RADIATION BASICS INTRODUCTION What is Radiation Types of

INTRODUCTION • Why are we afraid of Radiation? • Measuring Radiation • Patient Decontamination • Health Effects of radiation • Medical Management of Radiation Patients • Public Health Response

RADIATION • RADIATION is energy that comes from a source and travels through some material or through space. Light, heat, X-ray and microwave energy are types of radiation. • IONIZING RADIATION is produced by unstable atoms. Unstable atoms differ from stable atoms because they have an excess of energy, mass and/or both.

Properties Mass Electrical Charge Alpha (a) Beta (b) Gamma (g) Large mass 2 protons and 2 neutrons (4 amu)(helium nucleus) Solid mass (about 1/1838 of 1 amu) No mass electromagnetic wave or photon Mass of 1 amu + 2 positive -1 negative None Short range ¼ to 2 inches (4 cm) in dry air, up to about 10 feet (3 meters) in dry air Very far several hundred feet. Very high penetrating power since it has no mass or charge Very far. Several hundred feet. High penetrating power due to lack of charge (difficult to stop) 2 inches of air, A sheet of paper, dead layer of skin Plastic, aluminum foil, clothing safety glasses Inches of Lead, Concrete, Water, Steel Materials with high hydrogen content, water, concrete, plastic, polyethylene, boron cadmium Does not represent external hazard. Externally for unprotected skin and eyes. Whole body exposure. Can penetrate through the body. Internal hazard if the source is inside the body (inhaled, ingested, or injected in wound. ) Can deposit large amounts of energy in a small area internally Hazard may be internal or external. This depends on whether the source is outside or inside the body. Usually emitted by transuranic elements: Uranium, Plutonium, Americium, Radon, Radium Fissionable products such Fission Products. in soil, as Cesium 137, Tritium, industrial and medical sources. Carbon-14, and iodine 132 Cesium 137, Cobalt 60, depleted Uranium Range in the air Shielding External Hazard Biological Hazard Sources Neutron (n) Few natural sources. Fission nuclear reactors. Cosmic radiation Plutonium, Californium 252.

TYPES OF RADIATION IN ORDER OF PENETRATION • Alpha Particles • Beta Particles • Gamma Rays • Neutron Particles

LIMITING EXPOSURE • AS LOW AS REASONABLY ACHIEVABLE (ALARA) o o o TIME DISTANCE SHIELDING

INVERSE SQUARE LAW A = 4 x = 32 rem B = x = 8 rem C = 1/4 x = 2 rem

RADIATION POISONING • Place in food or water • Gets more difficult with increase in number of people to poison • Creates panic • Doesn’t require explosives or high technology • Done effectively in the past. • Slow to affect people, but time is dose dependent

RADIATION POISONING • Alexander Litvinenko o o o Polonium 210 (210 Po) – alpha emitter Lost hair, Severe nausea, vomiting Bone marrow badly damaged Unable to eat for 18 days, Died in 3 weeks 210 Po was in green tea Seven bar staff had levels of 210 Po Several customers also had evidence of 210 Po exposure from same pot

RADIATION DXPOSURE DEVICE (RED) • Radioactive source out of legal control • Potential to expose people to lethal doses of radiation • Irradiation, no incorporation if sealed source • Dose assessment, medical monitoring • Psychological & Economical impact

RADIATION DXPOSURE DEVICE (RED)

RADIOLOGICAL DISPERSAL DEVICE (RDD) • Conventional explosive incorporating radioactive materials • Explosion greatest hazard • Mostly creates panic with little injury

NUCLEAR DETONATION • TWO DIFFERENT THREATS o o Nuclear Weapon Detonation (HIGH YEILD) Improvised Nuclear Detonation (IND) (LOW YEILD)

IMPROVISED NUCLEAR DEVICE (IND) • Illicit nuclear weapon bought, stolen, or otherwise originating from a nuclear state, or built from the components of a stolen weapon or from scratch. (Pu or U) o Produces same physical and medical effects as nuclear weapon explosion

IMPROVISED NUCLEAR DEVICE (IND) o o Results in catastrophic loss of life, destruction of infrastructure, and contamination of a very large area If nuclear yield is NOT achieved, the result would likely resemble a RDD If nuclear yield is achieved, results would resemble a nuclear explosion Like nuclear explosions, IND explosions can be evaluated with a fallout map

FALLOUT MAP (PLUME)

