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COMMUNITY MANAGEMENT OF LOW DOSE RADIOLOGICAL EVENTS Joseph J. Contiguglia MD, MPH&TM, MBA Clinical COMMUNITY MANAGEMENT OF LOW DOSE RADIOLOGICAL EVENTS Joseph J. Contiguglia MD, MPH&TM, MBA Clinical Professor Tulane University School of Public Health & Tropical Medicine

OVERVIEW w. The Radiological Threat w. Priorities & Responsibilities w. Radiological Attack w. Radiological OVERVIEW w. The Radiological Threat w. Priorities & Responsibilities w. Radiological Attack w. Radiological Accident w. Community Actions

ENERGY FUELS & USES ENERGY FUELS & USES

w 38 states, particularly those in the east half & the west coast have w 38 states, particularly those in the east half & the west coast have a full power, licensed reactors w Nearly three million Americans live within 10 miles of an operating nuclear power plant.

CIA w Al-Qaida is interested in radiological dispersal devices (RDDs) or CIA w Al-Qaida is interested in radiological dispersal devices (RDDs) or "dirty bombs. " – Construction of an RDD is well within its capabilities w Radiological materials are relatively easy to acquire from industrial or medical sources. w May try to launch conventional attacks against the nuclear industrial infrastructure of the United States in a bid to cause contamination, disruption, and terror

WORLD SUMMIT TURNING ATTENTION TO NUCLEAR THREATS w President Barack Obama and other leaders WORLD SUMMIT TURNING ATTENTION TO NUCLEAR THREATS w President Barack Obama and other leaders of the Group of Eight major industrial countries were scheduled to open their second day of talks Saturday focused on nuclear standoffs with Iran and North Korea

INTERNATIONAL STRATEGIC NUCLEAR RISKS w “Iran would be raising the risk of a “World INTERNATIONAL STRATEGIC NUCLEAR RISKS w “Iran would be raising the risk of a “World War III” if it came to possess nuclear weapons. ” – President Bush, 2007 w “Iran puts the world at nuclear risk” – Hillary Clinton, May 2010 w "Israel must be wiped off the map” – Iranian President Mahmoud Ahmadinejad

RADIATION TYPES RADIATION TYPES

SCHEMATIC MODEL OF RADIONUCLIDE UPTAKE (AFTER VOELZ) Intake: Ingestion Inhalation Surface Lung Skin 1. SCHEMATIC MODEL OF RADIONUCLIDE UPTAKE (AFTER VOELZ) Intake: Ingestion Inhalation Surface Lung Skin 1. Intact 2. Wounds Lung Clearance GI Tract Uptake: Lymph Nodes Blood Kidney Excretion: Feces Urine A. Hogan, David E. , "Disaster Medicine 2 nd Ed. , " Lippincott Williams & Wilkins, Philadelphia, 2007 (Recycle) Deposition Sites 1. Whole Body 2. Bone 3. Liver 4. Thyroid

IRRADIATION & CONTAMINATION w Irradiation – exposure to a dose of radiation w Contamination IRRADIATION & CONTAMINATION w Irradiation – exposure to a dose of radiation w Contamination – Radioactive particles on the skin (external) – Particles inside the body organs (internal) w Decontamination – Remove Clothing (95%) – Wash with soap & water w Incorporation – The uptake of radioactive materials by body cells, tissues, and target organs

POTENTIAL LOW DOSE EVENTS w INTENTIONAL – Contaminating food/water with radioactive material – Spreading POTENTIAL LOW DOSE EVENTS w INTENTIONAL – Contaminating food/water with radioactive material – Spreading radioactive material into the environment • Using conventional explosives - dirty bomb • Using wind currents or natural traffic patterns – Bombing or destroying a nuclear reactor – Causing a truck/train carrying nuclear material to spill w ACCIDENTAL – Nuclear Reactor Accidents – Transportation Accidents (unintentional spill of radioactive material from a truck, train or plane) – Human Error

LOW DOSE SCENARIO w RDD / RED w Contamination / Exposure w Remember President LOW DOSE SCENARIO w RDD / RED w Contamination / Exposure w Remember President FDR – “You have nothing to fear but fear itself” w Just remember that fear itself is worth worrying about

IZMAYLOVSKY PARK (MOSCOW), 1995 w Terrorists from Chechnya w Buried, but did not detonate IZMAYLOVSKY PARK (MOSCOW), 1995 w Terrorists from Chechnya w Buried, but did not detonate w RDD w Dynamite and Cesium-137 w Removed from cancer treatment equipment. w Reporters were tipped off about its location and it was defused.

