RADIATION BASICS

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RADIATION BASICS
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INTRODUCTION

• What is Radiation?
• Types of Radiation
• Nonionizing Radiation
• Ionizing Radiation

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INTRODUCTION

• Radiation Spreading Events
• Radiation Poisoning
• Radiation Exposure Device (RED)
• Radiation Dispersal Device (RDD)
• Improvised Nuclear Detonation (IND)
• Nuclear Weapon Detonation (NWD)
• Time Distance Shielding
• Inverse Square Law
• Shelter in Place

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INTRODUCTION

• Why are we afraid of Radiation?
• Measuring Radiation
• Patient Decontamination
• Health Effects of radiation
• Medical Management of Radiation Patients
• Public Health Response

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RADIATION

• RADIATION is energy that comes from a source and
  travels through some material or through space.
  Light, heat, X-ray and microwave energy are types
  of radiation.
• IONIZING RADIATION is produced by unstable atoms.
  Unstable atoms differ from stable atoms because
  they have an excess of energy, mass and/or both.

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Properties Alpha (a) Beta (b) Gamma (g) Neutron (n)
Mass Large mass 2 protons and 2 neutrons (4 amu)(helium nucleus) Solid mass (about 1/1838 of 1 amu) No mass electromagnetic wave or photon Mass of 1 amu
Electrical Charge 2 positive -1 negative None None
Range in the air Short range ¼ to 2 inches (4cm) in dry air, up to about 10 feet (3 meters) in dry air Very far several hundred feet. Very high penetrating power since it has no mass or charge Very far. Several hundred feet. High penetrating power due to lack of charge (difficult to stop)
Shielding 2 inches of air, A sheet of paper, dead layer of skin Plastic, aluminum foil, clothing safety glasses Inches of Lead, Concrete, Water, Steel Materials with high hydrogen content, water, concrete, plastic, polyethylene, boron cadmium
External Hazard Does not represent external hazard. Externally for unprotected skin and eyes. Whole body exposure. Can penetrate through the body. Whole body exposure. Can penetrate through the body.
Biological Hazard Internal hazard if the source is inside the body (inhaled, ingested, or injected in wound.) Can deposit large amounts of energy in a small area internally Internal hazard if the source is inside the body (inhaled, ingested, or injected in wound.) Can deposit large amounts of energy in a small area internally Hazard may be internal or external. This depends on whether the source is outside or inside the body. Hazard may be internal or external. This depends on whether the source is outside or inside the body.
Sources Usually emitted by transuranic elements Uranium, Plutonium, Americium, Radon, Radium Fissionable products such as Cesium 137, Tritium, Carbon-14, and iodine 132 Fission Products. in soil, industrial and medical sources. Cesium 137, Cobalt 60, depleted Uranium Few natural sources. Fission nuclear reactors. Cosmic radiation Plutonium, Californium 252.
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TYPES OF RADIATION

• IN ORDER OF PENETRATION
• Alpha Particles
• Beta Particles
• Gamma Rays
• Neutron Particles

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LIMITING EXPOSURE

• AS LOW AS REASONABLY ACHIEVABLE (ALARA)
• TIME
• DISTANCE
• SHIELDING

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INVERSE SQUARE LAW
A 4x 32 rem B x 8 rem C 1/4x 2 rem
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RADIATION POISONING

• Place in food or water
• Gets more difficult with increase in number of
  people to poison
• Creates panic
• Doesnt require explosives or high technology
• Done effectively in the past.
• Slow to affect people, but time is dose dependent

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RADIATION POISONING

• Alexander Litvinenko
• Polonium 210 (210 Po) alpha emitter
• Lost hair, Severe nausea, vomiting Bone marrow
  badly damaged
• Unable to eat for 18 days, Died in 3 weeks
• 210 Po was in green tea
• Seven bar staff had levels of 210 Po
• Several customers also had evidence of 210 Po
  exposure from same pot

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RADIATION DXPOSURE DEVICE (RED)

• Radioactive source out of legal control
• Potential to expose people to lethal doses of
  radiation
• Irradiation, no incorporation if sealed source
• Dose assessment, medical monitoring
• Psychological Economical impact

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RADIATION DXPOSURE DEVICE (RED)
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RADIOLOGICAL DISPERSAL DEVICE (RDD)

• Conventional explosive incorporating radioactive
  materials
• Explosion greatest hazard
• Mostly creates panic with little injury

