radiological events radiologic events: attack on a nuclear power plant
TRANSCRIPT
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
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• 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
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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.
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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
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Nuclear Power Plant Disaster: Chernobyl, 1986
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Attacks on Reactors• Radioisotopes released
– Large quantities of radioiodines and radiocesiums
– A large variety of other radioisotopes may be released in smaller quantities
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Attacks on Reactors
• Which way is the wind blowing?– The radioactive cloud
from the burning reactor will travel according to wind direction.
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Attacks on Reactors
• Prevention– Individuals in the path of
the radioactive cloud need to be evacuated
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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
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Ionizing Radiation• Ionizing radiation includes both
electromagnetic (X and gamma rays) and particulate radiation
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• Alpha
• Neutrons
• Beta
Particles
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• A helium nucleus
• Unable to penetrate skin
• Emitted from radioisotopes
such a plutonium, uranium
++
n
n
Alpha Particles
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• Able to penetrate skin
• Negatively charged
• Can produce skin superficial burns
• Emitted by several radioisotopes (e.g. Cobalt
160)
Beta Particles
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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
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• 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
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RADIATION CANNOT BE SEEN, HEARD,
TASTED OR SMELLEDBut, it can be easily measured
if you have the right equipment
Detecting Radiation
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Alpha Survey Meter
Radiation DetectorsBeta and Gamma
Survey Meter
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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
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Contamination
• Contact with radioactive material (radionuclides) that can be spread to other people / properties
• Inhaled, ingested, transferred from surface to surface
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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
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Factors Determining Radiation Exposure
• Time
• Distance
• Shielding
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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
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Acute Radiation SyndromeA Spectrum of Disease
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Phases of Acute Radiation Syndrome
ProdromalStage
LatentStage
ManifestIllness Recovery
Time (days to years)
Exposure
www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp
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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
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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
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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
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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
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Andrews Curve
1: 1 Gy
2: 4 Gy
3: 6 Gy
4: 7.1 Gy
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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
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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
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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
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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
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Patient Management - Protocol
Based on:
• Injuries
• Signs and symptoms
• Patient history
• Contamination survey
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• 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
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• Contaminated patient – immediately isolated until monitored & decontaminated• Monitor EMS and ambulance
• ABC’s
• Cover all wounds
• Radiation burns are like sun burns
Management
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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
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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
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Protecting Staff from Contamination
• Use standard precautions
• Survey hands and clothing frequently
• Replace contaminated gloves or clothing
• Keep the work area free of contamination
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Examples of Radiation Skin Burns
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Decontamination of Skin
• Use multiple gentle efforts
• Use soap & water
• Cut hair if necessary (do not shave)
• Promote sweating
• Use survey meter
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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
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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
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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)
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Radioiodines and Thyroid Cancer
Radioiodines concentrateIn the thyroid gland and can increase the risk ofthyroid cancer
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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
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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
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Key Points
• Ionizing radiation includes:– Electromagnetic radiation: X and gamma– Particulate radiation: alpha, beta, neutrons
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• 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
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• 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
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• 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
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• Have a radiation disaster management plan in place for your hospital
• Be prepared for psychological consequences
Key Points
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• 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
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This completes the current presentation.