INTRODUCTIONINTRODUCTION

•What is Radiation?What is Radiation?

•Types of RadiationTypes of Radiationo Nonionizing RadiationNonionizing Radiationo Ionizing RadiationIonizing Radiation

INTRODUCTIONINTRODUCTION• Radiation Spreading EventsRadiation Spreading Events

o Radiation PoisoningRadiation Poisoningo Radiation Exposure Device (RED)Radiation Exposure Device (RED)o Radiation Dispersal Device (RDD)Radiation Dispersal Device (RDD)o Improvised Nuclear Detonation (IND)Improvised Nuclear Detonation (IND)o Nuclear Weapon Detonation (NWD)Nuclear Weapon Detonation (NWD)

• Time Distance ShieldingTime Distance Shielding• Inverse Square LawInverse Square Law• Shelter in PlaceShelter in Place

INTRODUCTIONINTRODUCTION• Why are we afraid of Radiation?Why are we afraid of Radiation?• Measuring RadiationMeasuring Radiation• Patient DecontaminationPatient Decontamination• Health Effects of radiationHealth Effects of radiation• Medical Management of Medical Management of

Radiation PatientsRadiation Patients• Public Health Response Public Health Response

RADIATIONRADIATION• RADIATIONRADIATION is energy that comes is energy that comes

from a source and travels through from a source and travels through some material or through space. some material or through space. Light, heat, X-ray and microwave Light, heat, X-ray and microwave energy are types of radiation. energy are types of radiation.

• IONIZING RADIATION IONIZING RADIATION is produced is produced by unstable atoms. Unstable atoms by unstable atoms. Unstable atoms differ from stable atoms because differ from stable atoms because they have an excess of energy, they have an excess of energy, mass and/or both.mass and/or both.

Properties Alpha () Beta () Gamma () Neutron (n)

Mass

Large mass 2 protons and 2 neutrons (4 amu)(helium nucleus)

Solid mass (about 1/1838 of 1 amu)

No mass electromagnetic wave or photon

Mass of 1 amu

Electrical Charge

+ 2 positive -1 negative None None

Range in the air

Short range ¼ to 2 inches (4cm) in dry air,

up to about 10 feet (3 meters) in dry air

Very far several hundred feet. Very high penetrating power since it has no mass or charge

Very far. Several hundred feet. High penetrating power due to lack of charge (difficult to stop)

Shielding

2 inches of air, A sheet of paper, dead layer of skin

Plastic, aluminum foil, clothing safety glasses

Inches of Lead, Concrete, Water, Steel

Materials with high hydrogen content, water, concrete, plastic, polyethylene, boron cadmium

External Hazard

Does not represent external hazard.

Externally for unprotected skin and eyes.

Whole body exposure. Can penetrate through the body.

Whole body exposure. Can penetrate through the body.

Biological Hazard

Internal hazard if the source is inside the body (inhaled, ingested, or injected in wound.) Can deposit large amounts of energy in a small area internally

Internal hazard if the source is inside the body (inhaled, ingested, or injected in wound.) Can deposit large amounts of energy in a small area internally

Hazard may be internal or external. This depends on whether the source is outside or inside the body.

Hazard may be internal or external. This depends on whether the source is outside or inside the body.

Sources

Usually emitted by transuranic elements: Uranium, Plutonium, Americium, Radon, Radium

Fissionable products such as Cesium 137, Tritium, Carbon-14, and iodine 132

Fission Products. in soil, industrial and medical sources. Cesium 137, Cobalt 60, depleted Uranium

Few natural sources. Fission nuclear reactors. Cosmic radiation Plutonium, Californium 252.

