-
DNAl.941108.010
.- ...-..I-
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1..
I’
MARCH 1990 EDITION
HRE- 85 6 Notes
Sources of Radiation in Space
NATURAL Van Allen Belt Solar Particle Radiation - Solar Flares - Solar Particle Events (SPE's) Galactic Cosmic Rays (GCR) ARTIFICIAL Nuclear Reactors Exoatornospheric Nuclear Weapons Sources of Radiation in Space
VAN ALLEN BELT (Trapped Particle Radiation)
0 Inner and Outer Zones - Protons - Electrons apace naaianon Notes -- I Space Radiation .I
Space Radiation Notes
Average Shuttle Crew Doses 28.5' Inclination
~ STS Launch Mission Altitude Crew Av Dose Mlsslon Vehicle Date Duration (hrs) (NM) (MRAD%~~*) ._-- 61-8 Atlantlc 26 Nov 85 165.0 205 19.0 51-1 Dlscovery 17 Jun 85 169.7 205 (rnax) 18.6 51 -G Dlscovery 27 Aug 85 192.2 240 (rnax) 13.3 41-C Challenger 06 Apr 84 167.7 269 79.9 51-J Atlantis 03 Oc: 85 94.8 275 106.5
~~~~~~ *Low LET Doses Measured by LIF-100 TLDs
Sources of Radiation in Space
SOLAR PARTICLE RADIATION
0 Solar Flares, SPE's Protons Helium ions
Space Radiation Notes
Sources of Radiation in Space
ARTIFICIAL
e\ 0 Nuclear Reactors .-, .&.tii. > - COSMOS 954 - COSMOS 1900
0 Exoatmospheric Nuclear Weapon Burst
*- I I--
Space Radiation
Exoatmospheric Nuclear Weapon Detonations -IMPACT 0 Unique effects used to neutralize space and terrestrial hardware systems - Loss of 6 U.S. satellites from Starfish
Used by enemy to deny U.S. space control - Significant impact on National Security objectives
Space Radiation Environment
- 1015 r ElectronsSolar Wind Auroral Electrons
1/Trapped Electrons
napped Protons /
I I I 1 I 1
1o-2 1oo 1o2 9 n4 Particle Energy (MeV) I" Harderian Tumors Histological Data 70
60 0 Argon
50
20
10 ACobalt ,-Control 01 ' I Ill 0 40 80 120 160 200 240 280 320 700 Dose (rad) Fry et. al.
- "C 24X0.05 Gy
- y single dose 4.16 Gy 12 C single dose 1.2 Gy -
y 24~0.174Gy Controls 01 I 1 amp& 1 Wmple 3 0 334-360 daya 4zod after akgle 5- mftar alngb t after akgk dose after Fx 567-513&I after Fa d.y. or la1 frKtlon 7 42MZBd r s557d 1st Fm 328 yo. 301 eye. 180 eyes
wagu1 el a1 ,-.,.-,- Notes Space Radiation
RBE of Heavy Ions in the Production of Neoplastic Transformation in Confluent CPHlOT; Cells (G,)
LET (keV/urn) Yang el. al. Space Radiation
-
3 ., Streaks and doubles !& Stars and flashes . I-2 I., -
_- I I Bragg Curve I ~Bragg- Peak
Dose Rate
~ Depth Measurement of dose or dose rate as a function of depth in Water exposed to a charge
I
4,
Relative Ionization Notes Space Radiation
Solar Particle Events (SPEs) Time Course of Event
I Avg: 90 mln 1 Avg: 60 mln I I Det&tion of Optical SPE Duration b Flare i4 2-100 Hrs. (W. J. Wagner 1987)
Solar Particle Events (SPEs) SPEs Show A Correlation With Solar Cycle 10.; 250 I I E>10 MeV N 5. 200 %
’ Events peak at approximately 1 REM/hr I (W J Wagner, 1987) Space Radiation
Because the Sun Rotates, Our Greatest Threat is From Its West Side (50" W)
Magnetic field lines
E TRo, = 1 day
I Proton flare danger longltuder tor earth
Dose Equivalent (REM) From AL SPE 04 Aug 1972 Solar Flare
ALUMINUM PRIMARY PROTONS ALPHA LOW ENERGY SHIELDING HEAVY IONS PRIMARY SECONDARY SECONDARIES NEUTRONS TOTAL - 00 23.25 249.55 100.75 15.11 285.2 674.3 05 6.82 104.32 30.85 4.63 111.14 257.3
10 2.91 53.17 29.45 4.42 67.89 158.1 20 0.372 17.67 3.57 0.823 17.83 40.3
30 0.264 6.82 2.34 0.357 7.72 17.5 40 0.109 3.24 -0.047 0.000 2.70 5.98
50 0.047 1.74 0.279 0.047 1.91 4.01 70 0.016 0.636 0.047 0.463 1.10 2.28
5 Jcm sell shielding shown included in rddilion 10 Ihe shielding Itsled
(SCC. 1986) Notes wace naaiation
d Sources of Radiation in Space
GALACTIC COSMIC RADIATION
0 High energy protons 0 Helium nuclei 0 Energetic heavy ions - --- Space Radiation
Long-Term Exposure from Space Radiation
Elemental Contributions to the Dose Equivalent From Galactic Cosmic Radiation at Solar Minimum After Passage Through 1 g/cm2 of Aluminum Shielding
20- I I I , , , , , , , , , , , l6 - Exo-Magnetosphere - Galactic Cosmic Radiation - Primaries and Fragments Dose l2 - Space Radiation Notes
Space Radiation Guidelines
Scenario Time Radiation Dose (REMS)’
Space Station 90 days 11 Geosynchronous 15 days 8 Earth Orbit Lunar Mission 88 days 7 Mars Mission 3 years 100 OSHA limit** 1 year 5
~ ~~ *Radiation Equivalent Man “US. Occupational Safety and Health Administration Source: U.S. Natlonal Council on Radiation Protectlon and Measurements
I Lethality Due to Acute Whole-Body Radiation Exposure
Irradiationflreatment LD5O (rad) Healthy adult, autologous bone marrow or blood stem cell transplant 1100
Healthy adult, supportive medical treatment 480-540
Healthy adult, minimal supportive care 320-360 Combined stresses, burns or trauma plus radiation <300 Weightlessness, calcium deficiency plus radiation ?
Human Biological Changes Microgravity Environment
Cephalad Fluid Shift Fluid Loss Plasma Volume Decrease RBC and Hemoglobin Mass Decrease Alterations in Serum Proteins Reduced Number of T-Cells Reduced T-cell Responsiveness to Infectious Challenge Other Cellular Immune Changes ? Space Radiation
Time Course of Physiological Shifts Associated With Acclimation to Weightlessness
IRREVERSIBLE PROCESSES Neuroveslibular System Flulds and Electrolytes Pk / Cardlovascular System
Bone and Calclum __ w Set Polnt
1-g Set Point A -- 3 1 t ,m 456 POINT OF' AD>PTATION Tlme Scale (months) Space Radiation Notes
Survival of Mice in Different Housing Conditions I ,y (0.4 Gyirnin) I
" Social Spatial Soc+Spa Social Spatial Crowded Crowded Crowded Uncrowded Uncrowded Crowding Conditions
I Questions for Members of Military Medical Departments-
Are there acute radiation hazards in space? Yes!
0 Solar particle events (outside geomagnetosphere)
0 Exoatmospheric nuclear weapon detonations I
I Questions for Members of Military Medical Departments
Are the radiations encountered in military space operations unique in comparison to the nuclear battlefield? Yes! Protons 0 HZE particles Spallation products High energy neutrons SDace Radiation
Questions for Members of Military Medical Departments
Are there long-term risks from exposure to space radiation while on manned military space missions? Yes! Cancer Cataracts
Military Man in Space (MMIS) Program
The purpose of the MMlS program is to explore the military potential of using the space environment to apply man's unique powers of observation and decision making. The potential of military man in space will be measured by conducting MMlS concept evaluations on the Space Shuttle Concept evaluations are described as those manned spaceflight activities that evaluate man's ability to enhance or conduct military operations In or from space.
Military Man in Space MMlS Handbook 01 October 1986
DoD Space Policy
DoD supports the potential use of military man-in-space and "will actively explore roles for military man-in-space focusing on unique or cost effective contributions to operational
missions. I'
(Lantham, 1987) Notes SDace Radiation
DoD Operational Use of Space
Force Enhancement
0 Force Application Space Control
(Lantharn, 1987)
DoD Operational Use of Space - Space Control - operations to ensure U.S. and Allied forces freedom of action in space, while limiting or denying enemy freedom of action in space.
Negation of enemy satellites Active protection of US. and Allied space systems (Lantharn, 1987)
Potential DoD Manned Space Missions
NASP Operations: - SlOP and contingency
Intelligence gathering
Satellite Servicing: - Maintain, retrieve and refurbish Space Radiation Notes Space Radiation Physical Principles of Nuclear Weapons Notes
EFFECT OF INCREASE MASS ON NEUTRON LOSS
- 4 --mf Critical Mass I Geometry
CR8T8CAL MASS- DENSITY Notes
EXPLOSIVE SUBCRITICP I I PROPELLANT . MACC
BEFORE FIRING IMMEDIATELY AFTER FIRING
\ 1 POSSIBLE CONFIGURATION OF A FISSION BOMB FUSE HIGH EXPLOSIVE TAMPER
FISSIONABLE MATERIAL
NEUTRON SOURCE
REMOVABLE PLUG
Hiroshima Physical Principles of Nuclear Weapons Notes
I TIME
I %
PERCENT OF FISSION YIELD AS FUNCTION OF MASS NUMBER
I MASS NUMBER Notes i .. . Average Energy Partition Fission of 23%~ by Thermal Neutrons Kinetic energy of fission fragments 82%
Prompt gammas 2.5% Prompt neutrons 3.5% Decay products Betas 4% Gammas 3.5% Neutrons 5%
Total energy released per fission: 205 MeV
1 2
EFFECT OF INCREASED MASS ON NEUTRON LOSS
I Physical Principles of Nuclear Weapons Notes
ENERGY = WORK = FORCE x DISTANCE Notes Physical Principles of Nuclear Weapons I CHEMICAL POTENTIAL ENERGY
NUCLEAR POTENTIAL -
NEUTRON
ENERGY UNITS
1 eV 3.8 x 1 ul Physical Principles of Nuclear Weapons Notes
YIELD-TO-WEIGHT RATIO I FISSIONABLE
BOHR ATOM
2 - # PROTONS N - # NEUTRONS A-Z+N
LEVEL STRUCTURE I CONTINUUM OF STATES
E3 J-E,-E, E2
I ENERGY LEVELS. ATOMIC ELECTRON
AE - 0.1 eV to 104 eV -PHOTON INFRARED to X-RAY Notes Physical Principles of Nuclear Weapons 1 LEVEL STRUCTURE
CONTINUUM Of STATES CONTINUUM
ENERGY LEVELS-ATOMICELECTRON NUCLEARLEVELS AE - 0 1 eV to 104,~ AE - 104 eV to 106,~ -PHOTON -PHOTON INFRARED IO X RAY GAMMA RAY
TRITIUM DECAY
3 3H1 2 H +-:e+:p
Tx = 12.33 years
HALF LIFE Physical Principles of Nuclear Weapons Notes
IMPLOSION WEAPON BOMB CASING
PLUTONIUM J?-3‘ 1 HEMISPHERES I
TO DETONATOR EXPLOSIVE DETONATOR FOR IMPLOSION WEAPON
“Fat Man”
Nagasaki
I 1 Notes Physical Principles of Nuclear Weapons
71BINDING ENERGY
A = 2 + N = Total Number of Neutrons and Photons
.. THERMONUCLEAR FUSION REACTIONS D + D = jHe + n + 3.2 MeV
0 -t D = T + 'H + 4.0 MeV D+ T =4He+n +17.6MeV
T + T = 4He + 2n + 1 1.3 MeV
LITHIUM DEUTERIDE R EACTlON %D + n - 4He + 3T+4.8 MeV+ D I Physical Principles of Nuclear Weapons Notes
I COMPONENTS OF AN ELECTROMAGNETIC WAVE I ELECTRIC COMPONENT,
I
ORIGIN OF BINDING ENERGY Notes I
E=MC~
E=ENERGY (in ERGS) M=MASS (in grams) C=SPEED OF LIGHT (3 x 10 10 cm/sec)
A=Z+N= NO. OF NUCLEONS
I
BINDING ENERGY
A=Z+N= NO. OF NUCLEONS N Physical Principles of Nuclear Weapons Notes
THERMONUCLEAR PROCESS
F'SS'oN + NEUTRONS + 205 MeV )r U-235
'LID + n -+ 4He + 3T + 4.8 MeV + D
3T + 2D -b4He + n + 17.6 MeV
NUCLEAR WEAPON DESIGN4 t /- It I
- FISSION WEAPON FUSION WEAPON
NORMAL RSSM-FUSIOII WEAPON ENHANCED WARHEAD FISSION MATERIAL (U-235 OR CU-239)
EXPLOSIVE CHARGE Physical Principles of Nuclear Weapons
SEQUENCE OF STATES IN FISSIONING DEVICE g = GENERATION, T = TEMPERATURE c
PLASMA STATE S>10 T~lOOOWK I
BREMSSTRAHLUNG PROCESS
X-RAY ELECTRON OY'O" NUCLEUS \ Physical Principles of Nuclear Weapons Notes -
EARLY FIREBALL PHASE Of 1 MT AIR BURST AT SEA LEVEL
TIME I ENERGY PARTITION
- RADIATION’ ‘D’EBRIS I .(c; &“t- f ENERGY PARTITION EXOATMOSPHERIC b
SUBSURFACE DETONATION
RADIATION
ENERGY PARTITION - Enhanced Standard Radiation Weapon Fission/Fusion
(fallout)
InitialRadiation Radiation Radiation Physical Principles of Ionizing Radiation Notes I
IONIZING RADIATION
Energy emitted from an atom or nucleus in the form of waves or particles
I I Notes Physical Priniples of Ionizing Radiation
I ~I IONIZING RADIATION
REPRESENTATIVE -IONIZING RADIATIONS a
Particulate, Charged, P- Directly Ionizing .~ P+ W P+ @ + Particulate, Uncharged, Indirectly__ -- Ionizing no b Electromagnetic, Uncharged, x Ray Indirectly Ionizing Y Ray - -- -
Alpha-' Physical Principles of Ionizing Radiation Notes
INVERSE SQUARE LAW
Exposure Rate (mR/hr)
10 40 160 160 40 10 I I I 1 1 1 200 100 50 50 100 200 Distance (ft)
ALPHA
0 a E 2He4++(Helium Nucleus) Massive
0 Doubly Charged
0 Emitted by Decay of Heavy Isotopes Notes Physical Priniples of Ionizing Radiation
BETA SHIELDING
One half inch of most materials are adequate for stopping the majority of energetic Betas Generally much less than a half inch of shielding material is required Shielding thickness required decreases proportional to density increase
Approximate BETA REDUCTIONS
Surgeon gloves ______3 0 '10 Cloth gloves ______4 5'10 Leather gloves ______55 '10 Coveralls ______3 0 '10
I
Recommended GAMMA SHIELDING
High "Z" Materials (Lead or Iron)
. if available m Physical Principles of Ionizing Radiation Notes
I EXTERNAL RADIATION PROTECTION I
TIME 1111) 1 Notes Physical Priniples of Ionizing Radiation
HALF-LIFE
c Nuclide Half - life
0.0000003 seconds
2 x 101* years or 2,000,000,000,000,000,000 years
~~~ ~
RE_LATIVE-A_CTIVITY OF FISSION PRODUCTS
RATE OF DECAY - -
- -
' ' ' ' ' ' ' ' ' ' OO 4 8 12 HOURS AFTER EXPLOSION Physical Principles of Ionizing Radiation Notes 1 Notes Physical Priniples of Ionizing Radiation I 1 Notes Physical Priniples of Ionizing Radiation U.S. GENERAL EXPOSURE ESTIMATES I AVERAGE INDIVIDUAL SOURCE DOSE (mrem/yr) Natural Background 100 (average in U.S.) Release of Radioactive 5 Material in Natural Gas. Mining, Milling, etc. Medical (whole-body equivalent) 90 Nuclear Weapons 5-8 (primary fallout) Nuclear Energy 0.28 Consumer Products 0.03
Total 200 mrem/yr
OTHER RADIATION SOURCES z e Physical Principles of Ionizing Radiation Notes I
R E M equals Quality Factor (QF) X RAD
I QUALITY FACTOR I - TYPES OF RADIATION QF- X-Rays, y -Rays,
I I/ , p -Electrons ______.1
1
International System of Units (SI) SIEVERT (Sv) Unit of dose equivalent is the sievert 1 Sv = 1 Joule/kg = 100 rems I Notes Physical Priniples of Ionizing Radiation
RADIATION ABSORBED DOSE (rad)
*Unit of Absorbed Dose
*Energy deposited by any ionizing radiation in a unit mass of any absorber 1 rad = 100 ergs/gm
International System of Units (SI) GRAY (Gy) Unit of absorbed dose is the gray 1 Gy=l Joule/kg=100 rads
REM
Unit of Dose Equivalent Measure of Relative Effectiveness of Absorbed Energy in causing a certain biological effect
I I Physical Principles of Ionizing Radiation Notes
RADIATION DOSE QUANTITJES
Ionization+ Roentgen Ph ysicaVChemical Effects 4 CeWTissue rad Damage + Early Biological Effects 4 Late Biological rem Effects
ROENTGEN -
The measure of the number of ion-pairs produced by gamma radiation in a certain volume of air
ROENTGEN Unit of Exposure
SI Units: coulomb/kilogram I Notes Physical Priniples of Ionizing Radiation
The CURIE
International System of Units (SI)
BECQUEREL (Bq)
Unit of activity is the becquerel 1 Bq = 1 nuclear transformation per second
1 Bq = 2.7 x Ci Physical Principles of Ionizing Radiation Notes
I PAIR ANNIHILATION 0.51 MeV
0.51 MeV
GAMMA AND X 9 RAY INTERACTIONS
0.01 0.1 1.o 10 100 Energy (MeV) Notes Physical Priniples of Ionizing Radiation
I II IPHOTOELECTRIC EFFECT
I
EJECTED PHOTON - PHOTOELECTRON
COMPTON PROCESS
0''
0.01 MeV- >lo0 MeV INCIDENT PHOTON SECONDARY PHOTON
COMPTON RECOIL ELECTRON 1
PAIR PRODUCTION \ 1 Physical Principles of Ionizing Radiation Notes A GAMMA (Y) EMISSION
y rays may be emitted from an excited nucleus following p- or u decay.
Y
GAMMA RAY SPECTRUM
Gamma ray has discrete energy Number of Energy of gamma Gamma ray depends on Rays radionuclide
Gamma Ray Energy
X AND 7 RAY INTERACTION WITH MATTER Notes Physical Priniples of Ionizing Radiation I I
BREMSSTRAHLUNG PROCESS
X-RAY ELECTRON OwToN
%e- YO-
* CHARACTERISTIC A-,, Oe. X-RAY PRODUCTION Oe- l e-O e'
CONTINUOUS ENERGY SPECTRUM AND ENERGY CHARACTERISTICS OF X-RAYS
CHARACTERISTIC
4 CONTl NUOUS
I Physical Principles of Ionizing Radiation Notes I 1 NEUTRON INTERACTION WITH MATTE1 I. NUCLEAR CAPTURE ~&-ii,!%fh\ Slow-moving neutron may be captured by the nucleus; resulting compound nucleus may become radioactive and emit particles and rays Ah
I THE ELECTROMAGNETIC SPECTRUM I
ENERGY, ELECTRON VOLTS
I J
X Rays: Originate from orbital electrons rearrangements and Bremsstrahlung --- II m-
Notes Physical Priniples of Ionizing Radiation
EXAMPLE ATOMS
3892 u
INELASTIC NEUTRON SCATTERING Y
Neutron Therrnalization
Process of reducing the energy of the neutron to the thermal region by elastic scattering. Physical Principles of Ionizing Radiation Notes I SPONTANEOUS fl FISSION
Unstable heavy nucleus fragments into two lighter nuclei with the ejection of two or three fission neutrons and gamma rays
Neutron Interactions
Elastic Scattering Inelastic Scattering Absorption
ELASTIC NEUTRON SCATTERING
INA
n 0-b E"
I Physical Priniples of Ionizing Radiation
I STRUCTURE OF THE ATOM I
Symbol Charge Mass Number
Proton p +1 1
Neutron n 0 1
Electron e -1 111840
NEUTRONS kT 1$3-p-- - . . THERMONUCLEAR L-1 L-1 WEAPON
NEUTRON SPECTRUM per KILOTON TOTAL ENERGY YIELD
1021
I , ..,,IIi 1 ENERGY INTERVAL IMaVl
I r Notes
P+ P+ i ,++' KG
I Physical Principles of Ionizing Radiation Notes
TENTH THICKNESS for 1 MeV Photons
Lead ______^______1.2 inches Steel______-_2.0 Aluminum ______4.6 Concrete...... 5.7 Earth (Dirt)_--______-___.11.0 Water ______14.0
Lead and other high 2 materials DO NOT PROVIDE effective shielding against NEUTRONS
NEUTRON SHIELDING
Low "Z" Elements (Hydrogen)
0 Thermal Neutron Absorber
. 0 Gamma Shielding Physical Priniples of Ionizing Radiation
1IONIZATION
* Ji Ionizing Radiation
L Cellular Radiation Biology Notes
IONIZING vs EXCITATION
z
t hz
IONIZATION The process of stripping off one or more orbital electrons from an atom
2nd Revision: 12/87 8 Cellular Radiation Biology
Ionizing Radiations I Alpha Beta X-Ray Gamma Neutron
Direct Effects: Through ionization and excitation
Indirect Effects: Interaction of directly altered molecules with other molecules
RADIATION CHEMISTRY DIRECT EFFECTS + -''@ + e- DAMAGED MOLECULE INDIRECT EFFECTS w t ACTIVATED -- - Cellular Radiation Biology Notes
INDIRECT vs DIRECT: l Presence of Water on Artemia Shrimp Hatching 100 \
O'O Hatching of Shrimp 50 cysts
0 0 1 2 3 4 Dose (R x lo5) Free radicals produced in water enhance biological damage
I RADIOANALYSIS OF WATER a
H20 +e- + H20' ton Pair
H20+-+H' + OH' Proton + Hydroxyl Radical
e-+ H20 -bH20- Aqueous Electron
H20--+OH- + H' Hydroxyl Ion + Free Radical
The Net Effect is: radiation H20 H'+ OH'
FREE RADICALS -*-- - Notes Cellular Radiation Biology RADIOLYSIS OF WATER I
3 3 I OH. FREE RADICALS H20< HO;
OXIDIZING 1 12 "" AGENT RADIATION
- GENERAL FORMULATION IN RADIOCHEMISTRY
radiation RH -R' + H'
ABSORBED DOSE
The energy imparted to matter per unit mass of irradiated material. The unit of absorbed dose is the rad (cGy). One rad equals 100 ergs per gram. Cellular Radiation Biology Notes
3I RELATIVE RADIOBIOLOGICAL EFFECTIVENESS
Dose of Standard Radiation Producing a Given Effect RBE = Dose of Test Radiation Producing the Same Effect
BIOLOGICAL EFFECTS OF RADIATION are dependent upon
Total Energy Deposited Distribution of Deposited Energy
H 0.1 p 1 keV Delta-Ray \ il" 10 MeV Proton 9' ' ...... : % .,,...... *'.'.'...... ; :. , . -
1 MeV Electron .I
5 keV Electron .. ..*>...... >. I . . ..__ I...... _. LINEAR ENERGY TRANSFER (LET) Energy deposited per unit path length Higher LET means local energy deposition and higher relative biological effectiveness .
LET is proportional to charge and size for particulate radiation.
LET is inversely proportional to energy for particulate and photon radiation.
iI LOW LET RADIATION and INDIRECT EFFECTS I ?'-+e- OH OH *
DNA I I -- 0- Notes Cellular Radiation Biologv-.
HIGH LET RADIATION and INDIRECT EFFECTS
1 DNA
I I
h Cellular Radiation Biology
I i
LOW LET RADIATION --- HIGH LET RADIATION
1 1 I
I I PROTEIN RUCTURE
i
I
TRANSMEMBRANE NORMAL CELL MEMBRANE GLYCOPROTEIN
ii ,ii CH3 L I C e Ilu la r Radiation Biology
OXIDATION " OXIDIZED FATTY ACIDS
RADIATION DAMAGE TO DNA H2-Bond
Pyrimidine Dimer DNA Cross Linkage
Cross linkage
Single Strand Break
Primary sites of radiation- induced cell lethality are situated in the nucleus and appear to be in the DNA molecule. 8 Cellular Radiation Biology
IRRADIATION OF NUCLEUS at relatively low doses will kill cells.
IRRADIATION OF CYTOPLASM requires much higher doses to kill cells.
-
a CELLULAR RADIOSENSITIVITY is correlated to the volume of: Nucleic Acid Nucleus * Chromosomes
RATE OF DNA DAMAGE FORMATION/CELL PER DAY IN MAN
~ ~ ~~ ~ ~ ~~~ Type of Damage Rate Source Depurination 25,000 Spontaneous Cytosine Deamination 350 Spontaneous Alkylation ON- 7 - MeG 84,000 SAM 00 - 6 - MeG 6,700 SAM Base Dimerization 50,000 uv Single Strand Breaks 100,000 Spontaneous Cellular Radiation Biology I DNA DAMAGE INDUCED BY RADIATION
Dose Single Strand Double Strand (rads) 'Breaks Breaks
0 70 per min (spontaneous) 10 10,000 500
500 500,000 25,000
CHROMOSOMAL CHANGES
NORMAL 'w
TERMINAL BCD DELETION DOT
INTERSTITIAL iv& DELETION TRANS- INVERSION 'w 4_, -DICENTRIC
CELLULAR RESPONSES TO RADIATION INSTANT DEATH (100 Gy Over Several Mln) INTERPHASE DEATH May Occur In Some Cells After 0.05 Gy Mitosis Is Most Sensitive Phase REPRODUCTIVE DEATH Loss Of Reproductive Potential After 1 Or More Mitoses Survival Of Cell But Permanent lnhlbltlon Of Mitosis MITOTIC DELAY Dependent On Dose Dose Rate Cell Type Cell Cycle Stage Block In G2 & Prolongation Of "S" Phase TR ANSFORMATION/MUTATION _-It -
Cellular Radiation Biology
MITOTIC DELAY FOLLOWING IRRADIATION
Partlal Synchronlratlon, Over Compenratlon, J 6 Abortlve Mltorer
Mltotlc 1- Index Ratio
0 E / E 0 Tlme After Irradlatlon _I) Mltollc Index of lrradlated Culture Mltotlc Index Ratlo: Mltotlc Index of Control
- SURVIVAL CURVES A MODEL FOR THE STUDY OF RADIATION EFFECTS ON LIVING SYSTEMS OBTAINED BY IRRADIATION OF A COLONY OF LIVING CELLS AND PLOTTING THE FRACTION OF SURVIVING CELLS VS. RADIATION DOSE
B.
