Radiological Events

Radiologic Events:

Attack on a Nuclear Power Plant

Radiological Events

• Recognize the potential consequences of a terrorist attack on a nuclear power plant

• Describe the different types of radiation particles and waves and their effect on the body

Objectives

Radiological Events

Objectives

• Differentiate between radiation exposure and contamination

• Recognize the characteristic signs and symptoms of acute radiation syndrome

• Learn to perform rapid assessment of nuclear/radiation events in a disaster situation

Radiological Events

• Learn specific antidotes and medical interventions for nuclear/radiation terrorism victims

• Learn specific pre-hospital and hospital management strategies including proper notification of radiation disasters

Objectives

Radiological Events

Case• Terrorists attack a nuclear power plant 30

miles outside a major metropolitan area by flying a high jacked jet liner into the plant.

• The impact results in an explosion and fire.

• Fire fighters and paramedics are called to the scene.

Radiological Events

Case• There are multiple casualties and

several trauma victims are being transported to your health care facility.

• The news media is questioning your health team regarding radiation exposure risks

Radiological Events

Nuclear Power Plant Disaster: Chernobyl, 1986

Radiological Events

Attacks on Reactors• Radioisotopes released

– Large quantities of radioiodines and radiocesiums

– A large variety of other radioisotopes may be released in smaller quantities

Radiological Events

Attacks on Reactors

• Which way is the wind blowing?– The radioactive cloud

from the burning reactor will travel according to wind direction.

Radiological Events

Attacks on Reactors

• Prevention– Individuals in the path of

the radioactive cloud need to be evacuated

Radiological Events

Electromagnetic Radiation• Electromagnetic

radiation includes a wide spectrum of radiation energy characterized by frequency and wave length.

• Ionizing radiation has high frequency and short wave length

Radiological Events

Ionizing Radiation• Ionizing radiation includes both

electromagnetic (X and gamma rays) and particulate radiation

Radiological Events

• Alpha

• Neutrons

• Beta

Particles

Radiological Events

• A helium nucleus

• Unable to penetrate skin

• Emitted from radioisotopes

such a plutonium, uranium

++

n

n

Alpha Particles

Radiological Events

• Able to penetrate skin

• Negatively charged

• Can produce skin superficial burns

• Emitted by several radioisotopes (e.g. Cobalt

160)

Beta Particles

Radiological Events

Neutron particles

• Uncharged

• Able to penetrate deeply

• Hazard inside nuclear reactors

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 concrete

Radiological Events

• Gamma and X radiation differ

by source: gamma rays comes

from the nucleus and X-rays

come from the electron orbits• Because they don’t have mass

or charge, they penetrate

very deeply

X-Rays and Gamma Rays

Radiological Events

RADIATION CANNOT BE SEEN, HEARD,

TASTED OR SMELLEDBut, it can be easily measured

if you have the right equipment

Detecting Radiation

Radiological Events

Alpha Survey Meter

Radiation DetectorsBeta and Gamma

Survey Meter

Radiological Events

Radiation Dose UnitsUnit Value

Rad (radiation absorbed dose)

0.01 J/kg

Rem (radiation equivalent-man)

Bio damage from 0.01 J/kg

Gray (Gy) 100 rad

Sievert (SV) 100 rem

Radiological Events

Contamination

• Contact with radioactive material (radionuclides) that can be spread to other people / properties

• Inhaled, ingested, transferred from surface to surface

Radiological Events

Exposure vs. Contamination

External Exposure: external irradiation of the body with rays or particles absorbed dose

Contamination: radioactive material (radionuclides) on patient (external) or within patient (internal).

Adapted from CDC Bioterrorism Web site

If the patient isexternally contaminatedwith radionuclides,you canDecontaminate

If radionuclides havegotten inside the body, consider chelationtherapy

Radiological Events

Factors Determining Radiation Exposure

• Time

• Distance

• Shielding

Radiological Events

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

Radiological Events

Acute Radiation SyndromeA Spectrum of Disease

Radiological Events

Phases of Acute Radiation Syndrome

ProdromalStage

LatentStage

ManifestIllness Recovery

Time (days to years)

Exposure

www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp

Radiological Events

Stage 1: (50-150 rads)

• No symptoms or minimal viral symptoms for up to 48 hours

• Spontaneous recovery usually occurs• Sterility is a risk

Stages of Acute Radiation Syndrome

Radiological Events

Stage 2: The Hematopoetic Syndrome (150- 400 rads)

• Whole body exposure• Bone marrow suppression occurs with loss of WBC and platelets• Infection and bleeding problems occur• LD 50 250-400 rads

Stages of Acute Radiation Syndrome

Radiological Events

Stage 3: Severe Hematopoetic Syndrome

(150-400 rads)

• Life saving bone marrow transplantation needed

• Care rationing during MCI will lower LD50

Stages of Acute Radiation Syndrome

Radiological Events

Absolute Lymphocyte Count

• Measure every 4 - 6 hours initial 48 hours

• Normal: approx 2500 cells/ml• > 1200: probably non-lethal• 300 to 1200 cells/ml: significant

(hospitalize)• < 300 cells/ml: critical

Radiological Events

Andrews Curve

1: 1 Gy

2: 4 Gy

3: 6 Gy

4: 7.1 Gy

Radiological Events

Stage 4: The Gastrointestinal Syndrome

(150-400 rads)