TYPES OF RADIATIONTYPES OF RADIATION

IN ORDER OF PENETRATIONIN ORDER OF PENETRATION

• Alpha ParticlesAlpha Particles

• Beta ParticlesBeta Particles

• Gamma RaysGamma Rays

• Neutron ParticlesNeutron Particles

LIMITING EXPOSURELIMITING EXPOSURE

• AS LOW AS REASONABLY AS LOW AS REASONABLY ACHIEVABLE (ALARA)ACHIEVABLE (ALARA)

o TIMETIMEo DISTANCEDISTANCEo SHIELDINGSHIELDING

INVERSE SQUARE LAWINVERSE SQUARE LAW

A = 4x = 32 remA = 4x = 32 rem

B = x = 8 remB = x = 8 rem

C = 1/4x = 2 remC = 1/4x = 2 rem

RADIATION POISONINGRADIATION POISONING• Place in food or waterPlace in food or water• Gets more difficult with increase in Gets more difficult with increase in

number of people to poisonnumber of people to poison• Creates panicCreates panic• Doesn’t require explosives or high Doesn’t require explosives or high

technologytechnology• Done effectively in the past.Done effectively in the past.• Slow to affect people, but time is Slow to affect people, but time is

dose dependentdose dependent

RADIATION POISONINGRADIATION POISONING• Alexander Litvinenko Alexander Litvinenko

o Polonium 210 (Polonium 210 (210 210 Po) – alpha emitterPo) – alpha emittero Lost hair, Severe nausea, vomiting Bone Lost hair, Severe nausea, vomiting Bone

marrow badly damagedmarrow badly damagedo Unable to eat for 18 days, Died in 3 weeksUnable to eat for 18 days, Died in 3 weekso 210 210 Po was in green teaPo was in green teao Seven bar staff had levels of Seven bar staff had levels of 210 210 PoPoo Several customers also had evidence of Several customers also had evidence of

210210 Po exposure from same pot Po exposure from same pot

• Radioactive source out of legal Radioactive source out of legal controlcontrol

• Potential to expose people to lethal Potential to expose people to lethal doses of radiationdoses of radiation

• Irradiation, no incorporation if Irradiation, no incorporation if sealed sourcesealed source

• Dose assessment, medical Dose assessment, medical monitoringmonitoring

• Psychological & Economical impactPsychological & Economical impact

RADIATION DXPOSURE DEVICE (RED) RADIATION DXPOSURE DEVICE (RED)

RADIATION DXPOSURE DEVICE (RED) RADIATION DXPOSURE DEVICE (RED)

RADIOLOGICAL DISPERSAL DEVICE (RDD)RADIOLOGICAL DISPERSAL DEVICE (RDD)

• Conventional explosive Conventional explosive incorporating radioactive incorporating radioactive materialsmaterials

• Explosion greatest hazardExplosion greatest hazard• Mostly creates panic with little Mostly creates panic with little

injuryinjury

NUCLEAR DETONATIONNUCLEAR DETONATION

• TWO DIFFERENT THREATSTWO DIFFERENT THREATSo Nuclear Weapon Detonation Nuclear Weapon Detonation

(HIGH YEILD)(HIGH YEILD)o Improvised Nuclear Detonation Improvised Nuclear Detonation

(IND) (LOW YEILD)(IND) (LOW YEILD)

IMPROVISED NUCLEAR IMPROVISED NUCLEAR DEVICE (IND)DEVICE (IND)

• Illicit nuclear weapon bought, Illicit nuclear weapon bought, stolen, or otherwise originating stolen, or otherwise originating from a nuclear state, or built from from a nuclear state, or built from the components of a stolen the components of a stolen weapon or from scratch. (Pu or U)weapon or from scratch. (Pu or U)o Produces same physical and medical effects Produces same physical and medical effects

as nuclear weapon explosion as nuclear weapon explosion

IMPROVISED NUCLEAR IMPROVISED NUCLEAR DEVICE (IND)DEVICE (IND)

o Results in catastrophic loss of life, destruction Results in catastrophic loss of life, destruction of infrastructure, and contamination of a very of infrastructure, and contamination of a very large area large area

o If nuclear yield is If nuclear yield is NOTNOT achieved, the result achieved, the result would likely resemble a RDDwould likely resemble a RDD

o If nuclear yield is achieved, results would If nuclear yield is achieved, results would resemble a nuclear explosionresemble a nuclear explosion

o Like nuclear explosions, IND explosions can be Like nuclear explosions, IND explosions can be evaluated with a fallout map evaluated with a fallout map

