Difference between revisions of "Radiation exposure (disaster)"

(Created page with "==Background== General - potentially easy to deal with since lots of people deal with radiation daily- univ, hosp, military - easy to detect with geiger counters - immediate...")
 
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==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==
 +
* we assume terrorists will only use one source of radiation at a time- combination sources unlikely
 +
* synergism between radiation and chemicals unlikely- manage chemical exp first, radiation second
 +
* 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
  
General
+
==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
  
- potentially easy to deal with since lots of people deal with radiation daily- univ, hosp, military
+
==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.
  
- easy to detect with geiger counters
+
==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
  
- immediate effects well known and easy to assess with blood counts
+
==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
  
Possible Scenarios
+
===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
  
- we assume terrorists will only use one source of radiation at a time- combination sources unlikely
+
==Treatment==
 +
* can be localized or whole body, internal or external deposition and contamination
 +
* mostly not emergency, just tx sxs and supportive care
  
- synergism between radiation and chemicals unlikely- manage chemical exp first, radiation second
+
===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
  
- only nuclear weapon will expose many people. all other types hard to expose many people
+
===Whole Body Exp===
 +
* acute radiation syndrome- within 12 hrs, nv for 48 hrs
 +
* dose >30 gy, CV and cns effects- hypotn, cerebral edema, sz, nv, ataxia, death
 +
* dose 10- 30 gy, gi syndrome- nvd- then latent for 1 wk then recurrent nvd 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
  
- small radiation dose do not affect people for many years
+
===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
  
Dispersal of Radiation without use of Explosives
+
===Contaminated Burns and Wounds===
 
+
# irrigate
- 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
+
# excise only if long acting radionuclides
 
+
# if whole body dose >1gy, close wound asap to prevent portal of infc
-highly radioactive substances- cobalt, cesium, iridium- used in radiotherapy and radiographic machines have penetrating radiation so easy to detect at check points
+
# in burns, radioactivity comes off with eschar and exudate
 
 
- 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
 
 
 
 
 
 
==Type of Radiation Exposure & ED 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 Exp
 
 
 
- acute radiation syndrome- within 12 hrs, nv for 48 hrs
 
 
 
- dose >30 gy, CV and cns effects- hypotn, cerebral edema, sz, nv, ataxia, death
 
 
 
- dose 10- 30 gy, gi syndrome- nvd- then latent for 1 wk then recurrent nvd 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
 
 
 
- irrigate
 
 
 
- excise only if long acting radionuclides
 
 
 
- if whole body dose >1gy, close wound asap to prevent portal of infc
 
 
 
- in burns, radioactivity comes off with eschar and exudate
 
 
 
 
  
 
==Disaster Management==
 
==Disaster Management==
 
 
 
- preparation, crisis management, consequences
 
- preparation, crisis management, consequences
  

Revision as of 21:50, 10 June 2011

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

  • we assume terrorists will only use one source of radiation at a time- combination sources unlikely
  • synergism between radiation and chemicals unlikely- manage chemical exp first, radiation second
  • 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

  • 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 Exp

  • acute radiation syndrome- within 12 hrs, nv for 48 hrs
  • dose >30 gy, CV and cns effects- hypotn, cerebral edema, sz, nv, ataxia, death
  • dose 10- 30 gy, gi syndrome- nvd- then latent for 1 wk then recurrent nvd 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


Psychosocial Sxs

- insomnia, anxiety, impaired concentration, social withdrawal