10/2/2015

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Radiological Dispersal Device &Nuclear DetonationEXPLOSION AND BLASTINJURIES

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Possible Scenarios

• Radiological Exposure Device• Improvised nuclear device (IND)• Nuclear weapon detonation• Nuclear power plant accident• Radioactive dispersal device (RDD)

including the "Dirty Bomb" scenario DPhoto Credit Sandia National Laboratories and Wikipedia

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“Dirty Bomb”

• Conventional explosive + radioactivematerial =“dirty bomb”

• Dispersal pattern variable• Combined blast and burn injuries• External and internal contamination• Potentially large population affected

Conventional

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Little Boy dropped on Hiroshima Min August 6 1945

Simulation Target

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Hypothetical Scenario in Downtown, Atlanta

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Severe damage zone (0,5 mile radius!• Near complete collapse• Few, if any. buildings still standing• 99% immediate fatalities

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Moderate damage /one (1 mile radius):■ Some collapsed buildings, blown out building

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�*- ~;;s£Significant thermal burns if outdoors38% immediate fatalities, 14% expectant

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Light damage zone:• 2-3 mile radius• 25% of windows are shattered• Huge numbers of glass injuries• 6% of casualties at risk of death

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Temporary blindness 5-10 miles away!

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Dangerous Fallout Zone or DangerousRadiation Zone:• Extends 25 miles downwind of ground

zero• Readies maximum extent at 1 hr• Severely hazardous fallout will

descend to the ground within a fewhours and may shrink to a few miles ina couple of days (decay)

• Mostly visible to naked eye (grains ofsand)

• Exposure rale >10 R/h

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Casualties (10 kT model)

• For large city with 2 million population- 230.000 immediate fatalities-323.000 injured survivors

• 99.000 will succumb without medical treatment• 73.000 will still succumb with medical treatment• 26,000 can be saved with medieal treatment

Acute Injuries after a NuclearDetonation

• Blast injuries- Blast wave can lake several seconds lo travel a few

milesGlass injuries (within a few miles)Duck and Cov er can protect people if they see thebright Hash of light (can be seen up to 100 miles away )

• May nol be possible in a ground burst inside a citv

• Thermal bums injuriesPrimary flame (fireball up to few miles away)Secondary fires

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Acute Injuries after a NuclearDetonation

• Radiation injuries- Prompt radiation (within first minute)

- Latent (after first minute)• Emitted from the fallout

- Composed of fission products and neutron activationproducts

- Acute Radiation Syndrome- Beta bums

Acute Injuries after a NuclearDetonation

• Combined injuries (estimated to occur in60%)

• Flash blindness ( up to 6 miles)• Electromagnetic pulse (EMP)

- No direct health effects- High voltage surge in conductors- Poorly characterized in an FND- Probably not beyond 2 miles of ground zero

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Significant dlffwencw in fallout patlrntf can tv»ultdirection* and (peed* at varying altitude* fB

nod fallout pattern: from varying wind

uddrnnier and Dillon, 2009)

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Long Term Effects

• Delayed Effects of Acute RadiationExposure (DEARE)- Pulmonary fibrosis

• Solid tumors• Leukemias

MECHANISM OF DISEASE

Ionizing Versus Non-ionizingRadiation

• Ionizing radiation interacts withhuman body through direct andindirect effects- Directly- Indirectly

non-tonJzIng ionizing

i~thirr• Non-ionizing radiation(microwaves, UV)

Does nol ionize other atoms or leadto the formation of free radicals • sr

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Radiation Damage

• Deterministic- Threshold dose- Local radiation injur)1- Acute radiation syndrome

* Stochastic- Random-Oncogenensis-Teratogenesis

Radiation Physics 101

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Radioactive Decay

• Atoms decay to reach a more stable state byemitting inonizing radiation in the form ofparticles or penetrating radiation (Gamma rays).

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Different Types of Radiation

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Types of Ionizing Radiation

Radiation Units: S.I. Versus USA

1 Gray (Gy) =1 Sievert (Sv) =

100 x RAD100 x REM

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2 Different yet PossibleOverlapping Entities

• Contamination- External- Internal

• Exposure- Whole body- Partial body

Radiation Protection in WholeBody Exposure

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Pick the Appropriate Personal ProtectiveEquipment (PPE)!

