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Medical Response to Nuclear and Radiological Events. Cham Dallas, PhD Director CDC Center for Mass Destruction Defense. Overview. Nuclear scenario effects Radiation injury Acute radiation syndrome Mass burn casualties External contamination Internal contamination

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Medical Response to Nuclear and Radiological Events

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Medical Response to Nuclear and Radiological Events

Cham Dallas, PhD

DirectorCDC Center for Mass Destruction Defense


  • 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









AFRRI, Medical Effects of Nuclear Weapons, “Blast and ThermalEffects” Lecture, 1990.

Nuclear Weapon Detonation Results: 1

Nuclear Weapon Detonation Results: 2

Nuclear Weapon Detonation Results: 3

White House


Lincoln Memorial

The Mall

Washington Monument



Scenario: Washington Mall

Effective Range for Blast Energy

AFRRI, Medical Effects of Nuclear Weapons, “Blast and Thermal Effects” Lecture, 1990.

Effective Range for Thermal Energy 1 kT Weapon

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






Fatality Possible (w/meander)


Prob Population

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 Brown80%

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 health.

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 radioactivity

  • 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 surface

  • 40% of total radioactivity

  • Much lower degree of risk relative to early fallout

Bikini Atoll (1 March 1954)

Radioactive Contamination

  • 15 mT thermonuclear 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 photons





1 m concrete









Radiation Exposure Types






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

    • Type II alveolar cell

  • Effect is dose-rate related

  • Pneumonitis

  • Fibrosis

Healthy lung


Radiation Skin Injury

  • 0.75 GyHair follicles change

  • 3 Gy Epilation

  • 6 Gy Erythema

  • 10 Gy Dry desquamation

  • 20 Gy Wet desquamation (transepithelial injury)


Radiation Burns

Causes of Burn Deaths

Distribution of Injuries in aNuclear Detonation

Single injuries


Combined injuries


Wounds +


Wounds +






Burns +

Wounds +



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.

Absolute lymphocyte count over 48 hours

Confirms significant radiation exposure

Andrews Lymphocyte Nomogram

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

ExpectantExpectant 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

…is for good men and women to do nothing.

All that is necessary for the triumph of evil…

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