RADIOLOGICAL DISPERSAL RADIOLOGICAL DISPERSAL DEVICE DEVICE “ “ DIRTY BOMB” DIRTY BOMB” Jordan H. Hankins, M.D. Jordan H. Hankins, M.D. University of Nebraska University of Nebraska Medical Center Medical Center Omaha Omaha
Feb 02, 2016
RADIOLOGICAL DISPERSAL RADIOLOGICAL DISPERSAL DEVICEDEVICE
““DIRTY BOMB”DIRTY BOMB”
Jordan H. Hankins, M.D.Jordan H. Hankins, M.D.University of Nebraska Medical University of Nebraska Medical Center Center OmahaOmaha
““Dirty Bomb” Dirty Bomb” (Radiological Dispersal Device)(Radiological Dispersal Device)
A dirty bomb is a “normal” bomb that A dirty bomb is a “normal” bomb that contains radioactive material as well as contains radioactive material as well as explosivesexplosives
After the initial blast of the explosives After the initial blast of the explosives radioactive material is dispersed, radioactive material is dispersed, spreading out radiation and spreading out radiation and contamination (that’s where the word contamination (that’s where the word “dirty” comes from)“dirty” comes from)
Why is the Dirty Bomb Why is the Dirty Bomb a Concern?a Concern?
Relatively easy to makeRelatively easy to make
Effects from radiation could be Effects from radiation could be more long-lasting than other types more long-lasting than other types of agents used in terrorismof agents used in terrorism
Could result in panic as well as Could result in panic as well as major economic, social impactmajor economic, social impact
Health Concerns of a Health Concerns of a Dirty BombDirty Bomb
The initial blast from the The initial blast from the explosive could kill peopleexplosive could kill people
The radioactive material released The radioactive material released in the blast may deposit on in the blast may deposit on (contaminate) people, their (contaminate) people, their clothing, and the ground surfaceclothing, and the ground surface
Radioactive material
Conventional explosive(e.g. fertilizer, semtex)
Time fuse
Detonator
Radioactive Dispersal Device (RDD)
Topics that we will coverTopics that we will cover
What is ionizing radiation?What is ionizing radiation?How is it harmful?How is it harmful?
Radiation threat scenarios Radiation threat scenarios
Appropriate medical responsesAppropriate medical responses
Psychological aspectsPsychological aspects
ResourcesResources
Radioactivity
The Electromagnetic Spectrum
Photon RadiationPhoton Radiation
Gamma and X-raysGamma and X-rays– Electromagnetic – like lightElectromagnetic – like light– Gamma from a radioactive nucleusGamma from a radioactive nucleus– X-rays from a deviceX-rays from a device– Penetrating Penetrating – Responsible for whole body radiationResponsible for whole body radiation– Cause of almost all radiation deathsCause of almost all radiation deaths
Particulate RadiationParticulate Radiation(from a radioactive nucleus)(from a radioactive nucleus)
AlphaAlpha– Range is less than a cell lengthRange is less than a cell length– No damage on the skin surfaceNo damage on the skin surface– If absorbed potential for injuryIf absorbed potential for injury
BetaBeta– Range is <1mm ~1cm in tissueRange is <1mm ~1cm in tissue– Can produce a “beta burn” on skinCan produce a “beta burn” on skin
Neutron – not a factor in the pastNeutron – not a factor in the past
Alpha, beta and gamma rays
The “Dirty Bomb”The “Dirty Bomb”
What are the radioisotopes?What are the radioisotopes?– I-131I-131 8 days 8 days– Ir-192Ir-192 74 days 74 days– Co-60 Co-60 5 years 5 years– Sr-90Sr-90 28 years 28 years– Cs-137 Cs-137 30 years 30 years– Ra-226Ra-226 1620 years1620 years– C-14C-14 5730 years 5730 years
How Does Radiation Injure How Does Radiation Injure Biological TissueBiological Tissue
Produces free radicalsProduces free radicals
Breaks chemical bonds in DNABreaks chemical bonds in DNA
May start programmed cell death known May start programmed cell death known as apoptosisas apoptosis
There are repair mechanisms which can There are repair mechanisms which can repair single strand breaks in DNArepair single strand breaks in DNA
Interaction of alpha, beta, gamma rays with matter:
Ionization
When is Radiation Harmful?When is Radiation Harmful?When is Radiation Harmful?When is Radiation Harmful?
