Tareg Bey, MD, FAAEM, FACMT, DEAA

Professor of Emergency Medicine
Department of Emergency Medicine
University of California Irvine
Orange, CA

Nuclear and Radiological Emergencies
Tareg Bey, MD, FAAEM, FACMT,DEAA
Professor of Emergency Medicine
Department of Emergency Medicine
University of California Irvine
Orange, CA

Goals and Objectives
• Emphasize the need for more education of health care
providers, rescue and public safety personnel for
radionuclear
• Review the different radionuclides and their sources
which could serve for radioactive contamination,
incorporation and radiological terrorism.
• Discuss the need for reviewing the stockpile situation
for radionuclear decorporation antidotes.
• Review briefly two examples for incorporation of a
radionuclide. One for which decorporation is effective
and one for which it is not.

About Radiation

Medicine Industry Private Aerospace Household Research Energy .Sources of Radionuclides • • • • • • • Hospital.

files. Placement of Radioactive Materials in Public Places http://japanifik.com/2007/08/nagasaki-bomb-fat-man.wordpress. Nuclear Device Detonation 2.Terrorists Scenario Choice 1. Meltdown of Nuclear Reactor 3.jpg . Dirty Bomb 4.

9 km). 50 % fatalities from immediate radiation exposure • Within 7. . 50 % fatalities from thermal burns • Within 1 mile (1.8 miles (2.5 miles (800 m). 50 % fatalities from debris impact • Within 1.4 km) 50 % fatalities from radiation exposure within one hour.7 miles (12.6 km) radius.Nuclear Weapon: 20 kT Ground Burst • 180 ft (60 m) radius crater • Within 0.

com/Pho tos/Nagasaki/images/NG30.atomicarchive.Question: What Are We Preparing For ? http://www.jpg .shtml http://www.com/Hi story/coldwar/p19_image.atomicarchive.

International Nuclear Event Scale (INES by the IAEA) • Scale 0 – 7 • 0: No Safety Significance • 7: Major Accident • 4-7: Upper level • 1-3: lower level • Matrix.org/Publications/Factsheets/English/ines. industrial accident • Radioactivity release.iaea.public interest http://www.pdf .

Examples of Rated Events • 1986 Chernobyl/Soviet Union: widespread effect INES Level 7 • Tokaimura/Japan: Nuclear fuel processing facility. 7 injured with hot steam. 2 workers dead. INES level 4 • Mihama/Japan nuclear power plant. 40 contaminated. INES level 1. 5 people die. . Officially no release of radioactivity.

jp/j-east/article/200523/000020052305A0920525.uk/nolpda/ukfs_news/hi/newsid_3547000 /3547828.bbc.iaea.uk/1/hi/sci/tech/5165736.php .stm • http://www.edu/probing/nuclearpower.html • http://sciencelinks.org/Publications/Factsheets/English/ines.Accidents in Nuclear Power Plants • http://news.gov/hazard/nuclear/index.bbc.co.co.pdf • http://news.rps.fema.psu.stm • http://www.shtm • http://www.

Radiological Terrorism Scenarios • • • • Nuclear Device Detonation Meltdown of Nuclear Reactor Dirty Bomb Placement of Radioactive Materials in Public Places .

TV screens.. glass industry ) • Cesium-137 (Medicine) • Iridium-192 ___________________________ • Strontium-90 (Medicine. energy in aerospace industry) . medicine) • Plutonium-238 (heat source.60 (Medicine.Radioactive Isotopes Suitable for Nuclear Terrorism • Cobalt.) • Radium-226 (brachytherapy. remote weather stations.

• In doubt evacuate and help trauma victims. .Protection Against Radiation and Radioactivity • Alpha particles: Sheet of paper • Beta particles: 3 mm aluminum • Gamma: Lead and distance • Chemical protective suits do not offer a barrier to gamma radiation. • A radiation safety officer or health physicist should assist with preparedness planning.

wounds Irradiation Internal Contamination External Contamination Wound contamination .Radiation Accidents: Categories of Injuries • • • • • • Trauma Burns.

energy in aerospace industry) . remote weather stations. TV screens.) • Radium-226 (brachytherapy..Radioactive Isotopes Suitable for Nuclear Terrorism • Cobalt. medicine) • Plutonium-238 (heat source.60 (Medicine. glass industry ) • Cesium-137 (Medicine) • Iridium-192 ___________________________ • Strontium-90 (Medicine.

Exposure versus Contamination • Contamination: Radioactive material is on the patient (and clothes) or has been incorporated. Example: Radioactive dust in hair or Ingestion of Polonium 210 and distribution within the body. .

inhalation. wound contamination—blast injuries) – Internal contamination can be extremely dangerous • Exposure to ionizing radiation (gamma radiation) .How Does Dispersed Radioactive Material Become Dangerous to Humans ? Exposure: • Contamination (alpha and beta radiation) – External contamination (radioactive dust) – Internal contamination (ingestion.

Thorough washing with special attention to hair. • Internal contamination with incorporation of radioactive material poses a great hazard because of continuous irradiation . Follow by “external decontamination”.Contamination with Radioactive Material • External contamination: Removing outer clothes may get rid of 90 % of all radioactive dust.

