Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs! Module Seven Radiation Emergencies Training Support Package 1 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Learning Objectives • Review key concepts: radiation types and exposure/ dose • Identify where radiation is found • Describe five potential major terrorist scenarios involving radiation • Describe clinical response strategies Module Seven – Radiation Emergencies 2 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Where are Nuclear Materials Found • Irradiation facilities • Nuclear reactors • Materials testing • X-ray devices • Isotope production facilities • Radionuclides used in medicine/research • ??????? Module Seven – Radiation Emergencies 3 1! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Devices Containing Radioactive Source Materials • Estimated 2 million devices in the USA contain licensed radioactive sources, but there is no comprehensive national inventory. • Companies have reported losing track of almost 1700 sources since 1998. More than half have yet to be found. [Nuclear Threat Initiative, Monterrey Institute of International. Studies. 2003] Module Seven – Radiation Emergencies 4 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Five major terrorist scenarios 1. Surreptitious placement of a radiation source 2. Stealth dispersal of radioactive material 3. Explosive radiation dispersal (“dirty bomb”) 4. Attack on a nuclear power plant 5. Detonation of a nuclear weapon Module Seven – Radiation Emergencies 5 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Surreptitious Placement of Radiological Source Module Seven – Radiation Emergencies 6 2! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Malevolent Use of Radiation Guangdong Province, China 2002 • A nuclear medicine expert who managed a laser medical center got into a dispute with his partner. • He used forged papers to purchase an industrial device containing iridium-192, and placed the source in the ceiling of his partner's office. • The partner became ill within days, experiencing low white blood count, bleeding gums, fatigue, dizziness, nausea. • 74 members of the hospital staff were also sickened before an inspection identified the source. [www.cnn.com/2003/world/asiapcf/east/10/02/ china.radiation] Module Seven – Radiation Emergencies 7 Chemical Agents of Opportunity for Terrorism: TICs & TIMs (Stealth) Dispersal of Radioactive Material: Cesium-137 Radiation Accident Goiania, Brazil (1987) • On 9/13/87, two scavengers found abandoned teletherapy device in abandoned medical clinic building. Device contained 1,375 Ci of Cesium-137. • Unit partially dismantled, then sold a few days later to a junkyard, where dealer used power tools to gain access to luminescent powder. Powder was distributed among relatives and neighbors. • 11 heavily exposed people admitted to hospital over next 2 weeks, suffering from nausea, vomiting, diarrhea, dizziness, and skin lesions. On 9/28/87, the illnesses were recognized as acute radiation syndrome and a major public health response was initiated. Module Seven – Radiation Emergencies 8 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Goiania Radiation Accident • Widespread population monitoring due to concern over water contamination from junkyard run-off. • 112,000 surveyed for contamination • 249 contaminated – 120 externally contaminated clothing – 129 externally and internally contaminated • 46 received chelation with Prussian Blue • 20 required specific hospital treatment • 14 developed bone marrow depression • 8 treated with GM-CSF • 4 died due to hemorrhage and infection. • Exposure was 4-6 Gy Module Seven – Radiation Emergencies 9 3! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Radiological Dispersal Devices: “Dirty Bombs” • A relatively small conventional explosive may be able to disperse radiation from even a small source over many city blocks • However, if radiation is detected promptly, few individuals are likely to absorb a lethal dose before they can evacuate the area • In terms of human casualties, unlikely to be a “weapon of mass destruction.” • Radiation sickness will be limited to individuals who have ingested, inhaled, or otherwise internalized substantial amounts of the source Module Seven – Radiation Emergencies 10 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Attack on a Nuclear Power Plant Module Seven – Radiation Emergencies 11 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Chernobyl (April, 1986) The world’s largest example of a “smoking disperser of radioactive material?” • 134 Acute Radiation Syndrome victims, 48 with burns • 28 Acute radiation injury deaths, plus 19 late deaths • Up to 4000 excess cancer deaths estimated among 600,000 heaviest exposed (liquidators, evacuees, nearby residents) • Source: WHO Chernobyl Forum 2006 Module Seven – Radiation Emergencies 12 4! