1. TMT Handbook: Responding to a crisis resulting from the malevolent use of ionizing radiation Carlos Rojas-Palma et al. Belgian Nuclear Research Center (SCKCEN) carlos.rojas.palma@sckcen.be National REP Conference Chicago, IL, March 2010 Copyright © 2009 SCKCEN

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3. First and Foremost My first appearance at the NREP conference was exactly 10 years ago in Reno, NV.

4. First and Foremost My first presentation at the NREP conference was exactly 10 years ago in Reno, NV. Since then I have attended a number of conferences, visited several cities in the US and above all, I have made many friends.

5. First and Foremost My first presentation at the NREP conference was exactly 10 years ago in Reno, NV. Since then I have attended a number of conferences, visited several cities in the US and above all, I have made many friends. My sincere appreciation to the organizing committee for giving me this opportunity to share our achievements.

6. Outline of this presentation  Introduction  State-of-the-art vs Need  Approach adopted  Accomplishments  Planned activities  Closing remarks and hopefully…  Q&A

7. Introduction  Probably since TMI in the US and Tchernobyl (Чернобыль) in Europe, emergency preparedness and response plans have been tailored and developed having Nuclear Power Plants at the center of the emergency planning zone and being responsible for a major release of radioactivity that could have a potential impact on people and environment.

8. For years this memory has been motivating our activities and efforts...

9. … This effort must continue despite the still increasing belief of our political masters that resources are not needed for being prepared, The fading memory of an accident that took place almost a quarter of a century ago DOES exacerbate this thought…

10. However the following events... Madrid, Spain (2004)

11. London, UK (2005)

13. Moscow (RU) - March 29, 2010

14. There are disaffected groups Seeking to create disruption and panic in the society, determined to using whatever is out there to achieve their objectives…

15. What if these nut cases want to use ionizing radiation? We have the responsibility of being prepared for this as well !!

16. The need EURATOM RESEARCH AND TRAINING PROGRAMME ON NUCLEAR ENERGY (2002-2006)

17. WORK PROGRAMME 2005/06 Emergency Management (Specific Targeted Research Project, RAD PROT-2005/6-3.3.4.1-2) Objectives: To develop improved and more holistic approaches for the effective and timely monitoring and treatment of populations exposed as a result of the malevolent use of radiation or radioactive material. Scope: Approach/es should be applicable to the full range of scenarios that have been postulated as potential malevolent uses of radiation or radioactive material Monitoring approaches should focus on effective and timely triage of potentially exposed populations Treatment approaches should be practicable taking account of the potential numbers of affected people and contingent damage from blast, explosion, other toxic agents, etc Priority should be given to the practicable development or customisation of existing knowledge and techniques A holistic and fully integrated approach will be required with the active and multi-disciplinary participation of the research community and end users. The main output should be practicable tools or guidance that can find broad application. A modest scale STREP should be sufficient to achieve these objectives.

18. TMT Handb ok A handbook for the triage, monitoring and treatment of people exposed to a malevolent use of ionizing radiation (TMT Handbook)

19. State-of-the-art vs need Until recently, European national emergency response plans have been focused on accidents at nuclear industry sites, Recent events have highlighted the possible threat from malevolent use of ionizing radiation or radioactive material,  Any incident would occur at a location not known in advance (therefore, no site-specific plans)  Location could be a highly populated urban area  Large numbers of people could be affected  Radiation exposures could range from very low to substantial, and could be combined with conventional injuries Existing international guidance is generic in nature

20. Malevolent uses of ionizing radiation Improvised explosive device with a radiological payload (IEDr), Contamination of water or food supplies, Radiation Exposure Device (RED), Improvised Nuclear Device (IND)

21. IEDr Credits: Fred Harper – US Sandia National Lab.

22. The case of a Radiological Exposure Device (RED) The ALARA tool developed to estimate dose to workers has been, in this case, used to estimate the possible consequences of an act of terrorism involving ionizing radiation, such a radiation exposure device, both in terms of received dose and number of affected people.