Dose Dose
(Acute Exposure)(Acute Exposure)
EffectsEffects
15 Rem15 Rem First physical effects First physical effects
(white blood cell count)(white blood cell count)
100 Rem100 Rem Threshold for radiation sickness Threshold for radiation sickness (e.g., nausea, anorexia, vomiting)(e.g., nausea, anorexia, vomiting)
450 Rem450 Rem 50% will die within 30 days without 50% will die within 30 days without medical treatmentmedical treatment
Radiation Dose ComparisonsRadiation Dose Comparisons
Average background radiation dose is 0.3 remAverage background radiation dose is 0.3 rem // yearyear
A mammogram produces about 1.0 mremA mammogram produces about 1.0 mrem
A CT scan produces about 1.0 remA CT scan produces about 1.0 rem
Sources of RadiationSources of Radiation
BackgroundBackground– CosmicCosmic– TerrestrialTerrestrial– InternalInternal
Industrial and TherapyIndustrial and Therapy– DevicesDevices– SourcesSources
Example Radiation DosesExample Radiation DosesExample Radiation DosesExample Radiation DosesChest Dental x-rayChest Dental x-ray 5 – 10 mrem5 – 10 mrem
Flying RT from LA to ParisFlying RT from LA to Paris 10 mrem10 mrem
Hip X-rayHip X-ray 80 mrem80 mrem
Annual Dose to the Average Annual Dose to the Average American from natural background American from natural background radiationradiation
300 mrem300 mrem
Heart Scan (Rest/Stress)Heart Scan (Rest/Stress) 1200 mrem1200 mrem
Whole Body CTWhole Body CT 3000 mrem3000 mrem
Annual Dose Limit for WorkersAnnual Dose Limit for Workers 5000 mrem5000 mrem
Threshold Dose for Radiation Threshold Dose for Radiation SicknessSickness
100,000 mrem100,000 mrem
Dose Effect RelationshipsDose Effect Relationships
Background radiation ~ 300 milli rem/yrBackground radiation ~ 300 milli rem/yr
Below 10 rad no laboratory effect foundBelow 10 rad no laboratory effect found
Below 50 rad no clinical effectBelow 50 rad no clinical effect
Above 120 rad nauseaAbove 120 rad nausea
Above 170 rad vomitingAbove 170 rad vomiting
LDLD5050 ~ 400 rad without treatment ~ 400 rad without treatment
LDLD100100 ~ 600 rad without treatment ~ 600 rad without treatment
TEDE Dose Comparable Risk
Comparable Risks
Living in New York City for6 Months (Pollution)
Working in a "Safe" Industry (e.g., Office Setting)
Smoking 14 Packs of Cigarettes
Average Radiation an AmericanReceives in 10 Years from NaturalBackground Radiation
Driving from LA to Atlanta
5 Rem
3 Rem
0 Rem
0.5 Rem
1 Rem
2 Rem
TEDE Dose Effects
Survival Improbable WithoutMedical Treatment (CRC)
LD 50/30 - Death of 50% ofPopulation Within 30 DaysWithout Medical Treatment (CRC)
Early Effects of Acute RadiationSyndrome. Survival 100%Without Medical Treatment (CRC)
25 Rem - Lifesaving Activities (EPA)
5 Rem - Annual Rad Worker Limit (NRC)
700 Rem
450 Rem
100 Rem
0 Rem
Fluoro-Induced Skin Injuries Fluoro-Induced Skin Injuries EffectEffect Single Dose ThresholdSingle Dose Threshold OnsetOnset
Early Transient ErythemaEarly Transient Erythema 200 rad200 rad 2 – 24 hr2 – 24 hr
Temporary EpilationTemporary Epilation 300 rad300 rad 3 Weeks3 Weeks
Permanent EpilationPermanent Epilation 700 rad700 rad 3 Weeks3 Weeks
Dry DesquamationDry Desquamation 1400 rad1400 rad 4 Weeks4 Weeks
Moist DesquamationMoist Desquamation 1800 rad1800 rad 4 Weeks4 Weeks
Secondary UlcerationSecondary Ulceration 2400 rad2400 rad > 6 Weeks> 6 Weeks
Ischemic Dermal NecrosisIschemic Dermal Necrosis 1800 rad1800 rad > 10 Weeks> 10 Weeks
Dermal AtrophyDermal Atrophy 1000 rad1000 rad > 12 Weeks> 12 Weeks
Dermal Necrosis Dermal Necrosis > 1200 rad> 1200 rad > 1 Yr> 1 Yr
ChernobylChernobyl Acute Radiation Syndrome Acute Radiation Syndrome
PatientsPatients rad Hours to # # Day ofrad Hours to # # Day of
N & V Pts Died DeathN & V Pts Died Death
80-200 80-200 >2 31 0 >2 31 0 - -
200-400200-400 1-2 1-2 43 43 11 96 96
400-600400-600 0.5-1 0.5-1 21 21 77 16-4816-48
600-1600 600-1600 0.50.5 2020 2020 10-9110-91
115 28115 28
Results of Significant Whole Results of Significant Whole Body Radiation ExposureBody Radiation Exposure
Rapidly DeliveredRapidly Delivered
Prodromal symptomsProdromal symptoms– Delayed 1 to 6 hoursDelayed 1 to 6 hours– Duration 48 hoursDuration 48 hours
Latent periodLatent period– For 2 to 3 weeks there is no outward signFor 2 to 3 weeks there is no outward sign
Acute Radiation SyndromesAcute Radiation Syndromes
Topics that we will coverTopics that we will cover
What is ionizing radiation?What is ionizing radiation?How is it harmful?How is it harmful?
