radiation as a weapon of terror
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South Carolina Area Health Education Consortium
Radiation as a Radiation as a Weapon of TerrorWeapon of Terror
South Carolina Area Health Education Consortium
AcknowledgementsAcknowledgements• South Carolina Area Health Education
Consortium (AHEC)– Funded by the Health Resources and Services
Administration. • Grant number: 1T01HP01418-01-00
– P.I. : David Garr, MD, Executive Director AHEC– BT Project Director: Beth Kennedy, Associate
Program Director AHEC– Core Team:
• BT Co-director: Ralph Shealy, MD• BT Project Manager: Deborah Stier Carson, PharmD• BT CME Director: William Simpson, MD• IT Coordinator: Liz Riccardone, MHS• Web Master: Mary Mauldin, PhD• P.R Coordinator: Nicole Brundage, MHA• Evaluation Specialist: Yvonne Michel, PhD• Financial Director: Donald Tyner, MBA
South Carolina Area Health Education Consortium
AcknowledgmentAcknowledgment
This material has been prepared for SC AHEC Bioterrorism Training Network
by Ralph M. Shealy, M.D., FACEP
Co-Director of SC AHEC Bioterrorism Training Network
Medical Director for Operations, Charleston County EMS
Medical Director, Charleston County Rescue Squad
South Carolina Area Health Education Consortium
Objectives 1Objectives 1
• At the conclusion of this presentation, the participant will:– List five radiological/nuclear threats– Identify three effects of a radiological incident
on the community– Describe the availability of, and the threat
posed by, radiological materials on the international black market
– Define ionizing radiation and radioactive contamination.
South Carolina Area Health Education Consortium
Objectives 2Objectives 2
– State the four basic types of ionizing radiation.
– State the potential biological effect from acute radiation exposure
– Identify the protective measures of time distance, and shielding.
– List the five possible health effects from ionizing radiation exposure
South Carolina Area Health Education Consortium
Objectives 3Objectives 3
– List materials that are most effective in shielding alpha, beta, gamma, and neutron radiation.
– List five sources that can be used as a radiological dispersion device
– List five dispersal techniques
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Effects of a Radiological Effects of a Radiological IncidentIncident
• Panic.
• Mass casualties with difficult injuries.
• Medical facilities overloaded.
• Contamination issues.
• Gridlock.
• Public services disrupted.
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A True StoryA True Story
“Boy Scout builds working nuclear breeder reactor from readily available materials!”
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IngredientsIngredients
• Radium-226 from antique clocks with luminous radium dials.
• Americium-241 from smoke detectors.
• Beryllium-9 stolen from a local college.
• Thorium-232 collected from Coleman gas lantern mantles.
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• The reactor became significantly more radioactive within a matter of weeks as it produced Uranium-233.
• When he could detect the radiation from 5 doors down, he terminated the experiment.
• The EPA stated that the 40,000 nearby residents could have been put at risk had radioactive dust been accidentally liberated.
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RadiationRadiation• Energy that comes from a source and
travels through some material or through space.
• Light, heat, and sound are types of radiation
• Types of radiation associated with radioactivity are alpha and beta particles and gamma and x-rays.
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Radiation Released When a Radiation Released When a Radioactive Atom DecaysRadioactive Atom Decays
• Alpha particles
• Beta particles
• Gamma rays and x-rays
• Neutron radiation
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Alpha ParticlesAlpha Particles
• Helium nucleus• Contain two protons and two neutrons.• Have strong positive charge• Is a large particle• Will travel only a few inches in air• Will not penetrate paper or dead skin• Only dangerous when incorporated in the
body by ingestion, inhalation or through a wound.
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Beta ParticlesBeta Particles
• Very small particle• Carry a negative charge• Actually an electron traveling at very high
speed• A high-energy beta particle can travel
about ten feet in air and can penetrate paper and human skin
• Can be shielded by plastic, glass, and metal foil
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Gamma Rays Gamma Rays and X-raysand X-rays
• Pure energy photons and not particles
• No mass or electrical charge
• Travel at the speed of light
• Very short wavelength
• Can penetrate and damage all organs
• Shielded by lead, steel, and concrete
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Neutron Neutron RadiationRadiation
• Neutron radiation is a high speed neutron particle
• Have no electrical charge
• Neutrons ionize matter by direct collision with electrons.