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NUCLEAR DETONATION

• TWO DIFFERENT THREATS
• Nuclear Weapon Detonation (HIGH YEILD)
• Improvised Nuclear Detonation (IND) (LOW YEILD)

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IMPROVISED NUCLEAR DEVICE (IND)

• Illicit nuclear weapon bought, stolen, or
  otherwise originating from a nuclear state, or
  built from the components of a stolen weapon or
  from scratch. (Pu or U)
• Produces same physical and medical effects as
  nuclear weapon explosion

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IMPROVISED NUCLEAR DEVICE (IND)

• Results in catastrophic loss of life, destruction
  of infrastructure, and contamination of a very
  large area
• If nuclear yield is NOT achieved, the result
  would likely resemble a RDD
• If nuclear yield is achieved, results would
  resemble a nuclear explosion
• Like nuclear explosions, IND explosions can be
  evaluated with a fallout map

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FALLOUT MAP (PLUME)
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FISSION PRODUCTS FROM A NUCLEAR DETONATION FISSION PRODUCTS FROM A NUCLEAR DETONATION FISSION PRODUCTS FROM A NUCLEAR DETONATION FISSION PRODUCTS FROM A NUCLEAR DETONATION FISSION PRODUCTS FROM A NUCLEAR DETONATION
Isotope Isotope Half Life Alpha (a) Beta (b) Gamma (g) Radiotoxicity Hazard
Name Symbol Half Life Alpha (a) Beta (b) Gamma (g) Radiotoxicity Hazard
Cesium 137Cs 30 yrs b, g I, ING, SC, WBE
Strontium 90Sr 29 yrs b I, ING, SC
Carbon 14 C 5,730 yrs b I, ING, SC
Zirconium 95 Zr 65 days b I, ING, SC
Uranium 235U 700 mil yrs a I, IHG,
Uranium 238U 4.47 bil yrs a I, IHG,
Plutonium 239Pu 24 Thou yrs a I, IHG,
Cesium 134Cs 3 yrs b, g I, ING, SC, WBE
Yttrium 91Y 58 Days b I, ING
Tellurium 127Te 105 days b, g I, ING, SC, WBE
Antimony 125Sb 2 yrs b I, ING, SC
Ruthenium 106Ru 1 yrs b I, ING, SC
Cerium 144Ce 285 days b I, ING, SC
Iodine 131I 8 days b I, ING
Thorium 234Th 24 days a, b I, ING, SC
Americium 241Am 430 yrs a I
Curium 243Cm 35 yrs a I
Neptunium 237Np 2.2 mil yrs a I
76 of all Fallout
Always some
CDC List of Interest out of 300
I Inhalation, ING Ingestion, SC Skin
Contact, WHE Whole Body Exposure, FF Full
Face Respirator
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RADIATION DECAY
AFRRI - MEIR
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Fallout is distributed downwind from the blast
site in a plume-like pattern.
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ELECTROMAGNETIC PULSE (EMP)

• At the instant of the detonation (same time as
  thermal, gamma, and light)
• Greatest nearest the epicenter and only lasts
  seconds
• Disruption of the electrical grid, electronic and
  communications equipment
• Equipment entering the area after EMP will
  function normally
• Cell phones and handheld radios with small
  antennas may not be affected (Repeaters and
  towers will be)

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INITIAL BLAST INJURY

• Thermal
• Burns
• Mortality Increases With Radiation
• High Intensity Visible Light
• Eye Damage

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BLAST INJURY

• Over Pressure and Under Pressure
• Blunt Trauma
• Penetrations

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SHELTERING IN PLACE (SIP)

• SIP will normally be the preferred protective
  action.
• SIP should be directed if the projected effective
  dose greater than 10 mSv (1 rem).
• SIP need not be implemented if the projected
  effective dose is less than 1 mSv (100 mrem).

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SHELTERING IN PLACE (SIP)

• A brick building provides better protection than
  a brick veneer building, which is better than
  that of a frame building.
• Less radiation exposure (increasing the
  Protection Factor) is seen at interior locations
  and below ground
• Moving to a higher floor in the building
  increases the distance from the ground source but
  increases exposure from radiation on the rooftop.
  

