What to do to prepare for a nuclear accident

1-800-BE-READY (237-3239)

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Hotlines for information:

• CDC at 800-CDC-INFO
• 1-800-BE-READY
• The Conference of Radiation Control Program Directors at 502-227-4543
• The Nuclear Regulatory Commission Office of Public Affairs can be contacted at 301-415-8200
• The Federal Emergency Management Agency (FEMA) can be reached at 202-646-4600
• The Radiation Emergency Assistance Center/Training Site at 865-576-3131

• The U.S. Department of Energy (DOE) at 800-DIAL-DOE

 

SHOWER AND SHELTER -

WHAT TO DO AT HOME AFTERWARDS

This information is from peer reviewed medical journals.

"The public response should be “shelter and shower.” Sheltering (particularly at home) is prudent early in a radiologic event, because families congregate at home and showers, clean clothing, food, and water are available. Sheltering also provides authorities time to assess the situation more completely. Evacuation might be indicated later for people in some locations, depending on the specific situation and the extended dose estimates. In other locations, remaining sheltered may result in lower radiation exposure." (Flynn D., 2006)

"Exposed skin and hair should be cleansed with soap and water repeatedly..."(Udeani J., 2002)

"Removing clothing alone can decrease external radioactive contamination by 90%.

Washing with soap and lukewarm or room-temperature water is effective and removes another 90% of contamination (about 99% of the total is removed after both steps have been performed)." (Flynn D., 2006)

Medications to take within 4 hours: Potassium Iodide

If you do not have the pill now- home remedy (not proven)

 

Radiation Emergencies - what to do from the CDC

 

Pueblo.gov information on Nuclear and Radiological Attacks - what to do before, during & after

 

What to do in case of nuclear threat 1-800-BE-READY

 

What to do if there is a radiation threat or 'dirty bomb'

 

How You Can Limit Contamination

 

What you can do - preparation

 

Sheltering in Place during a Radiation Emergency

 

Types of disasters from FEMA

 

Nuclear emergency: What would you do?

 

NIMS- National Incident Management System

 

State by state emergency management offices (FEMA) phone numbers

 

Health Concerns

Acute Radiation Syndrome

THE TREATMENT OF BURNS - Atomic Bombing: How to Protect Yourself

"The first thing to remember about a burn, no matter how severe or slight, or what the cause, is to keep it from getting infected. In other words, keep germs out, just as you are careful to keep germs out of an open cut or other wound...In case of an atom bomb attack, and often in other cases of burn injuries, it may not be possible to get the victim to medical aid very quickly. In such a case, put a sterile dressing on the burn to cover it and protect it both from the air and from germs."

Mass Casualties: Burns- not related to radiation but intersects

 

Journal articles

 

Nuclear terrorism: triage and medical management of radiation and combined-injury casualties. (includes abstract) Flynn DF; Surgical Clinics of North America, 2006 Jun; 86 (3): 601-36.

link - This link will work if you are logged into your local public or school library database. Full text likely available.

Quote: "This article addresses the medical effects of nuclear explosions and other forms of radiation exposure, assessment of radiation dose, triage of victims, definitive treatment of radiation and combined-injury casualties, and planning for emergency services after a terrorist attack involving a nuclear device. It reviews historical events of mass radiation-induced casualties and fatalities at Hiroshima, Chernobyl, and Goiania, and discusses various scenarios for nuclear terrorism."

The first phase of treatment in a hospital:

"During the first 72 hours the initial phase of treatment will be directed toward treatment of trauma and burns, external decontamination, and very early initiation of potassium iodide, where appropriate. After detonation of a nuclear weapon, most casualties will be combined-injury patients. Emergency surgical care involves resuscitation, control of hemorrhage, and minimization of sepsis with débridement techniques."

Decontamination instructions:

"Removing clothing alone can decrease external radioactive contamination by 90%.

Washing with soap and lukewarm or room-temperature water is effective and removes another 90% of contamination (about 99% of the total is removed after both steps have been performed). Soap emulsifies and dissolves most contaminants. Wounds and body orifices usually are decontaminated first. Wounds should be rinsed with saline. To prevent cross-contamination, wounds and burns should be covered with waterproof dressings before the skin is decontaminated. Abrasions and lacerations usually are relatively easy to decontaminate. Stubborn contamination may be excised from lacerations. Puncture wounds, most often on the hands, are sometimes difficult because of poor access to the contaminants and difficulty in determining the degree and depth of contamination. Irrigation with standard water picks may be successful. Burns should be rinsed gently with water and cleared of debris. In patients whose burns cannot be completely decontaminated, most of the contamination will remain in the burn eschar when it sloughs. Some patients may have imbedded metal fragments (shrapnel). When metallic shrapnel is removed, it should be evaluated for radioactivity and either shielded or placed in a safe location. Potentially radioactive fragments should be handled with forceps, not with gloved hands. Contaminated wastewater can be released into sewers without restriction. For intact skin, a wet washcloth and basin (with or without a low-velocity, low-volume water spray) may be used to remove a significant amount of superficial contamination. Gentle brushing may help remove contamination from the skin, but care should be taken not to damage the skin, because some contamination could be absorbed through injured skin. Experience has shown that shampoo can be effective for skin decontamination in addition to soap, if soap alone is inadequate. On some occasions, povidone-iodine can be used as an antiseptic-germicide on the intact skin. It has the added benefit of nonradioactive iodine absorption through intact skin to block the thyroid partially when there is internal contamination from radioactive iodine-131. Hair can be decontaminated with any commercial shampoo. Cutting or clipping the hair, if appropriate, can remove contaminants, but cutting the eyebrows should be avoided, because they may not grow back. Fingernails and toenails should be checked and cut if necessary."