• Shielded by carbon, lithium, cadmium, boron, plastic, and water
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Background RadiationBackground Radiation
• Sources of normal background radiation are:– Cosmic radiation– Sources in the earth’s crust– Sources deposited in the body from
food and water– Naturally occurring radon in the soil
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Manmade Sources of Manmade Sources of Background RadiationBackground Radiation
• Tobacco products contain radon absorbed by the plant leaf.
• Medical radiation from x-rays, nuclear medicine diagnostics, and radiation therapy.
• Building materials contain terrestrial radiation sources.
• Water supply contains dissolved radioactive minerals
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Sources of Sources of Radioactive IsotopesRadioactive Isotopes
• Natural sources – Radon in air– Radium in soil – Uranium ore
• Machine produced nuclear interactions– Cyclotrons– Linear accelerators
• Nuclear reactors
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Moral of the Boy Scout Moral of the Boy Scout StoryStory
Intelligent people with enough determination can build sophisticated
nuclear devices using readily available materials and information that can be collected from sources
accessible to the public.
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Nuclear Expertise Can be Nuclear Expertise Can be BoughtBought
• Thousands of former Soviet weapons scientists have not successfully found suitable new jobs in the civilian economy and are currently impoverished.
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Radioactive Radioactive Materials Materials
Can Be BoughtCan Be Bought
• Russia currently has no consolidated system of nuclear materials registration and it is very difficult to track the quantity, deployment, and transportation of nuclear material.
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Nuclear Black MarketNuclear Black Market• Weapons grade nuclear materials are located
in nearly 100 facilities in the former Soviet Union.
• The black market for radioactive materials is very active in Russia since 1993.
• The United Nations Atomic Energy Agency has documented 370 confirmed incidents of nuclear trafficking between 1993 and 2001.
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Nuclear Black MarketNuclear Black Market
• Reactor wastes are the ideal material for terrorists to use in radiation dispersal devices (“dirty bombs”).
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Nuclear Black MarketNuclear Black Market
• Security at nuclear plants and storage facilities in the former Soviet Union is lax.
• Facilities are in dilapidated condition.
• There is much evidence of an active and lucrative trade in radioactive materials in a country in deep economic decline.
South Carolina Area Health Education Consortium
Nuclear Black MarketNuclear Black Market
• Most intense around and inside nuclear plants in the former Soviet Union.
• Fifteen kilograms of commercial grade uranium were found under the bathtub of one plant employee.
• In Moscow in 1995, enriched uranium was found inside a cabinet secured with a bicycle lock.
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Suitcase BombsSuitcase Bombs
• A Russian Lieutenant General testified in 1998 that ninety suit-case sized one kiloton atomic bombs were unaccounted for.
• We know that this weapon is feasible, since we built them in the 1960’s.
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Nuclear Power PlantsNuclear Power Plants
• High and low level wastes are the byproducts of electricity production at nuclear power plants.
• Terrorists could use these to contaminate an area so that it could not be accessed or used safely.
• Many engineering safeguards at a nuclear power plant are disabled during a “Shut Down”. The reactor is most vulnerable to attack at that time.
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Radiological Dispersal Radiological Dispersal DeviceDevice
(“Dirty Bomb”)(“Dirty Bomb”)• A radioactive Dispersal Device spreads
radioactive contamination over an area.
• Radioactive material can be acquired from numerous unsecured locations.– Radiographic, industrial, medical,
agricultural, defense wastes, reactor waste.
• The radioactive material can be easily dispersed with a conventional explosive.
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ContaminationContamination
• Deposition of radioactive material in any place where it is not desired, particularly where its presence can be harmful.
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Avoiding ContaminationAvoiding Contamination
• Use respirator early• Use time, distance, and shielding effectively• Removal of outer garments removes most
radiological contamination.• Soap and water remove most of the rest.• Do not eat, drink, smoke, scratch, apply
make-up or rub your eyes in a contaminated environment.
• Avoid cuts and abrasions.
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Irradiated versus Irradiated versus ContaminatedContaminated
• A patient who has been exposed to ionizing radiation has been injured by the exposure but does not emit radiation himself. There is no ongoing source of radiation injury.
• A patient who has be contaminated with radiation-emitting materials continues to be injured by them and posses a threat to others.
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Critical Point for Health Critical Point for Health ProvidersProviders
“It is impossible for a living patient to be so contaminated as to pose a threat to care providers.”
(Medical Management of Radiological Casualties, December, 1999, P. 67.)
