radiological and nuclear disaster: evaluation of the …€¦ · medicine (nuclear medicine,...

RADIOLOGICAL AND NUCLEARDISASTER: EVALUATION OF THE DISASTER: EVALUATION OF THE

PROBLEMCOL Patricia Lillis-Hearne MD MHA

AFRRIAlbert L. Wiley MD PhD FACR

REAC/TS

DISCLOSURES

DR WILEY: NONEDR LILLIS HEARNE NONEDR LILLIS-HEARNE: NONE

LEARNING OBJECTIVES

Identify the potential causes of radiation mishapsD ib l l f th it i di l iDescribe levels of authority in a radiologic or nuclear disasterDistinguish between a radiologic and a nuclearDistinguish between a radiologic and a nuclear eventIdentify where to go for further information on

di l i l di tradiological disasters

ACR/ASTRO/AAPMDisaster Primer

“A radiation disaster is a possibility for which we must be prepared Radiologists radiation oncologists and medicalprepared. Radiologists, radiation oncologists and medical physicists will play a vital role as responders and as sources for accurate information for patients, the public and the medical community.”community.

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andndTerrorismTerrorism

5

Where Do Accidents Occur?Where Do Accidents Occur?

Irradiation facilitiesNuclear reactorsIsotope production facilitiesMaterials testing (sealed sources)Materials testing (x-ray devices)X-ray and radiotherapy devices (medicine, research)Unsealed radionuclides (medicine, research)TransportationMilitMilitary????

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S REAC/TS R di i A id R i

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Source: REAC/TS Radiation Accident Registry

What Causes Radiation “Accidents”?What Causes Radiation “Accidents”?

Usually Human Error

Lost or mishandled sourcesMedical misadministrationBypassing InterlocksFailure to use criticality controlFailure to use criticality controlCalibration/programming errorsInadequate radiation protection programs, supervision/quality control, and training/written procedurescontrol, and training/written proceduresHuman factors

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Reality:Reality: Major Radiation “Accidents” Worldwide Major Radiation “Accidents” Worldwide (1944(1944--Dec 2007); “Classification by Device”Dec 2007); “Classification by Device”

Radiation Devices 319Sealed Sources 210

X-ray Devices 83

Accelerators 25

Radar Generators 1

R di i t 93Radioisotopes 93Diagnosis and Therapy 38

Transuranics 28

Fission Products 11

Tritium 2

Radium Spills 1

Other 13

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Criticalities 20Critical Assemblies 8

Reactors 6

Ch i l O ti 6

8

Chemical Operations 6

Total 432Source: REAC/TS Registry

Things To ConsiderThings To Consider

There are different types and extents of radiation injury, depending on the accident scenariodepending on the accident scenario.

Whole-body irradiations (WBI TBI)(WBI vs TBI)

Partial-body irradiations (PBI)Local radiation injury (LRI)Internal contamination from radioisotopes

There may be acute and chronic effects

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There may be acute and chronic effects.

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An Industrial Radiography Example: LocationAn Industrial Radiography Example: Location

Yanango, 42 megawatt hydroelectric plant, located 300 km east of Lima Perulocated 300 km east of Lima, Peru.

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10

DeviceDevice

192 Ir “gamma camera” with a 1.37 TBq (37 Ci) source

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11

Dose RatesDose Rates

For a 30 Ci For a 30 Ci 192192Ir radiography sourceIr radiography source

DistanceDistance[cm][cm]

Dose RateDose Rate[rad/min] or [cGy/min][rad/min] or [cGy/min]

SurfaceSurface 36,00036,000

11 2,4002,400

22 60060022 600600

33 267267

44 150150

12

44 150150

55 9696

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MedicalMedical

3737--yearyear--old male put source in his old male put source in his pocket with ~6pocket with ~6--hour exposurehour exposurepocket with 6pocket with 6 hour exposurehour exposure

Initial symptoms of nausea / Initial symptoms of nausea / vomiting and one episode of vomiting and one episode of di hdi hdiarrheadiarrhea

Erythema on upper posterior thighErythema on upper posterior thigh

AdmissionAdmission

TTX X -- IV fluids, 500mg Cipro bid, 8mg IV fluids, 500mg Cipro bid, 8mg

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dexamethasone tid, Naprosyndexamethasone tid, Naprosyn--like like pain medspain meds

