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Medical Response to Nuclear and Radiological
TerrorismStevan Cordas DO MPH
Clinical Associate Professor TCOM/UNTHSC
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• Consultant Texas Department of Health - WMD Education
• Consultant American Osteopathic Association – Washington Bureau – WMD
• Certified Occupational Medicine (Toxicology)
• Trained in Cleveland Institute of Nuclear Medicine
• Former U.S. Army Medical Corps• Steering Committee - Medical Reserve
Corps (Dallas, Tarrant, Denton and Collins County)
• Author of WMD – AOA DO-online for CME
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What Is Radiation?
Radiation is energy transported in the form of particles or waves.
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Exposure Vs. Contamination
Exposure: irradiation of the body absorbed dose (Gray, rad)
Contamination: radioactive material on patient (external)or within patient (internal)
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Penetration Abilities of Different Types of Radiation
Alpha ParticlesStopped by a sheet of paper
Beta ParticlesStopped by a layer of clothingor less than an inch of a substance (e.g. plastic)
Gamma RaysStopped by inches to feet of concreteor less than an inch of lead
RadiationSource
NeutronsStopped by a few feet of concreteCDC
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Measure of
Amount ofradioactive material Ionization in air
Absorbed energy per mass
Absorbed dose weighted by type of radiation
Radiation UnitsQuantity
Activity
Exposure
Absorbed Dose
Dose Equivalent
Unit
curie (Ci)
roentgen (R)
rad
rem
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A Gray (Gy)
The Gray (Gy) is a unit of absorbed dose and reflects an amount of energy deposited into a mass of tissue (1 Gy = 100 rads). In this lecture, the absorbed dose we are referring to is that dose inside the patient's body (i.e., the dose which is normally measured with personal dosimeters). For most purposes, one rem equal one rad. One mrem is one thousandth of one rem and is a common means of expressing radiation.
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Radiation Doses and Dose Limits
Flight from Los Angeles to London 5 mrem
Annual public dose limit 100 mrem
Annual natural background 300 mrem
Fetal dose limit 500 mrem
Barium enema 870 mrem
Annual radiation worker dose limit 5,000 mrem
Heart catheterization (skin dose) 45,000 mrem
Life saving actions guidance (NCRP-116) 50,000 mrem
Mild acute radiation syndrome 200,000 mrem
LD50/60 for humans (bone marrow dose) 350,000 mremRadiation therapy (localized & fractionated) 6,000,000 mrem
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Radioactive Material
• Radioactive material consists of atoms with unstable nuclei
• The atoms spontaneously change (decay) to more stable forms and emit radiation
• A person who is contaminated has radioactive material on their skin or inside their body (e.g., inhalation, ingestion or wound contamination)
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Half-life (HL)• Physical Half-Life
Time (in minutes, hours, days or years) required for the activity of a radioactive material to decrease by one half due to radioactive decay
• Biological Half-LifeTime required for the body to eliminate half of the radioactive material (depends on the chemical form)
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Effective Half-life
The net effect of the combination of the physical & biological half-lives in removing the radioactive material from the body
• Half-lives range from fractions of seconds to millions of years
• 1 HL = 50% 2 HL = 25%3 HL = 12.5%
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Potential Types of Weapons
• Stolen nuclear material from a hospital, industry, university, power plant or disposal facility
• Creation of a “dirty bomb” Generally thought to be the most likely scenario.
