Medical Response to Nuclear and Radiological Events

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Medical Response to Nuclear and Radiological
Events
Cham Dallas, PhD DirectorCDC Center for Mass
Destruction Defense
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Overview

• Nuclear scenario effects
• Radiation injury
• Acute radiation syndrome
• Mass burn casualties
• External contamination
• Internal contamination
• Pharmaceutical intervention strategies

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Question

• Which of the following are most likely to occur
  and result in significant casualties?
• A. Nuclear power plant release
• B. Improvised nuclear devise
• C. Conventional nuclear weapon
• D. Dirty bomb

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Potential Nuclear/Radiological Hazards in the
U.S.

• Simple radiological device
• Dirty conventional bomb
• Improvised nuclear device (IND)
• 1 kT suitcase nuke
• Ballistic missile attack
• 250 kT nuclear weapon city killer

Plutonium
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Diversion of Nuclear Weapons

• 50 100 1 kT suitcase nuclear weapons are
  unaccounted for.

The Threat of Nuclear Diversion. Statement for
the Record by John Deutch, Director of the
Central Intelligence to the Permanent
Subcommittee on Investigations of the Senate
Committee on Government Affairs, 20 March 1996.
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Energy Partition
Standard Fission/Fusion
Thermal
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Blast
50
Fallout
10

Initial Radiation
5
AFRRI, Medical Effects of Nuclear Weapons,
Blast and Thermal Effects Lecture, 1990.
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Nuclear Weapon Detonation Results 1
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Nuclear Weapon Detonation Results 2
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Nuclear Weapon Detonation Results 3
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Scenario Washington Mall
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Effective Range for Blast Energy
AFRRI, Medical Effects of Nuclear Weapons, Blast
and Thermal Effects Lecture, 1990.
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Effective Range for Thermal Energy 1 kT Weapon
AFRRI, Medical Effects of Nuclear Weapons, Blast
and Thermal Effects Lecture, 1990.
13
Safe Separation Distances for Eye Injuries 1 kT
Weapon
AFRRI, Medical Effects of Nuclear Weapons, Blast
and Thermal Effects Lecture, 1990.
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Atlanta SSE Med Wind 250 kT Fatalities
Probability of Fatality (Default Plot) Time 32
days, 0.0 hours Mean Probability of Fatality
Expected Prob Population 90 0.9 455,934 50
0.5 661,169 10 0.1 886,681 Fatality
Possible (w/meander) Expected
Prob Population 90 0.9
455,934
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Atlanta 250 kT SSE wind 7 mph
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New York 250 kT Nuclear Detonation
Mortality Probability 3.9m Affected Red
90 Lt Brown 80 Yellow 70 Green
60 Pale Blue 50 Dark Blue 40 Lt Purple
30 Dk Purple 20 Dk Pink 10 Lt Pink
1
17
Seattle Mortality Probability under 350 kT with
NNE Wind
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What Is Fallout?

• A complex mixture of more than 200 different
  isotopes of 36 elements
• 2 oz of fission products formed for each kT of
  yield
• Size lt1 micron to several mm

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Question

• The risk from delayed fallout that is dispersed
  long distances (gt100 miles) still has a
  devastating impact on public health.
• A. True
• B. False

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Early Fallout

• That which reaches the ground during the first 24
  hours after detonation
• Early fallout fraction 50 70 of total
  radioactivity
• Highest degree of fallout risk

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Delayed Fallout

• Arrives after the first day, very fine invisible
  particles which settle in low concentrations over
  a considerable portion of the earths surface
• 40 of total radioactivity
• Much lower degree of risk relative to early
  fallout

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Bikini Atoll (1 March 1954)
Radioactive Contamination

• 15 mT thermonuclear
  detonation fallout
• Population affected
  300 in public domain
• Int/Ext contamination
• Local radiation injury
• Mild ARS
• Thyroid injury