LONG-TERM CONTAMINATION DUE TO CESIUM BOMB IN WASHINGTON, DC. (FAS) w Inner Ring: One LONG-TERM CONTAMINATION DUE TO CESIUM BOMB IN WASHINGTON, DC. (FAS) w Inner Ring: One cancer death per 100 people due to remaining radiation (5% increase) w Middle Ring: One cancer death per 1, 000 people due to remaining radiation (. 5% increase) w Outer Ring: One cancer death per 10, 000 people due to remaining radiation (. 05% increase): EPA recommends decontamination or destruction

INTERNATIONAL ATOMIC ENERGY AGENCY & WORLD HEALTH ORGANIZATION w Between 1944 and 1999 in INTERNATIONAL ATOMIC ENERGY AGENCY & WORLD HEALTH ORGANIZATION w Between 1944 and 1999 in 405 accidents worldwide, approximately 3000 persons were injured, with 120 fatalities (including the 28 Chernobyl victims). w Recently, the number of accident involving radiation sources has increased. w Often the victims are unaware that they may have been exposed to radiation.

RADIOLOGICAL ACCIDENT RADIOLOGICAL ACCIDENT

RADIOACTIVE MATERIALS (CLASS 7) w Protective cylindrical or boxlike overpacks w Metal casks with RADIOACTIVE MATERIALS (CLASS 7) w Protective cylindrical or boxlike overpacks w Metal casks with cooling fins

OFFICE OF SECURE TRANSPORTATION OFFICE OF SECURE TRANSPORTATION

NUCLEAR WASTE w Yucca Mountain is a mountain in Nevada approximately 100 miles (160 NUCLEAR WASTE w Yucca Mountain is a mountain in Nevada approximately 100 miles (160 km) northwest of the Las Vegas metropolitan area. It is the proposed site for the Yucca Mountain nuclear waste repository.

w If the proposed Yucca Mountain waste repository opens, a large number of irradiated w If the proposed Yucca Mountain waste repository opens, a large number of irradiated fuel and high-level waste shipments will converge in Nevada. Depending on a range of factors, hundreds to thousands of shipments will traverse Nevada annually for a period of 24 to 38 years.

EVERY HIGH DOSE EVENT IS SOMEONE ELSE’S LOW DOSE EVENT w Per capita thyroid EVERY HIGH DOSE EVENT IS SOMEONE ELSE’S LOW DOSE EVENT w Per capita thyroid doses in the continental United States resulting from all atmospheric nuclear tests conducted at the Nevada Test Site from 1951 -1962.

PSYCHOLOGICAL FACTORS IN RADIATION THREATS w. Characteristics of Ionizing Radiation – Odorless – Colorless PSYCHOLOGICAL FACTORS IN RADIATION THREATS w. Characteristics of Ionizing Radiation – Odorless – Colorless – Penetrating – Continuing CHERNOBYL

DELAYED PSYCHOLOGICAL EFFECTS w Survivor guilt w Psychosomatic complaints w Acute stress disorder w DELAYED PSYCHOLOGICAL EFFECTS w Survivor guilt w Psychosomatic complaints w Acute stress disorder w Traumatic stress disorders – 11% of uninjured – 8 % of moderately injured – 31% of severely injured

PRIORITIES & RESPONSIBILITIES PRIORITIES & RESPONSIBILITIES

FEDERAL RESPONSE IS BASED ON MANY FACTORS w Ability of state, local, and tribal FEDERAL RESPONSE IS BASED ON MANY FACTORS w Ability of state, local, and tribal officials to respond w Type and/or amount of radioactive material involved w Extent of the impact or potential impact on the public and environment w Size of the affected area.

EPA RADIOLOGICAL RESPONSIBILITIES w Establishing Protective Action Guides – Tell emergency responders how to EPA RADIOLOGICAL RESPONSIBILITIES w Establishing Protective Action Guides – Tell emergency responders how to minimize the impact of a radiological incident w Helping state agencies develop emergency response plans w Establishing emergency radiation detection and measurement systems in cooperation with the Nuclear Regulatory Commission

EPA COORDINATION w Response for radiological materials not regulated by another federal agency. w EPA COORDINATION w Response for radiological materials not regulated by another federal agency. w Lost radiation sources, sources of unknown origin, and naturally occurring materials such as radium. w U. S. response to foreign radiological accidents or events that have the potential to affect the United States