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MedicalMedical

D+2 (Feb 22, 1999) Blistering, vesicular lesion withvesicular lesion with inflammatory halo

D+5 (Feb 25 1999) ClindamycinD 5 (Feb 25, 1999) Clindamycin 300mg tid started & Cipro ↑750mg bid

14

14

Absorbed doses in GyAbsorbed doses in GyNormalized to 30 Gy at the rim of the lesion (radius = 5 cm)Normalized to 30 Gy at the rim of the lesion (radius = 5 cm)

LEFT0

-2Absorbed dose Absorbed dose di t ib ti fdi t ib ti f2

-4

6

distribution for distribution for horizontal crosshorizontal cross--section at source level section at source level with sourcewith source skinskin-6

-8

10

with sourcewith source--skin skin distance of 3 mmdistance of 3 mm

-10

-12

14

15-16

-14

18

15

-18-12 -10 -8 -6 -4 -2 0 2 4 6 8

Gy at X cm depth

Moist desquamation on wife’s sacral region Moist desquamation on wife’s sacral region 18 March 199918 March 1999

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16

Lymphocyte KineticsLymphocyte Kinetics

2100

AbsoluteAbsolute

1500

1800

2100

900

1200

1500

300

600

900

17

0

300

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90D P tD P t

17

Days PostexposureDays Postexposure

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D+28 19 March 1999 Ulcerative lesion 2cm deep D+28 19 March 1999 Ulcerative lesion 2cm deep -- continues to continues to expand. expand.

D+32 Increasingly painful. Morphine infusion started. RadiationD+32 Increasingly painful. Morphine infusion started. Radiation--

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induced sciatic neuropathy. induced sciatic neuropathy. D+39 First febrile episode. D+39 First febrile episode.

Goiania, Brazil 137Cs Accident September 13, 1987

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19

CesiumCesium--137137

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20

Skin lesion initially diagnosed incorrectly

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Individual MonitoringIndividual Monitoring

112,000 people were screened

249 contaminated people:120 people had their clothes and shoes contaminated;129 people had external and internal contamination

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How Much Intake and How Much Intake and What Is the Dose (CEDE)?What Is the Dose (CEDE)?

Step 1) Estimate the Intake Using Intake Retention Fractions.

Whole Body Retention: Cs-137 At 190 dayso e ody ete t o Cs 3

5.00E-01

6.00E-01

ng

At 190 days about 18% of Cs-137 remains in

2.00E-01

3.00E-01

4.00E-01

actio

n R

emai

nin remains in

whole body.

24 0.00E+00

1.00E-01

2.00E 01

0 50 100 150 200 250 300 350 400

Fra

24

0 50 100 150 200 250 300 350 400

Days Post Inhalation

Assume Measured 1.48 MBq Assume Measured 1.48 MBq [40 uCi] of Cs[40 uCi] of Cs--137 at 190 Days137 at 190 Days

Intake (Inhalation) = 1.48 MBq/0.18 = 8.2 MBq

[40 uCi/0.18 = 222 uCi ]Step 2) Compare to Annual Limit on Intake (ALI).

ALI = 7 4 MBq [200 uCi ] for Cs-137ALI 7.4 MBq [200 uCi ] for Cs 137

(Gives 0.05 Sv [5 rem ] CEDE)

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So individual has 110% of ALI and

Dose of 0.55 Sv [5.5 rem].

25

[ ]

Initial Internal Initial Internal Contamination MeasurementsContamination Measurements

Range Bq

RangeμCi/mCi

No. of PersonsBq μCi/mCi

104-105 0.27 - 2.7 μCi 11μ

105-106 2.7 – 27 μCi 15

106-107 27 – 270 μCi 23

107-108 270 μCi – 2.7 mCi 20

108-109 2.7 – 27 mCi 7

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1010 27 mCi 1

Total 67

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Results of Initial Cytogenetic DosimetriyResults of Initial Cytogenetic Dosimetriy