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ALARAALARA
• Minimize exposure to radiation and contamination.
• Keep exposure “As Low as Reasonably Achievable”
• Time – Distance – Shielding
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Time Practical PearlsTime Practical Pearls
• Break task into many small segment.
• A different individual performs each small segment.
• Time of exposure is minimized.
• Total radiation dose is minimized
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Practical Distance PearlsPractical Distance Pearls• The Inverse Square Law:
– Doubling the distance from a source halves the radiation dose
– Halving the distance from a source increases the dose four times!
– Distancing oneself from a source by even a small amount will significantly decrease ones radiation exposure.
South Carolina Area Health Education Consortium
Practical Shielding PearlsPractical Shielding Pearls
• Four to twelve inches of soil used to cover a discrete radiation source will stop 50% to 90% of the radiation!
• An engine block, a concrete wall, or an earthen berm can be adequate shielding if kept between a rescuer and the source.
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Ionizing RadiationIonizing Radiation
• Ionizing radiation interacts with the atoms in tissue and causes cellular damage.
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External ExposureExternal Exposure
• Like an x-ray: the source of radiation is remote from the person.
• The person is NOT radioactive.
• The person is NOT a threat to others.
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Internal ExposureInternal Exposure
• The most serious chronic risk.• Inhaled radioactive particles in the
air.• Ingested contaminated food or water.• Absorbed material through the skin
or mucous membranes.• Incorporated contaminants in a
wound.
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Health EffectsHealth Effects
• Ionizing radiation damages cells by interacting with its atoms.
• The nucleus is especially sensitive.• Even low dose radiation effects
chromosomes.• Chromosome damage may result in
mutations, possibly resulting in malignancies or fetal abnormalities.
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Health EffectsHealth Effects
• Ionization of cellular water produces hydrogen peroxide.
• Intercellular hydrogen is very toxic and more destructive than the radiation itself.
• Hydrogen peroxide is more destructive than the radiation itself.
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Health EffectsHealth EffectsRadiation Sensitivity of Radiation Sensitivity of
Different CellsDifferent Cells
• Developing sperm cells• White blood cells• Red blood cells• Small intestine• Stomach• Neural tissue (nerves, spinal cord, brain)• Colon• Skin• Muscle• Bone• Collagen
MOST Sensitive
LEAST Sensitive
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Whole Body EffectsWhole Body Effects
• High dose radiation over a short period of time produces acute health complications.
• Low doses of radiation over an extended period of time may produce chronic health complications
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Acute Radiation Acute Radiation SyndromeSyndrome
• Prodromal Stage
• Latent Stage
• Manifest Illness
• Recovery or Death
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Acute Radiation Acute Radiation SyndromeSyndrome
• Low dose ( up to 100,000 millirem)• Moderate dose (100,000 to
1,000,000 millirem)• High dose (greater than 1,000,000
millirem)• LD50 is about 300,000 to 500,000,
depending on the extent of medical care.
South Carolina Area Health Education Consortium
Drug Intervention for Drug Intervention for Acute Thyroid ExposureAcute Thyroid Exposure
• Iodine concentrates in thyroid.• Radioiodine enters by inhalation and
ingestion.• Normal iodine will saturate the gland so
that radioiodine cannot be absorbed.• Potassium iodide (KI) is effective if taken
before exposure.• KI does not protect against any other
isotope.
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Chronic Radiation Chronic Radiation ExposureExposure
• Somatic Effects
• Genetic Effects
• In-Utero Effects
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Lifetime Increased Lifetime Increased Cancer RiskCancer Risk
• Stomach• Lung• Liver• Colon• Bladder
• Breast• Ovaries• Thyroid• Skin• Bone marrow
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SummarySummary
• Radiation can be an effective terrorist weapon.
• It is possible to sabotage sources of radiation in the community or even to construct radiological weapons of various types.
• Sources of expertise and materials are available.
• Health professionals can take steps to protect themselves while providing care to victims of a radiological attack.
South Carolina Area Health Education Consortium
AcknowledgementAcknowledgement• This presentation borrows heavily from
– “The Weapons of Mass Destruction Radiation/Nuclear Course for Hazardous Materials Technicians” produced by the U.S. Department of Justice Office for Domestic Preparedness, the U.S. Department of Energy, and Bechtel Nevada.
– “Emergency Medicine, Fourth Edition, produced by the American College of Emergency Physicians and edited by Judith Tintinalli, M.D.
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