"DECONTAMINATION TEAM DRESS:

Caregivers should follow strict isolation-type procedures (universal precautions). Barrier clothing is worn, including cap, mask, eye protection, gown, gloves, and shoe covers. All seams and cuffs should be secured with masking tape. Ideally, a dosimeter should be worn at the collar level. A complete surgical scrub suit ideally would include a plastic apron or waterproof gown for use when washing contaminated patients and double gloves, with the inner gloves taped to the scrub suit, to prevent cross contamination, because glove changes may be necessary."

"The decontamination-treatment area for those injured needs to be delineated and, if possible, established in an area away from the main flow of emergency department activity, near a separate emergency department entrance. It should be appropriate for both emergency medical care and decontamination, with access to water. Ideally, the floor should be covered and with taped-down nonskid plastic sheets (however, butcher's paper or other appropriate covering may be substituted)."

"Skin decontamination needs to be done early because reducing the time radioisotopes remain in direct contact with the skin lessens the severity of the radiation burn that develops later [5], [16]. In contrast to thermal burns, which appear almost immediately, the development of radiation burns takes weeks to evolve fully."

"Infections are a major cause of mortality in the irradiated host because of immunosuppressive effects that result from declining lymphohematopoietic elements secondary to radiation-induced bone marrow aplasia (reversible or irreversible). After wounds or burns have been débrided, topical antibiotics should be used, and the wound should be covered with nonadherent dressings."

SHOWER AND SHELTER - WHAT TO DO AT HOME

"Massive amounts of contamination are injected into the lower atmosphere, producing a downwind radioactive plume containing radioactive dust and particles. Prolonged contact with fallout on the skin can result in serious skin damage plus increased whole-body dose. Therefore, the public response should be “shelter and shower.” Sheltering (particularly at home) is prudent early in a radiologic event, because families congregate at home and showers, clean clothing, food, and water are available. Sheltering also provides authorities time to assess the situation more completely. Evacuation might be indicated later for people in some locations, depending on the specific situation and the extended dose estimates. In other locations, remaining sheltered may result in lower radiation exposure."

 

Management of nuclear casualties. (includes abstract) Udeani JC; Topics in Emergency Medicine, 2002 Jun; 24 (2): 40-6, 79-82. Link - This link will work if you are logged into your local public or school library database. Full text likely available.

Quote: "Radioactive agents pose a significant threat to the efficient operation of any emergency department and challenge the ability of emergency physicians to provide lifesaving patient care. A well-planned, organized system of triage and hospital preparedness is critical. All health care providers involved in the early treatment of these patients must understand the clinical presentations, treatment options, and preventive measures to prevent further contamination of other individuals. This article reviews some of the important concepts in management of nuclear catastrophes"

"Four mechanisms ofinjury are implicated in
trauma caused by explosions. Primary blast
injuries are the direct effects of rapid increases
in atmospheric pressure causing barotrauma.
Most of the primary blast wave
injuries tend to affect areas of tissue-fluid/
gas interface and result in most on-scene
deaths.^'' The most common organ affected is
the ear (tympanic membrane rupture). Patients
with ruptured tympanic membranes
have been exposed to pressures usually exceeding
15 psi.^"'' In a case series of 647 survivors
of bombings in Israel from 1994 to
1996, 29.8% of them had blast injuries; of
those injuries, 89.6% had tympanic membrane
injuries.^ The most common injury to the tympanic
membrane involves a linear tear to the
inferior portion of the eardrum.
Primary blast injuries to the lung produce
the most profoimd and serious life-threatening
problems to victims. Tliese injuries result from
a rapid increase in intrathoracic pressures. Victims
may suffer from a whole range of problems
including pneumothoraces, contusions,
subpleural petechiae, and parenchymal hemorrhages.
In addition, local disruption of blood
vessels in close proximity to air-filled spaces
may cause a bronchopleural fistula. Arterial air
embolism to the brain or heart may be the
most common cause of rapid death in initial
survivors of blast injuries.*' Blast injuries to the
howel involve mechanisms similar to pulmonary
injuries. Hematomas, petechiae, and
perforation are commonly encountered.*'"
Secondary' blast injuries are penetrating
trauma induced by flying debris. The blast
wind, which immediately follows the blast
wave, is a displacement of air that accelerates
debris. Tertiary injuries occur when the victim
is propelled by blast wind."^ Blunt and penetrating
traumas account for most of these injuries
and are usually seen in victims close to
the blast. Finally, quaternary' blast injuries are
miscellaneous blast events that include exposure
to toxic gases, radiation, bums, and crush
injuries sustained from collapsing buildings."

