Difference between revisions of "Radiation exposure (disaster)"

(Early Management)
(Altered to reference updated guidance f)
Line 1: Line 1:
==Background==
+
== Background ==
* potentially easy to deal with since lots of people deal with radiation daily- univ, hosp, military
 
* easy to detect with geiger counters
 
* immediate effects well known and easy to assess with blood counts
 
  
===Possible Scenarios===
+
*potentially easy to deal with since lots of people deal with radiation daily- univ, hosp, military
* we assume terrorists will only use one source of radiation at a time- combination sources unlikely
+
*easy to detect with geiger counters
* synergism between radiation and chemicals unlikely- manage chemical exp first, radiation second
+
*immediate effects well known and easy to assess with blood counts
* only nuclear weapon will expose many people. all other types hard to expose many people
 
* small radiation dose do not affect people for many years
 
  
===Dispersal of Radiation without use of Explosives===
+
=== Rad/Nuke Scenarios of Concerns<br> ===
* minimally radioactive sources maybe used to create fear and panic- ex- exempt low level radioisotopes from nuc medicine, research. no immediate effects and probability of long term effects low
 
*highly radioactive substances- cobalt, cesium, iridium- used in radiotherapy and radiographic machines have penetrating radiation so easy to detect at check points
 
* if souce is metallic- there will be radiation exposure but no contamination. if powder get both exposure and contamination
 
* if handle it, will get local skin injury and are risk for acute radiation syndrome
 
  
===Dispersal of Radiation with use of Conventional Explosives===
+
*Nuclear Power Plant Incidents/Accidents<br>
* is greater concern since will be able to spread to more people and assoc traumatic injuries- will also cause additional fear, panic
+
*Radiological Exposure Devices
* extent of dispersal depends on physical form of source- solid or powder, explosive type, atmospheric conditions
+
*Radiological Dispersal Devices
* health hazard only a few city blocks- goal of response to monitor and contain.
+
*Improvised Nuclear Devices
  
===Nuclear Reactor Attack===
+
=== Dispersal of Radiation without use of Explosives ===
*reactor if steel vessel in concrete building. if damaged, is designed to slow down stop reaction
+
 
*if cooling system damaged, may get some radiation leak- radioactive iodine and noble gases
+
*minimally radioactive sources maybe used to create fear and panic- ex- exempt low level radioisotopes from nuc medicine, research. no immediate effects and probability of long term effects low
*gas escape for reactor core will have immediate nearby health effects and rad iodine can have thyroid CA in kids long term at great diistances
+
*highly radioactive substances- cobalt, cesium, iridium- used in radiotherapy and radiographic machines have penetrating radiation so easy to detect at check points
*many nuclear engineering dept at univ have small reactors and are easy targets
+
*if souce is metallic- there will be radiation exposure but no contamination. if powder get both exposure and contamination
 +
*if handle it, will get local skin injury and are risk for acute radiation syndrome
 +
 
 +
=== Dispersal of Radiation with use of Conventional Explosives ===
 +
 
 +
*is greater concern since will be able to spread to more people and assoc traumatic injuries- will also cause additional fear, panic
 +
*extent of dispersal depends on physical form of source- solid or powder, explosive type, atmospheric conditions
 +
*health hazard only a few city blocks- goal of response to monitor and contain.
 +
 
 +
=== Nuclear Reactor Attack ===
 +
 
 +
*reactor if steel vessel in concrete building. if damaged, is designed to slow down stop reaction  
 +
*if cooling system damaged, may get some radiation leak- radioactive iodine and noble gases  
 +
*gas escape for reactor core will have immediate nearby health effects and rad iodine can have thyroid CA in kids long term at great diistances  
 +
*many nuclear engineering dept at univ have small reactors and are easy targets  
 
*spent radioactive fuel rods stored in less secure places but hard to expose large population to this solid source
 
*spent radioactive fuel rods stored in less secure places but hard to expose large population to this solid source
  
===Nuclear Weapon Detonation===
+
=== Nuclear Weapon Detonation ===
* unlikely use by terrorists since needs high level of expertise- but low yield weapon can be made or higher yield weapon could be stolen and used
+
 
