Radiologic Events:
Attack on a Nuclear Power Plant
Radiological Events
Objectives
• Recognize the potential consequences of
a terrorist attack on a nuclear power plant
• Describe the different types of radiation
particles and waves and their effect on the
body
Radiological Events
Objectives
• Differentiate between radiation exposure
and contamination
• Recognize the characteristic signs and
symptoms of acute radiation syndrome
• Learn to perform rapid assessment of
nuclear/radiation events in a disaster
situation
Radiological Events
Objectives
• Learn specific antidotes and medical
interventions for nuclear/radiation
terrorism victims
• Learn specific pre-hospital and hospital
management strategies including proper
notification of radiation disasters
Radiological Events
Case
• Terrorists attack a nuclear power plant 30
miles outside a major metropolitan area by
flying a high jacked jet liner into the plant.
• The impact results in an explosion and fire.
• Fire fighters and paramedics are called
to the scene.
Radiological Events
Case
• There are multiple casualties and
several trauma victims are being
transported to your health care facility.
• The news media is questioning your
health team regarding radiation
exposure risks
Radiological Events
Nuclear Power Plant Disaster:
Chernobyl, 1986
Radiological Events
Attacks on Reactors
• Radioisotopes released
– Large quantities of radioiodines and
radiocesiums
– A large variety of other radioisotopes may
be released in smaller quantities
Radiological Events
Attacks on Reactors
• Which way is the
wind blowing?
– The radioactive cloud
from the burning
reactor will travel
according to wind
direction.
Radiological Events
Attacks on Reactors
• Prevention
– Individuals in the path of
the radioactive cloud need
to be evacuated
Radiological Events
Electromagnetic Radiation
• Electromagnetic
radiation includes a
wide spectrum of
radiation energy
characterized by
frequency and wave
length.
• Ionizing radiation has
high frequency and
short wave length
Radiological Events
Ionizing Radiation
• Ionizing radiation includes both
electromagnetic (X and gamma rays)
and particulate radiation
Radiological Events
Particles
• Alpha
• Beta
• Neutrons
Radiological Events
Alpha Particles
• A helium nucleus
• Unable to penetrate skin
• Emitted from radioisotopes
such a plutonium, uranium
Radiological Events
n
n
++
Beta Particles
• Able to penetrate skin
• Negatively charged
• Can produce skin superficial burns
• Emitted by several radioisotopes (e.g.
Cobalt 160)
Radiological Events
Neutron particles
• Uncharged
• Able to penetrate deeply
• Hazard inside nuclear reactors
Radiological Events
Penetration Abilities of Different
Types of Radiation
Alpha Particles
Stopped by a sheet of paper
Radiation
Source
Beta Particles
Stopped by a layer of clothing
or less than an inch of a substance
(e.g. plastic)
Gamma Rays
Stopped by inches to feet of concrete
or less than an inch of lead
Neutrons
Stopped by a few feet of concrete
X-Rays and Gamma Rays
• Gamma and X radiation differ
by source: gamma rays comes
from the nucleus and X-rays
come from the electron orbits
• Because they don’t have mass
or charge, they penetrate
very deeply
Radiological Events
Detecting Radiation
RADIATION CANNOT BE SEEN,
HEARD, TASTED OR SMELLED
But, it can be easily measured
if you have the right equipment
Radiological Events
Radiation Detectors
Alpha Survey Meter
Radiological Events
Beta and Gamma
Survey Meter
Radiation Dose Units
Unit
Value
Rad (radiation
absorbed dose)
Rem (radiation
equivalent-man)
Gray (Gy)
0.01 J/kg
Sievert (SV)
100 rem
Radiological Events
Bio damage from 0.01 J/kg
100 rad
Contamination
• Contact with radioactive material (radionuclides)
that can be spread to other people / properties
• Inhaled, ingested, transferred from surface to
surface
Radiological Events
Exposure vs. Contamination
External Exposure: external
irradiation of the body with rays or
particles  absorbed dose
Contamination: radioactive material
(radionuclides) on patient (external)
or within patient (internal).