Radiation threat scenariosRadiation threat scenarios
Appropriate medical responsesAppropriate medical responses
Psychological aspectsPsychological aspects
ResourcesResources
Radiation Threat ScenariosRadiation Threat Scenarios
Nuclear deviceNuclear device
Damage to nuclear power plantDamage to nuclear power plant
Dirty bombsDirty bombs
Nuclear DeviceNuclear Device
RiskRiskExposure to Exposure to rays and neutrons rays and neutronsFallout of fission products Fallout of fission products
(including short-lived iodine isotopes(including short-lived iodine isotopes))
OutcomeOutcomeLarge number of acute deathsLarge number of acute deathsLong-term carcinogenesisLong-term carcinogenesis
Likelihood Likelihood RemoteRemote
Attack on aAttack on a nuclear power plant nuclear power plant
RiskRiskAttack on the reactor itself:Attack on the reactor itself: Attack on stored used fuel elementsAttack on stored used fuel elements
Release of fission products: I-131, Cs-137, etcRelease of fission products: I-131, Cs-137, etc
OutcomeOutcomeUnlikely to involve acute deathsUnlikely to involve acute deathsLong-term carcinogenesisLong-term carcinogenesis
Likelihood Likelihood Extremely unlikelyExtremely unlikely
Dirty BombsDirty Bombs (Radioactive dispersal devices, RDD)(Radioactive dispersal devices, RDD)
RiskRiskRelease of radioactive cesium, cobalt or americiumRelease of radioactive cesium, cobalt or americium
Small number of contaminated peopleSmall number of contaminated people
Large number of very slightly contaminated peopleLarge number of very slightly contaminated people
Psychological chaos (many frightened people)Psychological chaos (many frightened people)
OutcomeOutcomeUnlikely to result in acute deathsUnlikely to result in acute deaths
Risk of long-term carcinogenesisRisk of long-term carcinogenesis
Likelihood Likelihood LikelyLikely
December 1998December 1998
Argun, Chechnya – A container filled with radioactive materials found attached to an explosive mine hidden near a railway line. It is safely defused.
The location is Argun, near the Chechen capital of Grozny, where a Chechen group, led by Shamil Basayev, operated an explosives workshop.
June 2002June 2002
Chicago, Illinois -- Jose Padilla, a US citizen with links to Al Qaeda, is arrested in Chicago airport on suspicion of planning to build and detonate a dirty bomb.
F.B.I agents suspect Padilla had recently undergone training in Pakistan, where he allegedly studied the mechanics of dirty-bomb construction, including how to wire explosive devices and how to optimize bombs for radiological dispersion.
January 2003January 2003
A collage of dirty bomb plans journalists recently discovered in Afghanistan
Herat, Afghanistan -- Based on evidence uncovered in Herat, including detailed diagrams and computer files, British intelligence agents conclude that Al Qaeda has succeeded in constructing a small dirty bomb, though the device has not been found.
August 1994August 1994
Three people Three people arrested at Munich arrested at Munich airport having airport having flown on a flown on a Lufthansa flight Lufthansa flight from Moscow from Moscow carrying 363 grams carrying 363 grams of plutoniumof plutonium
NovemberNovember 19951995
Moscow, Russia -- A group of Chechen rebels contacts a Russian TV station to claim that they have buried a cache of radiological materials in Moscow's Ismailovsky Park.
There, the authorities find a partially buried container of radioactive cesium.
March 1998March 1998
Cesium tubes similar to the ones missing from Greensboro
Greensboro, North Carolina -- Nineteen small tubes of cesium are taken from a locked safe in Moses Cone Hospital. The total activity was 22 Gbq (0.6 Ci).
Each tube was three-quarters of an inch long by one-eighth of an inch wide and were used in the treatment of cervical cancer. The cesium is never recovered.
March 2002March 2002Nucor Steel Mill, Hertford, NCNucor Steel Mill, Hertford, NC
2 Ci cesium industrial gauge found on scrap 2 Ci cesium industrial gauge found on scrap metal conveyer beltmetal conveyer belt
Traced back to a batch of four belonging to a Traced back to a batch of four belonging to a bankrupt Baltimore chemical company. Three bankrupt Baltimore chemical company. Three have been located.... have been located....
