THE DAY AFTER:RESPONSE TO NUCLEAR-RAOIOLOGICAL TERRORISMB Y S . C H R I S T O P H E R S U P R U N J R

IN 1983, JASON ROBARDS STARRED IN A MADE FOR TEL-evision movie called "The Day After" about a surprise attackby the (then) Soviet Union. The movie shoi:ked the audienceswho saw it by its intimate portrayal of the horrors associated

with nuclear fallout. Many of us have these same images engraved inour minds from a generation of nuclear brinksmanship played outbetween the United States and its fotmer adversary, the SovietUnion, The stot7 has changed as we fast-forward to 2005 with ter-rorists who are willing to use nuclear and radiological materials notas a bargaining chip or a bluff at the summit table but as a tool forreligious, social, and economic nirvana.

Atomic energy's potential as a weapon gained notoriety whenEnrico Eermi discovered how to separate the atom in 1942. The atomi.s separated into protons, which are positively charged, and neutronsin its center. Atoms also have electrons, whose charge is negative.The electrons rotate around the atom's core in separate orbits aboutthe center based on the atomic weight of the atom in question. Atomsare the building blocks of the universe and when they are separated,or forced together, they can create enormous amounts of energy. Themen and women who developed atomic weapons created a creaturethat we now must carefully control. Atomic energy can neither beheld too tightly nor too loosely as disaster awaits us on eitherextreme. Atomic energy, which saved thousands from continued warduring World War II, endangered just as many in the Cold War andtoday, in what Count de Marenches calls "the Fourth World War," orthe war on terrorism.' As first rcsponders. our responsibility is tounderstand the science of atomic energy, just as we understand thescience of combustion. With this knowledge we can be proactive inour response and not reactive in fear.

One example of this power, and of the hydrogen bomb in particu-lar, came in 1952 when the ivy Mike bomb was detonated onElugelab Island in the Pacific Ocean. The detonation created a fire-ball five kilometers in diameter and a mushroom cloud that reached17 kilometers into the atmosphere in 90 seconds. The blast also cre-

• S. CHRISTOPHER SUPRUN JR., NREMT-P, CCEMT-P. is an tbe EMSirainer fur tbe CarrolIton (TXl Fire Department and a 12-year paramedic/fire-

figbter and instructor. He has taugbt and written on EMS, terrorism response,

and incident management for fire departments, federal and local law enforce-

ment, and private industry. He is an adjunct instructor in emergency medicine

at The George Washington University Emergency Health Sciences program

in Washington. D.C.

ated a crater 6,000 feet across and 160 feet deep. The cloud from thefireball drew up 100 million tons of debris and the island was obliter-ated, literally wiped clean from the Earth. This device was approxi-mately 10 megatons, the equivalent of 10 million tons of TNT, ormore firepower than had been dropped by Allied Forces duringWorld War I!.'

RADIATION TRAUEL/PENETRATIONThe way in which radiation travels is an important factor in fire

and EMS response to radiological incidents. Just as we select specif-ic personal protective equipment (PPE) for diseases, we wouldn'tconsider using a mask for a bloodborne disease, because a mask onlyprovides protection from particulates and airborne agents. With radi-ation, as with disease processes, we need to look at how radiation istransmitted. Radiation is just "out there." but difterent radiation getsto us in different ways, and we must protect ourselves accordingly.

The four types of radiation are alpha, beta, gamma/x-ray, and neu-tron. Alpha radiation travels just inches from its source and can bestopped with almost anything from the dead layer of skin to a pieceof notebook paper. Beta radiation travels slighlly farther, penetratingsome skin, bul can be stopped by simple materials like wood.Gamma radiation is stopped only by dense metals such as lead andposes a greater risk to tire and EMS responders. Neutrons travel withgreat intensity and are deflected by water or other dense materials.losing some of their energy in the "collision."

