CHAPTER 5 Radiological and Nuclear Weapons

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1 2 CHAPTER 5 Radiological and Nuclear Weapons Jim Smith, MSS, JD, Ed.D.,., NREMT-P John E. Campbell, M.D., FACEP 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Overview 5 Radiological Weapons 6 primer Methods of exposure to radiation as a weapon Detection of a radiation attack Dealing with the radiation scene Decontamination Pearls Radioactive material is a true terror Radioactive material is a weapon because it generates fear out of proportion to the actual hazard, disrupts society, and is very expensive to clean up. is even more frightening than most weapons because, even though it is deadly, you can t t see it or feel it The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

2 2008 The Companies, Inc. All rights reserved. Atomic Structure: Atom Made up of protons, neutrons, and electrons Protons and neutrons are in the nucleus. Electrons orbit them. 7 Protons have positive charge. Neutrons have no charge. Electrons have a negative charge. Electrons have almost no mass. Most of atom is empty space. Atomic Structure: Atom The Companies, Inc. All rights reserved A radioactive atom is one that has an excess of mass or energy. The atom rids itself of either mass or energy or both by emitting an energetic particle and/or energy in the form of electromagnetic waves. This process is called radioactive decay. There are four primary forms of radioactive emissions: Alpha particles Beta particles Gamma rays Neutrons 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved Alpha particle: This particle is emitted from the nucleus of a radioactive atom and is made up of 2 protons and 2 neutrons. Can travel only a few centimeters in air and has very little penetrating power. It can t penetrate the skin. Must be ingested to harm the human body. Beta particle: This particle is emitted from the nucleus of a radioactive atom and has the mass and negative charge of an electron. Can travel a few meters in air but only a few millimeters in tissue It is both an external and internal threat but is easily shielded The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

3 2008 The Companies, Inc. All rights reserved Gamma ray: This is short-wavelength electromagnetic radiation from the nucleus of a radioactive atom. Other than the fact that it comes from the nucleus rather than the outer shell, it is identical to an X-ray. X Gamma rays will travel many meters in air and will pass through the human body. Lead apron will not stop it. It is both an external and internal threat and requires heavy shielding. Neutron: Neutrons are human-made made and do not occur in nature. Requires special equipment (or a nuclear bomb) to produce. Neutrons will travel many meters in air and penetrate the human body easily. It is an external threat but can be shielded with water or plastic. Requires a special detector 2008 The Companies, Inc. All rights reserved. Penetrating Power of alpha beta gamma 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Isotopes 17 Isotopes 18 An isotope is another form of an element that differs in the form of the nucleus. An isotope may or may not be radioactive. The hydrogen atom has one proton in its nucleus while its nonradioactive isotope deuterium has one proton and one neutron. Hydrogen Deuterium Heavy Hydrogen The radioactive isotope of hydrogen is tritium and it has one proton and two neutrons in its nucleus. It emits a beta particle (electron). Because it glows in the dark tritium is used on watch faces and gun sights. Deuterium and tritium are still hydrogen but have different properties. Depending on the element, radioactive isotopes may emit any of the radioactive wave particles. Hydrogen Deuterium Tritium 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

4 2008 The Companies, Inc. All rights reserved Post break 2008 The Companies, Inc. All rights reserved. Damage 21 Damage 22 damages human cells by disrupting the DNA of the cell. Dividing cells (growing( growing) ) are affected more, so radiation affects skin, hair follicles, blood cells, and cells of the lining of the GI tract first. burns look just like thermal burns but heal more slowly and are prone to develop cancer later. Cancer cells also divide rapidly and so radiation is used to kill cancerous tumors The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Damage 23 Damage 24 An individual exposed only to an external source of radiation, is NOT radioactive or contaminated and may be approached without risk, just like after a chest x-ray x or CT scan. in very high doses will kill cells quickly. At lower doses radiation may only damage the DNA of the cells, predisposing them to become cancerous. Damage to eggs or sperm may cause mutations or congenital deformities in the offspring. Many victims of radiation exposure die of infection because of damage to the protective white blood cells The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