Quick TidbitQuick Tidbit
Industrial RadiographyIndustrial Radiographyaccounts for accounts for halfhalf of all reported of all reported serious radiation accidents serious radiation accidents worldwide in both developing & non-worldwide in both developing & non-developing countriesdeveloping countries
Moisture Density Gauges, contain small quantities Moisture Density Gauges, contain small quantities of americium-241 and cesium-237of americium-241 and cesium-237
About 22,000 in use in the US.About 22,000 in use in the US. About 50 per year reported as missing About 50 per year reported as missing
GoiGoiâânia, Brazil, 1987nia, Brazil, 1987Population 1.3 millionPopulation 1.3 million
Goiania Brazil IncidentGoiania Brazil Incident
Physicians abandon cancer clinic in Physicians abandon cancer clinic in 19851985
Also abandoned is an old (1950’s) Also abandoned is an old (1950’s) teletherapy unit containing about teletherapy unit containing about 1400 curies of Cesium-1371400 curies of Cesium-137
September 13, 1987; two September 13, 1987; two scavengers removed the lead scavengers removed the lead cylinder from the devicecylinder from the device
Cylinder sold to junkyard dealer; Cylinder sold to junkyard dealer; canister opened containing canister opened containing luminescent blue stones luminescent blue stones
Goiania, Brazil 1987Goiania, Brazil 1987
Therapy machine 1,400 Ci Cs-137Therapy machine 1,400 Ci Cs-137
Sold to junk dealer who saw a glowSold to junk dealer who saw a glow
He exposed source, invited neighborsHe exposed source, invited neighbors
20 significant exposures20 significant exposures– 8 Acute Radiation Syndromes8 Acute Radiation Syndromes– 4 deaths4 deaths– 6 year old girl ate ~ 27 mCi and died6 year old girl ate ~ 27 mCi and died
Chronology - GoianiaChronology - Goiania
Sept 10 – 13: Two scavengers got to disused clinic & Sept 10 – 13: Two scavengers got to disused clinic & dismantle the rotating assembly; take the shiny casing to dismantle the rotating assembly; take the shiny casing to one of their housesone of their houses
Sept 13: Both scavengers vomiting but assumed it was Sept 13: Both scavengers vomiting but assumed it was something they had eatensomething they had eaten
Sept 14: One scavenger has diarrhea & one hand visibly Sept 14: One scavenger has diarrhea & one hand visibly swollen swollen
Sept 15: Scavenger seeks medical attention, told it was Sept 15: Scavenger seeks medical attention, told it was some type of allergic reaction to something he atesome type of allergic reaction to something he ate
Chronology - GoianiaChronology - Goiania
Sept 18: Under a mango tree the source capsule’s 1 Sept 18: Under a mango tree the source capsule’s 1 mm window punctured & some source is removed, mm window punctured & some source is removed, source wheel is removedsource wheel is removed
Sept 18: Pieces of the rotating assembly sold to junkyard Sept 18: Pieces of the rotating assembly sold to junkyard owner who places in garage that nightowner who places in garage that night
-- Notices a blue glow & takes capsule Notices a blue glow & takes capsule into house.into house.-- Over the next 3 days relative & Over the next 3 days relative & acquaintances were invited to see the acquaintances were invited to see the
capsulecapsule
Chronology - GoianiaChronology - Goiania
Sept 21: Friend of junkyard owner removes fragments Sept 21: Friend of junkyard owner removes fragments who gave some to his brother & took the rest home who gave some to his brother & took the rest home (junkyard dealer also distributed fragments to family). (junkyard dealer also distributed fragments to family). Several individuals daub powder onto their skin.Several individuals daub powder onto their skin.
Sept 21-23: Wife of junkyard owner vomiting with Sept 21-23: Wife of junkyard owner vomiting with diarrhea & goes to hospital. Told allergic reaction to diarrhea & goes to hospital. Told allergic reaction to something she ate. Mother comes to care for her for 2 something she ate. Mother comes to care for her for 2 days before returning to her home taking a significant days before returning to her home taking a significant amount of contamination with her.amount of contamination with her.
Chronology - GoianiaChronology - Goiania
Sept 22-24: Junkyard workers work on extracting lead Sept 22-24: Junkyard workers work on extracting lead from rotating assemblyfrom rotating assembly
Sept 23: Scavenger admitted to hospital & then Sept 23: Scavenger admitted to hospital & then transferred to Tropical Diseases Hospitaltransferred to Tropical Diseases Hospital
Sept 24: Brother of junkyard owner takes some source Sept 24: Brother of junkyard owner takes some source fragments home & placed on table during a meal – 6 fragments home & placed on table during a meal – 6 year old daughter handles fragments while eatingyear old daughter handles fragments while eating
Sept 25: Lead & remnants sold to another junkyardSept 25: Lead & remnants sold to another junkyard
Chronology - GoianiaChronology - Goiania
Sept 28: Significant number of people ill. Wife of Sept 28: Significant number of people ill. Wife of junkyard owner is convinced glowing powder causing junkyard owner is convinced glowing powder causing sickness. sickness.
– Has an employee go to other junkyard to put remnants in a bagHas an employee go to other junkyard to put remnants in a bag
– They take the bag (by bus) to hospital & she places bag on desk They take the bag (by bus) to hospital & she places bag on desk of a physician & declares it is “killing her family”of a physician & declares it is “killing her family”