Range [Sv] No. of Persons Relative Frequency [%]0 – 0 5 43 61 430 0.5 43 61.43

0.5 – 1.0 8 11.43

1.0 – 2.0 6 8.57

2.0 – 3.0 5 7.14

3.0 – 4.0 0 0

4 0 – 5 0 3 4 294.0 5.0 3 4.29

5.0 – 6.0 3 4.29

6.0 – 7.0 2 2.58

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Total 70 100.00

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Goiania DataGoiania Data

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Acute Clinical OutcomesAcute Clinical Outcomes

Individual Radiological Information (approximate)MF1 5 7 Gy (died)MF1 5.7 Gy (died)DF 7 Gy (lived) Possibly spent more time outside (fractionated)MA1 10 MBq (270 μCi) intake, 4.3 Gy external (cytogenetics)IS 4.5 Gy (died) Probable very acute dose.AS 5.3 Gy (died) Probable very acute dose.LF2 1GB (27 Ci) i t k 6 G t l (di d)LF2 1GBq (27 mCi) intake, 6 Gy external (died)GS 100 MBq (2.7 mCi) intake, 3 Gy, significant burn on shoulderDr. PM 1.3 Gy, negligible intake (left source in bag)

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y g g ( g)

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QUESTIONS?QUESTIONS?

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andndTerrorismTerrorism

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PreparednessPreparednessPreparedness and readiness

We all know what we mean when we say it, but

How do you evaluate it?

How prepared is prepared enough?

How do prioritize your resources?

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Response Is Part of the Strategy

“The United States must be prepared to respond to the use of WMD against our citizens, our military forces, and those of friends and allies. We will develop and maintain the capability to reduce to the extent possible the potentially horrific consequences of WMD attacks at home and abroad.”

- National Strategy to Combat Weapons of Mass Destruction (2002)

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RAD/NUC TerrorismRAD/NUC Terrorism

RADIOLOGIC SOURCES (More Likely)• Nuclear Reactors• Radiation Devices (From

Industry/Medicine/Research)Industry/Medicine/Research)− Explosive (Dirty-Bomb) or Non-Explosive

NUCLEAR DEVICES (Less Likely)Improvised Nuclear Device (IND)• Improvised Nuclear Device (IND)

• Nuclear Weapon

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Potential for Nuclear AttackPotential for Nuclear Attack

“Today, it would be easy for adversaries to introduce and detonate a nuclear explosive clandestinely in the United States.”

“It is a central thesis of this report that clandestine nuclear attack and defense against it should be treated as an emerging aspect of strategic warfare and that it should warrant national and DoD attentionwarrant national and DoD attention that is as serious as that devoted to missile defense.”

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The worst assumption we can make is that the penemy

is too dumb to use his best option against us, d th f t t f itand therefore to not prepare for it.

LGEN Von Ryper, USMC Commander,USMC Combat Dev Ctr, on asymmetric warfare, 1998

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“AL QAEDA ‘ HAS THE RIGHT TO KILL 4 MILLIONAL QAEDA …HAS THE RIGHT TO KILL 4 MILLION AMERICANS, 2 MILLION OF THEM CHILDREN,’ IN RETALIATION FOR THE DEATHS…THE UNITED STATES AND ISRAEL HAVE INFLICTED ONSTATES AND ISRAEL HAVE INFLICTED ON MUSLIMS”.

Ref: Al Qaeda spokesman Sulaiman Abu Ghaith, 2002, per “Securing the Bomb,” Nuclear Threat Initiative, May 2004.

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Major Radiation Accidents Worldwide 1944 - December 2004

Radiation Devices 316Sealed Sources 208

X-ray Devices 82

Accelerators 25

Radar Generators 1

Radioisotopes 92Radioisotopes 92Diagnosis and Therapy 38

Transuranics 28

Fission Products 11

Tritium 2

Radium Spills 1

Other 12

C iti liti 19Criticalities 19Critical Assemblies 7

Reactors 6

Chemical Operations 6

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p

Total 427Source: REAC/TS Registries

Nuclear Weapons StockpilesJan 2005 Estimate by GlobalSecurity.org

Country Available Deliverable

U it d St t 10 640 6 390United States 10,640 6,390

Russia 16,000 3,242

China 400? ~325China 400? ~325

France 350 350

Israel 200 200Israel 200 200

United Kingdom 200 200

India 110-150 110

Pakistan 75 75

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North Korea 13? 13?