FALLOUT MAP (PLUME)FALLOUT MAP (PLUME)

FISSION PRODUCTS FROM A NUCLEAR DETONATIONFISSION PRODUCTS FROM A NUCLEAR DETONATION

IsotopeHalf Life

Alpha (Beta (

Gamma

Radiotoxicity HazardName Symbol

Cesium 137Cs 30 yrs I, ING, SC, WBEStrontium 90Sr 29 yrs I, ING, SCCarbon 14 C 5,730 yrs I, ING, SCZirconium 95 Zr 65 days I, ING, SCUranium 235U 700 mil yrs I, IHG,Uranium 238U 4.47 bil yrs I, IHG,Plutonium 239Pu 24 Thou yrs I, IHG,Cesium 134Cs 3 yrs I, ING, SC, WBEYttrium 91Y 58 Days I, INGTellurium 127Te 105 days I, ING, SC, WBEAntimony 125Sb 2 yrs I, ING, SCRuthenium 106Ru 1 yrs I, ING, SCCerium 144Ce 285 days I, ING, SCIodine 131I 8 days I, INGThorium 234Th 24 days I, ING, SCAmericium 241Am 430 yrs ICurium 243Cm 35 yrs INeptunium 237Np 2.2 mil yrs I

76 % 76 % of all of all FalloutFallout

Always Always somesome

CDC List CDC List of of Interest Interest out of out of 300+300+

I – Inhalation, ING – Ingestion, SC – Skin Contact, WHE – Whole Body Exposure, FF – Full Face Respirator I – Inhalation, ING – Ingestion, SC – Skin Contact, WHE – Whole Body Exposure, FF – Full Face Respirator

RADIATION DECAYRADIATION DECAY

AFRRI - MEIRAFRRI - MEIR

Fallout is distributed downwind from Fallout is distributed downwind from the blast site in a plume-like pattern. the blast site in a plume-like pattern.

ELECTROMAGNETIC PULSE (EMP)ELECTROMAGNETIC PULSE (EMP)

• At the instant of the detonation (same time as At the instant of the detonation (same time as thermal, gamma, and light)thermal, gamma, and light)

• Greatest nearest the epicenter and only lasts Greatest nearest the epicenter and only lasts seconds seconds

• Disruption of the electrical grid, electronic and Disruption of the electrical grid, electronic and communications equipmentcommunications equipment

• Equipment entering the area after EMP will Equipment entering the area after EMP will function normallyfunction normally

• Cell phones and handheld radios with small Cell phones and handheld radios with small antennas may not be affected (Repeaters and antennas may not be affected (Repeaters and towers will be)towers will be)

INITIAL BLAST INJURYINITIAL BLAST INJURY

• ThermalThermalo BurnsBurnso Mortality Increases With Mortality Increases With

RadiationRadiation

• High Intensity Visible LightHigh Intensity Visible Lighto Eye DamageEye Damage

BLAST INJURYBLAST INJURY

• Over Pressure and Under PressureOver Pressure and Under Pressureo Blunt TraumaBlunt Traumao PenetrationsPenetrations

SHELTERING IN PLACE (SIP)SHELTERING IN PLACE (SIP)

• SIP will normally be the preferred SIP will normally be the preferred protective action.protective action.

• SIP should be directed if the projected SIP should be directed if the projected effective dose greater than 10 mSv (1 effective dose greater than 10 mSv (1 rem). rem).

• SIP need not be implemented if the SIP need not be implemented if the projected effective dose is less than 1 projected effective dose is less than 1 mSv (100 mrem). mSv (100 mrem).

SHELTERINGSHELTERING IN PLACE (SIP) IN PLACE (SIP)• A brick building provides better protection than a A brick building provides better protection than a

brick veneer building, which is better than that of a brick veneer building, which is better than that of a frame building. frame building.