– Wife & employee take to health center & initially diagnosed as Wife & employee take to health center & initially diagnosed as contracting a tropical diseasecontracting a tropical disease
– One physician suspects patients’ skin lesions caused by One physician suspects patients’ skin lesions caused by radiation damage; physicians propose that a medical physicist radiation damage; physicians propose that a medical physicist look at the suspicious packagelook at the suspicious package
Chronology - GoianiaChronology - Goiania
Sept 29: Medical physicist arrives early & borrow Sept 29: Medical physicist arrives early & borrow a dose rate meter from a government agencya dose rate meter from a government agency– At some distance away from hospital turns on meter & At some distance away from hospital turns on meter &
goes to high scale irrespective of direction meter is goes to high scale irrespective of direction meter is pointed; assumed it is defective & goes back to fetch pointed; assumed it is defective & goes back to fetch a replacementa replacement
– In the interim physician at hospital calls in fire brigadeIn the interim physician at hospital calls in fire brigade
– Physicist determines there is a major source of Physicist determines there is a major source of radiation at hospital & stops fire brigade from dumping radiation at hospital & stops fire brigade from dumping source into riversource into river
Chronology - GoianiaChronology - GoianiaSept 29: Plans made for receiving contaminated Sept 29: Plans made for receiving contaminated persons in the city’s Olympic stadiumpersons in the city’s Olympic stadium– Over 112,000 people monitored for radioactivityOver 112,000 people monitored for radioactivity– 249 contaminated; 22 people identified at the stadium 249 contaminated; 22 people identified at the stadium
as highly exposedas highly exposed– Total of 4 deaths (2 men, 1 woman, 1 child)Total of 4 deaths (2 men, 1 woman, 1 child)
ChernobylChernobyl 27 April 1986 27 April 1986
The Worlds Largest Dirty BombThe Worlds Largest Dirty Bomb
Operator error and confusion combined Operator error and confusion combined with an unforgiving outdated designwith an unforgiving outdated design
A major steam explosion followed by A major steam explosion followed by firefire
ChernobylChernobyl
The explosion blew out and ruptured fuel The explosion blew out and ruptured fuel rodsrodsThe fire sent major radioactivity into the The fire sent major radioactivity into the smokesmokeFiremen sent to put out the fire with water Firemen sent to put out the fire with water wore wore canvas clothes which were canvas clothes which were permeable to water and carried the permeable to water and carried the radioactivity to the skin surfaceradioactivity to the skin surface
ChernobylChernobylHealth ConsequencesHealth Consequences
444 workers on site444 workers on site– 268 construction workers268 construction workers– 176 staff members176 staff members
In 30 minutes 29 admissions to medical In 30 minutes 29 admissions to medical stationstationStripped off water soaked clothesStripped off water soaked clothesOne death from traumaOne death from traumaOne death in 5 hrs from thermal burnOne death in 5 hrs from thermal burn
ChernobylChernobyl Acute Radiation Syndrome Acute Radiation Syndrome
PatientsPatients rad Hours to # # Day ofrad Hours to # # Day of
N & V Pts Died DeathN & V Pts Died Death
80-200 80-200 >2 31 0 >2 31 0 - -
200-400200-400 1-2 1-2 43 43 11 96 96
400-600400-600 0.5-1 0.5-1 21 21 77 16-4816-48
600-1600 600-1600 0.50.5 2020 2020 10-9110-91
115 28115 28
ChernobylChernobylHealth ConsequencesHealth Consequences
Triage for acute radiation syndrome was Triage for acute radiation syndrome was based on vomiting from 1 to 6 hours after based on vomiting from 1 to 6 hours after accidentaccident– Vomiting indicated > 170 radVomiting indicated > 170 rad
These people need a white countThese people need a white count
– No vomiting, no significant radiationNo vomiting, no significant radiation
Delay in vomiting was reliable in predicting Delay in vomiting was reliable in predicting who needed hospitalizationwho needed hospitalization
ChernobylChernobyl
At destination all clothes removedAt destination all clothes removedShowers and new clothesShowers and new clothesAverage of 12 rem to 135,000Average of 12 rem to 135,000At evacuation of Pripyat exposure rate was 12 At evacuation of Pripyat exposure rate was 12 rem/hourrem/hourEven frame houses provided protection from Even frame houses provided protection from falloutfalloutThere is use for duct tape and plastic sheetingThere is use for duct tape and plastic sheeting
ChernobylChernobyl
135,000 people lived within 30 km135,000 people lived within 30 kmThe town of Pripyat (45,000) was not The town of Pripyat (45,000) was not immediately evacuatedimmediately evacuatedThis was a correct decision that reduced This was a correct decision that reduced the population dosethe population dose1500 buses evacuated 45,000 in 3 hours1500 buses evacuated 45,000 in 3 hoursSpecial polymer to “oil” the roadsSpecial polymer to “oil” the roads
ChernobylChernobyl
16,000 cancers expected normally16,000 cancers expected normally
Estimated 300 to 700 fatal cancers will be Estimated 300 to 700 fatal cancers will be undetectable in the background of 16,000undetectable in the background of 16,000
Radiation induced cancers are undetectable in Radiation induced cancers are undetectable in the large number of naturally occurring cancersthe large number of naturally occurring cancers
Topics that we will coverTopics that we will cover
What is ionizing radiation?What is ionizing radiation?How is it harmful?How is it harmful?
