The Role of Public Health in a Nuclear or Radiological ...

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  • The Role of Public Health in a Nuclear or Radiological ...

    1. 1. The Role of Public Health in aThe Role of Public Health in a Nuclear or RadiologicalNuclear or Radiological Terrorist IncidentTerrorist Incident Centers for Disease Control and Prevention Atlanta, Georgia, USACenters for Disease Control and Prevention Atlanta, Georgia, USA February 3, 2005February 3, 2005 James M. Smith, PhD,James M. Smith, PhD, Associate Director for Radiation, EHHE, NCEHAssociate Director for Radiation, EHHE, NCEH Charles W. Miller, PhD,Charles W. Miller, PhD, Chief of the Radiation Studies Branch, EHHE, NCEHChief of the Radiation Studies Branch, EHHE, NCEH Debra McBaugh, CHP,Debra McBaugh, CHP, Head of Environmental Radiation Section,Head of Environmental Radiation Section, Dept. of Health, WashingtonDept. of Health, Washington
    2. 2. What Is Radiation?What Is Radiation? Nuclear Radio/TV Sun Ligh t Heat Microwave
    3. 3. Electromagnetic SpectrumElectromagnetic Spectrum EnergyEnergy ElectricalElectrical PowerPower Radio/TVRadio/TV MicrowaveMicrowave LightLight NON-IONIZINGNON-IONIZING RADIATIONRADIATION X-rayX-ray GammaGamma IONIZINGIONIZING RADIATIONRADIATION FrequencyFrequency UVUV
    4. 4. Common RadioactiveCommon Radioactive Nuclides or IsotopesNuclides or Isotopes  NaturalNatural e.g.,e.g., 1414 C,C, 4040 K,K, 238238 UU  MedicalMedical e.g.,e.g., 99m99m Tc,Tc, 131131 I,I, 201201 Tl,Tl,  FalloutFallout e.g.,e.g., 6060 Co, Cs-137,Co, Cs-137, 239239 PuPu
    5. 5. Radiation MeasurementRadiation Measurement  Absorbed doseAbsorbed dose Energy absorbed per unit mass of tissueEnergy absorbed per unit mass of tissue RadRad (USA) or(USA) or GrayGray (international)(international) 1 Gray (Gy) = 100 rads1 Gray (Gy) = 100 rads  Biologically effective doseBiologically effective dose Risk of suffering from health effectsRisk of suffering from health effects following exposure to radiationfollowing exposure to radiation remrem (USA) or(USA) or SievertSievert (International)(International) 1 Sievert (Sv) = 100 rem1 Sievert (Sv) = 100 rem
    6. 6. Annual Radiation DoseAnnual Radiation Dose 0 10 20 30 40 50 60 OtherOtherMedicalMedical EarthEarth 0.35 rem/yearaverage dose0.35 rem/yearaverage dose CosmicCosmicInternalInternalRadonRadon PercentagePercentage
    7. 7. Basic MechanismBasic Mechanism DNA is theDNA is the primary targetprimary target for biologicalfor biological effectseffects
    8. 8. Health Effects of RadiationHealth Effects of Radiation ExposureExposure  Lethal at high dosesLethal at high doses  MutagenicMutagenic  CarcinogenicCarcinogenic  Other biological effects,Other biological effects, especially at high dosesespecially at high doses
    9. 9. Acute Effects ofAcute Effects of Radiation ExposureRadiation Exposure  100-400 rem100-400 rem Nausea and vomiting,Nausea and vomiting, fatigue, loss of appetite, malaise;fatigue, loss of appetite, malaise; recovery likely within 3 monthsrecovery likely within 3 months  400-600 rem400-600 rem: All of the above, plus: All of the above, plus diarrhea, fever, hemorrhage,diarrhea, fever, hemorrhage, inflammation of mouth/throat,inflammation of mouth/throat, emaciation;emaciation; 50% of those exposed will die50% of those exposed will die
    10. 10. Late Effects of RadiationLate Effects of Radiation ExposureExposure  Radiation can transform cells,Radiation can transform cells, leading to:leading to:  Late effects, primarily cancerLate effects, primarily cancer  Years (decades) may pass betweenYears (decades) may pass between exposure and the effectexposure and the effect  Health effects highly influencedHealth effects highly influenced by variety of factorsby variety of factors  radiation typeradiation type  age and gender person exposedage and gender person exposed  organ or tissue irradiatedorgan or tissue irradiated