"Exposed skin and hair should be cleansed
with soap and water repeatedly until the
dosimeter readings are minimal."

 

Harrison TW. Gustafson EM. Dixon JK. Radiologic emergency: protecting schoolchildren & the public. [Journal Article, CEU, Exam Questions, Pictorial, Review] American Journal of Nursing. 2003 May; 103(5): 41-50. (35 ref)
AN: 2003080375.


Quotes:
'Public tap water would probably be safe to use during the first few hours after a radioactive release because it would be in underground pipes that had not yet been contaminated. It should be collected and stored in clean containers.'

'A full discussion of sheltering considerations in a variety of emergencies and disasters is contained in the FEMA publication Are You Ready? A Guide to Citizen Preparedness, available online at www.fema.gov/areyouready ., a few points of which should be emphasized. Existing and prospective shelters should be identified in advance. In a radiologic emergency, again, the best shelter would be determined by the nature of the event, the distance from the source of contamination, and many other factors. If an explosion of a nuclear device, dirty bomb, or compromised reactor core were imminent, finding shelter below ground to protect against explosion would be best (should there happen to be warning in advance of such an event). However, if the hazard consists of airborne contaminants only, people should not go to basement areas or to the top floor of a building because radioactive contaminants settle on the ground and on roofs. Rooms and other spaces above ground provide better shelter—preferably interior halls or rooms without windows or ventilation open to the outside, such as air conditioners and fireplaces. Otherwise, windows, vents, air conditioning, fireplaces, and all other routes by which outside air might enter the shelter should be closed and sealed, if possible.'

 

A review of triage and management of burns victims following a nuclear disaster. Kumar P; Burns (03054179), 1994 Oct; 20 (5): 397-402. Link- This link will work if you are logged into your local public or school library database.

Disaster triage of massive casualties from thermonuclear detonation. (includes abstract) Laurent CL; Journal of Emergency Nursing, 1990 Jul-Aug; 16 (4): 248-51. Link - This link will work if you are logged into your local public or school library database.

Medications to help

Potassium Iodide (KI)- buy it here

DTPA
Prussian Blue
Neupogen

More about potassium Iodide:

"These numbers represent the best current thinking in terms of daily dosage of potassium iodide to protect the thyroid, said Dr. David Orloff of the Food and Drug Administration. He emphasized that the overall benefits of protective KI far exceed the risks of overdosing, especially in children.

* Adults (older than 18 years): 130 mg

* Pregnant or lactating women: 130 mg

* Newborns (up to 1 month old): 16 mg

* Infants (aged 1 month to 3 years): 32 mg

* Children 3-18 years: 65 mg *

* Teens weighing more than 150 pounds should take the adult dosage.

Source: "Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies," www.fda.gov/cder/guidance/4825fnl.htm

Patients can buy Iosat at www.anbex.com.

Information about KI is available from the FDA at www.fda.gov/cder/drugprepare/KI_Q&A.htm." (Splete, H., 2003)

How it works (in layman's terms)

"Experts agree that radioactive iodine and cesium, commonly used in cancer therapy and industrial radiography, are the most likely ingredients of a dirty bomb. How to minimize the damage? Start by wearing a mask--the thicker, the better. Then pop these chemical cures.

POTASSIUM IODIDE The thyroid is the only organ that collects iodine, so strike first. "Each thyroid cell is a parking lot with a specific number of spaces," explains Andrew Karam, Ph.D., a founding member of the Health Physics Society's Homeland Security Committee who, while in the navy's nuclear-power program, was contaminated 30 times. "If you put stable iodine in there first, you block the radioactive stuff." Potassium iodide is available online at KI4U.com. Take up to 130 milligrams (mg) as soon as you can after the blast.

PRUSSIAN BLUE Cesium likes to attack blood cells. Don't let it. This iron compound binds to the radioactive particles and escorts them out of the body through urine. (The urine turns blue, which would be cool under different circumstances.) Take 1 to 2 mg twice a day for up to 3 weeks after exposure, says Karam." (Schipper, D., 2005)

"Can I give it to my pets?

There have been no studies concerning animals and the administration of Potassium Iodide for radiation emergencies. Like humans, animals do not normally have any allergic reaction to limited doses of Potassium Iodide. For animals with no known iodine allergies (ask your vet) it is a relatively safe drug. If you wish to administer it to your pet, follow the human dosage amounts listed below in the "What is the dosage?" info and give the appropiate dosage based upon weight. For instance, the dosage for a 2-year-old child would be 32mg (1/4 tablet). If an average 2-year-old weighs 25 -30 lbs., a dog weighing the same would take the same dosage, 32mg (1/4 tablet). If a 2-week-old infant weighs on average 9 pds., then you would give a 9 pound cat/dog 16mg (1/8 tablet). Crush it up and put it in their food. Please consult with a vet in advance to make sure your pet can safely take Potassium Iodide (found in table salt, fish oil, kelp, daily vitamins, etc.)" preparedness.com

If you do not have the pills now -home remedies

and myth busters

"Researchers at Pennsylvania State University's medical center in Hershey have stumbled onto what may be an effective home remedy to prevent serious radioactive contamination of the thyroid gland from iodine-131 emitted in the event of a major nuclear plant mishap. They swab the skin with a tincture of iodine...the effective dose in rats suggests human skin swabbing need only cover an area the size of a hand or scraped knee" (Science News, 1985) link to article This article is discussed by it's author here. The followup study done in 1989 stated "Topical application of tincture of iodine (I) was found to be effective in blocking the thyroid uptake of orally administered 131I in humans." Depending on the amount and the person. (Miller, K., 1989) link to article

Though I cannot vouch for these sources they are online webpages stating topical iodine is helpful for radiation.