• Less radiation exposure (increasing the Protection Less radiation exposure (increasing the Protection Factor) is seen at interior locations and below Factor) is seen at interior locations and below ground ground

• Moving to a higher floor in the building increases Moving to a higher floor in the building increases the distance from the ground source but increases the distance from the ground source but increases exposure from radiation on the rooftop. exposure from radiation on the rooftop.

SHELTERING IN PLACE SHELTERING IN PLACE (SIP)(SIP)

Radiation ???Radiation ???

Maybe I’m contaminated… OH what shall Maybe I’m contaminated… OH what shall I do…I do…

GOIANIA, BRAZIL 1987GOIANIA, BRAZIL 1987

• 249 people contaminated249 people contaminated• 20 people hospitalized 20 people hospitalized • 4 people died4 people died• 2000 m2000 m22 contaminated. contaminated. • 112,800 monitored in soccer stadium112,800 monitored in soccer stadium

Which Do You Fear Which Do You Fear Most?Most?

OROR

H1N1 influenza pandemic H1N1 influenza pandemic (1918-1919) killed more (1918-1919) killed more people than WW I – people than WW I – 20 to 40 mil.20 to 40 mil.

Which Do You Fear Which Do You Fear Most?Most?

OROR

Yersinia pestis Yersinia pestis DeathsDeathsPlague of Justinian Plague of Justinian (541–542 AD) (541–542 AD) 25 mil. in Byzantine Empire25 mil. in Byzantine EmpireBlack Death Black Death (1348 - 1350) (1348 - 1350) 40 – 60 % of Europe40 – 60 % of EuropeGreat Plague Great Plague (1665–1666) (1665–1666) 20 % of London20 % of London

What would you rather What would you rather live next to?live next to?

OROR

Union Carbide India LimitedUnion Carbide India Limited12/84, methyl isocyanate gas release12/84, methyl isocyanate gas release

Little or No WarningLittle or No WarningWarning Warning

Time to EvacuateTime to Evacuate

3,787 Dead3,787 Dead558,125 injuries 558,125 injuries • 38,478 temporary partial disabling38,478 temporary partial disabling• 3,900 severely/permanently 3,900 severely/permanently disablingdisabling

Three Mile Island - 0 Death/InjuriesThree Mile Island - 0 Death/InjuriesFukushima - 0 Deaths 3 injuries (latent period?)Fukushima - 0 Deaths 3 injuries (latent period?)Chernobyl – Warning time not used Chernobyl – Warning time not used SIP, KI, evacuation too lateSIP, KI, evacuation too late 47 known deaths from ARS47 known deaths from ARS >9,000 Cancer WHO estimated 2006>9,000 Cancer WHO estimated 2006

WOUNDS AND RADIATION• WOUNDS LEFT OPEN AND ALLOWED TO HEAL ARE WOUNDS LEFT OPEN AND ALLOWED TO HEAL ARE

POTENTIALLY FATAL DUE TO INFECTIONPOTENTIALLY FATAL DUE TO INFECTION

• WOUND HEALING MARKEDLY COMPROMISED WITHIN WOUND HEALING MARKEDLY COMPROMISED WITHIN HOURS OF RADIATION INJURYHOURS OF RADIATION INJURY

• WOUNDS SHOULD BE CLOSED AS SOON AS POSSIBLE. WOUNDS SHOULD BE CLOSED AS SOON AS POSSIBLE.

• EXTENSIVE DEBRIDEMENT OF WOUNDS MAY BE EXTENSIVE DEBRIDEMENT OF WOUNDS MAY BE NECESSARYNECESSARY

• CHECK WOUNDS PRIOR TO CLOSING WITH GEIGER CHECK WOUNDS PRIOR TO CLOSING WITH GEIGER COUNTER OR OTHER SOURSE…ALPHA CAN BE MASKED COUNTER OR OTHER SOURSE…ALPHA CAN BE MASKED BY BLOODBY BLOOD

“RADIOLOGICAL DECONTAMINATION SHOULD NEVER INTERFERE WITH ACUTE MEDICAL CARE. UNLIKE CHEMICAL AGENTS, RADIOACTIVE PARTICLES WILL NOT CAUSE ACUTE INJURY

