damaged. If your building is stable, stay where you are. Close windows and doors; turn off air conditioners, heaters or other ventilation systems.

97 If there is a radiation or a dirty bomb threat 1.If you are inside and there is an explosion near where you are or you are warned of a radiation release inside, cover nose and mouth and go outside immediately. Look for a building or other shelter that has not been damaged and quickly get inside. 2.Once you are inside, close windows and doors; turn off air conditioners, heaters or other ventilation systems. 3.If you think you have been exposed to radiation, take off your clothes and wash as soon as possible. 4.Stay where you are, watch TV, listen to the radio, or check the Internet for official news as it becomes available.

98 If there is a nuclear blast If there is advance warning: Take cover immediately, as far below ground as possible, though any shield or shelter will help protect you from the immediate effects of the blast and the pressure wave. If there is no warning: 1.Quickly assess the situation. 2.Consider if you can get out of the area or if it would be better to go inside a building to limit the amount of radioactive material you are exposed to. 3.If you take shelter go as far below ground as possible, close windows and doors, turn off air conditioners, heaters or other ventilation systems. Stay where you are, watch TV, listen to the radio, or check the Internet for official news as it becomes available. To limit the amount of radiation you are exposed to, think about shielding, distance and time. Use available information to assess the situation. If there is a significant radioactive contamination threat, health care authorities may advise you to take potassium iodide. It may protect your thyroid gland, which is particularly vulnerable, from radioactive iodine exposure. Plan to speak with your health care provider in advance about what makes sense for your family.

99 Conclusions Radiation dispersal devices could cause significant contamination with low levels of radiation, but would result in few if any radiation casualties. Much of the radiation dispersal devices impact will depend on how much we over-react to the dangers of radiation. A nuclear weapon would result in substantial casualties and confusion from many effects, with radiation injury being the dominant one in the fallout region. In a fallout scenario, wise actions on sheltering/evacuation will save thousands of lives. You can prepare by knowing (and teaching) the facts about radiation, and having a plan about what to do in a radiation emergencya good place to start is

100 OUTLINE Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear device, dirty bomb Equivalent Experiences: Chernobyl, Goiana 4. Health Management of Affected Population

101 The Real Medical Radiation Problems Fear Communication Failure Uncertainty Inaction Chaos

102 Key Points for Emergency Responders Responders –Lifesaving first aid is the First Priority –Familiarize yourself with work area Survey instrumentation, protective clothing, respiratory protection suitable to accident conditions –Evacuate personnel to safe areas –Assessment of radiological hazard Public –Prevention is key as therapeutic measures are limited –Shelter vs Evacuation –Contamination Rule of thumb: % contamination removed with clothing Showering will remove an additional 7%

103 Facility Preparation Activate hospital plan –Obtain radiation survey meters –Call for additional support: Staff from Nuclear Medicine, Radiation Oncology, Radiation Safety (Health Physics) –Establish area for decontamination of uninjured persons –Establish triage area Plan to control contamination –Instruct staff to use universal precautions and double glove –Establish multiple receptacles for contaminated waste –Protect floor with covering if time allows –For transport of contaminated patients into ED, designate separate entrance, designate one side of corridor, or transfer to clean gurney before entering, if time allows

104 Decontamination Center Establish a decontamination center for people who are contaminated, but not significantly injured. –Center should provide showers for many people. –Replacement clothing must be available. –Provisions to transport or shelter people after decontamination may be necessary. –Staff decontamination center with medical staff with a radiological background, health physicists or other staff trained in decontamination and use of radiation survey meters, and psychological counselors

105 Key Points Contamination is easy to detect and most of it can be removed It is very unlikely that ED staff will receive large radiation doses from treating contaminated patients Protecting Staff from Contamination Universal precautions Survey hands and clothing with radiation meter Replace gloves or clothing that is contaminated Keep the work area free of contamination

106 Contaminated Waste Treatment Area Layout Radiation Survey HOT LINE STEP OFF PAD CONTAMINATED AREA BUFFER ZONE CLEAN AREA Radiation Survey & Charting ED Staff Clean Gloves, Masks, Gowns, Booties Separate Entrance Trauma Room

107 Detecting and Measuring Radiation Instruments –Locate contamination - GM Survey Meter (Geiger counter) –Measure exposure rate - Ion Chamber Personal Dosimeters - measure doses to staff –Radiation Badge - Film/TLD –Self reading dosimeter (analog & digital)

108 Patient Management - Priorities Triage Medical triage is the highest priority Radiation exposure and contamination are secondary considerations Degree of decontamination dictated by number of and capacity to treat other injured patients

109 Patient Management - Triage Triage based on: Injuries Signs and symptoms - nausea, vomiting, fatigue, diarrhea History - Where were you when the bomb exploded? Contamination survey

110 Classification of Medical Radiation Problems Anxiety Acute Radiation Syndrome Local Radiation Injury External Radionuclide Contamination Local Trauma with Radionuclide Contamination Internal Radionuclide Contamination 82-A