AFFRI

Lost Nuclear Material

March 1998: 11 Cs-137 brachytherapy rods totaling 22 GBq stolen from Greensboro, NC hospital – never recoveredfrom Greensboro, NC hospital never recovered

30 thousand lost sources in the US alone

Over 2M rad sources reported lost worldwide

• Several hundred thousand considered threat• Several hundred thousand considered threat

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Seizures of Radioactive Material

Date of Seizure Location Material Description11/14/2002 Tanzania Uranium

09/20/2002 Ukraine Strontium-90 (1 Source)06/10/2002 Russia Uranium (2kg)06/10/2002 Russia Uranium (2kg)05/30/2002 Lithuania Cesium-137 (1kg)05/15/2002 Bulgaria Plutonium-239 & AmBe05/01/2002 B l C i 137 (6 S )05/01/2002 Belarus Cesium-137 (6 Sources)04/07/2002 Chechnya Cesium-137 (10 Sources)04/05/2002 Uganda Cobalt-60 (1 Source)03/25/2002 Tajikistan Uranium (639 gm)03/25/2002 Afghanistan Cobalt-60

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March 15, 2004:Oakridge, TN, (AP)--Claiming g , , ( ) gone victory in the fight against weapons of mass destruction, U.S. officials on Monday displayed a few examples of p y ptons of nuclear weapons gear retrieved from Libya.

Included high speed centrifugesIncluded high-speed centrifuges to separate weapons fuel from uranium hexafluoride gas.

Pakistan scientist sold equipment to Libya, North Korea and Iran.

42FOUO

UNCLASSIFIED

A “Dirty Bomb”

A Radiological Dispersion Device (RDD) whichA Radiological Dispersion Device (RDD) which combines a conventional explosive with radioactive material• Not a Nuclear Weapon• Not a Nuclear Weapon• Not a Weapon of Mass Destruction, rather

A Weapon of Mass Disruption or Dislocation• Impact depends on type of explosive, amount and

type of radioactive material and weather conditionstype of radioactive material, and weather conditions

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Radiological Dispersal Device

A crude device that spreads radioactive material, aka, “dirty bomb”

The diluted spread material does NOT generally present a radiation hazard to anyone.

Purpose of an RDD:

•Psychological Impact-Terrorizey g p

•Denies access to an area

•Presents a massive cleanup problem

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Composite RDD

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Credit: AFRRI

RDD Considerations

Physical formPhysical form

Solid metal (cobalt-60)Powder (cesium chloride)Liquid (technicium-99m)Gas (krypton-85)

Delivery systemDelivery system

ExplosionAerosolDeliberate placement

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Sources of RDD Materials

Medicine (nuclear medicine, teletherapy, brachytherapy)

Industry (gamma radiography, well-logging, sterilization, food preservation radiothermal generators)

Commercial products (smoke detectors, luminescent dials)

Radioactive waste

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Aerosol RDD

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Hypothetical RDD attack

Mixture is spread in line at an amusement park.

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Chronology of Potential RDD Use

Moscow, Russia (Nov 1995): Chechen rebels plant radioactive source in public park

Argun, Chechnya (Dec 1998): RDD found near a railway line

K d l k h R i (J 2001) t l l d lKandalaksha, Russia (Jun 2001): two people plunder a nuclear powered lighthouse

Moscow Russia (Nov 2002): small amounts of weapons-gradeMoscow, Russia (Nov 2002): small amounts of weapons grade nuclear materials missing

Herat, Afghanistan (Jan 2003): evidence that Al Qaedat t d RDDconstructed an RDD

http://www.pbs.org/wgbh/nova/dirtybomb/chrono.html

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9/11 Type Attack on a Nuclear Facility