Medical Management Of Radiological Casualties Handbook, Second Edition, Military Medical Operations Armed Forces Radiobiology Research Institute, April 2003

IONIZING RADIATIONIONIZING RADIATION

In most cases patients In most cases patients

subjected to nuclear subjected to nuclear

or radiological agents or radiological agents

will be exposed, butwill be exposed, but

not contaminated. not contaminated. Hiroshima thermal burn victim Hiroshima thermal burn victim

IONIZING RADIATIONIONIZING RADIATION• A person is A person is externallyexternally contaminated if contaminated if

radioactive material is on skin or radioactive material is on skin or clothing. clothing.

• A person is A person is internallyinternally contaminated if contaminated if radioactive material is breathed in, radioactive material is breathed in, swallowed, or absorbed through wounds. swallowed, or absorbed through wounds.

• The The environmentenvironment is contaminated if is contaminated if radioactive material is spread about or radioactive material is spread about or uncontained.  uncontained.  

CPMCPM

• A measure of radioactivity. A measure of radioactivity. • The number of atoms in a The number of atoms in a

given quantity of radioactive given quantity of radioactive material that are material that are detecteddetected to to have decayed in one minute. have decayed in one minute.

• Versus Disintegration Per Versus Disintegration Per Minute (DPM)Minute (DPM)

ROENGTON (R)ROENGTON (R)• Used to measure a quantity called Used to measure a quantity called

exposure. exposure.

• Gamma and X-rays, and only in air. Gamma and X-rays, and only in air.

• Measure of the ionizations of the Measure of the ionizations of the molecules in a mass of air. molecules in a mass of air.

• The main advantage of this unit is The main advantage of this unit is that it is easy to measure directlythat it is easy to measure directly

RADRAD• rad (rad (radiation absorbed doseradiation absorbed dose))• Used to measure a quantity called Used to measure a quantity called

absorbed dose.absorbed dose.• Amount of energy actually absorbed in Amount of energy actually absorbed in

material material o any type of radiationany type of radiationo any materialany material

• Does not describe the biological effects Does not describe the biological effects of the different radiations.of the different radiations.

REM (REM (roentgen equivalent roentgen equivalent manman))

• called equivalent dose. called equivalent dose. • absorbed dose in human tissue to the absorbed dose in human tissue to the

effective biological damage of the radiation. effective biological damage of the radiation. • Not all radiation has the same biological Not all radiation has the same biological

effecteffect• Equivalent dose is often expressed in terms Equivalent dose is often expressed in terms

of thousandths of a rem, or rem. of thousandths of a rem, or rem.

DOSAGEDOSAGE

• For X rays and gamma rays in For X rays and gamma rays in soft tissuesoft tissue

• Exposure ≈ Absorbed Dose ≈ Exposure ≈ Absorbed Dose ≈ Dose EquivalentDose Equivalent

1 R ≈ 1 rad ≈ 1 rem1 R ≈ 1 rad ≈ 1 rem

DOSAGEDOSAGE

  UNITSUNITS RADIOACTIVITYRADIOACTIVITYABSORBED ABSORBED

DOSEDOSEDOSE DOSE

EQUIVALENTEQUIVALENTEXPOSUREEXPOSURE

Common Common UnitsUnits

curie (Ci)curie (Ci) radrad remremroentgen roentgen

(R)(R)

SI UnitsSI UnitsBecquerel Becquerel

(Bq)(Bq)Gray (GY)Gray (GY) Sievert (Sv)Sievert (Sv)

Coulomb Coulomb (C)(C)

DOSAGEDOSAGEConversion EquivalenceConversion Equivalence

1 curie = 3.7 x 101 curie = 3.7 x 101010

disintegrations per seconddisintegrations per second ==1 becquerel = 1 becquerel =

1 disintegration per second1 disintegration per second

1 millicurie (mCi)1 millicurie (mCi) == 37 megabecquerels (MBq)37 megabecquerels (MBq)