"And lacking an oral source of iodine, applying 2 percent tincture of iodine to the skin works almost as well. Painting iodine on the abdomen in a 4 x 8 inch patch blocks thyroidal radioiodine uptake by 95 to 99 percent. " Google scholar article, also mentioned in this masters of nursing paper

"If no tablets available, you can topically (on the skin) apply an iodine solution, like tincture of iodine or Betadine, for a similar protective effect. Iodine solutions are NEVER to be ingested or swallowed, and should not be used if allergic to iodine."

"It is poisonous to ingest (drink/swallow) elemental iodine, iodine tablets (widely sold for water purification), tincture of iodine, or Povidone-iodine solutions (like the Betadine® brand solution). They are all both ineffective for thyroid-blocking and very dangerous, perhaps even fatal to have a child drink any of them.

However, there has been some promising research, though, with both humans and dogs into topically (on the skin) applied Povidone-Iodine (10%) solution (such as Betadine® or Povidex® solutions), and also with tincture of iodine, to test the absorption rates of iodine directly, and safely, through the skin." ki4u

Some websites also claim:

"If no tablets available, you can topically (on the skin) apply an iodine solution, like tincture of iodine or Betadine, for a similar protective effect. (WARNING: Iodine solutions are NEVER to be ingested or swallowed.) For adults, paint 8 ml of a 2 percent tincture of Iodine on the abdomen or forearm each day, ideally at least 2 hours prior to possible exposure. For children 3 to 18, but under 150 pounds, only half that amount painted on daily, or 4 ml. For children under 3 but older than a month, half again, or 2 ml. For newborns to 1 month old, half it again, or just 1 ml. (One measuring teaspoon is about 5 ml, if you don't have a medicine dropper graduated in ml.) If your iodine is stronger than 2%, reduce the dosage accordingly. Absorption through the skin is not as reliable a dosing method as using the tablets, but tests show that it will still be very effective for most. Do not use if allergic to iodine." nukalert

 

FOODS

"DO NOT MAKE A FUTILE, HARMFUL ATTEMPT TO EAT ENOUGH IODIZED SALT TO RESULT IN THYROID BLOCKING. Iodized salt contains potassium iodide, but in such a low concentration that it is impossible to eat enough iodized salt to be helpful as a blocking agent." OISM

"Certain foods contain substances which are metabolized to 5-vinyloxazolidine-2-thione and thiocyanate. 5-Vinyloxazolidine-2-thione and thiocyanate may compete with iodide and negatively affect the iodine status of the thyroid gland and may cause hypothyroidism. These food substances are called goitrogens and are found in foods such as cassava and such cruciferous foods as cabbage, Brussels sprouts, broccoli, cauliflower and rutabaga. Certain flavonoids may have goitrogenic activity. C-gluosylflavones such as vitexin, which are found in millet, have been found to inhibit thyroid peroxidase activity. The soybean isoflavones genistein and daidzein have also been found to inhibit thyroid peroxidase."

 

VITAMINS that help with radiation

 

Bairati I (2005). Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients. (includes abstract) Journal of Clinical Oncology, Aug 20; 23 (24): 5805-13.

This article cites:

.# The alpha-tocopherol, beta-carotene lung cancer prevention study: Design, methods, participant characteristics, and compliance—The ATBC Cancer Prevention Study Group. Ann Epidemiol 4:1-10, 1994[Medline]
# Omenn GS, Goodman GE, Thornquist MD, et al: Risk factors for lung cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial. J Natl Cancer Inst 88:1550-1559, 1996[Abstract/Free Full Text]
# Ferreira PR, Fleck JF, Diehl A, et al: Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: A double-blind randomized trial. Head Neck 26:313-321, 2004[CrossRef][Medline]
# Mills EE: The modifying effect of beta-carotene on radiation and chemotherapy induced oral mucositis. Br J Cancer 57:416-417, 1988[Medline]
# Sanchiz F, Milla A, Artola N, et al: Prevention of radioinduced cystitis by orgotein: A randomized study. Anticancer Res 16:2025-2028, 1996[Medline]
# Metz JM, Smith D, Mick R, et al: A phase I study of topical Tempol for the prevention of alopecia induced by whole brain radiotherapy. Clin Cancer Res 10:6411-6417, 2004[Abstract/Free Full Text]
# Halperin EC, Gaspar L, George S, et al: A double-blind, randomized, prospective trial to evaluate topical vitamin C solution for the prevention of radiation dermatitis: CNS Cancer Consortium. Int J Radiat Oncol Biol Phys 26:413-416, 1993[Medline]
Bairati I, Meyer F, Gélinas M, et al: Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients. J Clin Oncol 23:5805-5813, 2005