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SHELTERING IN PLACE (SIP)
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FEAR
RADIATION
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Radiation ???
Maybe Im contaminated OH what shall I do
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GOIANIA, BRAZIL 1987

• 249 people contaminated
• 20 people hospitalized
• 4 people died
• 2000 m2 contaminated.
• 112,800 monitored in soccer stadium

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Which Do You Fear Most?
OR
H1N1 influenza pandemic (1918-1919) killed more
people than WW I 20 to 40 mil.
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Which Do You Fear Most?
OR
Yersinia pestis Deaths Plague of Justinian
(541542 AD) 25 mil. in Byzantine Empire Black
Death (1348 - 1350) 40 60 of Europe Great
Plague (16651666) 20 of London
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What would you rather live next to?
Warning Time to Evacuate
OR
Little or No Warning
Union Carbide India Limited 12/84, methyl
isocyanate gas release
Three Mile Island - 0 Death/Injuries Fukushima -
0 Deaths 3 injuries (latent period?) Chernobyl
Warning time not used SIP, KI, evacuation
too late 47 known deaths from ARS
gt9,000 Cancer WHO estimated 2006

• 3,787 Dead
• 558,125 injuries
• 38,478 temporary partial disabling
• 3,900 severely/permanently
• disabling

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WOUNDS AND RADIATION

• WOUNDS LEFT OPEN AND ALLOWED TO HEAL ARE
  POTENTIALLY FATAL DUE TO INFECTION
• WOUND HEALING MARKEDLY COMPROMISED WITHIN HOURS
  OF RADIATION INJURY
• WOUNDS SHOULD BE CLOSED AS SOON AS POSSIBLE.
• EXTENSIVE DEBRIDEMENT OF WOUNDS MAY BE NECESSARY
• CHECK WOUNDS PRIOR TO CLOSING WITH GEIGER COUNTER
  OR OTHER SOURSEALPHA CAN BE MASKED BY BLOOD

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RADIOLOGICAL DECONTAMINATION SHOULD NEVER
INTERFERE WITH ACUTE MEDICAL CARE. UNLIKE
CHEMICAL AGENTS, RADIOACTIVE PARTICLES WILL NOT
CAUSE ACUTE INJURY
Medical Management Of Radiological Casualties
Handbook, Second Edition, Military Medical
Operations Armed Forces Radiobiology Research
Institute, April 2003
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IONIZING RADIATION

• In most cases patients
• subjected to nuclear
• or radiological agents
• will be exposed, but
• not contaminated.

Hiroshima thermal burn victim
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IONIZING RADIATION

• A person is externally contaminated if
  radioactive material is on skin or clothing.
• A person is internally contaminated if
  radioactive material is breathed in, swallowed,
  or absorbed through wounds.
• The environment is contaminated if radioactive
  material is spread about or uncontained.  

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CPM

• A measure of radioactivity.
• The number of atoms in a given quantity of
  radioactive material that are detected to have
  decayed in one minute.
• Versus Disintegration Per Minute (DPM)

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ROENGTON (R)

• Used to measure a quantity called exposure.
• Gamma and X-rays, and only in air.
• Measure of the ionizations of the molecules in a
  mass of air.
• The main advantage of this unit is that it is
  easy to measure directly

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RAD

• rad (radiation absorbed dose)
• Used to measure a quantity called absorbed dose.
• Amount of energy actually absorbed in material
• any type of radiation
• any material
• Does not describe the biological effects of the
  different radiations.

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REM (roentgen equivalent man)

• called equivalent dose.
• absorbed dose in human tissue to the effective
  biological damage of the radiation.
• Not all radiation has the same biological effect
• Equivalent dose is often expressed in terms of
  thousandths of a rem, or rem.

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DOSAGE

• For X rays and gamma rays in soft tissue
• Exposure Absorbed Dose Dose Equivalent
• 1 R 1 rad 1 rem

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DOSAGE
 UNITS RADIOACTIVITY ABSORBED DOSE DOSE EQUIVALENT EXPOSURE
Common Units curie (Ci) rad rem roentgen (R)
SI Units Becquerel (Bq) Gray (GY) Sievert (Sv) Coulomb (C)
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DOSAGE
Conversion Equivalence Conversion Equivalence Conversion Equivalence
1 curie 3.7 x 1010disintegrations per second 1 becquerel 1 disintegration per second
1 millicurie (mCi) 37 megabecquerels (MBq)
1 megabecquerel (MBq) 0.027 millicuries (mCi)
1 rad 0.01 gray (Gy)
1 rem 0.01 sievert (Sv)
1 gray (Gy) 100 rad
1 sievert (Sv) 100 rem
1 roentgen (R) 0.000258 coulomb/kilogram (C/kg)
1 coulomb/kilogram (C/kg) 3,880 roentgens
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CONVERSION FACTORS CONVERSION FACTORS CONVERSION FACTORS
To convert from To Multiply by
Curies (Ci) becquerels (Bq) 3.7 x 1010
millicuries (mCi) megabecquerels (MBq) 37
microcuries (µCi) megabecquerels (MBq) 0.037
milliroentgens (mR) microcoulombs/k (µC/kg) 0.258
millirads (mrad) milligrays (mGy) 0.01
millirems (mrem) microsieverts (µSv) 10