Decontamination of Radionuclides • Decontamination of external radiological contamination is a key measure to decrease morbidity and mortality from radioactive material. food or wounds) . • External decontamination will also help to prevent further internal contamination (inhalation.

• Protective masks and personal protective equipment (PPE) to avoid INHALATION and SKIN CONTACT. Danger of radioactive incorporation.Radiation Protection of Personnel • Time. shielding. • Distance is the best protection. • No eating. drinking or smoking at the rescue site. distance. 3 principles. • Evacuation and decontamination .

Decontamination Equipment .

Detection and Protection • Detectors – Geiger counter (beta and gamma) – Alpha meter – Dosimeter (gamma in rads/hour) • Personal Protective Equipment – Water resistant gowns. eye protection. masks. double glove . shoe covers. caps.

stockpiling strategies focus on medical countermeasures –Biological –Chemical incidents •The Centers for Disease Control’s Strategic National Stockpile initially for biological incidents.Background •Current U. forward CHEMPACK (chemical incidents) added later •Stockpiling for radiation emergencies is needed •Focus now by the World Health Organization .S.

Dirty Bomb 4. Meltdown of Nuclear Reactor 3.Terrorists Scenario Choice 1. Nuclear Device Detonation 2. Placement of Radioactive Materials in Public Places .

Scenario Modeling and Hazard Vulnerability • Number of potentially exposed patients • Types of radionuclides • System for rapid identification of involved radionuclides • Treatment regimens • Consider availability within minutes to hours .

and local incident management system must all be in place and exercised .Scenario Modeling and Hazard Vulnerability • Determine placement of countermeasure stockpiles • Supply limitations (Prussian blue/single German manufacturer) • An activation. distribution.

wounds Irradiation Internal Contamination External Contamination Wound contamination .Radiation Accidents: Categories of Injuries • • • • • • Trauma Burns.

Example: Nuclear Power Plant Accident • Industrial accident • Multiple types of injuries have been described including trauma • Possible exposure to radiation and contamination will complicate medical management .

Recommended Antidotes Radionuclide Approach •Titrium •Iodine-125 or 131 •Dilution (force fluids) •Blockage (potassium iodide) •Mobilization (antithyroid drugs) •Cesium-134 or cesium-137 •Reduction of GI absorption (Prussian Blue) •Plutonium or other •Chelation with zinc or transuranic elements calcium diethylenetriamine pentaacetic acid (DPTA) .

plutonium. Bk) • Intravenous form (also aerosol Zn-DTPA) . Curium (Ca.Diethylenetriamene pentaacetate (DTPA) • Ca-DTPA and Zn-DTPA • Within first 24 hrs– Ca-DTPA is 10 times more effective than Zn-DPTA. Then equally effective • Indications (FDA): Americium.

DTPA Source: http://orise.orau.gov/images/reacts/dtpa-sm.jpg .

daily . for five days • Bioassay .Diethylenetriamene pentaacetate (DTPA) • The first 24 hours are important for effective treatment • Decorporation treatment is time-sensitive • Greatest effect within 1 hour • 1 g .

lavage. charcoal or laxatives) .Recommended Antidotes Radionuclide Approach •Strontium-89 or strontium-90 •Reduction of absorption: aluminum phosphate gel antacids •Blockage: strontium lactate •Displacement: Oral phosphate •Mobilization: ammonium chloride or parathyroid extract •Unknown •Reduction of absorption (emetics.

--- • Elimination • Increase elimination via kidney and gut . reduction of absorption • Distribution • Reduce uptake in a specific organ.Pharmacokinetics • Absorption • Prevent further absorption – Decontamination. – Thyroid gland - • Biotransformation • --.

Radioisotops and Pharmacology • An Isotope is one of two or more atoms with the same atomic number but with different numbers of neutrons. A stable isotope is a chemical isotope that is not radioactive. • Radioisotopes can be used in imaging tests or as a treatment for cancer. • A radioisotope is an unstable element that releases radiation as it breaks down. .

Number of electrons: 53 • Stable Iodine: Atoms 53. Neutrons: 74 53 (A) +74 (N) = 127 .Radioisotops • Example: Iodine with an Atomic Number or 53.

Radioisotopes and Pharmacology • Stable isotopes of the same element the same chemical characteristics and therefore behave chemically and physiologically almost identically. • The mass differences are due to a difference in the number of neutrons .

Example: I-131 • I-131 is radioactive. and emits beta and gamma radiation. . has an 8 day half-life. Both iodine-129 and iodine-131 are produced by the fission of uranium atoms during operation of nuclear reactors and by plutonium (or uranium) in the detonation of nuclear weapons.

RADPACK Considerations •Blast injuries •Thermal injuries •Radiation injuries •Treat the patient before the poison •Prevent or reduce exposure •Enhance the elimination of the agent •Consider specific adjuncts .

• Multiple hospitals across the US have started to stockpile radionuclear decorporation antidotes. • Decontamination of radionuclides is a key measure but it should not health care personnel to address major life-threatening trauma first. rescue and public safety personnel is important • Different radionuclides and their sources can cause radioactive contamination. . incorporation and be used for radiological terrorism.Summary • Additional education for health care providers.