RESPONSE
device (IND). Non-explosive release comes from intentional contamination of food and food distribution networks or the placement of concealed stationary irradiation devices in public places. In a food contamination scenario, ARS may be mistaken for simple food poisoning. Individuals in proximity to an RDD
detonation would be subject to the eff ects of explosive blast injury, such as primary blast eff ects, incendiary eff ects, and radiological contamination and exposure. Shrapnel may be contaminated with radionuclides with multiple half-lives or victims may inhale radioactive dust and smoke. A one-kiloton nuclear explosion could destroy several city blocks and impede rescue and medical responses for several weeks. Medical eff ects of radiation fall
into three broad categories: ARS due to whole body or substantial partial body irradiation, chronic eff ects, which include tissue fi brosis and organ dysfunction, and latent eff ects involv- ing carcinogenesis and genetic damage. In most cases, health care systems will be overwhelmed with the ‘worried well’ who have succumbed to the fear and anxiety generated by these events. The psychosocial impact will be
great. In an RDD detonation, cases of psychological trauma requiring intervention may exceed even physical trauma or any radiation-induced injuries or illness.
Impact on public health In the US, radiation-specifi c schemes for triage, treatment and transport (RTR system) provide a medical response model to forward-deploy resources and support. Specialised resources such as the Radiation Injury Network and REAC/TS are available. The destruction and incapacitation
EXPLAINING RADIATION Atoms – the basic building blocks of all matter – are composed of a central nucleus, electrons which orbit around the nucleus and carry a negative charge, protons which are positively charged and have a tendency to repel one another, and neutrons which do not carry a charge and are approximately the same size as protons. When there is an imbalance of the ratio of protons to neutrons, an element is radioactive. Such an element is referred to as a radioisotope, isotope or radionuclide. For an atom to return to a balanced equilibrium the nucleus must attain stability, which will result in the release of energy. This release is defi ned as radioactive decay or simple decay. This phenomenon will perpetuate until enough energy has been released to achieve nuclear stability. Essentially, radiation is the release of energy from atoms in the form of particles or waves. The fi rst form of radiation is fast-moving particles with varying degrees of kinetic energy that have both energy and mass (weight). The other form consists of pure energy, a form of electromagnetic energy. This would be radiation interacts with matter removing electrons from atoms (ionization) – a highly energetic form of radiation capable of causing profound biological and adverse health eff ects. The most common types of ionizing radiation consist of alpha particles,
beta particles, protons, gamma rays and X-rays. Alpha particles are energetic, but can only travel short paths. Beta particles travel farther. X-rays and gamma rays have a range of several metres, and can penetrate and ionize deep tissues. Alpha particles and beta particles will pose more of an internal hazard if they are inhaled or ingested, while beta particles are also capable of causing serious cutaneous radiation injury – ‘beta burns’.
MEASURING RADIATION Units of measurement for radiation include the rad (internationally known as the Gray’ (Gy). The rad or Gy is defi ned as the deposition of 0.01 joule of energy per kilogram of tissue. The rem (Radiation Equivalent Man) is now known as Sievert (Sv), and refl ects the type of radiation absorbed and the likelihood of biological damage. The Sv usually depicts the cumulative dose. The amount of activity, formerly the curie (Ci), is now known as the
Becquerel (Bq). This unit of measurement refl ecting radioactivity will be seen on shipping manifests, containers and vehicles transporting radioactive materials and needs to be noted, documented and reported by responders.
of the medical infrastructure will certainly hamper triage, treatment and transport of casualties. Radioactive contamination will pose serious constraints on scene responders, medical personnel and victims. The need for burn and trauma care will be immense, especially in an IND attack. Medical management will be conducted based on triage decision-making: immediate care, delayed care, palliative care and fatality management. Decontamination and radiological
Training in radiological response conducted by the Center for Domestic Preparedness at the CBRN Training Facility (COBRA) in Anniston, Ala.
survey and monitoring must commence in the fi eld and throughout the medical care continuum. Evaluation of radiological exposure will also deter- mine further triage and treatment options. Prognostic indicators such as
onset of vomiting aſt er exposure and blood lymphocyte counts will be critical determinants of medical care. Public health responses include ongoing assessments of medical and public health infrastructure, rapid assessment of needs, radiological monitoring, environmental health (food, water, air safety, sanitation, vector control), provision of special- ized laboratory capacity, management and distribution of strategic medical countermeasures such as potassium iodide (KI) for thyroid blockade, decorporation agents (chelating compounds), and cytokines for bone marrow suppression. As in any disaster event, local preparedness and response will be vital to reduce morbidity and mortality. ❚❙
Frank G. Rando is a consultant, clinician, educator and researcher in tactical, disaster and critical care medicine and a subject matter expert in healthcare and public health emergency management.
72 CBNW 2013/01
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