Radiologic Terrorism • Radiation Exposure • Dirty Bombs • Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb • Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR • Management of pregnant women and children
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Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three.
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Chernobyl accident, April 26, 1986, in the Ukrainian SSR
• Management of pregnant women and children
Management of Pregnant Women and Children Exposed to Radiation
• Evacuation– Priority evacuation protocols for pregnant
women, infants and pre-pubertal children– Evacuation to an identified location at least 50
miles from the source of radiation
• Potassium Iodide– KI tablets or liquid administered on
notification by authorities of the possibility of radiation exposure.
– Dose schedules and negligible toxicity
Evacuation of Pregnant Women and Children Exposed to Radiation
• Priority Evacuation– Priority identification signs should be provided
to pregnant women and families of infants and pre-pubertal children to display on the windshield for priority rapid “HOV-lane” emergency evacuation.
– Evacuation routes should be defined in advance.
• Distance from Radiation Source– The radiation plume travels in the direction and
at the speed of the prevailing winds.– Biologically significant radiation exposure may
occur 100-200 miles from the source depending upon the atmospheric conditions.
Management of Pregnant Women and Children Exposed to Radiation
• Evacuation– Priority evacuation protocols for pregnant
women, infants and pre-pubertal children– Evacuation to an identified location at least 50
miles from the source of radiation
• Potassium Iodide– KI tablets or liquid administered on
notification by authorities of the possibility of radiation exposure.
– Dose schedules and negligible toxicity
KI Therapy for Pregnant Women and Children Exposed to Radiation
• Potassium Iodide for Radioiodine Exposure– Pre-packaged, pre-distributed KI tablets or liquid
should be readily available in homes, schools, day care centers and nurseries near reactors.
– On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency.
• KI toxicity– Negligible, minor side effects, and rare in children.
Potassium Iodide Doses
AAP Committee on Environmental Health. Pediatrics 2003;111:1459
KI Therapy for Pregnant Women and Children Exposed to Radiation
• Potassium Iodide for Radioiodine Exposure– Pre-packaged, pre-distributed KI tablets or liquid
should be readily available in homes, schools, day care centers and nurseries near reactors.
– On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency.
• KI toxicity– Negligible except in very rare cases of iodinism.
Potassium Iodide Safety• KI toxicity
– Acute poisoning is uncommon– Hypersensitivity reactions are rare, but dangerous:
• Angioedema and laryngeal edema• Serum-sickness-like reactions
• Priority EvacuationDefined routes [HOV Routes]Priority evacuation Identification on vehicles
• Potassium iodidePriority 1: pregnant women and infantsPriority 2: young children
• Monitor TSH in infants and pregnant women
Radiologic Terrorism: Bibliography• Williams, Dillwyn. Science and society: Cancer after
nuclear fallout: lessons from the Chernobyl accident. Nature Reviews Cancer 2002;2:543-549 (01 Jul). [Review]
• CDC: www.bt.cdc.gov/radiation• AAP Policy Statement. Radiation disasters and children.
Pediat 2003;111(6):1455-1466.• Mettler FA, Voelz GL. Major radiation exposure – what to
expect and how to respond. NEJM 2002;346:1554-1561.• www.atomicarchives.com/Example/ExampleStart.shtml• Nauman J, Wolff J. Iodide prophylaxis in Poland after the
Chernobyl reactor accident: Benefits and risks. Am J Med 1993;94(5):524-532. [Review]
• Nagataki S, Yamashita S, Eds. Nagasaki Symposium Radiation & Human Health, Elsevier, 1996, p xii.