Medical Response to Nuclear and Radiological Events

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1 Medical Response to Nuclear and Radiological Events Cham Dallas, PhD Director CDC Center for Mass Destruction Defense BDLS is a registered service mark of the Board of Regents University System of Georgia

2 Overview Nuclear scenario effects Radiation injury Acute radiation syndrome Mass burn casualties External contamination Internal contamination Pharmaceutical intervention strategies

3 Question Which of the following are most likely to occur and result in significant casualties? A. Nuclear power plant release B. Improvised nuclear devise C. Conventional nuclear weapon D. Dirty bomb

4 Potential Nuclear/Radiological Hazards in the U.S. Simple radiological device Dirty conventional bomb Improvised nuclear device (IND) 1 kt suitcase nuke Ballistic missile attack Plutonium 250 kt nuclear weapon: city killer

Diversion of Nuclear Weapons 50 100 1 kt suitcase nuclear weapons are

Statement for the Record by John Deutch, Director of the Central

5 Diversion of Nuclear Weapons kt suitcase nuclear weapons are unaccounted for. The Threat of Nuclear Diversion. Statement for the Record by John Deutch, Director of the Central Intelligence to the Permanent Subcommittee on Investigations of the Senate Committee on Government Affairs, 20 March 1996.

6 Energy Partition Standard Fission/Fusion Thermal Blast 50% 35% Initial Radiation 5% Fallout 10 % AFRRI, Medical Effects of Nuclear Weapons, Blast and Thermal Effects Lecture, 1990.

7 Nuclear Weapon Detonation Results: 1

8 Nuclear Weapon Detonation Results: 2

9 Nuclear Weapon Detonation Results: 3

10 Scenario: Washington Mall White House Lincoln Memorial Washington Monument The Mall Capitol Potomac River

11 Effective Range for Blast Energy AFRRI, Medical Effects of Nuclear Weapons, Blast and Thermal Effects Lecture, 1990.

12 Effective Range for Thermal Energy 1 kt Weapon AFRRI, Medical Effects of Nuclear Weapons, Blast and Thermal Effects Lecture, 1990.

13 Safe Separation Distances for Eye Injuries 1 kt Weapon AFRRI, Medical Effects of Nuclear Weapons, Blast and Thermal Effects Lecture, 1990.

14 Atlanta SSE Med Wind 250 kt Fatalities Probability of Fatality (Default Plot) Time: 32 days, 0.0 hours Mean Probability of Fatality Prob Expected Population 90% ,934 50% ,169 10% ,681 Fatality Possible (w/meander) Expected Prob Population 90% ,934

15 Atlanta 250 kt SSE wind 7 mph

16 New York: 250 kt Nuclear Detonation Mortality Probability 3.9m Affected Red 90% Lt Brown 80% Yellow 70% Green 60% Pale Blue 50% Dark Blue 40% Lt Purple 30% Dk Purple 20% Dk Pink 10% Lt Pink 1%

17 Seattle Mortality Probability under 350 kt with NNE Wind

18 What Is Fallout? A complex mixture of more than 200 different isotopes of 36 elements 2 oz of fission products formed for each kt of yield Size <1 micron to several mm

19 Question The risk from delayed fallout that is dispersed long distances (>100 miles) still has a devastating impact on public health. A. True B. False

20 Early Fallout That which reaches the ground during the first 24 hours after detonation Early fallout fraction 50 70% of total radioactivity Highest degree of fallout risk

21 Delayed Fallout Arrives after the first day, very fine invisible particles which settle in low concentrations over a considerable portion of the earth s surface 40% of total radioactivity Much lower degree of risk relative to early fallout

22 Bikini Atoll (1 March 1954) 15 mt thermonuclear detonation fallout Population affected: 300 in public domain Int/Ext contamination Local radiation injury Mild ARS Thyroid injury Radioactive Contamination Radiodermatitis

23 Ionizing Radiation Radiation that consists of directly or indirectly ionizing particles or photons Alpha Beta Gamma Neutron 1 m concrete

24 Radiation Exposure Types Irradiation External Contamination Internal Contamination * * *

25 Acute Radiation Syndrome Systemic effects of radiation Prodromal Hematologic Gastronintestinal Pulmonary Cutaneous Neurovascular Combined injury

