Radiation as a Weapon of Terror

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Radiation as a Weapon of Terror
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Acknowledgements

• South Carolina Area Health Education Consortium
  (AHEC)
• Funded by the Health Resources and Services
  Administration.
• Grant number 1T01HP01418-01-00
• P.I. David Garr, MD, Executive Director AHEC
• BT Project Director Beth Kennedy, Associate
  Program Director AHEC
• Core Team
• BT Co-director Ralph Shealy, MD
• BT Project Manager Deborah Stier Carson, PharmD
• BT CME Director William Simpson, MD
• IT Coordinator Liz Riccardone, MHS
• Web Master Mary Mauldin, PhD
• P.R Coordinator Nicole Brundage, MHA
• Evaluation Specialist Yvonne Michel, PhD
• Financial Director Donald Tyner, MBA

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Acknowledgment

• This material has been prepared for SC AHEC
  Bioterrorism Training Networkby
• Ralph M. Shealy, M.D., FACEPCo-Director of SC
  AHEC Bioterrorism Training Network
• Medical Director for Operations, Charleston
  County EMS
• Medical Director, Charleston County Rescue Squad

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Objectives 1

• At the conclusion of this presentation, the
  participant will
• List five radiological/nuclear threats
• Identify three effects of a radiological incident
  on the community
• Describe the availability of, and the threat
  posed by, radiological materials on the
  international black market
• Define ionizing radiation and radioactive
  contamination.

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Objectives 2

• State the four basic types of ionizing radiation.
  
• State the potential biological effect from acute
  radiation exposure
• Identify the protective measures of time
  distance, and shielding.
• List the five possible health effects from
  ionizing radiation exposure

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Objectives 3

• List materials that are most effective in
  shielding alpha, beta, gamma, and neutron
  radiation.
• List five sources that can be used as a
  radiological dispersion device
• List five dispersal techniques

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Effects of a Radiological Incident

• Panic.
• Mass casualties with difficult injuries.
• Medical facilities overloaded.
• Contamination issues.
• Gridlock.
• Public services disrupted.

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A True Story

• Boy Scout builds working nuclear breeder
  reactor from readily available materials!

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Ingredients

• Radium-226 from antique clocks with luminous
  radium dials.
• Americium-241 from smoke detectors.
• Beryllium-9 stolen from a local college.
• Thorium-232 collected from Coleman gas lantern
  mantles.

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• The reactor became significantly more
  radioactive within a matter of weeks as it
  produced Uranium-233.
• When he could detect the radiation from 5 doors
  down, he terminated the experiment.
• The EPA stated that the 40,000 nearby residents
  could have been put at risk had radioactive dust
  been accidentally liberated.

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Radiation

• Energy that comes from a source and travels
  through some material or through space.
• Light, heat, and sound are types of radiation
• Types of radiation associated with radioactivity
  are alpha and beta particles and gamma and
  x-rays.

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Radiation Released When a Radioactive Atom Decays

• Alpha particles
• Beta particles
• Gamma rays and x-rays
• Neutron radiation

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Alpha Particles

• Helium nucleus
• Contain two protons and two neutrons.
• Have strong positive charge
• Is a large particle
• Will travel only a few inches in air
• Will not penetrate paper or dead skin
• Only dangerous when incorporated in the body by
  ingestion, inhalation or through a wound.

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Beta Particles

• Very small particle
• Carry a negative charge
• Actually an electron traveling at very high speed
• A high-energy beta particle can travel about ten
  feet in air and can penetrate paper and human
  skin
• Can be shielded by plastic, glass, and metal foil

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Gamma Rays and X-rays

• Pure energy photons and not particles
• No mass or electrical charge
• Travel at the speed of light
• Very short wavelength
• Can penetrate and damage all organs
• Shielded by lead, steel, and concrete

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Neutron Radiation

• Neutron radiation is a high speed neutron
  particle
• Have no electrical charge
• Neutrons ionize matter by direct collision with
  electrons.
• Shielded by carbon, lithium, cadmium, boron,
  plastic, and water