To understand radiation's ability to permeate materials may beeasier to understand with the following analogy. Imagine a chainlink fence. Alpha energy is akin to a bowling ball rolling toward thefence—the fence will easily stop the ball when it comes in contact.Beta energy is like a tennis ball; if you throw it toward the fence, itmay get embedded in the links of the fence, but it will be stopped.Gamma radiation is akin to a bullet fired toward the fence; it willtravel through the links without difficulty and continue on until itsenergy has dissipated or something heavy stops it, such as a leadwall. Finally, neutron radiation is like the light from a flashlightaimed at the fence; its energy will pass through the fence and travelfor hundreds of yards beyond.

As in the analogy, note that the alpha and beta radiation trav-el as solid objects (i.e.. particles) such as radioactive dust thatcan be inhaled into the body. Since this is a possibility, anyresponse to a suspected radioactive incident should includeusing airborne particle protection with a HEPA 95 filter mask or

FireEngineering.com FIREENGINEERING J u n e 2 0 0 5 I t S

The Day After: Response to Nuclear-Radiological Terrorism

better, so that particulates are not inhaled.Gamma radiation, on the other hand, travels as a ray; Level A haz-

mat suits provide no more protection from gamma radiation thanbunker gear—very little to none. Therefore, responders must use theALARA principle—as lov̂ - as reasonably achievable. This conceptmay be unfamiliar to many providers but may be understood as time,distance, and shielding. Whenever we are in a hazardous materialsenvironment, we will want to limit our time, increase our distancefrom the contamination, and increase our shielding. The same prin-ciples apply when dealing with radiation.

NEW!Fire Engineering Books & Videos

brings you the latest shoring,vehicle extrication, and

technical rescue titles in thefire industry.

Call 1.800.752.9764or visit

www.fireengineeringbooks.comto order today!

Vehicle Extrication1-59370-021-0/Softcover/$69US

Emergjncy Rescue Shoring Techniques-912212-59-4/Hardcover/April 2005/S69 US

TecRnTca! Rescue Operations Volume 21-59370-020-2/Hardcover/Si09 US

116 l u n e 2005 FfRE ENGINEERING

ORDINARY EXPOSURESBecause we don't work with radiation every day, there is a natu-

ral hut needless apprehension in dealing with radiation incidents.Most of our fears are overcome with factual information. The reali-ty of radiation is that although it does pose some dangers, it is a com-mon denominator in all of our lives and, in some cases, less danger-ous than other choices we make every day. Radiation has beenaround since the heginning of time.

We are exposed every day to multiple radiation sources includingcosmic, natural, and man-made radiation. An example of natural

1 radiation is radon. Man-made radiation isnot limited to nuclear weapons. If you are apolice officer, you may have tritium nightsights on your pistol. Anyone who has visitedthe local emergency room or dentist as apatient prohably has been exposed to X-rayradiation. Firefighters aren'i exempt either-Many departments install smoke detectorsfor individuals in the community, and theyhave radioactive sources in them as well.These sources do generate radioactive emis-sions, but the amount of radiation is so smallwe don't fear it. Every day we receiveapproximately I millirem (mRem) of radia-tion simply from radioactive sources affect-ing us from outer space. This is 365 mRemper year and is considered normal—the U.S.Environmental Protection Agency (EPA)does not even include it as part of the annu-al radiation dosage people receive.

Let's put the danger of "routine" radioac-tive exposure in perspective. We know wewill be exposed to at least 365 mRem ofradiation from outer space annually. TheEPA limits additional exposure from naturalsources at 100 mRem per year for the gener-al public. If you experience 100 mRem ofradiation every year, after 70 years, your lifeexpectancy might be shortened by 10 days.^

However, any number of other routineexposures, experiences, or life situationswill, on average, shorten one's life by muchmore. For example, according to statistics,alcohol abuse reduces life expectancy by oneyear; being 25 percent overweight by 777days^more than two years; and smoking apack of cigarettes a day by 2.250 days orroughly six years. Worse than that, being anunmarried male will reduce life expectancyby nearly 10 years, or 3.500 days; an unmar-ried female's life expectancy could bereduced by 1,600 days (3).