.*
*
” -t’lt 40 a.78 0.10 UQ - 500 x 0.78 - Notes
?.tn
Cell- surviving Fraction
1 1
FACTORS WHICH AFFECT RADIATION RESPONSE DOSE RADIATION QUALITY DOSE RATE OR FRACTIONATION REPOPULATION CHEMICAL MODIFIERS CELL DIFFERENTIATION
COMBINED EFFECTS of LET and DOSE RATE on CELL SURVIVAL CURVES
L 0 WE'R DOSE RA TE ' 00051 i I 0 200 400 600 DOSE (rads) I I Single Doses Fractionated Doses I
lo1V
0 400 800 1200 400 800 1200 1600 Dose (rads)
THE USE OF SURVIVAL CURVES TO STUDY MODIFICATION OF RADIOSENSITIVITY
Survival Fraction . or Oxygen
\ Control
0 1 0 Increasing Radiation Dose 3 I
Metaphase / IAnaDhase. ~-- L s./ THE CELL C”^’ - r Telophase
Cytoplasmic A Duplicaflon
- Cellular Radiation Biology Notes r RADIOSENSITIVITY VARIES WITH THE CELL CYCLE
I 04 i I 0 tncrraslng Radlallon Dora 4 (s,nclrlr, ,96a)
Law of 1 BERGONIE and TRIBONDEAU
The more rapidly reproducing cells are more radiosensitive
The least functionally differentiated cells are more radiosensitive
RELATIVE RADIOSENSITIVITY OF MAMMALIAN TISSUES
SENSITIVE Spermatogonia Lymphocytes Hematopoietic Tissues LESS SENSITIVE Epithelium Epidermis RESISTANT Central Nervous System Muscle Bone Blast and Thermal Effects Notes 1 Megaton Air Burst 37 sec I \ 1 \ Prirnarv Blast\:
Reflected Blast 4 Wave Front \\
Mach Front Overpressure 1 psi
Wind Velocity 40 MPH
0 2 4 6 8 10 12 14 16 I Kilometers I PEAK OVERPRESSURE OR STATIC OVERPRESSURE
Maximum air pressure developed by the blast wave
DYNAMIC OVERPRESSURE I OR DRAG FORCE
Winds produced by the differential pressure areas in the blast wave
I Nares Blast and Thermal Effects I TYPICAL OVERPRESSURE DAMAGE
1 psi ...... Windows shattered I 2 psi ...... Aluminum panels ripped off 3 psi ...... 12" concrete wall shattered and parked aircraft destroyed 5 psi ...... Brick houses destroyed Trucks overturned Telephone poles collapsed Blast and Thermal Effects
Generation > 30 Temperature > 500,000"K Time = sec
1 Megaton Air Burst - 1.8 Sec Fireball
Nuclear and Thermal Radiation
_- - . Primary Blast Wave Front
~~ 0 2 4 6 8 Kilometers Notes Blast and Thermal Effects
I 1 Megaton Air Burst - 4.6 sec
Nuclear and Thermal Radiation
r/\Primarv Blast Wave Front Reflected Blast Wave Front
Mach Reflection Overpressure 16 psi and Wind Velocity 400 MPH
L 1 1 0 2 4 6 8 Kilometers
z Mach Y Formation
Incident Wave Reflected Wave
Mach Stem - . __ Surface
1 Megaton Air Burst = 11 sec Nuclear and Thermal Radiation Primary Blast Wave Front Reflected Blast Wave Front
Mach Front Overpressure 6 psi
/Wind Velocity 180 MPk'
L 1 I I 1 0 2 4 6 8 10 Kilometers 1 Blast and Thermal Effects Notes
I YIELD vs WEIGHT
I 132TONS 1320 KT I
NUCLEAR DETONATION PHENOMENA Thermal Radiation Blast Ionizing Radiation Electromagnetic Pulse (EMP) I Notes Blast and Thermal Effects ENERGY PARTITION
Standard Fission/Fusion aThermal (fallout) Radiation Unitial Radiation
SEQUENCE OF STATES IN FISSIONING DEVICE g = GENERATION, T = TEMPERATURE
PLASMA STATE P> 30 T 2500 000.K
BREMSSTRAHLUNG PROCESS
X-RAY PHOTON Notes Blast and Thermal Effects Notes Blast and Thermal Effects
The Biological Effects of Blast Energy Blast and Thermal Effects Notes
BLAST
F Static Crushing -Overpressure Effect - Injury 5 psi Eardrum Rupture 0.- 15 psi Lung Damage
,50 psi I
Overpressure Injury
Pressure Level
Rate of Change Blast and Thermal Effects
Blast Dynamic Overpressure L 41 . -1. Translational Injuries - Lacerations - Contusions - Fractures Deceleration - LO50 -22 m/sec Impact - Injury threshold - 3 m/sec LO50 -11 m/sec
BLAST
~ DYNAMIC OVERPRESSURE
2. MISSILE INJURIES Lacerations Penetrating wounds Blunt injury EFFECTS OF 10 gm GLASS FRAGMENT Injury threshold 15 m/sec Serious wounds 55 m/sec
White House m
Memorial Capitol
\ 1 Blast and Thermal Effects Notes I PROBABILITY OF RADIATION CASUALTIES
INCREASING PROBABILITY
I
EFFECTIVE RANGE FOR BLAST ENERGY 1 kt WEAPON Whit? House STATIC OVERPRESSURE
Capitol
.o,’/-
EFFECTIVE RANGE FOR BLAST ENERGY 1 kt WEAPON
hington Monument . Notes Blast and Thermal Effects
Protection Against Effects of Blast Wave A. Effective evasive action can be taken B. Open terrain: - Make yourself a smaller target by lying down perpendicular to the blast wave (e.g. your feet pointed towards GZ) - Wear your helmet C. Protective barriers - Blast-resistant barriers will shield against debris carried by blast winds and reduce chances of displacement injuries
THERMAL EFFECTS OF A NUCLEAR WEAPON
Thermal Pulse Curve
, 8- -n0 6.
.e I- 04 .-> -CIm
d 2- I
- Minimum 1 "'2'4'6'8d 10 12
Relative Time Notes Blast and Thermal Effects I EFFECTIVE RANGE FOR THERMAL ENERGY INFRARED 1 kt WEAPON \1
Lm
Visible Radiation
1 I Notes Blast and Thermal Effects
EYE INJURIES Flash Blindness TRANSIENT Retinal Burns PERMENANT
RETINAL 8URNS
I __.- e
Blast and Thermal Effects Notes I
White House
Gkl Lincoln Memorial Capitol 0000 The Mall H
Washington Monument
I Safe Separation Distances for Eye Injuries Weapon Yield.1 kT. Detonation Altitude-300 Meters Personnel Altitude.Sea Level Baitimo- - \ \ E r-DaTtime Visibilit Gaithersburg . 46 km i/ *& Rockville - Retinal Burns 16.7 km
flash Blindness I 5.9 km <
Safe Separation Distances for Eye Injuries Weaoon Yield.1 kT, Detonation Altituk-300 Meters. Personnel Altitude.Sea level Blast and Thermal Effects
Protection Against Thermal Injury 1. Burns - speed of light A. Evasive action - unless forewarned - nothing B. Terrain - if forewarned (thermal energy travels in a straight line) Protective barriers Hills Building Tanks Bunkers Trees C. Protective effect of clothing
Protection Against Thermal Injury 2. Eye injuries - speed of light A. Evasive action - unless forwarned - nothing B. Terrain - if forewarned (thermal energy travels in a straight line) Protective barriers Buildings, tanks, trees Eye protection C. Protective goggles PLZT (lead lanthanum zirconate titanite)
20 O/O transmission nor maI1 y 0% transmission within 50 psec after fireball Blast and Thermal Effects Notes
Open State
ELECTRIC VECTOR OF ENTERING LINEARLY POLARIZED LIGHT7 ELECTRIC VECTOR OF EXITING LINEARLY r POLARIZED LIGHT UNPOLARIZED LIGHT SOURCE
rI
PLZT ELECTROOPTIC CERAMIC POLARIZER
Closed State
ELECTRIC VECTOR OF ENTERING LINEARLY POLARIZED LIGHT 7
E LE CTROOPTIC CERAMIC POLARIZER Nares Blast and Thermal Effects
i Effective Range for Conventional Fusion/Fission
Weapon Yield (kT) 0.5 10 100 1000 6 psi 380 rn 1000 m 2200 rn 4600 m
2 O Burns 580 2100 5500 14500 500 rads 700 1200 1700 2400 Acute Radiation Syndrome I Notes I
And there arose Vast - masses of smoke: And whosoever beheld this died within the space of half a day.
Chronicles of Este A.D. 1346
Acute Radiation Syndrome
Definition:
A combination of clinical syndromes occurring in stages during a period of hours to weeks after exposure, as injury to various tissues and organs is expressed. Acute Radiation Syndrome I Notes
Factors That Alter Response To Radiation Damage
Total dose Dose rate Portion of the body exposed Uniformity of exposure Age of the victim State of health Availability of treatment
Cell Renewal System
RELATIVE CELLS RADIOSENSITIVITY Stem High (primitive) 4 Differentiating c I Mature Low
Order of Radiosensitivity in Mammalian Cells
Spermatogonia Stomach
Lymphocytes 0 Colon Erythroblasts Skin Rest of hemopoietic tissue f"4 Muscle Central nervous system - Bone I Small intestine Collagen Acute Radiation Syndrome I Notes I I Hematopoietic Syndrome Prodromal Period
Nausea, vomiting, anorexia and possible diarrhea
Severe diarrhea during first two days with lethal dose
Hematopoietic Syndrome Latent Period -
Essentially asymptomatic, except for mild weakness, for about three weeks
Hematopoietic Syndrome Overt Clinical Picture
Patient severely ill during fourth and fifth week; hemorrhage and infection Notes Acute Radiation Syndrome I Acute Radiation Syndrome I Notes
I HEMATOLOGICAL RESPONSE to 100 rads WHOLE-BODY EXPOSURE
- 2; 10 t THROMBOCYTES W - t-- HEMOGLOBIN -300 - 8:- 8:- x
-0 100 LYMPHOCYTES 0 '"''''''~~~ 0 10 20 30 40 50 60 TIME (days)
HEMATOLOGICAL RESPONSE to 200 rads WHOLE-BODY EXPOSURE - 14 ...... ,..., 0 a8 12: THROMBOCYTES -II HEMOGL OBlN
LYMPHOCYTES I I O' 0 ' li ' 20 ' 30 ' 40 ' 50 ' sb
HEMATOLOGICAL RESPONSE to 300 rads WHOLE-BODY EXPOSURE
10 b- THROMBOCYTES I
~[~~~~CYT~1' O0 0 0 10 20 30 40 50 60 TIME (days) -
Notes Acute Radiation Syndrome I
1Absolute Lymphocytes Relationship 3000 Between ...... Early Changes in Peripheral Blood Lymphocyte Counts and Degree of Radiation Radiation Injury Injury
Time (days) I
MEAN GRANULOCY COUNT FOLLOWING IRRADIATION
\600 0 10 201 30 40 50 60
DAYS POSTIRRADIATION Acute Radiation Syndrome 1 Notes
Systemic Effects of Hematopoietic Syndrome
0 lmmunodysfunction Increased Infectious Complications Hemorrhage Anemia Impaired Wound Healing
I
I Notes i I ACUTE RADIATION SYNDROME
Syndrome D~~~ Performance Llfe-threatening Survival Decrements lnjurles (UnSIJppOrled (Gy) Patient)
5 Prolonged Reaction Moderate Dealh Time, Decrement lnlertlnal (2-3 wks) Gastro- Performance Damage lntestlnai 7 Accuracy
9 Severe Early Transient Gastrolntesiinai Dealh 10 Incapacllalion Damage (1-2 wkr)
Pathophysiology of c GI Syndrome
Depletion of the epthelial cells lining the lumen of the gastrointestinal tract
Intestinal bacteria gain free acess to the body
Hemorrhage through the denuded areas
Loss of absorptive capacity
Cells per Crypt Section
0 1 0 1 Days2 Postirradiation3 4 5 I I Acute Radiation Syndrome I Notes
G. I. VASCULAR DAMAGE
MUSCULARIS MUCOSAE
SUBMUCOSA
CIRCULAR MUSCLE
LONGITUDINAL MUSCLE .. SEROSA Notes Acute Radiation Syndrome I Notes I I Gastrointestinal Syndrome
Prodromal Period Severe nausea, vomiting and occassionally watery diarrhea and cramps, within hours after exposure
Gastrointestinal Syndr0m.e -
Asymptomatic for five to seven days 1
Gastrointestinal Syndrome
Overt Clinical Picture Return of severe diarrhea, vomiting and diarrhea with fever Progression to bloody diarrhea, shock and death --- - Notes Acute Radiation Syndrome I
Systemic Effects of GI Syndrome - ~~ A. Malabsorption D. GI Bleeding - Malnutrition - Anemia B. Paralytic Ileus E. Sepsis - Vomiting - Abdominal Distension C. Fluid and Electrolyte Shifts - Dehydration - Acute Renal Failure - Cardiovascular Collapse
ACUTE RADIATION SYNDROME 1
RADIAT'ON PERFORMANCE LIFE-THREATENING SURVIVAL SYNDROME DOSE DECREMENTS INJURIES (UNSUPPORTED (Gy) PATIENT) I
15 DEATH NEURO- 20 LOSS OF NEUROVASCULAR (5-12 DAYS) VASCULAR 25 CONSCIOUSNESS DAMAGE DEATH 30 (2-5 DAYS)
Cardiovascular/Central Nervous System Syndrome
Symptoms
0 Vomiting and diarrhea within minutes
0 Confusion and disorientation
0 Severe hypotension Edema Fatalities within 24-48 hours Acute Radiation Syndrome I Notes
Initial Hypotension
0 Dose ...... High
0 Latency ...... Minutes
Duration ...... Minutes to Hours
Etiology ...... Humoral (?)
Vascular Lesions c
0 DAMAGE TO THE MICROCIRCULATION
POSTULATED AS A MECHANISM IN THE PRODUCTION OF "CLINICAL" DAMAGE IN DIFFERENT ORGANS
Blood Pressure
1 I I -160 120
(mmHg) 80
diastolic 40 0 0 10 20 30 40 0 10 20 30 40 50 I Time Postexposure (hours)
I Notes Acute Radiation Syndrome I Hemodynamic Effects of I Acute Radiation
120 110 Percent of Control 100 Value 90 80 1 I I I I J 0 5 10 15 20 25 30 Time Postirradiation (min)
Cardiovascular/Central Nervous
c System Syndrome
Prodromal Period
0 Burning sensation within minutes of exposure Nausea and vomiting within the first hour Loss of balance, and confusion with prostration
Cardiovascular/Central Nervous System Syndrome
Latent Period
Apparent improvement for several hours Notes
I
Overt Clinical Picture
Within five to six hours, watery diarrhea, respiratory distress, and gross CNS signs
High Dose Central Nervous System
Syndrome d
Dose prcbably 10,000 rads Direct toxicity to brain cells Results in: - Brain edema - Ataxia - Disorientation - Coma - Death
ACUTE RADIATION SYNDROME
RADIATION SURVIVAL PERFORMANCE LIFE-TMREATENWG SVNDROME DOSE (UNSUPPORTED (GI) DECREMENTS INJURIES PATIFNTI
0 MOTlVATlON LOSS. BONE MARROW PROBABLE 1 FATIGUE. WEAKNESS, DAMAGE HEMATOLOGIC ANOREXIA LIKELY 3 NAUSEA, EMESIS. SEVERE BONE LD50 ------4 DIARRHEA MARROW DAMAGE
5 MOMRATE INTESTINAL DEATH TIM, DECREMENT 6 DAYAOE (2-3 WKS) GASTRO- , PERFORMANCE ACCURACY YTESTINAL 8 HIPOTENSION SEVERE DEATH
VASCULAR 25 CONSCIOUSNESS DAMAGE DEATH 30 (2-5 DAIS) 1
. J
I Acute Radiation Syndrome II Notes fl
1 ACUTE RADIATION SYNDROME astrointestinal
Cardiovascular
CNS
MENW Prediction 1987
Combined injuries will affect the majority (65 - 70%) of victims of future radiation injury' 'from accidents, incidents, or war w wuLG3 Acute Radiation Syndrome II '- 1 Categories of Radiation Injuries
1. Radiation Injury Unlikely 2. Radiation Injury Probable 3. Radiation Injury Severe
Use of Symptoms to Assess Probability of Radiation Injury
Unlikely Probable Severe Nausea - +++ Vomiting - +++ Diarrhea --/+to +++ Hyperthermia - -/+to +++ Hypotension - +to ++ Erythema - -/+to ++ CNS Dysfunction - -/+to ++
Radiation Dose Under 500 cGy
No Immediate Life-threatening Hazard Exists I-
Acute Radiation Syndrome II Notes I
: --I-
6 24 hours
1u 5 10 days 1- 2 4 8 weeks Acute Radiation Syndrome II
Mortality in Rats Exposed to Thermal Burn plus 250 kVp X ray I
ABCD ABCD ABCD ABCD R: 0 100 150 500 rad MLTD. 0 52 131 26 1
Awn 4 y*N.1%
I A
Triage Scheme for Combined Injury
RADIATION Unlikely Probable Severe
Measurement of Severity
Prodromal Effects - Time of onset - Degree of symptoms - Duration of symptoms Hematologic Changes - Lymphocyte counts Physical Dosimetry - Attendant Readable Acute Radiation Syndrome II Notes 24 - 48 Hr Lymphocyte Counts
Severe Exposure 4 500 - 1000/mm3
Little Exposure b 1500/mm3
Absolute Lymphocytes Rela tlonship 3000 Between 1...... -...... I c Early Changes in Peripheral Normal Blood Range Lymphocyte Counts and Moderate 1 Degree of Radiation Injury Very Severe -ethal 012 Time (days)
Fatal Radiation
Nausea and vomiting within hours
Prompt explosive bloody diarrhea Acute Radiation Syndrome II r Monocyte Lymphocytes 0. me Large Small Granulocytes 0 UO Non-Segmented Forms J.I
Mature Forms a
Radiation Effects
Anemia Infection Bleeding Delayed Wound Healing
Healing of Rabbit Fractures
800 R Unirradiated Irradiated
32 days
I Acute Radiation Syndrome II Notes Nuclear Casualty Management
No life th dening hazard exists for radiation casualties who can ultimately survive so . . . treat conventional injuries FIRST
First Actions
0 Standard Medical Emergency Procedures - Ventilation - Perfusion - Stop hemorrhage Decontan-a. don After Stabilization Radiation Injury NOT- Acutely Life Threatening
Decontamination Procedures
I 1. Remove patient’s clothing. 2. Wash patient with detergent and water. Notes Acute Radiation Syndrome II
Primary Determinant of Survival
Management of infection
Stop bleeding
Treatment Options for
d Radiation Injury
0 Replace fluid and electrolytes Platelet transfusions Manage sources of infection Use combinations of antibiotics for mixed infections
Platelet Transfusion
TREAT: 1. Prophylactically, if counts 420,00O/mm3
2. If bleeding and bone marrow depression regardless of platelet counts Acute Radiation Syndrome II Notes
Management of Infection
Antibiotics Biological Response Modifiers Wound Dressings Surgical Management
Prophylactic Antibiotics
Selective, Gut Decontamination - poorly absorbed oral preparations - initiated shortly after exposure - self-administration is an option
Parenteral Agents Used ONLY- Around Time of Abdominal Surgery - and then STOPPED
Empiric Antibiotics
0 Treat when specific signs of infection appear (i.e. fever spike)
0 Not recommended for expectant casualty
Typically, therapy only becomes necessary several WEEKS after exposure
CONTINUE treatment until granulocytes exceed 500/mm3 Acute Radiation Syndrome II , Sepsis After Irradiation
1. PREVENTION Wound Debridement Topical Antimicrobials & Dressings Environmental Control of Nosocomials Minimal Use of Invasive & Indwelling Devices Fluid & Electrolyte Resuscitation Nutritional Support
0. Selective, Gut Decontamination
0. hGM-CSF 0. Early Administration of Immuno/Hematopoietic Modulators
0. experimental
Sepsis After Irradiation
II. PARENTERAL ANTIMICROBIAL MEASURES
0 Antibacterial Antibiotics (2-3 different types)
0 Immunoglobulin "G" (anti-LPS)
0 Antifungal & Antiviral Agents (when indicated)
Sepsis After Irradiation
111. MANAGEMENT OF SHOCK
0 Hemodynamic Pressure Monitoring and Use of Pressor Agents
0 Avoidance of Corticosteroids Except in Adrenal Insufficiency
0. Antibody to TNF (Cachectin) 00 Mexperimental Acute Radiation Syndrome II Notes I Treatment of Soft Tissue Injury Contamination
bEdRIDEMENT
I Antiseptics Antibiotics Immunizations
Wounded by Conventional Weapons I Initial and Reparative Reconstructive Surgery Surgery
1 4 5 10 20 50 100 Days after Wounding
Wounded by Nuclear Weapons
Initial and Reparative Surgery Reconstructive Surgery Restricted Surgery
1 2 5 10 20 50-. 100.-- Days after Wounding I SCHd.1964
Management Objectives
1. Resuscitate and stabilize the traumatic injury 2. Decontaminate the patient 3. Perform emergency surgery 4. Initiate evaluation of the radiation exposure 5. Limit exposure of medical attendants Notes Acute Radiation Syndrome II
Dose Estimation and Diagnostic I Criteria for Acute Radiation Effects
Early prodromal signs and symptoms Dynamic blood profile Cutaneous effects Cytogenetics
Chernobyl -. Major Conclusions
J BMT may not be best therapy for mass casualty combined injury situation. - 50% died of associated injuries. - Heterogeneity of exposure (3 surviving stem cells). - Difficulty in finding matched donors. - No. of lives saved may not balance with marrow induced deaths.
Sepsis is overwhelming cause of death.
Summary of Acute Radiation Syndrome
SYNDROME/DOSE PROGNOSIS* Hematopoietic 0 - 200 cGy Excellent 200 - 600 cGy 0 - 90% death Gastrointestinal 600 - 1000 cGy 90 - 100°/~death above 1000 cGy 100% death CV/CNS 3000+ cGy certain death 'based on no treatment, uniform whole body exposure Acute Radiation Syndrome II
Questions
~
HOW to evaluate severity of injury? - Clinlcal parameters - Area of burns - Lymphocytes - Circulating Factors (enzymes, hormones, etc.) - Cytogenetic abnormalities Can bone marrow growth and viability factors enhance survival? Role for selective gut decontamination? Bioiogic response modifiers? What does conventional BMT have to offer? rrures Radioprotection Notes
Balance Between Tactical Demand and Radiation Hazard
I Tactical Radiation m- m-
Radioprotection
Development of Alternatives
Critical Need High Priority Research Area
a Primary Objective
To enhance post-nuclear attack effective- ness by developing a drug or regimen that will reduce the number of radiation casualties among military troops exposed to ionizing radiation on the nuclear battlefield.
4
RADIATION CASUALTIES
No Radioprotec tants Radioprotectants I Radioprotection Notes
I SCENARIOS
Nuclear Battlefield - Attack Phase - Post-Attack Phase Weapon or Reactor Accident Civil Defense Space Exploration
I RADIOPROTECTANT REQUIREMENTS I increase Survival I Not Interfere with Combat Performance Minimum or Controllable Side Effects Easily Self-Administered Not Abusable Repeated Administration Compatible with Other Drugs Duration of Action 2 Hours Shelf Life 5 Years - Radioprotection
**0 I
I Fre('2 Superoxldes +radicals4 Peroxlder # lndlrect f x- Y
IImportance of Free -Radicals and Oxygen Intermediates I
0 Relatively Long Lifetime Extends Damage Away from Primary Track Responsible for Oxygen Effect Amplifies Damage I
Effect of Reactive Intermediates
t I Distance J Radioprotection Notes
Dlrect L
Stem “Damaged+ Cell + cell +Organlrm molecules death dcpletlon death
Free ‘2 Superoxldes
-)radlcals7 Peroxldes lndlrec3’”t n f x* ‘I
Direct vs Indirect Damage*
DIRECT INDIRECT Primary Mechanism Primary Mechanism for High LET for Low LET Protection Difficult Protection Achievable - Purely Physical - Extremely Rapid (410 -14 sec) - Heavy Damage
* Both are operative for all types of radiation
Consequences
Inherent Upper Limit to Protection
Indicates Scenarios for Use __- mm- Radioprotection
Nuclear Battlefield - Attack Phase Weapon(s) Detonated - Forewarning Unlikely - Prompt Radiation Radiation Fields - Complex - Varying Ratios of Neutron and Gamma Radiation Protective Agents Marginally Useful
Nuclear Battlefield - Post Attack Phase - Operational Recovery - Operations in Fallout Areas - Prior Knowledge of Radiation Exposure Likely - Residual Radiation Radiation Fields - Relatively Simple - Virtually No Neutron Hazard - Gamma Radiation Protective Agents Ideal I
Stem "Damaged"+ Cell + cell +Orgsnlsm molecules death de,,letlon death
2o-, Free O2 Superoxldes II radlcals7 Peroxides
Indirect# f x* I Radioprotection Notes
Protection/Repair Agents
Sulfur Compounds Dietary-Components - WR2721 - Vitamin E - Other WRAIR Compounds -Vitamin A - Mercaptopropionyogoycine - Selenium (MPG) - N-Acetylcysteine (NAC)
Physiological Mediators - Prostaglandins - Leukotrienes - Platelet Activating Factor (PAF)
Regeneration Agents
lmmunomodulators - Glucan - Trehalose Dimycolate (TDM)
Cy t o kines - Interleukin-1(IL-1) - Tumor Necrosis Factor (TNF) - Granulocyte Macrophage Colony Stimulating F (GMCSF) Radioprotection 1 Chemical Protective Agents
Cysteine COOH I NHzCHCH2SH
Chemical Protective Agents
Cysteine COOH I NHZCHCHZSH
Cystearnire [p-Mercaptoethylamine (MEA)] NH,CHZCH, SH
Chemical Protective Agents
Cysteine COOH I NH2CHCH2SH
0 Cysteamine ID -Mercaptoethylamine NHzCH2CH2SH
WR 2721 -I- *- Notes r Dose Reduction Factor Percent of Survival After 30 Days.
1OOOIC
DRF
0010 Do D1 Radiation Dose
WR 2721
Most Studied Radioprotectant Effective Over Broad Range of Species
DRF = 2.7 (Mice) The "Gold-Standard"
WR 2721
Side Effects - Nausea & Vomiting - Hypotension - Performance Degradation
TI = 1.4
Poor Oral Availability - Acid Hydrolyzed - Slows Gastric Motility - "First-Pass" Metabolism --I v- Radioprotection
WR 2721
a Clinical Use Cancer Therapy - Differential Protection - Reduces Cyclophosphamide & CisplatiToxicity - Phase II L 111 Clinical lials Disorders of Calcium Metabolism - Induces Hypocalcemia - Inhibits Parathyroid Hormone Secretion Military Use DRF= 1.2 - No Side Effects - No Performance Degradation -TI = 7.0
-I Characteristics Radioprotection Notes
I Compound Structural Formula
Clinically Used Sulf yhydryls
Mercaptopropionylglycine COOH OCH 3 (MPG) I II I CH2NHCCHSH
0 COOH N-Acetylcysteine II I CH3CNHCHCH2SH
I RADIOPROTECTANT APPROACHES
DIETARY Good Nutrition Vitamins (E and A) Selenium
Natural radlatlon Metabollrm girease L1 FREE RADICALS 1 L Molecular SCAVENGING damage J Vltamln E ENZYMATIC DETOXIFICATION A C Catalase Glutathlone Superoxide 0- dlrmutare O7 + H,O, H20 + 0, (Copper. ’ ‘\(_SelenlumP Zlnc) -Glutathlone peroxldare Glutathlone- Glutathione dlrulflde u Glutathlone I reductase qadioprotection
Survival With Vitamin E
100%
75% ...... Control 850 R\. ', ...... \ .... ~..i...... 850 R 5 % -. u -1 +. z.-. 25% ...... -...... \ ...... \ , Control %.- 7. 750 R '"--.-.-.-.-.i-.- 1 I I I I I I I I I I I I 1-1 0 4 8 12 16 20 24 28 Days
PHYSIOLOGICAL MEDIATORS
EICOSANOIDS Prostaglandins Leukotrienes Platelet Activating Factor (PAF)
RADIOPROTECTION BY DPGE,
120 100
80 30 Day Survival 60
40
20
Q- 900 1100 1300 1500 1700 Radiation Dose (cGy)
1 Radioprotection Notes 9
Regeneration Agents
IMMUNOMODULATORS+
MACROPHAG # CYTOKINES
PROGENITOR
PLASMA CELL ACTIVATED T-CELLS (CELLULAR (HUMORAL IMMUNlT Y) IMMUNITY)
Effect of Glucan Preirradiation on Survivability of Mice 100 r"!
