Post on 22-Jan-2016
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BDLS is a registered service mark of the Board of Regents University System of Georgia
Medical Response to Nuclear and Radiological Events
Cham Dallas, PhD
DirectorCDC Center for Mass Destruction Defense
Overview
• Nuclear scenario effects
• Radiation injury
Acute radiation syndrome
Mass burn casualties
External contamination
Internal contamination
• Pharmaceutical intervention strategies
Question
Which of the following are most likely to occur and result in significant casualties?
A. Nuclear power plant release
B. Improvised nuclear devise
C. Conventional nuclear weapon
D. “Dirty” bomb
Potential Nuclear/Radiological Hazards in the U.S.
• Simple radiological device
• “Dirty” conventional bomb
• Improvised nuclear device (IND)
• 1 kT “suitcase nuke”
• Ballistic missile attack
• 250 kT nuclear weapon: “city killer”
Plutonium
Diversion of Nuclear Weapons
50 –100 1 kT “suitcase” nuclear weapons are unaccounted for.
The Threat of Nuclear Diversion. Statement for the Record by John Deutch, Director of the Central Intelligence to the Permanent Subcommittee on Investigations of the Senate Committee on Government Affairs, 20 March 1996.
The Threat of Nuclear Diversion. Statement for the Record by John Deutch, Director of the Central Intelligence to the Permanent Subcommittee on Investigations of the Senate Committee on Government Affairs, 20 March 1996.
Standard Fission/FusionStandard Fission/Fusion
AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990..
Fallout 10%
Blast
50%
Thermal
35%
Initial Radiation 5%
Energy Partition
Nuclear Weapon Detonation Results: 1
Nuclear Weapon Detonation Results: 2
Nuclear Weapon Detonation Results: 3
Scenario: Washington Mall
White House
Capitol
Washington Monument
Lincoln Memorial The Mall
Potomac
River
AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990.
Effective Range for Blast Energy
AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990.
Effective Range for Thermal Energy 1 kT Weapon
AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990.
Safe Separation Distances for Eye Injuries 1 kT Weapon
Atlanta SSE Med Wind 250 kT Fatalities
ExpectedProb Population
90% 0.9 455,934
50% 0.5 661,169
10% 0.1 886,681
Fatality Possible (w/meander) Expected
Prob Population90% 0.9 455,934
Probability of Fatality (Default Plot)
Time: 32 days, 0.0 hours
Mean Probability of Fatality
Atlanta 250 kT SSE wind 7 mph
Mortality Probability 3.9m Affected
Red 90%
Lt Brown 80%
Yellow 70%
Green 60%
Pale Blue 50%
Dark Blue 40%
Lt Purple 30%
Dk Purple 20%
Dk Pink 10%
Lt Pink 1%
New York: 250 kT Nuclear Detonation
Seattle Mortality Probability under 350 kT with NNE Wind
What Is Fallout?
• A complex mixture of more than 200 different isotopes of 36 elements
• 2 oz of fission products formed for each kT of yield
• Size <1 micron to several mm
• A complex mixture of more than 200 different isotopes of 36 elements
• 2 oz of fission products formed for each kT of yield
• Size <1 micron to several mm
Question
The risk from delayed fallout that is dispersed long distances (>100 miles) still has a devastating impact on public health.
A. True
B. False
Early Fallout
• That which reaches the ground during the first 24 hours after detonation
• Early fallout fraction 50 –70% of total radioactivity
• Highest degree of fallout risk
• That which reaches the ground during the first 24 hours after detonation
• Early fallout fraction 50 –70% of total radioactivity
• Highest degree of fallout risk
Delayed Fallout
• Arrives after the first day, very fine invisible particles which settle in low concentrations over a considerable portion of the earth’s surface
• 40% of total radioactivity
• Much lower degree of risk relative to early fallout
• Arrives after the first day, very fine invisible particles which settle in low concentrations over a considerable portion of the earth’s surface
• 40% of total radioactivity
• Much lower degree of risk relative to early fallout
Bikini Atoll (1 March 1954)
• 15 mT thermonuclear detonation fallout
• Population affected: 300 in public domain
Int/Ext contamination
Local radiation injury
Mild ARS
Thyroid injury
• 15 mT thermonuclear detonation fallout
• Population affected: 300 in public domain
Int/Ext contamination
Local radiation injury
Mild ARS
Thyroid injury
Radioactive Contamination Radiodermatitis
AlphaAlpha
BetaBeta
GammaGamma
1 m concrete
NeutronNeutron
Ionizing Radiation
Radiation that consists of directly or indirectly ionizing particles or photons
Radiation that consists of directly or indirectly ionizing particles or photons