Another area of concern for both the gen-eral public and responders is the fear ofdeveloping cancer from excess radiation.Accurate information here can also reducethis fear. The EPA reports that in a samplepopulation of 10,000 people, it would expect

FireEng ineeri ng. com

The Day After: Response to Nuclear-Radiological Terrorism

2.000 (20 percent) to die from cancer that isnot attributed to radiation. The EPA esti-mates that if the entire group of 10,000 wereexposed to one Rem of ionizing radiationover the course of their lifetimes, anotherfive or six would die of cancer. This repre-sents approximately 0.06 percent ofincreased risk.*

These statistics do not imply that you canbe less careful when dealing with a suspectedradiation event, but it will give you somereassurance that, with good taetieal judg-ment and planning, you can do your jobeffectively. This preparation is essential pre-cisely because you will not need to use theinformation day in and day out—all themore reason to have contingency proceduresin place. You may think that your first-duewill never be the site of a radiological ter-rorist attack, but, unfortunately, the meansand desire are out there to hit you or yourneighbors. Joint planning and training is animportant component of preparing for aradiation dispersal device (RDD) attack.

"DIRTY BOMB" [RDD) AnACK POTENTIAL"hi the Wa-shington. D.C. region we are

tackling the possibility of a radiologicalattack witb a joint effort, with multiple juris-dictions around Washington workingtogether to attack radiological emergenciesthat occur bere." said Mike Sellitto. deputychief for special operations with the Districtof Columbia Fire Department.

Applied as an RDD or "dirty bomb."these effects could be devastating. TheUnited State.s Code has several definitionsof a weapon of mass destruction, but clearamong them is the use of "any weapon thatis designed to release radiation or radioac-tivity at a level dangerous to human life."-'

Is It possible for terrorists to have the abil-ity to strike America with a radioactive dis-persal device? Many articles on terrorism dis-cuss the ability of any would-be terrorist toobtain explosive materials at any time and inany city with a quick trip to a local feed/farmsupply store. But can they develop an RDD?Although a number of WMD professionalsand first responders have said they considerthe likelihood of an RDD attack on theUnited States limited because of the technicalknowledge required, one story that came outa few years ago should concern all involved.

In 1995 in Golf Manor, Michigan, a quietsuburb of Township, officials from the EPAwere scouring neighborhoods in baz-matsuits with various radiation detectors. In

their search, initiated by a curious policeofficer, they found that a local high schoolstudent working toward his Eagle Scout cer-tification had built a nuclear breeder teactotin his backyard. Working with enthusiasm,determination, and a little science knowl-edge, and employing mostly commonhousehold radiological sources, this teenag-er had built a nuclear reactor and created anenvironmental mess. Imagine the results ofthe same scenario involving a terrorist usingmore powerful radioactive materials andconventional explosives.

How dangerous actually was this reactor?The startling answer is that the reactor waspowerful enough to qualify parts of his neigh-borhtxxl for Superfund status. Dangerous lev-els of radioactivity were detected five doorsdown from where the teenager was buildingthis reactor. Although the cleanup only lasteda few days, it cost $60,000. Although thisteenager was not building a RDD and did nothave bad intentions with this project, thisepisode should demonstrate that it is possibleto synthesize and construct a nuclear deviceand that a terrorist could conceivably build adirty bomb.