26 Prodromal Component (0.5 3 Gy and higher) Immediate effect of cell membrane damage Onset of nausea, vomiting, diarrhea Mediated neurologically by the parasympathetic system

27 Respiratory Component (5 310 Gy and higher) Sensitive from highly vascular tissue Endothelial cells Type II alveolar cell Effect is dose-rate related Pneumonitis Healthy lung Pneumonitis Fibrosis

28 Radiation Skin Injury 0.75 Gy Hair follicles change 3 Gy Epilation 6 Gy Erythema 10 Gy Dry desquamation Erythema 20 Gy Wet desquamation (transepithelial injury)

29 Radiation Burns

30 Causes of Burn Deaths Direct result of accident 13% Infection 45% Organ system failure 41% Iatrogenic intervention 1%

Distribution of Injuries in a Nuclear Detonation Combined injuries (65% 70%) Wounds + Irradiation 5% Burns + Wounds + Irradiation 20% Wounds + Burns 5% Irradiation 15 20% Single

31 Distribution of Injuries in a Nuclear Detonation Combined injuries (65% 70%) Wounds + Irradiation 5% Burns + Wounds + Irradiation 20% Wounds + Burns 5% Irradiation 15 20% Single injuries (30% 40%) Burns 15 20% Burns + Irradiation 40% Wounds < 5% Data from Walker RI, Cerveny TJ Eds., Medical Consequences of Nuclear Warfare, TMM Publications, Falls Church, p 11.

Andrews Lymphocyte Nomogram Absolute lymphocyte count over 48 hours Confirms significant radiation exposure From Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry

32 Andrews Lymphocyte Nomogram Absolute lymphocyte count over 48 hours Confirms significant radiation exposure From Andrews GA, Auxier JA, Lushbaugh CC: The Importance of Dosimetry to the Medical Management of Persons Exposed to High Levels of Radiation. In Personal Dosimetry for Radiation Accidents. Vienna, International Atomic Energy Agency, 1965, pp 3-16

Priorities in Combined-Injury Triage- Radiation Doses Conventional Triage (No Radiation Exists) Changes in Expected Triage Following Radiation Exposure <1.5Gy 1.5 4.5Gy >4.

33 Priorities in Combined-Injury Triage- Radiation Doses Conventional Triage (No Radiation Exists) Changes in Expected Triage Following Radiation Exposure <1.5Gy Gy >4.5Gy >3 hr 1 3 hr <1 hr onset onset onset Immediate Immediate Immediate Expectant Delayed Delayed Expectant Expectant Minimal Minimal Expectant Expectant Expectant Expectant Expectant Expectant Modified from Medical Consequences of Nuclear Warfare, 1989, p. 39

layer taped) Pencil dosimeters, TLDs, survey meters Drapes

34 Decontamination Equipment Hospital surgical gown (waterproof) Cap, face shield, booties (waterproof) Double gloves (inner layer taped) Pencil dosimeters, TLDs, survey meters Drapes Plastic bags Butcher paper Large garbage cans Radiation signs and tape

35 Question Which of the following is the best decontamination agent? A. Dry removal B. Bleach C. Soap & water D. Waterless cleanser

36 Decon Agents: 1 Dry removal Soap/shampoo Household bleach 1:10 (sodium hypochlorite) Waterless cleansers Povidone-iodine Lava soap Cornmeal/Tide 50:50 Vinegar ( 32 P) or club soda Toothpaste

37 Internal Contamination Involves 4 Stages Deposition along route of entry Translocation Deposition in target organ Clearance

38 Therapeutic Interventions Plutonium/transuranics: DTPA Cesium: insoluble Prussian Blue Uranium: alkalinization of urine Radioiodine: radiostable iodine Tritium: radiostable water

39 All that is necessary for the triumph of evil is for good men and women to do nothing.

Improved Nuclear Device: Accessing Casualties,

Improved Nuclear Device: Accessing Casualties, Triage, and Treatment By Richard L. Alcorta, MD, FACEP State EMS Medical Director Maryland Institute for Emergency Medical Services Systems Exposure Scenario