80
60 . % Survival 40 -
2o0 01 5 10 15 20 25 30 Days Post 900 rads Irradiation 1 Radioprotection
COMBINED RADIOPROTECTIVE AGENTS
Protection/Repair Agents
'. Sulfur Compounds Dietary Components - WR2721 - Vitamin E - Other WRAlR Compounds - Vitamin A - Mercaptopropionyogoycine - Selenium (MPG) - N-Acetylcysteine (NAC)
Physiological Mediators - Prostaglandins - Leukotrienes - Platelet Activating Factor (PAF)
Advantages of Combined Agents
Maximizes Therapeutic Benefit Additive or Synergistic Effects Lower Doses Reduced Toxicity I Radioprotection Notes
COMBINATIONS
PROTECTION/REPAIR AGENTS + PROTECTION/REPAIR AGENTS - Vitamin E + Selenium - Selenium + WR 2721 - Prostaglandins + WR 2721
PROTECTION/REPAIR AGENTS + REGENERATION AGENTS - WR 2721 + Glucan - WR 3689 + Glucan - WR 2721 + Selenium + Glucan
REGENERATION AGENTS + REGENERATION AGENTS - Interleukin-1 (IL-1) + Tumor Necrosis Factor (TNF)
Radioprotection: Combined Treatment
I I I I I I I I I I 800 900 1000 1100 1200 1300 LD50
Effect of Selenium Pretreatment on Radioprotection by WR - 272 1 I
selenium selenium + WR-2721 30-day DRF ~1.1 DnF 12.5 Survival ( % 1 WR-2721 saline DRF 22.2
20
0 II
~~ 27 Radiation Dose (Gy) Radioprotection
STATUS
No "Magic Bullet" . . . (YET!)
0 What's available now Strict adherence to physical countermeasures (Time, Distance, Shielding) Good nutrition - Vitamin (E, A) and mineral (Se, Cu, Zn) supplements - Cruciferous vegetables Optimum health & fitness
STATUS
FIRST GENERATION AGENT Human testing in several years Characteristics - DRF b 1.4 (gamma radiation) - Intramuscular - No side effects - Single dose: 30-60 minutes pre-exposure - Combination: at least 1 protectionhepair + 1 regeneration
STATUS SECOND GENERATION AGENT 10+ years Mechanistic research Stimulate endogenous protective mechanisms Enhance repair Characteristics - Higher DRFs - Increased neutron effectiveness - "Site specific" - Low Dose - Oral, dermal patch, sub-lingual Notes
Robert Watson-Watt Chief Scientist British Radar Project lmmunumodulators & Cytokines Notes
-- ---. : -- r. .-- i: lmmunomodulators and Cytokines
..I. t I_.. - ...... _.... %-
Sites Amenable to Intervention "RADIOPROTECTION"
Rad 17Damage to Cell Injury Targets and/or Death 1 Acute Physiological Effects lncapacitation Hematopoietic and/or Death Gastrointestinal - Cardiovascular Central Nervous System
ACUTE RADIATION SYNDROME Gas trointestinat
CNS Notes lmmunumodulators & Cytokines 1 CASUALTY MANAGEMENT Organization of the Bone Marrow Stem Cell Compartment m
GRANULOCYTE
I MONOCYTE
1 BLAST GEMM \ -. PLURIPOTENT STEM CELL CFU-MEGA UEGA- PLATELETS KARYOCYTE RENEWALSELF - -- PROLIFERA 1ION
Ultimate Causes of Death in the Hematopoietic Syndrome Dose Range
Infectious complications/ Sepsis Hemorrhage Anemia
Objective:
Find ways to enhance survival by enhancing hematopoietic and immune reconstitution following radiation injury in the hemato- poietic syndrome dose range. lmmunumodulators & Cytokines Notes I
INCIDENT
PROPHYLACTIC THERAPEUTIC Protective Agents Clinical Support Restorative Agents
Supportive
Fluids and Electrolytes
Antimicrobial Agents
Platelets
.
Canine Survival Time After 6oCo Whole Body Exposures
20
Oays 12
Support .NO Support 4
Hematopoietic Syndrome +I It- 61 Syndrorns Mixed I Syndromes Notes
INCIDENT
PROPHYLACTIC THERAPEUTIC Protective Agents Clinical Support Restorative Agents
~ Restorative
lmmunomodulators
Cytokines / Cell Growth Factors
Bone Marrow Transplantation
Biological Response Modifier (BRM) lmmunoaugmenting or lmmunorestoring Agents (Hematopoietic Regula tors) Immunomodulators: Biological or Synthetic drugs inducing endogenous regulators Cytokines: Cloned endogenous regulators - Lymphokines - Monokines - Hematopoietic proliferation factors - Hematopoietic differentiation/maturation factors lmmunumodulators & Cytokines Notes I Rationale Behind Using Biological Response Modifiers (BRMs)
Enhance the function of mature cells involved in nonspecific and specific immune responses.
Some enhance hematopoietic proliferation and differentiation at the stem cell level.
CASUALTY MANAGEMENT Organization of the Bone Marrow Stem Cell Compartment CY
GRANULOCYTE
STEM CELL KARYOCYTE I RENEWAL -PROLYERA TlON Limitations
If ALL hematopoietic and immunologic stem cells have been destroyed, therapeutic intervention with lmmunomodulators or Hematopoietic Growth Factors will not be useful. Notes
Limitations
At radiation doses that permit the survival of even a very few stem cells, therapeutic use of lmmunomodulators and Hematopoietic Growth Factors can be useful.
* Limit ations
Radiation exposure during an accident is generally not uniform, thus increasing the possibility for the survival of at least a few stem cells. Notes lmmunumodulators 8t Cytokines
Glucan
A Polyglycan consisting of 8-1,3 Glucoside Linkages -
1 I
Effect of Glucan on Survival in Irradiated Mice
IMMUNOMODULATOR
MACROPHAGE
ACTIVATED MACROPHAGE I/ ENHANCED IRELEASE NONSPECIFIC HOST-- OF DEFENSE MECHANISMS CYTOKINESd ACCELERATED LY MPHO/HEMATOPOIETI REGENERATION ENHANCEDa FUNCTIONAL CAPACITY OF MATURE LYMPHO/HEMO CELLS Notes lmmunumodulators & Cytokines 1 Effect of Glucan on Prevention of Infection 1 and Enhancement of Bone Marrow Regeneration
35 1.o I I 1 I I 30 1 Saline ----- Percent 0.8 of Mice with 0.6 Marrow Bacteria Recovery in 0.4 ( 0 ) Tissues
(m) 0.2
7 9 11 13 15 17 19 Days Postirradiation (9 Gy)
c
n (4 \ *\ \\ Cytokines / Cell Growth Factors
Casualty Management Title Acronym Other Major Names Interleukin-1 IL-1 Lymphocyte-activating factor (LAF) Interleukin-2 IL-2 T-cell growth factor (TCGF) Interleukin-3 IL-3 Multi-colony-stimulating factor (multi-CSF)
Interleukin-4 IL-4 6-cell growth factor 1 (BSF-1) 6-cell stimulation factor-1 (BCGF-1)
Interleukin-5 IL-5 6-cell growth factor 2 (BCGF-2) Eosinophil-dif f erentiation fact or (EDF 1
Interleukin-6 IL-6 Interferon-D2 (IFN-P2) 6-cell stimulating factor (BSF-2) lmmunumodulators & Cytokines Notes 1 Casualty Management
Title Acronvm Other Major Names
Granulocyte/macrophage GM-CSF colony -stimulating factor Colony -stimulating Macrophage colony- M-CSF factor stimulating factor (CSF-1) Granulocyte colony- G-CSF stimulating factor
Tumor necrosis TNF-P Lymphotoxic factor p (LT) Tumor necrosis TNF- a factor a
Interferon- Y IFN-Y
I
Summary of Colony-StirnulatingFactor Effects on Hematopoietic Cella I # 31 3- 31 PLURIPOTENT STEM CELL
Peripheral Blood WBC and Platelet Response to Injection of rhC-CSF (10 mg/kg/d)
- /\.&# I I I I I I I- 700 - White e-* Percent of - Blood ***-*’ Base Cells / :.A *.*.* #* Value
... Notes lmmunumoduiators & Cvtokines
400 cGy Irradiated Canines: Peripheral Neutrophil and Platelet Response to rhG-CSF Therapy (dl-24)
I I I1I I I l I I I1II 4 *----Neutrophils - 140 -:?:: -Platelets 'i :;:* ,*: -
Neutrophils, platelets, % oi Base Value
Time (days) -G-CSF
400 cGy Irradiated Canines: Peripheral Neutrophil Response to rhG - CSF Therapy d
IIIIIIII -l G-CSF - 150 3 .-----dl-24 -
Neutrophlls, % of Base Value - - 11111I 0 9 18 27 36 45 54 70 100 7Time (days) G-CSF
Influence of Clinical Support and Cytokine, Therapy on Survival of Irradiated Canines -- - - I I- I- .. - rO* 0 - 0 - 0 04 0 -6 4 Won Support ..* Clinical 0: Cytokine Percent : Support 00 Therapy Mortality LD50 = .* LD50= 0 LO50 = 30 260 cGy ..'a 338 cGy 0& 450 cGy
10 0 0 0 0 8 A- - I -A A/l 200 --250 300 350 400 450 500 Dose (cGy) Notes
Advantages of lmmunomodulator \ and Cytokine Therapy potential action at several levels in tho modulation of hematopoietic and inflammatory rerponsos
Bone Marrow Stimulate production of progenitor and stem cells Increase production of white cells Decrease maturation time Mature Cells Increase viability Prime or activate neutrophils/macrophages Stimulate release of cytokines
Accessory Cells Stimulate release of cytokines
Act in Synergy Increase hematopoiesis and production of mature lympholhematopoietic cells
Dose Disparity Between Enhancement of Function and Proliferatiom
Function Activity 1 1:; picogram b Dose Growth Factor
I
3 Cytokines J CeOU Growth ffactors
0 Bone Marrow Transplantation Notes lmmunumodulators & Cytokines
Protocol for Use of Recombinant I Molecules After Lethal Irradiation . AB C D
Days Weeks A. Lethal radiation exposure, LD 50/30 to LD 100/30 range. B. Bone Marrow Transplant +,- depends on protocol. c. Use of recombinant, biologically active molecules, eg. CSF, IL-3, Epo, etc. D. Monitor enhanced recovery by early return of WBC, numbers of progenitor cells, functional granulocytes, survival.
160 140 O/O Normal 120 Pre-Irradiation Values 100 (Neutrophils) 80 60 40 20
0 0 10 20 30 40 Days
Alternate Approach to the Use of Single Survival -Enhancing Agents
Use multiple agents that act via different survival-enhancing mechanisms
- Use nontoxic doses of any single agent - Capitalize on optimal administration times for individual agents lmmunumodulators & Cytokines
Multiple Agent Combinations
lmmunomodulators plus cytokines
0 Cytokinz combinations
Immunomodulators/cytokines plus antibiotics
0 Immunomodulators/cytokines plus free radical scavengers
I Multiple Agent Combinations Notes lmmunumodulators & Cytokines
Effects 3f Glucan and G-CSF on Survival Following 8.0 Gy Cobalt - 60 Irradiation 100 Glucan + CSF 80
010 6o t f Survival !'. .-.-.-.-.-.-.--.- - Saline 20
0- 0- i 0 5 10 15 20 25 30 Time (days postirradiation)
* Multiple Agent Combinations
Multiple Agent Combinations
0 Immunomodulators/cytokines plus antibiotics Combined Injury Notes
I
PROBABILITY OF RADIATION CASUALTIES Notes Combined Injury I CNS Trauma - I
Sepsis
a
Probability 0. ./.' of Dying 0-1 I 1-6 I 6-24 I 1-3 I 3-7 I 7+
hr hrs hrs days days days Time After Wounding
WOUND SITE vs WOUNDING AGENT 70 - Total Casualties (2021) I' 0 Gunshot (526)
ll Mine/Booby Trap (399)
Percent Casualties
Single Multiple Head Thorax ' Abdomen ' Extremity Extremity I
'lncludtny Multipie Wounds 'Including Punelrrtlrlg Head'] rurih Wound; NSA - IIJNII*JHVN 1968
Blood Requirements vs Wounding Agents 1 yrtillery (787) 70 010 Casualties t- .. \ 4 6 Ok ...... \.
...... =I
0 1-2 3-4 5-6 7-8 9-10.~ b10 I Units of Blood (Admission to Completion of Surgery) Notes Low Level Rat liation Effects
I
fnternal (39)
'Medlcal Xrays (39)
clear Medicine (14) rConsumer Products (10)
Lother - nuclear plants, fallout, etc. (41)
CHAIN OF EVENTS
INCIDENT RADIATION
X,y --be- >zr + R- --, molecular +biological damage effect n +p+'
1+10-10 sec +t-10-5I sec sec to years
DELAYED OR LATE EFFECTS
I Low Level Radiation Effects Notes I
LOW LEVEL RADIATION EFFECTS Psychological Effects of Ionizing Radiation Notes I Learning and Memory:
Mean 20 Latency T' - T (sec) ::w/10 U sham 0.1 1.0 10 100 Dose (rads)
Retrograde amnesia produced on passive avoidance task
(Wheeler & Hardy, 1983)
Curiosity and Attention: Tendency to Investigate
Reduced investigation of novel objects or other subjects
(Harlow, 1962)
I Curiosity Mean i
Visual Curiosity .. Test ob I 1 I ' 1 1 I I ' I II @lndow@ccumulated 200 400 600 Roentgen800 1000 1200Dose I Psychological Effects of Ionizing Radiation Reduced Distractability 1
Monkey responses to:
e stiriuli . Extra-cage stimuli:
(Brown and McDowell, 1962)
Psychological Effects of Ionizing Radiation: Animal Data
Motivation Affective processes Learning and memory Curiosity and attention Psychological Effects of Ionizing Rac iiation Notes
NEUROPSYCHIATRIC CASUALTIES WOUNDED IN ACTION *
I I I
-1982 I WAR I,N LEBANON I
I I I I 20 40 60
I I Psychological Casualties
I Psychological Effects of Ionizing Radiation I Factors in the Production of Psychological I Casualties in Conventional Warfare
0 Intensity / Duration of battle Group leadership and cohesiveness Availability of information Physical strain Individual expectations Experience / Morale
NEUROPSYCHIATRIC & COMBAT CASUALTIES AMONG 3 INFANTRY BATTALIONS IN - SICILIAN CAMPAIGN ttle Casualties 120 uropsychiatric Casualties 90 -
60
30
0 10-15 16-21 22-27 JULY Source US Army Surgeon General 1943 Vineberg 1965
I Factors in the Production of Psychological Casualties in Conventional Warfare
Intensity / Duration of battle Group leadership and cohesiveness Availability of information Physical strain Individual expectations Experience / Morale I I Notes Psychological Effects of Ionizing Radiation
Psychological Casualties
Quantitative differences vs Qualitative differences
Factors That May Influence Quantitative or Qualitative Differences: d
Greater intensity Presence of ionizing radiation Threat of nuclear annihilation Psychological milieu (Denial)
I
Fear Dread Denial Psychological Effects of Ionizing Radiation
Denial may influence training / survival
"Remaining relatively unworried and inactive, despite the horrific possibility of nuclear war, is not irrational if people are correct in judging that their activism would have no consequences."
Factors That May Influence Quantitative or Qualitative Differences:
Greater intensity Presence of ionizing radiation Threat of nuclear annihilation IPsychological milieu (Denial) Psvcholonical Effects of lonizina Radiation Notes Relevant Data
1. Nuclear Accidents 2. Radiation Therapy 3. Conventional War and Disaster Models 4. Japanese Experience
But, all available data have flaws ...
Emphasis on- Psychological Changes Experienced after Hiroshima and Nagasaki Bombings
-s II 1 . Notes Psvchological Effects of Ionizing Radiation I
Overview of Psychological Data Derived from the Japanese Atomic Bomb Experience
Acute effects: Psychic numbing Fear reactions (panic?) Changes in social relationships
Psychic numbing or "closing off": A reduced motivation?
Motivational Change?
" . . . Those who were able walked silently toward the suburbs in the distant hills, their spirits broken, their initiative gone. When asked whence they came, they pointed toward the city and said 'that way': and when asked where they were going, pointed away from the city and said, 'this way'. They were 50 broken and confused that they moved and behaved like automatons. Their reactions astonished outsiders who reported with amazement the spectacle of long files of people holding stolidly to a narrow, rough path when close by was a smooth, easy road going in the me direction. The outsiders could not grasp the fact that they were wit- nessing the exodus of a people who walked in the realm of dreams." Notes
1 1
Probability of task performance under reduced motivation?
"At Misasa Bridge, they encountered a long line of soldiers making a bizarre forced march away from the Chugoku Regional Army Headquarters in the center of town. All were grotesquely burned, and they supported themselves with staves or leaned on one another."
Hiroshima I Notes Psychological- Effects of Ionizing- Radiation
Performance of Highly Motivated Task
". . . We were under military order to return to our unit immediately in case of any attack or emergency, so I returned almost without thinking. . . At first I couldn't get through . . . So in the evening I started out again. This time I didn't try to help anyone but just walked through them. I was worried about the Army camp because according to what . , . people told me, it hadsimply gone up in flames and disappeared. I was also ashamed about taking such a long time to return. But when I finally got back to the camp, just about
everyone was dead - - so there was no one to scold me . . . "
Performance of Hiahly Motivated Task kont'd)
" . . . The next thing Idid was to look for the ashes of the military code book - - since we had a military order to look for this book even if it were burned, as it was a swret code which had to be protected. Finally I located the ashes of the book, and wrapped them in a furoshiki and carried this around with me. I wanted to take it to the military headquarters as won as possible, but when I finally did take it there in the morning, the officer scolded me for doing such a stupid thing . . . I was fresh from the Military Academy and my head was full of such regulations." I Psychological Effects of Ionizing Radiation Notes
I Fear reactions - Subjective feelings of extreme fear but little "panic"
I Notes Psychological Effects of Ionizing Radiation I 1 I I Maintenance of 1 social relations and 1 helping behaviors
I I
.
"Many, although injured themselves, supported relatives who were worse off. Almost all had their heads bowed, looked straight ahead, were silent, and showed no expression whatsoever."
Air War and Emotional Stress Psychological Effects of Ionizing Radiation Notes
J
F-.-,.I--- .
Overview of Psychological Data Derived from the Japanese Atomic Bomb Experience
Chronic effects: Psychoses vs neuroses Psychosomatic symptoms Anxiety / phobias Post traumatic stress disorder Survivor guilt
i ..
Few psychoses (impaired thinking and emotion: out of contact with reality )
But,
Many neuroses (anxiety reactions, obsessions, compulsions) Notes Psychological Effects of Ionizing Radiation
Rumors 4
0 No trees and flowers would grow
0 All would die in 3 months
a The city would be uninhabitable for 70 years
Phobic Reactions
"Whenever a plane was wen after that, people would rush into their shelters. They were in and out so much that they did not have
time to eat, they were so nervous they could not work . . . "
Air War and Emotional Stress
"It began to rain . . . the drops grew abnormally large, and some- one (in the evacuation area) shouted, 'the Americans are dropping
gasoline. They're going to set fire to us!' "
Hirashime Psychological Effects of Ionizing Radiation Notes
Psychological Trauma
". . . I had to cross the river to reach the station. As 1 came to the river and went down the bank to the water, I found that the stream was filled with dead bodies. I started to cross by crawling over the corpses, on my hands and knees. As 1 got about a third of they way across, a dead body began to sink under my weight and I went into the water, wetting my burned skin. It pained severely. I could go no further, as there was a break in the bridge of corpses, so 1 turned back to the shore, and started to walk upstream, hoping to come upon another way across."
Post Traumatic Stress Disorder (continuing to live in the emotional environment of the traumatic event)
Persistent startle response and irritability Explosive reactions Fixation on the trauma Reduced personality functioning Atypical dream life rrures 1~
Psychosomatic symptoms
a Atomic Bomb NeUrO8i8
"Frankly speaking. even now I haw fear. . . Even today people die in the hospitals from A-bomb disease. and when I hear about this I worry that I rnwt too sooner or later have the mething happen to me . . . I have 8 special feeling that Irn different from ordinary people . . . that I have a mark of wounds - as if Iwere a cripple . . . It is not a matter of lacking something externally, but rather something like a handicap - something mental &at does not show - the baling that I wn mmmlly different fmm ordinwy people . . . so Vvhm I hrr &out people who dm from A-bomb diraase or who have operations bacause of this illness, then I feel that Iam the same kind of person as they . . . '*
Death in Life
Survivor Guilt Psychological Effects of Ionizing Radiation Notes I "I was almost dead . . . I should have died . . . I did die or at least am not alive . . . or, if I am alive, it is impure of me to be so . . . anything which I do which affirms life is also impure and an insult to the dead who alone are pure . . . and by living as if dead, I take the place of the dead and give them life."
Lifton, 1963
Care Problems +. +.
Patient's uncertainty of injury
Psychological impact of inability to care for all casualties
Decisions concerning mission requirements
1 - Care Requirements I Conventional Therapies Proximity I Recency Expectancy Notes Psychological Effects of Ionizing Radiation 1 Prevention of Psychological Reactions to Nuclear Warfare
Training Social cohesiveness
I1 . . dangers that are thus foreseen are already half
o v er c o me. "
Von Schell, 1930
Training
"Yamaguchi's lecture on A-bomb precautions, he pointed out later, was not lost upon his colleagues. With the young designer's words still fresh in their minds (at the time of the second bombing) they lept for the cover of desks and tables. 'As a result', said Yamaguchi, 'my section staff suffered the least in that building, in other sections there was a heavy toll of
serious injuries from flying glass.' " rsychological Effects of Ionizing Radiation Training a Real
0 Accurate Relevant
I
Importance of Primary Groups
I Review Psychological effects of ionizing radiation Importance of psychological factors Psychological effects of conventional vs nuclear warfare Overview of psychological data derived from the Japanese Atomic Bomb experience: - Psychic numbing - Psychoses vs neuroses - Fear reactions - Psychosomatic symptoms - Social relations - Anxiety / phobias - Survivor guilt - Post traumatic stress disorder Care of psychological casualties
I I 1 Psychological Effects of Ionizing Radiation Affective Processes
Increased indicators of animal "emotionality" after 25 Gy (head Only) (Arnold, 1962)
Animals of "strong temperament" (strugglers, vocalizers) have reduced radiation effects (0.5 Gy) (Biagini and diPaola, 1962) I Learning and Memory:
Memory disruption of classically conditioned responses
(Meyerson, 1962)
Preirradiation Ammonia +Apnea
Light & Tone + Ammonia II) Apnea Light & Tone +Apnea
Postirradiation Light & Tone + No Response or Shortened Apnea Ammonia + Apnea A Notes 1 2201 I 1 AVOIDANCELEVER 2M ---[ WARNING LEVER 180 I 4 160 -
140 -
120 - 100 - 80 -
60 -
40 -
01 I, I 'I1 1 I Control 0-10 io-20 20.30 30.40 40.50 50-60 60-70 70.80I 80.901 I MINUTES POSTIRRADIATION
Motivation and the Rat Brain (self=stimulation sites)
Septum ~
v) 1.0 1 , I 1 Q v) gz 2 0.8- *\*/*\* 2s \*-* - mt%r"n .- r 5 0.6- om 0": Lateral Hypothalamus 0 - Septum a~Q c. 0.4 t .,o .s r;; D *- 0 P 0.2- s:.-c v) Psychological Effects of Ionizing Radiation
Psychological Effects of lonizing Radiation: Animal Data Motivation Affective processes Learning and memory Curiosity and attention
Motivation:
Tendency to perform vs Capacity to perform Psvchological Effects of Ionizing Radiation
I EFFECTIVE RANGE OF A
I Radiation - induced Changes in the =€&&=-iSystem
0
0
0 Notes Performance Decrement
COMPUTER MODELS OF PERFORMANCE DEGRADATION
Individual Crew Unit
SUMMARY
Importance of behavioral data
0 Sources of behavioral data Characteristics of ET1 Factors influencing ET1 Behavioral radioprotection PD associated with a sublethal dose of ionizing radiation Human response program Notes Performance Decrement 1 Expected Response to Radiation I
1hr 1 Zay 1 moA Time After Exposure
1
I Expected Response to Radiation - for Physically Undemanding Tasks
Dose kGy)
100
Time After Exposure
4
10,000
Dose ~GY) 1,000
100 A 1 hr 1 dayA 1 moA Time After Exposure ;-::Physically Demanding =Physically Undemanding Tasks Tasks Performance Decrement Notes _d-
SYMPTOM COMPLEXES
113121 Tired, with moderate weakness; mild fever and headache; like starting to come down with flu 514111 Vomited several times including dry heaves; severely nauseated and will soon vomit again; very tired and weak
REPRESENTATIVE COMBAT SYSTEMS
4 0 INFANTRY - TOWATVM901 - 54 Ib missile, 300 meters, 16 sec - four crew members ARMOR - M60A3 (Ml) TANKS - 30 Ibs 105 mm shell - four crew members ARTILLERY - 155 mm SELF-PROPELLED HOWITZER - 100 Ib projectile - batallion-level fire support company - gun + FDC + OP'S + (TACFIRE)
100 - I I I I I - Squad Leader 80 --- - -.-.- Loader - - - .'! Gunner !\ 60 ------. j?*f \.,. Driver p. Percent - I \.../'
Symptom Complex __ --I - Performance Decrement . EFFECTS OF PROMPT WHOLE - BODY RADIATIONS ON HUMANS EXPOSURE DOSE (rads) WHICH PRODUCES EFFECT 50% INCIDENCE
~ Loss of appetite 170 Nausea 250 Fatigue 260 Blood pressure drop 300 Vomiting 320 Diarrhea 350 DEATH 450 Incapacitation 3000
HUMAN RESPONSE PROGRAM
~
RADIATION 1111) SICKNESS
SICKNESS * PERFORMANCE
PERFORMANCE +EFFECTIVENESS I Notes Performance Decrement CURRENT NUCLEAR RADIATION CRITERIA
DOSE (rads) CASUALTY CRITERIA 18,000 Immediate Permanent Incapacitation 8,000 Immediate Permanent Incapacitation (physically demanding task) 3,000 Immediate Transient Incapacitation 650 Latent Lethality
TROOP SAFETY CRITERIA
150 Emergency Risk 70 Moderate Risk 50 Negligible Risk
DNA HUMAN RESPONSE PROGRAM Intermediate Dose
TROOP < INTEADMOEIATE < CASUALTY SAFETY CRITERIA (30 Gy)
I RADIATION DOSES TO UNIFORMLY DISTRIBUTED MILITARY PERSONNEL EXPOSED TO A TACTICAL NUCLEAR WEAPON
NEGLIGIBLE INCAPACITATING
I MIDLETHAL (450 rads) lmmunumodulators 81 Cytokines
Survival- Enhancing Effect of Postirradiation Glucan Combined With Orally Administered WR- 3689
Treatment
I I I 7 8 9 10 L050/3~Radiation Dose (Gy)
Summary - * There appears to be a valid role for immuno- modulators and cytokines in the therapy of radiation injury in the dose range of the hematopoietic syndrome. Decrease both severity and duration of postirradiation neutropenia and myelosup- pression Enhance survival Enhance the effectiveness of low doses of other protective and therapeutic agents - Traditional radioprotectants - Antibiotics -- -4
lmmunumodulators 8t Cytokines Notes 1 Effects of Glucan and Pefloxacin Treatments on Survival in Irradiated Mice
I 100 I I
80
Percent 60 Survival at 30 days 40
20
0 Glucan Glucan + Antibiotic Untreated Antibiotic Treatment c 1
Mu1t ip I e Agent Comb inati o ns
0 Immunomodulators/cytokines plus free radical scavengers
Survival -Enhancing Effect of Postirradiation Glucan or C-CSF Combined with WR-2721
Treat ment
L I I I I 78 9 10 11 12 13 LD50/30 Radiation Dose (Gy) Notes Performance Decrement -BEHAVIORAL INCAPACITATION AS A FUNCTION OF RADIATION DOSE
Percent
3-Channeled Accelerod
I I
I
RADIATION QUALITY EDSO’S (PROBITS) FOR ACCLELEROD PERFORMANCE - Neutron 98 --o Percent Gamma 8s --. Bremsstrahlung 81 ...... Electron 61 -...... o .....-.’ Subjects 70 o,,.....”’ with 50 .....’..... Perfor- ,...... “b.e.’ mance 30 ...“‘o._.. kcrement 10 ... I 1 1 1- I I I I 0.1 I 1 40 50 60 Dose70 (Gy)80 SO 100 160 Notes Performance Decrement DETERMINANTS OF INCAPACITATION
TASK COMPARISON FOLLOWING 2500 cGy IRRADIATION 100%- 1 VISUAL 80
60
(100% ETI) 20 t- II 2500 cGy MIDHEAD DOSE 1 I I 1 I A 20 40 60 80 100 120 PULSE MINUTES POSTIRRADIATION L
BEHAVIORAL INCAPACITATION AS FUNCTION OF RADIATION DOSE FOR VISUAL DISCRIMINATION TASKS
Unstressed 18.0 N/g = 0.4141 d Performance Decrement Notes
100
EARLY TRANSIENT INCAPACITATION death
Percent 0 Correct Response 100
PERFORMANCE DECREMENT
0 I 1 hour hours-da y s RADIATION EXPOSURE
ETI/PD CONTINUUM
25 lOO~/O OI I 75 6 5 O/o
ET1 = failure to work for a pre-specified period of time, Le., 6 trials PD = below pre-specified criteria, i.e., 22 score or 465%
MONKEY SPEED STRESS VISUAL DISCRIMINATION BASED ON ENDPOINT
99.9 I I I Illll, I I I I IIII-1
Early Percent Performance 4 of Subjects 90 Showing 70 Signlflcant 50 Decrement 3o Transient Incapacitation
Early Performance Decrement 7.2 'Or-1 Early Transient Incapacitation 9.0 0.1 t I I 1 IIlj() 1 1111111 1 5 10 50 100 Dose (Gy) Notes , Monkey Behavioral Effect Level ~-
TASK ENDPOINT ED50 (~y) VDT ET1 18 SSVDT ET1 9 SSVDT EPD 7 DMTS EPD 3-5
VDT = visual discrimination task, 5 sec response time SSVDT = speed stress visual discrimination task, 0.7 sec or less response time DMTS = delayed match to sample task, 5 or 10 sec delay ET1 = early transient incapacitation EPD = early performance decrement
I
ATTENUATE ET1 WITH DRUGS: BEHAVIORAL RADIOPROTECTION
Direct
Incidental
Anti-emetics -~- Management of lnternaf Radionuclide Contamination
. -.e .. ALLOUT'.. - a.