* even if nuc weapon fizzled- will still be big blast
+
*unlikely use by terrorists since needs high level of expertise- but low yield weapon can be made or higher yield weapon could be stolen and used  
* destruction due to airblast and thermal radiation
+
*even if nuc weapon fizzled- will still be big blast  
* 1 psi increase breaks glass
+
*destruction due to airblast and thermal radiation  
* 12 psi 50% mortality
+
*1 psi increase breaks glass  
* fire ball -> flash/ flame burns, blindness
+
*12 psi 50% mortality  
* inonizing radiation released in first minute as intense pulse- is initial radiation
+
*fire ball -&gt; flash/ flame burns, blindness  
* residual radiation, after first minute is fission and activation products
+
*inonizing radiation released in first minute as intense pulse- is initial radiation  
* ground burst causes radioactive soil into atmsphre and fallout of hundreds of miles- fallout can be lethal at greater ranges than at the blast or fireball
+
*residual radiation, after first minute is fission and activation products  
 +
*ground burst causes radioactive soil into atmsphre and fallout of hundreds of miles- fallout can be lethal at greater ranges than at the blast or fireball
 +
 
 +
== Basic Principles ==
 +
 
 +
=== Physical Properties ===
 +
 
 +
*gamma and xrays- deep penetration
 +
*alpha- hazard only if ingested/ inoculated since penetration &lt;0.1mm
 +
*beta/ electrons- penetrate a few centimeters
 +
*Rads- is dose absorbed by specific tissue. internation unit for absorbed dose is "gray" Gy. 1 gy = 100 rads
 +
*different radioactive particles have diff effects at same absorbed dose- so use effective dose for comparison
 +
*effective dose is "REM". 100 rem = 1 sievert
 +
*one gray = one sievert when dealing with gamma and beta rays
 +
*effect of radiation based on time of exp, distance and shielding
 +
*dose decreases rapidly with square of distance and decreases on 1/9th if triple distance
 +
*shield with lead or stay indoors
 +
*radiation decays with time
 +
*short lived- iodines
 +
*long- cesium, stontium, cobalt
 +
*rate of decay also effects dose of exposure and may effect management decisions
 +
 
 +
=== Biological Principles ===
 +
 
 +
*some cells may die but if cells role not critical for survival, may not see effect
 +
*rapidly dividing cells- gi and bone marrow, most vulnerable
 +
*dose &lt;1gy, cells survive but get CA later
 +
*radiation induced CA dose related
 +
*leukemia within 2 yrs, solid tumors 5-10 or more yrs
 +
 
 +
== Treatment ==
 +
 
 +
*can be localized or whole body, internal or external deposition and contamination
 +
*mostly not emergency, just tx sxs and supportive care
 +
 
 +
=== Localized Exposure ===
 +
 
 +
*by direct handling. pt survives eventhough dose high since exposure drops rapidly with distance
 +
*rad burn like thermal burn- but signs can occur after a few days, vasc insuff after several months and causing necrosis of previously healed skin
 +
*tx c pain control, infc prophylaxsis, vasodilator tx, surg, skin graft,
 +
*extent of penetration important factor in outcome
 +
*beta rays from fallout only burn exposed skin
 +
 
 +
=== Whole Body Exposure ===
 +
 
 +
*Acute Radiation Syndrome
 +
**Within 12hr, N/V for 48hr
 +
**Dose &gt;30 gy: CV and CNS effects - hypotension, cerebral edema, sz, n/v/d, ataxia, death
 +
**Dose 10-30 gy: GI syndrome: N/V/D, then latent for 1 wk, then recurrent n/v/d this time with sepsis and death
 +
*hematopoetic syn- dose 2gy or higher- lymphocyte reduction within 48 hrs is indicator for rad exposure. get leukopenia and thrombocytopenia- bleeding and infc- may enhance recovery by hematopoetic factors
 +
*cutaneous syn- damaged skin may interact with other organ damage
 +
*amifostine- prophylactic radiation drug- causes hypotn as side effect unfortunately
 +
*androstenediol- boosts immune system
 +
*bone marrow xplant not helpful
 +
*even if tx and survive hematopoetic syn, still die from radiation pneumonitis, denuded gi tract, hepatic and renal dysfunction
  
==Basic Principles==
+
=== Internal Contamination ===
===Physical Properties===
 
*gamma and xrays- deep penetration
 
* alpha- hazard only if ingested/ inoculated since penetration <0.1mm
 
*beta/ electrons- penetrate a few centimeters
 
* Rads- is dose absorbed by specific tissue. internation unit for absorbed dose is "gray" Gy. 1 gy = 100 rads
 
