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Radiologic Events:. Attack on a Nuclear Power Plant. Objectives. Recognize the potential consequences of a terrorist attack on a nuclear power plant Describe the different types of radiation particles and waves and their effect on the body. Objectives.

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radiologic events

Radiologic Events:

Attack on a Nuclear Power Plant

  • Recognize the potential consequences of a terrorist attack on a nuclear power plant
  • Describe the different types of radiation particles and waves and their effect on the body
  • Differentiate between radiation exposure and contamination
  • Recognize the characteristic signs and symptoms of acute radiation syndrome
  • Learn to perform rapid assessment of nuclear/radiation events in a disaster situation
  • Learn specific antidotes and medical interventions for nuclear/radiation terrorism victims
  • Learn specific pre-hospital and hospital management strategies including proper notification of radiation disasters
  • Terrorists attack a nuclear power plant 30 miles outside a major metropolitan area by flying a high jacked jet liner into the plant.
  • The impact results in an explosion and fire.
  • Fire fighters and paramedics are called to the scene.
  • There are multiple casualties and several trauma victims are being transported to your health care facility.
  • The news media is questioning your health team regarding radiation exposure risks
attacks on reactors
Attacks on Reactors
  • Radioisotopes released
    • Large quantities of radioiodines and radiocesiums
    • A large variety of other radioisotopes may be released in smaller quantities
attacks on reactors9
Attacks on Reactors
  • Which way is the wind blowing?
    • The radioactive cloud from the burning reactor will travel according to wind direction.
attacks on reactors10
Attacks on Reactors
  • Prevention
    • Individuals in the path of the radioactive cloud need to be evacuated
electromagnetic radiation
Electromagnetic Radiation
  • Electromagnetic radiation includes a wide spectrum of radiation energy characterized by frequency and wave length.
  • Ionizing radiation has high frequency and short wave length
ionizing radiation
Ionizing Radiation
  • Ionizing radiation includes both electromagnetic (X and gamma rays) and particulate radiation
  • Alpha
  • Beta
  • Neutrons
alpha particles




Alpha Particles
  • A helium nucleus
  • Unable to penetrate skin
  • Emitted from radioisotopes

such a plutonium, uranium

beta particles
Beta Particles
  • Able to penetrate skin
  • Negatively charged
  • Can produce skin superficial burns
  • Emitted by several radioisotopes (e.g. Cobalt 160)
neutron particles
Neutron particles
  • Uncharged
  • Able to penetrate deeply
  • Hazard inside nuclear reactors
penetration abilities of different types of radiation
Penetration Abilities of Different Types of Radiation

Alpha Particles

Stopped by a sheet of paper

Beta Particles

Stopped by a layer of clothing

or less than an inch of a substance (e.g. plastic)



Gamma Rays

Stopped by inches to feet of concrete

or less than an inch of lead


Stopped by a few feet of concrete

x rays and gamma rays
X-Rays and Gamma Rays
  • Gamma and X radiation differ

by source: gamma rays comes

from the nucleus and X-rays

come from the electron orbits

  • Because they don’t have mass

or charge, they penetrate

very deeply

detecting radiation
Detecting Radiation


But, it can be easily measured

if you have the right equipment


Radiation Detectors

Alpha Survey Meter

Beta and Gamma Survey Meter

  • Contact with radioactive material (radionuclides) that can be spread to other people / properties
  • Inhaled, ingested, transferred from surface to surface

Exposure vs. Contamination

External Exposure: external irradiation of the body with rays or particles  absorbed dose

Contamination: radioactive material (radionuclides) on patient (external) or within patient (internal).


If the patient is

externally contaminated

with radionuclides,

you can



If radionuclides have

gotten inside the body,

consider chelation


injuries associated with radiological incidents
Injuries Associated with Radiological Incidents
  • Acute Radiation Syndrome (ARS)
  • Localized radiation injuries/cutaneous radiation syndrome
  • Internal or external contamination
  • Combined radiation injuries with

- Trauma

- Burns

  • Fetal effects
phases of acute radiation syndrome









Time (days to years)

Phases of Acute Radiation Syndrome

stages of acute radiation syndrome
Stages of Acute Radiation Syndrome

Stage 1:(50-150 rads)

  • No symptoms or minimal viral symptoms for up to 48 hours
  • Spontaneous recovery usually occurs
  • Sterility is a risk
stages of acute radiation syndrome34
Stages of Acute Radiation Syndrome

Stage 2: The Hematopoetic Syndrome (150- 400 rads)

  • Whole body exposure
  • Bone marrow suppression occurs with

loss of WBC and platelets

  • Infection and bleeding problems occur
  • LD 50 250-400 rads
stages of acute radiation syndrome35
Stages of Acute Radiation Syndrome

Stage 3: Severe Hematopoetic Syndrome

(150-400 rads)

  • Life saving bone marrow transplantation needed
  • Care rationing during MCI will lower LD50
absolute lymphocyte count
Absolute Lymphocyte Count
  • Measure every 4 - 6 hours initial 48 hours
  • Normal: approx 2500 cells/ml
  • > 1200: probably non-lethal
  • 300 to 1200 cells/ml: significant (hospitalize)
  • < 300 cells/ml: critical
andrews curve
1: 1 Gy