• Nuclear detonation from a device.• Nuclear reactor sabotage
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Hypothetical Suitcase Bomb
Chairman Dan Burton Committee – Demonstration of example “suitcase nuke” made from US nuclear shell
CDC
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Radionuclide Half-Life Activity Use
Cesium-137 30 yrs 1.5x106 Ci Food Irradiator
Cobalt-60 5 yrs 15,000 Ci Cancer Therapy
Plutonium-239 24,000 yrs 600 Ci Nuclear Weapon
Iridium-192 74 days 100 Ci Industrial Radiography
Hydrogen-3 12 yrs 12 Ci Exit Signs
Strontium-90 29 yrs 0.1 Ci Eye Therapy Device
Examples of Radioactive Materials
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Examples of Radioactive Materials
Iodine-131 8 days 0.015 Ci Nuclear Medicine Therapy
Technetium-99m 6 hrs 0.025 Ci Diagnostic Imaging
Americium-241 432 yrs 0.000005 Ci Smoke Detectors
Radon-222 4 days 1 pCi/l Environmental Level
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Trinity Site N.M. 5:29 AM July 16th 1945
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Types of Radiation Hazards• External Exposure - whole-body or partial-
body (no radiation hazard to EMS staff)
• Contaminated - – external radioactive
material: on the skin– internal radioactive
material: inhaled, swallowed, absorbed through skin or wounds
ExternalExposure
InternalContamination
ExternalContamination
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Scope of Event
Event Number of Deaths Most Deaths Due to
RadiationAccident
None/Few Radiation
RadioactiveDispersalDevice
Few/Moderate(Depends on
size of explosion &proximity of persons)
Blast Trauma
Low YieldNuclear Weapon
Large(e.g. tens of thousands inan urban area even from
0.1 kT weapon) Radiation Exposure
Blast Trauma Thermal Burns
Fallout (Depends on Distance)
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Map of Our Nuclear Power Plants
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Facility Preparation• Activate hospital plan
– Obtain radiation survey meters
– Call for additional support: Staff from Nuclear Medicine, Radiation Oncology, Radiation Safety (Health Physics)
– Plan for decontamination of uninjured persons
– Establish triage area
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Develop Radiological Response Team
• Team Coordinator (leader)
• Emergency physician(s)
• Nurse (s)• Triage Officer• Administrator• Radiation Safety
Officer
• Maintenance• Public Information
Officer• Security• Laboratory
Personnel• Technical
Recorder
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Consult With Radiation Experts
• Radiation Safety Officer
• Health Physicist
• Medical Physicist
• Conference of Radiation Control Program Directors (www.crcpd.org)
CDC
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Consult With Radiation Experts
• Determining/documenting presence of radioactivity, activity levels, and radiation dose
• Collecting samples to document contamination
• Assisting in decontamination procedures
• Disposing of radioactive waste
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Detecting and Measuring Radiation• Instruments
– Locate contamination - GM Survey Meter (Geiger counter)
– Measure exposure rate - Ion Chamber• Personal Dosimeters - measure doses to
staff– Radiation Badge - Film/TLD– Self reading dosimeter
(analog & digital)
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Biodosimetry Assessment Tool
Armed Forces Radiobiology Research Institute
www.afrri.usuhs.mil/
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Facility Preparation
• Plan to control contamination
– Instruct staff to use universal precautions and double glove
– Establish multiple receptacles for contaminated waste
– Protect floor with covering if time allows
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ContaminatedWaste
Waste
Treatment Area Layout
RadiationSurvey
HOTLINE
STEPOFFPAD
CO
NT
AM
INA
TE
D A
RE
AB
UF
FE
R Z
ON
EC
LE
AN
AR
EA
Radiation Survey
& Charting
ED Staff
Clean Gloves, Masks,Gowns, Booties
Separate Entrance
Trauma Room
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Immediate Medical Management• Triage
– ARS– localized/ cutaneous– combined injury
• Initial stabilization and treatment
• Psychological effects
• Record keeping/ Dose assessment
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Key Points
• Contamination is easy to detect and most of it can be removed
• It is very unlikely that ED staff will receive large radiation doses from treating contaminated patients
Protecting Staff from Contamination
• Universal precautions• Survey hands and clothing
with radiation meter• Replace gloves or clothing that is contaminated• Keep the work area free of
contamination
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Patient Management - Priorities
Triage• Medical triage is the highest
priority• Radiation exposure and
contamination are secondary considerations
• Degree of decontamination dictated by number of and capacity to treat other injured patients
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Patient Management - Triage
Triage based on:• Injuries• Signs and symptoms -
nausea, vomiting, fatigue, diarrhea
• History - Where were you when the bomb exploded or incident occurred?