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Background Radiation

• Sources of normal background radiation are
• Cosmic radiation
• Sources in the earths crust
• Sources deposited in the body from food and water
• Naturally occurring radon in the soil

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Manmade Sources of Background Radiation

• Tobacco products contain radon absorbed by the
  plant leaf.
• Medical radiation from x-rays, nuclear medicine
  diagnostics, and radiation therapy.
• Building materials contain terrestrial radiation
  sources.
• Water supply contains dissolved radioactive
  minerals

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Sources of Radioactive Isotopes

• Natural sources
• Radon in air
• Radium in soil
• Uranium ore
• Machine produced nuclear interactions
• Cyclotrons
• Linear accelerators
• Nuclear reactors

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Moral of the Boy Scout Story

• Intelligent people with enough determination can
  build sophisticated nuclear devices using readily
  available materials and information that can be
  collected from sources accessible to the public.

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Nuclear Expertise Can be Bought

• Thousands of former Soviet weapons scientists
  have not successfully found suitable new jobs in
  the civilian economy and are currently
  impoverished.

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Radioactive Materials Can Be Bought

• Russia currently has no consolidated system of
  nuclear materials registration and it is very
  difficult to track the quantity, deployment, and
  transportation of nuclear material.

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Nuclear Black Market

• Weapons grade nuclear materials are located in
  nearly 100 facilities in the former Soviet Union.
  
• The black market for radioactive materials is
  very active in Russia since 1993.
• The United Nations Atomic Energy Agency has
  documented 370 confirmed incidents of nuclear
  trafficking between 1993 and 2001.

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Nuclear Black Market

• Reactor wastes are the ideal material for
  terrorists to use in radiation dispersal devices
  (dirty bombs).

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Nuclear Black Market

• Security at nuclear plants and storage facilities
  in the former Soviet Union is lax.
• Facilities are in dilapidated condition.
• There is much evidence of an active and lucrative
  trade in radioactive materials in a country in
  deep economic decline.

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Nuclear Black Market

• Most intense around and inside nuclear plants in
  the former Soviet Union.
• Fifteen kilograms of commercial grade uranium
  were found under the bathtub of one plant
  employee.
• In Moscow in 1995, enriched uranium was found
  inside a cabinet secured with a bicycle lock.

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Suitcase Bombs

• A Russian Lieutenant General testified in 1998
  that ninety suit-case sized one kiloton atomic
  bombs were unaccounted for.
• We know that this weapon is feasible, since we
  built them in the 1960s.

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Nuclear Power Plants

• High and low level wastes are the byproducts of
  electricity production at nuclear power plants.
• Terrorists could use these to contaminate an area
  so that it could not be accessed or used safely.
• Many engineering safeguards at a nuclear power
  plant are disabled during a Shut Down. The
  reactor is most vulnerable to attack at that time.

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Radiological Dispersal Device(Dirty Bomb)

• A radioactive Dispersal Device spreads
  radioactive contamination over an area.
• Radioactive material can be acquired from
  numerous unsecured locations.
• Radiographic, industrial, medical, agricultural,
  defense wastes, reactor waste.
• The radioactive material can be easily dispersed
  with a conventional explosive.

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Contamination

• Deposition of radioactive material in any place
  where it is not desired, particularly where its
  presence can be harmful.

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Avoiding Contamination

• Use respirator early
• Use time, distance, and shielding effectively
• Removal of outer garments removes most
  radiological contamination.
• Soap and water remove most of the rest.
• Do not eat, drink, smoke, scratch, apply make-up
  or rub your eyes in a contaminated environment.
• Avoid cuts and abrasions.

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Irradiated versus Contaminated

• A patient who has been exposed to ionizing
  radiation has been injured by the exposure but
  does not emit radiation himself. There is no
  ongoing source of radiation injury.
• A patient who has be contaminated with
  radiation-emitting materials continues to be
  injured by them and posses a threat to others.

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Critical Point for Health Providers

• It is impossible for a living patient to be so
  contaminated as to pose a threat to care
  providers.
• (Medical Management of Radiological Casualties,
  December, 1999, P. 67.)