23. RED Cont’d The radiation exposure device scenario consisted of a hidden radioactive source is left in a public place with the purpose of irradiating as many people as possible. In this case, we have chosen a subway as a public place and the source is supposedly to be 60 Co. Here, 60 Co is a gamma emitter with a main energy of 1173 and 1332 keV.

24. RED Cont’d We analysed two cases: a) the source is left inside the car; b) the source is left on the platform at a given station

25. RED Cont’d The source is hidden inside the subway car

26. RED Cont’d The source is left hidden on the platform at the station

27. RED Cont’d Gamma radiation pattern observed at a height of 1.2 m on the platform when the source is placed on the train

28. RED Cont’d passenger position on the train

29. RED Cont’d Dose to people on the train as function of distance and exposure time

30. RED Cont’d Dose to people on the platform, when source is on the train as a function of distance and exposure time

31. RED Cont’d Dose to people on the train when source is hidden on the platform

33. RED Cont’d both source and passengers are on the platform

34. RED Cont’d The results of this research provided the TMT Handbook project with valuable information on the potential number of casualties exhibiting acute radiation syndrome, signs of overexposure to ionising radiation and on the type of treatment they would require.

35. In a nutshell Provide practicable guidelines on the management of people Consider range of reasonable scenarios Make use of existing knowledge and practice Harmonization across European countries Handbook, Training Course - Radiological Exposure Device (RED) - Radiological Dispersion Device (RDD) - Contamination of food or water - Improvised Nuclear Device (IND) Workshop IAEA WHO ICRP NCRP EC projects (TIARA, CONRAD) Survey of current practice (TMT/CONRAD)

37. The handbook covers

38. Guidelines on Triage and Monitoring - Monitoring to confirm a radiation emergency - Establishing zone boundaries - Contamination/exposure control - Initial actions Trauma triage Radiological triage Location Clinical signs and symptoms Initial monitoring of people (external / internal) Decontamination of people - Monitoring strategies Monitoring techniques (external / internal) - Later triage - Dose assessment methods - Recording and reporting results - Transport of victims to hospital.....

39. Guidelines on Medical Treatment - Preparing the hospital & patient reception - Hospital triage - Management of irradiated people Acute radiation syndrome Localised radiation injuries - Management of contaminated people - Cytogenetic dosimetry - Public health issues - Dealing with the psycho-social impact

40. Team description

41. Planned activities To continue disseminating the handbook thru IAEA, WHO and above all EC To engage in EU CBRN task force activities leading to a sustainable development of the handbook To translate the handbook into a number of EU languages to be more effective and guarantee its use.

42. Closing remarks It has been challenging to develop a useful operational handbook that is applicable at a strategic, tactical and operational level across a number of countries. Ensuring a sufficient level of detail to be useful without being overly prescriptive that might result in its exclusion from use in some areas. Networking and sharing of information and know- how is essential to reach an adequate level of knowledge and partnership between radiological experts and medical specialists. Need for regular training courses and workshops.

43. I wasn’t alone in this… Carlos Rojas-Palma 1, Klaas van der Meer 1, Astrid Liland 2, Alicja Jaworska 2, Ane Jerstad 2, Phil Kruse 3, Karen Smith 3, Tua Rahola 4, Maarit Muikku 4, George Etherington 5, Maria del Rosario Pérez 6, Zhanat Carr 6 and Genowefa Smagala 7 1 Belgian Nuclear Research Centre (SCKCEN) 2 Norwegian Radiation Protection Authority (NRPA) 3 Enviros Consulting, United Kingdom 4 Radiation and Nuclear Safety Authority (STUK), Finland 5 Health Protection Agency, United Kingdom 6 World Health Organisation 7 Central Laboratory for Radiation Protection, Poland

44. acknowledgements This work was partially supported by the EC under the 6th EURATOM Contract Number FP6- 036497 and by the Research Council of Norway. We are grateful to all European Emergency response organizations that agreed to assess and evaluate the handbook. Our appreciation to all international experts who actively participated in the various workshops organized by the World Health Organization.