RADIOLOGICAL AND NUCLEAR DISASTER: EVALUATION OF THE DISASTER: - - PowerPoint PPT Presentation

RADIOLOGICAL AND NUCLEAR DISASTER: EVALUATION OF THE DISASTER: EVALUATION OF THE PROBLEM

COL Patricia Lillis-Hearne MD MHA AFRRI Albert L. Wiley MD PhD FACR REAC/TS

DISCLOSURES DR WILEY: NONE DR LILLIS HEARNE NONE DR LILLIS-HEARNE: NONE

LEARNING OBJECTIVES Identify the potential causes of radiation mishaps D ib l l f th it i di l i Describe levels of authority in a radiologic or nuclear disaster Distinguish between a radiologic and a nuclear Distinguish between a radiologic and a nuclear event Identify where to go for further information on di l i l di t radiological disasters

ACR/ASTRO/AAPM Disaster Primer

“A radiation disaster is a possibility for which we must be prepared Radiologists radiation oncologists and medical

• prepared. Radiologists, radiation oncologists and medical

physicists will play a vital role as responders and as sources for accurate information for patients, the public and the medical community.” community.

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and nd Terrorism Terrorism

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Where Do Accidents Occur? Where Do Accidents Occur?

• Irradiation facilities
• Nuclear reactors
• Isotope production facilities
• Materials testing (sealed sources)
• Materials testing (x-ray devices)
• X-ray and radiotherapy devices (medicine, research)
• Unsealed radionuclides (medicine, research)
• Transportation

Milit

• Military
• ????

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S REAC/TS R di i A id R i

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Source: REAC/TS Radiation Accident Registry

What Causes Radiation “Accidents”? What Causes Radiation “Accidents”?

Usually Human Error

Lost or mishandled sources Medical misadministration Bypassing Interlocks Failure to use criticality control Failure to use criticality control Calibration/programming errors Inadequate radiation protection programs, supervision/quality control, and training/written procedures control, and training/written procedures Human factors

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Reality: Reality: Major Radiation “Accidents” Worldwide Major Radiation “Accidents” Worldwide (1944 (1944-

• Dec 2007); “Classification by Device”

Dec 2007); “Classification by Device”

Radiation Devices 319

Sealed Sources 210 X-ray Devices 83 Accelerators 25 Radar Generators 1

R di i t 93 Radioisotopes 93

Diagnosis and Therapy 38 Transuranics 28 Fission Products 11 Tritium 2 Radium Spills 1 Other 13

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Criticalities 20

Critical Assemblies 8 Reactors 6 Ch i l O ti 6

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Chemical Operations 6

Total 432

Source: REAC/TS Registry

Things To Consider Things To Consider

• There are different types and extents of radiation injury,

depending on the accident scenario depending on the accident scenario.

Whole-body irradiations

(WBI TBI) (WBI vs TBI)

Partial-body irradiations (PBI) Local radiation injury (LRI) Internal contamination from radioisotopes

• There may be acute and chronic effects

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There may be acute and chronic effects.

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An Industrial Radiography Example: Location An Industrial Radiography Example: Location

Yanango, 42 megawatt hydroelectric plant, located 300 km east of Lima Peru located 300 km east of Lima, Peru.

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Device Device

192 Ir “gamma camera” with a 1.37 TBq (37 Ci) source

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Dose Rates Dose Rates

For a 30 Ci For a 30 Ci 192

192Ir radiography source

Ir radiography source

Distance Distance [cm] [cm] Dose Rate Dose Rate [rad/ min] or [cGy/ min] [rad/ min] or [cGy/ min]

Surface Surface 36,000 36,000 1 2,400 2,400 2 600 600 2 600 600 3 267 267 4 150 150

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4 150 150 5 96 96

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Medical Medical

• 37

37-

• year

year-

• old male put source in his
• ld male put source in his

pocket with ~6 pocket with ~6-hour exposure hour exposure pocket with 6 pocket with 6 hour exposure hour exposure

• Initial symptoms of nausea /

Initial symptoms of nausea / vomiting and one episode of vomiting and one episode of di h di h diarrhea diarrhea

• Erythema on upper posterior thigh

Erythema on upper posterior thigh

• Admission

Admission

• TX

X - IV fluids, 500mg Cipro bid, 8mg

IV fluids, 500mg Cipro bid, 8mg

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dexamethasone tid, Naprosyn dexamethasone tid, Naprosyn-

