Radiological Preparedness Case Studies: Training for Accidents

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Radiological Preparedness Case Studies
Training for Accidents Dirty Bombs

• Carl Schopfer
• Carl.Schopfer_at_UMDNJ.edu

Senior Research Assistant NJ Center for Public
Health Preparedness
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How to Educate a Diverse Population?

• Health educators
• Higher education professionals
• Mental Health responders
• Volunteer disaster response groups
• Employees of industrial facilities
• Law enforcement

• Health officers
• Environmental health specialists
• Emergency Response groups
• Infection control professionals
• Epidemiologists

Emily Perry, NJCPHP Center Manager
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Various Training Approaches

• Didactic Training
• Web-Based Courses
• Distance Education Modules
• Lectures, Seminars Workshops
• Case-Based Curriculum Development
• Use for students with diverse learning levels
• Allow students to focus on different aspects
• Emphasizes skills over facts learned
• Advantage for adult students
• Rated high for future relevance and skills

Am. J. Preventive Medicine, May 2003 Supp.
Lloyd F. Novick, MD, MPH
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Why Study Accidents to Prepare for Terror?

• Fortunately, no radiological attacks..Yet
• Major accidents involve several groups
• Governments
• Emergency Services
• Public
• Outside Technical Experts
• Media
• Healthcare Community
• These groups interact in complex ways
• There is a need for quick accurate response

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Case Study - Three Mile Island

• Learn the rationale for a KI distribution plan
  and the risks and benefits of implementation
• Describe on what points to counsel patients and
  public about radiation risk
• Understand the concepts behind the terms
  radiation exposure, absorbed dose, dose
  equivalent, collective DE
• Identify reliable sources of information
• Identify populations at risk

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Case study - Chernobyl

• Describe how to identify acute radiation syndrome
• Distinguish between external and internal
  contamination
• Learn the basics of management of radiological
  casualties
• Identify specialized state and federal radiation
  response resources
• Advice to give on monitoring and decontamination
  of people, equipment, property and the environment

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Case Study - Goiania

• Describe how the public should be informed of
  hazardous areas, and of protective actions
• How to address protection of the water and food
  supply
• How to address mass concern, mental health and
  behavioral health issues
• Explain the basics of radiation background
• Distinguish between external and internal
  contamination
• Describe how clean is clean, and what is a
  safe dose level

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What is the Terror Threat?

• Radiological Dispersion Device (RDD)
• Dirty Bomb - conventional explosive disperses
  material
• Doesnt have heat, blast, prompt radiation
  effects of nuclear bomb
• Covert Placement or Dispersal
• Placement of high-intensity source
• Simple contamination or poisoning
• Sabotage of Nuclear Power, Transport or Storage
  Facility
• Improvised Nuclear Device or Actual Weapon
• Suitcase Nukes
• Use of fissile material to initiate fission
  reaction
• Other device to disperse radioactive material

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Radiological Nuclear Weapons Availability

• Nuclear Weapons require resources of a nation
• Is high tech, but accomplished in 1945
• Can be stolen, perhaps bypass safeguards
• Would not have to be high-yield
• RDD the Next Best Thing
• Considered in WWII and tested by Iraq in 1980s
• Military an area denial weapon
• Simple construction, deployment
• Simple Dispersal or Placement
• Sabotage or Outright Attack

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Weapons of Mass Destruction

• Attractive to Terrorists
• Have a high effect / resource ratio
• Use target organization resources against itself
• Can be done covertly, making deterrence difficult
• CBRNE are scary and useful against soft targets
• RDDs and Nuclear Attacks
• Nuclear weapon large loss of life, physical
  damage and economic impact, and long-term
  radioactive contamination
• RDDs potentially economic impact, and long-term
  radioactive contamination

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Radiological Terrorist Events

• Izmailovo Park, Moscow Chechen insurgents place a
  dynamite/radiocesium device which did not explode
  (1996)
• Argun, Chechnya Suspected Chechen rebels deploy
  an explosive mine with unidentified radioactive
  material (1998)
• Chicago, USA Jose Padilla arrested on suspicion
  of planning to build and detonate a dirty bomb
  (2002)
• Herat, Afghanistan British Intelligence weapons
  researchers conclude Al Qaeda succeeded in
  constructing a small dirty bomb (2003)

