Description Abstract - There is a need for professional advice on measures to be undertaken should a radiological attack occur. This report
reaffirms the applicability of existing ICRP recommendations to such situations. It is mainly concerned with attacks involving 'radiological
dispersion devices'. Many aspects of emergency scenarios after a radiological attack may be similar to those arising from radiological
accidents, but there are also differences. For instance, a radiological attack would probably be targeted at a public area, possibly
in an urban environment, where the presence of radiation is not anticipated and the dispersion conditions commonly assumed for emergencies
in nuclear facilities may not be applicable. First responders and rescuers need to be adequately trained and have the proper equipment
to identify radiation and radioactive contamination. Radiological protection specialists must be available to provide advice. It may
be prudent to assume that radiological, chemical, and/or biological agents are involved until proven otherwise. This calls for an 'all-hazard'
approach to the response. The main aim must be to prevent acute health effects of a 'deterministic' nature and restrict the likelihood
of late health effects of stochastic nature such as cancer and hereditary effects. A supplementary aim is to minimise environmental contamination
and general disruption. Actions to avert exposures are much more effective than possible medical treatment after exposure has occurred.
Responders at recovery and restoration should be protected according to normal occupational standards and dose limits. This restriction
may be relaxed for informed volunteers undertaking urgent rescue operations, and is not applicable for volunteered life-saving actions.
However, specific protection measures are recommended for female workers who may be pregnant or nursing an infant. The immediate
countermeasures to protect the public in the rescue phase are primarily caring for people with traumatic injuries and controlling access.
Subsequent actions include respiratory protection, personal decontamination, sheltering, iodine prophylaxis (if radioiodines are involved)
and temporary evacuation. In the recovery phase, definitive relocation and resettlement may be needed in extreme cases. This phase may
require restoration and cleanup, management of resulting radioactive waste, management of corpses containing significant amounts of radioactive
substances, and dealing with long-term exposure caused by remaining radioactive residues. The guidance is based solely on radiological
protection considerations and should be seen as a decision-aiding tool to prepare for the aftermath of a radiological attack. It is expected
to serve as input to a final decision-making process that may include other societal concerns, consideration of lessons learned in the
past, and the participation of stakeholders. A radiological attack could cause radioactive contamination of consumer goods such
as water, food and other commodities. This possible outcome, however, is unlikely to lead to significant internal contamination of a
large number of people due to the large amounts of radioactive material that would be required to reach high levels of contamination.
Intervention measures in the aftermath of the radiological attack should result in a systematic and flexible approach, taking into account
the conditions and invoking actions as warranted by the circumstances. Many potential scenarios clearly cannot induce immediate severe
radiation injuries. In order to prevent overreaction, radiological protection decisions must be proportional to the magnitude of the
radiological attack.