52EPRI/NEI Aircraft Impact Study, 2002

CHERNOBYL 1986Nuclear Reactor

70% contamination fell on

Nuclear ReactorAccident

70% contamination fell on 26% of Belarus

Est. 114 million Curies entered environmententered environment

50,000 Km2 restricted removed from use

400,000 evacuated

137Cs, 134Cs, 90Sr, 131I 239Pu

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131I, 239Pu

Chernobyl CS-137 Fallout PatternChernobyl CS-137 Fallout Pattern

Contaminated: > 1 Ci/m2 (37 kBq/m2) w/Cs-137

54Photos: DOE, National Archives[Chernobyl Forum Report, 2003 – 2005, 2nd Rev, IAEA]

( )Strict radiation control: > 15 Ci/m2 (555 kBq/m2) w/Cs-137

Impact of a Dirty Bomb

Most serious injuries from the explosion

• Unlikely radioactive material would kill

Radioactive material dispersedRadioactive material dispersed

Significant psychological impact

Cleanup costly and will take weeks to months to complete

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Goiania, Brazil 1987

1375 curie Cesium-137 spread throughout aneighborhoodneighborhood• External and internal exposure hazards

Four victims died within four weeksTwenty victims hospitalized249 people had detectable external and/or internal contamination112,000 screened (500 screened for each victim), ( )Site remediation took months to complete (October 1987-March 1988)An accident what if a terrorist event!An accident – what if a terrorist event!

Ref: IAEA-TECDOC-1009, 1998.

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Perceptions Shaped by the Cold War

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The Best Laid Plans …

Preparedness is more thanis more than having a plan.

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Challenges to Medical Response

Magnitude

- Psychological impact of nuclear weapon use- Casualties larger than planned for - Local transportation unusable- Comms disrupted/overwhelmed - Mass panic & flight- Medical systems overwhelmed - Responders limited by radiation

Lack of Timely, Accurate, Needed Info- Medical systems overwhelmed - Responders limited by radiation

- Weapon size unknown - Fallout pattern unknown

C di ti Ch ll

Weapon size unknown Fallout pattern unknown- Weapon location unknown - Number of casualties unknown- Nature of attack unknown - Initial positioning of

responders delayedCoordination Challenges

- Lack of initial info may stall response - Public info campaign- No Federal/State/Local plans for NW terrorism - Long-term effects

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p g- Federal/State conflict over resources

HIROSHIMA AFTERHIROSHIMA AFTERHIROSHIMA AFTERHIROSHIMA AFTER

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National Planning Scenario #1; Low Yield Nuclear Detonation

Many Prompt Casualties come from blast and thermal effects

Blast overpressure

b ast a d t e a e ectsFallout Casualties are from Radiation

PROMPT EFFECTSPROMPT EFFECTSPROMPT EFFECTSPROMPT EFFECTS

FALLOUT EFFECTSFALLOUT EFFECTS

65Burns Ionizing radiation

Heavy Building Effects

??? ?X X X

??

?

?

???

?

?

?

X XX XXX

XX

XX

XX? ??

??

???

?

Fireball X

XX XXX X X

XX

XXX

XX?

X

?

????

? ?

?Fireball220m in Diameter XXX X

X

XXX

XXX

? ??

??

?XX X X

X

?

X

6666

?

?XX X?

? 50% 10%

Blast Effects; Buildings & People

Low Survival of HeavyBuildings within areaBuildings within area

Overpressure lung injury & fatalities from impact

>10psi 678m

Brick House 5 psi

Low Survival of LightBuildings within areaEardrum ruptures and

~ 5 psi

6767

ppossible incapacitation>5psi 1km ~250k people (day)

Radiation and Thermal EffectsUnprotected Population (Clear Day & Line of Sight)Unprotected Population (Clear Day & Line of Sight)

3o Burns LD-501.5km ~360,000 peopleGraphic: AFRRI 1.5km 360,000 people

2o Burns1 9km

100 G

1.9km

1o Burns

200 G LD 10

100cGy Injury-101.6km2.5km

200cGy LD-101.5km

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300cGy LD-501.4km 300,000 people1 cGy = 1 rad1 cGy = 1 rad

Long Range Prompt Effects

Flash BlindnessFlash Blindness7km to 12 km7km to 12 km

EMP: Service disruptionsEMP: Service disruptions& Equipment Damage& Equipment Damage

Graphic: AFRRI

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Missile Injury ThresholdMissile Injury Threshold0.6psi 4.5km ~750k people0.6psi 4.5km ~750k people

