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INTRODUCTION
• What is Radiation?
• Types of Radiation
o Nonionizing Radiation
o Ionizing Radiation
INTRODUCTION
• Radiation Spreading Events
o
o
o
o
o
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
INTRODUCTION
Why are we afraid of Radiation?
Measuring Radiation
Patient Decontamination
Health Effects of radiation
Medical Management of
Radiation Patients
• Public Health Response
•
•
•
•
•
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.
Properties
Mass
Electrical
Charge
Alpha (a)
Large mass 2 protons and 2
neutrons (4 amu)(helium
nucleus)
Beta (b)
Solid mass (about 1/1838
of 1 amu)
Gamma (g)
No mass electromagnetic wave
or photon
Neutron (n)
Mass of 1 amu
+ 2 positive
-1 negative
None
None
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)
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
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.
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.
Usually emitted by
transuranic elements:
Uranium, Plutonium,
Americium, Radon, Radium
Fissionable products such Fission Products. in soil,
as Cesium 137, Tritium,
industrial and medical sources.
Carbon-14, and iodine 132 Cesium 137, Cobalt 60,
depleted Uranium
Range in the air
Shielding
External Hazard
Biological
Hazard
Sources
Few natural sources. Fission
nuclear reactors. Cosmic
radiation Plutonium,
Californium 252.
TYPES OF RADIATION
IN ORDER OF PENETRATION
• Alpha Particles
• Beta Particles
• Gamma Rays
• Neutron Particles
LIMITING EXPOSURE
• AS LOW AS REASONABLY
ACHIEVABLE (ALARA)
o
o
o
TIME
DISTANCE
SHIELDING
INVERSE SQUARE LAW
A = 4x = 32 rem
B = x = 8 rem
C = 1/4x = 2 rem
RADIATION POISONING
• Place in food or water
• Gets more difficult with increase in
number of people to poison
• Creates panic
• Doesn’t require explosives or high
technology
• Done effectively in the past.
• Slow to affect people, but time is
dose dependent
RADIATION POISONING
• Alexander Litvinenko
o
o
o
o
o
o
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
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
RADIATION DXPOSURE DEVICE (RED)
RADIOLOGICAL DISPERSAL DEVICE
(RDD)
• Conventional explosive
incorporating radioactive
materials
• Explosion greatest hazard
• Mostly creates panic with little
injury
NUCLEAR DETONATION
• TWO DIFFERENT THREATS
o
o
Nuclear Weapon Detonation (HIGH
YEILD)
Improvised Nuclear Detonation
(IND) (LOW YEILD)
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)
o
Produces same physical and medical
effects as nuclear weapon explosion
IMPROVISED NUCLEAR
DEVICE (IND)
o
o
o
o
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
FALLOUT MAP (PLUME)
FISSION PRODUCTS FROM A NUCLEAR DETONATION
Isotope
Name
Cesium
Strontium
Carbon
Zirconium
Uranium
Uranium
Plutonium
Cesium
Yttrium
Tellurium
Antimony
Ruthenium
Cerium
Iodine
Thorium
Americium
Curium
Neptunium
Symbol
137Cs
90Sr
14 C
95 Zr
235U
238U
239Pu
134Cs
91Y
127Te
125Sb
106Ru
144Ce
131I
234Th
241Am
243Cm
237Np
Half Life
Alpha (a)
Beta (b)
Gamma (g)
30 yrs
29 yrs
5,730 yrs
65 days
700 mil yrs
4.47 bil yrs
24 Thou yrs
3 yrs
58 Days
105 days
2 yrs
1 yrs
285 days
8 days
24 days
430 yrs
35 yrs
2.2 mil yrs
b, g
b
b
b
a
a
a
b, g
b
b, g
b
b
b
b
a, b
a
a
a
Radiotoxicity
Hazard
I, ING, SC, WBE
I, ING, SC
I, ING, SC
I, ING, SC
I, IHG,
I, IHG,
I, IHG,
I, ING, SC, WBE
I, ING
I, ING, SC, WBE
I, ING, SC
I, ING, SC
I, ING, SC
I, ING
I, ING, SC
I
I
I
I – Inhalation, ING – Ingestion, SC – Skin Contact, WHE – Whole Body Exposure, FF – Full Face Respirator
76 %
of all
Fallout
Always
some
CDC List
of
Interest
out of
300+
RADIATION DECAY
AFRRI - MEIR
Fallout is distributed downwind from the
blast site in a plume-like pattern.
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)
INITIAL BLAST INJURY
• Thermal
o
o
Burns
Mortality Increases With Radiation
• High Intensity Visible Light
o
Eye Damage
BLAST INJURY
• Over Pressure and Under Pressure
o Blunt Trauma
o Penetrations
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).
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.
SHELTERING IN PLACE
(SIP)
Maybe I’m contaminated… OH what shall I do…
GOIANIA, BRAZIL 1987
•
•
•
•
•
249 people contaminated
20 people hospitalized
4 people died
2000 m2 contaminated.
112,800 monitored in soccer stadium
Which Do You Fear
Most?
OR
H1N1 influenza pandemic
(1918-1919) killed more
people than WW I –
20 to 40 mil.
Which Do You Fear
Most?
OR
Yersinia pestis Deaths
Plague of Justinian (541–542 AD)
25 mil. in Byzantine Empire
Black Death (1348 - 1350)
40 – 60 % of Europe
Great Plague (1665–1666)
20 % of London
What would you rather
live next to?
Warning
Time to Evacuate
OR
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
>9,000 Cancer WHO estimated 2006
Little or No Warning
Union Carbide India Limited
12/84, methyl isocyanate gas release
3,787 Dead
558,125 injuries
• 38,478 temporary partial disabling
• 3,900 severely/permanently
disabling
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 SOURSE…ALPHA CAN BE MASKED
BY BLOOD
“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
IONIZING RADIATION
In most cases patients
subjected to nuclear
or radiological agents
will be exposed, but
not contaminated.