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs What is Radiation? • Radiation is Energy • This energy can be in the form of: – electromagnetic waves, or – subatomic particles Module Seven – Radiation Emergencies 13 Chemical Agents of Opportunity for Terrorism: TICs & TIMs What is Ionizing Radiation? • Ionizing radiation has enough energy to strip electrons off atom- all nuclear radiation is ionizing • Ionizing or “nuclear” radiation has the clear potential to “terrify” the public as it is associated with the destructive force of nuclear weapons • Invisible • Undetectable to the senses Module Seven – Radiation Emergencies 14 Chemical Agents of Opportunity for Terrorism: TICs & TIMs What is Non-ionizing Radiation • Many other forms of radiation are non-ionizing • Examples: – UV – Radio waves – Microwaves – Light Module Seven – Radiation Emergencies 15 5! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Types of Ionizing Radiation • Alpha – High energy “helium nucleus” • Beta – High energy “electron” • Gamma – Electromagnetic energy from within a nucleus • X-ray – Electromagnetic energy from outside a nucleus • Neutron – Neutral particle emitted from the nucleus Module Seven – Radiation Emergencies 16 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Different Types of Radiation Module Seven – Radiation Emergencies 17 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Radiation vs Radioactive Material • Radiation – Energy transported in the form of waves or particles (i.e alpha, beta, gamma, or x-rays) • Radioactive material – Materials that emit ionizing radiation Module Seven – Radiation Emergencies 18 6! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Exposure Module Seven – Radiation Emergencies 19 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Contamination (Internal or External) Module Seven – Radiation Emergencies 20 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Radiation Terms • Activity – Amount of disintegrations/sec – Units: Curie or Becquerel • Absorbed dose – Amount of energy deposited – Units: rad or Gray • Dose equivalent – Amount of biological damage/risk – Units: rem or Sievert Marie Curie Module Seven – Radiation Emergencies 21 7! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Radiation Exposures • Natural background radiation (annual average): 360 mrem • Air travel round trip (London-New York): 4 mrem • Chest X-ray: 10 mrem • Smoking 1.5 packs/day x1 yr: 16,000 mrem • Mild acute radiation sickness: 200,000 mrem • LD50 for irradiation (w/i 60 days w/o treatment): 450,000 mrem Module Seven – Radiation Emergencies 22 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Injuries Associated with Radiological Incidents • Acute Radiation Syndrome • Localized radiation injuries • Fetal effects • Contamination • Trauma Module Seven – Radiation Emergencies 23 Chemical Agents of Opportunity for Terrorism: TICs & TIMs What Radiation Does Not Do • Immediate death • Immediate burns/wounds • Irradiation alone is not a medical emergency or threat to medical providers • Treat the patient first! Module Seven – Radiation Emergencies 24 8! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Acute Radiation Syndrome (ARS) • A group of signs and symptoms that develop after total body irradiation. • Generally requires high dose whole body exposure, at a high dose rate, to penetrating (e.g. gamma) radiation • More severe exposures lead to more rapid onset of symptoms and severity of illness Module Seven – Radiation Emergencies 25 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Phases of Acute Radiation Syndrome Module Seven – Radiation Emergencies 26 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Acute Radiation Syndrome • Subclinical <100 rads • Hematopoietic >100 rads • Cutaneous >300 rads • Gastrointestinal >600 rads • CNS >3000 rads Current nomenclature: 1 Grey (Gy) = 100 rads Module Seven – Radiation Emergencies 27 9! Module 7 - Radiation Emergencies! Chemical Agents of Opportunity for Terrorism: TICs & TIMs Hematopoietic Syndrome (1-5 Gy) • Manifests as fall in lymphocyte count • Lymphocyte nadir typically 8-30 days post exposure • Higher doses → earlier nadir • Stem cells die, platelets are consumed • Pancytopenia → death from sepsis, hemorrhage Module Seven