DEPARTMENT OF HOMELAND SECURITY COORDINATION w A federal agency has requested assistance under the DEPARTMENT OF HOMELAND SECURITY COORDINATION w A federal agency has requested assistance under the National Response Plan. w State and local authorities have requested federal assistance when overwhelmed w Multiple federal agencies have become substantially involved w The President uses the authority of the Stafford Act to declare a disaster

DOE ACCIDENT RESPONSE ASSETS DOE ACCIDENT RESPONSE ASSETS

DOE EMERGENCY RESPONSE SERVICES w REAC/TS provides incident response and consultation to physicians across DOE EMERGENCY RESPONSE SERVICES w REAC/TS provides incident response and consultation to physicians across the globe. w We also maintain specialized response teams consisting of a physician, nurse/paramedic and a health physicist to ensure our readiness to respond to a radiation emergency.

DOE RADIOLOGICAL INCIDENT MEDICAL CONSULTATION w Provides advice and consultation to emergency personnel responsible DOE RADIOLOGICAL INCIDENT MEDICAL CONSULTATION w Provides advice and consultation to emergency personnel responsible for the medical management of radiation accidents.

DOE MEDICAL MANAGEMENT OF RADIATION INCIDENTS w Physicians and health physicists are available to DOE MEDICAL MANAGEMENT OF RADIATION INCIDENTS w Physicians and health physicists are available to answer questions of a general nature or inquiries related to a specific incident involving radiation exposure, or external or internal contamination

NUCLEAR WEAPON ACCIDENT SITE Do. D 3150. 8 -M NUCLEAR WEAPON ACCIDENT SITE Do. D 3150. 8 -M

STATE DEPT. OF HEALTH LAB w Rapid radiological analysis of a variety of samples STATE DEPT. OF HEALTH LAB w Rapid radiological analysis of a variety of samples and report the results back http: //www. health. state. ny. us/

RADIOLOGICAL ACCIDENT RADIOLOGICAL ACCIDENT

HUMAN ERROR w Tickling the dragon’s tail w On May 21, 1946, Dr. Louis HUMAN ERROR w Tickling the dragon’s tail w On May 21, 1946, Dr. Louis Slotin performed an experiment that involved the creation of one of the first steps of a fission reaction – A sketch to determine the amount of radiation to which each person in the room had been exposed

TRANSPORTATION ACCIDENTS w 18 -Wheeler Accident Spills Radioactive Material in Pineville w The spill TRANSPORTATION ACCIDENTS w 18 -Wheeler Accident Spills Radioactive Material in Pineville w The spill occurred during rush-hour traffic at the intersection of US Highway 165 (Monroe Highway) and US Highway 167 (the Cottingham Expressway) in Pinevile, Louisiana.

TRANSPORTATION ACCIDENTS TRANSPORTATION ACCIDENTS

TRANSPORTATION ACCIDENT w Reload of spent nuclear fuel of nuclear submarines and its subsequent TRANSPORTATION ACCIDENT w Reload of spent nuclear fuel of nuclear submarines and its subsequent transportation for reprocessing may be carried out by the vessel – floating technical base.

TRANSPORTATION ACCIDENT w Eighty days after it fell into the ocean following the January TRANSPORTATION ACCIDENT w Eighty days after it fell into the ocean following the January 1966 midair collision between a nucleararmed B-52 G bomber and a KC-135 refueling tanker over Palomares, Spain, this B 28 RI nuclear bomb was recovered from 2, 850 feet (869 meters) of water

LOST (ORPHAN) RADIATION SOURCES AND DEVICES w The Goiânia accident in central Brazil produced LOST (ORPHAN) RADIATION SOURCES AND DEVICES w The Goiânia accident in central Brazil produced over 200 cases of radiation poisoning. w On 13 September 1987, an old nuclear medicine source was scavenged from an abandoned hospital in Goiânia, the capital of the central Brazilian state of Goiás. w It was subsequently handled by many people

GOIANIA BRAZIL w Panic caused more than 112, 000 people – 10% of the GOIANIA BRAZIL w Panic caused more than 112, 000 people – 10% of the population – to request radiation surveys w At a makeshift facility in the city’s Olympic Stadium, 250 people were found contaminated. w 28 had sustained radiation-induced skin burns w 50 had ingested cesium - increased risk of cancer w 2 men, 1 woman, and 1 child died from acute gamma radiation exposure

GOIANIA BRAZIL w In addition to the human toll, contamination had been tracked over GOIANIA BRAZIL w In addition to the human toll, contamination had been tracked over roughly 40 city blocks. w Of the 85 homes found to be significantly contaminated, 41 were evacuated and 7 were demolished. w Through routine travels, within that short time people had cross-contaminated houses nearly 100 miles away. w Cleanup generated 3, 500 m 3 radioactive waste at a cost of $20 million.