UNSPENT FUEL
Trltlum Utanlum Plutonium
MEDICALLY IMPORTANT RADIONUCLIDES
Amerlclum Plutonium Californium Polonium Cerium Strontium Ceslum Tritium Curium Uranium Iodine ui-
a------II
DIAGNOSTIC TECHNIQUES TO MEASURE RADIOACTIVE CONTAMINATION 4) 111 V& Measurements Whole Body Counters Special 2 V+ Counters -low energy chest counters for Pu and Am -Plutonium wound monltor -thyroid counters -Anger camera or scannlng equlpment
L J
BASIS FOR TREATMENT DECISIONS
Critical Initial Treatment Risk/Benefit Solubility /Chemical Proper ties of Contaminants MFP
I Infectious Complications Noted
Survival of Mice Infected with K. pneumoniae 4 Days After 6oCo Radiation (7 GY)-- 1 100 I
80
Percent 60 Survival 40
0 - Saline MPL-TDM P-Glucan I Group
Alone
40 20
SURVIVAL
I 401 TDM \
c
- LYMPHOCYTES L GROWTH FACTORS IMMUNOMODULATORS
TISSUE INTEGRIT OTHER DEFENSE! PORTWE THERAPY Suppression Notes Infectious Complications
EFFECTS OF GLUCAN AND PEFLOXACIN TREATMENTS ON SURVIVAL IN IRRADIATED MICE
...... Percent Survival ...... at 30 days ......
Treatment
Percent Survival of 7 Gy Irradiated and Infected Mice Given Antibiotic or lmmunomodulator Therapy 5 = 106 5 pnrwn~(5000 LD50130 or 1 LD50/30 to a normal, untreated mouse) RW ... neumonlae 100 Sallne I 80 (Saline) TDM 100 % 60- (Squalene) Swvlval - Ii 40 - I! - I! I! 20 - OJllll0 5 IIIII~~~~~J 15 7n 10 15 20 Days --
SUPPORTIVE Pharmacologlc regulatton INCIDENT Immunoglobulin Antimicrobial agents Fluid 8 electrolytes Platelets
. /////////////~~~~~~~~~~~~~~~~~~,...... PROTECTIVE RESTORATIVE
modulators , Infectious Complications Notes I
REPAIR TISSUE I TREAT I I SY MP,TOMS 4 I DIRECT I
I BLOCK I MEDIATORS CONTROL INFECTION
SEPSIS AFTER IRRADIATION
1. PREVENTION * Wound Debridement Topical Antimicrobials & Dressings Environmental Control of Nosocomials Minimal Use of Invasive & Indwelling Devices Fluid & Electrolyte Resuscitation Nutritional Support
0. Selective, Gut Decontamination
00 hGM-CSF
0. Early Administration of Immuno/Hematopoietic Modulators 0. experimental
SEPSIS AFTER IRRADIATION
II. PARENTERAL ANTIMICROBIAL MEASURES
Antibacterial Antibiotics (2-3 different types)
'0 Immunoglobulin "G" (anti-LPS)
Antifungal & Antiviral Agents (when indicated) --I uvyll
Notes infectious Complications
SEPSIS AFTER IRRADIATION
111. MANAGEMENT OF SHOCK
0 Hemodynamic Pressure Monitoring and Use of Pressor Agents
0 Avoidance of Corticosteroids Except in Adrenal Insufficiency
00 Antibody to TNF (Cachectin)
oo experimental
EPIDEMIC DISEASE
35% of the survivors will die of infectious diseases during the first year after an attack. I Major types of diseases responsible for epidemics among survivors would be enteric and respiratory infections.
I
It must be remembered that many ddseases are merely under control and not eradicated. Should a sudden breakdown in medical support and individual hygiene measures of an army occur, these diseases will probably rise in incidence to lower combat readiness and effectiveness. In the age of terror weapons, one must keep in mind the terrors of nature. I Irranagement of Internal Radionuclide Contamination 1 DIAGNOSTIC TECHNIQUES TO MEASURE RADIOACTIVE CONTAMINATION
1) Surface Contamlnatlon Determlnatlon Alpha Monltorlng Beta-gamma Monltorlng Surface Swlpe Monltorlng Nose Swipes
DIAGNOSTIC TECHNIQUES TO MEASURE RADIOACTIVE CONTAMINATION
2) Penetrating Radlatlon Assessment Mlxed External-Internal Exposure
DIAGNOSTIC TECHNIQUES TO MEASURE RADIOACTIVE CONTAMINATION
3) Bloassay 01 Excretions Analysls Interpretation Time 01 Exposure Varlatlon 01 Excretion Rates Excretion Characteristics of Inhdatlon Exposure I mrernar naaionuclide Contamination Notes
INITIAL MANAGEMENT OF THE PATIENT 4) Hospital Management: Pre-emergency Planning Decontaminatlon of Patient Evaluation of Contaminated Patient -history -physical exam -lab tests
NCRP Report No. 65
MANAGEMENT OF PERSONS ACCIDENTALLY CONTAMINATED WITH RADIONUCLIDES
DIAGNOSTIC TECHNIQUES TO MEASURE RADIOACTIVE CONTAMINATION
1) Surface Contaminatlon Determination
2) Pcnetratlng Radlatlon Assessment
3) Bloassay ot Excretla 4) In Vivo Measurements Notes Management of Internal Radionuclide Contamination I INITIAL MANAGEMENT OF THE PATIENT 1) Uptake and Clearance Mechanisms: Internal Contamination Routes -inhalation -ingestion -contaminated wounds Clearance Times -respiratory -gastrointestinal
INITIAL MANAGEMENT OF THE PATIENT
2) initial Measurements of Radioactivity: Nasal Swabs Estimate Internal Contamination
INITIAL MANAGEMENT OF THE PATIENT -II - w ,W~armogetrnrtnrOT Internal Radionuclide Contamination Notes
Management of Internal Radionuclide Contamination
INITIAL MANAGEMENT OF THE PATIENT
1) Uptake and Clearance Mechanisms 2) Measurements 3) On-Site Management 4) Hospital Management NOteS Performance Decrement
DETERMINANTS OF INCAPACITATION
.~ -
SURVIVAL TIME FOLLOWING IRRADIATION
- - - Hours -
1000 2000 3000 4000 5000 6000 7000 Dose (cGy) - Notes Performance Decrement - I I MATCHING-TO-SAMPLE TASK 100 I - 80- 3 - - \\0 ' Percent 60 - - Performance - 40 - - - 20 - 0 Bruner. lg7? ' --- Dose Rate (rads/min)
MULTIPLE EXPOSURE STUDY
Group 1 5000 I Group 2 2500 2500 Group 3 2500 2500 Group 4 2500 2500 Group 5 2500 2500 Group 6 2500 2500 Group 7 2500 2500 Group 8 2500 2500
I MULTIPLE DOSE EFFECTS I TWO 2500 cGy DOSES/5000 cGy TOTAL MIDHEAD DOSF 1 2 3 GROUPS 4 5 6 7 8 I I I I 100I 0 25 50 75 MEAN PERCENT CORRECT
L Notes Performance Decrement
I Head shielding attenuates €TI in the dog and pig, but not necessarily- in the monkey. -
DETERMINANTS OF INCAPACITATION #
0 Dose
Dose Rate or Fractionation of Dose
I I Notes Performance Decrement I Percentage of Incapacitation in 120 Monkeys as a Function of Radiation
80 - 70 - 60 - - - Percent - - -
500 1000 2000 3000 5000 Dose (cGy)
DETERMINANTS OF INCAPACITATION -
0 Dose Portion of Body Irradiated
0 Dose Rate or ffraGtionation off Dose
0 OuaCi8y off Radiatioons
0 Uask ReqUiremeon8s
- t Whole Body - 20 - PULSE - - 2,500 rads - Notes Performance Decrement
MONKEY RESPONSE TO 3000 RADS (FREE-IN-AIR) -111 ~--__~~.~- EMESIS SURVIVING FRACTION
RESPONSE LATENCY INCREASE
0 01 01 10 100 TIME POSTIRRADIATION Ihoursl
DETERMINANTS OF INCAPACITATION
Dose Portion of Body Irradiated Dose Rate or Fractionation of Dose Quality of Radiations Task Requirements
DETERMINANTS OF INCAPACITATION
Dose Notes Performance Decrement t
PhY 'S Activ Performance Decrement 1 ANIMAL I EXPERIMENTATION
Lovelace Foundation Brooks AFB AFRRI
EXPECTED POSTIRRADIATION RESPONSE - 100 A 1 I+ I 75 - I I
Percent I Correct 50 - I
Response I I
PULSE Time Postirradiation (minutes)
Monkey Performance After Irradiation Notes
OVERVIEW
Importance of behavioral data
0 Sources of behavioral data Characteristics of ET1 Factors influencing ET1 Attenuation of ET1 PD associated with a sublethal dose o ionizing radiation Human response program
SOURCES OF RADIATION EFFECTS- INFORMATION
Hiroshima/Nagasaki Clinical Irradiations Radiation Accidents Animal Experiments
EARLY TRANSIENT INCAPACITATION Performance Decrement I I
RANGE AND AREA FOR RADIATION DOSES FROM A 1 kT FISSION WEAPON
Dose (rads) 3000 650 Area (km2) 1.4 2.6 Notes Performance Decrement
1
I .ruummagczmmien'L OT Internal Radionuclide Contamination
THERAPEUTIC MANAGEMENT
2) Contaminated Wound Tx Trandocatlon and Absorptlon Unremoved Contaminants Beta-gamma Emlttlng Contamlnant Hazards Treatment/Surgical Considerations
~ ~~ ~~
* THERAPEUTIC MANAGEMENT 3) Internal Contamlnatlon Treatment Reduce 01 Abrorptlon rtomach lavage, emetlcr, purgatlver, Ion exchange rerlnr, Prurrlrn blue, Al-antacldr, algb~ter,BaS04, phytater Blocklng/DUutlng Agentr MobYUng Agentr mtlthyrold, NHaCI, dkwetkr, eXp.ctorHltr/WI.kntr, PTE, cortlcorteroldr Chdatorr EDTA, DTPA, dlmercaprol, pcnlclllamlnc, deteroxamlne
1
THERAPEUTIC MANAGEMENT
4) Lung Lavage Decreased Radiation Pneumonitis Risk /Benet It ~- Intern& Radionuclide Contamination
Significant Radionuclide Information 11 CMt.mln.tbn 'fra8tWt Vk' I/W DTPA I/W DTPA 1/01 DTPA 1/5/01 Prm. BLn I/Qi DTPA I/01/S sat KI I/W DTPA I MrrmC.prd 1/01 A-4 I/S/cY Forco %O I/S/W DTPA
7 = MJ.tkn; 01 = 6.rtrohterth.l AbrorpHon; 8 = Skh W = Womd Abrorptkn
THERAPEUTIC MANAGEMENT
1) Skln Decontamlnatlon 2) Contaminated Wound Tx 3) Internal Contamlnatlon Tx 4) Lung Lavage
THERAPEUTIC MANAGEMENT
1) Skln Oecontamlnatlon Phyrlologlcal Conrlderatlons Contamlnatlon Survey General Prlnclpler -soaps -scrubbing -chelators -bleach -hair removal -chemical Notes Performance Decrement
COMPARISON OF ETI/PD AND POSTRADIATION MBP AND HIPPOCAMPAL BLOOD FLOW
*---.* ETIIPD - O...... OBlood Flow - CorrectMean Responses/Percent 80'- *-*MBP - Percent of 60 - - \\I: Preradiation Mean - - II: t. ;-. 40 I: 1 ... o:?.: - - I '. /.... 9'"" %.; .___ - I .... - 0..... 20 - \,*--+--* -* ""0 - - '\ I -*-* 0 I I I I I I I i
DIRECT ATTENUATION 4
Stabilize blood flow, blood pressure, histamine
Norepinepherine ,
Chlorpheniramine
Disodium Cromoglycate
Cimetidine
INCIDENTAL ATTENUATION RADIOPROTECTANTS FOR LETHALITY
WR-1607 WR-2721 (Ethiofos) Combinations Performance Decrement
ANTI - EMETICS
Metoclopramide: disrupt motor performance
Dazopride: drowsiness
Zacopride: no behavioral toxicity!
SYMPTOM CODING - Upper GI Lower GI Fatigue/Weakness Cardiovascular Infection/Bleeding Fluid Balance
UPPER GI DISTRESS (UG)
1 No effect 2 Upset stomach; clammy and sweaty; mouth waters and swallows frequently 3 Nauseated; considerable sweating; swallows frequently to avoid vomiting 4 Vomited once or twice; nauseated and may vomit again 5 Vomited several times including the dry heaves; severely nauseated and will soon vomit again Notes Performance Decrement
RADIOPROTECTANT FOR BEHAVIOR
I
I 0
PROPOSED MECHANISMS FOR EARLY TRANSIENT INCAPACITATION - Seizure Coma Histamine Release Hypotension Endorphin Release Interference with Cellular Metabolism Free Radical-Superoxide Toxicity Anoxia Intracranial Pressure
ACUTE RADIATION SYNDROME
Frostration bDeath i 10' I I I ! I I I I ! I I Dose JranSlent +Prodromal b Manifest (cGy) lo3 Incapacltatlgn Phase I Illness I ! I I i Prodromal Latent _.Manifest 102 I Phase :'Period Illness I I I I Minutes Hours Days Weeks I EXPC ;URE Time Postexposure I Performance Decrement Rat Barpressing for Food After 450 rads at 250 rads/min
120 J I I I I I I
Responses per Second (O/O Control)
::I,I, , , 0 ,I 0 5 10 15 20 25 30 35 Sessions
DEFENSE NUCLEAR AGENCY Human Response Program
Objective: Assess the Effects of Nuclear Weapons Environments on Combat Personnel Operational Medical
CURRENT NUCLEAR RADIATION CRITERIA
DOSE (rads) CASUALTY CRITERIA 18,000 Immediate Permanent lncapacita t ion 8,000 Immediate Permanent lncapacitation (physically demanding task) 3,000 Immediate Transient lncapacitation
650 Latent Lethality Infectious Complications
Whole cells -+ Cell fragments + Biochemically + Host mediators defined component
Yeast -+ Zymosan -+ Glucan -+ Cytokines (kolated (Synthesized) (Recombinant) from yeast)
Effect of Glucan on Prevention of Infection a_nd Enhancement of Bone Marrow Regeneration
35 I I I I I I 1.o I .. I 0.8 Percent ---Saline of Mice -Giucan CFU- with 0.6 Per Bacteria Femur 0') In 15 .*' 0.4 (0) Tissues 10 )CCo* (8) **.-' 0.2 I I -1 -1 I 0 6 7 9 11 13 15 17 19 Days Postirradiation (9 Gy)
Effect of Glucan on Canine Survival when Administered Postirradiation
.e...... ::::::::: :::::::::: :::::::::: :::::::::: ::::::::::: :::::::::: :: I. I I 1 I I I I 1 0 10 20 30 40 50 60 70 Day Postirradiation Infectious Complications Notes
PRIMATE SURVIVAL FOLLOWING .I8 Gy IRRADIATION
~~ ~ No Supportive Therapy 1 Supportive Allogeneic Partial2 Therapy Only BMT Shielding Survivors -0 -0 -5 -4 Total 4 4 5 4 Mean Survival 12.5 16.3 b30 b30 Time (days) antibiotics, fluids, platelets *less than 1% surviving stem cells
EFFECT OF SHIELDING AND rCSF ON RECOVERY OF MONKEYS FOLLOWING 800 cGy IRRADIATION
Unshielded Shielded Granulocytes x Shielded + rHGM-CSF / x 10-3 4"hi2 0 0 10 20 30 40 Days
"If only I had the means to create fever artificially, I should be able to cure all illness."
500 BC 1 Days After Radiation
z lglV
May shift G- to G+ Infection
No overall better outcome in 41 burn patients
No effect in irradiated mouse model
DOSIMETRY AND ORIENTATION: Shielded 8.0 Gy Protocol
Dose (Gy) Infectious Complications Notes
Treatment of Radiation-Induced Hemopoietic Syndrome in Canines
therapeutic control
148 177 1.5 TREATMENT: A) Ringer's lactate, i.v., 40 ml/kg body wt. at 24 h p.e. and as Indicated E) Antibiotics - gentamycin (3 mg/kg 2x daily) and Cefotaxlme (30 mg/kg 2x dally) when WBC below 1000/mm3 C) Platelets on days 8, 11, 14, 17 postirradiation
100 r
80 Fatality/ Casualty 60 Production s2 Rate 40 ( 1 20
0
I Treatment of Burn Infection Percent With Immunoglobulin I Survival
I 1:l - 0 'O- 1:8 -
0 1:16 -
-
20 1~32- !Mannitol 0-- I I I 0 1 2 3 4 5 Days Notes Infectious Complications
SURVIVAL OF IRRADIATED MICE (10 Cy), TREATED WITH ANTIMICROBIALS
18 -
No. of - Animals 10 - 8-
- 2-
0 2 4 6 8 10 12 14 16 18 Days
- ANTIBIOTIC THERAPY Synergistic Combinations New Preparations Enzyme Inhibitors Mixed Infection and Appropriate Therapy I
Percent Survival According to Therapeutic Intervention in a Septic Shock Animal Model Antibiotics -I + I
I I -__.Y - Infectious Complications Notes
DECREASING ANTIBIOTIC INFECTION TREATMENT DURING DECREASED DEFENSE CAPACITY
bltnsc aPPuaI"I
SELECTIVE DECONTMINATION INFECTION DURING DECREASED DEFENSE CAPACITY
colodz8llon reslstanct
SIYI polcnllally palhogmlc conlamlnanli
EFFECT OF SELECTIVE DECONTAMINATION WITH A QUINOLONE ON HUMAN GASTROINTESTINAL FLORA
10
8
log 6 CFUfg faeces 4
2
0 0 2 4 6 8 10 Days
I Notes Infectious Complications
q Mucosal 0.0 0 00 0 Disseminated Infection Opportunistic 0 0.0 Pathogen Barrier
CHERNOBYL: - Infection Management* Selective decontamination Multiple antibiotics Gamma globulin Amphoteracin B Acyclovir
' not as effective against combined injury, GVH reaction, or radiation enteritis
INFECTION NORMAL DEFENSE CAPACITY
HlLSTlNU CoCONIZAlIoN I
colonlzallon rtilrlanc* I Infectious Complications Notes
Signals of lnflsrnmaton Fihrogenesis Km*I Svrcam Il~rsurRepntrl conp*mnt sprm c Cblling SVS1.m. t Debridement J \ By Macrophage PMN Euudmtlon
I Relationship of Time to Occurance of Wound Infection in Mice with Staphylococcus aureus After Radiation (6.5 Gyl 10000 R”] 100
--LL--L-10 O:, 5 4 6 810 Time Postirradiation (days)
PREREQUISITES FOR INFECTION
Compromised Defenses
Colonization Infectious Complications
~
REASONS FOR INFECTION
c
Oropharyngeal respiratory tree colonization
0 Wound contamination Intestine colonization Artificial invasive devices Profound immunosuppression Pathogens in environment
FACTORS WHICH PREDISPOSE TO WOUND INFECTION
Foreign bodies
Time lag Number, location, and extent of wounds
\
A Infectious Complications Notes
Infectious Complications of Trauma and ;j ,.f i 3- Radiation I -2 L-
CNS Trauma -
0-1 1-6 6-24 1-3 3-7 7+ hr hrs hrs days days days Time After Wounding
ASSOCIATION OF INTESTINAL FLORA WITH POST-RADIATION EVENTS
ENDOTOXIN
ENDOTOXIN GRANULOCYTES
.. A 2 4 6 a 10 . 12 14 Day: FTIGHT JUNCT +TJ+ +DEATH+ DISRUPTION DISRUPT OCCURS Notes Combined Injury
THERMAL INJURY MANAGEMENT
AGGRESSIVE CONSERVATIVE Primary Excision Special Personnel O.R. Time Speclal Facllltles Special Anesthesia Time Consumlng
Limitation Riskv.I Relative Uncomplicated Results Post-Op
SUGGESTIONS .. Full thickness burns should be primarily excised and grafted Partial thickness burns should probably be cared for by aggres- sive topical therapy and avoidance of nosocomial sepsis IF experimental data on radiated animals is similar to human data Notes
I
IMMUNOLOGIC EFFECTS OF COMBINED INJURY SYNDROME
Bone Marrow Suppression
I Disruption of Epidermal Barriers Depression of the Reticuloendo- thelial System
PRINCIPLES OF CONTROLLING INFECTION IN BURN CARE z
Use of Antimicrobials
Support of Immune Mechanisms
Elimination of Infection Reservoirs
Suppression of Infection Transfer
TOPICAL ANTIBACTERIAL THERAPY OBJECTIVES:
Prevent Invasive Sepsis (Effective Against Common Flora of Burn Wound)
- Used Early - Used Late Maintain Process of Tissue Regeneration Promote Patient Comfort Minimize Systemic Toxicity Minimize Nursing Effort Minimize Opportunistic Secondary Growth Minimize Bacterial Resistance (Eg Fungus)
I Combined Injury Notes
Radiation Wound Closure
I I I I I 1 I I I I I 0 20 40 60 80 100 Percent Mortality I Messer Schmidt
Canine Intestinal Bullet Wounds Plus Radiation d
Wounds + Surgery
Wound + Radiation
0 20 40 60 80 100 Percent Mortality
Soft Tissue Injuries
Control of hemorrhage Debridement Repair of vital structures lrriga tion Wound closure considerations Notes Combined Injury Problems
Wound Colonization Failure Delayed Primary Closure Wound Sepsis - Systemic Sepsis Delay in Healing Occasional Amputation
Problems
Loss of skin Loss of muscle Bone injuries Neuro-vascular injuries What is viable 8t what is not Should an amputation be considered Notes Combined Injury
CHOICES FOR WOUND CLOSUREl
Delayed Primary elosure Granulation Base and Graft Early Closure by Graft Autologous Synthetic
Treatment of Soft Tissue Injury Contamination
Debridement Antiseptics Antibiotics Immune Enhancement
How to Deal With the Problem
Resuscitation 0 Mechanism of Injury Team Effort Meticulous OR. Management Return to O.R. at 48 Hours for Wound Inspection Extend Debridement PRN S.T.S.G./Mesh I VVI I mu11 IGU II IJUr y Notes
SURGICAL INFECTION
Wound Environment Plays a Major Role in the Genesis of Wound Sepsis
Open Wound Sepsis
I Superficial Wound Colonization Tissue Invasion Septic Metastasis Systemic Sepsis I
Number of Positive Bacterial Cultures in 63 Extremity Wounds
Days of Hospitalization Bacteria 1 3 5
Gram Positive 90 36 23 I Gram Negative 98 78 123 Combined Injury
TIMING OF SURGICAL MANAGEMENT OF COMBINED INJURIES 1 Routine Trauma Initial Reparative Reconstructive Surgery Surgery Surgery
D, I11- 1 2 5 10 50 100 Days after Injury
Radiation Plus Trauma Initial Reparative Reconstructive Surgery Surgery Surgery Surgery Precluded ,II I I1111 I It11111 =I - 1 2 5 10 50 100 Days after Injury
Radiation Injuries
Radlallon Exposure b C~nlYmollon tkopIastIc dlseise Cataracts G~~WIIC Risk A
Monitor & Admlnlster IV FWds AntWQIkr Platdet Transluston Whole Bbodl Sublathd
Nutrltlonal Support CBC Lymphocyle b Ptaldet Counts .Urinary Output 6 Urkalysls Ridloassay I of Excreta Cytogenetic Study I
C
Prognosis for almost all combined injuries worse than for radiation injury alone. Notes Combined Injury I
Lymphocytes Relationship 3000 1...... Between ...... 11 Early Changes in Peripheral Blood 2000 Lymphocyte Counts and Degree of 1000 Radiation Injury 500 injury 100 012 Time (days)
Premise for Early Enteral Feeding
SHOCKITRAUMA EARLY ENTERAL FEEDlNG PARENTERAL FEEDING
0 Nutrlents stimulate villi growth Villi atrophy from enteral starvation Gut mucosal barrier intact Gut mucosal barrier breaks Healthy mucosa limits translo- down cation of bacteria Unhealthy mucosa allows translocation of bacteria/ Immune system clears limited endotoxin volume of translocated bacteria Complement activation occurs Results: 4 Stress response Results: *Stress response 4 Risk of sepsis *Risk of sepsis
Outcome = Trauma Study 50 II 40 Enteral N = 20 60 Percent TPN 30 N = 23
20
0 Morbidity Sepsis Abscess/ Pneumonia Combined Injury I
VASCULAR INJURIES
Ligation Primary Repair Autogenous Graft Synthetic Graft? or Antibiotic Bond?