 

(1985). Tincture of iodine keeps radiation away. (possible home remedy in event of nuclear plant mishap). Science News. Dec 7, 128 p360(1). link to article

Miller, K.L. (1989). Effectiveness of skin absorption of tincture of I in blocking radioiodine from the human thyroid gland. Health Physics [Health Phys], 56 (6), pp. 911-4. link to article

Splete, H. (2003). Handling a nuclear incident: potassium iodide. (Some Regional Distribution Plans in Place). Internal Medicine News, 36 (8). p8(1).

Schipper, D. (2005). Pills that protect you.(Cesium and Potassium iodide in radiography). Men's Health, 20 (7). p138.

Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients. (includes abstract) Bairati I; Journal of Clinical Oncology, 2005 Aug 20; 23 (24): 5805-13. (journal article - clinical trial, research, tables/charts) PMID: 16027437 CINAHL AN: 2009157768


Spare tactics: advances in radiation therapy include techniques that help keep surrounding tissue healthy. Kinsley M; Nursing Spectrum -- New York & New Jersey Edition, 2006 Aug 14; 18A (17): 10-1. (journal article - pictorial) CINAHL AN: 2009273549

Check emergency department victims for radiation... Koenig KL, Goans RE, Hatchett RJ et al. Medical treatment of radiological casualties: current concepts. Ann Emerg Med 2005;45:643-52. Casavant MJ; Annals of Emergency Medicine, 2006 Jan; 47 (1): 120-1. (journal article - commentary, letter, response) PMID: 16387228 CINAHL AN: 2009111238

 

 

Books

Rose, K. (2001). One nation underground : the fallout shelter in American culture, New York : New York University Press.

UA927 .R67 2001

 

Couch, D. & Boswell J., (2003). U.S. Armed Forces Nuclear, Biological and Chemical Survival Manual, New York, NY : Basic Books.

"Curling up in a basement corner after a nuclear blast, for example, can cut your radiation dose by a factor of ten (provided you are outside the "100 percent lethality " zone), while heavy clothing and a wet cloth over the nose and mouth help protect in a chemical or biological strike. After an attack, most fallout/toxins/spoors can be washed off, preferably with diluted bleach. And do use that duct tape."

 

Russian threat perceptions and plans for sabotage against the United States : hearing before the Military Research and Development Subcommittee of the Committee on Armed Services, House of Representatives, One Hundred Sixth Congress, first session, hearing held October 26, 1999.
Publisher: Washington : U.S. G.P.O. : For sale by the U.S. G.P.O., Supt. of Docs., Congressional Sales Office, 2000.

Hoffman, Bruce (1986). Terrorism in the United States and the potential threat to nuclear facilities; prepared for the U.S. Department of Energy, Santa Monica, CA : Rand.

 

Gordin, M. (2007). Five days in August : how World War II became a nuclear war. Princeton, N.J. : Princeton University Press.
Subject: Hiroshima-shi (Japan) History Bombardment, 1945.
Nagasaki-shi (Japan) History Bombardment, 1945.
Atomic bomb United States History.
World War, 1939-1945 Japan.
Capitulations, Military Japan History 20th century.
D767.25.H6 G67 2007

 

Keep out of trouble: Waiting for the end of the world [by] Richard Ross [book review]
Bowerman, Clare.
Blueprint (London, England), no. 222, pp. 62, Aug 2004
Photo book of atomic bomb shelters around the world.

Photo book of atomic bomb shelters around the world.

 

 

Survival city: adventures among the ruins of atomic America, by T. Vanderbildt
Farish, Matthew.
Environment and planning D, society & space, vol. 21, no. 1, pp. 127-129, Feb 2003

 

 

Shelters against explosions of nuclear and other non conventional warfare
Dannish, Sami A.; Golam, Mohammad A.
International journal for housing science and its applications, vol. 17, no. 3, pp. 163-171, 1993

 

 

Before the nuclear dust settles
Luder, Owen
Building, vol. 251, no. 33, pp. 21, Aug 1986

 

 

Search terms: Air raid shelters -- 20th century -- United States Atomic bombs and bombing, fallout shelter*, Bunkers -- United States, Air raid shelters -- Conservation and restoration, Air raid shelters -- Research, Air raid shelters

 

 

A compilation of quotes from other, mostly government sites.