Radiation threat scenarios Radiation threat scenarios
Appropriate medical responsesAppropriate medical responses
Psychological aspectsPsychological aspects
ResourcesResources
Radioactive Material Use at Radioactive Material Use at UNMC/The Nebraska Medical CenterUNMC/The Nebraska Medical Center
Radiation Oncology/Nuclear Medicine DepartmentsRadiation Oncology/Nuclear Medicine Departments
Designated Cancer Center (numerous therapies involving Designated Cancer Center (numerous therapies involving higher amounts of radioactive material)higher amounts of radioactive material)
Over 90 research labs with ~ 350 individuals working work Over 90 research labs with ~ 350 individuals working work with radioactive materialwith radioactive material
Dedicated Radiation Safety Office with many types of Dedicated Radiation Safety Office with many types of equipment used for radiation measuring/detection equipment used for radiation measuring/detection
Radiation Health CenterRadiation Health Center
Evaluation/Decontamination Evaluation/Decontamination CenterCenter
An incident caused by nuclear terrorism (accident) may An incident caused by nuclear terrorism (accident) may create large numbers of contaminated people who are create large numbers of contaminated people who are not injured and worried people who may not be injured or not injured and worried people who may not be injured or contaminatedcontaminated
Measures need to be Measures need to be taken to prevent these taken to prevent these people from people from overwhelming the overwhelming the emergency room – which emergency room – which is the purpose of the is the purpose of the Evaluation/DecontaminaEvaluation/Decontamination Centertion Center
Consideration for DeconConsideration for Decon Location Selection Location Selection
Consideration for DeconConsideration for Decon Location Selection Location Selection
– Shower & locker room facilities (M/F) highly Shower & locker room facilities (M/F) highly desirabledesirable
– ParkingParking
– Ability to secure siteAbility to secure site
– EMS and transport capabilitiesEMS and transport capabilities
– Shower & locker room facilities (M/F) highly Shower & locker room facilities (M/F) highly desirabledesirable
– ParkingParking
– Ability to secure siteAbility to secure site
– EMS and transport capabilitiesEMS and transport capabilities
Possible Candidates: Schools, Colleges, Community and Civic Centers
Decon Center LocationDecon Center Location Decon Center LocationDecon Center Location
UNMC’s onsite decon center located at its UNMC’s onsite decon center located at its student life building, but might also use UNO’s student life building, but might also use UNO’s field house and student recreation centerfield house and student recreation center
UNMC’s onsite decon center located at its UNMC’s onsite decon center located at its student life building, but might also use UNO’s student life building, but might also use UNO’s field house and student recreation centerfield house and student recreation center
Basic SetupBasic Setup All individuals initially monitored for All individuals initially monitored for contamination (e.g., portal monitor)contamination (e.g., portal monitor)
Individuals NOT contaminated (e.g., Individuals NOT contaminated (e.g., setting off monitor) are sent homesetting off monitor) are sent home
Individuals who are contaminated are Individuals who are contaminated are directed for decontamination & further directed for decontamination & further monitoringmonitoring
Major Instrumentation UsedMajor Instrumentation UsedMajor Instrumentation UsedMajor Instrumentation Used
• Portal MonitorPortal Monitor – Used to quickly – Used to quickly determine in an individual is determine in an individual is contaminatedcontaminated
• Survey MeterSurvey Meter – Can also be used to – Can also be used to determine if an individual is determine if an individual is contaminated and to pinpoint the contaminated and to pinpoint the location of the contaminationlocation of the contamination
• Personnel DosimetersPersonnel Dosimeters – Used by the – Used by the emergency response personnel to emergency response personnel to measure their radiation dose from the measure their radiation dose from the radiation given off by contaminated radiation given off by contaminated individualsindividuals
• Portal MonitorPortal Monitor – Used to quickly – Used to quickly determine in an individual is determine in an individual is contaminatedcontaminated
• Survey MeterSurvey Meter – Can also be used to – Can also be used to determine if an individual is determine if an individual is contaminated and to pinpoint the contaminated and to pinpoint the location of the contaminationlocation of the contamination
• Personnel DosimetersPersonnel Dosimeters – Used by the – Used by the emergency response personnel to emergency response personnel to measure their radiation dose from the measure their radiation dose from the radiation given off by contaminated radiation given off by contaminated individualsindividuals
Portal Monitors/Survey MetersPortal Monitors/Survey Meters
Portal monitors at entrance & Portal monitors at entrance & exit of the RHC will be used to exit of the RHC will be used to determine if victims are determine if victims are “clean”, or, have been “clean”, or, have been decontaminated (might also decontaminated (might also use one to clear ambulance & use one to clear ambulance & personnel)personnel)
Portal monitors are the best Portal monitors are the best option for monitoring a large option for monitoring a large number of individualsnumber of individuals
Detects low amounts of gamma Detects low amounts of gamma radioactivity as the individuals radioactivity as the individuals walk through (can use survey walk through (can use survey meters to localize areas of meters to localize areas of contamination)contamination)
Portal Monitor SpecificationsPortal Monitor SpecificationsPortal Monitor SpecificationsPortal Monitor Specifications
Can detect as low as Can detect as low as 1 uCi of Cs-137 at 1 uCi of Cs-137 at normal walking speednormal walking speed
Radiation detectors run Radiation detectors run vertically within PVC vertically within PVC postsposts
Easy to setupEasy to setup