I Clinical Assessment
Observe and record time of onset of clinical signs and symptoms
Perform daily blood count
Perform neurologic check/physicals
Determine treatment modality Notes Combined Injury
QUESTIONS CONCERNING - LARGE BOWEL INJURIES
Adhere to Old Concepts Be Selective in Their Management Exteriorize All Injuries
I
I - Notes Lombined Injury Tq;$
Splenic Injuries
Maximum effort to repair
Minimum effort to repair
Partial splenectomy
Indications remain as they are I Notes Combined Injury
TRAUMA SURGEON
OPER A TIVE: Adequate Anesthesia Adequate Exposure Control of Bleeding Debride Necrotic Tissue @Repair What Needs to Be Repaired and Drain
I
BLUNT AND PENETRATING ABDOMINAL INJURIES Combined Injury Notes
I m-
Fluid Replacement Therapy
Crystalloid Colloid - Blood' - Blood Products'
*Require irradiation prior to use Notes Combined Injury
Trauma Surgeon
Manage airway Control hemorrhage Resucitate from shock Diagnose injuries Establish surgical priorities Combined Injury Notes
I
TRIAGE
By Conventional Injuries - Trauma - Burns
9 By Radiation Injury - Prodromal symptoms - Hematologic picture Corn lined Injury
WHOLE BODY RADIATION TRAUMA
The Stresses: Shock Pain Necrotic Tissue @Infection: Dose and Vir ilence of Microorganisms Bacterial Toxins
WHOLE BODY RADIATION TRAUMA The Responses: Immunosuppression or Defect (overwhelming infection) Insufficient Organ Function (shock, respiratory failure) Energy Impaired (substrate availability/use low or absent Protein Synthesis Impaired (amino acid availability/use low) The Results: Multisystem Failure Death Combined Injury 1 Surgical Infection
I
Contaminated 111
I I I 0 10 20 30 40 50
C.S.T.U. of Maryland
d 90 Nosocomial Infection 135 patients 2 days 0 Nosocomial Infection 94 patients 2 days Antibiotic Therapy -Culprit Reverse Isolation Decrease # of Personnel
Hand Washing
A of Sury V179 Match 1974
I SERUM SUPPRESSIVE FACTORS
Prostaglandins/Leukotrienes Interferon Bacterial Endotoxins Cutaneous "Burn Toxins" Denatured Proteins Cot ticosterords Neutrophil Products Histamine Serum Proteins/Polypeptides: - lrnrnunoregulatory or Globulin - Immune Complexes. Autoantibodies Iatrogenic, Drugs, etc. I Low Level Radiation Effects I DEVELOPMENTAL EFFECTS
PREIMPLANTATION (week 1)
Extremely radiosensitive
No residual effect on survivors
X-IRRADIATION-INDUCED CONGENITAL ANOMALIES
MOUSE GESTATION DAYS 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ' Cieavage Death ' '
Fetal Death ...... I.. {..j..l..,
IEFFECTS ON HUMANS EXPOSED IN UTERO
Growth Retardation (crltlcal perlod 3-20 weeks) Microcephaly Mental Retardatlon Skeletal Abnormality Eye Anomalles (most critlcal perlod IS 6- I 1 weeks) Low Level Radiation Effects
HIROSHIMA AND NAGASAKI Mental Retardation I Cases Resulting from Radiation Exposure 1001
. --I Fetal Dose (Gy) I
AMERICAN COLLEGE OF OBSTETRICS AND GYNECOLOGISTS
Risk Estimate (1980):
1-5 x Congenital Anomalies/Person-REM
GENETIC EFFECTS
Gene Mutations - Single dominant - Sex-linked Recessive - Recessive Chromosome Aberrations - Nondisjunctions - Breakage Low Level Radiation Effects Notes rit GENETIC EFFECTS ,,v < c Gene mutations .c Single dominant F1 generation
- polydactyly . - muscular dystrophy - achondroplasrnia - Huntington's chorea - retinoblastoma - anemia - ;..?c.. L
GENETIC EFFECTS-
Recessive
Sex-linked recessive - hemophilia - color blindness
GENETIC EFFECTS
Chromosomal damage - nondisjunctions - breakage Low Level Radiation Effects
CHROMOSOMAL CHANGES
NORMAL IA 0 RING TERMINAL -D- t I C) DOT
INTERSTITIAL -1 DELETION TRANS- ,+ ,+ :b, LOCATION
1 d DICENTRIC
I I I 1 FACTORS WHICH AFFECT - I MUTAGENICITY Dose Rate or Fractionation I LET Oxygen Temperature Radioprotectants Sex and Age I
ESTIMATED ANNUAL GENETICALLY SIGNIFICANT DOSE
SOURCE DOSE (mrem/yr) Cosmic Radiation 28 Total from Natural Sources 82 Medical X rays 20 Commercial Nuclear Power-occupational 4 0.15 National Laboratories-occupational 4 0.2 Military Applications-occupational 4 0.04 Weapons-testing Fallout 4.5 Consumer Products 4.5 Air Travel 4 0.5 I I Low Level Radiation Effects r Genetic Effects of 1 rem of Radiation
Additional Cases per mil/rern/Generation Incidence Type of Disorder per Million 1st Generation Equilibrium Autosomal dominant - Severe 2,500 5-20 25 - Mild 7,500 1-15 75 X-linked 400 41 45 Recessive 2,500 41 slow increase Chromosomal - Translocations 600 45 little increase - Trisomies 3,800 41 41 Congenital - Abnormalities 20,000-30,000 10 10-100
SOMATIC EFFECTS
Aplastic Anemia
Cataracts
Aging
Cancer
I I CATARACTS
Lens fiber disorganization Threshold 2-5 Gy (single) or 10 Gy (fractionated)
11 Gy: 10 mo - 35 yr latency interval; 100°/~ cataract formation I Age and LET dependent Notes Low Level Radiation Effects
i
REDUCTION IN THE LIFE SPAN OF MICE WITH RADIATION OR RADIOMIMETIC AGENTS
Mean Survival Treatment Time (days)
Control 638 5-6Gy 396 Nitrogen Mustard 56 1 (3.7-4.5 mg/kg)
Triethylene Melamine 508
CARCINOGENESIS
Initiation - Radiation - Chemical Agents Promotion -Stem Cell Division - Non-carcinogenic - Vitamins Latency (critical mass)
RADIATION CARClNOGENESld Sources of Data: Hiroshima and Nagasaki Diagnostic Irradiation Occupationally Exposed Workers Local lrradia tion for Nonneopiastic Diseases
B Radiation and Chemotherapy Patients Low Level Radiation Effects Notes
CARCINOGENESIS Tissue and organ sensitivity Diagnostic exposures (10's rads) leukemia breast cancer thyroid cancer Therapeutic exposures ( 100's rads)
lung 0 skin 0 colon 0 brain 0 stomach cervixhterus 0 ovarian
DOSE RESPONSE RELATIONSHIP LINEAR, NON THRESHOLD
RESPONSE
DOSE RESPONSE RELATIONSHIP NON-LINEAR, NON-THRESHOLD
RESPONSE
DOSE ---.. I*I-
Notes Low Level Radiation Effects
1 LEUKEMIA
I 0
0 Dose100 to marrow,200 rad 300
Radiation-Induced Cancer among Japanese A-Bomb Survivors through 1974 - Lifespan Studv
82,000 Survivors
19,646 Deaths
3,842 Cancer Deaths
185 Radiation-induced cancers from dose-response analysis
I
EFFECT OF LET AND DOSE RATE ON CANCER INDUCTION High LET High Dose Rate I f High LET LOW Dose Rate
Cancer Incidence
Radlatlon Dose Low Level Radiation Effects Notes
CARCINOGENESIS
Leukemia
Breast cancer
Thyroid cancer
All Forms of Leukemia Age < 15 ATB
Y .-v) [z
0 5 10 15 20 25 Time After Exposure (years)
CARCINOGENESIS
Breast cancer
- Almost exclusively in women
- Incidence and latency - No dose rate effect L -- ** - Notes Low Level Radiation Effects
CARCINOGENESIS
Thyroid cancer
- Increased incidence in women - Genetic predisposition - LET
RADIATION INDUCED BREAST CANCER 2oo~VlVOr¶Atomic Bomb1950-1974 Massachusetts
- T T IFluoroscopy 400 -
lncldence of Breast Cancer/ 100.000 WY
50
0- 0- 0- 0 200 400 600 Dose0 (rad) 200 400 600 Breast
I Low Level Radiation Effects Notes
RELATIVE RISKS AFTER A SINGLE DOSE OF RADIATION
Threshold Dose Relative Risk ( rad 1 (cases per 1OG/yr/rad)
Leukemia' 20 3.1
Breast 51 6.6-8.7
Thyroid 6-7 1.6 - 9.3
'no fetal threshold dose, linear induction
Cancer Mortality Risk Estimates (cancer deathdl OB) *
TYPE OF CANCER BElR (1972) ICRP UNSCEAR BElR (1980)
Leukemia 25 20 15.25 22 Lung 39 20 25 28 Breast (F + 2) 45 13 30 11 Bone 6 5 2-5 0.5 GI Tract 30 - 25 19 Thyroid - 5 5-15 7 Other 30 50 25 31
TOTAL 180 100 120 120
I Notes Low Level Radiation Effects
LOCATION OF NEVADA TEST SITE (NTS)
OREGON UTI* I 7
US CONUS NUCLEAR TESTS (NTPR 1945 - 1962)
ATMOSPHERIC 91 UNDERGROUND 5 SAFETY 32
TOTAL 128 Low Level Radiation Effects Notes
US PACIFIC NUCLEAR TESTS (NTPR 1945 - 1962)
ATMOSPH E R IC 111 SAFETY 1 I - TOTAL 112
Incidence of Leukemia Among a Random Sample of SMOKY Participants if-mJ& \q’< Expected Observed
I Leukemias 3 -4 8
1977 C.D.C. Report Notes Low Level Radiation Effects
Cause of Death Among SMOKY Participants 1957-1 979
Expected 0 bserved
All Causes 364.8 3 20 Leukemia 3.1 8 Neoplasms 64.3 64 Digestive 23.1 14 Circulatory 139 103 Respiratory 16.6 9 Accident 56.4 64 KIA 0.02 12 1983 C.D.C. Report
United States ‘Department of Defense DEFENSE NUCLEAR AGENCY
Write Test Histories Identify Participants Assign or Reconstruct Doses Survey Mortality and Morbidity Declassify Relevant Documents
Participants Participant Estimated Identified Dose Data Service Participants by Name % Retrieved % - Army 58,000 46,424 80 21,542 46
Navy 105,195 105,195 100 104,626 99
Air Force 25,000 23.693 95 20.954 aa
Marine Corps 1 1,500 1 1,468 99 10,186 89
Do0 Civilians 4,622 4,622 100 4,608 99 - TOTAL 204,317 191,402 94 161,916 85 Notes Nuclear Weapons Accidents__
I Other - 3% T
WEAPONS SAFETY CONCEPTS
c INHERENT DESIGN SAFETY
DESIGNED-IN SAFETY - Strong Links - Weak Links
PERSONNEL RELIABILITY - Screening - Two Man Rules
WEAPONS CARRIER SAFETY SYSTEMS
I R. i Nuclear Weapons Accidents Notes I
uclear Weapons Accidents and Response Procedures ..._ L.,._
PAST AND FUTURE NUCLEAR STOCKPILES
USA & USSR 25
20
:USA 'USSR
5 Catastrophe Expected
I Year 1 Radiological Defense Notes
Fallout is Manageable if you know what to do Notes Human Radiation Exposure
Major Radiation Accidents Worldwide Acute Radiation Deaths
4 1944 1968 Date Site Total- No. Injured 1945 Los Alamos 2 Elllrl- 1946 Los Alamos 8 Ill1 ' 111ll lllll~11111~ lllll* 11111 /Ill1 1954 Marshall Is. 290 a88 .. . .. ,8822 Japan. Fish'men 1958 Yugoslavia 6 a 1111 11111 11111 '$ Ill1 IIIII 1958 Los Alamos 3 lIlIZ lllll 1960 Russia 1 % 1961 Germany 3 1962 Mexico City 5 ...mil mn?F m? Ill?1111 1963 P.R. China 6 eettttic;!BMM? 1964 Germany 4 ...a 1964 Rhode Island 7 ~1111Ill1 Ill1 1968 Wisconsin 1 m? IlllTBl iiiiTTBI+Local OFatality .Internal STBI, Local & Internal F Fetus S = Surgery ?=Female 'Deceased, Natural Causes
Rhode Island 24 July 1964
1800 hours
Criticality Accident Mr. Peabody Human Radiation Exposure Notes
LOS ALAMOS, 1958, MR. KELLEY CLINICAL COURSE: 35 HOURS APPROX. STAGE TIME SYMPTOMS 1 0-0.5 hr Physical Collapse Mental Incapacitation 2 0.5-2 hr Cardiovascular Shock (BP 0) Abdominal Pain lncoherent Vomiting 3 2 - 30 hr Improvement B Stabilization 4 30-35 hr Irritability Uncooperativeness Mania Coma
Los Alamos, 1958, Mr. Kelley Peripheral Blood Leukocyte Changes IIIIJI
0 Granulocytes - Lymphocytes -
2 6 10 14 18 22 26 30 34 Time After Exposure (hours)
LOS ALAMOS, 1958, MR. KELLEY CLINICAL COURSE: 35 HOURS APPROX. STAGE TIME SYMPTOMS 1 0-0.5 hr Physical Collapse Mental Incapacitation 2 0.5-2 hr Cardiovascular Shock (BP = 0) Abdominal Pain Incoherent Vomiting 3 2-30 hr Improvement 8, Stabilization 4 30-35 hr Irritability Uncooperativeness Mania Coma L Human Radiation Exposure
LOS ALAMOS, 1958, MR. KELLEY CLINICAL COURSE: 35 HOURS APPROX. STAGE TIME SYMPTOMS I 1 0-0.5 hr Physical Collapse Mental Incapacitation I 2 0.5-2 hr Cardiovascular Shock (BP = 0) Abdominal Pain Incoherent Vomiting 3 2-30 hr Improvement 8 Stabilization 4 30-35 hr Irritability Uncooperativeness Mania Coma
Los Alamos, 1958, Mr. Kelley Changes in Blood Hemoglobin and Hematocrit
V5[-; V5[-; *.-.* ).- 80 60
Hemoglobin %m_m.emL 4o Hematocrit
(gm) Hematocrit (YO) 4 20
0 '0 8 16 24 32 Time (hours)
Los Alamos, 1958, Mr Kelley Changes in Rectal Temperature
102 OF 100
0 8 16 24 32
b Human Radiation Exposure Notes 1
Los Alamos 1958
Mr. Kelley
Los Alamos, 1958, Mr. Kelley
Rm 218 0 20 40 Scale (feet)
Los Alamos, 1958 Mr. Kelley Averaged Total Body Dose: 4,500 rads Upper Abdominal Dose: 12,000 rads Notes Human Radiation Exposure 1 Major Radiation Accidents Worldwide Acute Radiation Deaths 1 1972-March 1988 Date Site Total No. Injured 1972 Bulgaria lrn 1975 Brescia, Italy 1 1978 Algeria 7 9 lIll$?F1111 ?lllll... Ill1 9 MS .S 1981 Oklahoma 1 as' . 1982 Norway 1m 1983 Argentina 1H 1984 Morocco 26(?) mm?a?m?m?mma 1/11 ?lllll 1111 1985 Canada 1 MP 1986 GeorgiaITexas 3 MPmP. ? 1986 Chernobyl 24,200 aMR? R 28 11111 199(6S) 1987 Yakima, WA 2 1987 Goiania, Brazil 244 ..m$m?ma?l??l? 19 Hi IlllTBl !2TBI+Local .Local Only OFatality IInternal 88 TBI, Local 10Comb. Inj. S Surgery F = Fetus P Patient 81 Internal
~
Major Radiation Accidents Worldwide Acute Radiation Deaths 1944-1968
4 Date Site Total No. Injured 1945 Los Alamos 2 1/11 1946 Los Alamos 8 1111 * Ill18 1111111 11111* lllll* IIIII 11111 1954 Marshall Is. 290 MS. . ,8822 Japan. Fish'men 1958 Yugoslavia 6 I111 1011 lllll ? Ill1 IIIII 1958 Los Alamos 3 1111 ' 111l1 1960 Russia 1 la 1961 Germany 3 MB. 1962 Mexico City 5 ~~?F~&IIII 1963 P.R. China 6 w~!i@tttiStttftiP$ 1964 Germany 4 1964 Rhode Island 7 mllll.... Ill1 1111 1968 Wisconsin 1 .P IlllTBl ZlTBI+Local OFatality .Internal 88TBI, Local & Internal F = Fetus S = Surgery ?= Female 'Deceased, Natural Causes
Los Alamos 30 December 1958 1635 hours Criticality Accident Mr. Kelley Human Radiation Exposure Notes
Frequency Distribution of Major Radiation Accidents (by .device) Worldwide: 1940 -March 1988 I Ac%%s I 50 I Radiation Devices
Year I
Human Exposures Resulting In: 4
Acute Radiation Syndrome
Local Burns
Hematopoietic Syndrome
Major Radiation Accidents Worldwide Acute Radiation Deaths 1944 - 1968 Date Site Total No. Injured 1945 Los Alamos 2 IIll/ 1946 Los Alamos 8 0 I111 111l~ l1I1l1 lllIl* I111 lllll iI/l/ 1954 Marshall Is. 290 a8 8822 Japan. Fish'men 1958 Yugoslavia 6 /Ill lllll 111ll Ill/ lllll 1958 Los Alamos 3 liil Ill/ 1111 1960 Russia 1 1961 Germany 3 1962 Mexico City 1963 P.R. China 1964 Germany 1964 Rhode Island 1968 Wisconsin IITBI iiiiTBI+Local OFatality Internal F = Fetus S = Surgery ?= Causes I Human Radiation Exposure
Major Radiation Accidents: Worldwide Human Experience 1944 - March 1988" Number Persons Significant Fatalities Accidents involved Exposures (Acute Effects) 294 1371 633 37 (1) (135,000) (24,200) (28) (237)' 111 12441 POI 141
a Source: DOE-REAC/TS Radiation Accident Registries USDOE/NRC Accident Dose Criteria cb- 1 Gray (1 Chernobyl Data [I Goiania, Brazil Data
Major Radiation Accidents: Worldwide TvDes of lniuries 1944 - March 1988 a INDIVIDUALS INJURY 2DOSE CRITERIAa FATALITIES TBI 225 rems 173 20 (U.S. 2) TBI 225 rems Local 2600 rems 72 9 (US. 3) Local+ 2600 rems 198 4 (U.S. 39 Int. Dose LMPBB 77 3 (U.S. lb) Mixed (TBI+LOC+INT) Marshatlese 110 0 Japanese Fisherman 23 1 Goiania Brazil 20 4 Chernob yl 24,200 (237d, 22' + 6" 24,853 69 (US. 9') a DOEiNRC accident dose criteria LIOO rads Medical rnlsadventures ' Combined lnjurles SL-1 fatalltles not included .* Radiation Only
Major Radiation Accidents: Worldwide 1944 -March 1988 Classification of Radiation Accidents by "Device" "Criticalities" Critical Assemblies 5 Reactors a Chemical Operations 5 Radiation Devices Sealed Sources 131 X-Ray Devices 63 Accelerators 14 Total Radar Generators 1 Radioisotopes 296 Transuranics 27 Tritium 3 * Only two since Fission Products 1965 Radium Spills 2 Diagnosis and Therapy 23 Other 4 Human Radiation Exposure
Services Provided by REAWTS Medical Care and Consultation Health Physics Support Whole-body Counting Internal Dosimetry Dosimetry Cytogenetic Dosimetry Chelation Therapy Teaching and Training Human Accident Registries
Radiation Accident Dose Criteria* Condition Criteria - 1. Dose to whole-body, bone 25 rem marrow or gonads
2. Dose to skin of whole-body 600 rem or extremities
3 Dose to other tissues or 75 rem organs from external source 4. Internal bur dens 112 NCRP maximum organ burden 5 Medical rnisadminrstration All mrsadministr a tion resulting in doses b/= doses listed under 1. 2, 3, or 4 above
I Major Radiation Accidents: Worldwide Human Experience 1944 - March 1988' Number Significant ** Accidents Exposures 296 24,853 Persons Fa talities Involved (acute effects) 136,615 69
Source: DOE-REAC/TS Radiation Accident Registries ** USDOE/NRC Accident Dose Criteria Human Radiation Exposure Human Radiation Exposure Notes I
I
- Human Exposures: Experimental Environmental Clinical War Accidental
Radiation Accidents Notes cNuclear Weapons Accidents Local I Governments
MEDICAL SUPPORT FUNCTION 4
1. Treatment of Injuries
2 Collection 8 Processing of Bioassay Samples 3. Liaison with Treatment Facilities & Laboratories 4 Base Camp Sanitation B Medical
~ Support
RADIOLOGICAL SAFETY OFFICER
1 Advise On- scene Commander 2 Contamination Control Procedures 3. Exposure LimitsISafe Stay Times 4 Radiological Safety Guidance 5 Decontamination Procedures 6 Guidance for Handling Radioactive Materials I 7 Site Restoration 8 Cleanup Notes Nuclear Weapons Accidents
PLUTONIUM HAZARDS
INHALATION WOUND CONTAMINATION INGESTION SKIN CONTAMINATION EXTERNAL RADIATION
RADIAC
RADIOACTIVITY I DETECTION INDICATION AND COMPUTATION Nuclear Weapons Accidents Notes I
r: . *
Aerinl Hadiologtcal Survey 4.3 Aerial Photography
Y
Atmospheric Release Advisory Capability (ARAC)
ARAC NETWORK
Department Depar tmenl of Energy of Defense Sites Sites
DOE Emergency Response
Federal Aviation States Administration Notes Nuclear Weapons Accidents
..
I
a, STATE GOVERNMENTS >- '. 4 <- 2' 1% -. . \>/-' Notes Nuclear Weapons Accidents ATRAP Ai3 TRAMPORTABLE RAEIAC PACKAGE
KELLY NU, TX
AFRAT
AIR FORCE RADIATION ASSESSMENT TEAM BROOKS AFB, TX
RAMT
RADiOLOGlCAL ADVISORY YEDKAL TEAM WALTER REED ARMY HEMAL CENTER, MD
ADVICE AN0 GUIDANCE
VERGENCY MEDICAL CARE Nuclear Weapons Accidents Notes I JNACC MISSION
CENTRALIZED AGENCY FOR INFORMATION ON RADIOLOGICAL ASSISTANCE
Capabilities Listing (NARCL)-
DNA ADVISORY TEAM
SITE MANAGEWW HEALTH PHYSICS EO0 CONTAMINATION COUi‘ROt PUBLIC AFFAIRS LEGAL
SECURITY I CoMMUwJCAT- Notes Nuclear Weapons Accidents
Broken Arrow Initial Notification
\\
'* LI 00s P $t ClNClDO WHSR JNACC J Notes r INITIAL RESPONSE FORCE
I I 1 Disaster Security Medical Fire Preparedness Radiological Control
Weapons Communications Public Operations Affairs
INITIAL RESPONSE FORCE
1 Rescue Operations 2 Accident Site Security 3 Firefighting 4 Emergency Safing of Weapons 5. Radiation Monitoring 6 Command, Control 8 Communications 7 Public Affairs Activities
SERVICE RESPONSE FORCE
-.- Notes Nuclear Weapons Accidents RESPONSE ORGANIZATIONS Environmental Department Department WHSA Protection of State of Labor NMCC / H~HS
UOV I \ State Officials I Force NEST Harvest Eagle
I I
Weapons Recovery Sit e Rest ora tion . Nuclear Weapons Accidents Notes
I \ NUCLEAR ACCIDENT 1 RESPONSE \ I
! ! 1 ! I /------/-- Notes
WEAPONS RADIOACTIVE MATERIALS d
PLUTONIUM (Pu) URANIUM (U) TRITIUM (H3)
WEAPONS NON RADIOACTIVE HAZARDS
BERYLLIUM (Be) LITHIUM (LO LEAD (Pb) PLASTICS Nuclear Weapons Accidents
Weapons Accidents
TO DETONATOR - EXPLOSIVE DETONATOR I FOR IMPLOSION WEAPON
POSSIBLE RESULTS OF WEAPON ACCIDENTS
No detonation regardless of: Dropping Mashing Breaking Burning High explosive detonation
I Nuclear Weapons Accidents Notes
I 'I Notes Nuclear Weapons Accidents
9 FEB 66 CHARGES NEAR CATASTROPHE FROM U.S. BOMB
SOVIETS SAY "NUCLEAR VOLCANO" IN SEA OFF SPAIN
PERSONNEL AT CAMP WILSON AND SAN JAVIEA 17 JANUARY - 11 APRIL 1966 (AS OF MONDAY; WEEKLY) CAMP WILSON SPANISH (LESS SAN JAVIER AMERICANS GUARDIA CIVIL) AMERICANS TOTAL
JAN 17 49 0 1 50 24 583 0 50 633 31 665 37 73 775 FEB 7 666 25 53 744 14 632 36 51 719 21 66 1 36 47 744 28 618 33 50 701 MAR 7 522 33 42 597 14 47 1 32 31 535 21 330 - 31 36 1 28 144 - 28 172 APR 4 34 - 12 56
VEHICLES AT CAMP WILSON, 15 FEBRUARY
TYPE DESCRIPTION QUANTITY BUS ...... 29 PASSENGER ...... 10 CARRIER ...... 3/4-TON. 4x4, M-37 ...... 2 CATERPILLAR ...... D-6 ...... 1 COMPRESSOR ...... AIR ...... 3 FORKLIFT...... 6,000 POUND ...... 1 GRADER ...... ROAD ...... 3 JEEP ...... 1/4-TON, 4~ MIXER ...... CONCRETE ...... 2 ...... 530 8 ...... 3 SHREDDER ...... TREE ...... 2 TRUCK 8. TRAILERS ...... VARIOUS ...... WAGON ...... STATION ...... 5 WRECKER --- ...... -3 TOTAL 121 Nuclear Weapons Accidents Notes Notes Nuclear Weapons Accidents 9
--
I Nuclear Weapons Accidents Notes
-- c IS-s. Notes Nuclear Weapons Accidents Human Radiation Exposure Notes I Rhode Island 7964 Mr. Peabody
I
Rhode Island, 1964 Mr. Peabody a Averaged Total Body Dose: 12,000 rads Neutron/Gamma Ratio: 0.4 Pelvic Dose: 46,000 rads Head Dose: 14,000 rads
Rhode Island, 1964, Mr. Peabody Clinical Course: 49 hours Approximate Time Symptoms 0-1 75 hours Dazed and incapacitated followed by behavioral recovery, abdominal cramps, diarrhea and vomiting
Hospital Abdominal cramps, headache, thirst, chllls, Arrival' perspiring profusely, diahhrea BP = 160/80 Pulse 100 and regular Temperature = 1004 OF Normal pupillary response Difficulty in enunciatirlg words Lungs clear
175-4 hours BP = 85/40 Pulse 110 Pressor
drugs administered + Patient not observed durlng travel to hospital Notes Human Radiation Exposure
Rhode Island, 1964, Mr. Peabody Clinical Course: 49 hours
Approximate Time Symptoms 8-10 hours Euphoria, Temperature = 102'F Edema in arms
24-48 hours Urine flow decreased Edema in hands and arms worsened BP maintained through norepinephrine therapy 48-49 hours Deterioration Restlessness, fatigue, (death) apprehensiveness, labored breathing Diminished visual acuity BP could not be maintained
Rhode Island, 1964, Mr. Peabody
d Pathology Heart Acute Pericarditus Lungs Edema Brain Rare Focal Lesions, Vascular Damage
Major Radiation Accidents Serious Local Radiation Burns (Selected)
Total Significant Date Site Source Site of Injury Exposures 1948 Enewetok P Hands 4 .s.s.s. 1955 Australia 137cs Thigh 1 MS Kentucky X-Ray Hand 1 .s 1960 Sandia Electrons Face, Hand 1 .S 1968 W. Germany lg2Ir Thigh 6 8#lS Argentina 137Cs Both Legs 1 tWiS
1969 Glasgow 92 ~r Chest 1'lIiis 1971 New Haven X-Ray Hands 2 .s.s 1 Local Only Local + TBI S = Surgery 'Deceased, Natural Causes I Notes t Major Radiation Accidents
1. Stored Position
Cable Guide Tubes 2. Source in Transit
3. Source at Radiographic Site Notes Human Radiation Exposure r 1
Iridium-192 Accident Clinical and Exposure Data Calculated Radiation 4 Dose Total Duration of Signs and Skin Body Case Exposure Symptoms (rem) (rad) 50 M Source in Nausea: 80-400K 75- 100 right hip 60-90 mins pocket for after exposure, 45 minutes burning pain, erythema progressing to severe burn, starting at 6 hours
Iridium-192 Accident Dosimetry Data
0 Source:
lg21r, 28 + 2 Ci on June 5, 1979 Exposure Rate: 2250 R/rnin at 1 cm (June 5, 1979) Depth Dose in Tissue (Rad/45 min) Source Distance from Skin (cm) Depth (cm) 0 cm 1 cm
52,000 16,000 19,000 9,000 5,200 3,400 1,800 1,300 Human Radiation Exposure Notes
rads Acute Local Irradiation b 300 Epilation begin around day 17. -600 Erythema, distinguish from thermal burn, minutes- weeks post-exposure depending upon dose
b 600 Edema 1000-2000 Blistering, 2-3 weeks post-exposure depending upon dose. "~3000 Ulceration, 1-2 months post- exposure depending upon dose. 5000- 6000 Gangrene, necrosis, deep ulceration.
t J
L Notes Human Radiation Exposure
Major Radiation Accidents Radiation Devices (Selected) 1978-March 1988 c Significant Date Site Source Exposures 1978 Algeria 192 1r 7 amllllF 1111 1/11 1111 LIS INS 1979 California 1921~ io m BMI 1980 P.R. China 60 co 1 11111 1981 Oklahoma 192 ~r 1 ms 1982 Norway 6OCO lam 1983 Juarez, Mexico 6oCo 193(?) rt$! h8 1111 1111 11111 11111 11111 11111 1984 Morocco 192 Ir 26(?) rm~~~rm~~llllllllllllllll~l~l 1985 Canada Accel 1 mP 1986 Georgia/Texas Accel 3 lslPllIDPMlP 1987 Yakima, WA Accel 2 WP MIP 1987.~. Gioania. Brazil 137Cs 244 88 88 .. 19 .. Ill1 TBI Only Local Only ii2 TBI + Local 0 Fatality &TBI, Local S = Surgery, F Fetus, P = Patient & Internal
Sealed Source Accidents Worldwide: 1955 - March 1988 Human Radiation Exposure Notes
Mexican Cobalt-60 incident (1983). Source Description
0 Cobalt-60 teletherapy unit built by Picker.
0 2855 curies in September 1969 when built.