• like

like pain meds pain meds

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Medical Medical

D+2 (Feb 22, 1999) Blistering, vesicular lesion with vesicular lesion with inflammatory halo D+5 (Feb 25 1999) Clindamycin D 5 (Feb 25, 1999) Clindamycin 300mg tid started & Cipro ↑ 750mg bid

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Absorbed doses in Gy Absorbed doses in Gy Normalized to 30 Gy at the rim of the lesion (radius = 5 cm) Normalized to 30 Gy at the rim of the lesion (radius = 5 cm)

LEFT

• 2

Absorbed dose Absorbed dose di t ib ti f di t ib ti f

2

• 4

6

distribution for distribution for horizontal cross horizontal cross-

• section at source level

section at source level with source with source skin skin

• 6
• 8

10

with source with source-skin skin distance of 3 mm distance of 3 mm

• 10
• 12

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15

• 16
• 14

18

15

• 18
• 12 -10 -8 -6 -4 -2 0 2 4 6 8

Gy at X cm depth

Moist desquamation on wife’s sacral region Moist desquamation on wife’s sacral region 18 March 1999 18 March 1999

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Lymphocyte Kinetics Lymphocyte Kinetics

2100

Absolute Absolute

1500 1800 2100 900 1200 1500 300 600 900

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300 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90

D P t D P t

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Days Postexposure Days Postexposure

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D+28 19 March 1999 Ulcerative lesion 2cm deep D+28 19 March 1999 Ulcerative lesion 2cm deep -

• continues to

continues to expand. expand. D+32 Increasingly painful. Morphine infusion started. Radiation D+32 Increasingly painful. Morphine infusion started. Radiation-

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induced sciatic neuropathy. induced sciatic neuropathy. D+39 First febrile episode. D+39 First febrile episode.

Goiania, Brazil

137Cs Accident September 13, 1987

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Cesium Cesium-

• 137

137

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Skin lesion initially diagnosed incorrectly

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Individual Monitoring Individual Monitoring

112,000 people were screened 249 contaminated people: 120 people had their clothes and shoes contaminated; 129 people had external and internal contamination

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How Much Intake and How Much Intake and What Is the Dose (CEDE)? What Is the Dose (CEDE)?

Step 1) Estimate the Intake Using Intake Retention Fractions.

Whole Body Retention: Cs-137

At 190 days

• e
• dy

ete t o Cs 3

5.00E-01 6.00E-01 ng

At 190 days about 18% of Cs-137 remains in

2.00E-01 3.00E-01 4.00E-01 action Remainin

remains in whole body.

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0.00E+00 1.00E-01 2.00E 01 50 100 150 200 250 300 350 400 Fra

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50 100 150 200 250 300 350 400 Days Post Inhalation

Assume Measured 1.48 MBq Assume Measured 1.48 MBq [40 uCi] of Cs [40 uCi] of Cs-

• 137 at 190 Days

137 at 190 Days Intake (Inhalation) = 1.48 MBq/0.18 = 8.2 MBq [40 uCi/0.18 = 222 uCi ] Step 2) Compare to Annual Limit on Intake (ALI). ALI = 7 4 MBq [200 uCi ] for Cs-137 ALI 7.4 MBq [200 uCi ] for Cs 137 (Gives 0.05 Sv [5 rem ] CEDE)

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So individual has 110% of ALI and Dose of 0.55 Sv [5.5 rem].

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[ ]

Initial Internal Initial Internal Contamination Measurements Contamination Measurements

Range Bq Range μCi/mCi

• No. of Persons

Bq μCi/mCi 104-105 0.27 - 2.7 μCi 11 μ 105-106 2.7 – 27 μCi 15 106-107 27 – 270 μCi 23 107-108 270 μCi – 2.7 mCi 20 108-109 2.7 – 27 mCi 7

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1010 27 mCi 1 Total 67

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Results of Initial Cytogenetic Dosimetriy Results of Initial Cytogenetic Dosimetriy

Range [Sv]

• No. of Persons

Relative Frequency [%]

0 – 0 5 43 61 43 0.5 43 61.43 0.5 – 1.0 8 11.43 1.0 – 2.0 6 8.57 2.0 – 3.0 5 7.14 3.0 – 4.0 4 0 – 5 0 3 4 29 4.0 5.0 3 4.29 5.0 – 6.0 3 4.29 6.0 – 7.0 2 2.58