• Contamination survey
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Psychological Casualties
• Terrorist acts involving toxic agents (especially radiation) are perceived as very threatening
• Mass casualty incidents caused by nuclear terrorism will create large numbers of worried people who may not be injured or contaminated
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Psychological Casualties
• Provide psychological support to patients and set up a center in the hospital for staff
• Establish triage (monitoring and counseling) centers to prevent psychological casualties from overwhelming health care facilities– Staff counseling centers with
physicians with a radiological background, health physicists with instrumentation and psychological counselors
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Patient Management - Decontamination
• Carefully remove and bag patient’s clothing and personal belongings (typically removes 95% of contamination)
• Survey patient and, if practical, collect samples
• Handle foreign objects with care until proven non-radioactive with survey meter
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Patient Management - Decontamination
• Decontamination priorities: – Decontaminate wounds first, then
intact skin – Start with highest levels of
contamination• Change outer gloves frequently to
minimize spread of contamination
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Patient Management - Decontamination (Cont.)
• Protect non-contaminated wounds with waterproof dressings
• Contaminated wounds:– Irrigate and gently scrub with surgical
sponge– Extend wound debridement for removal
of contamination only in extreme cases and upon expert advice
• Avoid overly aggressive decontamination • Change dressings frequently
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Patient Management - Decontamination (Cont.)
• Decontaminate intact skin and hair by washing with soap & water
• Remove stubborn contamination on hair by cutting with scissors or electric clippers
• Promote sweating• Use survey meter to monitor
progress of decontamination
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Patient Management - Decontamination (Cont.)
• Cease decontamination of skin and wounds– When the area is less than twice background, or– When there is no significant reduction between
decon efforts, and– Before intact skin becomes abraded.
• Contaminated thermal burns– Gently rinse. Washing may increase severity of
injury.– Additional contamination will be removed when
dressings are changed.• Do not delay surgery or other necessary
medical procedures or exams…residual contamination can be controlled.
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Patient Management - Patient Transfer
Transport injured, contaminated patient into or from the ED:
• Clean gurney covered with 2 sheets
• Lift patient onto clean gurney
• Wrap sheets over patient• Roll gurney into ED or out
of treatment room
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Facility Recovery• Remove waste from the Emergency Department
and triage area• Survey facility for contamination• Decontaminate as necessary
– Normal cleaning routines (mop, strip waxed floors) typically very effective
– Periodically reassess contamination levels– Replace furniture, floor tiles, etc. that cannot
be adequately decontaminated• Decontamination Goal: Less than twice normal
background…higher levels may be acceptable
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Data Management
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Injuries Associated With Radiological Incidents
• Acute Radiation Syndrome (ARS)• Localized radiation injuries/
cutaneous radiation syndrome• Internal or external contamination• Combined radiation injuries with - Trauma - Burns • Fetal effects
CDC
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• Occurs only in patients who have received very high radiation doses (greater than approximately 100 rem or rads (1 Gy)) to most of the body
• Dose ~ 15 rem – no symptoms, possible chromosomal
aberrations• Dose ~ 50 rem
– no symptoms, minor decreases in white cells and platelets
Radiation Sickness Acute Radiation Syndrome
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• Prodromal stage
– nausea, vomiting, diarrhea and fatigue
– higher doses produce more rapid onset and greater severity
• Latent period (Interval)– patient appears to recover– decreases with increasing dose
• Manifest Illness Stage– Hematopoietic– Gastrointestinal– CNS
Acute Radiation Syndrome (Cont.)For Doses > 100 rem
Time of Onset
Severity of Effect
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Acute Radiation Syndrome (ARS)
• Radiation must be of penetrating type (X-rays, gamma rays or neutrons)
• Most or all of body must be exposed.• The dose must be from an external
source.• Dose must be delivered in a short
time. Not fractionated.
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The Three ARS Syndromes
• Hematopoetic – Between 0.7 Gy and 10 Gy– Mortality rate is proportional to dosage.– Death from hemorrhage and infection– Absence of stem cells with leukopenia
and thrombocytopenia. If they survive, anemia later.