5 2008 The Companies, Inc. All rights reserved. Acute Syndrome 25 Acute Syndrome 26 People exposed to radiation will develop ARS only if all the following are true: high dose radiation penetrated deeply (i.e., x-rays) large area effected does was delivered quickly Diagnosis made by estimating dose and time of onset of symptoms/signs: Time to onset of vomiting Lymphocyte depletion kinetics Physical exam Clinical signs and symptoms associated with ARS and its subsyndromes 2008 The Companies, Inc. All rights reserved. Damage 27 Damage 28 exposure can be measured in RADs or REM. For practical purposes they are the same. The effect of various whole-body doses of radiation on humans: 25 REM: No detectable effect 50 REM: Slight temporary blood changes 100 REM: Mild radiation sickness (nausea and fatigue) a couple of days later 400 REM: Half of those exposed will die. exposure can be measured in SI (international units). gray (Gy( Gy): absorbed energy per unit mass of tissue 1 Gy = 1 Joule/kilogram = 100 rad. Gray can be used for any type of radiation (e.g., alpha, beta, neutron, gamma), but it does not describe the biological effects of different radiations 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Dose Calculator 29 Physical Exam Should include: 30 Vital signs Body temperature - evaluate for fever Blood pressure - evaluate for hypotension Pulse - evaluate rate and strength Respiratory rate Skin examination Erythema Blistering Edema Desquamation Neurologic examination Level of consciousness Ataxia Motor/sensory deficits Presence or absence of reflexes Papilledema Gastrointestinal examination Abdominal tenderness Gastrointestinal bleeding Hematologic examination Ecchymoses Petechiae of mucous membrane and skin 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

6 2008 The Companies, Inc. All rights reserved. Physical Exam Should include: 31 Physical Exam Should include: 32 Vital signs Body temperature - evaluate for fever Blood pressure - evaluate for hypotension Pulse - evaluate rate and strength Respiratory rate Skin examination Erythema Blistering Edema Desquamation Neurologic examination Level of consciousness Ataxia Motor/sensory deficits Presence or absence of reflexes Papilledema Gastrointestinal examination Abdominal tenderness Gastrointestinal bleeding Hematologic examination Ecchymoses Petechiae of mucous membrane and skin Vital signs Body temperature - evaluate for fever Blood pressure - evaluate for hypotension Pulse - evaluate rate and strength Respiratory rate Skin examination Erythema Blistering Edema Desquamation Neurologic examination Level of consciousness Ataxia Motor/sensory deficits Presence or absence of reflexes Papilledema Gastrointestinal examination Abdominal tenderness Gastrointestinal bleeding Hematologic examination Ecchymoses Petechiae of mucous membrane and skin 2008 The Companies, Inc. All rights reserved. Physical Exam Should include: 33 Physical Exam Should include: 34 Vital signs Body temperature - evaluate for fever Blood pressure - evaluate for hypotension Pulse - evaluate rate and strength Respiratory rate Skin examination Erythema Blistering Edema Desquamation Neurologic examination Level of consciousness Ataxia Motor/sensory deficits Presence or absence of reflexes Papilledema Gastrointestinal examination Abdominal tenderness Gastrointestinal bleeding Hematologic examination Ecchymoses Petechiae of mucous membrane and skin Vital signs Body temperature - evaluate for fever Blood pressure - evaluate for hypotension Pulse - evaluate rate and strength Respiratory rate Skin examination Erythema Blistering Edema Desquamation Neurologic examination Level of consciousness Ataxia Motor/sensory deficits Presence or absence of reflexes Papilledema Gastrointestinal examination Abdominal tenderness Gastrointestinal bleeding Hematologic examination Ecchymoses Petechiae of mucous membrane and skin 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