 

 

How You Can Limit Contamination
Since radiation cannot be seen, smelled, felt, or tasted, people at the site of an incident will not know whether radioactive materials were involved. You can take the following steps to limit your contamination.
1. Get out of the immediate area quickly. Go inside the nearest safe building or to an area to which you are directed by law enforcement or health officials.
2. Remove the outer layer of your clothing. If radioactive material is on your clothes, getting it away from you will reduce the external contamination and decrease the risk of internal contamination. It will also reduce the length of time that you are exposed to radiation.
3. If possible, place the clothing in a plastic bag or leave it in an out-of-the-way area, such as the corner of a room. Keep people away from it to reduce their exposure to radiation. Keep cuts and abrasions covered when handling contaminated items to avoid getting radioactive material in them.
4. Wash all of the exposed parts of your body using lots of soap and lukewarm water to remove contamination. This process is called decontamination. Try to avoid spreading contamination to parts of the body that may not be contaminated, such as areas that were clothed.
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.
http://www.bt.cdc.gov/radiation/contamination.asp


Sheltering in place
The terrorist events of 2001 made many people wonder about the possibility of a terrorist attack involving radioactive materials. People who live near but not in the immediate area of the attack may be asked to stay home and take shelter rather than try to evacuate. This action is called “sheltering in place.” Because many radioactive materials rapidly decay and dissipate, staying in your home for a short time may protect you from exposure to radiation. The walls of your home may block much of the harmful radiation. Taking a few simple precautions can help you reduce your exposure to radiation. The Centers for Disease Control and Prevention has prepared this fact sheet to help you protect yourself and your family and to help you prepare a safe and well-stocked shelter.
Preparing a Shelter in Your Home
The safest place in your home during an emergency involving radioactive materials is a centrally located room or basement. This area should have as few windows as possible. The further your shelter is from windows, the safer you will be.
Preparation is the key. Store emergency supplies in this area. An emergency could happen at any time, so it is best to stock supplies in advance and have everything that you need stored in the shelter.
Every 6 months, check the supplies in your shelter. Replace any expired medications, food, or batteries. Also, replace the water in your shelter every 6 months to keep it fresh.
Make sure that all family members know where the shelter is and what it is for. Caution them not to take any items from that area. If someone “borrows” items from your shelter, you may find that important items are missing when they are most needed.
If you have pets, prepare a place for them to relieve themselves in the shelter. Pets should not go outside during a radiation emergency because they may track radioactive materials from fallout into the shelter. Preparing a place for pets will keep the radioactive materials from getting inside the shelter.


Preparing Emergency Supplies
Stock up on supplies, just as you would in case of severe weather conditions or other emergencies. Following is a list of things to consider when preparing your emergency kit.
• Food with a long shelf life—Examples of this include canned, dried, and packaged food products. Store enough food for each member of the household for at least 3 days.
• Water—In preparation for an emergency, purchase and store bottled water or simply store water from the tap. Each person in the household will need about 1 gallon per day; plan on storing enough water for at least 3 days.
• A change of clothes and shoes—Check clothing every 6 months and remove clothes that no longer fit or are unsuitable for seasonal weather. Remember to include underwear, socks, sturdy shoes or work boots, and winter or summer clothes as needed.
• Paper plates, paper towels, and plastic utensils—Store disposable dishware and utensils because you will not have enough water to wash dishes and because community water sources may be contaminated.
• Plastic bags—Because you may not be able to leave your shelter for several days, you will need to collect your waste in plastic bags until it can be removed.
• Bedding—Store sheets, blankets, towels, and cots for use during the time that you cannot leave your shelter.
• Battery-operated radio and batteries—Electrical power may not be on for several days. A battery-operated radio will allow you to listen to emergency messages.
• Medicines—Have 2-3 days’ dose of your current prescription medicines in a childproof bottle for your shelter medical kit; label with the name and expiration date of the medicine. (Discuss with your doctor the best way to obtain this small amount of extra medicine.) Be sure to check medicines in your kit every 6 months to make sure they are not past the expiration date.
• Toiletries—Keep a supply of soap, hand sanitizer, toilet paper, deodorant, disinfectants, etc.
• Flashlight and batteries—Electrical power may be out for several days. A flashlight will help you see in your shelter.
• A telephone or cell phone—Although cell phone or ground phone service may be interrupted, there is still a chance that you will be able to use a phone to call outside for information and advice from emergency services.
• Extra eyeglasses or contact lenses and cleaning supplies.
• Duct tape and heavy plastic sheeting—You can use these items to seal the door to your shelter and to seal any vents that open into your shelter for a short period of time if a radiation plume is passing over.
• Pet food, baby formula, diapers, etc.—Don’t forget the other members of your family. If you have an infant, store extra formula and diapers. If you have pets keep a 3-day supply of pet food.
• First aid kit—You can purchase a first-aid kit or prepare one yourself. Be sure to include the following items:
o Sterile adhesive bandages
o Sterile gauze pads in 2 inch and 4 inch sizes
o Adhesive tape
o Sterile rolled bandages
o Scissors
o Tweezers
o Needle
o Thermometer
o Moistened towelettes
o Antiseptic ointment
o Tube of petroleum jelly or other lubricant
o Soap or hand sanitizer
o Latex or vinyl gloves
o Safety pins
o Aspirin or aspirin free pain reliever
o Antidiarrhea medication
o Laxatives
o Antacids for stomach upset
o Syrup of ipecac to cause vomiting if advised by the Poison Control Center
o Activated charcoal to stop vomiting if advised by the Poison Control Center
• Games, books, and other entertainment—Because you may be in your shelter for several days, keep items on hand to occupy your family during that time. Children are likely to get bored if they have to stay in one place for long periods. Think of activities that they will enjoy doing while in the shelter—finger painting, coloring, playing games, etc.
Tips before Entering a Shelter
If you are outside when the alert is given, try to remove clothing and shoes and place them in a plastic bag before entering the house. During severe weather, such as extreme cold, remove at least the outer layer of clothes before entering the home to avoid bringing radioactive material into your shelter. Leave clothing and shoes outside. Shower and wash your body with soap and water. Removing clothing can eliminate up to 90% of radioactive contamination. By taking this simple step, you will reduce the time that you are exposed and also your risk of injury from the radiation.
Before entering the shelter, turn off fans, air conditioners, and forced-air heating units that bring air in from the outside. Close and lock all windows and doors, and close fireplace dampers.
When you move to your shelter, use duct tape and plastic sheeting to seal any doors, windows, or vents for a short period of time in case a radiation plume is passing over (listen to your radio for instructions). Within a few hours, you should remove the plastic and duct tape and ventilate the room. Suffocation could occur if you keep the shelter tightly sealed for more than a few hours.
Keep your radio tuned to an emergency response network at all times for updates on the situation. The announcers will provide information about when you may leave your shelter and whether you need to take other emergency measures.
http://www.bt.cdc.gov/radiation/shelter.asp


