COMMUNITY MANAGEMENT OF LOW DOSE RADIOLOGICAL EVENTS

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COMMUNITY MANAGEMENT OF LOW DOSE RADIOLOGICAL
EVENTS

• Joseph J. Contiguglia MD, MPHTM, MBA
• Clinical Professor
• Tulane University School of Public Health
  Tropical Medicine

2
OVERVIEW

• The Radiological Threat
• Priorities Responsibilities
• Radiological Attack
• Radiological Accident
• Community Actions

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ENERGY FUELS USES
4

• 38 states, particularly those in the east half
  the west coast have a full power, licensed
  reactors
• Nearly three million Americans live within 10
  miles of an operating nuclear power plant.

5
CIA

• Al-Qaida is interested in radiological dispersal
  devices (RDDs) or "dirty bombs."
• Construction of an RDD is well within its
  capabilities
• Radiological materials are relatively easy to
  acquire from industrial or medical sources.
• May try to launch conventional attacks against
  the nuclear industrial infrastructure of the
  United States in a bid to cause contamination,
  disruption, and terror

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WORLD SUMMIT TURNING ATTENTION TO NUCLEAR THREATS

• President Barack Obama and other leaders of the
  Group of Eight major industrial countries were
  scheduled to open their second day of talks
  Saturday focused on nuclear standoffs with Iran
  and North Korea

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INTERNATIONAL STRATEGIC NUCLEAR RISKS

• Iran would be raising the risk of a World War
  III if it came to possess nuclear weapons.
• President Bush, 2007
• Iran puts the world at nuclear risk
• Hillary Clinton, May 2010
• "Israel must be wiped off the map
• Iranian President Mahmoud Ahmadinejad

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RADIATION TYPES
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SCHEMATIC MODEL OF RADIONUCLIDE UPTAKE (AFTER
VOELZ)
Ingestion
Inhalation
Surface
Intake
Lung Clearance
Lung
Skin 1. Intact 2. Wounds
GI Tract
Lymph Nodes
Uptake
Blood
(Recycle)
Kidney
Deposition Sites
1. Whole Body 2. Bone 3. Liver 4. Thyroid
Excretion
Feces
Urine
A. Hogan, David E., "Disaster Medicine 2nd Ed.,"
Lippincott Williams Wilkins, Philadelphia, 2007
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IRRADIATION CONTAMINATION

• Irradiation exposure to a dose of radiation
• Contamination
• Radioactive particles on the skin (external)
• Particles inside the body organs (internal)
• Decontamination
• Remove Clothing (95)
• Wash with soap water
• Incorporation
• The uptake of radioactive materials by body
  cells, tissues, and target organs

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POTENTIAL LOW DOSE EVENTS

• INTENTIONAL
• Contaminating food/water with radioactive
  material
• Spreading radioactive material into the
  environment
• Using conventional explosives - dirty bomb
• Using wind currents or natural traffic patterns
• Bombing or destroying a nuclear reactor
• Causing a truck/train carrying nuclear material
  to spill
• ACCIDENTAL
• Nuclear Reactor Accidents
• Transportation Accidents (unintentional spill of
  radioactive material from a truck, train or
  plane)
• Human Error

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LOW DOSE SCENARIO

• RDD / RED
• Contamination / Exposure
• Remember President FDR
• You have nothing to fear but fear itself
• Just remember that fear itself is worth worrying
  about

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IZMAYLOVSKY PARK (MOSCOW), 1995

• Terrorists from Chechnya
• Buried, but did not detonate
• RDD
• Dynamite and Cesium-137
• Removed from cancer treatment equipment.
• Reporters were tipped off about its location and
  it was defused.

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LONG-TERM CONTAMINATION DUE TO CESIUM BOMB IN
WASHINGTON, DC. (FAS)

• Inner Ring One cancer death per 100 people due
  to remaining radiation (5 increase)
• Middle Ring One cancer death per 1,000 people
  due to remaining radiation (.5 increase)
• Outer Ring One cancer death per 10,000 people
  due to remaining radiation (.05 increase) EPA
  recommends decontamination or destruction

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INTERNATIONAL ATOMIC ENERGY AGENCY WORLD HEALTH
ORGANIZATION

• Between 1944 and 1999 in 405 accidents worldwide,
  approximately 3000 persons were injured, with 120
  fatalities (including the 28 Chernobyl victims).
• Recently, the number of accident involving
  radiation sources has increased.
• Often the victims are unaware that they may have
  been exposed to radiation.