EMP: Temporary disruptionsEMP: Temporary disruptions

Combined Effects

Typical Overpressure Damage Nighttime shot, the only

psi Damage 1 Windows shattered

2 Aluminum panels ripped off

light is from the blast

2 3 Wall of 12-inch concrete shattered;

parked aircraft destroyed

5 Brick houses destroyed; trucks overturned; telephone poles collapsedE d R t

Thermal pulse ignites paint and woodEardrum Rupture

15 Lung Damage

50 LD50

wood

Pressure wave destroys house

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1km from ~16kT yields (~ 6 psi)

Prompt Effects Summary

Prompt casualties (injuries + fatalities) include blast and burns, not just radiation exposure• “… missile injuries will predominate. About half of the patients seen will

have wounds of their extremities. The thorax, abdomen, and head will be involved about equally.”*

Literature and models predict:Literature and models predict:• 100,000s casualties can occur from the prompt effects in the first few

minutes within a few miles of detonation site,

O f f• Overall number of casualties likely to be reduced by protection from the urban landscape and being within heavy buildings, however

• Tertiary effects (building collapse, glass and debris missiles, and flash-blindness accidents) may increase number of casualtiesblindness accidents) may increase number of casualties.

Those outdoors within a few miles can be temporarily blinded

Dust and debris from air blast will cloud the air.

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*NATO, 1996, NATO Handbook on the Medical Aspects of NBC Defensive Operations (Part I - Nuclear). Departments of the Army, Navy, and Air Force: Washington, D.C.

FalloutFallout

The nuclear detonation creates a large cloud of radioactive dust and water vapor which fall back to earth contaminatingdust and water vapor which fall back to earth contaminating horizontal surfaces.

Dangerous levels of fallout creates visible dust and debris.Dangerous levels of fallout creates visible dust and debris. These particles give off penetrating radiation that can injure people (even in cars or inadequate shelter)

Fallout decays rapidly away with time, and is most dangerous in the first few hours after the detonation

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Prompt Effects + 2 Hour Integrated Outdoor ExposurePrompt Effects + 2 Hour Integrated Outdoor Exposure

Most potential acute injuries confined to within 15km

Effects or contamination using weather from May 23, 2005Injury threshold (100 cGy) defined as 5-30% chance of Acute Symptoms (nausea and vomiting within 4 hours)~ NCRP Commentary #19, 2005

Prompt and fallout areas not congruent

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100cGy in 2 hours Boundary100cGy in 2 hours BoundaryOutdoor Injury ThresholdOutdoor Injury Threshold

15km long, ~ 15km long, ~ 300,000300,000 people in areapeople in area

Shattered Window ThresholdShattered Window ThresholdMany behind windows injured Many behind windows injured 4.5km ~4.5km ~750,000750,000 people in areapeople in area

Downwind Dose Rate @ 15 Minutes

Fallout Effects

Dose RateDose Rate100 cGy/hr

10 cGy/hr

1 cGy/hry

.1 cGy/hr

1,500 cGy/hr~ 8 minutes until fatality h h ld h d

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threshold at that dose rate1 cGy = 1 rad (deep dose)1 cGy = 1 rad (deep dose)Fatality threshold (2 Gy) defined as 5% chance of acute death from radiation without medical treatment (NCRP Commentary #19, 2005)

Downwind Dose Rate @ 2 hours

Fallout Effects

Dose RateDose Rate100 cGy/hr10 cGy/hr10 cGy/hr1 cGy/hr1 cGy/hr.1 cGy/hr

180 cGy/hr~ 1 hour until fatality

threshold at that dose rate

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Downwind Dose Rate @ 48 hours

Fallout Effects

Dose RateDose Rate100 cGy/hr(Not Present)

10 cGy/hr1 cGy/hr

7 G /h

.1 cGy/hr

7 cGy/hr~ 1 day until fatality

threshold at that dose rate

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2 Hour Integrated Outdoor Exposure