* different radioactive particles have diff effects at same absorbed dose- so use effective dose for comparison
 
* effective dose is "REM". 100 rem = 1 sievert
 
* one gray = one sievert when dealing with gamma and beta rays
 
* effect of radiation based on time of exp, distance and shielding
 
* dose decreases rapidly with square of distance and decreases on 1/9th if triple distance
 
* shield with lead or stay indoors
 
* radiation decays with time
 
* short lived- iodines
 
* long- cesium, stontium, cobalt
 
* rate of decay also effects dose of exposure and may effect management decisions
 
  
===Biological Principles===
+
*may enter thru burns, wounds, inhale, ingest
*some cells may die but if cells role not critical for survival, may not see effect
+
*need to know type of radionuclide and chemical form
* rapidly dividing cells- gi and bone marrow, most vulnerable
+
*need to tx quickly to be effective
* dose <1gy, cells survive but get CA later
+
*reduce absorption, dilute, blockage, displacement by non radioactive materials, mobilization, chelation
* radiation induced CA dose related
+
*potassium iodine for nuc weapon detonation or reactor breach- prevents radioiodine from accumulating in thyroid. take shortly after exp to be effective- if give too much get iodism
* leukemia within 2 yrs, solid tumors 5-10 or more yrs
+
*dose- 130 mg adults, 65 mg 3- 18ys, 32 mg 1mo- 3yr, 16 mg for age&lt; 1mo
 +
*chelators- calcium, zinc, only for plutonium or americium
  
==Treatment==
+
=== External Contamination ===
* can be localized or whole body, internal or external deposition and contamination
 
* mostly not emergency, just tx sxs and supportive care
 
  
===Localized Exposure===
+
*clothes and exp skin- just clean up and prevent spread
* by direct handling. pt survives eventhough dose high since exposure drops rapidly with distance
+
*clean with soap and water
* rad burn like thermal burn- but signs can occur after a few days, vasc insuff after several months and causing necrosis of previously healed skin
+
*if extremis- stabilize first, then decontam
* tx c pain control, infc prophylaxsis, vasodilator tx, surg, skin graft,
+
*do not abraid skin while cleaning
* extent of penetration important factor in outcome
 
* beta rays from fallout only burn exposed skin
 
  
===Whole Body Exposure===
+
=== Contaminated Burns and Wounds ===
*Acute Radiation Syndrome
 
**Within 12hr, N/V for 48hr
 
**Dose >30 gy: CV and CNS effects - hypotension, cerebral edema, sz, n/v/d, ataxia, death
 
**Dose 10-30 gy: GI syndrome: N/V/D, then latent for 1 wk, then recurrent n/v/d this time with sepsis and death
 
* hematopoetic syn- dose 2gy or higher- lymphocyte reduction within 48 hrs is indicator for rad exposure. get leukopenia and thrombocytopenia- bleeding and infc- may enhance recovery by hematopoetic factors
 
* cutaneous syn- damaged skin may interact with other organ damage
 
* amifostine- prophylactic radiation drug- causes hypotn as side effect unfortunately
 
* androstenediol- boosts immune system
 
* bone marrow xplant not helpful
 
* even if tx and survive hematopoetic syn, still die from radiation pneumonitis, denuded gi tract, hepatic and renal dysfunction
 
  
===Internal Contamination===
+
#irrigate
* may enter thru burns, wounds, inhale, ingest
+
#excise only if long acting radionuclides
* need to know type of radionuclide and chemical form
+
#if whole body dose &gt;1gy, close wound asap to prevent portal of infc
* need to tx quickly to be effective
+
#in burns, radioactivity comes off with eschar and exudate
* reduce absorption, dilute, blockage, displacement by non radioactive materials, mobilization, chelation
 
* potassium iodine for nuc weapon detonation or reactor breach- prevents radioiodine from accumulating in thyroid. take shortly after exp to be effective- if give too much get iodism
 
* dose- 130 mg adults, 65 mg 3- 18ys, 32 mg 1mo- 3yr, 16 mg for age< 1mo
 
* chelators- calcium, zinc, only for plutonium or americium
 
  
===External Contamination===
+
== Disaster Management ==
* clothes and exp skin- just clean up and prevent spread
 