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Total 70 100.00

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Goiania Data Goiania Data

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Acute Clinical Outcomes Acute Clinical Outcomes Individual

Radiological Information (approximate) MF1 5 7 Gy (died) MF1 5.7 Gy (died) DF 7 Gy (lived) Possibly spent more time outside (fractionated) MA1 10 MBq (270 μCi) intake, 4.3 Gy external (cytogenetics) IS 4.5 Gy (died) Probable very acute dose. AS 5.3 Gy (died) Probable very acute dose. LF2 1GB (27 Ci) i t k 6 G t l (di d) LF2 1GBq (27 mCi) intake, 6 Gy external (died) GS 100 MBq (2.7 mCi) intake, 3 Gy, significant burn on shoulder

• Dr. PM

1.3 Gy, negligible intake (left source in bag)

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y g g ( g)

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QUESTIONS? QUESTIONS?

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and nd Terrorism Terrorism

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Preparedness Preparedness

Preparedness and readiness We all know what we mean when we say it, but How do you evaluate it? How prepared is prepared enough? How do prioritize your resources?

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Response Is Part of the Strategy

“The United States must be prepared to respond to the use of WMD against our citizens, our military forces, and those of friends and

• allies. We will develop and maintain the capability to reduce to the

extent possible the potentially horrific consequences of WMD attacks at home and abroad.”

• National Strategy to Combat Weapons of Mass Destruction

(2002)

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RAD/NUC Terrorism RAD/NUC Terrorism

RADIOLOGIC SOURCES (More Likely)

• Nuclear Reactors
• Radiation Devices (From

Industry/Medicine/Research) Industry/Medicine/Research) − Explosive (Dirty-Bomb) or Non-Explosive

NUCLEAR DEVICES (Less Likely)

Improvised Nuclear Device (IND)

• Improvised Nuclear Device (IND)
• Nuclear Weapon

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Potential for Nuclear Attack Potential for Nuclear Attack

“Today, it would be easy for adversaries to introduce and detonate a nuclear explosive clandestinely in the United States.” “It is a central thesis of this report that

clandestine nuclear attack and defense against it should be treated as an emerging aspect of strategic warfare and that it should warrant national and DoD attention warrant national and DoD attention that is as serious as that devoted to missile defense.”

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The worst assumption we can make is that the p enemy is too dumb to use his best option against us, d th f t t f it and therefore to not prepare for it.

LGEN Von Ryper, USMC Commander, USMC Combat Dev Ctr, on asymmetric warfare, 1998

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“AL QAEDA ‘ HAS THE RIGHT TO KILL 4 MILLION AL QAEDA …HAS THE RIGHT TO KILL 4 MILLION AMERICANS, 2 MILLION OF THEM CHILDREN,’ IN RETALIATION FOR THE DEATHS…THE UNITED STATES AND ISRAEL HAVE INFLICTED ON STATES AND ISRAEL HAVE INFLICTED ON MUSLIMS”.

Ref: Al Qaeda spokesman Sulaiman Abu Ghaith, 2002, per “Securing the Bomb,” Nuclear Threat Initiative, May 2004.

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Major Radiation Accidents Worldwide 1944 - December 2004

Radiation Devices 316

Sealed Sources 208 X-ray Devices 82 Accelerators 25 Radar Generators 1

Radioisotopes 92 Radioisotopes 92

Diagnosis and Therapy 38 Transuranics 28 Fission Products 11 Tritium 2 Radium Spills 1 Other 12

C iti liti 19 Criticalities 19

Critical Assemblies 7 Reactors 6 Chemical Operations 6

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p

Total 427 Source: REAC/TS Registries

Nuclear Weapons Stockpiles

Jan 2005 Estimate by GlobalSecurity.org

Country Available Deliverable U it d St t 10 640 6 390 United States 10,640 6,390 Russia 16,000 3,242 China 400? ~325 China 400? ~325 France 350 350 Israel 200 200 Israel 200 200 United Kingdom 200 200 India 110-150 110 Pakistan 75 75

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North Korea 13? 13?