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RADIOLOGICAL ACCIDENT
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RADIOACTIVE MATERIALS (CLASS 7)

• Protective cylindrical or boxlike overpacks
• Metal casks with cooling fins

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OFFICE OF SECURE TRANSPORTATION
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NUCLEAR WASTE

• Yucca Mountain is a mountain in Nevada
  approximately 100 miles (160 km) northwest of the
  Las Vegas metropolitan area. It is the proposed
  site for the Yucca Mountain nuclear waste
  repository.

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• If the proposed Yucca Mountain waste repository
  opens, a large number of irradiated fuel and
  high-level waste shipments will converge in
  Nevada. Depending on a range of factors,
  hundreds to thousands of shipments will traverse
  Nevada annually for a period of 24 to 38 years.

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EVERY HIGH DOSE EVENT IS SOMEONE ELSES LOW DOSE
EVENT

• Per capita thyroid doses in the continental
  United States resulting from all atmospheric
  nuclear tests conducted at the Nevada Test Site
  from 1951-1962.

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PSYCHOLOGICAL FACTORS IN RADIATION THREATS

• Characteristics of Ionizing Radiation
• Odorless
• Colorless
• Penetrating
• Continuing

CHERNOBYL
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DELAYED PSYCHOLOGICAL EFFECTS

• Survivor guilt
• Psychosomatic complaints
• Acute stress disorder
• Traumatic stress disorders
• 11 of uninjured
• 8 of moderately injured
• 31 of severely injured

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PRIORITIES RESPONSIBILITIES
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FEDERAL RESPONSE IS BASED ON MANY FACTORS

• Ability of state, local, and tribal officials to
  respond
• Type and/or amount of radioactive material
  involved
• Extent of the impact or potential impact on the
  public and environment
• Size of the affected area.

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EPA RADIOLOGICAL RESPONSIBILITIES

• Establishing Protective Action Guides
• Tell emergency responders how to minimize the
  impact of a radiological incident
• Helping state agencies develop emergency response
  plans
• Establishing emergency radiation detection and
  measurement systems in cooperation with the
  Nuclear Regulatory Commission

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EPA COORDINATION

• Response for radiological materials not regulated
  by another federal agency.
• Lost radiation sources, sources of unknown
  origin, and naturally occurring materials such as
  radium.
• U.S. response to foreign radiological accidents
  or events that have the potential to affect the
  United States

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DEPARTMENT OF HOMELAND SECURITY COORDINATION

• A federal agency has requested assistance under
  the National Response Plan.
• State and local authorities have requested
  federal assistance when overwhelmed
• Multiple federal agencies have become
  substantially involved
• The President uses the authority of the Stafford
  Act to declare a disaster

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DOE ACCIDENT RESPONSE ASSETS
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DOE EMERGENCY RESPONSE SERVICES

• REAC/TS provides incident response and
  consultation to physicians across the globe.
• We also maintain specialized response teams
  consisting of a physician, nurse/paramedic and a
  health physicist to ensure our readiness to
  respond to a radiation emergency.

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DOE RADIOLOGICAL INCIDENT MEDICAL CONSULTATION

• Provides advice and consultation to emergency
  personnel responsible for the medical management
  of radiation accidents.

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DOE MEDICAL MANAGEMENT OF RADIATION INCIDENTS

• Physicians and health physicists are available to
  answer questions of a general nature or inquiries
  related to a specific incident involving
  radiation exposure, or external or internal
  contamination

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NUCLEAR WEAPON ACCIDENT SITE
DoD 3150.8-M
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STATE DEPT. OF HEALTH LAB

• Rapid radiological analysis of a variety of
  samples and report the results back

http//www.health.state.ny.us/
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RADIOLOGICAL ACCIDENT
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HUMAN ERROR

• Tickling the dragons tail
• On May 21, 1946, Dr. Louis Slotin performed an
  experiment that involved the creation of one of
  the first steps of a fission reaction
• A sketch to determine the amount of radiation to
  which each person in the room had been exposed

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TRANSPORTATION ACCIDENTS

• 18-Wheeler Accident Spills Radioactive Material
  in Pineville
• The spill occurred during rush-hour traffic at
  the intersection of US Highway 165 (Monroe
  Highway) and US Highway 167 (the Cottingham
  Expressway) in Pinevile, Louisiana.

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TRANSPORTATION ACCIDENTS
39
TRANSPORTATION ACCIDENT

• Reload of spent nuclear fuel of nuclear
  submarines and its subsequent transportation for
  reprocessing may be carried out by the vessel
  floating technical base.