GOIANIA BRAZIL w Psychological effects included fear and depression for a large fraction of GOIANIA BRAZIL w Psychological effects included fear and depression for a large fraction of the city’s inhabitants. w Neighboring provinces isolated Goiania and boycotted its products. w The price of their manufactured goods dropped 40% and stayed low for more than a month. w Tourism collapsed and recent population gains were reversed by business regression. w Economic losses of hundreds of millions of dollars. w Need for a broader understanding of radiation.

NUCLEAR POWER ACCIDENTS NUCLEAR POWER ACCIDENTS

NUCLEAR POWER ACCIDENTS 3 MILE ISLAND w On 28 March 1979, there was an NUCLEAR POWER ACCIDENTS 3 MILE ISLAND w On 28 March 1979, there was an accident at the Three Mile Island nuclear power station near Harrisburg, Pennsylvania. w Radioactive gas was released a couple of days after the accident

THREE MILE ISLAND w Not enough to cause any dose above regular background levels THREE MILE ISLAND w Not enough to cause any dose above regular background levels to local residents w Conflicting information released during the event exacerbated the public's fears

WHAT HAPPENED w A meltdown is the most dangerous type of nuclear power accident. WHAT HAPPENED w A meltdown is the most dangerous type of nuclear power accident. w At Three Mile Island (TMI), there was a "loss of coolant" accident, meaning that cooling water that surrounds the core and keeps it cool was lost. w The temperature of the core rose so high that the materials actually melted. w Some radioactive gases did escape to the atmosphere. w Average dose to area residents was about 1 millirem HYPOTHESIZED UNIT-2 CORE DAMAGE

WHAT WILL PREVENT ANOTHER WHAT WILL PREVENT ANOTHER "THREE MILE ISLAND" w Plant design and equipment requirements w Operator training and staffing, w Fitness-for-duty programs to guard against alcohol or drug abuse w Early detection of problems w Public information about plant performance w Regulatory controls and enforcement w Self policing by the industry w Emergency preparedness

CHERNOBYL UKRAINE w On 26 April 1986 the world's most severe nuclear reactor accident CHERNOBYL UKRAINE w On 26 April 1986 the world's most severe nuclear reactor accident occurred in Chernobyl, Ukraine w An area of about 5 million hectares was contaminated and 160, 000 people had to be permanently evacuated. w Radioactive material affected not only the Ukraine but also Western Europe.

WHAT HAPPENED? w Two explosions brought about a rupture in the reactor, causing radionuclides WHAT HAPPENED? w Two explosions brought about a rupture in the reactor, causing radionuclides to travel several kilometres into the atmosphere and contaminating the surrounding area. w The radionuclides in the atmosphere caused widespread contamination as they spread over much of Europe and around the world. World Nuclear Association www. world-nuclear. org/info/inf 36. html COGnizant-CANDU Owners Group Monthly Newletter

AFTERMATH w Fewer than 50 deaths directly attributed to radiation almost all being highly AFTERMATH w Fewer than 50 deaths directly attributed to radiation almost all being highly exposed rescue workers w UN report predicts that up to 4, 000 people could eventually die of the long-term effects

CHERNOBYL EPA RESPONSE w Monitored radioactivity levels in the US w Established a group CHERNOBYL EPA RESPONSE w Monitored radioactivity levels in the US w Established a group to provide advice on preventing contamination of the food supply and protecting public health w Established an information center to gather and distribute facts and data w Arranged daily press conferences to keep the public up-to-date and answer concerns

FUKUSHIMA DAIICHI 2011 w w w 1. The cooling systems, which stop the fuel FUKUSHIMA DAIICHI 2011 w w w 1. The cooling systems, which stop the fuel heating up to unsafe levels, failed at two of Fukushima's reactors - 1 and 3. 2. This meant water stopped circulating and began to boil, leading to a rise in pressure. 3. It is believed this rise in pressure caused the casing around the fuel rods to become damaged. When they came into contact with water, it created hydrogen gas. 4. As engineers tried to vent this gas outside the containment chamber to relieve the pressure, the gas exploded when it came into contact with oxygen. The containment chamber was not damaged, but part of the outer concrete shell was blown off. 5. Fuel rods inside reactors 1 and 3 continue to heat the water and engineers are using sea water as an emergency coolant.