Can run on “D” batteries Can run on “D” batteries if necessaryif necessary
Can detect as low as Can detect as low as 1 uCi of Cs-137 at 1 uCi of Cs-137 at normal walking speednormal walking speed
Radiation detectors run Radiation detectors run vertically within PVC vertically within PVC postsposts
Easy to setupEasy to setup
Can run on “D” batteries Can run on “D” batteries if necessaryif necessary
Kit provided allows Kit provided allows monitor to be usedmonitor to be used to survey vehiclesto survey vehicles
However, the major However, the major advantage of the portal advantage of the portal monitor over survey monitor over survey meters is meters is SPEEDSPEED
However, the major However, the major advantage of the portal advantage of the portal monitor over survey monitor over survey meters is meters is SPEEDSPEED
Decon Center FlowchartDecon Center Flowchart Decon Center FlowchartDecon Center Flowchart
Gym
Student Life Center Lower Level
Weights, Aerobics
Women'sLocker
Men'sLocker
Alarm
If able, Survey for Location of Contamination
ENTRY POINT
No Alarm
EXIT POINT
EX
IT P
OIN
TUNMC Decontamination Setup
ENTRY POINTEXIT POINT
Rop
e
Don Booties
"Clean" Checkout Desk
Dividing Curtain Gate
Gym Area Setup
No Alarm
Security
MinimumDistance = 6 ft
Carpet
Alarm(Shower)
De
con S
torag
e Ro
om
EXIT POINT
Rope
Checkout Desk
Gate
Shower SetupSecurity
ShowerArea
FromGym
SpotSurvey
Showering Sequence1. Undress2. Clothing placed in labeled plastic bag3. Personal items in smaller labeled plastic bag4. Shower (lukewarm)5. Towel off, don tyvek suits6. Take personal items, exit locker room, go to portal monitor
GoiGoiâânia incident: Equivalent tonia incident: Equivalent to large-sized dirty-bomb scenario in Manhattan large-sized dirty-bomb scenario in Manhattan
130,000 people (10%) came to ER / 130,000 people (10%) came to ER / temporary screening locationstemporary screening locations
250 (0.2%) were contaminated250 (0.2%) were contaminated
20 (0.01%) required treatment20 (0.01%) required treatment
UNMC Facilities Used for UNMC Facilities Used for Radiation Radiation
Accidents/TerrorismAccidents/Terrorism
Decontamination Room & Decontamination Room & Radiation Health Center (RHC)Radiation Health Center (RHC)
Evaluation/Decontamination Evaluation/Decontamination Center(sCenter(s))
Radiation Health CenterRadiation Health Center
Nebraska legislature in the early Nebraska legislature in the early 1970’s required that a Radiation 1970’s required that a Radiation Health Center be established as Health Center be established as the Fort Calhoun & Cooper the Fort Calhoun & Cooper Nuclear Stations were coming Nuclear Stations were coming onlineonline
Purpose of the RHC was primarily Purpose of the RHC was primarily to treat individuals injured at the to treat individuals injured at the nuclear power plants who were nuclear power plants who were radioactively contaminated or radioactively contaminated or exposed to high levels of radiation exposed to high levels of radiation (e.g., only a few individuals)(e.g., only a few individuals)
New ER Decontamination RoomNew ER Decontamination Room
Hixson-Lied Center for Clinical Excellence Hixson-Lied Center for Clinical Excellence has recently openedhas recently opened
Decontamination Room, near the entrance Decontamination Room, near the entrance of ER, designed to decontaminate of ER, designed to decontaminate individuals contaminated with chemicals or individuals contaminated with chemicals or injured victims contaminated with injured victims contaminated with radioactivity radioactivity
Will be used as the new location of the Will be used as the new location of the Radiation Health CenterRadiation Health Center
Exposure Exposure vs.vs. Contamination Contamination
External Exposure: External Exposure: irradiation of the body irradiation of the body from external source from external source
Contamination: Contamination: radioactive radioactive material on patient material on patient (external) or within patient (external) or within patient (internal) (internal)
Removing internal contamination is more problematic
Decontamination room located adjacent to the Decontamination room located adjacent to the new ER (covered parking for ambulance)new ER (covered parking for ambulance)
Grated floor allows collection of rinse (sump pump Grated floor allows collection of rinse (sump pump into a 55 gallon barrel)into a 55 gallon barrel)
Hose reel for additional Hose reel for additional decon capability (e.g. decon capability (e.g. decon gurney)decon gurney)
Bathroom in Decon Room (e.g., forexcreta collection, hand decon)
Radioactive “clean” victims can then be sent Radioactive “clean” victims can then be sent directly in the ERdirectly in the ER
Patient Management - PrioritiesPatient Management - Priorities
Standard medical triage is the highest Standard medical triage is the highest prioritypriority –– don’t delay givingdon’t delay givingcritical care because a patient is critical care because a patient is contaminatedcontaminated
Radiation exposure and contamination Radiation exposure and contamination arearesecondary considerations secondary considerations
Staff radiation protection Staff radiation protection
Fundamental PrinciplesFundamental Principles -- Time Time -- Distance Distance -- Shielding Shielding
Personnel Protective EquipmentPersonnel Protective Equipment
Contamination ControlContamination Control
Maximize DistanceMaximize DistanceMaximize DistanceMaximize Distance
Radiation dose rate drops off significantly Radiation dose rate drops off significantly as you increase your distance from the as you increase your distance from the sourcesource
Radiation dose rate drops off significantly Radiation dose rate drops off significantly as you increase your distance from the as you increase your distance from the sourcesource
SummarySummary
““Dirty Bomb”Dirty Bomb”– Remove radioactive debris from bodyRemove radioactive debris from body
Remove imbedded radioactivity in woundsRemove imbedded radioactivity in wounds
Become proficient with your radiation detection Become proficient with your radiation detection equipmentequipment
At 1rad/hour you can work within guidelines for ~ At 1rad/hour you can work within guidelines for ~ 5 hours5 hours
We’re All in the Same We’re All in the Same Boat Together!Boat Together!
