Emergency Preparedness 14:
Nuclear Devices Portal
In the initial approach to patients who have experienced injuries from an explosion or blast, the health care provider team must remain cognizant of the potential risk that the victims may have become contaminated with nuclear radiation, either during an accident in a nuclear material containing industry or by an act of terrorism.
Nuclear terrorism can cause the release of radiation on the general public in several ways. These include:
Dispersal of Radioactive Materials Without an Explosive Device. This may occur from the distribution of stolen radioactive materials such as from a hospital radiotherapy department. This radioactive material can then be delivered by covert exposure of people in crowded places, such as by placing a high gamma source (eg, cobalt) in a busy shopping center, or by the dispersion of plutonium through a building’s ventilation system.
Use of a Radiological Dispersal Device – ie, the spreading of radioactive materials with a conventional explosive device (called a dirty bomb). An example of this is detonation in a busy public building of a regular explosive device contaminated with radioactive materials. This explosion would cause both physical destruction and injury along with radioactive contamination of the victims as well as potentially the rescuers. The radiation exposure in a case like this may not initially be apparent to health care providers or rescuers.
Nuclear Power Plant Sabotage. This may occur either from an explosive attack on a nuclear reactor or sabotage of critical components of the nuclear reactor system resulting in a meltdown and disabling of the nuclear reactor’s cooling system.
Detonation of an Improvised Nuclear Device. Terrorists may construct a homemade nuclear bomb or improvised nuclear device and detonate it in a highly populated area (often referred to as a suitcase bomb).
Detonation of a Commercially Manufactured Nuclear Weapon. Terrorists may pirate or purchase a nuclear weapon from one of the countries in the world making nuclear bombs. This could then be detonated causing a great deal of destruction and extensive radioactive contamination.
Intentional Use of Nuclear Weapons. One of the nuclear powers of the world may elect to intentionally detonate a nuclear bomb for political reasons. At the time of detonation of a nuclear bomb, atoms are split or joined (fission or fusion) to produce an intense wave of heat, light, pressure, and radiation. This creates a large fireball that vaporizes everything, including water and soil. The vaporized materials are carried upward, creating the characteristic mushroom cloud. The radioactive material formed by the nuclear explosion mixes with the vaporized material created by the fireball. As this vaporized material, radioactively contaminated from the nuclear blast, cools, it condenses and forms into small particles that fall back to the earth as dust or fallout. This fallout can be carried for hundreds of miles by air currents and cause contamination of persons, water supplies, and food at great distances away from the original blast.1
Nuclear Accident. In addition to the risk of nuclear terrorism, nuclear accidents do occur. Examples2 include: (1) Goiania, Brazil in 1987 where cesium left in an abandoned clinic caused the contamination of 249 persons, of whom 20 required hospitalization, 14 demonstrated bone marrow depression, and 4 died from hemorrhage and/or sepsis. (2) Chernobyl, U.S.S.R. in 1986 where a nuclear reactor accident killed 2 initially by explosion. In addition, 237 needed hospitalization, and 134 developed acute radiation syndrome (ARS). An additional 28 died within 3 months.
Radiation damages occur at the cellular level. By affecting the DNA of rapidly dividing cells, radiation gives rise to syndromes especially involving the skin, the bone marrow, and the gastrointestinal (GI) tract. The timing of the onset of symptoms, morbidity, and mortality are all dose dependent. (The larger the dose, the faster the onset of symptoms, and the greater the morbidity and mortality.) (Vol III—EMP15 Acute Radiation Syndrome)
Health care facility response to a radiation incident includes:
High index of suspicion for radiation exposure when large, unexplained explosions occur.
High index of suspicion for covert or silent radiation exposure when many patients demonstrate unexplained severe nausea and vomiting or other symptoms suggestive of ARS.
Appropriate protocols in place (triage, treatment, transfer, radiation monitoring).
A radiation safety officer available to evaluate and monitor patients and staff.
Identification of areas appropriate for proper decontamination and isolation.
Radiation casualties are triaged by their total illnesses and/or injury pattern(s). Patients in acute distress with or without radiation are triaged ahead of stable radiation victims.
Initial care of patients exposed to radiation takes contamination with radioactive material into account. Contaminated patients have radioactive material on and/or in their bodies and continue to accumulate radiation injury. They are a potential source of radiation to those around them. They need special handling, monitoring, decontamination (external and/or internal), and therapy:
Medically unstable contaminated patients are stabilized before complete decontamination takes place, although removing clothing and covering their hair helps considerably.
External decontamination: Remove clothing and wash patient with soap and water until radioactivity cannot be detected. Decontaminate wounds first and protect patients from further contamination while completing the task. Safely dispose of clothing and wastewater.
Internal decontamination: Admit to an isolation room with safe collection and disposal of bodily fluids and secretions. Special therapeutic agents such as Prussian blue or diethylenetriamine pentaactic acid might be needed to limit uptake and/or facilitate removal of radioactive material.
Uncontaminated but irradiated patients require no decontamination and pose no threat of contamination to others, as they are not radioactive. Treatment is directed toward whatever problems they have and/or might develop from the dose of radiation they have received.
Keep current information and resources for the medical treatment of radiation injuries on site in case communications are disrupted.
Help for radiation incident preparedness and acute incident management is available. (Vol III—EMP20 Additional References and Resources)
Reference
- Frequently Asked Questions About a Nuclear Blast. Available at: www.bt.cdc.gov/radiation/nuclearfaq.asp. Accessed: August 14, 2004.