0 Contained approximately 6,000 pellets; each pellet measured one millimeter. Decayed to 400 curies in December 1983.
0 Each pellet contained 50 to 70 millicuries. One pellet measured 22 R/hr at 5 centimeters Human Radiation Exposure
Mexican Cobalt-60 Incident (1983) Source History
1969 Picker Cobalt-60 teletherapy unit owned by Methodist Hospital, Lubbock, Texas 1 1 / 12/77 Recharged with 2885 Curies. Methodist Hospital sold to X-Ray Equipment Company, Fort Worth, Texas 11/14/77 X-Ray Equipment Company sold to Centro Medico, Juarez Unit stored in warehouse. 1 1/83 Unit dismantled and hospital electrician allowed to sell for scrap.
Mexican Cobalt-60 Incident (1983) Source History (continued) d 12/06/83 Unit sold to Jonke Fenix Salvage, Juarez. Container holding sources breached. 12/83 Metal and pellets converted to steel products at Falcon de Juarez Foundry in Juarez and Aceros de Chihuahua in Chihuahua. 01/17/84 Truck loaded with rebar detected at Los Alamos National Laboratory. 0 1 /20/84 Jonke Fenix secured. 0 1/26/84 Pickup truck secured. Human Radiation Exposure Notes
Schematic of the Mexican Junk yard Before Cleanup 0.3
01.2 5
4.0 1.0 0.4
I
Schematic of the Mexican Junkyard After Cleanup
0.02
__
I J Notes Human Radiation Exposure
-~~
Location of Contaminated Truck in Residential Area I
-. Typical Response of Blood Borne Factors After and Acute Dose of Radiation
Lymphocytes a Neutrophils x 1000 I1 I I I I 12 - --Thrombocytes
Hemoglobin 12 Thrombocytes (W) 8 (x 1000) 4
0 10 20 30 40 50 60 T Time (days)
Mexican Cobalt-60 Accident Victim's Whlte Blood Cell Count Data
20 25 31 5 10 15 202529 5 10 1520 January February March Human Radiation Exposure Notes r
Cytogenetic Studies in Biological Dosimetry
0 Ionizing radiation induces specific types of chromosomal aberrations in mammalian cells and these lesions can be easily identified microscopically.
0 The number of lesions induced in a population of exposed cells can be directly correlated with dose of radiation absorbed by the tissue.
Structural Chromosome Aberrations Intra-Chromosomal
Inter-Chromosomal Symmetric Normal Translocation Dicentric Chromosomes and Fragment '-x-;~~.:l+.- ..&u ..&u
Iv-.
-xi... -xi...
"K Notes Human Radiation Exposure
Dicentric Induction in Human Lymphocytes Exposed to Cobalt-60 Gamma Radiation acute, high dose rate
Dicentrics/Cell Theoretical yield following chronic, 7 low dose rate 0.4 exposure \/ 0.2 - .'\ -
"0 100 200 300 400 500 Dose (rad)
Preliminary Dose Estimates for 10 Persons Accidentally Exposed to Cobalt-60 Radiation "Equivalent Whole-Body"
4 Dose Estimates Continuous Number Number Dicentric/ Acute Protracted Patient Metaphases Dicentrics Cell Exposure ExDosure MEX 1 500 69 0.138 151 'L 880 MEX 2 500 119 0.283 203 1530 MEX 3 500 4 0.008 27 % 50 MEX 4 500 2 0.004 16 % 25 MEX 5 500 16 0.032 66 %+ 204 MEX 6 500 10 0.020 50 %+ 127 MEX 7 500 48 0.096 124 % 611 MEX 8 500 13 0.026 58 % 165 MEX 9 500 1 0 002 10 2. 13 MEX 10 500 59 0 118 139 % 752
Major Radiation Accidents Severe Internal Doses (Selected) 1969-March 1988 Significant Date Site Source Exposures 1969 Wisconsin 859 IMP 1970 Des Moines 32P IllIlP 1970 Erwin 235" Ill1 1973 U.K. 106Ru 11lIl 1976 Hanford 241Am IOII 1977 Denver 32P IIlllP 1980 Houston goy *~~~~~~plIllP' 1983 Texas 241Am /Ill 1987 Goiania,Brazil 137Cs mm 88 a ...I%.. 11111 mFatality, Patients with Preexisting Disease 11111lnternal Dose ' Deceased, Natural Causes UFatality P = Patient &TBI, Local and Internal
-- Human Radiation Exposure Notes I
Goiania, Brazil, September 1987
"Worst radiation accident in the West ern Hemisphere"
00 -
100 -
200 - Notes Human Radiation Exposure
Goiania accident sequence:
13 Sept Scavengers removed canister containing Cesium- 137 (1400 curies) from an abandoned cancer therapy clinic
18 Sept Canister sold to scrap dealer
21 Sept Junkyard workers pry open platinum capsule containing Cesium- 137
22-23 Sept Cesium-137 "cake" broken into pieces and distri- buted to family members and friends
28 Sept Radiation sickness first diagnosed
29 Sept Brazilian Nuclear Energy Commission dispatch team to Goiania
Goiania accident data: a 78,000+ people screened
244 people contaminated
4 people dead (as of Dec 87) 54 people hospitalized Contamination of a 2000-square meter area
One contaminated site emitting 1.2 Gy/hr
Goiania accident preliminary dose/therapy information:
0 20 most serious victims: 1 - 8 Gy
0 All 20 had internal contamination
0 Given Prussian Blue (binds to Cesium-137)
6 treated with granulocyte-macrophage colony-stimulating factor (GMCSF) - 4 of these died, 2 living Human Radiation Exposure
Sources of assistance in case of radiation accident:
0 AFRRI Medical Radiobiology Advisory Team (MRAT) Bethesda, MD (202) 295-3909 (24 hrs)
Radiation Emergency Assistance Center/ Training Site (REAC/TS) Oak Ridge, TN (615) 481-1000 (Mon-Fri, 0800- 1630; later use ext 1502 to call beeper #24 1)
c Notes Biomedical Lessons of Chernobyl
CHERNOBYL 26 April, 1986 0200
HEALTH SERVICES NOTIFICATION 15 MIN
29 VICTIMS EVALUATED 30-40 MIN
VICTIMS DECONTAMINATED THEMSELVES
NAUSEA 81 VOMITING PRIMARY ADMITTING CRITERIA 0600 HOURS - 108 HOSPITALIZATIONS Notes Biomedical Lessons of Chernobyl
Chernobyl 1986 Cause: 0 Poorly planned experiment of generator's kinetic energy. Results: 0 Heat output surged from 7% capacity to 50% in 10 seconds.
0 Ruptured pressure tubes passing through graphite moderator. Combustable gases (hydrogen) formed and produced explosion and graphite fire. Fire put out by dropping 220 tons of sand, metal, and boron from aircraft. Notes Biomedical Lessons of Chernobyl
EMERGENCY PUBLIC HEALTH RESPONSES
Remaining population (90,000) from 30-km zone evacuated in next few days because of continuing contamination due to changing plume direction
Consumption of milk containing 1 x Ci/L or more of 1-131 was banned
All children from 30-km zone were sent to summer sanitorium in the country
Chernobyl 26 April 1986
2000 - exposed & screened, thyroid scan, physical, signs & symptoms 500 - identified at risk totally evaluated 200 - to Kiev 300 - Moscow Hospital No. 6
Chernobyl Moscow Hospital No. 6
300 multiple injuries 0 Beta, Gamma radiation burns '1 Thermal burns (10-1 00%) COMBINED Inhalation burns INJURIES Radionuclide ingestion Radionuclide contamination Biomedical Lessons of Chernobyl Notes
MEDICAL TEAM
HEMATOLOGIST RADIOTHERAPIST PHYSICIST LABORATORY ASSISTANT
CHERNOBYL 1ST 24 H,OURS
132 HOSPITALIZED PATIENTS 1 DEATH
1 UNACCOUNTED WORKER
EMERGENCY PUBLIC HEALTH RESPONSES
Immediately after accident Pripyat population (45,000) advised to remain indoors and close windows On April 26 open-air acitivities banned at all kindergartens, and schools; Iodine prophylactic treatment given there Evacuation of Pripyat began at 2 PM on April 27 as dose rate worsened; completed by 5 PM the same day Notes Biomedical Lessons of Chernobvl
CI Y
1 WEDICTION OF THE SEVERITY OF HEMATOPOIETIC SYNDROME based on the results of cytogenetic examination - of lymphocyte culture stimulated by PHA
Predlctlon curve Patlenl D
1 Granulocy tes X 1E + 911 Is relatlvely unltorm 0.1 (the dlslrlbutlon 01 dlcenlrlcs In IS cells has a Polsson shape). 8”ISI a Dlcentrlc close Is 3.3 Gy. II SI IS 4 0.01 1% I 1 I 0 10 20 30 40 50 60 Days Followlng lrradlatlon
Chernobyl Moscow Hospital No. 6
300 pts 200 b 1 Gy
0 50 b 3 Gy 50 b 5 Gy - lymphocytes - 5-12.2 Gy (7.4) I - cytogenetics - 5-14.2 Gy (9.2) Notes Biomedical Lessons of Chernobyl
INDIVIDUAL DOSES - WORKERS
rn TOTAL OF 237 PERSONS HOSPITALIZED WITH ACUTE RADIATION SICKNESS - NO MEMBERS OF THE GENERAL PUBLIC WERE INCLUDED IN THIS GROUP
NO EVIDENCE OF NEUTRON EXPOSURE BASED ON ANALYSIS FOR Na-22
SUBSTANTIAL AMOUNTS OFCs AND Pu FOUND IN VICTIMS
DOSE DISTRIBUTION - ALL 237 HOSPITALIZED VICTIMS RECEIVED ,100 cGy; OF THAT GROUP, 42 PEOPLE EXCEEDED 400 cGy UP TO A MAX. OF 1200 - 1600 cGy
HEMATOLOGICAL SURVEY
CBC, platelets, ESR
Daily
45 - 60 days Confirm earlier estimates ARS
CYTOGENETIC STUDIES
Peripheral blood - bone marrow
Evaluation exposure ## dicentrics/lOO cells
Tri, quad, penta were counted I as 2, 3 & 4 Notes Biomedical Lessons of Chernobyl
Chernobyl Magnitude of Injury
~~ ~
Area of Skin Involved * Lymphocyte decline' Granulocyte decline Onset of symptoms' Cytogenetics * 'useful
Chernobyl Patient Classification
Slight 105 None 1-2 None I I Moderate 1 53 I 1 I I 2-4 I Almost None Severe 23 7 2-7 4-6 617 weeks Extremely 22 21 4-50 6-16 All, Severe days 4 0 - 90% BSA .
Dermal Pathology
WIDESPREAD CUTANEOUS LESION
0 LIMITED TO EXPOSED AREAS PBURNS b 1% BSA 48 HRS BURNS INCOMPATIBLE WITH SURVIVAL 14 PTS ERYTHEMA WAVES
0 RECOVERY 50 - 60 DAYS
0 FAILURE TO HEAL L SKIN GRAFT 30% BSA OR I 21 PTS I
I Biomedical Lessons of Chernobyl Notes
Dose Estimation and Diagnostic Criteria for Acute Radiation Effects
Early prodromal signs and symptoms Dynamic blood profile Cutaneous effects Cy togenetics
Diagnostic Categories for the Acute Radiation Syndrome
Dose (Gy) Severity of ARS Prognosis
~~ 1-2 I (Mild) Completely favorable 2-4 I1 (Moderate) Relatively favorable 4-6 111 (Critical) Doubtful
b6 IV (Extremely Unfavorable critical)
DISTRIBUTION OF INJURIES
Surface injuries on unprotected areas
Injuries contact areas (clothing, wet footwear)
Injuries to skin - Beta burns I (48 PTS) Notes Biomedical Lessons of Chernobyl I MANAGEMENT OF INTESTINAL SYNDROME
Fluid electrolyte therapy
Parenteral nutrition
BONE MARROW SYNDROME THERAPY
OARS 2nd, 3rd, 4th degree .Aseptic area of hospital Strict reverse isolation Raw vegetables/fruit eliminated Selective intestinal decontamination
BONE MARROW SYNDROME THERAPY
Agranulocytic fever - Aminoglycoside, Cephalosporin, synthetic penicillin -Gamma globulin 6 gm x 4 BID - Amphotericin B - Acyclovir (localhystemic) - Biomedical Lessons of Chernobyl Notes
MANAGEMENT ~
Further external decontaminations
SSKl - 0.25 BID
Burn therapy
Oropharyngeal management
MANAGEMENT OF DERMAL PATHOLOGY
Anticoagulants
0 Aerosol "Lioxanol"
0 Tannin solution "Baliz" Hydrocortisone bandages Wax with antibiotics Notes Biomedical Lessons of Chernobyl 1
~ ~ ~
Donors - parents/brothers/sisters 113 donors examined 13 transplants performed 0600 cGy)
Fourth + sixteenth day HLA identical 6 patients HAPLO identical 4 patients
BONE MARROW TRANSPLANTATION
HAPLO identical + 1 antigen 3 patients Human embryo liver transplant 6 cases 7 "good" candidates died, burns 6 partial acceptance, 2 deaths Host vs Graft - Graft vs Host
Chernobyl Results
13 Bone Marrow Transplants - 3 parents haplotype mismatch - 10 siblings 3 HLA mismatch - 3/6 mismatches T cell depletion - 6 survivors 6 Fetal Liver Transplants - 0 survivors Notes Biomedical Lessons of Chernobyl r
BLOOD & COMPONENT THERAPY
Blood & components irradiated 1500 cGy
Thrombocytopenia 1 20 K Blood & platelets from single donor Freeze drying autologous, allogeneic platelets
Red cell transfusions b expected White cells were not infused Notes Biomedical Lessons of Chernobyl
Short - Term Effects of the Accident
EVACUATED Pripyat 49,000 Chernobyl 12,000 ACUTE RADIATION SICKNESS 30-km radius 74,000 Screened 500 Total 135,000 Hospitalized 237 Disabled 7-24
DEATHS Explosion 1 Thermal burns 2 Acute radiation injury Burns 19 Graft vs. host disease 2 Acute radiation syndrome -7 Total 31
Chernobyl Lessons
#
BIOLOGICAL DOSIMETRY can and must be done.
MEDICAL TREATMENT can significantly reduce the number of radiation deaths.
BONE MARROW TRANSPLANTS are of very limited use in treating radiation injuries.
RADIATION BURNS may be as life-threatening as moderate doses of radiation.
PSYCHOLOGICAL RESPONSES to potential radiation exposure may produce as many cases of sickness as actual exposure.
Potential Biomedical Information from the Chernobyl Accident
Details of the acute radiation syndrome
Effects of in-- utero exposure
0 Psychological disorders
ingestion and inhalation exposures
0 Late stochastic effects Notes Biomedical Lessons of Chernobyl I Potential Biomedical Information I from the Chernobyl Accident
0 Details of the acute radiation syndrome - Symptomatology - Lethal dose - Effectiveness of current therapy - Treatment of radiation burns - Treatment of combined injuries in immunosuppressed patients - Role of dosimetry
Potential Biomedical Information
4 from the Chernobyl Accident
Effects of in-- utero exposure - Reduced head size - Mental retardation - Developmental disorders - Attention deficits - Conduct disorders I
Potential Biomedical Information from the Chernobyl Accident
Psychological disorders - Organic mental disorders - Anxiety disorders - Somatoform disorders - Dissociative disorders - Factitious disorders I Biomedical Lessons of Chernobyl I Chernobyl Major Conclusions
0 BMT may not be best therapy for mass casualty combined injury situation. - 50% died of associated injuries. - Heterogeneity of exposure (? surviving stem cells). - Difficulty in finding matched donors. - No. of lives saved may not balance with marrow induced deaths.
0 Sepsis is overwhelming cause of death.
Patient Classification
Number of patients a Distrib. Degree Dose No. of Survival of beta IIof ARS (Gy) Total Moscow Kiev deaths (days) burns IV 6.0-16 21 20 1’ 20’ 10-90 All 111 4.2-6.3 21 21 - 7 16-40 Most II 2.0-4.0 55 43 12 1 96 Few I 0.8-2.1 140 31 109 - - None
Total 237 115 122 28
‘One patient who died 4 days after the accident from “combined thermoradiation injury“ was not included in the final patient and fatality count.
~
Human Lethality (LDS0 ) from Nuclear Weapons Effects* Dose Nagasaki Concrete (Gy) Treatment Building Cohorts
0 Radiation (75 persons) 3.0 None 0 Radiation + Blast + Burns 2.6 None (97 persons)
Chernobyl NPS Victims
0 Radiation + Burns 6.0 Comprehensive (237 persons)
Radiation exposures ranged from 100-2000 rads Biomedical Lessons of Chernobyl
TREATMENTS FOR RADIATION SICKNESS
~ ~~ EFFECTIVE INEFFECTIVE Environmental Fetal-liver control transplants Broad-spectrum antibiotics Antifungal QUESTIONABLY EFFECTIVE Antiviral Fresh platelets Bone-marrow Total parenteral feeding transplant Electrolyte replacement
-
LESSONS LEARNED
c
Early Dx & proper disposition
Triage methodology corroborated Severe ARS (4th degree) can be 21 patients - 19 deaths Mild ARS (1st and 2nd ARS - no deaths) Recovery +/- 90 days
LESSONS LEARNED
~ ~~
42 patients uniform exposure b 400 cGy
50 patients additional had beta burns Thermal burns 40/90% contributed to mortality
Surgical management burns - 5 patients Internal contamination present in most patients Sepsis uniform cause of death Biomedical Lessons of Chernobyl Notes
Potential Biomedical Information from the Chernobyl Accident
0 Ingestion and inhalation exposures - Thyroid disorders - Effects of potassium iodide - Pulmonary and mucosal effects
Potential Biomedical Information from the Chernobyl Accident-
Late stochastic effects - Neoplastic - Genetic
Resource Commitment
1240 MD 920 RN 300 PA 720 MS I Intensive medical care provided I 24 hours per day 1 Chernobyl Resource Commitment I
Medical personnel: ______6,000
Physicians mobilized within 12 hrs: ______.3,000
Expenses: ______$3 Billion
Reactor Accidental Releases - Activity Released (Curies)
I Biomedical Lessons of Chernobyl
~
Accident Timetable - 13 Sept 87 Canister removed from abandoned clinic 18 Sept 87 Canister sold to junkyard dealer 21 Sept 87. Canister opened by junkyard worker 22,23 Sept 87 "Blue" powder (cesium) given to family/friends 28 Sept 87. Junkyard dealer goes to clinic - Nausea, vomiting - Flu-like symptoms 29 Sept 87 Others become sick, go to clinic, Nat'l. Comm. for Nuclear Energy (C.NEN) notified, team sent to Golania 1 Oct 87 IAEA contacted IAEA Team (USA, Argentina, Germany, Russia) Triage, hospitalization, treatment 13 Dec 87 Flu medical evaluation; site clean-up in progress Apr 88 Two patients remain hospitalized Sept 88 One patient remains hospitalized
Goiania Accident Data
124,000+ screened 244 contaminated 54 treated - 34 treated and released - 20 hospitalized 10 Naval Hospital Rio 10 Golania General Hospital - 4 deaths Area of contamination: approx. 800 acres (2000 x 2000 meters) Dose emitting from various sites, one site emitting 1.2 Gy/hr Aerial overflights used to identify hotspots b 200,000 mR/hr Air and water samples NOT contaminated I Biomedical Lessons of Chernobyl Notes
- Goianta, Brazil, September 1987
"Worst radiation accident in the Western Hemisphere"
Science, 1987
00 North Atlantlc
100 -
200-
I Notes Biomedical Lessons of Chernobyl
Management of Gastrointestinal Syndrome
~~~~
Fluid and electrolyte therapy Parenteral nutrition Routine diet Antiemetics 3
c
Dermal Pathology I CHERNOBYL Partial thickness Most likely Beta Early appearance Extensive Correlated with outcome GO1ANlA Deep partial thickness Most likely beta burns Late appearance Painful Limited size Not related to outcome Bone Marrow Syndrome
CHERNOBYL Lymphopenia Early Anemia Severe Bleeding bevere Thrombocytopenia -Severe GO1ANlA Lymphopenia Delayed Granulocytopenia -Delayed Anemia Rare Thrombocytopenia __Rare Coagulopathy Rare
Gastrointestinal Syndrome
c CHERNOBYL Early nausea & vomiting (triage symptom) Diarrhea Nutritional support required
GO1ANlA Nausea, vomiting, & diarrhea, not incapacitating Nutritional support required (one patient) Biomedical Lessons of Chernobyl Notes
Internal Contamination
Reduce absorption and internal deposition Increase elimination/excretion Decontamination - Chelation: Prussian Blue (Ionic exchange) - Enhanced perspiration: exercise bicycles - Forced fluids
Dose/Therapy Information
20 PATIENTS, DOSE EXPOSURE: 1-8 Gy INTERNAL CONTAMINATION + urine + stool + perspiration TREATMENT: Chelation therapy Infection/sepsis - Prussian Blue - Antibiotics Bone marrow stimulation - Antifungals - CSF - Antiviral Notes Biomedical Lessons of Chernobyl I Management of I Hematopoietic Syndrome
Platelet transfusion BM biopsies Colony Stimulating Factor (hGM-CSF)
GM - CSF Recipients Granulocyte Count Dose Exposure Wdl) Patient Sex (cGy) day: 1 5 10 GM-CSF 1' F 600 100 0- 6d 2. F 570 450 150 - 5d 3' M 530 450 150 21,000 750ug 10d I 4' M 450 300 190 - 5 M 440 470 900 - 800-200~g 6d 6 F 430 0 700 15,000 750-400ug 10d 7 M 300 500 6000 - 800-200ug 6d I 8 M 270 100 2400 - 750-250ug 15d 'Died 1I
Management of Infectious Complications
0 Prophylactic oral antibiotics Parenteral antibiotics Broad spec. Penicillin, Cephalosporin, Aminoglycoside
0 Colony Stimulating Factor GM-CSF Antifungal Amphotericin B Antiviral Acyclovir Gamma globulin Nuclear Winter Notes
TTAPS BASIS DUST b MARTIAN DUST STORMS b VOLCANIC ERUPTIONS - EL CHICHO'N - TAMBORA b METEORITE IMPACTS - MASS SPECIES EXTINCTION
SMOKE b P.J. CRUTZEN, J.W. BIRKS, AMBIO 11,- 114 (1982)
NUCLEAR EXCHANGE SCENARIOS
4 YIELD TOTAL 'IQ YIELD URBAN OR WARHEAD TOTAL YIELD SURFACE INDUSTRIAL YIELD NUMBER OF CASE (MT) BURSTS TARGETS RANGE (MT) EXPLOSIONS
~ ~~____ Bssellne 5,000 57 20 0.1 - 10 10.400 Exchange Low Yleld 5,000 10 33 0.1 - 1 22,500 .- I: Alrbursls 10,000 MT 10,000 63 15 0.1 - 10 16,160 Yaxlmum 3,000 MT 3,000 50 25 0.3 - 5 5.433 Exchange
3.000 MT 3,000 50 0 1 - 10 2.250 Counterforce
NUCLEAR EXCHANGE SCENARIOS (cont d)
% YIELD TOTAL % YIELD URBAN OR WARHEAD TOTAL YIELD SURFACE INDUSTRIAL YIELD NUMBER OF CASE (MT) BURSTS TARGETS RANGE (MT) EXPLOSIONS
~ ~~ 1,000 MT 1,000 50 25 0.2 - 1 2,250 Exchange 300 MT Southern 300 0 50 1.o 300 Hemlsphere 100 MT 100 0 100 0.1 1.000 Clly Attack SILOS "Severe" 5.000 100 0 5 - 10 700 Case 25,000 MT 25,000 72 10 0.1 - 10 28.300 I "Future War" Notes Nuclear Winter Nuclear Winter
NUCLEAR WINTER
EFFECTS OF LARGE SCALE NUCLEAR WAR d
750 MILLION DEATHS - BLAST 1.1 BILLION DEATHS - BLAST, THERMAL, RADIATION
1.1 BILLION INJURIES
30 - 50% OF TOTAL HUMAN POPULATION KILLED OR SERIOUSLY INJURED
CONCENTRATED IN NORTHERN HEMISPHERE
NUCLEAR WINTER
DARKNESS AND WIDESPREAD, DRASTIC, LONG-TERM SURFACE COOLING CAUSED BY ABSORPTION AND SCATTERING OF SUNLIGHT IN UPPER ATMOSPHERE BY SMOKE, DUST, AND CHEMICAL PRODUCTS GENERATED BY A NUCLEAR EXCHANGE
0 EXTREMELY DIRE EFFECTS ON THE BIOSPHERE POSSIBLE Notes Nuclear Winter
M S
.. . .. , ., . .
- TURCO,R. P.
TOON, 0. B.
ACKERYAN,T. P. POLLACK,J. B. SAGAN,CARL
LONG-TERM BIOLOGICAL CONSEQUENCES OF NUCLEAR WAR
PAUL R. EHRLICH, et 81.
SCIENCE, -222: 4630,1293,23 DEC, 1983 Nuclear Winter Notes
PROPERTIES & AMOUNTS OF SMOKE
DARK PARTICLES OF ORGANIC MATERIAL
STRONGLY ABSORBS VISIBLE LIGHT
0 TOTAL EMISSION (BASELINE CASE) = 2.25 x lo8 TONS
STRATOSPHERIC INJECTION = 12 x lo6 TONS
4
AFTER
TEMPERATURE PROFILE
-W -00 -40 -?O 0 ZO I
20 MILES ~
15 ~~~
10 -- Notes N u clear Winter
LIGHT & TEMPERATURE
VISIBLE LIGHT: 1% OF AMBIENT
SURFACE TEMPERATURES IN CONTINENTAL INTERIORS: -20 OC TO -40 C WITHIN 2 WEEKS
RECOVERY: 4 MONTHS TO A YEAR, OR MORE
- SECONDARY EFFECTS METEOROLOGIC ALTERATIONS INTERHEMISPHERIC TRANSPORT
METEOROLOGIC PERTURBATIONS
0 VIOLENT COASTAL STORMS b HEAVY SNOWFALLS POSSIBLE
HEAVY, SEMI-PERMANENT BLANKET OF FOG OVER LARGE BODIES OF WATER
AVERAGE DECLINE IN PRECIPITATION RATES IN CONTINENTAL INTERIORS b MASSIVE THERMAL INVERSION
i Notes -Pe rf o r ma nc e Dec remen t
113121 Tired, with moderate weakness; mild fever and headache; like starting to come down with flu 514111 Vomited several times including dry heaves; severely nauseated and will soon vomit again; very tired and weak
I
TOW Missile M60A3 Tank
155 mm Howitzer .. Chinook Helicopter
I
Individual Crew I I Unit Performance Decrement
I I I I I I Squad Leader Loader 7 60 t ...... Driver
0 5 10 15 20 25 30 Symptom Complex
Coast Guard (motion sickness) * Helicopter Crew (in progress)
* Good agreement with predicted effect
._-__. I Physically Demanding Tasks =Physically Undemanding Tasks Performance Decrement 1. Human Response Program Intermediate Dose Analysis I
No reasonable data base exists for radiation effects.