1 megabecquerel (MBq)1 megabecquerel (MBq) == 0.027 millicuries (mCi)0.027 millicuries (mCi)

1 rad1 rad == 0.01 gray (Gy)0.01 gray (Gy)

1 rem1 rem == 0.01 sievert (Sv)0.01 sievert (Sv)

1 gray (Gy)1 gray (Gy) == 100 rad100 rad

1 sievert (Sv)1 sievert (Sv) == 100 rem100 rem

1 roentgen (R)1 roentgen (R)==

0.000258 coulomb/kilogram 0.000258 coulomb/kilogram

(C/kg)(C/kg)

1 coulomb/kilogram (C/kg)1 coulomb/kilogram (C/kg) == 3,880 roentgens3,880 roentgens

CONVERSION FACTORSCONVERSION FACTORSTo convert fromTo convert from ToTo Multiply byMultiply by

Curies (Ci) becquerels (Bq) 3.7 x 1010

millicuries (mCi) megabecquerels (MBq) 37microcuries (µCi) megabecquerels (MBq) 0.037milliroentgens (mR)

microcoulombs/k (µC/kg)

0.258

millirads (mrad) milligrays (mGy) 0.01millirems (mrem) microsieverts (µSv) 10

becquerels (Bq) curies (Ci) 2.7 x 10-11

megabecquerels (MBq)

millicuries (mCi) 0.027

megabecquerels (MBq)

microcuries (µCi) 27

microcoulombs/kilogram (µC/kg)

milliroentgens (mR) 3.88

milligrays (mGy) millirads (mrad) 100microsieverts (µSv) millrems (mrem) 0.1

RADIATION PATIENT RADIATION PATIENT TRIAGETRIAGE

• Contaminated/exposed patientsContaminated/exposed patients

• Wounded but not Wounded but not contaminated/exposedcontaminated/exposed

• Wounded and contaminated/ Wounded and contaminated/ exposedexposed

Health Effects and Emergency Medical Conditions of Exposure to Radiation

Condition Pre Clinical Clinical Lethal

Radiation 25 to 100

rem100 to 250

rem250 to 650

rem650 to 1,000

rem1,000 to 35,000 rem over 35,000rem

Vomiting Incidents

None 5 to 50 % 50 to 100 % 100 % 100 % 100 %

Vomiting Delay Time

N/A3 to 6 hours

2 to 3 hours 15 to 30 min 5 to 20 min less than 3 min

Leading Organ

NoneBone Marrow, Blood System, Stomach

and Intestinal System

Tiny Blood Vessels, Stomach and

Intestinal System

Brain, Spinal Cord (Central

Nervous System)

SignsMild

Weakness

Reduced White Blood Cells

Destroyed White Blood Cells

Diarrhea, FeverConvulsions,

Tremors

Therapy Reassurance

Blood System

Restoration

Blood Transfusion

Drubs, (Cytokines)

Bone Marrow

Transplant

Maintain Electrolytes

Sedatives

Prognosis Excellent Excellent Good Poor Death Death

Incidence of Death

None 0 to 5 % 15 to 80 % 80 to 90 % Almost 100 % 100 %

TREATMENT OF TREATMENT OF CONTAMINATED WOUNDSCONTAMINATED WOUNDS

• In a contamination accident, any In a contamination accident, any wound must bewound must be considered considered contaminated until proven contaminated until proven otherwiseotherwise and should be and should be decontaminated prior to decontaminated prior to decontaminating intact skin.decontaminating intact skin.