    11. 11. Time:Time: Distance:Distance: Shielding:Shielding: IncreaseIncrease distance betweendistance between you and the sourceyou and the source DecreaseDecrease time spent nearthetime spent nearthe radioactive sourceradioactive source IncreaseIncrease the physicalthe physical shielding between youshielding between you and the sourceand the source
    12. 12. Common SheltersCommon Shelters StructureStructure Dose ReductionDose Reduction FactorsFactors Wood Frame (1Wood Frame (1stst floor)floor) 10%10% Wood Frame (Basement)Wood Frame (Basement) 40%40% MasonryMasonry 40%40% Large buildingLarge building 80%80% Fromthe Environmental Protection Agency’s Manualof ProtectiveActionGuides and ProtectiveActions forNuclearIncidents, AppendixC
    13. 13. Potential Terrorist ScenariosPotential Terrorist Scenarios  RadiologicalRadiological  Radiological dispersion device;Radiological dispersion device; e.g., “dirty bomb”e.g., “dirty bomb”  Malicious use of radioactiveMalicious use of radioactive substancessubstances  NuclearNuclear  Attack on nuclear facilityAttack on nuclear facility  Nuclear weaponNuclear weapon  Improvised nuclear device (IND)Improvised nuclear device (IND)
    14. 14. Improvised Nuclear DeviceImprovised Nuclear Device Little BoyLittle Boy
    15. 15. Mass Radiological CasualtiesMass Radiological Casualties ““For an improvised nuclearFor an improvised nuclear device >100,000 patients coulddevice >100,000 patients could require evaluation and treatment.”require evaluation and treatment.” Department of Homeland Security Working Group onDepartment of Homeland Security Working Group on Radiological Dispersal Device (RDD) Preparedness, MedicalRadiological Dispersal Device (RDD) Preparedness, Medical Preparedness and Response Sub-Group Report (May, 2003)Preparedness and Response Sub-Group Report (May, 2003)
    16. 16. Radioactive SourcesRadioactive Sources  157,000 licensed users in U.S.157,000 licensed users in U.S.  2,000,000 devices containing2,000,000 devices containing radioactive sourcesradioactive sources  Approximately 400 sources lostApproximately 400 sources lost or stolen in U.S. every yearor stolen in U.S. every year
    17. 17. Sources used in mobile cesiumirradiators inSources used in mobile cesiumirradiators in the formerSoviet Unionthe formerSoviet Union Photos courtesy of the International Atomic Energy Agency (IAEA) Recovered transportRecovered transport containercontainer Sources Around the WorldSources Around the World
    18. 18. GoiGoiâânia, Brazilnia, Brazil
    19. 19. GoiGoiâânia Radiological Releasenia Radiological Release ObsoleteObsolete radiotherapyradiotherapy machinemachine Abandoned cancer clinicAbandoned cancer clinic Photos courtesy of the International Atomic Energy Agency (IAEA)
    20. 20. GoiGoiâânia Morbiditynia Morbidity  249 exposed; 54249 exposed; 54 hospitalizedhospitalized  Eight withEight with radiation sicknessradiation sickness  Four people diedFour people died  112,000 people112,000 people monitoredmonitored (>10% of(>10% of total population)total population) Photos courtesy of the International Atomic Energy Agency (IAEA)
    21. 21. The Role of CDC in aThe Role of CDC in a Nuclear orNuclear or Radiological TerroristRadiological Terrorist IncidentIncident
    22. 22. All Emergencies Are LocalAll Emergencies Are Local Terrorist Attack Local Public Health Response Organizations State Public Health Response Organizations Federal Public Health Response Organizations
    23. 23. National Response PlanNational Response Plan www.dhs.govwww.dhs.gov