How Can I Protect Myself During a Radiation Emergency?
• After a release of radioactive materials, local authorities will monitor the levels of radiation and determine what protective actions to take.
• The most appropriate action will depend on the situation. Tune to the local emergency response network or news station for information and instructions during any emergency.
• If a radiation emergency involves the release of large amounts of radioactive materials, you may be advised to “shelter in place,” which means to stay in your home or office; or you may be advised to move to another location.
• If you are advised to shelter in place, you should do the following:
o Close and lock all doors and windows.
o Turn off fans, air conditioners, and forced-air heating units that bring in fresh air from the outside. Only use units to recirculate air that is already in the building.
o Close fireplace dampers.
o If possible, bring pets inside.
o Move to an inner room or basement.
o Keep your radio tuned to the emergency response network or local news to find out what else you need to do.
• If you are advised to evacuate, follow the directions that your local officials provide. Leave the area as quickly and orderly as possible. In addition –
o Take a flashlight, portable radio, batteries, first-aid kit, supply of sealed food and water, hand-operated can opener, essential medicines, and cash and credit cards.
o Take pets only if you are using your own vehicle and going to a place you know will accept animals. Emergency vehicles and shelters usually will not accept animals.
http://www.bt.cdc.gov/radiation/emergencyfaq.asp

 