FISSION PRODUCTS FROM A NUCLEAR DETONATION Isotope Name Cesium Strontium Carbon Zirconium Uranium Plutonium Cesium Yttrium Tellurium Antimony Ruthenium Cerium Iodine Thorium Americium Curium Neptunium Symbol 137 Cs 90 Sr 14 C 95 Zr 235 U 238 U 239 Pu 134 Cs 91 Y 127 Te 125 Sb 106 Ru 144 Ce 131 I 234 Th 241 Am 243 Cm 237 Np Half Life Alpha (a) Beta (b) Gamma (g) 30 yrs 29 yrs 5, 730 yrs 65 days 700 mil yrs 4. 47 bil yrs 24 Thou yrs 3 yrs 58 Days 105 days 2 yrs 1 yrs 285 days 8 days 24 days 430 yrs 35 yrs 2. 2 mil yrs b, g b b b a a a b, g b b b b a, b a a a Radiotoxicity Hazard I, ING, SC, WBE I, ING, SC I, IHG, I, ING, SC, WBE I, ING, SC I, ING, SC I I – Inhalation, ING – Ingestion, SC – Skin Contact, WHE – Whole Body Exposure, FF – Full Face Respirator 76 % of all Fallout Always some CDC List of Interest out of 300+

RADIATION DECAY AFRRI - MEIR

Fallout is distributed downwind from the blast site in a plume-like pattern.

ELECTROMAGNETIC PULSE (EMP) • At the instant of the detonation (same time as thermal, gamma, and light) • Greatest nearest the epicenter and only lasts seconds • Disruption of the electrical grid, electronic and communications equipment • Equipment entering the area after EMP will function normally • Cell phones and handheld radios with small antennas may not be affected (Repeaters and towers will be)

INITIAL BLAST INJURY • Thermal o o Burns Mortality Increases With Radiation • High Intensity Visible Light o Eye Damage

BLAST INJURY • Over Pressure and Under Pressure o Blunt Trauma o Penetrations

SHELTERING IN PLACE (SIP) • SIP will normally be the preferred protective action. • SIP should be directed if the projected effective dose greater than 10 m. Sv (1 rem). • SIP need not be implemented if the projected effective dose is less than 1 m. Sv (100 mrem).

SHELTERING IN PLACE (SIP) • A brick building provides better protection than a brick veneer building, which is better than that of a frame building. • Less radiation exposure (increasing the Protection Factor) is seen at interior locations and below ground • Moving to a higher floor in the building increases the distance from the ground source but increases exposure from radiation on the rooftop.

SHELTERING IN PLACE (SIP)

Radiation ? ? ? Maybe I’m contaminated… OH what shall I do…

GOIANIA, BRAZIL 1987 • • • 249 people contaminated 20 people hospitalized 4 people died 2000 m 2 contaminated. 112, 800 monitored in soccer stadium

Which Do You Fear Most? OR H 1 N 1 influenza pandemic (1918 -1919) killed more people than WW I – 20 to 40 mil.

Which Do You Fear Most? OR Yersinia pestis Deaths Plague of Justinian (541– 542 AD) 25 mil. in Byzantine Empire Black Death (1348 - 1350) 40 – 60 % of Europe Great Plague (1665– 1666) 20 % of London

What would you rather live next to? Warning Time to Evacuate OR Three Mile Island - 0 Death/Injuries Fukushima - 0 Deaths 3 injuries (latent period? ) Chernobyl – Warning time not used SIP, KI, evacuation too late 47 known deaths from ARS >9, 000 Cancer WHO estimated 2006 Little or No Warning Union Carbide India Limited 12/84, methyl isocyanate gas release 3, 787 Dead 558, 125 injuries • 38, 478 temporary partial disabling • 3, 900 severely/permanently disabling

WOUNDS AND RADIATION • WOUNDS LEFT OPEN AND ALLOWED TO HEAL ARE POTENTIALLY FATAL DUE TO INFECTION • WOUND HEALING MARKEDLY COMPROMISED WITHIN HOURS OF RADIATION INJURY • WOUNDS SHOULD BE CLOSED AS SOON AS POSSIBLE. • EXTENSIVE DEBRIDEMENT OF WOUNDS MAY BE NECESSARY • CHECK WOUNDS PRIOR TO CLOSING WITH GEIGER COUNTER OR OTHER SOURSE…ALPHA CAN BE MASKED BY BLOOD

“RADIOLOGICAL DECONTAMINATION SHOULD NEVER INTERFERE WITH ACUTE MEDICAL CARE. UNLIKE CHEMICAL AGENTS, RADIOACTIVE PARTICLES WILL NOT CAUSE ACUTE INJURY Medical Management Of Radiological Casualties Handbook, Second Edition, Military Medical Operations Armed Forces Radiobiology Research Institute, April 2003

IONIZING RADIATION In most cases patients subjected to nuclear or radiological agents will be exposed, but not contaminated. Hiroshima thermal burn victim

IONIZING RADIATION • A person is externally contaminated if radioactive material is on skin or clothing. • A person is internally contaminated if radioactive material is breathed in, swallowed, or absorbed through wounds. • The environment is contaminated if radioactive material is spread about or uncontained.