* clean with soap and water
 
* if extremis- stabilize first, then decontam
 
* do not abraid skin while cleaning
 
  
===Contaminated Burns and Wounds===
+
*preparation, crisis management, consequences
# irrigate
+
*FBI is lead agency in terrorist incident
# excise only if long acting radionuclides
+
*during consequence management, FEMA fed emerg management agency takes over
# if whole body dose >1gy, close wound asap to prevent portal of infc
+
*intervention- action to reduce exp and dose of radtn
# in burns, radioactivity comes off with eschar and exudate
+
*if dose 1 rem- stay in doors up to 2 days- evacuate for 1 wk if dose of 5 rem or more
 +
*temp relocation if dose 3 rem in first month or 1 rem in subsequent month
 +
*permanent resettlement if lifetime dose 100 rem
 +
*pot iodine only if thyroid dose 100 mgy or more
 +
*EMS occupational dose of 5 rem per yr dose not apply- allowable dose goes up for life saving event
 +
*at dose of 0.1 gy/hr- ems may go in for short time but dose maybe life threatening
  
==Disaster Management==
+
=== Early Management ===
* preparation, crisis management, consequences
 
* FBI is lead agency in terrorist incident
 
* during consequence management, FEMA fed emerg management agency takes over
 
* intervention- action to reduce exp and dose of radtn
 
* if dose 1 rem- stay in doors up to 2 days- evacuate for 1 wk if dose of 5 rem or more
 
* temp relocation if dose 3 rem in first month or 1 rem in subsequent month
 
* permanent resettlement if lifetime dose 100 rem
 
* pot iodine only if thyroid dose 100 mgy or more
 
* EMS occupational dose of 5 rem per yr dose not apply- allowable dose goes up for life saving event
 
* at dose of 0.1 gy/hr- ems may go in for short time but dose maybe life threatening
 
  
===Early Management===
+
*evacuate upwind if possible
* evacuate upwind if possible
 
  
[[Category:Rads]]
+
[[Category:Rads]] [[Category:Tox]] [[Category:EMS]]
[[Category:Tox]]
 
[[Category:EMS]]
 

Revision as of 23:53, 21 August 2013

Background

  • potentially easy to deal with since lots of people deal with radiation daily- univ, hosp, military
  • easy to detect with geiger counters
  • immediate effects well known and easy to assess with blood counts

Rad/Nuke Scenarios of Concerns

  • Nuclear Power Plant Incidents/Accidents
  • Radiological Exposure Devices
  • Radiological Dispersal Devices
  • Improvised Nuclear Devices

Dispersal of Radiation without use of Explosives

  • minimally radioactive sources maybe used to create fear and panic- ex- exempt low level radioisotopes from nuc medicine, research. no immediate effects and probability of long term effects low
  • highly radioactive substances- cobalt, cesium, iridium- used in radiotherapy and radiographic machines have penetrating radiation so easy to detect at check points
  • if souce is metallic- there will be radiation exposure but no contamination. if powder get both exposure and contamination
  • if handle it, will get local skin injury and are risk for acute radiation syndrome

Dispersal of Radiation with use of Conventional Explosives

  • is greater concern since will be able to spread to more people and assoc traumatic injuries- will also cause additional fear, panic
  • extent of dispersal depends on physical form of source- solid or powder, explosive type, atmospheric conditions
  • health hazard only a few city blocks- goal of response to monitor and contain.

Nuclear Reactor Attack

  • reactor if steel vessel in concrete building. if damaged, is designed to slow down stop reaction
  • if cooling system damaged, may get some radiation leak- radioactive iodine and noble gases
  • gas escape for reactor core will have immediate nearby health effects and rad iodine can have thyroid CA in kids long term at great diistances
  • many nuclear engineering dept at univ have small reactors and are easy targets
  • spent radioactive fuel rods stored in less secure places but hard to expose large population to this solid source

Nuclear Weapon Detonation

  • unlikely use by terrorists since needs high level of expertise- but low yield weapon can be made or higher yield weapon could be stolen and used
  • even if nuc weapon fizzled- will still be big blast
  • destruction due to airblast and thermal radiation
  • 1 psi increase breaks glass
  • 12 psi 50% mortality
  • fire ball -> flash/ flame burns, blindness
  • inonizing radiation released in first minute as intense pulse- is initial radiation
  • residual radiation, after first minute is fission and activation products
  • ground burst causes radioactive soil into atmsphre and fallout of hundreds of miles- fallout can be lethal at greater ranges than at the blast or fireball