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• Dose ~ 100 rem
– ~10% exhibit nausea and vomiting within 48 hr
– mildly depressed blood counts
• Dose ~ 350 rem
– ~90% exhibit nausea/vomiting within 12 hr, 10% exhibit diarrhea within 8 hr
– severe bone marrow depression
– ~50% mortality without supportive care
Acute Radiation Syndrome (Cont.)Hematopoietic Component - latent period from
weeks to days
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Acute Radiation Syndrome (Cont.)Hematopoetic Component - Latent
Period From Weeks to Days
• Dose ~ 500 rem
– ~50% mortality with supportive care
• Dose ~ 1000 rem
– 90-100% mortality despite supportive care
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Andrews LymphocyteNomogram
Andrews LymphocyteNomogram
From From Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Medical Management of Persons Exposed to High Levels of Radiation. Medical Management of Persons Exposed to High Levels of Radiation. In In Personal Personal Dosimetry for Radiation Accidents. Dosimetry for Radiation Accidents. Vienna, International Atomic Energy Agency, 1965, pp 3- 16Vienna, International Atomic Energy Agency, 1965, pp 3- 16
From From Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Medical Management of Persons Exposed to High Levels of Radiation. Medical Management of Persons Exposed to High Levels of Radiation. In In Personal Personal Dosimetry for Radiation Accidents. Dosimetry for Radiation Accidents. Vienna, International Atomic Energy Agency, 1965, pp 3- 16Vienna, International Atomic Energy Agency, 1965, pp 3- 16
Confirms suspected Confirms suspected radiation exposureradiation exposure
Determines significant Determines significant hematological hematological involvementinvolvement
Serial CBCs every 3 - 4 Serial CBCs every 3 - 4 hourshours
Confirms suspected Confirms suspected radiation exposureradiation exposure
Determines significant Determines significant hematological hematological involvementinvolvement
Serial CBCs every 3 - 4 Serial CBCs every 3 - 4 hourshours
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The Three ARS Syndromes
• Gastrointestinal – – Usually occurs with exposure to 10 and 100 Gy
(1000 to 10,000 rads) – – Nausea, vomiting and diarrhea. – Death within two weeks with complications of
infection (always have the hematopoetic syndrome as well), electrolyte imbalance, dehydration, hemorrhage.
– Survival uncommon.
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• Dose > 1000 rem - damage to GI system– severe nausea, vomiting and diarrhea (within
minutes)– short latent period (days to hours)– usually fatal in weeks to days
• Dose > 3,000 rem - damage to CNS– vomiting, diarrhea, confusion, severe
hypotension within minutes– collapse of cardiovascular and CNS– fatal within 24 to 72 hours
Acute Radiation Syndrome (Cont.)
Gastrointestinal and CNS Components
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The Three ARS Syndromes
• Cardiovascular Syndrome– Usually with extremely high dosage. >
50 Gy or 5000 rads. Some symptoms possible at 20 Gy.
– Cerebral edema, vasculitis, meningitis with convulsions, coma and death
– Cardiovascular collapse– Death in 3 days or less
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• Estimating the severity of radiation injury is difficult.– Signs and symptoms (N,V,D,F):
Rapid onset and greater severity indicate higher doses. Can be psychosomatic.
– CBC with absolute lymphocyte count
– Chromosomal analysis of lymphocytes (requires special lab)
Treatment of Large External Exposures
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Treatment of Large External Exposures
• Treat symptomatically. Prevention and management of infection is the primary objective.
– Hematopoetic growth factors, e.g., GM-CSF, G-CSF (24-48 hr)
– Irradiated blood products
– Antibiotics/reverse isolation
– Electrolytes
• Seek the guidance of experts.
– Radiation Emergency Assistance Center/ Training Site (REAC/TS)
– Medical Radiobiology Advisory Team (MRAT)
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Other Treatment Methods
• Minimize intake.Reduce and/or inhibit absorption.Block uptake.Use isotopic dilution.Promote excretion.Alter chemistry of the substance.Displace isotope from receptors.Chelate.