AFFRI

Lost Nuclear Material

• March 1998: 11 Cs-137 brachytherapy rods totaling 22 GBq stolen

from Greensboro, NC hospital – never recovered from Greensboro, NC hospital never recovered

• 30 thousand lost sources in the US alone
• Over 2M rad sources reported lost worldwide
• Several hundred thousand considered threat
• Several hundred thousand considered threat

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Seizures of Radioactive Material

Date of Seizure Location Material Description 11/14/2002 Tanzania Uranium 09/20/2002 Ukraine Strontium-90 (1 Source) 06/10/2002 Russia Uranium (2kg) 06/10/2002 Russia Uranium (2kg) 05/30/2002 Lithuania Cesium-137 (1kg) 05/15/2002 Bulgaria Plutonium-239 & AmBe 05/01/2002 B l C i 137 (6 S ) 05/01/2002 Belarus Cesium-137 (6 Sources) 04/07/2002 Chechnya Cesium-137 (10 Sources) 04/05/2002 Uganda Cobalt-60 (1 Source) 03/25/2002 Tajikistan Uranium (639 gm) 03/25/2002 Afghanistan Cobalt-60

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• March 15, 2004:

Oakridge, TN, (AP)--Claiming g , , ( ) g

• ne victory in the fight against

weapons of mass destruction, U.S. officials on Monday displayed a few examples of p y p tons of nuclear weapons gear retrieved from Libya.

• Included high speed centrifuges
• Included high-speed centrifuges

to separate weapons fuel from uranium hexafluoride gas.

• Pakistan scientist sold

equipment to Libya, North Korea and Iran.

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FOUO UNCLASSIFIED

A “Dirty Bomb” A Radiological Dispersion Device (RDD) which A Radiological Dispersion Device (RDD) which combines a conventional explosive with radioactive material

• Not a Nuclear Weapon
• Not a Nuclear Weapon
• Not a Weapon of Mass Destruction, rather

A Weapon of Mass Disruption or Dislocation

• Impact depends on type of explosive, amount and

type of radioactive material and weather conditions type of radioactive material, and weather conditions

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Radiological Dispersal Device

A crude device that spreads radioactive material, aka, “dirty bomb” The diluted spread material does NOT generally present a radiation hazard to anyone. Purpose of an RDD:

• Psychological Impact-Terrorize

y g p

• Denies access to an area
• Presents a massive cleanup problem

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Composite RDD

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Credit: AFRRI

RDD Considerations

Physical form Physical form

Solid metal (cobalt-60) Powder (cesium chloride) Liquid (technicium-99m) Gas (krypton-85)

Delivery system Delivery system

Explosion Aerosol Deliberate placement

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Sources of RDD Materials

• Medicine (nuclear medicine, teletherapy, brachytherapy)
• Industry (gamma radiography, well-logging, sterilization, food

preservation radiothermal generators)

• Commercial products (smoke detectors, luminescent dials)
• Radioactive waste

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Aerosol RDD

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Hypothetical RDD attack

Mixture is spread in line at an amusement park.

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Chronology of Potential RDD Use

• Moscow, Russia (Nov 1995): Chechen rebels plant radioactive

source in public park

• Argun, Chechnya (Dec 1998): RDD found near a railway line

K d l k h R i (J 2001) t l l d l

• Kandalaksha, Russia (Jun 2001): two people plunder a nuclear

powered lighthouse

• Moscow Russia (Nov 2002): small amounts of weapons-grade

Moscow, Russia (Nov 2002): small amounts of weapons grade nuclear materials missing

• Herat, Afghanistan (Jan 2003): evidence that Al Qaeda

t t d RDD constructed an RDD

http://www.pbs.org/wgbh/nova/dirtybomb/chrono.html

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9/11 Type Attack on a Nuclear Facility

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EPRI/NEI Aircraft Impact Study, 2002

CHERNOBYL 1986 Nuclear Reactor

• 70% contamination fell on

Nuclear Reactor Accident

• 70% contamination fell on

26% of Belarus

• Est. 114 million Curies

entered environment entered environment

• 50,000 Km2 restricted

removed from use

• 400,000 evacuated

137Cs, 134Cs, 90Sr, 131I 239Pu

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131I, 239Pu

Chernobyl CS-137 Fallout Pattern Chernobyl CS-137 Fallout Pattern

Contaminated: > 1 Ci/m2 (37 kBq/m2) w/Cs-137

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Photos: DOE, National Archives [Chernobyl Forum Report, 2003 – 2005, 2nd Rev, IAEA]