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ALARA

• Minimize exposure to radiation and contamination.
• Keep exposure As Low as Reasonably Achievable
• Time Distance Shielding

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Time Practical Pearls

• Break task into many small segment.
• A different individual performs each small
  segment.
• Time of exposure is minimized.
• Total radiation dose is minimized

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Practical Distance Pearls

• The Inverse Square Law
• Doubling the distance from a source halves the
  radiation dose
• Halving the distance from a source increases the
  dose four times!
• Distancing oneself from a source by even a small
  amount will significantly decrease ones radiation
  exposure.

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Practical Shielding Pearls

• Four to twelve inches of soil used to cover a
  discrete radiation source will stop 50 to 90 of
  the radiation!
• An engine block, a concrete wall, or an earthen
  berm can be adequate shielding if kept between a
  rescuer and the source.

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Ionizing Radiation

• Ionizing radiation interacts with the atoms in
  tissue and causes cellular damage.

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External Exposure

• Like an x-ray the source of radiation is remote
  from the person.
• The person is NOT radioactive.
• The person is NOT a threat to others.

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Internal Exposure

• The most serious chronic risk.
• Inhaled radioactive particles in the air.
• Ingested contaminated food or water.
• Absorbed material through the skin or mucous
  membranes.
• Incorporated contaminants in a wound.

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Health Effects

• Ionizing radiation damages cells by interacting
  with its atoms.
• The nucleus is especially sensitive.
• Even low dose radiation effects chromosomes.
• Chromosome damage may result in mutations,
  possibly resulting in malignancies or fetal
  abnormalities.

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Health Effects

• Ionization of cellular water produces hydrogen
  peroxide.
• Intercellular hydrogen is very toxic and more
  destructive than the radiation itself.
• Hydrogen peroxide is more destructive than the
  radiation itself.

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Health EffectsRadiation Sensitivity of Different
Cells
MOST Sensitive

• Developing sperm cells
• White blood cells
• Red blood cells
• Small intestine
• Stomach
• Neural tissue (nerves, spinal cord, brain)
• Colon
• Skin
• Muscle
• Bone
• Collagen

LEAST Sensitive
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Whole Body Effects

• High dose radiation over a short period of time
  produces acute health complications.
• Low doses of radiation over an extended period of
  time may produce chronic health complications

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Acute Radiation Syndrome

• Prodromal Stage
• Latent Stage
• Manifest Illness
• Recovery or Death

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Acute Radiation Syndrome

• Low dose ( up to 100,000 millirem)
• Moderate dose (100,000 to 1,000,000 millirem)
• High dose (greater than 1,000,000 millirem)
• LD50 is about 300,000 to 500,000, depending on
  the extent of medical care.

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Drug Intervention for Acute Thyroid Exposure

• Iodine concentrates in thyroid.
• Radioiodine enters by inhalation and ingestion.
• Normal iodine will saturate the gland so that
  radioiodine cannot be absorbed.
• Potassium iodide (KI) is effective if taken
  before exposure.
• KI does not protect against any other isotope.

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Chronic Radiation Exposure

• Somatic Effects
• Genetic Effects
• In-Utero Effects

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Lifetime Increased Cancer Risk

• Stomach
• Lung
• Liver
• Colon
• Bladder

• Breast
• Ovaries
• Thyroid
• Skin
• Bone marrow

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Summary

• Radiation can be an effective terrorist weapon.
• It is possible to sabotage sources of radiation
  in the community or even to construct
  radiological weapons of various types.
• Sources of expertise and materials are available.
• Health professionals can take steps to protect
  themselves while providing care to victims of a
  radiological attack.

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Acknowledgement

• This presentation borrows heavily from
• The Weapons of Mass Destruction
  Radiation/Nuclear Course for Hazardous Materials
  Technicians produced by the U.S. Department of
  Justice Office for Domestic Preparedness, the
  U.S. Department of Energy, and Bechtel Nevada.
• Emergency Medicine, Fourth Edition, produced by
  the American College of Emergency Physicians and
  edited by Judith Tintinalli, M.D.

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