becquerels (Bq) curies (Ci) 2.7 x 10-11
megabecquerels (MBq) millicuries (mCi) 0.027
megabecquerels (MBq) microcuries (µCi) 27
microcoulombs/kilogram (µC/kg) milliroentgens (mR) 3.88
milligrays (mGy) millirads (mrad) 100
microsieverts (µSv) millrems (mrem) 0.1
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RADIATION PATIENT TRIAGE

• Contaminated/exposed patients
• Wounded but not contaminated/exposed
• Wounded and contaminated/ exposed

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Health Effects and Emergency Medical Conditions of Exposure to Radiation Health Effects and Emergency Medical Conditions of Exposure to Radiation Health Effects and Emergency Medical Conditions of Exposure to Radiation Health Effects and Emergency Medical Conditions of Exposure to Radiation Health Effects and Emergency Medical Conditions of Exposure to Radiation Health Effects and Emergency Medical Conditions of Exposure to Radiation Health Effects and Emergency Medical Conditions of Exposure to Radiation Health Effects and Emergency Medical Conditions of Exposure to Radiation
Condition Pre Clinical Clinical Clinical Clinical Clinical Lethal Lethal
Radiation 25 to 100 rem 100 to 250 rem 250 to 650 rem 650 to 1,000 rem 650 to 1,000 rem 1,000 to 35,000 rem over 35,000rem
Vomiting Incidents None 5 to 50 50 to 100 100 100 100 100
Vomiting Delay Time N/A 3 to 6 hours 2 to 3 hours 15 to 30 min 15 to 30 min 5 to 20 min less than 3 min
Leading Organ None Bone Marrow, Blood System, Stomach and Intestinal System Bone Marrow, Blood System, Stomach and Intestinal System Bone Marrow, Blood System, Stomach and Intestinal System Bone Marrow, Blood System, Stomach and Intestinal System Tiny Blood Vessels, Stomach and Intestinal System Brain, Spinal Cord (Central Nervous System)
Signs Mild Weakness Reduced White Blood Cells Destroyed White Blood Cells Destroyed White Blood Cells Destroyed White Blood Cells Diarrhea, Fever Convulsions, Tremors
Therapy Reassurance Blood System Restoration Blood Transfusion Drubs, (Cytokines) Blood Transfusion Drubs, (Cytokines) Bone Marrow Transplant Maintain Electrolytes Sedatives
Prognosis Excellent Excellent Good Good Poor Death Death
Incidence of Death None 0 to 5 15 to 80 15 to 80 80 to 90 Almost 100 100
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TREATMENT OF CONTAMINATED WOUNDS

• In a contamination accident, any wound must be
  considered contaminated until proven otherwise
  and should be decontaminated prior to
  decontaminating intact skin.

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RADIATION PATIENT MOVEMENT

• Contaminated Cocoon
• Remember blood and water mask alpha particles
• In Hospital movement

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PATIENT DECONTAMINATION

• Non-contaminated
• Contaminated
• Clothing
• Survey
• Dry Decontamination

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PATIENT DECONTAMINATION

• TAKE NASAL SWAB SAMPLE
• REMOVE CLOTHING
• DRY DECONTAMINATION
• WASH WITH SOAP AND WATER

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PATIENT DECONTAMINATION

• Skin
• Hot water versus cold water
• Contaminated bandages, water and bodily fluids
• When to stop

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BURN PATIENTS

• Cleansing process is the same as with intact skin
  (except no scrub brush)
• Consult Burn Unit FIRST
• Physicians/nurses at Local Burn Center can give
  guidance

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TAKE SAMPLES

• Samples should be taken at the earliest possible
  time.
• Blood white blood cells count is extremely
  important
• Urine some isotopes
• Stool (feces) some isotopes

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REASSURING THE PATIENT

• Radiation is NOT contagious
• Explain the reason for monitoring and lab testing
• Reassure the patient

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REASSURING THE STAFF

• Radiation is NOT contagious
• Ensure the staff including maintenance and
  housekeeping understand the hazards of radiation.
• If the staff is afraid then that will transfer to
  the patient.