RADIATION PATIENT RADIATION PATIENT MOVEMENTMOVEMENT

• Contaminated – CocoonContaminated – Cocoon

• Remember blood and water Remember blood and water mask alpha particlesmask alpha particles

• In Hospital movementIn Hospital movement

PATIENT DECONTAMINATIONPATIENT DECONTAMINATION

• Non-contaminatedNon-contaminated

• ContaminatedContaminated– ClothingClothing– SurveySurvey– Dry DecontaminationDry Decontamination

PATIENT DECONTAMINATIONPATIENT DECONTAMINATION

• TAKE NASAL SWAB SAMPLETAKE NASAL SWAB SAMPLE

• REMOVE CLOTHINGREMOVE CLOTHING

• DRY DECONTAMINATIONDRY DECONTAMINATION

• WASH WITH SOAP AND WATERWASH WITH SOAP AND WATER

PATIENT DECONTAMINATIONPATIENT DECONTAMINATION

• SkinSkin• Hot water versus cold waterHot water versus cold water• Contaminated bandages, water Contaminated bandages, water

and bodily fluidsand bodily fluids• When to stopWhen to stop

BURN PATIENTSBURN PATIENTS• Cleansing process is the same Cleansing process is the same

as with intact skin (except no as with intact skin (except no scrub brush)scrub brush)

•Consult BConsult Burn Unit urn Unit FIRSTFIRST

• Physicians/nurses at Local Physicians/nurses at Local Burn Center can give guidanceBurn Center can give guidance

TAKE SAMPLESTAKE SAMPLES• Samples should be taken at Samples should be taken at

the earliest possible time.the earliest possible time.

o BloodBlood – white blood cells count is – white blood cells count is extremely importantextremely important

o UrineUrine – some isotopes – some isotopes

o StoolStool (feces) – some isotopes (feces) – some isotopes

REASSURING THE REASSURING THE PATIENTPATIENT

• Radiation is NOT contagiousRadiation is NOT contagious

• Explain the reason for Explain the reason for monitoring and lab testingmonitoring and lab testing

• Reassure the patient Reassure the patient

REASSURING THE REASSURING THE STAFFSTAFF

• Radiation is NOT contagiousRadiation is NOT contagious

• Ensure the staff including Ensure the staff including maintenance and housekeeping maintenance and housekeeping understand the hazards of radiation.understand the hazards of radiation.

• If the staff is afraid then that will If the staff is afraid then that will transfer to the patient.transfer to the patient.

MEDICAL MANAGEMENT OF MEDICAL MANAGEMENT OF INTERNAL CONTAMINATIONINTERNAL CONTAMINATION

• REDUCES THE ABSORBED RADIATION REDUCES THE ABSORBED RADIATION DOSE AND THE RISK OF FUTURE DOSE AND THE RISK OF FUTURE BIOLOGICAL EFFECTSBIOLOGICAL EFFECTS

• DILUTING AND BLOCKING AGENTS DILUTING AND BLOCKING AGENTS ENHANCE ELIMINATION RATES OF ENHANCE ELIMINATION RATES OF RADIONUCLIDES (RADIONUCLIDES (IODIDE COMPOUNDSIODIDE COMPOUNDS))

• MOBILIZING OR CHELATING AGENTS MOBILIZING OR CHELATING AGENTS (CALCIUM EDETATE (EDTA)(CALCIUM EDETATE (EDTA)

MEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATIONMEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATION

Isotope DrugAdministestrati

onComments

Americium Ca-DTPA, Zn-DTPA ParenteralZn-DTPA is initially 10 times less effective than Ca-DTPA for initial chelation of transuranics. After 24 hours efficiency of both agents is about the same.

Cesium Prussian blue OralActs by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time.

Cobalt Unknown try penicillamine Oral Nothing too good

Iodine Potassium Iodide (KI) OralWithin about first 4 hours, used to block uptake of radioactive iodine.

Iridium Unknown try penicillamine Oral Nothing too good

Palladium Unknown try penicillamine Oral Nothing too good

Phosphorus Na phosphate or K phosphate.

Oral Used to block uptake of radioactive phosphate

Plutonium Ca-DTPA, Zn-DTPA ParenteralZn-DTPA is initially 10 times less effective than Ca-DTPA for initial chelation of transuranics. After 24 hours efficiency of both agents is about the same.

Radium calcium OralAlginates are also useful to reduce GI absorption oral to reduce GI absorption and increase urinary excretion.

Rubidium Prussian blue Oral

Acts by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time.