2: 4 Gy

3: 6 Gy

4: 7.1 Gy

Andrews Curve
stages of acute radiation syndrome38
Stages of Acute Radiation Syndrome

Stage 4: The Gastrointestinal Syndrome

(150-400 rads)

  • GI lining cells die
  • Severe diarrhea and electrolyte losses
  • Life saving fluid and electrolyte replacement
stages of acute radiation syndrome39
Stages of Acute Radiation Syndrome

Stage 5: The CNS Syndrome (>1500 rads)

  • Confusion, ataxia, and sensory deficits
  • Death within 48 hrs regardless of treatment
  • Early appearance of CNS symptoms is an ominous sign
pre hospital management
Pre-Hospital Management
  • Evacuation of persons who are in the path of a radiation cloud is the most effective pre-hospital measure – this action is the responsibility of public health authorities
  • Need effective communication with residents as to steps they can take to reduce exposure
patient management priorities
Patient Management - Priorities
  • Initial triage and decontamination are ideally done outside the hospital (have a plan in place) to avoid contamination of the ED
  • Patients exposed only to external EM radiation (e.g. x-ray or gamma rays) are not radioactive; patients exposed to particulate radiation will be radioactive
  • Standard medical triage is the highest priority
  • Radiation exposure and contamination are secondary considerations
patient management protocol
Patient Management - Protocol

Based on:

  • Injuries
  • Signs and symptoms
  • Patient history
  • Contamination survey
hospital management
Hospital Management
  • Security
  • Radiation Safety Officers/dosimeters, GM
  • 24-hour hotline (217) 785-0600
    • Radiation Duty Officer @ Illinois Department of Nuclear Safety
  • Waste disposal
    • Labeled, plastic bags
  • Contaminated patient – immediately isolated until monitored & decontaminated
    • Monitor EMS and ambulance
  • ABC’s
  • Cover all wounds
  • Radiation burns are like sun burns
external contamination
External Contamination
  • Radioactive material (usually in the form of dust particles) on the body surface and/or clothing
  • Radiation dose rate from contamination is usually low, but while it remains on the patient it will continue to expose the patient and staff
patient decontamination
Patient Decontamination
  • Remove and bag the patient’s clothing and personal belongings (this typically removes 80 - 90% of contamination)
  • Handle foreign objects with care until proven non-radioactive with survey meter
  • Survey patient and collect samples

- Survey face, hands and feet

- Survey rest of body


Protecting Staff from Contamination

  • Use standard precautions
  • Survey hands and clothing frequently
  • Replace contaminated gloves or clothing
  • Keep the work area free of contamination
decontamination of skin
Decontamination of Skin
  • Use multiple gentle efforts
  • Use soap & water
  • Cut hair if necessary (do not shave)
  • Promote sweating
  • Use survey meter
cease patient decontamination
Cease Patient Decontamination
  • When decontamination efforts produce no significant reduction in contamination
  • When the level of radiation of the contaminated area is less than twice background
  • Before intact skin becomes abraded

Consider internal contamination

decontamination of wounds
Decontamination of Wounds
  • Contaminated wounds:
    • Irrigate and gently scrub with surgical sponge
    • Debride surgically only as needed
  • Contaminated thermal burns:
    • Gently rinse
    • Changing dressings will remove additional contamination
radioiodines and thyroid cancer
Radioiodines and Thyroid Cancer

Radioiodines concentrate

In the thyroid gland and

can increase the risk of

thyroid cancer

you can reduce the radioiodine thyroid dose by giving potassium iodide
You can reduce the radioiodine thyroid dose by giving potassium iodide
  • Potassium Iodide (KI) considerations
    • Who should get KI?
    • Useful at the beginning of an exposure
    • Only protects against thyroid cancer
key points
Key Points
  • Ionizing radiation includes:
    • Electromagnetic radiation: X and gamma
    • Particulate radiation: alpha, beta, neutrons
key points57
Key Points
  • Patient can be:
    • Irradiated externally
    • Contaminated with radionuclides
  • Which patients are radioactive?
    • Those contaminated with radionuclides
    • These patients need to be decontaminated
    • Some internally deposited radionuclides can be removed with chelation therapy
key points58
Key Points
  • Protect yourself from radiation:
    • Reduce the time of exposure
    • Increase the distance from the radiation source
    • Apply shielding between yourself and the radiation source
key points59
Key Points
  • Acute Radiation Syndrome:
    • Stages progress from hematopoetic to gastrointestinal to central nervous system with increasing dose
    • The absolute lymphocyte count is the best predictor of dose
  • Long-term consequences
    • Increase in cancer, especially thyroid cancer
    • With radioiodine exposure, thyroid dose can be reduced by using KI
key points60
Key Points
  • Have a radiation disaster management plan in place for your hospital
  • Be prepared for psychological consequences


  • CDC Bioterrorism –
  • Radiation Emergency Assistance Center & Training Site (REAC/TS) -
  • Medical management of radiological casualties handbook -