radiation as a weapon of terror

South Carolina Area Health Education Consortium

Radiation as a Radiation as a Weapon of TerrorWeapon of Terror


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


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


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.



– 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



– 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


Effects of a Radiological Effects of a Radiological IncidentIncident

• Panic.

• Mass casualties with difficult injuries.

• Medical facilities overloaded.

• Contamination issues.

• Gridlock.

• Public services disrupted.


A True StoryA True Story

“Boy Scout builds working nuclear breeder reactor from readily available materials!”


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.


• 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.


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.


Radiation Released When a Radiation Released When a Radioactive Atom DecaysRadioactive Atom Decays

• Alpha particles

• Beta particles

• Gamma rays and x-rays

• Neutron radiation


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.


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


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


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


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


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


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


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.


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.


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.


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.


Nuclear Black MarketNuclear Black Market

• Reactor wastes are the ideal material for terrorists to use in radiation dispersal devices (“dirty bombs”).



• 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.



• 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.


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.


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.


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.


ContaminationContamination

• Deposition of radioactive material in any place where it is not desired, particularly where its presence can be harmful.


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.


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.


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.)


ALARAALARA

• Minimize exposure to radiation and contamination.

• Keep exposure “As Low as Reasonably Achievable”

• Time – Distance – Shielding


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


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.


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.


Ionizing RadiationIonizing Radiation

• Ionizing radiation interacts with the atoms in tissue and causes cellular damage.


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.


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.


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.


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.


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


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


Acute Radiation Acute Radiation SyndromeSyndrome

• Prodromal Stage

• Latent Stage

• Manifest Illness

• Recovery or Death


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.


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.


Chronic Radiation Chronic Radiation ExposureExposure

• Somatic Effects

• Genetic Effects

• In-Utero Effects


Lifetime Increased Lifetime Increased Cancer RiskCancer Risk

• Stomach• Lung• Liver• Colon• Bladder

• Breast• Ovaries• Thyroid• Skin• Bone marrow


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.


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.

radiation as a weapon of terror

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