    24. 24. NRP StructureNRP Structure Base PlanBase Plan EmergencyEmergency Support FunctionSupport Function AnnexesAnnexes SupportSupport AnnexesAnnexes IncidentIncident AnnexesAnnexes AppendicesAppendices Concept of Operations, CoordinatingConcept of Operations, Coordinating Structures, Roles and Responsibilities,Structures, Roles and Responsibilities, Definitions, etc.Definitions, etc. Groups capabilities & resources intoGroups capabilities & resources into functions that are most likely neededfunctions that are most likely needed during an incidentduring an incident Describes common processes andDescribes common processes and specific administrative requirementsspecific administrative requirements Outlines procedures, roles andOutlines procedures, roles and responsibilities for specificresponsibilities for specific contingenciescontingencies Glossary, Acronyms, andGlossary, Acronyms, and Compendium of NationalCompendium of National Interagency PlansInteragency Plans
    25. 25. Emergency Support Function #8Emergency Support Function #8  HHS is Coordinating AgencyHHS is Coordinating Agency  CDC is tasked with:CDC is tasked with:  Health surveillanceHealth surveillance  Worker health and safetyWorker health and safety  Public health informationPublic health information  Vector controlVector control  All hazard public health andAll hazard public health and medical consultation, technicalmedical consultation, technical assistance, and supportassistance, and support
    26. 26. Nuclear/RadiologicalNuclear/Radiological Incident AnnexIncident Annex  Department of Homeland SecurityDepartment of Homeland Security coordinates the Federal response tocoordinates the Federal response to radiological Incidents of National Significanceradiological Incidents of National Significance  Department of Justice has lead responsibilityDepartment of Justice has lead responsibility for criminal investigationsfor criminal investigations  Coordinating Agency is determined by theCoordinating Agency is determined by the type of emergencytype of emergency  HHS is a Cooperating AgencyHHS is a Cooperating Agency
    27. 27. HHS ResponsibilitiesHHS Responsibilities  Inspect production, processing, storage,Inspect production, processing, storage, and distribution facilities for human foodand distribution facilities for human food and animal feedsand animal feeds  Collect samples of agricultural products toCollect samples of agricultural products to monitor and assess the extent ofmonitor and assess the extent of contaminationcontamination  Provide advice on proper medicalProvide advice on proper medical treatmenttreatment  Provide advice and guidance in assessingProvide advice and guidance in assessing the impact of the effects of radiologicalthe impact of the effects of radiological incidentsincidents
    28. 28. CDC ResponsibilitiesCDC Responsibilities  Manage long-term public monitoring,Manage long-term public monitoring, collecting and processing blood samples,collecting and processing blood samples, bodily fluids/matter samples, and advicebodily fluids/matter samples, and advice concerning medical assessment andconcerning medical assessment and triage of victimstriage of victims  Track victims’ treatments and long-termTrack victims’ treatments and long-term health effectshealth effects  Provide assessment and treatmentProvide assessment and treatment teams for those exposed to radiation, orteams for those exposed to radiation, or contaminated with radioactive materialscontaminated with radioactive materials
    29. 29. Focus Group Research from theFocus Group Research from the Associated Schools of PublicAssociated Schools of Public HealthHealth ““I haven’t heard that I am involvedI haven’t heard that I am involved and I don’t want to be involved.”and I don’t want to be involved.” ““Right now, the lab has no plans,Right now, the lab has no plans, and is not directly involved. We areand is not directly involved. We are more involved if there is a biologicalmore involved if there is a biological attack.”attack.”