WHEN CARING FOR THESEPATIENTS

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Respiratory Protection• Common!) available protective masks nrcgeneralh sufficient pre-

decontanunation• OSHA'MIOSH Hospital staff taking care of patients tn the pre-

dccontanunation and decontamination areas. PAPRs or HEPA filternegative pressure masks arc described as minimum

' ’PERSONAL PROTECTIONREQUIRED BEYOND THIS

REQUIRED BEYOI

TRAUMAÿ TRAUI

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Personal Protection• Standard Precautions

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Radiation Detection in the EDt• Victims should be surveyed withGeiger-Mtiller counters.

Radiation Detection in the ED

--i❖ Survey patient for radiologicalcontamination and mark areas on bodydiagram.❖ Remove contaminated clothes and labelthem.❖Except lor an instance ofhighly-radioactive shrapnel, contaminationshould NOT deter medical staff from treatinglife-threatening injuries.

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Radiation Survey in the ED andDecontamination

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DIAGNOSIS OF INTERNALCONTAMINATION

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In Vivo Measurements• Whole body counters• Chest counters for

Plutonium and Uranium• Wound monitoring

instruments 1Whole Body Dosimetry

• Using whole body counters or scanners thatare potentially available at nuclear medicinedepartments.

• It is crucial to know when thecontamination occurs as well as whichradionuclide is involved.

www.bt.cdd.gov/radiation/clinicians/evaluation/index.as

Diagnosis By Excretion(Bioassay) Sampling

• Collect unne or feces to measure excretion rates• Challenging interpretation

Time when conlamtnationoccuredCharctenstics of inhaled or internalized radionuclides

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Internal ContaminationAcute Radiation Syndrome

CLINICAL IMPACT ANDCONSEQUENCES

Clinical Consequences of InternalContamination

• Acute and subacute- Lnd organ dammage- Acute Radiation Syndrome- Multiorgan failure

• Chronic-Solid tumors- Leukemias

Management Strategies

♦ Supportive care• Decreasing absorption• Decorporation and enhance elimination• Long term monitoring

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Internal Contamination

Iodine Kt (potassium iodide)

Transuranics such asPlutonium& Americium

Zn-DTPACa-DTPA

Uranium Bicarbonate

CesiumRubidiumThallium

Prussian Blue*[Ferrihexacyano- Ferrate (II)]

Tritium Water

Transuranics• Used for Transuranics such

as Plutonium andAmericium

• first dose should beCalcium DTPA followed b\Zinc DTPA

• Duration of therapy will beguided by urine or fecestransuranic concentrations

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Cesium-137• 46 Goiania pts contaminated with

Cs-137 treated with PrussianBlue

• Less than 1 % is absorbed• Exchanges a cation and binds

Cesium or Thallium• Decreases GI absorption and

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Radioactive Iodine Exposure

• iodine Prophylaxis and Treatment- Potassium iodide (Kl) is an effective, inexpensive

thyroid-blocking agent

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Saturate the Critical Organ with the Stable Isotope

ACUTE RADIATIONSYNDROME (ARS)

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Acute Radiation Syndrome(ARS)

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• Deterministic effect• Prodrome phase• Hematopoetic syndrome• Gastrointestinal

syndrome• CV/’CNS syndrome

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Prodrone• Vague Sx nausea.

vomiting, headache.♦ Help predict the dose.

the higher the absorbeddose the earlier and themore frequent the Sxoccur

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Hematopoetic Syndrome (2-6 Gy)

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Lymphocyte Depletion Kinetics

♦ Andrew's nomogramhelps estimate the doseof radiation.

• WBC withdifferential every6 hrs for firsl24-48 hours.

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Cytogenetics• Rate of dicentric

chromosomes inperipherallymphocytes.

• Available atREAC/TS.

• Takes a few days.

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Management of theHematopoetic Syndrome

• Complications: infection and bleeding.* Treatment is supportive:

Reverse isolationIVF

- blood products- Antibiotics- Colony stimulating factors such as filgrastim or G-CSF

(300 meg s'c per day)Stem cell transplant

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♦mPopulation Monitoring• The process to screen people for radioactive

contamination or exposure to radiation, assist withdecontamination, register, and prioritize for furtherfollow up.

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• Primary objective is to identify people who are inimmediate danger.

• It is a local/state effort: similar to PODs.

w\vw bt cdc gov/'radiatum pdfipopulation-moniloring-guide pdf

Community Reception Centers(CRC)

• The place to conduct population monitoring”• Primary services include

external contamination screening, external decontamination.prioritizing people for further care

• Benefits include- providing needed services to alTccted and concerned people, reducing

burden on hospitals, managing scarce medical resources, supportingpublic shelters

• Staffing- Health physics (radiation safety), nursmg'medical, and general staff

Thank You!

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