Description Abstract-In the present report, ICRP provides information on radiation doses to the infant due to intakes of radionuclides in maternal
milk. As in Publication 88 (ICRP, 2001) on doses to the embryo and fetus following intakes of radionuclides by the mother, intakes
by female members of the public and female workers are addressed. Acute and chronic intakes are considered at various times before and
during pregnancy as well as during the period of breastfeeding. Dose coefficients per unit intake by the mother (Sv/Bq) are given for
the selected radionuclides of the same 31 elements for which age-specific biokinetic models were given in Publications 56, 67, 69,
and 71 (ICRP, 1989, 1993, 1995a,b). For these elements, doses were calculated for the most radiologically significant natural or
artificial radionuclides that might be released into the environment due to various human activities. Dose coefficients are also given
in this report for radionuclides of an additional four elements: sodium, magnesium, phosphorus, and potassium.
Relevant human and
animal data on elemental and radionuclide transfer to milk are reviewed. The biokinetic models for adults given in earlier ICRP publications
are adapted to include transfer to milk. Model predictions of fractional transfer of ingested or inhaled activity to milk are discussed
in the report, and the corresponding dose coefficients for the infant are compared with dose coefficients for in utero exposure, as given
in Publication 88 (ICRP, 2001). Illustrative information is also given on doses to the female breast from radionuclides in breast
milk, and external doses received by the child from radionuclides retained in the tissues of the mother. For the additional elements
considered in this report, but not in Publication 88 (ICRP, 2001), information is also given on doses to the embryo and fetus
following maternal intakes of radioisotopes during or before pregnancy.
A CD-ROM is to be issued giving data that will supplement
the information given in this report. In addition to the dose coefficients given here, committed equivalent doses to the various organs
and tissues of the offspring will be given. Dose coefficients will also be given for inhalation of a range of aerosol sizes for the selected
radionuclides of the elements covered by this report. Keywords: Dose coefficient; Maternal intake; Milk; Infant dose; Ingestion;
Inhalation
Contents ABSTRACT
GUEST EDITORIAL
PREFACE 5
EXECUTIVE SUMMARY 8
1. INTRODUCTION 17
BACKGROUND 17
Security of Radiation Sources 17
Radiation-Related
Malevolence 18
AIM OF THE REPORT 19
INTENDED AUDIENCE 21
2. CHARACTERIZING THE SITUATION 22
POTENTIAL SCENARIOS 22
Threat 22
Initiators
23
Common Features 24
SPECIAL FEATURES 25
Location 25
Public Perception 25
Source Term Characterization 26
Covert Situations 26
Public
Sentiment 27
Advance Warning 27
Criminal Investigation 28
Challenges 29
PLANNING 29
?All-hazard? Planning 30
Disaster Management 31
Medical
Preparedness 31
Psychological Issues 32
Exercises 33
EXPOSURE 34
Quantification 34
Pathways 36
INITIAL REACTION 38
Reacting to an Explosion
38
Reacting to an IND 38
RESPONSE PHASES 39
Rescue and Early Actions 39
Recovery 40
Restoration 40
LINKS 40
3. POTENTIAL HEALTH EFFECTS
ATTRIBUTABLE TO RADIATION EXPOSURE 42
BIOLOGICAL HEALTH EFFECTS 42
Deterministic effects 42
Stochastic effects 43
Prenatal exposure effects
43
Other issues with pregnant women and children 45
Special considerations for INDs 45
Summary of Biological Health Consequences 46
PSYCHOLOGICAL
HEALTH EFFECTS 46
Distress 47
Fear of Cancer and other Health Effects attributable to Radiation 47
4. PROTECTING RESPONDERS 48
OCCUPATIONAL PROTECTION APPROACH 49
Occupational Dose Guidelines 50
OCCUPATIONAL PROTECTION TECHNIQUES 52
Managing Field Exposures 52
Protective Clothing
53
Respiratory Protection 54
5. PROTECTING THE PUBLIC 54
RESCUE PHASE (IMMEDIATE ACTIONS) 54
Controlling access and spread of contamination
55
Immediate care of people with traumatic injuries 56
Triage Dose Assessment 58
Psychological triage and disposition 59
Respiratory
protection 60
RESCUE PHASE (URGENT ACTIONS) 60
Personal Decontamination 60
Sheltering 61
Evacuation 64
Iodine Prophylaxis 66
RECOVERY
PHASE 68
Refined Dose Assessment 68
Biological assays 68
Temporary Relocation and Resettlement 70
RESTORATION PHASE 71
Cleanup 71
Management
of Radioactive Waste 73
Radioactive Residues 74
Discontinuation of Protective Actions 75
Final dose assessment 76
SUMMARY OF DOSE CRITERIA
FOR PROTECTING THE PUBLIC 77
Generic Optimized Protection Levels 77
Operational Levels 78
CONTROLLING CONTAMINATION OF CONSUMER GOODS
78
Basic Criteria 79
International consensus on radiological criteria for radionuclides in commodities 80
Radionuclides in Bulk Amounts
of Materials 80
Radionuclides in Foods 81
Radionuclides in Water Supplies 82
Control in the Affected Area 84
Control Outside the Affected
Area 84
PARTICULAR SITUATIONS 84
Handling Situations with ?Hot Particles? 84
Handling Contaminated Corpses 85
6. MEDICAL INTERVENTION
87
ESSENTIAL ELEMENTS OF MEDICAL TREATMENT 87
OTHER IMPORTANT MEDICAL ISSUES 89
Identification of radionuclides 89
Secondary treatment
centers 89
Biodosimetry 90
Skilled personnel 90
Training Medical Personnel 91
Long term follow-up 91
7. COMMUNICATION 92
REFERENCES 94
ANNEX I: TERMINOLOGY 99
ANNEX II: POTENTIAL SCENARIOS 110
Malicious Intent 110
Unannounced Events 110
Thefts 110
Radiation Exposure Devices
111
Radioactive Dispersion Devices 111
Site-Specific Radioactive Contamination 112
Radioactive Contamination of Food and Water Supplies
113
Attacking Nuclear Facilities 113
Improvised Nuclear Devices 114
ANNEX III: MEDICAL ISSUES 115
PLANNING FOR PUBLIC HEALTH & MEDICAL
INTERVENTION 115
Threats 115
Unannounced Events 115
Irradiation 115
Contamination of food and water supplies 116
RDDs 117
Attack upon
a nuclear facility 117
RELEVANT INFORMATION FOR IMMEDIATE MEDICAL PROGNOSIS AND INITIAL TREATMENT OF RADIATION EFFECTS ATTRIBUTABLE TO
EXTERNAL RADIATION 117
Prodromal phase of acute radiation syndrome 119
Change of lymphocyte counts in the initial days of acute radiation
syndrome depending on the dose of acute whole body exposure 121
Latent phase of acute radiation syndrome 121
Findings of critical phase
of acute radiation syndrome following whole body exposure 122
Principal therapeutic measures for acute radiation syndrome according to
degree 123
Onset time of clinical signs of skin injury depending on the dose received 123
THERAPIES FOR INTERNAL CONTAMINATION 124
Blocking,
diluting and displacement agents 124
Reduction of gastrointestinal absorption 126
Chelating agents 127
THERAPIES FOR EXTERNAL EXPOSURE
128
Prevention and treatment of infections 129
Maintenance of fluid and electrolyte balance 129
Specific treatments of bone marrow depression
130
Radioprotective agents 133
ANNEX IV: PSYCHOLOGICAL ISSUES 134
COMMUNICATION BETWEEN CARE PROVIDERS AND PATIENTS 136
DEBRIEFING 138
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