EMERGENCY RESPONSE

As a first responder, you may be called torespond to an explosion involving the disper-sal of radioactive materials. Two types ofhealth effects for victims and responders arephysical injuries resulting from the detona-tion of the conventional explosive and theeffects of radiation exposure from the mate-rial used in the device. A standardized triagemethod such as START (simple triage andrapid transport) will help organize victimsinto appropriate treatment categories, buttriage in a radiological incident is different.Patients need to be categorized as cleanimmediate, delayed, walking wounded, ordead: and contam'muted immediate, delayed.walking wounded, or dead. I know this rais-es red flags, but patients must be triagecJ andsegregated based on their level of radiologi-cal contamination. This will be a complexprocess of first triaging patients based on thestandard method of green, yellow, red, orblack and then using a Geiger-Mueller orother radiation detector to locate contamina-tion sources and then direct patient move-ment into either a decon line or treatmentarea. For our purposes, patient contamina-tion may be indicated if readings indicatetwice that of background radiation readingswhen responders first arrive on-scene.

Wouldn't it be niceto see what you'recuning intoP

The Searchcams Mongoose"gives rescuers the edge in vehicleextrication. Use the smali cameraheadto quickiy assess injuriesand entrapment in hard-to-reach

areas.

SEARCH SYSTEMSI N C O R P O R A T E D

www.searchsystems.com800/722-2824-661/399-7107

Circle 174 or go to FireEngineering.com

Soe what Odyssey has tooffer from Basic Command

Cabinet systems to fullTurn-Key

Convoraions.

COMMAND VANS

FIRSTReSPOND€RS

CHIGF VGH CLES

MOBILE COMMANDPOSTS

L GHT RESCUES

HAZMAT TRUCKSAND TRAILERS

317 Richard Mine Rd. \A/harton. NJ O7aB5

8OO-5 3 5-9-441

FireEngineering.com Circle 175 or go to FireEngineering.com

The Day After: Response to Nuclear-Radiological TerrorismRegarding exposure and contamination, consider the following

analogy to radiation exposure and contamination. If you are sittingat a bar having a beverage, you are exposed to the beverage. As longas the beverage sits on the counter, there is no contamination. Shouldyou drink it or make an inappropriate advance and it gets poured onyou, then you are contaminated.

Since red flags have already been raised about treating patientswho have not been decontaminated, let me now add bright, blinkinglights to the situation and add that patients requiring immediatetreatment should be treated first and even transported to the ER with-out decontamination, other than clothing removal, if they requireimmediate treatment to save their lives.

"If you're an EMS responder and your job is to save lives, then savelives," says Major Craig Moss, a member of the Pentagon's CBRN(Chemical. Biologic. Radiologic. and Nuclear) Directorate. "You're get-ting 80 to 90 percent of the contaminant ofF just by removing theirclothes."

Treating patients without deconning them seems awkward at best, butthis is supported by the U.S. Department of Tmnsponation EmergencyResponse Guidebook. If a victim is exposed to even 25 Rem (the EPA'sthreshold for entering a situation only for lifesaving purposes), then thatperson has been exposed to tme-quarter of the threshold amount atwhich medical effects for acute radiation exposure are demonstratedand should be evacuated from the danger zone and treated.

"The golden hour clock doesn't stop just because a terrorist usesa dirty bomb. Most of these injuries are going to be from the con-ventional explosive and will need advanced care. Radiation shouldnot stop fire and rescue personnel from doing what they do best—•providing victims the best chance to live." says Moss.

For patients who are not critically injured, decon must be per-formed carefully and thoroughly. Although decon of radiological vic-tims could take an entire article on its own. I will highlight a few keyelements. First, perform a radiological assessment using a Geiger-Mueller or other radiation detector, slowly moving it over parts of thebody to locate any radioactive contamination. After this, victims willnot be subjected to the typical decon "drowning" that we routinelypractice in haz-mat drills. Instead, victims of radiological contamina-tion will be deconned using a "half-dry" decon method.

Typically, with dry decon, we are considering biological exposure.In this case, we u.se a decon method that will not flush contaminantinto the ground, sewer systems, and water tables—the SQIRT methodof decon: Spray (the clothes); Quarantine (or protect the airway);Incise (cut) the patient's clothing; Roll and remove the clothing; andTransfer the contaminated material to an overpack drum.