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TRANSPORTATION ACCIDENT

• Eighty days after it fell into the ocean
  following the January 1966 midair collision
  between a nuclear-armed B-52G bomber and a KC-135
  refueling tanker over Palomares, Spain, this
  B28RI nuclear bomb was recovered from 2,850 feet
  (869 meters) of water

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LOST (ORPHAN) RADIATION SOURCES AND DEVICES

• The Goiânia accident in central Brazil produced
  over 200 cases of radiation poisoning.
• On 13 September 1987, an old nuclear medicine
  source was scavenged from an abandoned hospital
  in Goiânia, the capital of the central Brazilian
  state of Goiás.
• It was subsequently handled by many people

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GOIANIA BRAZIL

• Panic caused more than 112,000 people 10 of
  the population to request radiation surveys
• At a makeshift facility in the citys Olympic
  Stadium, 250 people were found contaminated.
• 28 had sustained radiation-induced skin burns
• 50 had ingested cesium - increased risk of cancer
  
• 2 men, 1 woman, and 1 child died from acute gamma
  radiation exposure

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GOIANIA BRAZIL

• In addition to the human toll, contamination had
  been tracked over roughly 40 city blocks.
• Of the 85 homes found to be significantly
  contaminated, 41 were evacuated and 7 were
  demolished.
• Through routine travels, within that short time
  people had cross-contaminated houses nearly 100
  miles away.
• Cleanup generated 3,500 m3 radioactive waste at a
  cost of 20 million.

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GOIANIA BRAZIL

• Psychological effects included fear and
  depression for a large fraction of the citys
  inhabitants.
• Neighboring provinces isolated Goiania and
  boycotted its products.
• The price of their manufactured goods dropped 40
  and stayed low for more than a month.
• Tourism collapsed and recent population gains
  were reversed by business regression.
• Economic losses of hundreds of millions of
  dollars.
• Need for a broader understanding of radiation.

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NUCLEAR POWER ACCIDENTS
46
NUCLEAR POWER ACCIDENTS
3 MILE ISLAND

• On 28 March 1979, there was an accident at the
  Three Mile Island nuclear power station near
  Harrisburg, Pennsylvania.
• Radioactive gas was released a couple of days
  after the accident

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THREE MILE ISLAND

• Not enough to cause any dose above regular
  background levels to local residents
• Conflicting information released during the event
  exacerbated the public's fears

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WHAT HAPPENED

• A meltdown is the most dangerous type of nuclear
  power accident.
• At Three Mile Island (TMI), there was a "loss of
  coolant" accident, meaning that cooling water
  that surrounds the core and keeps it cool was
  lost.
• The temperature of the core rose so high that the
  materials actually melted.
• Some radioactive gases did
• escape to the atmosphere.
• Average dose to area residents
• was about 1 millirem

HYPOTHESIZED UNIT-2 CORE DAMAGE
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WHAT WILL PREVENT ANOTHER "THREE MILE ISLAND"

• Plant design and equipment requirements
• Operator training and staffing,
• Fitness-for-duty programs to guard against
  alcohol or drug abuse
• Early detection of problems
• Public information about plant performance
• Regulatory controls and enforcement
• Self policing by the industry
• Emergency preparedness

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CHERNOBYL UKRAINE

• On 26 April 1986 the world's most severe nuclear
  reactor accident occurred in Chernobyl, Ukraine
• An area of about 5 million hectares was
  contaminated and 160,000 people had to be
  permanently evacuated.
• Radioactive material affected not only the
  Ukraine but also Western Europe.

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WHAT HAPPENED?

• Two explosions brought about a rupture in the
  reactor, causing radionuclides to travel several
  kilometres into the atmosphere and contaminating
  the surrounding area.
• The radionuclides in the atmosphere caused
  widespread contamination as they spread over much
  of Europe and around the world.