    30. 30. Preparing to RespondPreparing to Respond  Partner with other state and localPartner with other state and local agenciesagencies  Identify team roles and people to fillIdentify team roles and people to fill thesethese  Determine public health roles inDetermine public health roles in incident command structureincident command structure  Develop communicationsDevelop communications messagesmessages
    31. 31. Preparing to RespondPreparing to Respond  Determine responsibilities of stateDetermine responsibilities of state partners and establish contactpartners and establish contact informationinformation  Develop a list of resourcesDevelop a list of resources  Web sitesWeb sites  Local fire departmentsLocal fire departments  EPA regional officesEPA regional offices  HAZMAT teamsHAZMAT teams  Local nuclear medicine staffLocal nuclear medicine staff  Radioactive materials licenseesRadioactive materials licensees  State Radiation Control Program DirectorState Radiation Control Program Director
    32. 32. RequestingRequesting Federal AssistanceFederal Assistance  Governor can request federalGovernor can request federal assistance when state resourcesassistance when state resources and capabilities are overwhelmedand capabilities are overwhelmed  Federal officials will provideFederal officials will provide assistance andassistance and recommendationsrecommendations  Local public health will still haveLocal public health will still have responsibilitiesresponsibilities
    33. 33. Local GovernmentLocal Government ResponsibilitiesResponsibilities  Local Chief Executive Officer (i.e.,Local Chief Executive Officer (i.e., mayor, city or county manager)mayor, city or county manager)  Coordinates local resourcesCoordinates local resources  Suspends local laws or ordinancesSuspends local laws or ordinances Communicates with the publicCommunicates with the public  Tribal Chief Executive OfficerTribal Chief Executive Officer  All of the aboveAll of the above  May communicate directly with federalMay communicate directly with federal officialsofficials
    34. 34. State and LocalState and Local Public Health ResponsePublic Health Response  Monitor workers’ health andMonitor workers’ health and safetysafety  Assure safe shelters andAssure safe shelters and healthy food and waterhealthy food and water suppliessupplies  Coordinate sampling andCoordinate sampling and laboratory analysis of sampleslaboratory analysis of samples
    35. 35. State and LocalState and Local Public Health ResponsePublic Health Response  Field investigations andField investigations and monitoring of peoplemonitoring of people  Criteria for entry andCriteria for entry and operations at the incident siteoperations at the incident site  Disease control and preventionDisease control and prevention measuresmeasures
    36. 36. Medical SupportMedical Support  Evaluate health and medicalEvaluate health and medical impacts on the public andimpacts on the public and emergency personnelemergency personnel  Develop medical interventionDevelop medical intervention recommendationsrecommendations  Treat impacted citizensTreat impacted citizens  Request Strategic NationalRequest Strategic National Stockpile (formerly NationalStockpile (formerly National Pharmaceutical Stockpile)Pharmaceutical Stockpile)
    37. 37. Protective Action GuidesProtective Action Guides  ShelteringSheltering  EvacuationEvacuation  RelocationRelocation  DecontaminationDecontamination  Worker PPEWorker PPE
    38. 38. Protective ActionsProtective Actions  If you are inside, shelter in placeIf you are inside, shelter in place  Stay indoorsStay indoors  Turn off ventilation systemsTurn off ventilation systems  Close and lock windows and doorsClose and lock windows and doors  If you are outside,If you are outside,  Cover your nose and mouth with aCover your nose and mouth with a clothcloth  Leave the area and go insideLeave the area and go inside
    39. 39. Protective ActionsProtective Actions  If you think you may beIf you think you may be contaminated,contaminated,  Remove outer layer of clothing andRemove outer layer of clothing and seal it in a plastic bagseal it in a plastic bag  Shower or wash your hands and faceShower or wash your hands and face  Listen for further instructionsListen for further instructions  Seek medical attention only forSeek medical attention only for severe injuriessevere injuries
    40. 40. Long-term Response IssuesLong-term Response Issues  Surveillance and epidemiologicalSurveillance and epidemiological studiesstudies  Establish exposure registry andEstablish exposure registry and monitor long-term impactsmonitor long-term impacts  Provide information to public andProvide information to public and responders on long-term healthresponders on long-term health effectseffects
    41. 41. More InformationMore Information  CDC Radiation EmergenciesCDC Radiation Emergencies www.bt.cdc.gov/radiationwww.bt.cdc.gov/radiation  Department of Homeland SecurityDepartment of Homeland Security www.dhs.govwww.dhs.gov  Environmental Protection AgencyEnvironmental Protection Agency www.epa.gov/radiationwww.epa.gov/radiation  Nuclear Regulatory CommissionNuclear Regulatory Commission www.nrc.gov/what-we-do/radiation.htmlwww.nrc.gov/what-we-do/radiation.html

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