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• Radionuclide-specific
• Most effective when administered early
• May need to act on preliminary information
• NCRP Report No. 65, Management of Persons Accidentally Contaminated with Radionuclides
Treatment of Internal Contamination
Radionuclide Treatment RouteCesium-137 Prussian blue OralIodine-125/131 Potassium iodide OralStrontium-90 Aluminum phosphate OralAmericium-241/ Ca- and Zn-DTPA IV infusion,Plutonium-239/ nebulizerCobalt-60
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Blocking Radioactive Iodine
• The dominant initial internal contaminant after a reactor accident, nuclear weapons test, or any incident involving fresh fission products is likely to be 131I.
• Block thyroid if radioactive iodine is a factor or if you are unsure. Give potassium Iodide 130 mg immediately to an adult then continue for 7 days.
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Special Considerations• High radiation dose and trauma interact
synergistically to increase mortality• Close wounds on patients with doses > 100
rem• Wound, burn care and surgery should be
done in the first 48 hours or delayed for 2 to 3 months (> 100 rem)
24 - 48 Hours
~3 Months
EmergencySurgery
Hematopoietic RecoveryNo Surgery
After adequatehematopoietic recovery
SurgeryPermitted
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Cutaneous Radiation Syndrome
• May occur as part of the ARS
• May occur from beta rays or X-rays without ARS
• May be due to contamination of patients skin or clothing from radioactive particles.
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Cutaneous Radiation Syndrome
• Inflammation• Erythema usually with itching at first• Dry desquamation, epilation, • Moist desquamation• Ulceration, blisters,• Basal cell layer damaged, sebaceous and
sweat glands destroyed. Hyperpigmentation later
• Delayed onset of about days to weeks.
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Biological Effects of Ionizing RadiationBiological Effects of Ionizing Radiation
Deterministic effects:Deterministic effects: occur when the dose is above a given threshold
(characteristic for the given effect); severity increases with the dose; many cells must die or have their function altered
examples: erythema, fibrosis, marrow depletion, cataract.examples: erythema, fibrosis, marrow depletion, cataract.
Stochastic (probabilistic):Stochastic (probabilistic): have no known threshold; probability of occurrence increases with dose; may result from alteration in only one or a few
cells examples: carcinogenic - various neoplasms, examples: carcinogenic - various neoplasms, genetic - various hereditary disorders.genetic - various hereditary disorders.
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Radiation EffectsRadiation Effects
Early(Deterministic only)
LocalRadiation injury ofindividual organs:Functional and/or
morphologicalchanges withinhrs-days-weeks
Acute radiation disease Acute radiation syndrome(LD50/60 ~ 3.5Sv LD ~ 5 Sv)
Late
Deterministic(Above DQ, cummul.) - Rad. Dermatitis- Rad. Cataracta - Teratogenic
(DQ,F~0,1Sv)
(Probability increaseswith dose)- Tumors, leukemia- Genetic effects
StochasticSystemic
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• Skin - No visible injuries < 100 rem– Main erythema, epilation >500 rem– Moist desquamation >1,800 rem– Ulceration/Necrosis >2,400 rem
• Cataracts– Acute exposure >200 rem– Chronic exposure >600 rem
• Permanent Sterility– Female >250 rem– Male >350 rem
Localized Radiation Effects - Organ System Threshold Effects
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Time of Onset of Clinical Signs of Skin Time of Onset of Clinical Signs of Skin Injury Depending on the Dose ReceivedInjury Depending on the Dose Received
SymptomsSymptoms Dose range Dose range Time of onset Time of onset
(Gy) (Gy) (day) (day)
Erythema 3-10 14-21 Epilation >3 14-18 Dry desquamation 8-12 25-30 Moist desquamation 15-20 20-28 Blister formation 15-25 15-25 Ulceration >20 14-21 Necrosis >25 >21
Ref.: IAEA-WHO: Diagnosis and Treatment of Radiation Injuries.