Radiodermatitis
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Ionizing Radiation
Radiation that consists of directly or indirectly
ionizing particles or photons
Alpha
Beta
Gamma
Neutron
1 m concrete
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Radiation Exposure Types
Internal Contamination
External Contamination
Irradiation
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Acute Radiation Syndrome

• Systemic effects of radiation
• Prodromal
• Hematologic
• Gastronintestinal
• Pulmonary
• Cutaneous
• Neurovascular
• Combined injury

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Prodromal Component (0.53 Gy and higher)

• Immediate effect of cell membrane damage
• Onset of nausea, vomiting, diarrhea
• Mediated neurologically by the parasympathetic
  system

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Respiratory Component(5310 Gy and higher)

• Sensitive from highly vascular tissue
• Endothelial cells
• Type II alveolar cell
• Effect is dose-rate related
• Pneumonitis
• Fibrosis

Healthy lung
Pneumonitis
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Radiation Skin Injury

• 0.75 Gy Hair follicles change
• 3 Gy Epilation
• 6 Gy Erythema
• 10 Gy Dry desquamation
• 20 Gy Wet desquamation (transepithelial
  injury)

Erythema
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Radiation Burns
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Causes of Burn Deaths
Direct result of accident 13
Infection 45
Organ system failure 41
Iatrogenic intervention 1
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Distribution of Injuries in aNuclear Detonation
Single injuries (3040)
Combined injuries (6570)
Wounds
Burns
Wounds
5
Irradiation
Irradiation
5
1520
Burns
Wounds
Irradiation
20
Burns 1520
Burns
Wounds lt 5
Irradiation 40
Data from Walker RI, Cerveny TJ Eds., Medical
Consequences of Nuclear Warfare, TMM
Publications, Falls Church, 1989. p 11.
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Andrews Lymphocyte Nomogram

• Absolute lymphocyte count over 48 hours
• Confirms significant radiation exposure

From Andrews GA, Auxier JA, Lushbaugh CC The
Importance of Dosimetry to the Medical
Management of Persons Exposed to High Levels of
Radiation. In Personal Dosimetry for Radiation
Accidents. Vienna, International Atomic Energy
Agency, 1965, pp 3- 16
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Priorities in Combined-Injury Triage- Radiation
Doses
Conventional Triage Changes in Expected
Triage (No Radiation Exists) Following
Radiation Exposure lt1.5Gy 1.54.5Gy
gt4.5Gy gt3
hr 13 hr lt1 hr onset
onset onset Immediate
Immediate Immediate Expectant Delayed
Delayed Expectant Expectant Minimal
Minimal Expectant Expectant Expectant Ex
pectant Expectant Expectant
Modified from Medical Consequences of Nuclear
Warfare, 1989, p. 39
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Decontamination Equipment

• Hospital surgical gown (waterproof)
• Cap, face shield, booties (waterproof)
• Double gloves (inner layer taped)
• Pencil dosimeters, TLDs, survey meters
• Drapes
• Plastic bags
• Butcher paper
• Large garbage cans
• Radiation signs and tape

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Question

• Which of the following is the best
  decontamination agent?
• A. Dry removal
• B. Bleach
• C. Soap water
• D. Waterless cleanser

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Decon Agents 1

• Dry removal
• Soap/shampoo
• Household bleach 110 (sodium hypochlorite)
• Waterless cleansers
• Povidone-iodine
• Lava soap
• Cornmeal/Tide 5050
• Vinegar (32P) or club soda
• Toothpaste

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Internal Contamination Involves 4 Stages

• Deposition along route of entry
• Translocation
• Deposition in target organ
• Clearance

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Therapeutic Interventions

• Plutonium/transuranics DTPA
• Cesium insoluble Prussian Blue
• Uranium alkalinization of urine
• Radioiodine radiostable iodine
• Tritium radiostable water

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is for good men and women to do nothing.
All that is necessary for the triumph of evil