Estimate ineffectiveness with theoretical statistical models Surveyed available information Created symptom complexes Personnel estimates of ineffectiveness Notes Performance Decrement ‘I
NEGLIGIBLE INCAPACITATING RISK (0.5 GY)
I MIDLETHAL (4.5 Gy)
PERFORMANCE A SICKNESS
*-,---,
Exposure dose (Gy) which produces Eff ecl 50% incidence Loss of appetite 1.7 Nausea 2.5 Fatigue 2.6 Blood pressure drop 3.0 Vomiting 3.2 Diarrhea 3.5 DEATH 4.5
Incapacitation 30.0 (<9.0?) ------Performance Decrement I I - I I
Assess the operational and medical effects of nuclear weapons environments on combat personnel %
Casualty Criteria
~ -- 180 Immediate Permanent Incapacitation
80 Immediate Permanent Incapacitation (physically demanding task) 30 (<9?) Immediate Transient Incapacitation
4.5 Latent Lethality
TROOP < INTERMEDIATE CASUALTY SAFETY DOSE < CRITERIA (1.5 GY) (30 GY)
I Notes Performance Decrement I I I
I I I 1 I 0 5 10 15 20 25I 30I 35 A Sessions IRRADIATED I I
Time Postirradiation Performance Decrement 1
0 Seizure Coma Histamine Release Hypotension 0 Endorphin Release 0 Interference with Cellular Metabolism 0 Free Radical-superoxide Toxicity 0 Anoxia
0 Intracranial Pressure
I J
/'
Condition P 10 - Demanding ... Mmimum/Demanding --- No performance
I I 1 1 I 1 7 8 9 10 11 12 Radiation Dose (Gy) Notes Performance Decrement I
Zacopride G ranisetron Ondansetron
Incidental Attenuation WR-1607 WR-2721 Combinations
I Radioprotectant for Behavior
I 0 Performance Decrement
100 - - Baseline %.e-. \ - CI 80- u 0 - - L \--go\ \.-- ---eg--. - WR-2721 6 60- .I... 0 - CI -.....*-.. - f 40- - 2 - - p" 20 - *... .*.. - WR-27211 - N = 6Igroup *.-...... * - Radiation*
= significant, ~~0.05 %
Metoclopramide disrupts motor performance Dazopride causes drowsiness Zacopride has no behavioral toxicity!
Placebo (oral; 0.2 ml/kg)
P
>" 20 Zacopride (oral, 0.3 mg/kg) 70 Episodes -1 Episode In 516 Monkeys In 116 Monkeys *.Performance Decrement Notes
Stabilize blood flow, blood pressure, and histamine
0 Norepinepherine Ch lo rp heniram ine
-
0 2 4 6 a10 12 14 16 18 20 22 24 Irradiated Test Period (50 trials, 8 min)
Incidental Attenuation WR-1607 WR-2721 Combinations Performance Decrement r
Attenuate ET1 with drugs: Direct Incidental Anti-emetics
OJ I I I , J A 20 40 60 Irradiation Time Postirradiation (min) Notes Performance Decrement I 100 t 1
EARLY TRANSIENT INCAPACITATION death
0 Cn. - 5 g 100 L f" P EARLY PERFORMANCE DECREMENT
0 1 hour hours-days PULSE
c 99.9 I I I [Illll I
99 ,e 90 - - - - 70 - - 50 - -- - - 30 - - 10 - EbOGY) - Early Transient lncapaciratlon 9 o 1 Early Pertormance Decrement 7 2 3- - I I Ill,. 0.1 I I I I llll I 1 5 10 50 100 Dose (Gy)
-Task Endpoint ED50 (Gy) VDT ET1 18 SSVDT ET1 9 SSVDT EPD 7 DMTS EPD 3-5
VDT = visual discrimination task, 5 sec response time SSVDT = speed stress visual discrrminatlon task, 0 7 sec or less response time DMTS = delayed match to sample task, 5 or 10 sec delay ET1 = early transient incapacitation EPD = early performance decrement Performance Decrement
I 1
I I I I 4 20 40 60 80 looI 1201 PULSE Minutes Postirradiation 1 I
Unstressed Speed stressed
99.9 I , , 1111 I -v) 99
I 0.1 F I ,,, 1 2 5 Dose10 (Gv) 50 100 Notes Performance Decrement I 1
I 1
99 I I I I I
95 - 0, 90- El:0 0 m- .Z E 70 - 50- cn5e --- Electron bPg 30- - Proton $gn - Bremsstrahlung '5 10- , -.- Gamma 5- ' Neutron - 3- - 1 I I I I
Dose Portion of body irradiated Dose rate or fractionation of dose Type of radiation Task requirements notes Performance Decrement I
L I
%I- I
I I Performance Decrement Notes
Group 1 5000 Group 2 2500 2500 Group 3 2500 2500 Group 4 2500 2500 Group 5 2500 2500 Group 6 2500 2500 Group 7 2500 2500 Group 8 2500 2500
1 2 3 44 E5 Q 6 7 8 I I 1 1 1 0 25 50 75 100 Mean Percent Correct
Dose Portion of body irradiated Dose rate or fractionation of dose Type of radiation Task requirements Notes Performance Decrement
Dose Portion of body irradiated Dose rate or fractionation of dose Type of radiation Task requirements
v- 0 50 100 150 200 Dose Rate (cGyimin) Notes Performance Decrement
90 Ill,
80 - 70 - - - -
5000 500 1000 2000 3000 Dose (cGy)
Dose Portion of body irradiated Dose rate or fractionation of dose Type of radiation Task requirements Performance Decrement
m SE- cm- - - gg Y - - el- 0 c 1 I I I IIIII k , , I ,u 0.01 0.1 1 .o 10 100 1000 Time Postirradiation (hours)
a Dose Portion of body irradiated Dose rate or fractionation of dose Type of radiation Task requirements
Dose Portion of body irradiated Dose rate or fractionation of dose Type of radiation Task requirements Notes Performance Decrement
I , I
I
\
I I
Physica Activity
I I
I , Performance Decrement 1
I
)stlrradlation (minutes)
Death
0 hours to days PULSE hour Performance Decrement Notes I
Importance and sources of behavioral data Characteristics of and factors influencing ET1
1 0 Attenuate ET1 (Behavioral radioprotection)
0 Radiation, performance and lethality
0 PD and sublethal radiation
0 Human response program
0 Hiroshima/Nagasaki
0 Clinical Irradiations
0 Radiation Accidents
0 Animal Experiments
0 Lovelace Foundation Brooks AFB
0 AFRRI Notes Performance Decrement
I i
I 1 Notes
I 1 Revision- 8/91 - Internal Contamination
Significant Radionuclide Information
Radionuclide Radiation via' Americium Bone I/W DTPA Californium Bone IMI DTPA Cerium GI, Lung IIGI DTPA Cesium Total Body I/S/Gi Prus. Blue Curium Bone IIGI Iodine Thyroid I/GI/S sat KI Plutonium Bone IMI Polonium Lung I Dimercaprol Strontium Bone IIGI Tritium Total Body IISIGI Force H,O Uranium Bone IISMI NaHC03
*I = inhalation. GI = gastrointestinal absorptlon. S = skin absorption. W = wound absotptior
r Notes * Internal Contamination
Reduce GI Absorption
Emetics Purgatives Stomach lavage Prussian blue Aluminum containing antacids
Blocking and Diluting Agents
Iodides Forced fluids Calcium Phosphate Potassium
Mobilizing Agents
Antithyroid Diuretics Expectorants/lnhalants Parathyroid extract Corticosteroids Internal Contamination
- ~ __ ~ Chelating Agents
DTPA (Pu, Cf, Am) EDTA (Pb, Zn, Cu, Cd, Cr, Mn, Ni) Deferoxamine (Fe) Penicillamine (Cu, Fe, Hg, Pb, Au) Dimercaprol (Ar, Au)
Lung Lavage -
Weigh benefit against risk
Greatest risk due to general anesthesia
Medically Important Radionuclides
Americium Plutonium Californium Polonium Cerium Strontium Cesium Tritium Curium Uranium Iodine I Notes . Internal Contamination
Wounds
c
Wound Contamination
J Absorb and translocate to general circulation or to regional lymph node Solubility can change after interaction with body fluid Treat similar to dirt-laden wound Irrigation and routine debridement (decontaminate, but do not mutilate)
Elimination
Urine Feces Sweat inrernai Lontamination
Bioassay Sampling
Time of particular exposure Excretion rate of individual Solubility and retention characteristics
1.vivo Measurements
Whole body counters Chest counters Scintillation probe for wounds Thyroid counter
Treatment
Reduce GI absorption Blocking and diluting agents Mobilizing agents Chelating agents Lung lavage Notes Internal Contamination I
Soluble Materials
Move rapidly by blood eSusceptable to chelating agents Insoluble Materials
4
Retained in: - Reticuloendothelial system - Lymphatic system - Exposure site
Susceptable to physical measures
Inhalation inrernai Irunrarninarron
Respiratory Tract Clearance
Clearance Cumulative
Trachea Bronchi 1.0 I 1.1 Bronchioles 4.0 5.1 Terminal Bronchioles 10.0 15.1 and Alveolar Ducts
Alveoli 3 Months 3 Months to 5 Years to 5 Years
Ingestion
GI Tract Clearance
Mean Average Emptying Occupancy Time (hrs) I Time (hrs) Stomach 1 6 Small intestines 4 14 Upper large intestines 13-20 18 Lower large intestines 24 22
Total clearance time 42 hrs Radiation Accident Management
Emergency medical treatment Remove patient from accident scene Initial contamination control Radiological evaluation Interim care
Types of Interim Care
Decontamination of skin and hair Internal decontamination Decontamination of eyes and ears Wound decontamination Treatment for external exposure
Objectives
Provide emergency care Prevent spread of contamination (to patient and staff)
0 Decontaminate patient Internal Contamination I
NCRP Report No. 65
Management of Persons Accidentally Contaminated with Radionuclides
Sources of Internal Contamination
0 Industrial accidents Medical misadministrations Nuclear weapons accident (dispersal vs detonation) Fallout
Revised 8/91 %
C 0 MPA R IS 0 N Electromagnetic Pulse Notes
L
SCENARIO Performance Decrement Notes r*
Importance and sources of behavioral data Characteristics and factors influencing ET1 Behavioral radioprotection Radiation, performance and lethality PD and sublethal radiation Human response program 1 Notes
I ZOYLES- A
15 -
10 -
c
HEIGHT OF SMOKE DEPOSITION
TYPE OF FIRE HEIGHT
LONG-TERM 1 - 2 MILES
WILDFIRES 3 MILES
URBAN FIRES 5 1/2 MILES
FIRESTORMS STRATOSPHERE
PROPERTIES & AMOUNTS OF DUST
BRIGHT PARTICLES OF MINERALS & GLASSES
0 REFLECT & SCATTER SUNLIGHT
0 TOTAL EMISSION (BASELINE CASE) = 9.6 X 108 TONS
STRATOSPHERIC INJECTION = 768 X 106 TONS Nuclear Winter Notes
......
FACTORS
DUST b NUCLEAR BURSTS SMOKE b WILDFIRES b URBAN b FIRESTORMS b LONG TERM Notes Nuclear Winter
IMPACT
0 1000 rad: LETHAL TO MANY PLANT SPECIES
500 rad: WIDESPREAD MORTALITY AMONG MAMMALS
0 100 rad: SERIOUS ACUTE EFFECTS
10-100 rad: LONG-TERM CHRONIC CONSEQUENCES
CHEMICAL POLLUTANTS
PYROTOXINS
b co b DIOXINS
b NOx b FURANS
b CYANIDES b SURFACE 03 b VINYL CHLORIDES
SMOG AND ACID PRECIPITATION WIDESPREAD I
NITROUS OXIDES
FIREBALL GENERATED-STRATOSPHERE
OXIDES DESTROY OZONE
CATALYZE OZONE BREAKDOWN
INCREASE UV-B FLUX Nuclear Winter Notes
INTERHEMISPHERIC TRANSPORT
UPPER ATMOSPHERE SOLAR HEATING
MARTIAN DUST STORMS
EL CHICHO’N
c OTHER EFFECTS RADIATION CHEMICAL
RADIOACTIVE FALLOUT EXPOSURE (WHOLE BODY EXTERNAL GAMMA) DOSE DURATION LAND AREA
21000 rad 48 hrs 5% NML (5 x 106krn2)
2500 rad 48 hrs 30% NML (30 x 106krn2)
2100 rad 1 day - 1 mo 50% NML (50 x 106krn2)
210 rad 31 mo 50% NH Notes Nuclear Winter
I 1 TIMING OF BIOLOGICAL CONSEQUENCES Baseline (5,000 MT) Scenario TIME AFTER NUCLEAR WAR
I I
THE FIRST FEW WEEKS . . . - EXTREME COLD LACK OF FOOD, FUEL
WATER SHORTAGES MASSES OF DEAD HEAVY RADIATION SERIOUSLY INJURED SOCIAL SERVICE POLLUTION COLLAPSE VIOLENT WEATHER PSYCHOLOGICAL STRESS . . . ALL IN DARKNESS OR TWILIGHT
I
LATER . . .
ECOSYSTEM DECIMATION AGRICULTURAL SYSTEM COLLAPSE CHRONIC FOOD SHORTAGES RAMPANT DISEASE SPECIES EXTINCTION b SOUTHERN HEMISPHERE b NORTHERN HEMISPHERE Nuclear Winter Notes c IMPACT OF INCREASED UV RADIATION Immunosuppressive Plant life Plankton Corneal damage Cataracts
TIMING OF PHYSICAL EFFECTS Baseline (5,000 MT) Scenario * TIME AFTER NUCLEAR WAR Days Weeks Months Years
L RM B AL Notes
NUCLEAR ARSENALS
WORLD NUCLEAR ARSENALS (1983) - Number of RANGE Warheads Megatons
Deliverable USA 9,800 4,000 " s t r a t e gic " USSR 8,600 6,000 Other 300 ---mn Subtotal %19,000 53 10,000 Theater, naval, USA 16,000 2,000 and reserve USSR 14,000 ? 3.000 ? Other 600 ? 150 ? Subtotal %30,000 -535,000 TOTALS %50,000 %15,000 I
PAST AND FUTURE NUCLEAR STOCKPILES Strateglc Weapons 25,000 USA & USSR 20,000
/JUSA 15,000 10,000 1- 5.000 1 wpSsR e Expected Of Chatk Calwslrophs 0 ale No1 at Known Rhk 19 I Nuclear Winter Notes
SURVIVORS WOULD BE FACED WITH A VERY HOSTILE, HIGHLY MODIFIED, "BIOLOGICALLY DEPAUPERATE EA RTH."
In any large-scale nuclear exchange between the superpowers, global environmental changes sufficient to cause the extinction of a major fraction of the plant and animal species on the Earth are likely. In that event, the possibility of the extinction of Homo sapiens cannot be excluded. Ehrllch, 1983 -
...... :;;E...... A N ...... Y;;;;;;;;iT ii; ...... a...... ::::::..... :::::::...... H...... A,:.P ...... E'.N ...... Nuclear Winter Notes
NUCLEAR EXCHANGE SCENARIOS 5 YIELD TOTAL 96 YlELO URBAN on WARlEAO TOTAL YIELD SURFACE .WITRIAL YIELD uMn OF CASE IMTl BURSTS TARlETS ~A~lNTlEXMIIIOIS ~ - BASELINE 5.000 51 20 01-10 10400 EXCHAMEE LOW YIELD 5 000 IO 33 0 1-1 22 500"' rinBunsis 10000 MT"' loo00 63 15 01-10 16160 MAXIMUM 3000 MT 3.000 50 25 0 3-5 5 433 EXIIAMEE 3000 MT 3.000 50 0 1-10 2 250 COUNTERFORCE 1 ODD UTi,, 1.000 50 25 0.2-1 2.250 EXEMAMPE
SOLAR ENERGY FLUX AT THE GROUND 1000 I 'UnperturbedI - - t 4. global average
100 CASES: 1. Baseline, 5000 MT W/m* 4. Baseline, dust only Heavy overcast 14. 100 MT city attack 10 17. 10,000 MT "severe"
I 111Limit 91 photoslynthesis 0 100 200 300 400 Days After Detonation Notes Nuclear Winter 1 SURFACE LAND TEMPERATURES I C"" 1'I II I I1i 20 Ambient 1 temDerature 10
0 ___-__-___---- Freezing OC point of -10 pure water
-20 1. Baseline, 5,000 MT 4. Baseline, dust only -30 t 9. 10.000 MT exchange 1 14. 100 MT city attack ,l,,~llllll!lllI1 0 100 200 300 Days After Detonation
1 Notes Radiological Defense
Skin Decontamination Soap and Water Scrub Brush Q-Tips Dry Removal Waterless Cleaner KMn04and NaHS04
DECONTAMINATION PROCEDURES Start at top and work down Teams remain to windward Scrub after hosing Apply detergent to brushes Monitor between each scrubbing
DECONTAMINATION EFFICIENCIES Vacuum High Pressure Material Method Water
Glass 98 98 Painted Wood 99 98 Asphalt 72 92 Concrete 74 98 Unpainted Wood 36 05 Notes t PATIENT
WASHROOM DECONTAMINATION I CONTAMINATED ADAPTATION AREA
EXIT \ CLEA N
LENTRANCE CONTAMINATED Notes Radiological Defense
-
FAL L 0UT DECONT A MINA TI ON Aging/Natural Decay Sealing Removal
COUNTERMEASURES Remove contamination from exterior surfaces Establish clean areas Establish non-radiation areas Control Radiological Defense Notes I The primary objective of the OPERATIONAL RECOVERY PHASE is to resume vital tactical and combat functions
Decision Diagram For Plan of Action
E m N m I C .-0 .--m U m K
Tactical Demand
FALLOUT DECONTAMINATION
~~ Aging/Natural Decay Sealing Removal Notes Radiological Defense
FALLOUT PROTECTION I Time Distance Shielding Common Sense
- SHELTER EXITING Keep time outside to a minimum Wear protective clothing Avoid high contamination areas Don't stir the dust Cover nose and mouth
1
I Radiological Defense Notes TENTH THICKNESS for 1 MeV Photons
Lead ...... 1.2 inches
Steel ...... 2.0
Aluminum ...... 4.6 Concrete ...... 5.7
Earth (dirt) ...... 11.0
Water ...... 14.0
c
PROTECTIVE CLOTHING
e. Notes Radiological Defense
INVERSE SQUARE LAW Radiation intensity decreases by the square of the distance
,
d Radiation Rems per Hour
I Source Meters
I
FALLOUT PROTECTION Time Distance Shielding Common Sense I I ,Radiological Defense Notes
Stay Time = Dose Limit (hours) Exposure Rate in R/hr
Stay Time = 25 rems 50 R/hr Stay Time = 0.5 hr
ESTIMATED PERCENT SICKNESS
Period of Irradiation d Dose 1 Day 3 Days 1 Month 3 Months
~ 75 0 0 0 0 100 2 0 0 0 125 15 2 0 0 150 25 10 0 0 200 50 25 2 0 300 100 60 15 0 450 100 100 50 5 650 100 100 80 10
FALLOUT PROTECTION
I ~ ~ ~~ Time Distance Shielding I Common Sense Notes Radiological Defense
1FALLOUT PROTECTION I
Time Distance Shielding Common Sense -
4 RULE OF THUM5 For every seven-fold increase in time, the dose rate decreases by a factor of 10
SEVEN-TEN RULE 1 hr 1 7 hr 1/10 49 hr 1/100 343 hr 1/1000 or after 7 days 1/10 of dose rate) at day 1 J cRadiological Defense Notes Ideally use Instruments for Fallout Detection
I Gamma & Beta 1 Notes
I
I I
Fallout Detection
Qetection of Fallout by Physical Senses Radiological Defense Notes --
1
2 y
I i WETERZ EYD VIEW Notes Radiological Defense I I I I NATURAL SHELTERS Caves Culverts Tunnels Ravines
J ,Radiological Defense Notes
The primary objective of the EMERGENCY PHASE is to minimize personnel exposure to radiation
~ ~
FIELD EXPEDIENT SHELTERS Radiological Defense
I
The primary objective of the PRE-ATTACK PHASE is to anticipate countermeasures needed
- PRE - ATTACK COUNTERMEASURES Increase the effectiveness of any post-attack radiological countermeasures I
Ideally, have a Pre - attack Shelter Radiological Defense Notes
._....._
Radiological Defensec
Any action which can be taken to minimize the effects of nuclear radiation from fallout on personnel and operations
PHASES OF RADIOLOGICAL DEFENSE Pre-Attack Emergency Operational Recovery Notes Radiological Defense 4 BUILDINGS AS FALLOUT PROTECTION
5 STORY
%
I I
SHIPBOARD RADIATION AREAS ' RADIATION AREAS m CLEAN I CLEAN NONRADIATION AREAS
I Radiological Defense Notes
SHELTER REQUIREMENTS Adequate shielding Good ventilation Adequate sanitation
Adequate room for the number of people
FOOD AND WATER
Two weeks d Sealed food and water Gamma radiation does not hurt food Wash sealed containers before using If unsealed, do not eat if it cannot be washed Contamination is on the outside Animals
WATER For 2 weeks: 7 gallons per person Emergency sources Exposed water contaminated Normal water treatment Notes Nuclear Weapons Fallout I
Internal Hazards from Fallout
INTERNAL CONTAMINATION
T3 +p Pu239 +oc
A Fission Fragments Unspent Fuel
EXTENT OF INTERNAL HAZARD
Amount deposited
Energy of radiation --.. . Type of radiation Length of time in body Nares Nuclear Weapons Fallout I
Gamma Y Radiation
.