Contents ABSTRACT
GUEST EDITORIAL
PREFACE
EXECUTIVE SUMMARY
1. INTRODUCTION
BACKGROUND
Security of Radiation Sources
Radiation-Related Malevolence
AIM OF THE REPORT
INTENDED AUDIENCE
2. CHARACTERIZING THE SITUATION
POTENTIAL SCENARIOS
Threat
Initiators
Common Features
SPECIAL
FEATURES
Location
Public Perception
Source Term Characterization
Covert Situations
Public Sentiment
Advance Warning
Criminal Investigation
Challenges
PLANNING
?All-hazard? Planning
Disaster Management
Medical Preparedness
Psychological Issues
Exercises
EXPOSURE
Quantification
Pathways
INITIAL REACTION
Reacting to an Explosion
Reacting to an IND
RESPONSE PHASES
Rescue and Early Actions
Recovery
Restoration
LINKS
3. POTENTIAL HEALTH EFFECTS ATTRIBUTABLE TO RADIATION EXPOSURE
BIOLOGICAL HEALTH EFFECTS
Deterministic effects
Stochastic
effects
Prenatal exposure effects
Other issues with pregnant women and children
Special considerations for INDs
Summary of Biological
Health Consequences
PSYCHOLOGICAL HEALTH EFFECTS
Distress
Fear of Cancer and other Health Effects attributable to Radiation
4. PROTECTING
RESPONDERS
OCCUPATIONAL PROTECTION APPROACH
Occupational Dose Guidelines
OCCUPATIONAL PROTECTION TECHNIQUES
Managing Field Exposures
Protective Clothing
Respiratory Protection
5. PROTECTING THE PUBLIC
RESCUE PHASE (IMMEDIATE ACTIONS)
Controlling access and spread
of contamination
Immediate care of people with traumatic injuries
Triage Dose Assessment
Psychological triage and disposition
Respiratory
protection
RESCUE PHASE (URGENT ACTIONS)
Personal Decontamination
Sheltering
Evacuation
Iodine Prophylaxis
RECOVERY PHASE
Refined
Dose Assessment
Biological assays
Temporary Relocation and Resettlement
RESTORATION PHASE
Cleanup
Management of Radioactive Waste
Radioactive Residues
Discontinuation of Protective Actions
Final dose assessment
SUMMARY OF DOSE CRITERIA FOR PROTECTING THE PUBLIC
Generic Optimized Protection Levels
Operational Levels
CONTROLLING CONTAMINATION OF CONSUMER GOODS
Basic Criteria
International consensus
on radiological criteria for radionuclides in commodities
Radionuclides in Bulk Amounts of Materials
Radionuclides in Foods
Radionuclides
in Water Supplies
Control in the Affected Area
Control Outside the Affected Area
PARTICULAR SITUATIONS
Handling Situations with ?Hot
Particles?
Handling Contaminated Corpses
6. MEDICAL INTERVENTION
ESSENTIAL ELEMENTS OF MEDICAL TREATMENT
OTHER IMPORTANT MEDICAL
ISSUES
Identification of radionuclides
Secondary treatment centers
Biodosimetry
Skilled personnel
Training Medical Personnel
Long term
follow-up
7. COMMUNICATION
REFERENCES
ANNEX I: TERMINOLOGY
ANNEX II: POTENTIAL SCENARIOS
Malicious Intent
Unannounced Events
Thefts
Radiation Exposure Devices
Radioactive Dispersion Devices
Site-Specific Radioactive Contamination
Radioactive Contamination of Food
and Water Supplies
Attacking Nuclear Facilities
Improvised Nuclear Devices
ANNEX III: MEDICAL ISSUES
PLANNING FOR PUBLIC HEALTH &
MEDICAL INTERVENTION
Threats
Unannounced Events
Irradiation
Contamination of food and water supplies
RDDs
Attack upon a nuclear facility
RELEVANT INFORMATION FOR IMMEDIATE MEDICAL PROGNOSIS AND INITIAL TREATMENT OF RADIATION EFFECTS ATTRIBUTABLE TO EXTERNAL RADIATION
Prodromal phase of acute radiation syndrome
Change of lymphocyte counts in the initial days of acute radiation syndrome depending on
the dose of acute whole body exposure
Latent phase of acute radiation syndrome
Findings of critical phase of acute radiation syndrome
following whole body exposure
Principal therapeutic measures for acute radiation syndrome according to degree
Onset time of clinical
signs of skin injury depending on the dose received
THERAPIES FOR INTERNAL CONTAMINATION
Blocking, diluting and displacement agents
Reduction of gastrointestinal absorption
Chelating agents
THERAPIES FOR EXTERNAL EXPOSURE
Prevention and treatment of infections
Maintenance of fluid and electrolyte balance
Specific treatments of bone marrow depression
Radioprotective agents
ANNEX IV: PSYCHOLOGICAL
ISSUES
COMMUNICATION BETWEEN CARE PROVIDERS AND PATIENTS
DEBRIEFING
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