Medical Response to Nuclear and Radiological Events by jolinmilioncherie


									Medical Response to Nuclear
and Radiological Events

             Cham Dallas, PhD
   CDC Center for Mass Destruction Defense

         BDLS is a registered service mark of the
        Board of Regents University System of Georgia

•   Nuclear scenario effects
•   Radiation injury
     Acute radiation syndrome
     Mass burn casualties
     External contamination
     Internal contamination

•   Pharmaceutical intervention strategies

Which of the following are most likely to occur
and result in significant casualties?

         A. Nuclear power plant release
         B. Improvised nuclear devise
         C. Conventional nuclear weapon
         D. “Dirty” bomb
Potential Nuclear/Radiological Hazards
in the U.S.

 •   Simple radiological device
 •   “Dirty” conventional bomb
 •   Improvised nuclear device (IND)
 •   1 kT “suitcase nuke”
 •   Ballistic missile attack
 •   250 kT nuclear weapon: “city killer”
Diversion of Nuclear Weapons

 50 –100 1 kT “suitcase” nuclear weapons are
 unaccounted for.
 The Threat of Nuclear Diversion.
 Statement for the Record by John
 Deutch, Director of the Central
 Intelligence to the Permanent
 Subcommittee on Investigations
 of the Senate Committee on
 Government Affairs, 20 March 1996.
Energy Partition

         Standard Fission/Fusion

     Blast                                35%

                                     Fallout 10
     Initial Radiation 5%
                AFRRI, Medical Effects of Nuclear Weapons,
                “Blast and Thermal Effects” Lecture, 1990.
Nuclear Weapon Detonation Results: 1
Nuclear Weapon Detonation Results: 2
Nuclear Weapon Detonation Results: 3
Scenario: Washington Mall

                   White House

Lincoln Memorial                                The Mall
                          Washington Monument

Effective Range for Blast Energy

  AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990.
Effective Range for Thermal Energy 1 kT

  AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990.
Safe Separation Distances for Eye
Injuries 1 kT Weapon

 AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990.
Atlanta SSE Med Wind 250 kT Fatalities

                  Probability of Fatality (Default Plot)
                      Time: 32 days, 0.0 hours
                     Mean Probability of Fatality

                                 Prob    Population
                    90%           0.9     455,934
                    50%           0.5     661,169
                    10%           0.1     886,681
                     Fatality Possible (w/meander)
                    90%              0.9     455,934
Atlanta 250 kT SSE wind 7 mph
New York: 250 kT Nuclear Detonation

Mortality Probability
3.9m Affected
Red             90%
Lt Brown        80%
Yellow          70%
Green           60%
Pale Blue 50%
Dark Blue 40%
Lt Purple       30%
Dk Purple 20%
Dk Pink         10%
Lt Pink         1%
Seattle Mortality Probability under 350 kT
with NNE Wind
What Is Fallout?

 •   A complex mixture of more than 200
     different isotopes of 36 elements
 •   2 oz of fission products formed
     for each kT of yield
 •   Size <1 micron to several mm

 The risk from delayed fallout that is
 dispersed long distances (>100 miles)
 still has a devastating impact on public

             A. True
             B. False
Early Fallout

 •   That which reaches the ground during the
     first 24 hours after detonation

 •   Early fallout fraction 50 –70% of total

 •   Highest degree of fallout risk
Delayed Fallout

 •   Arrives after the first day, very fine invisible
     particles which settle in low concentrations
     over a considerable portion of the earth’s

 •   40% of total radioactivity

 •   Much lower degree of risk relative to early
Bikini Atoll (1 March 1954)

 •   15 mT thermonuclear        Contamination   Radiodermatitis
     detonation fallout
 •   Population affected:
     300 in public domain
      Int/Ext contamination

      Local radiation injury

      Mild ARS

      Thyroid injury
Ionizing Radiation

 Radiation that consists
 of directly or indirectly
 ionizing particles or


                             1 m concrete
Radiation Exposure Types

                    External        Internal
    Irradiation   Contamination   Contamination

                          **          
                                      

Acute Radiation Syndrome

 •   Systemic effects of radiation
      Prodromal
      Hematologic
      Gastronintestinal
      Pulmonary
      Cutaneous
      Neurovascular