111 Mass Casualties, Contaminated but Uninjured People, and Worried Well An incident caused by nuclear terrorism may create large numbers of contaminated people who are not injured and worried people who may not be injured or contaminated Measures must be taken to prevent these people from overwhelming the emergency department A triage site should be established outside the ED to intercept such people and divert them to appropriate locations. –Triage site should be staffed with medical staff and security personnel –Precautions should be taken so that people cannot avoid the triage center and reach the ED

112 Radiation Anxiety In the event of a nuclear or radiological weapon detonation, thousands of victims will be concerned about their possible exposure to ionizing radiation. Accurate knowledge of radiation dose can dramatically affect the assignment of triage category, BUT accepted methods for accurate post-exposure dosimetry take days to measure. Thus, clinical signs, symptoms and blood counts are best early indicators of radiation injury.

113 Psychological Casualties Terrorist acts involving toxic agents (especially radiation) are perceived as very threatening Mass casualty incidents caused by nuclear terrorism will create large numbers of worried people who may not be injured or contaminated Establish a center to provide psychological support to such people Set up a center in the hospital to provide psychological support for staff

114 Acute Radiation Syndrome Depending on the magnitude of the exposure, the hematopoietic system, the gastrointestinal tract, the cardiovascular and central nervous systems may be involved in damage. There are three major forms (in order of severity): –Hematological form –Gastrointestinal form –Neurovascular form

115 Thoma/Wald Prognostic Categories Group 1: 0.5 to 1.5 Gy; mostly asymptomatic with occasional minimal prodromal symptoms Group 2: 1.5 to 4 Gy; clinically manifested by transient N/V and mild hemotopoietic changes Group 3: 4 to 6 Gy; clinically manifested by severe hematopoietic changes with some GI symptoms Group 4: 6 to 14 Gy; clinically manifested by severe hematopoietic complications dominated by GI complications Group 5: >50Gy; manifested by marked early neuro- vascular changes

116 Prodromal stage –nausea, vomiting, diarrhea and fatigue –higher doses produce more rapid onset and greater severity Latent period (Interval) –patient appears to recover –decreases with increasing dose Manifest Illness Stage –Hematopoietic –Gastrointestinal –CNS Acute Radiation Syndrome (Cont.) For Doses > 100 rem Time of Onset Severity of Effect

117 Prodromal Appearance Time 39-J

118 Clinical Effects of ARS

119 Acute Local Radiation Injury EffectTime of Appearance (days) Threshold Dose (cGy) Erythemaminutes to weeks (dose dependant) at threshold Epilation Dry desquamation Moist desquamation

120 Skin - No visible injuries < 100 rem –Main erythema, epilation>500 rem –Moist desquamation >1,800 rem –Ulceration/Necrosis>2,400 rem Cataracts –Acute exposure>200 rem –Chronic exposure>600 rem Permanent Sterility –Female>250 rem –Male>350 rem Localized Radiation Effects - Organ System Threshold Effects

121 Special Considerations High radiation dose and trauma interact synergistically to increase mortality Close wounds on patients with doses > 100 rem Wound, burn care and surgery should be done in the first 48 hours or delayed for 2 to 3 months (> 100 rem) Hours ~3 Months Emergency Surgery Hematologic Recovery No Surgery After adequate hematopoietic recovery Surgery Permitted

122 OUTLINE Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear device, dirty bomb Equivalent Experiences: Chernobyl, Goiana 4. Health Management of Affected Population

123 Emergency Department Management of Radiation Casualties CAUTION

124 Patient Management - Decontamination Carefully remove and bag patients clothing and personal belongings (typically removes 95% of contamination) Survey patient and, if practical, collect samples Handle foreign objects with care until proven non-radioactive with survey meter Decontamination priorities : –Decontaminate wounds first, then intact skin –Start with highest levels of contamination Change outer gloves frequently to minimize spread of contamination

125 Patient Management - Decontamination (Cont.) Protect non-contaminated wounds with waterproof dressings Contaminated wounds: –Irrigate and gently scrub with surgical sponge –Extend wound debridement for removal of contamination only in extreme cases and upon expert advice Avoid overly aggressive decontamination Change dressings frequently Decontaminate intact skin and hair by washing with soap & water Remove stubborn contamination on hair by cutting with scissors or electric clippers Promote sweating Use survey meter to monitor progress of decontamination

126 Patient Management - Decontamination (Cont.) Cease decontamination of skin and wounds –When the area is less than twice background, or –When there is no significant reduction between decon efforts, and –Before intact skin becomes abraded. Contaminated thermal burns –Gently rinse. Washing may increase severity of injury. –Additional contamination will be removed when dressings are changed. Do not delay surgery or other necessary medical procedures or exams…residual contamination can be controlled.

