Radiological Terrorism: A Primer P. Andrew Karam, Ph.D., CHP Research Assistant Professor Rochester Institute of Technology 1 CHAPTER 1: RADIOLOGICAL FUNDAMENTALS...........................................................................................5 Types of radiation ....................................................................................................................... 5 ¾ Alpha radiation................................................................................................................5 ¾ Beta radiation.................................................................................................................. 5 ¾ Gamma radiation............................................................................................................. 6 ¾ Neutron radiation............................................................................................................ 6 Background radiation exposure .................................................................................................. 7 CHAPTER 2: BIOLOGICAL EFFECTS OF RADIATION EXPOSURE ...........................................................8 Acute exposure to high doses of radiation.................................................................................. 8 ¾ Prodromal syndrome....................................................................................................... 9 ¾ Hematopoeitic syndrome................................................................................................ 9 ¾ Gastrointestinal syndrome ............................................................................................ 10 ¾ Cerebrovascular syndrome............................................................................................ 10 Chronic exposure to low levels of radiation ............................................................................. 11 ¾ Linear, no-threshold model........................................................................................... 12 ¾ Threshold models.......................................................................................................... 12 Reproductive effects of radiation exposure .............................................................................. 13 Radiation exposure and the pregnant woman ........................................................................... 14 Radiation exposure and the pregnant woman ........................................................................... 15 CHAPTER 3: CHARACTERISTICS OF A RADIOLOGICAL TERRORIST ATTACK...............................16 Introduction............................................................................................................................... 16 Radiological versus Nuclear Weapons ..................................................................................... 17 ¾ Nuclear weapons........................................................................................................... 17 Radiological weapons ............................................................................................................... 18 Making a Radiological Dispersal Device (RDD) ..................................................................... 18 What Makes a “Good” RDD Isotope?...................................................................................... 19 Obtaining Radioactive Materials .............................................................................................. 19 ¾ Obtaining radioactive materials domestically............................................................... 21 Constructing an RDD................................................................................................................ 22 Preventing an RDD Attack ....................................................................................................... 22 Human effects of an RDD Attack............................................................................................. 24 ¾ Effects of the Explosion................................................................................................ 24 ¾ Radiological Health Effects .......................................................................................... 24 ¾ Inhalation pathway........................................................................................................ 25 ¾ Ingestion pathway......................................................................................................... 27 ¾ External exposure pathway........................................................................................... 27 Environmental Effects of Radiological Terrorism.................................................................... 29 Soil and Water Contamination.................................................................................................. 29 ¾ Soils............................................................................................................................... 29 ¾ Water............................................................................................................................. 29 Summary................................................................................................................................... 30 2 CHAPTER 4: HOSPITAL MANAGEMENT OF VICTIMS/PATIENTS AFTER A RADIOLOGICAL ATTACK....................................................................................................................................................................32 Determining radiation dose....................................................................................................... 32 ¾ Estimating radiation dose based on patient symptoms or biological response............. 32 ¾ How to classify victims of radiological emergencies during first 12 hours following the event...................................................................................................................................... 34 Assessing radiation exposure in first 12 hours following a radiological event ........................ 37 ¾ Software-based dose estimates ..................................................................................... 37 ¾ Hospital care by radiation injury group ........................................................................ 38 Radiological Incidents and Emergencies.................................................................................. 42 Radiological Incidents and Emergencies.................................................................................. 43 Radiological Incidents and Emergencies.................................................................................. 44 ¾ On-scene medical assistance......................................................................................... 44 ¾ Caring for patients exposed to high levels of radiation ................................................ 44 Clinical signs of radiation exposure.......................................................................................... 45 Treatment for patients exposed to high levels of whole-body radiation................................... 46 ¾ Caring for radioactively contaminated patients ............................................................ 46 ¾ Patients with contaminated skin but uncontaminated wounds ..................................... 46 ¾ Patients with embedded contaminated materials .......................................................... 47 ¾ Patients with internal contamination............................................................................. 47 ¾ Personal protective equipment (PPE) when working with contaminated patients ....... 48 Radiological control methods ................................................................................................... 49 ¾ Patient decontamination................................................................................................ 49 ¾ Emergency room contamination control....................................................................... 49 ¾ Medical staff contamination control ............................................................................. 49 ¾ Emergency care for badly injured, contaminated patients............................................ 49 ¾ If radiation safety personnel are present they should: .................................................. 49 Addressing minor radiological incidents .................................................................................. 50 ¾ General guidelines........................................................................................................ 50 ¾ Spill of radioactive material.......................................................................................... 50 ¾ Decontamination or contamination controls................................................................. 52 ¾ Skin contamination ....................................................................................................... 52 Traffic accidents involving radioactive materials..................................................................... 53 Radiological terrorism; general guidelines ............................................................................... 54 CHAPTER 5: MEDICAL RESPONSE TO NUCLEAR AND RADIOLOGICAL TERRORISM...................56 Medical response to radiological dispersion device (dirty bomb)............................................ 56 Medical response to an irradiator attack ..................................................................................