The UNMC Radiation The UNMC Radiation RHC/Decon Room RHC/Decon Room cannot handle large cannot handle large quantities of victimsquantities of victims
Everyone (hospitals) Everyone (hospitals) needs to be capable needs to be capable of handling of handling radioactively radioactively contaminated victimscontaminated victims
Topics that we will coverTopics that we will cover
What is ionizing radiation?What is ionizing radiation?How is it harmful?How is it harmful?
Radiation threat scenarios Radiation threat scenarios
Appropriate medical responsesAppropriate medical responses
Psychological aspectsPsychological aspects
ResourcesResources
Dirty BombDirty BombDirty BombDirty Bomb
Actual health effects from the Actual health effects from the radioactivity are likely radioactivity are likely minimalminimal – – the terror is based on people’s the terror is based on people’s psychological fear of radiation …… psychological fear of radiation …… a dirty bomb is a dirty bomb is NOTNOT a nuclear a nuclear bombbomb
Might be more appropriately called Might be more appropriately called a “Weapon of Mass Disruption”a “Weapon of Mass Disruption”
o
There Has Been a Fear of There Has Been a Fear of Radiation Beyond its Radiation Beyond its
CapabilityCapabilityRadiation is an excellent terror weaponRadiation is an excellent terror weapon– Fear of the “dirty bomb”Fear of the “dirty bomb”– Fear of a nuclear explosion at a nuclear Fear of a nuclear explosion at a nuclear
power plantpower plant
Actually, it is inefficient to kill humans with Actually, it is inefficient to kill humans with radiation, short of a nuclear explosionradiation, short of a nuclear explosion
Goiania Brazil IncidentGoiania Brazil IncidentFood and clothing products of Food and clothing products of Goiás were not accepted by people Goiás were not accepted by people outside Goiania for several weeks outside Goiania for several weeks after GRI because of contamination after GRI because of contamination fearsfears
Reported that the important clothing Reported that the important clothing and other industries in Goiânia and other industries in Goiânia suffered reduced sales of about suffered reduced sales of about 40% during the months of October 40% during the months of October and Novemberand November
Travelers from Goiânia were Travelers from Goiânia were occasionally refused rooms hotels occasionally refused rooms hotels in other states of Brazil. in other states of Brazil.
No. of No. of PeoplePeople
DoseDose
3333 5 – 100 Rem5 – 100 Rem
44 100 – 200 Rem100 – 200 Rem
22 200 – 300 Rem200 – 300 Rem
11 300 – 400 Rem300 – 400 Rem
11 500 – 600 Rem500 – 600 Rem
11 700 Rem700 Rem
THREETHREEMILE MILE
ISLANDISLAND
PENNSYLVANIAPENNSYLVANIAMarch 28 – 31, 1979March 28 – 31, 1979
Average dose to nearest 2 M – 1 mremAverage dose to nearest 2 M – 1 mrem
Average Yearly DeathsAverage Yearly Deaths
Radiation accidentsRadiation accidents 22– World wide including ChernobylWorld wide including Chernobyl
AutomobileAutomobile 50,00050,000– Just for USAJust for USA
FireFire 8,000 8,000– Just for USAJust for USA
Our Radiation MindsetOur Radiation Mindset
““China Syndrome”China Syndrome”
Three Mile IslandThree Mile Island
““On The Beach”On The Beach”
ChernobylChernobyl
““Deadly Radiation” not just radiationDeadly Radiation” not just radiation
The The conceptconcept that every bit of radiation is that every bit of radiation is carcinogeniccarcinogenic
Our Radiation MindsetOur Radiation Mindset
Radiation cures cancerRadiation cures cancer
Radiation causes cancerRadiation causes cancer
Godzilla – T Rex with sense of humorGodzilla – T Rex with sense of humor
Them – giant ants from Nevada sitesThem – giant ants from Nevada sites
Atomic Mary - face melted with stressAtomic Mary - face melted with stress
The Hulk- radiation experimentThe Hulk- radiation experiment
Spiderman - radioactive spider biteSpiderman - radioactive spider bite
Selected Further InformationSelected Further Information
CDC and OSHA have good starting websites:www.bt.cdc.gov/radiation/index.aspwww.osha.gov/SLTC/emergencypreparedness/rdd_tech.html
DocumentsAmerican College of Radiology:“Disaster Preparedness for Radiology Professionals” Download at www.acr.org/departments/educ/disaster_prep/dp_primer.html
National Council on Radiation Protection and Measurement Report No. 138, 2001“Management of Terrorist Events Involving Radioactive Material”
Support AgenciesSupport Agencies
Oak Ridge Radiation Emergency Assistance Oak Ridge Radiation Emergency Assistance Center (REAC/TS ) 865.576.3131/1005Center (REAC/TS ) 865.576.3131/1005
Nuclear Regulatory Commission (NRC) 24 Nuclear Regulatory Commission (NRC) 24 Hour Operations CenterHour Operations Center
Nebraska Emergency Management Agency Nebraska Emergency Management Agency (NEMA)(NEMA)
State of Nebraska Health & Human ServicesState of Nebraska Health & Human Services
Topics that we coveredTopics that we covered
What is ionizing radiation?What is ionizing radiation?How is it harmful?How is it harmful?
Radiation threat scenarios Radiation threat scenarios
Appropriate medical responsesAppropriate medical responses
Psychological aspectsPsychological aspects
ResourcesResources