radiological dispersal device “dirty bomb” jordan h. hankins, m.d. university of nebraska...

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



Radiation threat scenariosRadiation threat scenarios



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


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


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.


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


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


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






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






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





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