(rem = cGy)ExtentArea

300 G

Flash BlindnessFlash Blindness7km to 12 km7km to 12 km

>300 cGy7.6km8.8 km2

>200 cGy10.0km13.3 km2

>100 cGy14.8km25.1 km2

>50 cGy>50 cGy20.3km44.1 km2

>25 cGy26.6km73 9 k 273.9 km2

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Missile Injury ThresholdMissile Injury Threshold4.5km ~750k people in area4.5km ~750k people in area

2 Hour Integrated Outdoor Exposure

(rem = cGy)ExtentArea

300 G

(cGy = rem)ExtentArea

>1 000 G

Graphic: AFRRI

>300 cGy7.6km8.8 km2

>200 cGy10.0km

>1,000 cGy2.5km2.0 km2

>800 cGy3.2km0 013.3 km2

>100 cGy14.8km25.1 km2

2.6 km2

>600 cGy4.3km3.7 km2

>50 cGy20.3km44.1 km2

>25 cGy26 6km

>500 cGy5.1km4.7 km2

>400 cGy6 3km26.6km73.9 km2

6.3km6.2 km2

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4 Day Integrated Outdoor Exposure

Long range, non-acute4-day dose boundaries

25 cGy (30 min arrival)~50km

5 cGy (1 hr arrival)~100km

1 cGy (2 hr arrival)~200km ~1,000,000 people

Large population and short arrival times make evacuation difficult

Protective Action Guideline threshold for shelter or evacuation

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Large population and short arrival times make evacuation difficultModel uncertainties and “shadow evacuation” likely to greatly increase effected population

Fallout Effects Summary

The fallout cloud could climb 8km (5 miles) high and will be carried by upper atmosphere winds (often at high speeds)by upper atmosphere winds (often at high speeds)

100,000s of acute casualties from radioactive fallout can occur within 15km (9 miles) downwind of the GZ

The number of fallout casualties can be reduced by action (shelter / evacuation)

Radiation levels decay rapidly with timeRadiation levels decay rapidly with time

In the first few days, the primary health hazard is external gamma radiation from fallout on horizontal surfaces. Breathing in fallout d st is a minor concerndust is a minor concern

Radiation has a delayed effect. Although radiation sickness may occur within a few hours, victims of lethal radiation may not

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succumb for days or weeks

Federal response is complicated

The Nuc/Rad Incident Annex of the National Response Plan has:• 6 different coordinating agenciesg g• 17 cooperating agencies• Shifting agency roles and responsibilities depending on the type of

event the source involved and where it happensevent, the source involved, and where it happens• No 1-800-RAD-HELP

Developed for nuclear power plant accidents, the Federal Response is cumbersome and not well structured for RDD/IND response

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Lack of Scientific Consensus on Appropriate Actions

Conflicting advice on basic issues such as shelter or evacuate?

Many Cold War Civil Defense assumptions are invalid forassumptions are invalid for nuclear terrorism.

Updated analysis and planning

“Take coverimmediately, as far

below ground as possible..”p y p g

low yield nuclear detonations in modern cities is required.

“Avoid radioactive

possible..~ Ready.gov (DHS)1

fallout: evacuate the fallout zone quickly..”

~RAND2

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1US Department of Homeland Security, http://www.ready.gov/america/beinformed/nuclear.html2Individual Preparedness Response to Chemical, Radiological, Nuclear, and Biological Terrorist Attacks: A Quick GuideLynn E. Davis, Tom LaTourrette, David E. Mosher, Lois M. Davis, David R. Howell 30 pp. • 2003 • ISBN: 0-8330-3487-1

IND Preparedness IS All Hazards Preparedness

Crisis Communication Time Critical Decision MakingTime Critical Decision MakingMass Casualty / Mass CareResource PrioritizationBreaks down jurisdictional/discipline barriers

“Because major events will undoubtedly have aBecause major events will undoubtedly have a regional impact, there is no greater necessity than to collaborate on a regional basis to leverage expertise share specialized assets enhanceexpertise, share specialized assets, enhance capacity, and interoperate cohesively and effectively.”