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MEDICAL MANAGEMENT OF INTERNAL CONTAMINATION

• REDUCES THE ABSORBED RADIATION DOSE AND THE RISK
  OF FUTURE BIOLOGICAL EFFECTS
• DILUTING AND BLOCKING AGENTS ENHANCE ELIMINATION
  RATES OF RADIONUCLIDES (IODIDE COMPOUNDS)
• MOBILIZING OR CHELATING AGENTS (CALCIUM EDETATE
  (EDTA)

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MEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATION MEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATION MEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATION MEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATION
Isotope Drug Administestration Comments
Americium Ca-DTPA, Zn-DTPA Parenteral Zn-DTPA is initially 10 times less effective than Ca-DTPA for initial chelation of transuranics. After 24 hours efficiency of both agents is about the same.
Cesium Prussian blue Oral Acts by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time.
Cobalt Unknown try penicillamine Oral Nothing too good
Iodine Potassium Iodide (KI) Oral Within about first 4 hours, used to block uptake of radioactive iodine.
Iridium Unknown try penicillamine Oral Nothing too good
Palladium Unknown try penicillamine Oral Nothing too good
Phosphorus Na phosphate or K phosphate. Oral Used to block uptake of radioactive phosphate
Plutonium Ca-DTPA, Zn-DTPA Parenteral Zn-DTPA is initially 10 times less effective than Ca-DTPA for initial chelation of transuranics. After 24 hours efficiency of both agents is about the same.
Radium calcium Oral Alginates are also useful to reduce GI absorption oral to reduce GI absorption and increase urinary excretion.
Rubidium Prussian blue  Oral Acts by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time.
Strontium Calcium Gluconate and Ammonium Chloride Intravenous Oral ammonium chloride for acidification. Alginates are useful to reduce gastrointestinal absorption.
Thallium Prussian blue  Oral Acts by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time.
Tritium Water Oral Force water to promote diuresis
Uranium Ca-DTPA, Zn-DTPA Parenteral Na bicarbonate to alkalinize urine - see comments by Americium
Yttrium Ca-DTPA, Zn-DTPA Parenteral Within 4 hours only. - see comments by Americium
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PUBLIC HEALTH RESPONSE

• Protecting the publics health and safety.
• Education is the key. Fear of radiation is
  higher than other agents of terrorism. People are
  unfamiliar with radiation, including medical and
  public health professionals.
• Monitoring workers health and safety.
• Ensuring provision of health, medical services,
  mental health,
• safe shelters for the population.
• safety of food and water supplies.

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PUBLIC HEALTH RESPONSE

• Coordinating field investigations, sampling and
  laboratory analysis of biological and
  environmental samples.
• Assisting and Advising communities in
  decontamination and radiation response for public
  health and safety.
• Developing criteria for entry and operations
  within the incident site.

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PUBLIC HEALTH RESPONSE

• Population Monitoring is a process that directly
  after a radiation incident is reported and
  continues well into the recovery and after.
• Needed medical treatment.
• Presence of radioactive contamination
• Intake of radioactive materials into the body.
• Removal of external or internal contamination
• Dose received and resulting health risk from
  exposure.
• Long-term health effects on people and offspring.

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PUBLIC HEALTH RESPONSE

• Recommending radiation management protocols,
  prevention, and control measures for affected
  populations or individuals.
• Communicating necessary information to hospitals,
  medical providers, situation assessments and
  required safety measures to the public.
• Assisting law enforcement agencies with the
  criminal investigation.

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STRATEGIC NATIONAL STOCKPILE (SNS)

• The SNS is organized for flexible response
• Arizona State and Counties have plans receive and
  distribute SNS medicine and medical supplies
• Vendor Managed Inventory

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STRATEGIC NATIONAL STOCKPILE (SNS)

• National Repository Of
• Antibiotics,
• Chemical Antidotes,
• Radiation Drugs
• Antitoxins,
• Life-support Medications,
• IV Administration,
• Airway Maintenance Supplies,
• And Medical/Surgical Items.

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Are We Done Yet ?
Just a minute, one more thing
Go To
http//www.remm.nlm.gov/