IrradiationIrradiationInternal
ContaminationInternal
ContaminationExternal
ContaminationExternal
Contamination
***
***
*
*
Radiation Exposure Types
Acute Radiation Syndrome
• Systemic effects of radiation Prodromal
Hematologic
Gastronintestinal
Pulmonary
Cutaneous
Neurovascular
• Combined injury
• Systemic effects of radiation Prodromal
Hematologic
Gastronintestinal
Pulmonary
Cutaneous
Neurovascular
• Combined injury
Prodromal Component (0.5–3 Gy and higher)
• Immediate effect of cell membrane damage
• Onset of nausea, vomiting, diarrhea
• Mediated neurologically by the parasympathetic system
• Immediate effect of cell membrane damage
• Onset of nausea, vomiting, diarrhea
• Mediated neurologically by the parasympathetic system
Respiratory Component(5–310 Gy and higher)
• Sensitive from highly vascular tissue
Endothelial cells
Type II alveolar cell
• Effect is dose-rate related
• Pneumonitis
• Fibrosis
• Sensitive from highly vascular tissue
Endothelial cells
Type II alveolar cell
• Effect is dose-rate related
• Pneumonitis
• Fibrosis
Healthy lung
Pneumonitis
Radiation Skin Injury
• 0.75 Gy Hair follicles change
• 3 Gy Epilation
• 6 Gy Erythema
• 10 Gy Dry desquamation
• 20 Gy Wet desquamation (transepithelial injury)
• 0.75 Gy Hair follicles change
• 3 Gy Epilation
• 6 Gy Erythema
• 10 Gy Dry desquamation
• 20 Gy Wet desquamation (transepithelial injury)
Erythema
Radiation Burns
Direct result of accident 13%
Infection 45%
Organ system failure 41%
Iatrogenic intervention 1%
Causes of Burn Deaths
Burns + Irradiation 40% Wounds < 5%
Burns + Wounds + Irradiation
20%
Irradiation 15–20%
Burns 15–20%
Wounds + Irradiation 5%
Wounds + Burns
5%
Distribution of Injuries in aNuclear Detonation
Single injuries(30%–40%)
Combined injuries
(65%–70%)
Combined injuries
(65%–70%)
Data from Walker RI, Cerveny TJ Eds., Medical Consequences of Nuclear Warfare, TMM Publications, Falls Church, 1989. p 11.
Andrews Lymphocyte Nomogram
• Absolute lymphocyte count over 48 hours
• Confirms significant radiation exposure
From Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Medical Management of Persons Exposed to High Levels of Radiation. In Personal Dosimetry for Radiation Accidents. Vienna, International Atomic Energy Agency, 1965, pp 3- 16
Priorities in Combined-Injury Triage- Radiation Doses
Conventional Triage Changes in Expected Triage(No Radiation Exists) Following Radiation Exposure
<1.5Gy 1.5–4.5Gy >4.5Gy >3 hr 1–3 hr <1 hr
onset onset onset
Immediate Immediate Immediate Expectant
Delayed Delayed Expectant Expectant
Minimal Minimal Expectant Expectant
Expectant Expectant Expectant Expectant
Conventional Triage Changes in Expected Triage(No Radiation Exists) Following Radiation Exposure
<1.5Gy 1.5–4.5Gy >4.5Gy >3 hr 1–3 hr <1 hr
onset onset onset
Immediate Immediate Immediate Expectant
Delayed Delayed Expectant Expectant
Minimal Minimal Expectant Expectant
Expectant Expectant Expectant Expectant
Modified from Medical Consequences of Nuclear Warfare, 1989, p. 39Modified from Medical Consequences of Nuclear Warfare, 1989, p. 39
Decontamination Equipment
• Hospital surgical gown (waterproof)
• Cap, face shield, booties (waterproof)
• Double gloves (inner layer taped)
• Pencil dosimeters, TLDs, survey meters
• Drapes
• Plastic bags
• Butcher paper
• Large garbage cans
• Radiation signs and tape
• Hospital surgical gown (waterproof)
• Cap, face shield, booties (waterproof)
• Double gloves (inner layer taped)
• Pencil dosimeters, TLDs, survey meters
• Drapes
• Plastic bags
• Butcher paper
• Large garbage cans
• Radiation signs and tape
Question
Which of the following is the best decontamination agent?
A. Dry removal
B. Bleach
C. Soap & water
D. Waterless cleanser
Decon Agents: 1
• Dry removal
• Soap/shampoo
• Household bleach 1:10 (sodium hypochlorite)
• Waterless cleansers
• Povidone-iodine
• Lava soap
• Cornmeal/Tide 50:50
• Vinegar (32P) or club soda
• Toothpaste
• Dry removal
• Soap/shampoo
• Household bleach 1:10 (sodium hypochlorite)
• Waterless cleansers
• Povidone-iodine
• Lava soap
• Cornmeal/Tide 50:50
• Vinegar (32P) or club soda
• Toothpaste
Internal Contamination Involves 4 Stages
• Deposition along route of entry
• Translocation
• Deposition in target organ
• Clearance
• Deposition along route of entry
• Translocation
• Deposition in target organ
• Clearance
Therapeutic Interventions
• Plutonium/transuranics: DTPA
• Cesium: insoluble Prussian Blue
• Uranium: alkalinization of urine
• Radioiodine: radiostable iodine
• Tritium: radiostable water
…is for good men and women to do nothing.
…is for good men and women to do nothing.
All that is necessary for the triumph of evil…