CPM • A measure of radioactivity. • The number of atoms in a given quantity of radioactive material that are detected to have decayed in one minute. • Versus Disintegration Per Minute (DPM)

ROENGTON (R) • Used to measure a quantity called exposure. • Gamma and X-rays, and only in air. • Measure of the ionizations of the molecules in a mass of air. • The main advantage of this unit is that it is easy to measure directly

RAD • rad (radiation absorbed dose) • Used to measure a quantity called absorbed dose. • Amount of energy actually absorbed in material o any type of radiation o any material • Does not describe the biological effects of the different radiations.

REM (roentgen equivalent man) • called equivalent dose. • absorbed dose in human tissue to the effective biological damage of the radiation. • Not all radiation has the same biological effect • Equivalent dose is often expressed in terms of thousandths of a rem, or rem.

DOSAGE • For X rays and gamma rays in soft tissue • Exposure ≈ Absorbed Dose ≈ Dose Equivalent 1 R ≈ 1 rad ≈ 1 rem

DOSAGE UNITS RADIOACTIVITY Common Units curie (Ci) SI Units Becquerel (Bq) ABSORBED DOSE EQUIVALENT rad rem Gray (GY) Sievert (Sv) EXPOSURE roentgen (R) Coulomb (C)

DOSAGE Conversion Equivalence 1 curie = 3. 7 x 1010 disintegrations per second = 1 becquerel = 1 disintegration per second 1 millicurie (m. Ci) = 37 megabecquerels (MBq) 1 megabecquerel (MBq) = 0. 027 millicuries (m. Ci) 1 rad = 0. 01 gray (Gy) 1 rem = 0. 01 sievert (Sv) 1 gray (Gy) = 100 rad 1 sievert (Sv) = 100 rem = 0. 000258 coulomb/kilogram (C/kg) = 3, 880 roentgens 1 roentgen (R) 1 coulomb/kilogram (C/kg)

CONVERSION FACTORS To convert from To Multiply by Curies (Ci) millicuries (m. Ci) microcuries (µCi) milliroentgens (m. R) millirads (mrad) millirems (mrem) becquerels (Bq) megabecquerels (MBq) microcoulombs/k (µC/kg) milligrays (m. Gy) microsieverts (µSv) 3. 7 x 1010 37 0. 037 0. 258 0. 01 10 becquerels (Bq) megabecquerels (MBq) microcoulombs/kilo gram (µC/kg) milligrays (m. Gy) microsieverts (µSv) curies (Ci) millicuries (m. Ci) 2. 7 x 10 -11 0. 027 microcuries (µCi) 27 milliroentgens (m. R) 3. 88 millirads (mrad) millrems (mrem) 100 0. 1

RADIATION PATIENT TRIAGE • Contaminated/exposed patients • Wounded but not contaminated/exposed • Wounded and contaminated/ exposed

Health Effects and Emergency Medical Conditions of Exposure to Radiation Condition Pre Clinical Lethal Radiation 25 to 100 rem 100 to 250 rem 250 to 650 rem 650 to 1, 000 rem 1, 000 to 35, 000 rem over 35, 000 rem Vomiting Incidents None 5 to 50 % 50 to 100 % Vomiting Delay Time N/A 3 to 6 hours 5 to 20 min less than 3 min Leading Organ Signs Therapy None Mild Weakness 2 to 3 hours 15 to 30 min Bone Marrow, Blood System, Stomach and Intestinal System Reduced White Blood Cells Blood System Reassurance Restoratio n Destroyed White Blood Cells Tiny Blood Vessels, Brain, Spinal Stomach and Cord (Central Intestinal System Nervous System) Diarrhea, Fever Convulsions, Tremors Blood Transfusion Drubs, (Cytokines) Bone Marrow Transplant Maintain Electrolytes Sedatives Prognosis Excellent Good Poor Death Incidence of Death None 0 to 5 % 15 to 80 % 80 to 90 % Almost 100 %

TREATMENT OF CONTAMINATED WOUNDS • In a contamination accident, any wound must be considered contaminated until proven otherwise and should be decontaminated prior to decontaminating intact skin.