• GI lining cells die• Severe diarrhea and electrolyte losses• Life saving fluid and electrolyte

replacement

Stages of Acute Radiation Syndrome

Radiological Events

Stage 5: The CNS Syndrome (>1500 rads)

• Confusion, ataxia, and sensory deficits• Death within 48 hrs regardless of treatment• Early appearance of CNS symptoms is an

ominous sign

Stages of Acute Radiation Syndrome

Radiological Events

Pre-Hospital Management• Evacuation of persons who are in the

path of a radiation cloud is the most effective pre-hospital measure – this action is the responsibility of public health authorities

• Need effective communication with residents as to steps they can take to reduce exposure

Radiological Events

Patient Management - Priorities• Initial triage and decontamination are ideally

done outside the hospital (have a plan in place) to avoid contamination of the ED

• Patients exposed only to external EM radiation (e.g. x-ray or gamma rays) are not radioactive; patients exposed to particulate radiation will be radioactive

• Standard medical triage is the highest priority

• Radiation exposure and contamination are secondary considerations

Radiological Events

Patient Management - Protocol

Based on:

• Injuries

• Signs and symptoms

• Patient history

• Contamination survey

Radiological Events

• Security• Radiation Safety Officers/dosimeters,

GM• 24-hour hotline (217) 785-0600

• Radiation Duty Officer @ Illinois Department of Nuclear Safety

• Waste disposal• Labeled, plastic bags

Hospital Management

Radiological Events

• Contaminated patient – immediately isolated until monitored & decontaminated• Monitor EMS and ambulance

• ABC’s

• Cover all wounds

• Radiation burns are like sun burns

Management

Radiological Events

External Contamination

• Radioactive material (usually in the form of dust particles) on the body surface and/or clothing

• Radiation dose rate from contamination is usually low, but while it remains on the patient it will continue to expose the patient and staff

Radiological Events

Patient Decontamination• Remove and bag the patient’s clothing

and personal belongings (this typically removes 80 - 90% of contamination)

• Handle foreign objects with care until proven non-radioactive with survey meter

• Survey patient and collect samples- Survey face, hands and feet- Survey rest of body

Radiological Events

Protecting Staff from Contamination

• Use standard precautions

• Survey hands and clothing frequently

• Replace contaminated gloves or clothing

• Keep the work area free of contamination

Radiological Events

Examples of Radiation Skin Burns

Radiological Events

Decontamination of Skin

• Use multiple gentle efforts

• Use soap & water

• Cut hair if necessary (do not shave)

• Promote sweating

• Use survey meter

Radiological Events

Cease Patient Decontamination

• When decontamination efforts produce no significant reduction in contamination

• When the level of radiation of the contaminated area is less than twice background

• Before intact skin becomes abraded

Consider internal contamination

Radiological Events

Decontamination of Wounds• Contaminated wounds:

– Irrigate and gently scrub with surgical sponge

– Debride surgically only as needed

• Contaminated thermal burns:– Gently rinse – Changing dressings will remove additional

contamination

Radiological Events

Specific TherapyRadionuclide Therapeutic Approach

Tritium Dilution (force fluids)

Iodine-125 or I-131 KI, or SSKI

Cesium-134 or cesium- 137 Prussian blue

Strontium-89, or 90 Decrease abs (antacids), blockage (strontium lactate), displacement (oral phosphate), mobilization (ammonium chloride)

Plutonium Zinc or calcium (DTPA)

Radiological Events

Radioiodines and Thyroid Cancer

Radioiodines concentrateIn the thyroid gland and can increase the risk ofthyroid cancer

Radiological Events

You can reduce the radioiodine thyroid dose by giving potassium

iodide• Potassium Iodide (KI)

considerations• Who should get KI?• Useful at the beginning of an

exposure• Only protects against thyroid

cancer

Radiological Events

Dosage (KI)

Age Group Dosage

Infants < 1 month 16 mg

Children 1 month – 3 yrs 32 mg

Children 3–18 yrs 65 mg

Adults 130 mg

Radiological Events

Key Points

• Ionizing radiation includes:– Electromagnetic radiation: X and gamma– Particulate radiation: alpha, beta, neutrons

Radiological Events

• Patient can be:– Irradiated externally– Contaminated with radionuclides

• Which patients are radioactive?– Those contaminated with radionuclides– These patients need to be decontaminated– Some internally deposited radionuclides can be

removed with chelation therapy

Key Points

Radiological Events

• Protect yourself from radiation:– Reduce the time of exposure– Increase the distance from the radiation

source– Apply shielding between yourself and the

radiation source

Key Points

Radiological Events

• Acute Radiation Syndrome:– Stages progress from hematopoetic to gastrointestinal

to central nervous system with increasing dose– The absolute lymphocyte count is the best predictor of

dose

• Long-term consequences– Increase in cancer, especially thyroid cancer– With radioiodine exposure, thyroid dose can be

reduced by using KI

Key Points

Radiological Events

• Have a radiation disaster management plan in place for your hospital

• Be prepared for psychological consequences

Key Points

Radiological Events

• CDC Bioterrorism – www.bt.cdc.gov

• Radiation Emergency Assistance Center & Training Site (REAC/TS) - http://www.orau.gov/reacts/default.htm

• Medical management of radiological casualties handbook - www.afrri.usuhs.mil

Resources

Radiological Events

This completes the current presentation.