D f H l d S i ’ N i l P d G id

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~Department of Homeland Security’s National Preparedness Guidance

Observations

State and Local Communities:• Few have a coordinated response plan for the aftermath nuclear

terrorism,

• There is a general lack of understanding of the response needs, and

• Uncertainty of the Federal State and local roles and responsibilitiesUncertainty of the Federal, State, and local roles and responsibilities

Decisions made in the first few hours • have the greatest public health and medical impact and

• are not likely to be technically informed (correct actions can be counter-intuitive)

There is a lack of scientific consensus on response strategiesThere is a lack of scientific consensus on response strategies

There is no “rule of thumb” that doesn’t negatively impact some population, but the scientific community needs to do better than saying “it depends ”

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but the scientific community needs to do better than saying it depends.

Recommendations

The scientific community needs to be engaged to improve basic understanding of a low yield nuclear detonation in a modern city, g y yincluding:• Efficacy of shelter and evacuation strategies• Type and distribution of injuries and public health infrastructure

E l ti f t t i• Evaluation of response strategies• Effects on critical infrastructure (e.g., communications & electricity)

Federal Government needs to clearly define policies guidanceFederal Government needs to clearly define policies, guidance, and clarify what it will be doing after a nuclear detonation in the US.

IND response strategies are community specific, and communities need preparedness tools and support specific to their needs.

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Small improvements in understanding and response planning can reduce potential casualties by 100,000s.

Questions?

8686National Academies 6/26/08 0900

National Planning Scenarios

“While much preparedness applies across the all-hazards spectrum, the National Strategy attaches special emphasis to preparing for catastrophic threats with “the greatest risk of mass casualties, massive property loss, and immense social disruption.” To address this mass casualties, massive property loss, and immense social disruption. To address this requirement, a Federal interagency working group developed National Planning Scenarios to illustrate the potential scope, magnitude, and complexity of a plausible range of major events, including terrorist attacks, major disasters, and other emergencies.”

I t i N ti l P d G l (2005)~Interim National Preparedness Goal (2005)

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Rad/Nuc Response Responsibilities

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From the Nuclear/Radiological Incident Annex of the NRP

DHS/S&T’s Radiological/Nuclear Response and Recovery R&D program- RDD Response Needs and Resources

“Top 5” needs identified by responders:• Develop and endorse consistent response

recommendations• Undertake a process to benchmark best practices

and identify gaps for RDD Playbookand identify gaps for RDD Playbook• Undertake a process to benchmark best practices

and identify gaps on the policies and procedures for operational guidance/protocols on sheltering versus evacuationversus evacuation

• Undertake a process to benchmark best practices and identify gaps on policies and procedures for medical emergency response and receipt of

ti tpatients• Disseminate comprehensive RDD communication

packets to local, state, and federal agencies

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Standards Development

National Council on Radiation Protection and Measurements• Commentary #19: Key Elements Of

PreparingEmergency Responders for Nuclear andRadiological Terrorism.Radiological Terrorism.

• Report (in progress): Key Decision Points andInformation Needed by Decision Makers in theAftermath of a Nuclear or Radiological TerrorismIncident.

American National Standard for Performance Criteria for Personal Emergency RadiationDetectors (PERDs) for E C t l

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Exposure Control (ANSI N42.49 – in progress)

National Laboratory expertise applied to IND response strategy

Ground Level detonation

300m detonation

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Recognition of Issue and a Path Forward

NUCLEAR PREPAREDNESSThe conferees are concerned that cities have little guidanceThe conferees are concerned that cities have little guidance available to them to better prepare their populations to react in the critical moments shortly after a nuclear event.

- Conference Report Public Law 110-28 (FY07 Supplemental).

National Laboratories support effort through:

Development of realistic IND primary, secondary, and tertiary effects to be used in response planningeffects to be used in response planning.

Consequence modeling Federal, State, and local response planning.

Support development of key response planning factors for an IND.

Technical support to Federal, State and local engagement, b i fi t h i l t t h t l t i l d

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briefings, technical support, outreach to relevant regional and national organizations and professional societies.

Discussion PointsIn Review

Radiological versus NuclearNuclear Weapons ProliferationNuclear DetonationR di l i l Di l D iRadiological Dispersal DeviceRadiation Exposure DeviceInduced CriticalityInduced CriticalityNuclear Material & WasteNuclear Reactor IncidentsNuclear Reactor Incidents

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radiological and nuclear disaster: evaluation of the …€¦ · medicine (nuclear medicine,...

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