Radiological Terrorism: Medical Response to Mass Casualties Part I

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Radiological TerrorismMedical Response to Mass
CasualtiesPart I

• James M. Smith, PhD
• Associate Director for Radiation
• Division of Environmental Hazards and Health
  Effects
• Centers for Disease Control and Prevention

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Radiation Events and Mass Casualties A Unique
Challenge

• Medical response infrastructure untested for
  major radiological event in the U.S.
• Clinician inexperience with radiation injuries
• Fear of radiation exposure expressed by public
  and caregivers
• Could be an exceptionally large number of
  casualties

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Potential Terrorist Scenarios

• Targeted attack on a nuclear installation
• Radiological Exposure Device (RED), e.g, hidden
  radioactive source
• Radiological Dispersal Device (RDD), e.g., Dirty
  bomb
• Detonation of an
• Improvised Nuclear Device (IND)

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Radiological Exposure DeviceCase Study Goiânia,
Brazil, 1987

• Radioactive source stolen
• Contamination spread throughout community
• 54 hospitalized, 8 with radiation sickness 4
  died
• 112,000 people monitored (gt10 of total
  population)

Source International Atomic Energy Agency (IAEA)
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Can Terrorists Obtain Radioactive Sources?

• 157,000 licensed users in U.S.
• 2,000,000 devices containing radioactive sources
• About 400 sources lost or stolen in U.S. every
  year

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Radiological Dispersal Device (RDD) The dirty
bomb

• Usually detonation of conventional explosive
  laced with radioactive material (e.g. Co-60)
• Significant radiation exposures not likely unless
  victim near explosion
• Tens to hundreds could present with conventional
  traumatic injury, external contamination and
  potential internal contamination
• Hundreds to thousands could present for
  radiological screening, counseling on health
  effects, or psychosocial trauma

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Worst Case Improvised Nuclear Device (IND)

• Immediate national emergency would be declared
  with military disaster assistance
• Could potentially kill/injure tens of thousands
  in a metropolitan area
• Thousands could present with combined blast, burn
  and radiation injury
• Hundreds of thousands could bedisplaced and
  require exposure andmedical monitoring,
  decontamination,counseling
• Major hospitals couldbe destroyed or rendered
  inoperable

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National Response Plan

• Describes how federal government will coordinate
  operations
• Outlines procedures, roles and responsibilities
  for specific contingencies
• Defines resources/groups most likely needed
  during an incident
• Remember All emergencies are local.
• Federal/State resources will require many hours
  to days before arriving

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Community Emergency Planning
Fire, Police, EMS
Public Works, Highways
Red Cross
Pharmacies
Urgent Care Centers, Dialysis Centers
Local Community Organizations
News Media
Other Area Hospitals/Clinics
Medical/Nursing Associations
Hospital
Ports/Airports
Public Officials/Civic Leaders
Health Departments
Utilities, Communication Providers
Local Businesses
Weather Services
Nursing Homes, Assisted Living Facilities
Churches, Social Welfare Organizations
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The Secondary Assessment Center

• Establish secondary assessment center (s) in
  advance
• Useful for pre-clinical screening, assessing
  exposure and contamination, conducting triage
  decon, reuniting families
• Separate from hospital
• Basic step in protecting hospital

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Secondary Assessment Center (continued)

• Establish by working with communities and
  local/state agencies in advance
• Consider nontraditional sites and personnel
• Community facilities (schools, churches)
• Allied health professionals, retired health care
  workers, community nurses

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Decontamination
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DecontaminationKey Principles

• Contamination is easy to detect and most of it
  can be removed
• It is highly unlikely that radiological
  contamination poses a significant risk to care
  providers
• Therefore provision of life-saving treatment
  should take priority over radiological
  decontamination
• Patients without life-threatening injury should
  be decontaminated prior to treatment

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Protecting Staff from Contamination

• Standard precautions PPE (with N-95 if available)
• Change outer gloves frequently
• Personal dosimeters recommended
• Full body survey
• when exiting warm
• zone

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Embedded Radioactive Fragments

• Although unlikely, metallic shrapnel from a
  highly radioactive source may become embedded in
  wounds
• A radiation survey identifies a high radiation
  field
• Remove radioactive fragments with forceps seal
  in lead container (work with radiation protection
  specialsit)
• Use additional staff protection measures
• Time (decrease time spent near radioactive
  source)
• Distance (increase distance between you and
  source)
• Shielding (increase physical shielding between
  you and source)

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Summary of Part I

• A variety of scenarios exist for radiological and
  nuclear terrorism
• These scenarios are possible, and radioactive
  sources are plentiful
• Radiation exposures vary widely with different
  scenarios
• All emergencies are local
• Federal/State resources will require many hours
  to days before arriving

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Summary of Part I (cont.)

• Contamination is easy to detect and most of it
  can be removed
• Provision of life-saving treatment should take
  priority over radiological decontamination

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References for Part I www.bt.cdc.gov/radiation

• Radiological Terrorism Just in Time Training for
  Hospital Clinicians
• Interim Guidelines for Hospital Response to Mass
  Casualties from a Radiological Incident
• Dirty Bombs
• Nuclear Blast