Radiological Events
Adapted from CDC Bioterrorism Web site
If the patient is
externally
contaminated
with radionuclides,
you can
Decontaminate
If radionuclides have
gotten inside the body,
consider chelation
therapy
Factors Determining
Radiation Exposure
• Time
• Distance
• Shielding
Radiological Events
Injuries Associated with
Radiological Incidents
• Acute Radiation Syndrome (ARS)
• Localized radiation injuries/cutaneous radiation
syndrome
• Internal or external contamination
• Combined radiation injuries with
- Trauma
- Burns
• Fetal effects
Radiological Events
Acute Radiation Syndrome
A Spectrum of Disease
Radiological Events
Phases of Acute Radiation
Syndrome
Exposure
Prodromal
Stage
Latent
Stage
Manifest
Illness
Time (days to years)
www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp
Radiological Events
Recovery
Stages of Acute Radiation
Syndrome
Stage 1: (50-150 rads)
• No symptoms or minimal viral
symptoms for up to 48 hours
• Spontaneous recovery usually occurs
• Sterility is a risk
Radiological Events
Stages of Acute Radiation
Syndrome
•
•
•
•
Stage 2: The Hematopoetic Syndrome (150400 rads)
Whole body exposure
Bone marrow suppression occurs with
loss of WBC and platelets
Infection and bleeding problems occur
LD 50 250-400 rads
Radiological Events
Stages of Acute Radiation
Syndrome
Stage 3: Severe Hematopoetic Syndrome
(150-400 rads)
• Life saving bone marrow transplantation
needed
• Care rationing during MCI will lower LD50
Radiological Events
Absolute Lymphocyte Count
• Measure every 4 - 6 hours initial 48
hours
• Normal: approx 2500 cells/ml
• > 1200: probably non-lethal
• 300 to 1200 cells/ml: significant
(hospitalize)
• < 300 cells/ml: critical
Radiological Events
Andrews Curve
1:
2:
3:
4:
1 Gy
4 Gy
6 Gy
7.1 Gy
Radiological Events
Stages of Acute Radiation
Syndrome
Stage 4: The Gastrointestinal Syndrome
(150-400 rads)
• GI lining cells die
• Severe diarrhea and electrolyte losses
• Life saving fluid and electrolyte
replacement
Radiological Events
Stages of Acute Radiation
Syndrome
Stage 5: The CNS Syndrome (>1500 rads)
• Confusion, ataxia, and sensory deficits
• Death within 48 hrs regardless of treatment
• Early appearance of CNS symptoms is an
ominous sign
Radiological Events
Pre-Hospital Management
• Evacuation of persons who are in the
path of a radiation cloud is the most
effective pre-hospital measure – this
action is the responsibility of public health
authorities
• Need effective communication with
residents as to steps they can take to
reduce exposure
Radiological Events
Patient Management - Priorities
• Initial triage and decontamination are ideally
done outside the hospital (have a plan in
place) to avoid contamination of the ED
• Patients exposed only to external EM
radiation (e.g. x-ray or gamma rays) are not
radioactive; patients exposed to particulate
radiation will be radioactive
• Standard medical triage is the highest priority
• Radiation exposure and contamination are
secondary considerations
Radiological Events
Patient Management - Protocol
Based on:
• Injuries
• Signs and symptoms
• Patient history
• Contamination survey
Radiological Events
Hospital Management
• Security
• Radiation Safety Officers/dosimeters,
GM
• 24-hour hotline (217) 785-0600
• Radiation Duty Officer @ Illinois Department
of Nuclear Safety
• Waste disposal
• Labeled, plastic bags
Radiological Events
Management
• Contaminated patient –
immediately isolated until
monitored & decontaminated
• Monitor EMS and ambulance
• ABC’s
• Cover all wounds
• Radiation burns are like sun
burns
Radiological Events
External Contamination
• Radioactive material (usually in the form
of dust particles) on the body surface
and/or clothing
• Radiation dose rate from contamination