7 2008 The Companies, Inc. All rights reserved. Methods of Exposure to If the radioactive isotope is a fissionable material (plutonium( or uranium) ) that could be used to start a chain reaction leading to a nuclear explosion, it could be used to make a nuclear weapon. Nuclear weapons are difficult to make but could be stolen or purchased from a country with nuclear weapon capability. 37 Methods of Exposure to Radioactive powder or liquid could be delivered by conventional explosion or by spraying from an aircraft. A building could be contaminated by placing radioactive powder into the ventilation system. The material could be mailed in a package or envelope. The material could be spread by hand but would likely contaminate the terrorist The Companies, Inc. All rights reserved. Methods of Exposure to If simply exposed to radiation from a sealed source or from an X-ray X generator the victim may be injured but does not become radioactive and is no danger to others. Having an X-ray X taken is an example. If someone has radioactive material deposited on their skin they may be injured and are a danger to others until they wash the radioactive material off. 39 Methods of Exposure to When radioactive material is inhaled or ingested, it will continue to radiate the organs of the body for the life of the isotope. Some radioactive isotopes have a chemical affinity for a certain organ of the body and will accumulate there, causing damage to that organ: Radioactive iodine accumulates in the thyroid gland. Radioactive cesium accumulates in the liver. Radioactive strontium accumulates in bone The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Methods of Exposure to The person who has inhaled or ingested radioactive material may or may not be dangerous to others,, depending on the penetrating power of the particle ingested. Alpha particles would be no danger to others. Beta particles may or may not,, depending on distance. Gamma rays would harm others. People cannot swallow X-ray X generators. Neutrons would be dangerous to others. 41 as a Weapon There have been threats of the use of nuclear devices against the U.S. for many years. Nuclear bombs are likely to be available to determined, well-financed terrorists. Several cities have been targets of nuclear extortion threats. No real bombs used but the external appearance of the bogus bombs was exactly the same as a real one The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

8 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. 45 TX at Hospital 46 Further scanning and identifying the material in question May include internal decontamination chelation (or removal) 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved TX at Hospital - Plutonium 239 Special Care for the Dead half life ~ 20 years builds up in lungs, bones, liver, gonads If nuclear blast - delay removal If no blast - no delay required may require chelation excretion via urine consider specialized teams for removal 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

9 2008 The Companies, Inc. All rights reserved. as a Weapon 49 as a Weapon 50 The most practical method of terrorist attack would be to use a radiological dispersion device (RDD) such as a conventional bomb to disperse a radioactive material over a wide area. These are called dirty dirty bombs. A simple method of attack would be to place the material in powder form in a ventilation system of a building or mail it in a package. RDDs produce a denial of use of a facility or a location for a prolonged period of time. It is often easier to tear down and remove a building than to remove the radiation contamination. There are long-term health issues in people who are exposed to high radiation doses. It is extremely expensive to decontaminate a site that has been contaminated with radioactive material The Companies, Inc. All rights reserved. as a Weapon 51 as a Weapon 52 Some radioactive isotopes have such long lives that they can render an area uninhabitable for many years. The plutonium released by the Chernobyl nuclear reactor accident has made 25% of the farmland and forests of Belarus uninhabitable for the next 25,000 years. Plutonium is fairly well secured in most places,, but Cobalt-60 (half-life life >5 years) and Cesium-137 (half-life life 30 years) are both powerful gamma ray emitters and they are used in industry where security is generally poor The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved Detection of a Attack Detection of a Attack cannot be detected by human senses, so special detectors must be used. HazMat teams routinely wear small detectors called radiation pagers that alarm when they detect even a small amount of radiation. Those who must work in the contaminated environment should wear dosimeters. Pencil dosimeter Can be worn on PPE to get an ongoing reading of radiation exposure. The reading is crude. Thermoluminescent dosimeters Are more accurate recorders of radiation exposure but do not give an immediate reading and require a separate machine to read them. They are worn on the PPE to record an accurate reading on total radiation exposure by the individual The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

10 2008 The Companies, Inc. All rights reserved. Dosimeters 55 Pager 56 Pencil Dosimeters Thermoluminescent dosimeter 2008 The Companies, Inc. All rights reserved. Detection of a Attack There are several kinds of radiation detection instruments available. The low range beta-gamma or alpha radiation detector is most commonly used. It is best for gamma radiation detection but may be overwhelmed by high levels of gamma radiation and fail to detect it. 57 Low Range Beta-Gamma or Alpha Detector 58 Hotdog Probe 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Safe Limits of Exposure to 5 REM (measurement of radiation exposure) per year is the normal limit. Average chest X-ray X is REM. 25 REM for emergencies This dose should cause no detectable changes. 100 REM to save a life This might cause nausea and weakness a couple of days later. 59 Safe Limits of Exposure to At a radiation emergency scene the incident commander or the radiation safety officer will set the allowed limits of exposure for those who must enter the hot zone. You would normally enter the hot zone only to save lives. As a general rule when the pencil dosimeter shows a radiation dose of 50% of the limit you must leave the scene The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

