RESPONSE
A handful of dust I
Frank G. Rando on assessing radiation during response to nuclear terrorism
n 1987, in Goiania, Brazil a radiotherapy source containing cesium-137 was stolen from an abandoned cancer treatment facility. Some 1,375 curies of the
radioisotope was removed from the radiotherapy device aſt er it was sold to a scrap metal dealer. This resulted in more than 112,800 individuals requiring radiological monitoring, of which 249 were found to be contami- nated; 129 both internally and exter- nally; 49 were hospitalized; 28 had local radiation injury; and 4 fatalities occurred due to acute radiation syndrome (ARS). The alleged assassi- nation of Russian dissident Alexander Litvinenko with the radioisotope polonium-210 also created a radiologi- cal emergency in London in November 2006. This event activated the British Health Protection Agency’s (HPA) emergency response plans and alerted medical professionals and public health authorities in the USA via the Health Advisory Network (HAN), as well as the rest of the international health and intelligence communities. According to the HPA, Litvinenko received a dose of approximately 3 gigabecquerals of radioactivity, the equivalent of roughly 100 lethal doses. These two incidents – one accidental and the other malevolent and inten- tional – continue to be used as models in terrorism scenarios for radiological emergency preparedness and conse- quence management, including for theſt , diversion and smuggling of weapons-grade isotopes and medical, commercial and industrial sources. To fully prepare for and respond to the consequences of any event
involving radioactivity, personnel need to have a working knowledge of basic radiation theory. In reality, ionizing radiation is the most exten- sively studied and well-understood environmental agent, and its biomedi- cal eff ects are well documented. The combined experiences of the Hiroshima and Nagasaki atomic bombings, Cold War biomedical studies of civilians, radiological accidents (Chernobyl 1986, Fukushima 2011), nuclear criticality accidents, transportation accidents, and extensive environmen- tal contamination created by military
“Give me a handful of dust, and
I will show you true fear.” T.S. Elliot
(referring to radioactive contamination)
based programmes in the former Soviet Union and USA, have led to the generation and analysis of scientifi c and biomedical data that have proven useful in emergency preparedness and consequence management for radiological-nuclear terrorism events. A radiological release is detectable and measurable by currently available instrumentation and units of measure- ment. Radiological hazards and exposures can be mitigated and drastically reduced by applying simple strategies.
“The dose maketh the poison” In assessing ionizing radiation, as with drugs and chemicals “the dose maketh the poison.” The potential health
eff ects of radiation are dose- dependent, and the dose received is dependent upon four variables: source of radiation, distance from the source, duration of exposure, and shielding. Responders are familiar with the protective strategy of time, distance and shielding. Identifying the radiological source is also vitally important to ascertain the extent and type of radiation being released. Three types of radiation exposure
can occur: external irradiation, contamination, or incorporation (internal deposition and uptake of radionuclides by cells, tissues, and target organs such as thyroid and bone). Generally, the toxicokinetics and toxicodynamics of incorporated radionuclides are based upon their distinctive chemical properties (e.g. concentration of radioactive iodine in the thyroid gland). Concomitant physical injury and predisposing medical conditions will complicate radiation exposure.
Medical management All three types of radiation exposure may occur in combination and present various response and medical management challenges. This set of circumstances and co-morbidities are highly likely in the aſt ermath of a detonation of a radiological dispersal device (RDD) or improvised nuclear
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