 •   Combined injury
Prodromal Component
(0.5–3 Gy and higher)

 •   Immediate effect of cell membrane damage

 •   Onset of nausea, vomiting, diarrhea

 •   Mediated neurologically by the
     parasympathetic system
Respiratory Component
(5–310 Gy and higher)

 •   Sensitive from highly vascular tissue
      Endothelial cells                     Healthy lung
      Type II alveolar cell

 •   Effect is dose-rate

 •   Pneumonitis

 •   Fibrosis
Radiation Skin Injury

 •   0.75 Gy Hair follicles change

 •   3 Gy     Epilation

 •   6 Gy     Erythema

 •   10 Gy    Dry desquamation           Erythema

 •   20 Gy    Wet desquamation
              (transepithelial injury)
Radiation Burns
Causes of Burn Deaths

 Direct result of accident   13%
 Infection                   45%
 Organ system failure        41%
 Iatrogenic intervention     1%
Distribution of Injuries in a
Nuclear Detonation

 Combined                                                         Single injuries
                                    Wounds +
  injuries                                                         (30%–40%)
             Wounds +                Burns
(65%–70%)                             5%
             Irradiation 5%                            Irradiation
        Burns +
       Wounds +
          20%                                                     Burns 15–20%

          Burns +
                                                              Wounds < 5%
       Irradiation 40%

         Data from Walker RI, Cerveny TJ Eds., Medical Consequences
         of Nuclear Warfare, TMM Publications, Falls Church, 1989. p 11.
Andrews Lymphocyte Nomogram

               •   Absolute lymphocyte
                   count over 48 hours
               •   Confirms significant
                   radiation exposure

                   From Andrews GA, Auxier JA, Lushbaugh
                   CC: The Importance of Dosimetry to the
                   Medical Management of Persons Exposed
                   to High Levels of Radiation. In Personal
                   Dosimetry for Radiation Accidents. Vienna,
                   International Atomic Energy Agency, 1965,
                   pp 3- 16
Priorities in Combined-Injury Triage-
Radiation Doses

 Conventional Triage                  Changes in Expected Triage
 (No Radiation Exists)                Following Radiation Exposure
                                  <1.5Gy          1.5–4.5Gy                >4.5Gy
                                   >3 hr            1–3 hr                  <1 hr
                                  onset            onset                   onset
 Immediate                      Immediate          Immediate              Expectant
 Delayed                         Delayed           Expectant              Expectant
 Minimal                         Minimal           Expectant              Expectant
 Expectant                      Expectant          Expectant              Expectant

     Modified from Medical Consequences of Nuclear Warfare, 1989, p. 39
Decontamination Equipment

 •   Hospital surgical gown (waterproof)
 •   Cap, face shield, booties (waterproof)
 •   Double gloves (inner layer taped)
 •   Pencil dosimeters, TLDs, survey meters
 •   Drapes
 •   Plastic bags
 •   Butcher paper
 •   Large garbage cans
 •   Radiation signs and tape

 Which of the following is the best
 decontamination agent?

       A. Dry removal

       B. Bleach

       C. Soap & water

       D. Waterless cleanser
Decon Agents: 1

 •   Dry removal
 •   Soap/shampoo
 •   Household bleach 1:10 (sodium hypochlorite)
 •   Waterless cleansers
 •   Povidone-iodine
 •   Lava soap
 •   Cornmeal/Tide 50:50
 •   Vinegar (32P) or club soda
 •   Toothpaste
Internal Contamination Involves 4 Stages

 •   Deposition along route of entry
 •   Translocation
 •   Deposition in target organ
 •   Clearance
Therapeutic Interventions

 •   Plutonium/transuranics: DTPA

 •   Cesium: insoluble Prussian Blue

 •   Uranium: alkalinization of urine

 •   Radioiodine: radiostable iodine

 •   Tritium: radiostable water
All that is necessary for the triumph of evil…

                           …is for good men
                           and women to do

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