( ) Strict radiation control: > 15 Ci/m2 (555 kBq/m2) w/Cs-137

Impact of a Dirty Bomb

• Most serious injuries from the explosion
• Unlikely radioactive material would kill
• Radioactive material dispersed

Radioactive material dispersed

• Significant psychological impact
• Cleanup costly and will take weeks to months to complete

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Goiania, Brazil 1987

• 1375 curie Cesium-137 spread throughout a

neighborhood neighborhood

• External and internal exposure hazards
• Four victims died within four weeks
• Twenty victims hospitalized
• 249 people had detectable external and/or internal contamination
• 112,000 screened (500 screened for each victim)

, ( )

• Site remediation took months to complete

(October 1987-March 1988)

• An accident

what if a terrorist event!

• An accident – what if a terrorist event!

Ref: IAEA-TECDOC-1009, 1998.

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Perceptions Shaped by the Cold War

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The Best Laid Plans … Preparedness is more than is more than having a plan.

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Challenges to Medical Response

Magnitude

• Psychological impact of nuclear weapon use
• Casualties larger than planned for
• Local transportation unusable
• Comms disrupted/overwhelmed
• Mass panic & flight
• Medical systems overwhelmed
• Responders limited by radiation

Lack of Timely, Accurate, Needed Info

• Medical systems overwhelmed
• Responders limited by radiation
• Weapon size unknown
• Fallout pattern unknown

C di ti Ch ll

Weapon size unknown Fallout pattern unknown

• Weapon location unknown
• Number of casualties unknown
• Nature of attack unknown
• Initial positioning of

responders delayed

Coordination Challenges

• Lack of initial info may stall response
• Public info campaign
• No Federal/State/Local plans for NW terrorism
• Long-term effects

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• Federal/State conflict over resources

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HIROSHIMA AFTER HIROSHIMA AFTER HIROSHIMA AFTER HIROSHIMA AFTER

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HIROSHIMA AFTER HIROSHIMA AFTER HIROSHIMA AFTER HIROSHIMA AFTER

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HIROSHIMA AFTER HIROSHIMA AFTER HIROSHIMA AFTER HIROSHIMA AFTER

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National Planning Scenario #1; Low Yield Nuclear Detonation

Many Prompt Casualties come from blast and thermal effects

Blast overpressure

b ast a d t e a e ects Fallout Casualties are from Radiation

PROMPT EFFECTS PROMPT EFFECTS PROMPT EFFECTS PROMPT EFFECTS FALLOUT EFFECTS FALLOUT EFFECTS

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Burns Ionizing radiation

Heavy Building Effects

? ? ? ? X X X ? ? ? ? ? ? ? ? ? ? X X X X X X X X X X X X ? ? ? ? ? ? ? ? ?

Fireball X

X X X X X X X X X X X X X X ? X ? ? ? ?? ? ? ?

Fireball

220m in Diameter X

X X X X X X X X X X ? ? ? ? ? ? X X X X X ? X

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? ? X X X ? ? 50% 10%

Blast Effects; Buildings & People

Low Survival of Heavy Buildings w ithin area Buildings w ithin area Overpressure lung injury & fatalities from impact

>10psi 678m

Brick House 5 psi

Low Survival of Light Buildings w ithin area Eardrum ruptures and

~ 5 psi

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p possible incapacitation

>5psi 1km ~250k people (day)

Radiation and Thermal Effects Unprotected Population (Clear Day & Line of Sight) Unprotected Population (Clear Day & Line of Sight)

3 o Burns LD-50

1.5km ~360,000 people

Graphic: AFRRI

1.5km 360,000 people

2 o Burns

1 9km

100 G

1.9km

1 o Burns

200 G LD 10 100cGy Injury-10

1.6km 2.5km

200cGy LD-10

1.5km

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300cGy LD-50

1.4km 300,000 people

1 cGy = 1 rad 1 cGy = 1 rad

Long Range Prompt Effects

Flash Blindness Flash Blindness 7km to 12 km 7km to 12 km EMP: Service disruptions EMP: Service disruptions & Equipment Damage & Equipment Damage

Graphic: AFRRI 69

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Missile Injury Threshold Missile Injury Threshold