127 Initial Management of Externally Contaminated Patient Gross Decontamination –Removal of Contaminated Clothing –Washing and removal of Contaminated Hair –Removal of Gross Wound Contamination Intermediate Stage (at clean location,if necessary) –Removal of Contaminated Clothing –Further Local Decontamination, Swabs of Body Orifices –Supportive Measures, First Aid Final Stage –Patient Discharged with Fresh Clothing –More Definitive Decontamination (surgical) and Other Therapy at Dispensary or Hospital

128 Handling contaminated patients

129 Patient decontamination Monitor to determine if decontamination is needed Remove outer clothing Wash exposed skin surfaces Flush wounds with water Do not scrub or abrade skin! Low levels of contamination are not a health hazard and can be left in place if not easily removed (they will decay quickly).

130 Early Treatment For Radionuclide Contaminated Wounds Irrigate Wound –Saline –Water Decontaminate Skin (But Do Not Injure) –Detergent Continue Wound Irrigation Until Radiation Level Is Zero or Constant Treat Wound as Usual –Consider Excision of Embedded Long-Lived High- Hazard Contaminants

131 Therapy For Isotope Decorporation Dilution – 3 H: Water – 32 P: Phosphorus (Neutraphos) Blocking – 137 Cs: Prussian Blue – 131 I, 99 Tc: KI (Lugols) – 90 Sr, 85 Sr: Na-Alginate (Gaviscon), Al- Phosphate or Hydroxide Gel (Phosphajel or Amphojel)

132 Therapy For Isotope Decorporation (cont.) Mobilization – 86 Rb: Chlorthalidone (Hygroton) Chelation – 252 Cf, 242 Cm, 241 Am, 239 Pu, 144 Ce, Rare Earths, 143 Pm, 140 La, 90 Y, 65 Zn, 46 Sc: DTPA – 210 Pb: EDTA, Penicilamine – 210 Po: Dimercaprol (BAL) – 203 Hg, 60 Co: Penicilamine

133 Radionuclide-specific Most effective when administered early May need to act on preliminary information NCRP Report No. 65, Management of Persons Accidentally Contaminated with Radionuclides Treatment of Internal Contamination RadionuclideTreatment Route Cesium-137Prussian blueOral Iodine-125/131Potassium iodideOral Strontium-90Aluminum phosphateOral Americium-241/Ca- and Zn-DTPAIV /or Plutonium-239/ nebulizer Cobalt-60

134 Treatment of Internal Contamination: Treatment Options Reduce G.I. Absorption Hasten Excretion Use Blocking and Diluting Agents When Appropriate Use Mobilizing Agents Use Chelating Agents If Available

135 Patient Management - Patient Transfer Transport injured, contaminated patient into or from the ED: Clean gurney covered with 2 sheets Lift patient onto clean gurney Wrap sheets over patient Roll gurney into ED or out of treatment room

136 Facility Recovery Remove waste from the Emergency Department and triage area Survey facility for contamination Decontaminate as necessary –Normal cleaning routines (mop, strip waxed floors) typically very effective –Periodically reassess contamination levels –Replace furniture, floor tiles, etc. that cannot be adequately decontaminated Decontamination Goal: Less than twice normal background…higher levels may be acceptable

137 Key Points Medical stabilization is the highest priority Train/drill to ensure competence and confidence Pre-plan to ensure adequate supplies and survey instruments are available Universal precautions and decontaminating patients minimizes exposure and contamination risk Early symptoms and their intensity are an indication of the severity of the radiation injury The first 24 hours are the worst; then you will likely have many additional resources

138 Resources Radiation Emergency Assistance Center/ Training Site (REAC/TS) (865) Medical Radiobiology Advisory Team (MRAT) Armed Forces Radiobiology Research Institute (AFRRI) (301) –Medical Management of Radiological Casualties Handbook, 2003; and Terrorism with Ionizing Radiation Pocket Guide Websites: – - Response to Radiation Emergencies by the Center for Disease Control – - Disaster Preparedness for Radiology Professionals by American College of Radiology – - Medical Treatment of Radiological Casualties

139 Resources Books: –Medical Management of Radiation Accidents; Gusev, Guskova, Mettler, –Medical Effects of Ionizing Radiation; Mettler and Upton, –The Medical Basis for Radiation-Accident Preparedness; REAC/TS Conference, –National Council on Radiation Protection Reports No. 65 (Contaminated Patient Care) and No. 138 (Radiation Injury Care). Articles: –Major Radiation Exposure - What to Expect and How to Respond, Mettler and Voelz, New England Journal of Medicine, 2002, 346: –Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group, Waselenko,, Annals of Internal Medicine, 2004, 140: –Guidebook for the Treatment of Accidental Internal Radionuclide Contamination of Workers; Gerber, Thomas RG (eds), Radiation Protection Dosimetry, 1992.

Download ppt "Preparing for an Unplanned Radiation Event. Radiation Terrorism and Response 1.Radiation Basics 2.Radiation Protection Rules 3.Radiation Threats Nuclear."

Similar presentations

Ads by Google