IAEA Safety Reports Series, No. 2, Vienna, 1998
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Longer Term Considerations Following Radiation Injury
• Neutropenia• Pain management
• Necrosis
• Plastic/reconstructive surgery
• Psychological effects (PTSD)
• Counseling
• Dose assessments• Possible increased risk of cancer
Consult Radiation Emergency Assistance Center/ Training Site (REAC/TS) for advice for further treatment: www.orau.gov/reacts/, 865-576-1005.
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Chronic Health Effects From Radiation
• Radiation is a weak carcinogen at low doses• No unique effects (type, latency, pathology)• Natural incidence of cancer ~ 40%;
mortality ~ 25%• Risk of fatal cancer is estimated as ~ 4%
per 100 rem • A dose of 5 rem increases the risk of fatal
cancer by ~ 0.2%• A dose of 25 rem increases the risk of fatal
cancer by ~ 1%
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Stochastic Effects of Radiation Exposure
Frequency is proportional to doseFrequency is proportional to dose
No threshold doseNo threshold dose
No method for identification of the No method for identification of the appearance of this effect of ionizing appearance of this effect of ionizing radiation in individualsradiation in individuals
Increase in occurrence of stochastic effect Increase in occurrence of stochastic effect can be proved with epidemiological method can be proved with epidemiological method onlyonly
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Human Data on Radiation CancerogenesisHuman Data on Radiation Cancerogenesis
Type or localization of cancer
Populationgroups
Leukemia Thyroidgland
Lung Breast Bone Skin
A-bombsurvivors + + + +Ra-dial painters +Earlyradiologists +U-miners +
Exposed in anuclearaccident
+
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Cancer Deaths Attributable to A-bombs
In 86,572 survivors of Hiroshima and Nagasaki A-bombing 7,827 persons died of cancer in 1950-90:
Observed Expected Excess (%)All tumors 7578 7244 334 (4.4)Leukaemia 249 162 87 (35.0)All cancers 7827 7406 421 (5.4)
Ref: Pierce et al, Rad.Res. 146: 1-27, 1996
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Cancer mortality of nuclear industry workersCancer mortality of nuclear industry workers
Observed/Expected deaths Total Trend
Dose ranges, mSv number test
<10 10- 20- 50- 100- 200- 400- of deaths (p-value)
O/E number of deaths from cancers other than leukemia
2234/
2228.3
462/
465.4
445/
479.6
276/
254.3
196/
190.5
161/
147.6
56/
67.3
3830 -0.28
(0.609)
O/E number of deaths from leukemia other than CLL (chronic lymphocytic leukemia)
60/
62.0
19/
17.2
14/
17.2
8/
9.0
8/
6.4
4/
4.7
6/
2.3
119 1.85
(0.046)
The ERR (excess relative risk) per Sv among the 95,673 nuclear industry workers of Canada,UK and USA (having a mean cumulative dose of 36.6 mSv in the combined cohort for thetotal period of observation, ie. 34 yrs in the USA and UK, and 29 years in Canada ) is
–0.07 for all cancers excluding leukemia, and 2.18 for leukemia excluding CLL.
Ref.: Cardis, E. et al: Combined Analyses of Cancer Mortality Among Nuclear IndustryWorkers in Canada, the UK and the USA. IARC Technical Report No.25, Lyon, 1995
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Latency Periods for Radiation-induced CancerLatency Periods for Radiation-induced Cancer
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Teratogenic Effects of RadiationTeratogenic Effects of Radiation Mental retardationMental retardation
Highest risk during major neuronal migration, on 8-15 weeks. Incidence increases with dose. At 1 Gy fetal dose 75% experience severe retardation
At 16-25 weeks, fetus shows no increase in mental retardation at doses < 0.5 Gy
IQ - Risk factor associated with diminution of IQ is 21-33 points at 1 Gy to fetus on 8-15 weeks.