RELATIVE THICKNESS OF VARIOUS MATERIALS - PRODUCING EQUIVALENT SHIELDING Lead
Steel
Concrete
Earth
Water
Wood
TENTH THICKNESS FOR 1 MeV PHOTONS Inches Lead 1.2 Steel 2.0 Aluminum 4.6 Concrete 5.7 Earth (dirt 11.0 Water 14.0 Nuclear Weapons Fallout Notes
RONGELAP CONTAMINATION
~~ ~
Big snow-like flakes Coral ash Blanketed Marshal Islanders Began 4-7 hours postdetonation Completed within 24 hours
MARSHALLESE CONTAMINATION-
Hot and damp Bodies moist Wore little clothing Unaware of fallout Took no precautions Notes Nuclear Weapons Fallout
Beta P Radiation
BETA SHIELDING
One half inch of most materials are adequate for stopping the majority of energetic betas
Generally much less than a half inch of shielding material is required
0 Shielding thickness required decreases proportional to density increase
EXTERNAL BETA HAZARD
Beta Burns Notes Nuclear Weapons Fallout
Protection from External Radiation
Alpha a Radiation
PLUTONIUM
Skin stops alpha
No external hazard Nuclear Weapons Fallout Notes HORNET 12 MARCH 1955 PREDICTED f I
HORNET 12 MARCH 1955 ACTUAL ( 1 vi c\,!. Nuclear Weapons Fallout APPLE 81 WASP PRIME 29 MARCH 1955 ACTUAL ( I I
TURK 7 MARCH 1955 PREDICl
c
ARIZONA
7 MARCH 1955 TURK fI \\
ARIZONA
'\La8 Vegar )yyJ \ Notes Nuclear Weapons Fallout
c TYPE OF RADIATION
Alpha Beta Gamma
EARLY FALLOUT HAZARD
Primary: external whole-body gamma Secondary: external beta burns
Tertiary: internal beta exposure Nuclear Weapons Fallout Notes
I BIKINI BRAVO =CASTLE SERIES (Rongelap Incident)
1 March 1954
15 to 18 MT
7 feet above coral reef
€FFECIIVf ARRIVAL TIME Ihoutil c 0 6 1 8 9 10 >l 12 13 14 15 16 17 10 19 20 +
BIKINI BRAVO FALLOUT
7000 sq mi
20 miles upwind
350 miles downwind 60 miles at maximum width \ I
5561 AVUU SL " ) ' ' INIH33flZ
)nolle j suodeaM JeapnN SalON I/ I 5561 AWN S OM1 3lddW
stsinq aaejins ani1 ON 0
iy 001 ueql ssal :suodeaM
311s IS31 VaVA3N Notes Nuclear Weapons Fallout 5 DOSE RATE DISTANCE FROM GROUND ZERO (miles) S 0 40 2 MT SURFACE BURST 1 MT FISSION YIELD 3ndslhour 1 HOUR 30 2 EFFECTIVE WIND 15 rnph 28- 02TIME OF ARRIVAL (hours)
DOSE RATE DISTANCE FROM GROUND ZERO (miles) 0 40 80 120 r,,,,,. 1 HOUR 2 MT SURFACE BURST 1 MT FISSION YIELD EFFECTIVE WIND 15 mph r) c f
111111111 02468 TIME OF ARRIVAL (hours)
DOSE RATE
DISTANCE FROM GROUND ZERO (miles) 0 40 80 120 160 200 240 280 rllll,,II, I,,$ r 1 HOUR 2 MT SURFACE BURST L 1 MT FISSION YIELD L- - 6 HOURS
1 rmdlhour EFFECTIVE WIND 15 mph
18 HOURS
U 111111111,1,11,,1,1 0 2 4 6 8 10 12 14 16 18 TIME OF ARRIVAL (hours) Notes Nuclear Weapons Fallout
FRACTIONATION
Each different location has different radiological properties
FALLOUT PREDlCTI ON
Total fission yield
Burst height
Wind structure on top of cloud
IDOWNWIND DISTANCE FOR 1 RAOIHR--______1 Low Level Radiation Effects Notes
Personnel Dosimetry
Dose Component Number Available How Determined Statistics
External 162,000 65,000 Badged D> 25 rem = 39 Gamma 30,000 Badged & 5 internal 15,000 Reconstructed D 5 rem = 0 Average < 0.050 rem to the bone Neutron D > 25 rem = 8 5 < D <25 = 0 Average < 0.005 rem ~ Health Experience Survey a NAS MORTALITY STUDY 60,000 participants Series - Plumbbob (1957) fl+dLj 5 - Castle (1954) - Redwing (1956) - - Greenhouse (1951) f+ *d4, - Upshot-Knothole (1953) NAS HIROSHIMA/NAGASAKI REVIEW CAUSE OF DEATH AMONG NUCLEAR TEST PARTICIPANTS (1952 - 1981) Observed Expected SMR All Causes 51 13 6125 0.83 Leukemia 56 56 1.oo Genital 58 52 1.1 1 Neoplasms 1046 1243 0.84 Djge s t iv e 237 299 0.80 Ercula tory 1723 254 1 0.68 Respiratory 382 456 0.84 833 784 1.06 77 19 4.04 I 1985 N.R.C. Repor SUMMARY: MORTALITY OF NUCLEAR WEAPONS TEST PARTICIPANTS NATIONAL RESEARCH COUNCIL, May 1985 The total body of evidence we have reviewed cannot convincingly either affirm or deny that I the higher than statistically expected incidence of leukemia among SMOKY participants (or of prostate cancer among REDWING participants) is the result of radiation exposure incident to the tests However, when the data from all the tests are considered, there is no consistent or statistically significant evidence for an increase in leukemia or other malignant disease in nuclear test participants L THE NATIONAL DILEMMA 'OF 205,000 Do0 PARTICIPANTS, 34,000 WILL DIE OF NATURALLY OCCURRING CANCER If each participant received an average exposure of approximately 0.5 rem, this group may have an additional 11 cancer deaths (BEIR 111 estimated). Of 34,011 cancer deaths, which 1 1 (if any) were caused by nuclear test exposures? 0 Since the 11 can't be identified, how does the Nation compensate them? Notes Nuclear Weapons Fallout Neutron Activation on1 + (2,N) = (Z, N + 1) + 2 on1 + 27CoS9 = *7Co6O + 21.3 MeV e- ,, TIME , , b INDUCED AREA Initial neutrons touch earth Activation of materials at burst point Nuclear Weapons Fallout Notes CRATER FORMATION Fireball touched earth Vaporization of surface Vaporized materials enter cloud 0 Crater is formed FALLOUT PARTICLE FORMATION - Radioactive residue in cloud Dirt and debris in cloud Radioactive material condenses Fusion with dirt and debris Particle size: 1 cm to 0.002 cm I SOURCES OF FALLOUT Bomb debris I Induced ground elements 5rciL- Unspent fuel Notes Nuclear Weapons Fallout FIREBALL - PARTICLE FORMATION Fireball rises to high altitude Cloud cools Condensation of vapors Nuclear Weapons Fallout Notes DELAYED FALLOUT AND PARTICLE SIZE Arrives after 1 day Very small particles Descends very slowly 0 Global FIREBALL High temperature b300,OOO"C Gaseous (plasma) elements Expanding Hot fireball rises Vacuum created Strong updrafts - Notes Nuclear Weapons Fallout TYPES OF FALLOUT EARLY FALLOUT AND PARTICLE SIZE Arrives within 1 day Size: 0.01-1 cm Few hundred miles Nuclear Weapons Fallout Notes I I .- I NUCLEAR RADIATION INITIAL ______.______1 60 sec RESIDUAL ______b 60 sec - Neutron induced -----__-60 sec - Fallout ivuciear weapons Pallout Notes I I I INDUCED SOIL I RADIONUCLIDES ~ -Soil Mineral I Si, 0, Trace II Na, K 111 AI, Fe, Mg, TI IV Si, 0 UNSPENT FUEL Plutonium I Uranium Tritium I PERCENT 10 1 PERCENT OF - FISSION YIELD' AS FUNCTION OF MASS NUMBER lo-' - 10-2 - I THERMAL ! FISSION I 10-3 I - I I 10-4 Irllrrlrl~r t Notes Nuclear Weapons Fallout POTENTIAL FALLOUT (Activity) Total energy yield 0 Fusion fraction - ,? @hd~L.II~( Design of weapon - L_ I~~~\L .- ?&&~ Height of burst Nature of surface at ground zero Meteorological conditions Time after explosions GENERAL ENERGY PARTITION Fission Fusion 90% Explosion energy 9 5 O/o 10% Residual radiation 5 '/o FUSION WEAPON ACTIVITY ~~ Fission fragments Bomb debris Induced ground Unspent fuel Salting (?) Nuclear Weapons Fallout Notes ENHANCED WEAPON ACTlVlTY Fission fragments (reduced) Bomb debris (reduced) Induced ground 0 Unspent fuel AIR BURST - Fireball does not touch earth Over 2000 feet tactical Possible stem formation Afterwinds Fallout particles at very high altitudes NOteS Nuclear Weapons Fallout AIR BURST FALLOUT ACTIVITY Bomb debris Unspent fuel Fission fragments Salting (?) AIR BURST FALLOUT POTENTIAL SURFACE BURST Fireball touches earth Less than 2000 feet tactical Vaporization of surface Strong afterwinds Relatively large particles (ICM) I Nuclear Weapons Fallout Notes SURFACE BURST ACTIVITY Bomb debris Induced ground Unspent fuel Fission fragments Salting (?) SURFACE BURST FALLOUT POTENTIAL Early: very high (40-70°/0) Delayed: depends on conditions (30-60%) Notes Nuclear Weapons Fallout SUBSURFACE BURST No fallout potential -unless venting If venting, some early local fallout SHALLOW WATER BURST Similar to surface burst Sea salts and water in cloud Small particles Nuclear Weapons Fallout Notes SHALLOW WATER BURST FALLOUT POTENTIAL Early: reasonable (20-30%) Delayed: high (70-80%) EFFECT OF PARTICLE SIZE WIND and INITIAL HEIGHT ASSUMED CONSTANT 90,000 FT --+ LARGE PARTICLES FALL FAST, LAND CLOSE SMALL PARTICLES FALL 60,000 FT 4 SLOWLY, LAND FARTHER 30,000 FT + I GROUND IYores EFFECT OF HEIGHT WIND and PARTICLE SIZE ASSUMED CONSTANT 90,000 FT. M LARGE PARTICLES FALL SOONER, CLOSER SMALL PARTICLES FALL 60,000 FT. M SLOWLY, LAND FARTHER 30,000 FT. I_) GROUND d EFFECT OF VARIABLE WIND PARTICLE SIZE and INITIAL HEIGHT ASSUMED CONSTANT 90,000 FT 60,000 FT. LE’S MOVEMENT IS SUM 30,000 FT. GROUND SCAVENGING Increased removal rate Condensation on dirt and debris Precipitation Nuclear Weapons Fallout Notes I PRECIPITATION SCAVENGING Rainout Washout IRAINOUT I WASHOUT Nuclear Weapons Fallout PRECIPITATION SCAVENGING Local hot spots in overall fallout pattern Cleaning effect high ground Concentration low ground May wash particles into soil I Yield and Atmospheric Structure 130,000 - 110,000 - 90,000 - 70,000 - TROPICS - TROPOPAUSE 50,000 MID LATITUDES - TROPOPAUSE 30,000 - 10,000 - 0 Nuclear Weapons Fallout Notes REPRESENTATIVE NUCLEAR DETONATION CLOUD HEIGHTS. FEET 130.000 110.000 TROPICS '90.000 70.000 TROPYIPA( 50.000 30,000 10.000 0 ..c am 100 KT 1 MT 2( REPRESENTATIVE NUCLEAR FEET DETONATION CLOUD HEIGHTS - I Very slow descent Particles move in troposphere then are scavenged Fallout in temperate latitudes World wide FALLOUT PATTERNS IDEAL - FALLOUT PLANE Smooth infinite plane Fission fragments from 1 kT per square mile 2,900 rads/hr at 3 ft IDEAL FALLOUT PLANE IMPOSSIBLE Large portion of fission fragments fall near ground zero Dilution Earth not smooth Winds Scavenging Fractionation Notes Nuclear Weapons Accidents BROKEN ARROW , 0 a. HISTORICAL ACCIDENTS Goldsboro, NC ...... Jan 196 1 ./v Palomares, Spain ...... Jan 1966 Thule, Greenland ...... Jan 1968 Damascus, AR .._..._.....Sep 1980 Nuclear Weapons Accidents Notes NUCLEAR WEAPONS ACCIDENTS compared to other accidents 0 Possibility of Radioactive Contamination Presence of Classified Materials and Information Increased Public Concern t 1 Notes + INDICATED AREAS FOR FUTURE RESEARCH 1 - c NUCLEAR WINTER: GLOBAL CONSEQUENCES OF MULTIPLE NUCLEAR EXPLOSIONS R. P. Turco, 0. 6. Toon, T. P. Ackerman, J. B. Pollack, Carl Sagan Science, -2224630, 1283.23 Dec, 1983 RECENT NUCLEAR WINTER STUDIES Ref Thonipson R Schrie~tler (NCAR). Forelgn Affalrs. Sumlrner. 1986 Results compared with TTAPS and NAS with following improvenlents Three-(llnlenslon31 global circulation model - large heat capacity of oceans amellorates cooling over land ~ 75% of smoke removed wlthln 30 days - infrared "Greenhouse" effect of smoke also slgnlflcarlt in reduclng surface coollllq Excurslorls on total smoke loadngs 20-180 Tg - New work by Bing (LLNL) suggests smoke loading may have tieeri overestlnlated in NAS report by a factor of 2-4 - However, blackness of smoke may be underestlmated - NAS baseline estlrnate of 180 Tg may be an upper lirnit I Temperature proflle compared with TTAPS i Nuclear Winter POINTS OF CONTROVERSY 0 MAGNITUDE, IMPACT & DURATION OF PHYSICAL EFFECTS ADEQUACY OF COMPUTER MODELS METEOROLOGIC CHANGES b THERMAL INVERSION b RAINOUT CLOUD PATCHINESS LIMITED UNDERSTANDING OF ATMOSPHERIC PROCESSES REBUTTAL INDEPENDENT CONFIRMATIONS PEER REVIEW STRATOSPHERIC PARTICLE INJECTION CLIMATIC CHANGES INDUCED BY VOLCANIC ERUPTIONS LIMITED UNDERSTANDING OF ATMOSPHERIC PROCESSES CONCLUSIONS 0 ENORMOUS UNCERTAINTIES EXIST IN PROJECTIONS AND CALCULATIONS OF CLIMATIC EFFECTS OF A MAJOR NUCLEAR EXCHANGE OCCURRENCE OF A NUCLEAR WINTER CANNOT BE RULED OUT I Electromagnetic Pulse Notes 2 1 I 4 EMP COUPLING IN ACTION I t t i 1 EMP ENERGY I Notes Electromagnetic Pulse I COMMUNICATION STATION ANTENNA EMP ENERGY COLLECTORS OPEN WIRE COMMUNICATIONS AND POWER LINES MINIMIZING COLLECTION I Electromagnetic Pulse <-/-- Notes I1 1I- ll II r SHORTEN ANTENNAS 14 ELEVATED -- WORST CASE WIRING n I "RAT'S NEST" "TREE"' Notes Electromagnetic Pulse TRANSFER MINIMIZING TRANSFER UNPLIJG EQUIPMENT -1 I Electromagnetic Pulse Notes - I 1 CONTROL SHAFTS SCREEN UNDER , MASK PHONE JACK COVER - SENSITIVITY Notes sElectromagnetic Pulse EFFECTS OF EMP EQUIPMENT DAMAGE FUNCTIONAL DAMAGE OPERATIONAL UPSET TUBES ARE TOUGHER THAN TRANSISTORS w!4 "EX-TRANSISTOR" -* Notes ELECTROMAGNETIC ENERGY AND RADIO VULNERABILITY RC 292 ANTENNA WHIP WHIP REMOVED ARMORED INSIDE ANTFNNA ANTFNNA I VEtiicLC VtltirLE I OPERATIONAL NON-OPERATIONAL Notes Electromagnetic Pulse Estimating and Controlling Systems EMP Vulnerability 1. Shield to control EMP stress 2. Statistical methods/Fault tree analysis 3. Repeated testing at high simulated threat level 4. Recognize inherent uncertainty of results cElectromagnetic Pulse Notes TRANSIENT RADIATION EFFECTS ON ELECTRONICS (TREE) TREE EFFECTS - 0 IONIZATION 0 PHOTO CURRENTS 0 INCREASE CONDUCTIVITY 0 ATOMIC DISPLACEMENT CAUSES PHYSICAL BREAKDOWN OF RESISTORS, CAPACITORS, AND INSULATORS 0 ALTERS ELECTRICAL PROPERTIES OF SEMICONDUCTORS I Notes Electromagnetic Pulse - LONG RANGE SIGNAL TRANSMISSION MEANS 11 4 I HYPOTHETICAL THREE BURST MODIFICATION OF 1 TRANSMISSION WAVEGUIDE I BETA IONIZATION I I Magnetic Equator Electromagnetic Pulse Notes I SUSCEPTIBILITY TO RADIO BLACKOUT RADIO FREQUENCIES EFFECTS BAND LF 30 .300 kHz LEAST AFFECTED MF 300.3,OOO kHZ SOME DISTANT INTERFERENCE HF 3,000 - 30,000 kHZ MANY HOURS VHF 30,000kHz - FEW SECONDS 300 MHz TO MINUTES UHF 300 .3,000MHZ LITTLE EFFECT SHF 3 - 30 GHz VIRTUALLY NO EFFECT Notes Medical Operations I Conventional Casualties4 Individual casualty / Non-hostile Mass casualties / Non-hostile Individual casualty / Threat environment Mass casualties / Threat environment Nuclear Environment I Nuclear accident - no casualties Nuclear accident - radiation casualties Limited nuclear exchange Strategic nuclear exchange Notes Medical Operations US Military Medical Response in Nuclear Accidents Palomares, Spain - January, 1966 ~ ~ -~~ On-Site Medical Support Remote Location inTentage 2 Physicians, 6 Medcal Techs Arrived 48 Hrs After Accident Stayed to End of Clean-up (80+Days) US Military Medical Response u7 Nuclear Accidents Palomares, Spain - January, 1966 On-Site Medical Support Routine Sick CaY and Field Sanitation On-Site Emergency Medcal Treatment and Evacuation Support Bioassay Sample Collection Advise Recovery and Restoration Workers on Radiation Exposure ~ US Military Medcal Response in Nuclear Accidents Thule, Greenland - January, 1968 On-Site Medical Support Accident Adjacent to Base 0 Normal Facilities and Support Increased Population Supported 0 Increased Operations n Darkness and Extreme Cold Medical Operations I Predicted Distribution of Injuries Sustained in a Nuclear War Single Injuries: 30% to 40% Ionizing Radiation ...... 15% to 20% (including fallout) Burns ...... 15% to 20% Wounds ...... Up to 5% Predicted Distribution of Injuries Sustained in a Nuclear -War Burns + Wounds 8, Irradiation ...... 20% Burns 8, Irradiation ...... 40% i Wounds 8, Irradiation ...... 5% ,I i Wounds 8, Burns ...... 5 '/o - - Trav- 3 0 O/O Notes Medical Operations fi\ won Carrier I 20 kT at 2500 Yards 1 20 kT at 2500 Yards t Notes Medical Operations I 20 kT at 2500 Yards t Effective Range for Conventional Fission/Fmion Weapons Weapon Yield (kT) 10 50 100 1,000 2 burns 1.800 4,700 6,400 16,000 1,200 1,600 1,800 2,600 Notes Medical Operations I The Battlefield I Assembly Field Infantry Areas Artillery ? - Artillery Air Command Supply Communications Defense Posts Depot Center Q 0 @ 0 I I Medical Units Mobile Army Surgical Hospital Battalion Combat Support Hospital Aid Stations Evacuation Hospitals km A Medical Medical Companies Battalion Impact on Medical Operations Location - Forward area - Rear area Distance from target Time after attack Notes Medical Operations 1780 Nurses 1654 Casualties 298 M.D. 28 Uninjured 59 Functional Notes Medical Operations 1 Management of Nuclear Casualties Severity of Exposure and Symptoms 1 0 GI Syndrome Bone Marrow /Treatment I Suppression I Lethal Trauma Delayed and/or Burns Wound Healing Triage 4 By Conventional Injuries - Trauma - Burns By Radiation Injury Group Other injuries may modify group assignment and cause some overlap Avoiding Pitfalls to Successful Triage Never move a casualty backward Never hold priorty patient for further treatment Triage officers do NOT stop to treat patients Patients are never moved before triage Physicians 8 administrators must shift gears Notes Medical Operations I Nuclear Casualty Management Most casualties will have combined injuries ... Radiation doses above 200 rads markedly affect survival potential and ... may shift casualties to the Expectant Category. Estimates of Radiation Injury * IDEAL: Biologic Dosimetry AVAILABLE: - Signs and symptoms - Dosimetry Absolute Lymphocytes Relationship Between 3Ooo fiiiiiiil 9 ...... Early Changes in Peripheral Blood 2000 Lymphocyte Counts and Degree of 1000 Radiation Injury 500 100 012 Time (days) Notes Medical OPerations Use of Symptoms to Assess Probability of Radiation Injury UNLlKELY PROBABLE SEVERE Nausea - ++ +++ Vomiting - + +++ Diarrhea - -/+ -/+ to +++ Hyperthermia - - -/+ to +++ Hypotension - - + to ++ Erythemia - - -/+ to ++ CNS dysfunction - - -/+ to ++ Wounded by Conventional Weapons * Initial Repar a tive Reconstructive Surgery Surgery Surgery 1 5 10 50 100 Days after Woundmg Wounded by Nuclear Weapons Initial Reparative Surgery Reconstructive Surgery Surqery Restricted Surqer y 1 5 10 50 100 Days after Wounding Notes Medical Operations I Factors in the Production of Psychological Casualties in Conventional Warfare 0 Intensity / Duration of battle 0 Group leadership and cohesiveness 0 Availability of information Physical strain 0 Individual expectations 0 Experience / Morale Overview of Psychological Data Derived from the Japanese Atomic Bomb Experience Acute effects: Psychic numbing Fear reactions (panic?) Changes in social relationships Overview of Psychological Data Derived from the Japanese Atomic Bomb Experience Chronic effects: Psychoses vs neuroses Psychosomatic symptoms Anxiety / phobias Post traumatic stress disorder Survivor guilt Notes Medical Operations Very little IS known concerning the probable effects of an impending or actual nuclear attack on the emotional stability. morale, and motivation of military personnel The stress reaction in nuclear warfare might be what determines how effective a unit IS going to be The medical officer in support of the operational commander carries the dual responsibilities of providing medical care for combat casualties and to _- advise the commander on the operational capabilities of his troops. Command Radiation Guidance Army FM 101-31 Series - Animal experiments - Emphasized combat ineffectiveness Quantify Performance Decrement - Individual, crew and unit effects - Task and time dependence Notes Medical Operations I Expected Response to Radiation for Physically Demanding Tasks A A A 1 hr 1 day 1 mo Tirne After Exposure I c Training Real Accurate Relevant If = dangers that are thus foreseen are already half overcome.” Von Schell, 1930 ” Conserve the Fighting Force” Medical Commanders Must Maximize the Number of Soldiers Returning to Duty . . . Notes Medical Operations Expected Casualties Based on Worst Case Scenario Initial division strength ______~ 16,000 Total beds available - division _____.______160 cots - corps support ---....--..-----..--11 500 beds Major surgery 8 immediate treatment -...... -~------3,000 Other definitive care ~ ______-3,000 Minimal/buddy aid ______~ ______~ ______~ ____ 2,000 Hiroshima Burns 42,000 24,000 Serious Resources Required to Treat 35,000 Serious Burn Cases With Currently Accepted Techniques 175,000 Physicians/Nurses - 30% of all Physicians in U.S - 20% of all Nurses in US. 8,000 Tons of Supplies Cost Over $10,000,000 0 Transportation Required - 2,000 2 1/2 Ton Trucks - 160 Freight Cars I Medical Operations Forward Area Operation impacted within 1 hour Immediate casualties Limited transportation Cannot expect medical resuppl) Limited communications Rear Area If targeted - same as forward area If not targeted, operations impacted later - casualty load dependent on evacuation Expected Casualties Based on Worst Case Scenario Initial division strength ______._16,000 Soldiers receiving radiation (alone & combined injuries) 3,000 cGy Immediate incapacitation ______2,000 650 cGy Latent lethality _____.______.______6,000 150 cGy Minimal incapacitation ______2,000 Internal Contamination Other Uptake Routes - Percutaneous absorption may occur with tritium 0 Medical misadministration of radio p ha r maceut ical s Critical Organs Some radionuclides concentrate in specific organs. These "critical organs" receive a higher radiation dose or suffer the most biological effects. Solubility Determines Distribution Metals Heavy metals Tritium Complexes alter biological solubility infernal Lontamination Uptake and Retention ~ Portal of Entry Solubility Metabolism Particle size, shape, surface area Clearance Principle Routes of Uptake Inhalation Ingestion Contaminated wounds Nares Internal Contamination Good Housekeeping Rules!!! _. Change gloves often when handling patients Anything you touch will become contaminated (including yourself) 0 Dispose of contaminated wastes properly (bagged, tagged, and taped) Save water from wound irrigation for analysis Don't make more work for yourself! Internal Contamination Internal contamination gives continuous exposure to the organs, until the radionuclide is eliminated from the body or undergoes complete decay. Extent of Internal Hazard 0 Amount deposited Energy of radiation 0 Type of radiation Length of time in body - Physical half-life - Biological half-life Critical organ . internal contamination External contamination Use proper instruments Use general skin decontamination procedures Prevent further internalization of contaminants Use proper protective clothing Skin Decontamination c Remove patient's clothing Wash patient with soap and water l 95% EFFECTIVE ! Skin Decontarninat ion , @Soapand water - Soft bristle brush (for hands only) - Cotton applicators Dry removal Waterless hand cleaners Dilute bleach solution Diaper wipes Nuclear Winter Notes 30r sNormal Julv Temnerature NCAR RESULTS Ju--3u ... 18OTg Freezng 1 20 I I I I 0 10 20 30 Days Alter Slarl 01 Waf (Average July surldce temperatwe of all ldlld surface. thee snioke Io~diiq~,30 50 ON) NCAR CONCLUSIONS 0 "Despite the continued potential for Serious Nuclear Winter Effects, there does not seem to be a real potential for human extinction, nor is there a plausible threshold for severe environmental effects " Some interior areas (especially Canada and Siberia) may fall below freezing intermittently; some coastal areas experience little effect Chronic indirect effects, taken together, could threaten more people globally than the direct effects in a large nuclear war Smoke loading and improved atmospheric models need continued research Electromagnetic Pulse Notes I EMP vs Lightning Frequency Range Intensity Rise Time & Pulse Duration ELECTROMAGNETIC SPECTRUM CHART SPECTRUM COMPARISON INTENSlTY I9 I FREQUENCY Notes Electromagnetic Pulse ElectromagneticComparison ofFields 1 I I SOURCE (volts/meter)INTENSITY EMP 50,000 Radar 200 Radio Communication 10 Metropolitan IN o is e " 0.1 I I ELECTROMAGNETIC PULSE vs LIGHTNING TIME IN SECONDS 1ENERGY TRANSFORMATION Notes "6 PROCESS SYMMETRIC CHARGE DISTRIBUTION I RADIAL E LECTRIC SYMMETRIC FIELD RADIAL ELECTRON GAMMA FIELD RAYS SOURCE REGION I Notes Electromagnetic Pulse CHARGE ASYMMETRY I INDUCED BY EARTH'S SURFACE _-----_ ------+++ ++++++t+ -c -- + +=- -b EMP IN A SURFACE BURST SOURCE REGION 7 MAGNETIC FIELD IN GROUND CHARGE ASYMMETRY FROM CHANGES IN DENSITY OF THE ATMOSPHERE Electromagnetic Pulse Notes I I DISTURBANCE OF SYMMETRY NET ELECTRON CURRENT EM RAOiATlON 100- COMPARISON OF ** DAMAGE RADII FOR FM 10 CATEGORY IV * EQUIPMENT FROM FM 11 SURFACEILOW AIR 50 BURSTS 2opl/,1 , , , 0 1000 2000 3000 4000 I METERS HIGH - ALTITUDE BURST ASYMMETRY Notes Electromagnetic Pulse IDEALIZED RADIATION PATTERN 1 OF A VERTICALLY POLARIZED DIPOLE N N \ ‘S VERTICAL DIPOLE \\s I SURFACE PATTERN CROSS SECTION I c MAGNETIC FIELD ASYMMETRY I EMP IN A 0 HIGH ALTITUDE BURST Y ,...... ,...... %.. EM .....,... , ... r- ,,RADIATION .?I, FROM BURST 1 I Electromagnetic Pulse Notes Implications of EMP on Medical Care Communications Sterilization Running Water Medical Electronic Equipment Electric Light and Power 1 Notes Electromagnetic Pulse I COLLECTIO DAMAGE CHAIN TRANSFER / SENSITIVITY PRODUCTION d EMP Production Governed by 1. Weapon Yield 2. Weapon Deployment I tiectromagnetic Pulse Notes EMP Production Governed by 1. Weapon Yield 2. Weapon Deployment 3. Your Capability to Influence this Link in the Chain is Zero -1 iCOL .LECTI( EMP COUPLING MECHANISMS ELECTRIC INDUCTION MAGNETIC INDUCTION RESISTIVE COUPLING Notes Electromagnetic Pulse COMPONENTS OF AN ELECTROMAGNETIC WAVE ELECTRIC COMPONENT- MAGNETIC COMPONENT\ ELECTRIC COUPLING , ELECTRIC PORTION OF OMACNETIC WAVE -1 MAGNETIC COUPLING I Blast and Thermal Effects Notes Biological Effects of Nuclear Weapons Exposure Thermal Infrared - Responsible for Burns and Fires Medical Effects - Thermal Energy 1. Flash burns 2. Flame burns 3. Eye injury A. Retinal burns B. Flash blindness dazzle C. Loss of night vision Notes Blast and Thermal Effects White House \ \\ L,w \onno. The Mall El Combined Injury v I NUMBER OF PATIENTS WITH SKIN BURNS 48 8 1st 3 Weeks 4th - 7th Weeks 20 7 21 Incompatible Life Non- with Life Threatening threatening 8 12 upI to 60 - 100% 30 - 60% 3 0 O/o - Notes Combined Injury Combined Effects of Simultaneous I Whole - Body Irradiation and Burns on Rats 100 80 Burns Percent 60 Radiation Lethality Combined 40 20 n" 1OOR 250R 500R Causes of Burn Deaths Direct Result of Accident ...... 13% Infection ...... 45% Organ System Failure ...... 41O/O Iatrogenic ...... 1 O/O 100% Mortality from Contact Burns, WBI and PCN Group ~ ~~ O/O Burn 202 0 20 20 20 Rad WBI 0 100 25 100 100 Rx PCN 0 0 0 0 PCN O/O Mortality 12 0 20 75 14 Nuclear Weapons Accidents Notes RADCON RADIOLOGICAL mLTEAM ABERDEEN PROVWG GROUND. MD PERFORM RADIATION SURVEYS 4DVISE ON DECONTAMINATION SUPERVISE WASTE DISPOSAL - Notes Nuclear Weapons Accidents Special Assignment Airlift Missions I (SAAM 's) DOE A RG - ACCIDENT RESPONSEGROUP TEAM LEADER SCIENTIFIC ADVISOR WEAPON MSICWER ARNINC L F IRIW SPECIALIST SUPPORT COORollLLTOO FUNCTIONS OF DOEIARG Provides expertise/advice and assistance Scientific and technical aspects of nuclear weapons involved Evaluation and control of post accident procedures Render safe procedures Collection and identification of weapons debris Collects and correlates accident information received from DoD Develops chronological history of accident, weapons damage and response operations Notes Medical Operations I I US Military Medical Response in Nuclear Accidents Thule, Greenland - January, 1968 On-Site Medical Support Emergency Medical Treatment On-Site Field Sanitation Advise Recovery Workers on Radiation Exposure Bioassay Sample Collection I r US Military Medical Response in Nuclear Accidents Chetnobyl, USSR - April, 1986 I I I US European Command Chernobyl Task Force Mission Evaluate Radiological Impact on US Personnel in EuropeanTheater. Advise USEUCOM Surgeon on Actions Necessary To Ensure Public Health and Safety of Personnel in US Communities in Theater. I I US Mditary Medtcal Response in Nuclear Accidents Chernobyl, USSR - April, 1986 US European Command Chernobyl Task Force Directed by Senior Medical Corps Officer Medical Staff Consultants m. Preventive Medtcine / Pubkc Health Veterinary Medicine / Food Hygene Radiological Hygiene Nuclear Medtcme Medical Operations Medical Logistics Representatives From Safety and Pubbc Affairs Medical Operations 1 US Military Medical Response in Nuclear Accidents I Chernobyl, USSR - April, 1986 USEUCOM Chernobyl Task Force Operations Screening of US Tourists Returning From Kiev and Leningrad. USSR Radiological Advisory Medical Team Mission to US Ambassador, Moscow Ensure Security of Local Food Supplies for Consumption by US Personnel Independent Environmental Monitoring Program for US Communities MUNITION ATOMIC- 1 INCENDIARY ATOMIC- 1 650,000 ATTACK INSTANTANEOUS 3 HRS OVER INSTANTANEOUS DURATION 15 HR PERIOD KILLED 68,000 68.000 38.000 (KNOWN) INJURED 76,000 37 2 1,000 MISSING 13,000 16,000 SEVERAL THOUSAND Notes Human Radiation Exposure 18- 16 - Frequencies of Preliminary 14 - Radiation Doses from - Goiania Accident: 12 36 -Patients 10 - Frequencies 8- 6- 4- 2- ni " 0.2- 1.01- 2.01- 3.01- 4.01- 5.01- 6.01- 1.0 2 0 3.0 4.0 5.0 6.0 7.0 Dose (Gy) Notes Human Radiation Exposure 1 I I I Notes Biomedical Lessons of Chernobyl Notes Biomedical Lessons of Chernobyl I Clinical Presentation Flu-like symptoms .. No electrolyte abnormalities 0 No CNS changes by EEG Total body counts, 210 patients, 70% contamination internal contamination, 20 patients - Prussian Blue, 3-15 gm x 24 doses - Diuretics - Increased fluid intake - increased exercise (exercise bikes) 0 External contamination - Surgical debridement - Titanium Dioxide paste - Methyl Cellulose, ionic exchange - Soap and water Skin burns/lesions, 19 of 20 patients Skin/ Wound Contamination Initial radiation survey - GM counter - Total body counter Decontamination - Soap & water - Wound cleaning - Debridement - Chelation - Amputation I