0.6psi 4.5km ~750k people 0.6psi 4.5km ~750k people

EMP: Temporary disruptions EMP: Temporary disruptions

Combined Effects

Typical Overpressure Damage

Nighttime shot, the only psi Damage

1

Windows shattered

2

Aluminum panels ripped off

light is from the blast

2 3

Wall of 12-inch concrete shattered; parked aircraft destroyed

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Brick houses destroyed; trucks

• verturned; telephone poles collapsed

E d R t

Thermal pulse ignites paint and wood

Eardrum Rupture

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Lung Damage

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LD50

wood Pressure wave destroys house

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1km from ~16kT yields (~ 6 psi)

Prompt Effects Summary

Prompt casualties (injuries + fatalities) include blast and burns, not just radiation exposure

• “… missile injuries will predominate. About half of the patients seen will

have wounds of their extremities. The thorax, abdomen, and head will be involved about equally.”*

Literature and models predict: Literature and models predict:

• 100,000s casualties can occur from the prompt effects in the first few

minutes within a few miles of detonation site, O f f

• Overall number of casualties likely to be reduced by protection from the

urban landscape and being within heavy buildings, however

• Tertiary effects (building collapse, glass and debris missiles, and flash-

blindness accidents) may increase number of casualties blindness accidents) may increase number of casualties.

Those outdoors within a few miles can be temporarily blinded Dust and debris from air blast will cloud the air.

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*NATO, 1996, NATO Handbook on the Medical Aspects of NBC Defensive Operations (Part I - Nuclear).

Departments of the Army, Navy, and Air Force: Washington, D.C.

Fallout Fallout

The nuclear detonation creates a large cloud of radioactive dust and water vapor which fall back to earth contaminating dust and water vapor which fall back to earth contaminating horizontal surfaces. Dangerous levels of fallout creates visible dust and debris. Dangerous levels of fallout creates visible dust and debris. These particles give off penetrating radiation that can injure people (even in cars or inadequate shelter) Fallout decays rapidly away with time, and is most dangerous in the first few hours after the detonation

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Prompt Effects + 2 Hour Integrated Outdoor Exposure Prompt Effects + 2 Hour Integrated Outdoor Exposure

• Most potential acute injuries

confined to within 15km

Effects or contamination using weather from May 23, 2005 Injury threshold (100 cGy) defined as 5-30% chance of Acute Symptoms (nausea and vomiting within 4 hours) ~ NCRP Commentary #19, 2005

• Prompt and fallout areas not

congruent

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100cGy in 2 hours Boundary 100cGy in 2 hours Boundary

Outdoor Injury Threshold Outdoor Injury Threshold 15km long, ~ 15km long, ~ 300,000 300,000 people in area people in area

Shattered Window Threshold Shattered Window Threshold

Many behind windows injured Many behind windows injured 4.5km ~ 4.5km ~750,000 750,000 people in area people in area

Downwind Dose Rate @ 15 Minutes

Fallout Effects

Dose Rate Dose Rate 100 cGy/hr 10 cGy/hr 1 cGy/hr y .1 cGy/hr

1,500 cGy/hr

~ 8 minutes until fatality h h ld h d

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threshold at that dose rate

1 cGy = 1 rad (deep dose) 1 cGy = 1 rad (deep dose) Fatality threshold (2 Gy) defined as 5% chance of acute death from radiation w ithout medical treatment (NCRP Commentary #19, 2005)

Downwind Dose Rate @ 2 hours

Fallout Effects

Dose Rate Dose Rate 100 cGy/hr 10 cGy/hr 10 cGy/hr 1 cGy/hr 1 cGy/hr .1 cGy/hr

180 cGy/hr

~ 1 hour until fatality threshold at that dose rate

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threshold at that dose rate

1 cGy = 1 rad (deep dose) 1 cGy = 1 rad (deep dose) Fatality threshold (2 Gy) defined as 5% chance of acute death from radiation w ithout medical treatment (NCRP Commentary #19, 2005)

Downwind Dose Rate @ 48 hours

Fallout Effects

Dose Rate Dose Rate 100 cGy/hr

(Not Present)

10 cGy/hr 1 cGy/hr

7 G /h

.1 cGy/hr

7 cGy/hr

~ 1 day until fatality threshold at that dose rate

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threshold at that dose rate

1 cGy = 1 rad (deep dose) 1 cGy = 1 rad (deep dose) Fatality threshold (2 Gy) defined as 5% chance of acute death from radiation w ithout medical treatment (NCRP Commentary #19, 2005)