Strontium Calcium Gluconate and Ammonium Chloride

IntravenousOral ammonium chloride for acidification. Alginates are useful to reduce gastrointestinal absorption.

ThalliumPrussian blue

 OralActs by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time.

Tritium Water Oral Force water to promote diuresis

Uranium Ca-DTPA, Zn-DTPA Parenteral Na bicarbonate to alkalinize urine - see comments by Americium

Yttrium Ca-DTPA, Zn-DTPA Parenteral Within 4 hours only. - see comments by Americium

PUBLIC HEALTH RESPONSEPUBLIC HEALTH RESPONSE• ProtectingProtecting the public’s health and safety.the public’s health and safety.

• Education Education is the key. Fear of radiation is higher is the key. Fear of radiation is higher than other agents of terrorism. People are than other agents of terrorism. People are unfamiliar with radiation, including medical and unfamiliar with radiation, including medical and public health professionals. public health professionals.

• Monitoring Monitoring workers’ health and safety.workers’ health and safety.

• Ensuring Ensuring provision of health, medical services, provision of health, medical services, mental health, mental health, o safe shelters for the population.safe shelters for the population.o safety of food and water supplies.safety of food and water supplies.

PUBLIC HEALTH RESPONSEPUBLIC HEALTH RESPONSE

• Coordinating Coordinating field investigations, sampling and field investigations, sampling and laboratory analysis of biological and laboratory analysis of biological and environmental samples.environmental samples.

• Assisting and Advising Assisting and Advising communities in communities in decontamination and radiation response for decontamination and radiation response for public health and safety.public health and safety.

• Developing criteria Developing criteria for entry and operations for entry and operations within the incident site.within the incident site.

PUBLIC HEALTH RESPONSEPUBLIC HEALTH RESPONSE

• Population Monitoring Population Monitoring is is a process that directly a process that directly after a radiation incident is reported and after a radiation incident is reported and continues well into the recovery and after.continues well into the recovery and after.

o Needed medical treatment.Needed medical treatment.o Presence of radioactive contaminationPresence of radioactive contaminationo Intake of radioactive materials into the body.Intake of radioactive materials into the body.o Removal of external or internal contaminationRemoval of external or internal contaminationo Dose received and resulting health risk from exposure.Dose received and resulting health risk from exposure.o Long-term health effects on people and offspring.Long-term health effects on people and offspring.

PUBLIC HEALTH RESPONSEPUBLIC HEALTH RESPONSE• RecommendingRecommending radiation management protocols, radiation management protocols,

prevention, and control measures for affected prevention, and control measures for affected populations or individuals.populations or individuals.

• CommunicatingCommunicating necessary information to necessary information to hospitals, medical providers, situation hospitals, medical providers, situation assessments and required safety measures to assessments and required safety measures to the public. the public.

• AssistingAssisting law enforcement agencies with the law enforcement agencies with the

criminal investigationcriminal investigation.

STRATEGIC NATIONAL STRATEGIC NATIONAL STOCKPILE (SNS)STOCKPILE (SNS)

• The SNS is organized for The SNS is organized for flexible response flexible response

o Arizona State and Counties have Arizona State and Counties have plans receive and distribute SNS plans receive and distribute SNS medicine and medical suppliesmedicine and medical supplies

o Vendor Managed InventoryVendor Managed Inventory

STRATEGIC NATIONAL STRATEGIC NATIONAL STOCKPILE (SNS)STOCKPILE (SNS)

National Repository Of:National Repository Of:• Antibiotics, Antibiotics, • Chemical Antidotes, Chemical Antidotes, • Radiation DrugsRadiation Drugs• Antitoxins, Antitoxins, • Life-support Medications, Life-support Medications, • IV Administration, IV Administration, • Airway Maintenance Supplies, Airway Maintenance Supplies, • And Medical/Surgical Items. And Medical/Surgical Items.

Are We Done Are We Done Yet ?Yet ?Just a minute,Just a minute,

one more thing……one more thing……

Go ToGo To

http://www.remm.nlm.govhttp://www.remm.nlm.gov//