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Radiological Accidents

• Windscale, U.K. (1957)
• Palomares, Spain (1966)
• Three Mile Island, USA (1979)
• Goiania, Brazil (1987)
• Chernobyl, USSR (1986)
• Tomsk, USSR (1993)
• Tokaimura, Japan (1999)

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Radiological Dispersion Device

• The Department of Defense definition
• "any device, including any weapon or equipment,
  other than a nuclear explosive device,
  specifically designed to employ radioactive
  material by disseminating it to cause
  destruction, damage, or injury by means of the
  radiation produced by the decay of such
  material.
• Radiation presence may not be immediately obvious
• Unless strong source, prompt radiation injury
  unlikely
• Significant contamination of people and
  environment

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Preparing for a Radiological Attack

• Enhance awareness of acute radiation symptoms and
  treatment among healthcare providers
• Educate first responder and healthcare providers
  on contamination and low-level radiation issues.
• Provide basic detection capability for security
  organizations and first responders.
• Identify State Federal Support capabilities,
  clarify responsibilities
• Stockpile radiation exposure antidotes.
• Prepare educational materials to inform the
  public during and after an attack

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Radiation Physics Basics

• Ionizing but a relatively weak carcinogen and
  mutagen
• Comprised of particulate electromagnetic
  radiation
• a alpha b beta g gamma x x-rays n
  neutron
• Measures of radiation exposure
• Exposure, absorbed dose, dose equivalent
• Internal versus External Exposure
• Time, Distance, Shielding

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Radiation Background

• Several sources
• Cosmic
• Terrestrial
• Anthropogenic

300 mrem/yr
Source NCRP
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RDD Likely Impacts

• Expected to be terror and an expensive clean-up
• Contamination of Victims Environment
• Effect on Emergency Response
• Societal Effects
• Possible Benefits!?

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Contamination - Victims and Environment

• Likely to have zero to small number of fatalities
  within the immediate deployment area
• Injuries from blast effects
• most significant
• Stress-related injuries
• Moderate to wide-spread contamination

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Effect on Emergency Response

• Immediate, radiation-related health effects
  unlikely
• Depends on size of RDD, location, conditions
• Assessment of high radiation level can be made
  quickly
• Concern radioactive contamination may slow
  response
• Most important Treat conventionally wounded
  first
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  Decontaminate later
• Protect sensitive populations
• Public Health Sector Preparedness
• Prevent worried well from impacting system
• Triage where necessary

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Societal Effects

• Potential for initial public panic
• Concern whether large-scale relocation needed
• Economic Impact
• Potentially enormous, both business and personal
• Protracted societal distraction
• Political capital expended on clean-up priorities
• Large governmental clean-up costs
• Health Effects
• Psychological effects
• Increased cancer risk
• Long-term environmental monitoring

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Possible Benefits!?

• Force resolution of radioactive waste clean-up
  and disposal issues, including driving down
  disposal costs
• Educate lay public about radiation risk
• Tighter hazardous materials controls reduce
  accidents
• Hormesis?!

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Post-Event Clean-Up

• Possible to clean-up to pre-event levels?
• Probably not
• But health can be protected
• Economic costs and use restrictions

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Radioactive Material Characteristics

• Detection
• Cannot detect with senses
• Requires specialized equipment and training
• Physical form
• Initially, an airborne solid, dust or gas.
• Will adhere to surfaces, may dissolve in water.
• May re-suspend over time
• Persistence
• Depends on the half-life
• Environmental transport depends on chemistry, but
  also physical factors
• Both dilution and bio-concentration

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Radioisotope Candidates

• 137Cs
• 60Cu
• 192Ir
• 226Ra
• 241Am
• 239Pu
• Uranium
• 3H

• Irradiators industrial sources
• Irradiators
• Irradiators industrial sources
• Irradiators industrial sources
• Industrial sources
• Industrial sources
• Industrial sources
• Research, medical, consumer