2 Hour Integrated Outdoor Exposure

(rem = cGy) Extent Area 300 G

Flash Blindness Flash Blindness 7km to 12 km 7km to 12 km

>300 cGy 7.6km 8.8 km2 >200 cGy 10.0km 13.3 km2 >100 cGy 14.8km 25.1 km2 >50 cGy >50 cGy 20.3km 44.1 km2 >25 cGy 26.6km 73 9 k 2 73.9 km2

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Missile Injury Threshold Missile Injury Threshold

4.5km ~750k people in area 4.5km ~750k people in area

2 Hour Integrated Outdoor Exposure

(rem = cGy) Extent Area

300 G

(cGy = rem) Extent Area

>1 000

G

Graphic: AFRRI

>300 cGy

7.6km 8.8 km2

>200 cGy

10.0km

>1,000 cGy

2.5km 2.0 km2

>800 cGy

3.2km 0 0 13.3 km2

>100 cGy

14.8km 25.1 km2 2.6 km2

>600 cGy

4.3km 3.7 km2

>50 cGy

20.3km 44.1 km2

>25 cGy

26 6km

>500 cGy

5.1km 4.7 km2

>400 cGy

6 3km 26.6km 73.9 km2 6.3km 6.2 km2

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4 Day Integrated Outdoor Exposure Long range, non-acute 4-day dose boundaries

25 cGy (30 min arrival)

~50km

5 cGy (1 hr arrival)

~100km

1 cGy (2 hr arrival)

~200km ~1,000,000 people

Large population and short arrival times make evacuation difficult

Protective Action Guideline threshold for shelter or evacuation

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Large population and short arrival times make evacuation difficult Model uncertainties and “shadow evacuation” likely to greatly increase effected population

Fallout Effects Summary

The fallout cloud could climb 8km (5 miles) high and will be carried by upper atmosphere winds (often at high speeds) by upper atmosphere winds (often at high speeds) 100,000s of acute casualties from radioactive fallout can occur within 15km (9 miles) downwind of the GZ The number of fallout casualties can be reduced by action (shelter / evacuation) Radiation levels decay rapidly with time Radiation levels decay rapidly with time In the first few days, the primary health hazard is external gamma radiation from fallout on horizontal surfaces. Breathing in fallout d st is a minor concern dust is a minor concern Radiation has a delayed effect. Although radiation sickness may

• ccur within a few hours, victims of lethal radiation may not

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succumb for days or weeks

Federal response is complicated

• The Nuc/Rad Incident Annex of the National Response Plan has:
• 6 different coordinating agencies

g g

• 17 cooperating agencies
• Shifting agency roles and responsibilities depending on the type of

event the source involved and where it happens event, the source involved, and where it happens

• No 1-800-RAD-HELP

Developed for nuclear power plant accidents, the Federal Response is cumbersome and not well structured for RDD/IND response

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Lack of Scientific Consensus on Appropriate Actions

• Conflicting advice on basic

issues such as shelter or evacuate?

• Many Cold War Civil Defense

assumptions are invalid for assumptions are invalid for nuclear terrorism.

• Updated analysis and planning

“Take cover immediately, as far below ground as possible..”

p y p g low yield nuclear detonations in modern cities is required.

“Avoid radioactive possible.. ~ Ready.gov (DHS)1 fallout: evacuate the fallout zone quickly..” ~RAND2

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1US Department of Homeland Security, http://www.ready.gov/america/beinformed/nuclear.html 2Individual Preparedness Response to Chemical, Radiological, Nuclear, and Biological Terrorist Attacks: A Quick Guide

Lynn E. Davis, Tom LaTourrette, David E. Mosher, Lois M. Davis, David R. Howell 30 pp. • 2003 • ISBN: 0-8330-3487-1

IND Preparedness IS All Hazards Preparedness

Crisis Communication Time Critical Decision Making Time Critical Decision Making Mass Casualty / Mass Care Resource Prioritization Breaks down jurisdictional/discipline barriers

“Because major events will undoubtedly have a Because major events will undoubtedly have a regional impact, there is no greater necessity than to collaborate on a regional basis to leverage expertise share specialized assets enhance expertise, share specialized assets, enhance capacity, and interoperate cohesively and effectively.”