MicrocephalyMicrocephaly Observed in 30 children of ~1000 exposed in
Hiroshima and Nagasaki pregnant women The effect <0.3 Gy is not significantly different of
control
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Fetal IrradiationNo Significant Risk of Adverse
Developmental Effects Below 10 Rem
•Little chance of malformation. •Most probable effect, if any, is death of embryo. •Reduced lethal effects. •Teratogenic effects.•Growth retardation.•Impaired mental ability.•Growth retardation withhigher doses.•Increased childhood cancer risk. (~ 0.6% per 10
rem)
<2
2-7
7-40
All
Pre-implantation
Organogenesis
Fetal
Weeks After Fertilization
Period ofDevelopment
Effects
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Key Points• Medical stabilization is the highest priority• Train/drill to ensure competence and
confidence • Pre-plan to ensure adequate supplies and
survey instruments are available • Universal precautions and decontaminating
patients minimizes exposure and contamination risk
• Early symptoms and their intensity are an indication of the severity of the radiation injury
• The first 24 hours are the worst; then you will likely have many additional resources
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DISTRIBUTION OF 237 CHERNOBYL PATIENTS TREATEDFOR ACUTE RADIATION SYNDROME BY THE SEVERITYOF SICKNESS AND RANGE OF WHOLE BODY EXPOSURE
Degreeof ARS
Numberof patients
Deaths in3 months
Whole bodydose, Gy
IV 21 20 6-16
III 22 7 4-6
II 50 1 2-4
I 41 0 1-2
I-IV 134 28 1-16Not confirmed 103 0 <2
Ref.: Ilyin L.A.: Chernobyl - Myth and reality, Megapolis, Moscow, 1995 Wagemaker G. et al., IAEA/WHO/CEC Chernobyl Conf. Vienna, 1996
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The Three Basic Ways to Reduce Radiation ExposureTIMEDecrease the amount of time you spend near the source of radiation.DISTANCEIncrease your distance from a radiation source.SHIELDINGIncrease the shielding between you and the radiation source. Shielding is anything that creates a barrier between people and the radiation source. Depending on the type of radiation, the shielding can range from something as thin as a plate of window glass or as thick as several feet of concrete. Being inside a building or a vehicle can provide shielding from some kinds of radiation.
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Personally, What You Should Do!
Radiological Attack Avoid inhaling dust as it could be radioactive.
• If an explosion occurs outdoors and you are informed that radiation is involved, if you are outdoors, cover nose and mouth and seek indoor shelter as soon as possible.
• If you inside an undamaged building, stay there. Close windows and doors and shut down ventilation system. Exit when told that it is safe after testing.
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Personally, What You Should Do! Radiological Attack
• If an explosion occurs inside your building, cover nose and mouth and evacuate as soon as possible.
• Decontaminate by removing clothing and showering.
• Relocate outside the contaminate zone.• Obey public officials.• This is the scenario of a dirty bomb.
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Personally, What You Should Do! Actual Nuclear Attack
• Move out of the path of a nuclear fallout cloud as quickly as possible (10 minutes or less) if you are in the blast zone and can do so. Find medical help ASAP.
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Prepared by the Radiological Emergency Medical Preparedness & Management Subcommittee of the National Health Physics Society Ad Hoc Committee on Homeland Security.
Jerrold T. Bushberg, PhD, ChairKenneth L. Miller, MSMarcia Hartman, MS
Robert Derlet, MDVictoria Ritter, RN, MBA
Edwin M. Leidholdt, Jr., PhD
ConsultantsFred A. Mettler, Jr., MD
Niel Wald, MDWilliam E. Dickerson, MD
Appreciation to Linda Kroger, MS who assisted in this effort.
Reproduced with permission
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Other Resources• Additional slides by permission
Istvan Turai MD PhD, International Atomic Energy Commission
• CDC Video “Medical Response to Nuclear and Radiological Terrorism”
• REACT/• REAC/TS (Oak Ridge Radiation
Emergency Assistance Center/Training Site) DOE/OROC (865) 576-1005 http://www.orau.gov/orise.htm
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Always Contact Local Public Health Department
• Tarrant County Public Health 1101 S. Main Street Fort Worth, Texas 76104 817-321-4700
• Dallas County Department of Health & Human Services2377 N. Stemmons Freeway Dallas, Texas 75207-2710 214-819-2004.
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We will Always Remember
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Thank You for Coming
Stevan Cordas DO MPH
www.drcordas.com