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Health Effects

• Cannot feel or sense an exposure of any magnitude
• Acute Radiation Syndrome
• LD50 approx 300 rad (3Gy) adult, untreated
• Latency period - characteristic of
  radiation-induced carcinogenesis
• Low level exposure - increased risk of cancer

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Acute Effects

• Acute Radiation Syndrome (ARS)
• Nausea, vomiting and diarrhea
• Cataracts
• Hair loss
• LD50 approx 300 rad (3Gy) adult, untreated
• Loss of white blood cells
• Radiation cataracts (lens opacity)
• Death

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Low Level Effects

• Genetic Effects
• Cancer risks among the atomic-bomb survivors
• Site-specific cancer deaths
• Leukemia risks among atomic-bomb survivors
• Benign tumors uterus, parathyroid, thyroid
• Deaths due to non-cancer disease
• Effect on cholesterol levels, fertility, growth
• Chromosome aberrations in white blood cells
• Mutation in blood cells
• Effects upon the immune system
• Psychological effects
• Hormesis

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How To Know When an RDD is Used?

• Unexplained deaths of otherwise healthy
  individuals, ARS symptoms
• Suspicious explosion or fire, forensics
• Detection by emergency services
• Intelligence services
• Specialized detection equipment, monitoring
  stations
• Announcement or claim of perpetrators

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Treatment Guidelines Acute

• NCRP65
• AFRRI Biodosimetry Assessment Tool
• VA Pocket Card

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http//www.oqp.med.va.gov/cpg/uploads/bcr/RadCard9
.pdf
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Patient Management and Treatment Low Level
Exposures

• Treat life-threatening conditions FIRST
• Remove Clothing
• Decontaminate
• Copious water with mild soap
• Do not use abrasives or brushes

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Healthcare Personnel Protection

• Triage and admitting may need PPE
• Unless patients are very hot, exposure to
  providers should be minimal
• See webcast available on the CDC website
• Response to Nuclear and Radiological Terrorism

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Radiation Detection

• Environmental Monitors
• Site/Station Monitors
• Portable Equipment
• Radiation Safety Departments
• Laboratories

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Technical Assistance RAP map
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Selected References

• NCRP Report 138, Management of Terrorist Events
  Involving Radioactive Material
• NCRP Report 65 Management of Persons Accidentally
  Contaminated with Radionuclides
• Google it!

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(No Transcript)
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Internet Resources (1)

• National Safety Council, Environmental Health
  Center. Link for radiation at
• http//www.nsc.org/ehc/rad/radbroch.htm
• Centers for Disease Control, Emergency
  Preparedness Response, Radiation Emergencies
• http//www.bt.cdc.gov/radiation
• Radiation Emergency Assistance Center/Training
  Site
• http//www.orau.gov/reacts

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Internet Resources (2)

• Department of Homeland Security
• http//www.ready.gov/radiation.html
• American College of Radiology
• Disaster Preparedness for Radiology
  Professionals Response to Radiological Terrorism
• http//www.acr.org/departments/educ/disaster_prep
  /disaster-planning.pdf

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Internet Resources (3)

• howstuffworks
• http//science.howstuffworks.com/dirty-bomb.htm
• Radiation Effects Research Foundation
• http//www.rerf.or.jp
• Health Physics Society
• http//www.hps.org
• International Atomic Energy Agency
• http//www.iaea.org

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Internet Resources (4)

• Armed Forces Radiobiology Research Institute
• http//www.afrri.usuhs.mil
• Virtual Naval Hospital
• Initial Management of Irradiated or Radioactively
  Contaminated Personnel
• http//www.vnh.org/BUMEDINST6470.10A/TOC.html

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Other Resources

• RAND http//www.rand.org
• Other Sources of Information
• OHSA, DOE, EPA, NRC
• State Health and Environment Depts.
• Academic Centers for Public Health Preparedness

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Thank you!

• The New Jersey Center for Public Health
  Preparedness at UMDNJ
• www.NJCPHP.org
• email Carl.Schopfer_at_UMDNJ.edu