RADIATION PATIENT MOVEMENT • Contaminated – Cocoon • Remember blood and water mask alpha particles • In Hospital movement

PATIENT DECONTAMINATION • Non-contaminated • Contaminated – Clothing – Survey – Dry Decontamination

PATIENT DECONTAMINATION • TAKE NASAL SWAB SAMPLE • REMOVE CLOTHING • DRY DECONTAMINATION • WASH WITH SOAP AND WATER

PATIENT DECONTAMINATION • Skin • Hot water versus cold water • Contaminated bandages, water and bodily fluids • When to stop

BURN PATIENTS • Cleansing process is the same as with intact skin (except no scrub brush) • Consult Burn Unit FIRST • Physicians/nurses at Local Burn Center can give guidance

TAKE SAMPLES • Samples should be taken at the earliest possible time. o Blood – white blood cells count is extremely important o Urine – some isotopes o Stool (feces) – some isotopes

REASSURING THE PATIENT • Radiation is NOT contagious • Explain the reason for monitoring and lab testing • Reassure the patient

REASSURING THE STAFF • Radiation is NOT contagious • Ensure the staff including maintenance and housekeeping understand the hazards of radiation. • If the staff is afraid then that will transfer to the patient.

MEDICAL MANAGEMENT OF INTERNAL CONTAMINATION • REDUCES THE ABSORBED RADIATION DOSE AND THE RISK OF FUTURE BIOLOGICAL EFFECTS • DILUTING AND BLOCKING AGENTS ENHANCE ELIMINATION RATES OF RADIONUCLIDES (IODIDE COMPOUNDS) • MOBILIZING OR CHELATING AGENTS (CALCIUM EDETATE (EDTA)

MEDICATIONS USED TO TREAT AND/OR REMOVE INTERNAL RADIATION CONTAMINATION Isotope Drug Administestrati on Comments Americium Ca-DTPA, Zn-DTPA Parenteral Zn-DTPA is initially 10 times less effective than Ca-DTPA for initial chelation of transuranics. After 24 hours efficiency of both agents is about the same. Cesium Prussian blue Oral Acts by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time. Cobalt Unknown try penicillamine Oral Nothing too good Iodine Potassium Iodide (KI) Oral Within about first 4 hours, used to block uptake of radioactive iodine. Iridium Unknown try penicillamine Oral Nothing too good Palladium Unknown try penicillamine Oral Nothing too good Phosphorus Na phosphate or K phosphate. Oral Used to block uptake of radioactive phosphate Plutonium Ca-DTPA, Zn-DTPA Parenteral Zn-DTPA is initially 10 times less effective than Ca-DTPA for initial chelation of transuranics. After 24 hours efficiency of both agents is about the same. Radium calcium Oral Alginates are also useful to reduce GI absorption oral to reduce GI absorption and increase urinary excretion. Rubidium Prussian blue Oral Acts by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time. Strontium Calcium Gluconate and Ammonium Chloride Intravenous Oral ammonium chloride for acidification. Alginates are useful to reduce gastrointestinal absorption. Oral Acts by ion-exchange, adsorption, and mechanical trapping within crystal structure. Not absorbed through intact GI wall. Clearance depends on GI transit time. Thallium Prussian blue Tritium Water Oral Force water to promote diuresis Uranium Ca-DTPA, Zn-DTPA Parenteral Na bicarbonate to alkalinize urine - see comments by Americium Yttrium Ca-DTPA, Zn-DTPA Parenteral Within 4 hours only. - see comments by Americium

PUBLIC HEALTH RESPONSE • Protecting the public’s health and safety. • Education is the key. Fear of radiation is higher than other agents of terrorism. People are unfamiliar with radiation, including medical and public health professionals. • Monitoring workers’ health and safety. • Ensuring provision of health, medical services, mental health, o safe shelters for the population. o safety of food and water supplies.

PUBLIC HEALTH RESPONSE • Coordinating field investigations, sampling and laboratory analysis of biological and environmental samples. • Assisting and Advising communities in decontamination and radiation response for public health and safety. • Developing criteria for entry and operations within the incident site.

PUBLIC HEALTH RESPONSE • Population Monitoring is a process that directly after a radiation incident is reported and continues well into the recovery and after. o o o Needed medical treatment. Presence of radioactive contamination Intake of radioactive materials into the body. Removal of external or internal contamination Dose received and resulting health risk from exposure. Long-term health effects on people and offspring.

PUBLIC HEALTH RESPONSE • Recommending radiation management protocols, prevention, and control measures for affected populations or individuals. • Communicating necessary information to hospitals, medical providers, situation assessments and required safety measures to the public. • Assisting law enforcement agencies with the criminal investigation

STRATEGIC NATIONAL STOCKPILE (SNS) • The SNS is organized for flexible response o o Arizona State and Counties have plans receive and distribute SNS medicine and medical supplies Vendor Managed Inventory

STRATEGIC NATIONAL STOCKPILE (SNS) National Repository Of: • • Antibiotics, Chemical Antidotes, Radiation Drugs Antitoxins, Life-support Medications, IV Administration, Airway Maintenance Supplies, And Medical/Surgical Items.

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