World Nuclear Association www.world-nuclear.org/in
fo/inf36.htmlCOGnizant-CANDU Owners Group
Monthly Newletter
52
AFTERMATH

• Fewer than 50 deaths directly attributed to
  radiation almost all being highly exposed rescue
  workers
• UN report predicts that up to 4,000 people could
  eventually die of the long-term effects

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CHERNOBYL EPA RESPONSE

• Monitored radioactivity levels in the US
• Established a group to provide advice on
  preventing contamination of the food supply and
  protecting public health
• Established an information center to gather and
  distribute facts and data
• Arranged daily press conferences to keep the
  public up-to-date and answer concerns

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FUKUSHIMA DAIICHI 2011

• 1. The cooling systems, which stop the fuel
  heating up to unsafe levels, failed at two of
  Fukushima's reactors - 1 and 3.
• 2. This meant water stopped circulating and began
  to boil, leading to a rise in pressure.
• 3. It is believed this rise in pressure caused
  the casing around the fuel rods to become
  damaged. When they came into contact with water,
  it created hydrogen gas.
• 4. As engineers tried to vent this gas outside
  the containment chamber to relieve the pressure,
  the gas exploded when it came into contact with
  oxygen. The containment chamber was not damaged,
  but part of the outer concrete shell was blown
  off.
• 5. Fuel rods inside reactors 1 and 3 continue to
  heat the water and engineers are using sea water
  as an emergency coolant.

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COMMUNITY ACTIONS
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MEDIA PUBLIC INFORMATION TACTICAL CONSIDERATIONS
1. TARGETED 2. SPECIFIC 3. AUTHORITATIVE 4.
CONCISE
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CONTAMINATION RISK COMMUNICATIONS

• 1. Get out of the immediate area quickly.
• 2. Remove the outer layer of your clothing..
• 3. If possible, place the clothing in a plastic
  bag or leave it in an out-of-the-way area,
• 4. Wash all of the exposed parts of your body
  using lots of soap and lukewarm water to remove
  contamination.
• 5. After authorities determine that internal
  contamination may have occurred, you may be able
  to take medication to reduce the radioactive
  material in your body.

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COMMUNITY ACTIONS

• Be prepared to evacuate or find shelter in your
  home.
• Develop an emergency communication plan.
• Listen to the radio or television for official
  information.
• Remember your neighbors who may require special
  assistance
• Infants,
• Elderly people
• People with disabilities.

http//www.ndsu.edu/police_safety/safety/NDSU20Sa
fety20Officer20Homepage_files/radacdfs.pdf
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SHELTER-IN-PLACE SHELTER IN YOUR HOME

• Centrally located room or basement
• As few windows as possible
• The further your shelter is from windows, the
  safer you will be
• Store emergency supplies in this area
• Check the supplies
• Replace the water every
• three months
• Train family members

http//www.bt.cdc.gov/radiation/shelter.asp
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SHELTER-IN-PLACE SHELTER IN YOUR HOME

• Food 3 days
• Water
• Clothes
• Paper plates
• Plastic bags for garbage sanitation
• Bedding
• Battery radio
• Medicines
• Toiletries

• Flashlight batteries
• Phone
• Eyeglasses contact lenses / supplies
• Duct tape heavy plastic sheeting
• Pet food
• Baby formula diapers
• First aid kit
• Games, books, etc.

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IF ADVISED TO REMAIN AT HOME

• Bring pets inside.
• Close and lock windows and doors.
• Turn off air conditioning,
• vents, fans and furnace.
• Close fireplace dampers.
• Go to the basement
• Stay inside until authorities say it is safe.
• If you must go out, cover mouth and nose
• Be prepared to evacuate

http//www.bt.cdc.gov/radiation/evacuation.asp
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WHEN COMING IN FROM OUTDOORS
VIEW OF CHERNOBYL TAKEN FROM PRIPYAT

• Shower and change clothing and shoes.
• Put items worn outdoors in a plastic bag and seal
  it.

http//www.bt.cdc.gov/radiation/evacuation.asp
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IF ADVISED TO EVACUATE

• Listen to a radio or television for information
  on evacuation routes, temporary shelters, and
  procedures.
• Minimize contamination in house.
• Close and lock windows and doors.
• Turn off air conditioning,
• vents, fans, and furnace.
• Close fireplace dampers.
• Take disaster supplies.

http//www.bt.cdc.gov/radiation/evacuation.asp
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IF YOU LIVE NEAR A NUCLEAR POWER PLANT

• 10 miles
• Learn the emergency warning systems
• Contact the utility company for information
• The company is required by law to have plans in
  place for contacting people in the community
  during an emergency.
• The company must inform the community each year
  of its evacuation plans and routes

http//www.bt.cdc.gov/radiation/evacuation.asp
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ANTITERRORISM
DISASTER
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HERDING CATS
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SUMMARY

• The Radiological Threat
• Priorities Responsibilities
• Response
• Radiological Attack
• Radiological Accident
• Community Actions
• Plans are Nothing, Planning is Everything.
• Gen. George Patton

GEN GEORGE PATTON
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QUESTIONS?