11 2008 The Companies, Inc. All rights reserved. Indications of a Possible Attack You should be suspicious of radiation contamination and thus wear a radiation detector on your PPE in the following situations: All explosions of unknown origin All bombings Any situation with an unknown substance, particularly a substance received in the mail 61 Dealing with the Scene If you must enter the hot zone of a radiation incident, remember time, distance, shielding, and quantity: Time: Spend the least amount of time on scene as possible. Work in shifts if necessary. Distance: Stay as far away from the contaminated area as possible. exposure follows the inverse square law in that doubling the distance will decrease the exposure to one-fourth. Small changes in distance give big decreases in exposure The Companies, Inc. All rights reserved. 62 Dealing with the Scene If the radiation exposure was 32 REM per hour at point A (one foot from source), moving to two feet away decreases exposure to 8 REM per hour and at 4 feet decreases to 2 REM per hour. 63 Dealing with the Scene Time, distance, shielding, and quantity: Shielding: Try to maintain something dense such as metal or concrete between you and the contamination source. Quantity: Remove victim s s contaminated clothes and wash or shower the material off his body (wet decontamination) The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. 65 Minimal Protection - Tyvek suit 66 Should be worn with gloves and boots taped to suit Universal precaution barriers (at least) required over eyes, nose, and mouth 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

12 2008 The Companies, Inc. All rights reserved. Dealing with the Scene Generally in a radiation incident you would set the hot zone as meters ( feet) in all directions from the source. Try to stay upwind from the scene. If an explosion is involved the hot zone should be increased to 1,000 to 1,500 feet. Every person, vehicle, and item at the scene must be scanned with a radiation detector to rule out contamination. 67 Decontamination Perform wet decontamination of victims (remove clothes and shower). Runoff water is contaminated and should be contained. Victims must be surveyed with a radiation detector (pancake probe) to confirm that all contamination has been removed. If contamination is still present then the person must be washed again. To avoid ingesting radioactive material nobody is to eat or drink until they have been confirmed to be decontaminated The Companies, Inc. All rights reserved. Detector with Pancake Probe 69 Personal Dosimeter 70 Pancake probe 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Decontamination You should try to prevent contamination of open wounds: Cover the wound. Remove victim s s clothing. Wash victim s s body with soap and water. Remove dressing and flush the wound with water. Control run-off water while cleaning Recheck after cleaning 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

13 2008 The Companies, Inc. All rights reserved. Pearls Humans senses cannot detect radiation. You must use a radiation detector to scan: The scene of all explosions of unknown cause All bombing scenes All suspicious substances All suspicious mass casualty scenes Enter a radiation scene only to save lives. 73 Pearls Remember time, distance, shielding, and quantity. Remove victim s s contaminated clothes and have them shower immediately. Stay in hot zone no longer than absolutely necessary. Stay upwind and as far away from radiation source as possible. Wear appropriate PPE with respiratory protection. Try to keep dense objects between you and the radiation source. Decontaminate victims prior to treatment or transport The Companies, Inc. All rights reserved. 75 Who would have thought? The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved Nuclear (1 of 5) Nuclear (2 of 5) Personal Safety Only appropriately trained and equipped personnel should handle radiation emergencies. Basic Nuclear Physics Atoms Protons, neutrons, and electrons Isotopes and Half-Life Ionizing Alpha particles Beta particles Gamma rays Neutrons 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

14 2008 The Companies, Inc. All rights reserved. Nuclear (2 of 5) 79 Nuclear (3 of 5) 80 Ionizing Effects of on the Body Detection of RAD and REM Acute and Long-Term Effects 2008 The Companies, Inc. All rights reserved. Nuclear (4 of 5) Principles of Safety Time Distance Shielding 81 Nuclear (4 of 5) Principles of Clean Accidents Patient is exposed but not contaminated. Dirty Accidents Patient is contaminated by radioactive particles, liquids, gases, or smoke The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved. Nuclear (5 of 5) Management Park upwind. Look for signs of radioactive exposure. Use portable instruments to detect radioactivity. Normal emergency care principles should be applied. Externally radiated and internally contaminated patients pose little danger. Externally contaminated patients require decontamination. 83 Recommended Scene: staging command public X 84 wind EMS 2008 The Companies, Inc. All rights reserved The Companies, Inc. All rights reserved.

15 2008 The Companies, Inc. All rights reserved. 85