Hiroshima thermal burn victim
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.
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)
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
RAD
• rad (radiation absorbed dose)
• Used to measure a quantity called
absorbed dose.
• Amount of energy actually absorbed
in material
o any type of radiation
o any material
• Does not describe the biological
effects of the different radiations.
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.
DOSAGE
• For X rays and gamma rays in
soft tissue
• Exposure ≈ Absorbed Dose ≈
Dose Equivalent
1 R ≈ 1 rad ≈ 1 rem
DOSAGE
UNITS
RADIOACTIVITY
Common
Units
curie (Ci)
SI Units
Becquerel
(Bq)
ABSORBED
DOSE
DOSE
EQUIVALENT
rad
rem
Gray (GY) Sievert (Sv)
EXPOSURE
roentgen
(R)
Coulomb
(C)
DOSAGE
Conversion Equivalence
1 curie = 3.7 x 1010
disintegrations 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
=
0.000258 coulomb/kilogram
(C/kg)
=
3,880 roentgens
1 roentgen (R)
1 coulomb/kilogram (C/kg)
CONVERSION FACTORS
To convert from
To
Multiply by
Curies (Ci)
millicuries (mCi)
microcuries (µCi)
milliroentgens (mR)
millirads (mrad)
millirems (mrem)
becquerels (Bq)
megabecquerels (MBq)
megabecquerels (MBq)
microcoulombs/k (µC/kg)
milligrays (mGy)
microsieverts (µSv)
3.7 x 1010
37
0.037
0.258
0.01
10
becquerels (Bq)
megabecquerels
(MBq)
megabecquerels
(MBq)
microcoulombs/kilo
gram (µC/kg)
milligrays (mGy)
microsieverts (µSv)
curies (Ci)
millicuries (mCi)
2.7 x 10-11
0.027
microcuries (µCi)
27
milliroentgens (mR)
3.88
millirads (mrad)
millrems (mrem)
100
0.1
RADIATION PATIENT
TRIAGE
• Contaminated/exposed patients
• Wounded but not
contaminated/exposed
• Wounded and contaminated/
exposed
Health Effects and Emergency Medical Conditions of Exposure to Radiation
Condition Pre Clinical
Clinical
Lethal
Radiation
25 to 100
rem
100 to 250
rem
250 to 650
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 %
Vomiting
Delay Time
N/A
3 to 6
hours
5 to 20 min
less than 3 min
Leading
Organ
Signs
Therapy
None
Mild
Weakness
2 to 3 hours 15 to 30 min
Bone Marrow, Blood System, Stomach
and Intestinal System
Reduced
White
Blood
Cells
Blood
System
Reassurance
Restoratio
n
Destroyed White Blood
Cells
Tiny Blood Vessels,
Brain, Spinal
Stomach and
Cord (Central
Intestinal System Nervous System)
Diarrhea, Fever
Convulsions,
Tremors
Blood
Transfusion
Drubs,
(Cytokines)
Bone
Marrow
Transplant
Maintain
Electrolytes
Sedatives
Prognosis
Excellent
Excellent
Good
Poor
Death
Death
Incidence of
Death
None
0 to 5 %
15 to 80 %
80 to 90 %
Almost 100 %
100 %
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.
RADIATION PATIENT
MOVEMENT
• Contaminated – Cocoon
• Remember blood and water
mask alpha particles
• In Hospital movement
PATIENT DECONTAMINATION
• Non-contaminated
• Contaminated
– Clothing
– Survey
– Dry Decontamination
PATIENT DECONTAMINATION
• TAKE NASAL SWAB SAMPLE
• REMOVE CLOTHING
• DRY DECONTAMINATION
• WASH WITH SOAP AND WATER
PATIENT DECONTAMINATION
• Skin
• Hot water versus cold water
• Contaminated bandages, water
and bodily fluids
• When to stop
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
TAKE SAMPLES
• Samples should be taken at
the earliest possible time.
o
Blood – white blood cells
count is extremely important
o
Urine – some isotopes
o
Stool (feces) – some isotopes
REASSURING THE
PATIENT
• Radiation is NOT contagious
• Explain the reason for
monitoring and lab testing
• Reassure the patient
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.
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)
MEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATION
Isotope
Americium
Drug
Ca-DTPA, Zn-DTPA
Administestrati
on
Comments
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
Strontium
Calcium Gluconate and
Ammonium Chloride
Thallium
Tritium
Prussian blue
Water
Oral
Intravenous
Oral
Oral
Acts by ion-exchange, adsorption, and mechanical trapping
within crystal structure. Not absorbed through intact GI wall.
Clearance depends on GI transit time.
Oral ammonium chloride for acidification. Alginates are useful to
reduce gastrointestinal absorption.
Acts by ion-exchange, adsorption, and mechanical trapping
within crystal structure. Not absorbed through intact GI wall.
Clearance depends on GI transit time.
Force water to promote diuresis
PUBLIC HEALTH RESPONSE
• Protecting the public’s 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,
o safe shelters for the population.
o safety of food and water supplies.
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.
PUBLIC HEALTH RESPONSE
• Population Monitoring is a process that directly
after a radiation incident is reported and
continues well into the recovery and after.
o
o
o
o
o
o
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.
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.
STRATEGIC NATIONAL
STOCKPILE (SNS)
• The SNS is organized for
flexible response
o
o
Arizona State and Counties have
plans receive and distribute SNS
medicine and medical supplies
Vendor Managed Inventory
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.
Are We Done Yet ?
Just a minute,
one more thing……
Go To
http://www.remm.nlm.gov/

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