D f H l d S i ’ N i l P d G id

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~Department of Homeland Security’s National Preparedness Guidance

Observations

• State and Local Communities:
• Few have a coordinated response plan for the aftermath nuclear

terrorism,

• There is a general lack of understanding of the response needs, and
• Uncertainty of the Federal State and local roles and responsibilities

Uncertainty of the Federal, State, and local roles and responsibilities

• Decisions made in the first few hours
• have the greatest public health and medical impact and
• are not likely to be technically informed (correct actions can be

counter-intuitive)

• There is a lack of scientific consensus on response strategies
• There is a lack of scientific consensus on response strategies

There is no “rule of thumb” that doesn’t negatively impact some population, but the scientific community needs to do better than saying “it depends ”

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but the scientific community needs to do better than saying it depends.

Recommendations

• The scientific community needs to be engaged to improve basic

understanding of a low yield nuclear detonation in a modern city, g y y including:

• Efficacy of shelter and evacuation strategies
• Type and distribution of injuries and public health infrastructure

E l ti f t t i

• Evaluation of response strategies
• Effects on critical infrastructure (e.g., communications & electricity)
• Federal Government needs to clearly define policies guidance
• Federal Government needs to clearly define policies, guidance,

and clarify what it will be doing after a nuclear detonation in the US.

• IND response strategies are community specific, and communities

need preparedness tools and support specific to their needs.

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Small improvements in understanding and response planning can reduce potential casualties by 100,000s.

Questions?

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National National Academies Academies 6/26/08 /26/08 0900 0900

National Planning Scenarios

“While much preparedness applies across the all-hazards spectrum, the National Strategy attaches special emphasis to preparing for catastrophic threats with “the greatest risk of mass casualties, massive property loss, and immense social disruption.” To address this mass casualties, massive property loss, and immense social disruption. To address this requirement, a Federal interagency working group developed National Planning Scenarios to illustrate the potential scope, magnitude, and complexity of a plausible range of major events, including terrorist attacks, major disasters, and other emergencies.” I t i N ti l P d G l (2005) ~Interim National Preparedness Goal (2005)

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Rad/Nuc Response Responsibilities

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From the Nuclear/Radiological Incident Annex of the NRP

DHS/S&T’s Radiological/Nuclear Response and Recovery R&D program- RDD Response Needs and Resources

“Top 5” needs identified by responders:

• Develop and endorse consistent response

recommendations

• Undertake a process to benchmark best practices

and identify gaps for RDD Playbook and identify gaps for RDD Playbook

• Undertake a process to benchmark best practices

and identify gaps on the policies and procedures for operational guidance/protocols on sheltering versus evacuation versus evacuation

• Undertake a process to benchmark best practices

and identify gaps on policies and procedures for medical emergency response and receipt of ti t patients

• Disseminate comprehensive RDD communication

packets to local, state, and federal agencies

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Standards Development

• National Council on Radiation Protection

and Measurements

• Commentary #19: Key Elements Of

Preparing Emergency Responders for Nuclear and Radiological Terrorism. Radiological Terrorism.

• Report (in progress): Key Decision Points and

Information Needed by Decision Makers in the Aftermath of a Nuclear or Radiological Terrorism Incident.

• American National Standard for

Performance Criteria for Personal Emergency RadiationDetectors (PERDs) for E C t l

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Exposure Control (ANSI N42.49 – in progress)

National Laboratory expertise applied to IND response strategy

Ground Level detonation 300m detonation

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Recognition of Issue and a Path Forward

NUCLEAR PREPAREDNESS The conferees are concerned that cities have little guidance The conferees are concerned that cities have little guidance available to them to better prepare their populations to react in the critical moments shortly after a nuclear event.

• Conference Report Public Law 110-28 (FY07 Supplemental).

National Laboratories support effort through:

• Development of realistic IND primary, secondary, and tertiary

effects to be used in response planning effects to be used in response planning.

• Consequence modeling Federal, State, and local response

planning.

• Support development of key response planning factors for an

IND.

• Technical support to Federal, State and local engagement,

b i fi t h i l t t h t l t i l d

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briefings, technical support, outreach to relevant regional and national organizations and professional societies.

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Discussion Points Discussion Points In Review In Review Radiological versus Nuclear Nuclear Weapons Proliferation Nuclear Detonation R di l i l Di l D i Radiological Dispersal Device Radiation Exposure Device Induced Criticality Induced Criticality Nuclear Material & Waste Nuclear Reactor Incidents Nuclear Reactor Incidents

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