is usually low, but while it remains on
the patient it will continue to expose the
patient and staff
Radiological Events
Patient Decontamination
• Remove and bag the patient’s clothing
and personal belongings (this typically
removes 80 - 90% of contamination)
• Handle foreign objects with care until
proven non-radioactive with survey meter
• Survey patient and collect samples
- Survey face, hands and feet
- Survey rest of body
Radiological Events
Protecting Staff from
Contamination
• Use standard precautions
• Survey hands and clothing
frequently
• Replace contaminated gloves
or clothing
• Keep the work area free of
contamination
Radiological Events
Examples of Radiation Skin
Burns
Radiological Events
Decontamination of Skin
• Use multiple gentle efforts
• Use soap & water
• Cut hair if necessary (do not shave)
• Promote sweating
• Use survey meter
Radiological Events
Cease Patient Decontamination
• When decontamination efforts produce no
significant reduction in contamination
• When the level of radiation of the
contaminated area is less than twice
background
• Before intact skin becomes abraded
Consider internal contamination
Radiological Events
Decontamination of Wounds
• Contaminated wounds:
– Irrigate and gently scrub with
surgical sponge
– Debride surgically only as needed
• Contaminated thermal burns:
– Gently rinse
– Changing dressings will remove additional
contamination
Radiological Events
Specific Therapy
Radionuclide
Therapeutic Approach
Tritium
Dilution (force fluids)
Iodine-125 or I-131
KI, or SSKI
Cesium-134 or cesium- 137
Prussian blue
Strontium-89, or 90
Decrease abs (antacids),
blockage (strontium lactate),
displacement (oral phosphate),
mobilization (ammonium
chloride)
Plutonium
Zinc or calcium (DTPA)
Radiological Events
Radioiodines and Thyroid
Cancer
Radioiodines concentrate
In the thyroid gland and
can increase the risk of
thyroid cancer
Radiological Events
You can reduce the radioiodine
thyroid dose by giving potassium
iodide
• Potassium Iodide (KI)
considerations
• Who should get KI?
• Useful at the beginning of an
exposure
• Only protects against thyroid
cancer
Radiological Events
Dosage (KI)
Age Group
Infants < 1 month
Dosage
16 mg
Children 1 month – 3 yrs 32 mg
Children 3–18 yrs
65 mg
Adults
130 mg
Radiological Events
Key Points
• Ionizing radiation includes:
– Electromagnetic radiation: X and gamma
– Particulate radiation: alpha, beta, neutrons
Radiological Events
Key Points
• Patient can be:
– Irradiated externally
– Contaminated with radionuclides
• Which patients are radioactive?
– Those contaminated with radionuclides
– These patients need to be decontaminated
– Some internally deposited radionuclides can be
removed with chelation therapy
Radiological Events
Key Points
• Protect yourself from radiation:
– Reduce the time of exposure
– Increase the distance from the radiation
source
– Apply shielding between yourself and the
radiation source
Radiological Events
Key Points
• Acute Radiation Syndrome:
– Stages progress from hematopoetic to gastrointestinal
to central nervous system with increasing dose
– The absolute lymphocyte count is the best predictor of
dose
• Long-term consequences
– Increase in cancer, especially thyroid cancer
– With radioiodine exposure, thyroid dose can be
reduced by using KI
Radiological Events
Key Points
• Have a radiation disaster management
plan in place for your hospital
• Be prepared for psychological
consequences
Radiological Events
Resources
• CDC Bioterrorism – www.bt.cdc.gov
• Radiation Emergency Assistance Center
& Training Site (REAC/TS) http://www.orau.gov/reacts/default.htm
• Medical management of radiological
casualties handbook www.afrri.usuhs.mil
Radiological Events
This completes the current
presentation.
Radiological Events