COMMUNITY ACTIONS COMMUNITY ACTIONS

MEDIA PUBLIC INFORMATION TACTICAL CONSIDERATIONS 1. TARGETED 2. SPECIFIC 3. AUTHORITATIVE 4. CONCISE MEDIA PUBLIC INFORMATION TACTICAL CONSIDERATIONS 1. TARGETED 2. SPECIFIC 3. AUTHORITATIVE 4. CONCISE

CONTAMINATION RISK COMMUNICATIONS w 1. Get out of the immediate area quickly. w 2. CONTAMINATION RISK COMMUNICATIONS w 1. Get out of the immediate area quickly. w 2. Remove the outer layer of your clothing. . w 3. If possible, place the clothing in a plastic bag or leave it in an out-of-the-way area, w 4. Wash all of the exposed parts of your body using lots of soap and lukewarm water to remove contamination. w 5. After authorities determine that internal contamination may have occurred, you may be able to take medication to reduce the radioactive material in your body.

COMMUNITY ACTIONS w Be prepared to evacuate or find shelter in your home. w COMMUNITY ACTIONS w Be prepared to evacuate or find shelter in your home. w Develop an emergency communication plan. w Listen to the radio or television for official information. w Remember your neighbors who may require special assistance – Infants, – Elderly people – People with disabilities. http: //www. ndsu. edu/police_safety/NDSU%20 Safety%2 0 Officer%20 Homepage_files/radacdfs. pdf

SHELTER-IN-PLACE SHELTER IN YOUR HOME w Centrally located room or basement w As few SHELTER-IN-PLACE SHELTER IN YOUR HOME w Centrally located room or basement w As few windows as possible – The further your shelter is from windows, the safer you will be w Store emergency supplies in this area w Check the supplies w Replace the water every three months w Train family members http: //www. bt. cdc. gov/radiation/shelter. asp

SHELTER-IN-PLACE SHELTER IN YOUR HOME w w w w w Food – 3 days SHELTER-IN-PLACE SHELTER IN YOUR HOME w w w w w Food – 3 days Water Clothes Paper plates Plastic bags for garbage & sanitation Bedding Battery radio Medicines Toiletries w Flashlight & batteries w Phone w Eyeglasses & contact lenses / supplies w Duct tape & heavy plastic sheeting w Pet food w Baby formula & diapers w First aid kit w Games, books, etc.

IF ADVISED TO REMAIN AT HOME w Bring pets inside. w Close and lock IF ADVISED TO REMAIN AT HOME w Bring pets inside. w Close and lock windows and doors. w Turn off air conditioning, vents, fans and furnace. w Close fireplace dampers. w Go to the basement w Stay inside until authorities say it is safe. w If you must go out, cover mouth and nose w Be prepared to evacuate http: //www. bt. cdc. gov/radiation/evacuation. asp

WHEN COMING IN FROM OUTDOORS VIEW OF CHERNOBYL TAKEN FROM PRIPYAT w Shower and WHEN COMING IN FROM OUTDOORS VIEW OF CHERNOBYL TAKEN FROM PRIPYAT w Shower and change clothing and shoes. w Put items worn outdoors in a plastic bag and seal it. http: //www. bt. cdc. gov/radiation/evacuation. asp

IF ADVISED TO EVACUATE w Listen to a radio or television for information on IF ADVISED TO EVACUATE w Listen to a radio or television for information on evacuation routes, temporary shelters, and procedures. w Minimize contamination in house. w Close and lock windows and doors. w Turn off air conditioning, vents, fans, and furnace. w Close fireplace dampers. w Take disaster supplies. http: //www. bt. cdc. gov/radiation/evacuation. asp

IF YOU LIVE NEAR A NUCLEAR POWER PLANT w 10 miles w Learn the IF YOU LIVE NEAR A NUCLEAR POWER PLANT w 10 miles w Learn the emergency warning systems w Contact the utility company for information w The company is required by law to have plans in place for contacting people in the community during an emergency. w The company must inform the community each year of its evacuation plans and routes http: //www. bt. cdc. gov/radiation/evacuation. asp

A N T I T E R R O R I S M D A N T I T E R R O R I S M D I S A S T E R

HERDING CATS HERDING CATS

SUMMARY w The Radiological Threat w Priorities & Responsibilities w Response w Radiological Attack SUMMARY w The Radiological Threat w Priorities & Responsibilities w Response w Radiological Attack w Radiological Accident w Community Actions GEN GEORGE PATTON w “Plans are Nothing, Planning is Everything. ” – Gen. George Patton

QUESTIONS? QUESTIONS?