Basic Principles

Physical Properties

  • gamma and xrays- deep penetration
  • alpha- hazard only if ingested/ inoculated since penetration <0.1mm
  • beta/ electrons- penetrate a few centimeters
  • Rads- is dose absorbed by specific tissue. internation unit for absorbed dose is "gray" Gy. 1 gy = 100 rads
  • different radioactive particles have diff effects at same absorbed dose- so use effective dose for comparison
  • effective dose is "REM". 100 rem = 1 sievert
  • one gray = one sievert when dealing with gamma and beta rays
  • effect of radiation based on time of exp, distance and shielding
  • dose decreases rapidly with square of distance and decreases on 1/9th if triple distance
  • shield with lead or stay indoors
  • radiation decays with time
  • short lived- iodines
  • long- cesium, stontium, cobalt
  • rate of decay also effects dose of exposure and may effect management decisions

Biological Principles

  • some cells may die but if cells role not critical for survival, may not see effect
  • rapidly dividing cells- gi and bone marrow, most vulnerable
  • dose <1gy, cells survive but get CA later
  • radiation induced CA dose related
  • leukemia within 2 yrs, solid tumors 5-10 or more yrs

Treatment

  • can be localized or whole body, internal or external deposition and contamination
  • mostly not emergency, just tx sxs and supportive care

Localized Exposure

  • by direct handling. pt survives eventhough dose high since exposure drops rapidly with distance
  • rad burn like thermal burn- but signs can occur after a few days, vasc insuff after several months and causing necrosis of previously healed skin
  • tx c pain control, infc prophylaxsis, vasodilator tx, surg, skin graft,
  • extent of penetration important factor in outcome
  • beta rays from fallout only burn exposed skin

Whole Body Exposure

  • Acute Radiation Syndrome
    • Within 12hr, N/V for 48hr
    • Dose >30 gy: CV and CNS effects - hypotension, cerebral edema, sz, n/v/d, ataxia, death
    • Dose 10-30 gy: GI syndrome: N/V/D, then latent for 1 wk, then recurrent n/v/d this time with sepsis and death
  • hematopoetic syn- dose 2gy or higher- lymphocyte reduction within 48 hrs is indicator for rad exposure. get leukopenia and thrombocytopenia- bleeding and infc- may enhance recovery by hematopoetic factors
  • cutaneous syn- damaged skin may interact with other organ damage
  • amifostine- prophylactic radiation drug- causes hypotn as side effect unfortunately
  • androstenediol- boosts immune system
  • bone marrow xplant not helpful
  • even if tx and survive hematopoetic syn, still die from radiation pneumonitis, denuded gi tract, hepatic and renal dysfunction

Internal Contamination

  • may enter thru burns, wounds, inhale, ingest
  • need to know type of radionuclide and chemical form
  • need to tx quickly to be effective
  • reduce absorption, dilute, blockage, displacement by non radioactive materials, mobilization, chelation
  • potassium iodine for nuc weapon detonation or reactor breach- prevents radioiodine from accumulating in thyroid. take shortly after exp to be effective- if give too much get iodism
  • dose- 130 mg adults, 65 mg 3- 18ys, 32 mg 1mo- 3yr, 16 mg for age< 1mo
  • chelators- calcium, zinc, only for plutonium or americium

External Contamination

  • clothes and exp skin- just clean up and prevent spread
  • clean with soap and water
  • if extremis- stabilize first, then decontam
  • do not abraid skin while cleaning

Contaminated Burns and Wounds

  1. irrigate
  2. excise only if long acting radionuclides
  3. if whole body dose >1gy, close wound asap to prevent portal of infc
  4. in burns, radioactivity comes off with eschar and exudate

Disaster Management

  • preparation, crisis management, consequences
  • FBI is lead agency in terrorist incident
  • during consequence management, FEMA fed emerg management agency takes over
  • intervention- action to reduce exp and dose of radtn
  • if dose 1 rem- stay in doors up to 2 days- evacuate for 1 wk if dose of 5 rem or more
  • temp relocation if dose 3 rem in first month or 1 rem in subsequent month
  • permanent resettlement if lifetime dose 100 rem
  • pot iodine only if thyroid dose 100 mgy or more
  • EMS occupational dose of 5 rem per yr dose not apply- allowable dose goes up for life saving event
  • at dose of 0.1 gy/hr- ems may go in for short time but dose maybe life threatening

Early Management

  • evacuate upwind if possible