DRY OECONThe dry decon method starts wet; the victims are sprayed with squirt

bottles. This is done very minimally and is intended only to keep anyradioactive alpha or beta particulates from becoming airborne.

As usual. pr{)viders will concentrate on the patient's airway. It isimportant to keep the victim's airway protected from any dust thatdoes become airborne, so keep the airway "quarantined" and pro-tected by using a nonrebreather mask or HEPA filter mask.

Next, make two symmetrical cuts or incisions down the patient'sclothing. Make these cuts layer by layer, not through all the clothesat once.

After cuttting, clothing is rolled down the patient for removal andtransferred to an overpack drum. The patients can then be transferred

Eo the next decon stage in which they are wiped down with a tepidliquid solution to remove contaminant.

The patients are then reassessed for contamination with a radia-tion detector to determine if twice the level of background radiationis still present. If so. they may need to be redeconned or moved to aspecial casualty collection point for further specialized treatment.

SCENE MANAGEMENTAdditionally, among those things that must be done to manage the

scene are the Five Ss: Self, Size-up, Send information. Set up themedical group, and Stabilize the scene. Using a system like this tomake sure that all the bases are getting covered is very important.

Self. Nothing has changed from a bombing or chemical attack indealing with radiation. You should still hold your own safety as the mostimportant scene consideration. Rule One has always been to make ithome at the end of your shifl—injuring yourself or entering situationsthat require mitigation of some sort is reckless and inappropriate.

Size-up. Is this a conventional explosive blast or are there any indi-cations of radioactive materials? What do you see; how much of it; and.specifically, where are victims, structural damage, and so forth? Now.before you commit yourself to being the scene responder. stop. Reportwhat you see. What is typical of your scene, and what doesn't fit?

Send infurmation. Obtain and communicate good reliable infor-mation so that additional units including haz-mat teams can bedeployed. Federal Bureau of Investigation/police resources can beinformed, and hospitals can be prealerted. This is an enormous taskthat must be done: our professiunal dispatchers can do it with thecorrect information and appropriate direction.

Set up the medical group. Initiate triage and treatment sectors.Finally, on completion of the initial steps, help get the job done.Remember that victims of an RDD attack will possibly have multi-ple medical issues. Symptoms could include blast injuries from theconventional explosive used to disseminate the radioactive materialand burns from the explosive or from radioactive material.

Stabilize the scene. Control ingress and egress of victims andbystanders who want to help but may injure themselves in their efforts.

After reading this, fire and EMS responders will be more com-fortable providing their services a( a radiological incident scene.Training on measuring radiation and providing contaminated vic-tims with dry decon will mitigate this catastrophe more smoothlyshould it happen in your community. While the greal minds of thepast century such as Einstein. Fermi, and others made discoveriesthat eventually led to the development of these horrific weapons, youdon't have to be a genius to attack these events successfully andsafely, and the day after you can be back at the station house know-ing you tackled the task at hand. •

References1. Dc Marcnchcs. Count, and David R. Adelman, The Faurih World Wtir: Diplomacy

and Espionage in the Age of Terrorism. Morrow, 1992.

2. Clarke. T. "Refleciiims on Ihe golden jubilee of the first H-bomb tesi." Mature.November I, 2002. Available al ww"A.nalure,com/nsii/r5ii_pf/()2102S'l{),himl.

3. "General Employee Radiological Training." TMS course ESH738. AdvancedPhoton Source. U.S. Department of F.nergy. May IW9. Available al hllp://www.aps.anl.gtiv/u.ser/gert/gertl.hlml.

4. Hnvinmmcntal Protection Agency. "Understanding Radialicin." March 4. 2<KM.Available at http://www.epa.gov/radiation/undersland/health_effects.htm,

5. tJnited Statesi Code IS. Part I-Crimes. Chapter 1 LIB-Terrorism. Sec. 2332a. C 2 d.

118 J u n e 2005 FIRE ENGINEERING FireEngineering. com