Nuclear terrorism: triage and medical management of radiation and combined-injury casualties. (includes abstract) Flynn DF; Surgical Clinics of North America, 2006 Jun; 86 (3): 601-36.
link - This link will work if you are logged into your local public or school library database. Full text likely available.
Quote: "This article addresses the medical effects of nuclear explosions and other forms of radiation exposure, assessment of radiation dose, triage of victims, definitive treatment of radiation and combined-injury casualties, and planning for emergency services after a terrorist attack involving a nuclear device. It reviews historical events of mass radiation-induced casualties and fatalities at Hiroshima, Chernobyl, and Goiania, and discusses various scenarios for nuclear terrorism."
The first phase of treatment in a hospital:
"During the first 72 hours the initial phase of treatment will be directed toward treatment of trauma and burns, external decontamination, and very early initiation of potassium iodide, where appropriate. After detonation of a nuclear weapon, most casualties will be combined-injury patients. Emergency surgical care involves resuscitation, control of hemorrhage, and minimization of sepsis with débridement techniques."
Decontamination instructions:
"Removing clothing alone can decrease external radioactive contamination by 90%.
Washing with soap and lukewarm or room-temperature water is effective and removes another 90% of contamination (about 99% of the total is removed after both steps have been performed). Soap emulsifies and dissolves most contaminants. Wounds and body orifices usually are decontaminated first. Wounds should be rinsed with saline. To prevent cross-contamination, wounds and burns should be covered with waterproof dressings before the skin is decontaminated. Abrasions and lacerations usually are relatively easy to decontaminate. Stubborn contamination may be excised from lacerations. Puncture wounds, most often on the hands, are sometimes difficult because of poor access to the contaminants and difficulty in determining the degree and depth of contamination. Irrigation with standard water picks may be successful. Burns should be rinsed gently with water and cleared of debris. In patients whose burns cannot be completely decontaminated, most of the contamination will remain in the burn eschar when it sloughs. Some patients may have imbedded metal fragments (shrapnel). When metallic shrapnel is removed, it should be evaluated for radioactivity and either shielded or placed in a safe location. Potentially radioactive fragments should be handled with forceps, not with gloved hands. Contaminated wastewater can be released into sewers without restriction. For intact skin, a wet washcloth and basin (with or without a low-velocity, low-volume water spray) may be used to remove a significant amount of superficial contamination. Gentle brushing may help remove contamination from the skin, but care should be taken not to damage the skin, because some contamination could be absorbed through injured skin. Experience has shown that shampoo can be effective for skin decontamination in addition to soap, if soap alone is inadequate. On some occasions, povidone-iodine can be used as an antiseptic-germicide on the intact skin. It has the added benefit of nonradioactive iodine absorption through intact skin to block the thyroid partially when there is internal contamination from radioactive iodine-131. Hair can be decontaminated with any commercial shampoo. Cutting or clipping the hair, if appropriate, can remove contaminants, but cutting the eyebrows should be avoided, because they may not grow back. Fingernails and toenails should be checked and cut if necessary."
"DECONTAMINATION TEAM DRESS:
Caregivers should follow strict isolation-type procedures (universal precautions). Barrier clothing is worn, including cap, mask, eye protection, gown, gloves, and shoe covers. All seams and cuffs should be secured with masking tape. Ideally, a dosimeter should be worn at the collar level. A complete surgical scrub suit ideally would include a plastic apron or waterproof gown for use when washing contaminated patients and double gloves, with the inner gloves taped to the scrub suit, to prevent cross contamination, because glove changes may be necessary."
"The decontamination-treatment area for those injured needs to be delineated and, if possible, established in an area away from the main flow of emergency department activity, near a separate emergency department entrance. It should be appropriate for both emergency medical care and decontamination, with access to water. Ideally, the floor should be covered and with taped-down nonskid plastic sheets (however, butcher's paper or other appropriate covering may be substituted)."
"Skin decontamination needs to be done early because reducing the time radioisotopes remain in direct contact with the skin lessens the severity of the radiation burn that develops later [5], [16]. In contrast to thermal burns, which appear almost immediately, the development of radiation burns takes weeks to evolve fully."
"Infections are a major cause of mortality in the irradiated host because of immunosuppressive effects that result from declining lymphohematopoietic elements secondary to radiation-induced bone marrow aplasia (reversible or irreversible). After wounds or burns have been débrided, topical antibiotics should be used, and the wound should be covered with nonadherent dressings."
SHOWER AND SHELTER - WHAT TO DO AT HOME
"Massive amounts of contamination are injected into the lower atmosphere, producing a downwind radioactive plume containing radioactive dust and particles. Prolonged contact with fallout on the skin can result in serious skin damage plus increased whole-body dose. Therefore, the public response should be “shelter and shower.” Sheltering (particularly at home) is prudent early in a radiologic event, because families congregate at home and showers, clean clothing, food, and water are available. Sheltering also provides authorities time to assess the situation more completely. Evacuation might be indicated later for people in some locations, depending on the specific situation and the extended dose estimates. In other locations, remaining sheltered may result in lower radiation exposure."

Management of nuclear casualties. (includes abstract) Udeani JC; Topics in Emergency Medicine, 2002 Jun; 24 (2): 40-6, 79-82. Link - This link will work if you are logged into your local public or school library database. Full text likely available.
Quote: "Radioactive agents pose a significant threat to the efficient operation of any emergency department and challenge the ability of emergency physicians to provide lifesaving patient care. A well-planned, organized system of triage and hospital preparedness is critical. All health care providers involved in the early treatment of these patients must understand the clinical presentations, treatment options, and preventive measures to prevent further contamination of other individuals. This article reviews some of the important concepts in management of nuclear catastrophes"
"Four mechanisms ofinjury are implicated in
trauma caused by explosions. Primary blast
injuries are the direct effects of rapid increases
in atmospheric pressure causing barotrauma.
Most of the primary blast wave
injuries tend to affect areas of tissue-fluid/
gas interface and result in most on-scene
deaths.^'' The most common organ affected is
the ear (tympanic membrane rupture). Patients
with ruptured tympanic membranes
have been exposed to pressures usually exceeding
15 psi.^"'' In a case series of 647 survivors
of bombings in Israel from 1994 to
1996, 29.8% of them had blast injuries; of
those injuries, 89.6% had tympanic membrane
injuries.^ The most common injury to the tympanic
membrane involves a linear tear to the
inferior portion of the eardrum.
Primary blast injuries to the lung produce
the most profoimd and serious life-threatening
problems to victims. Tliese injuries result from
a rapid increase in intrathoracic pressures. Victims
may suffer from a whole range of problems
including pneumothoraces, contusions,
subpleural petechiae, and parenchymal hemorrhages.
In addition, local disruption of blood
vessels in close proximity to air-filled spaces
may cause a bronchopleural fistula. Arterial air
embolism to the brain or heart may be the
most common cause of rapid death in initial
survivors of blast injuries.*' Blast injuries to the
howel involve mechanisms similar to pulmonary
injuries. Hematomas, petechiae, and
perforation are commonly encountered.*'"
Secondary' blast injuries are penetrating
trauma induced by flying debris. The blast
wind, which immediately follows the blast
wave, is a displacement of air that accelerates
debris. Tertiary injuries occur when the victim
is propelled by blast wind."^ Blunt and penetrating
traumas account for most of these injuries
and are usually seen in victims close to
the blast. Finally, quaternary' blast injuries are
miscellaneous blast events that include exposure
to toxic gases, radiation, bums, and crush
injuries sustained from collapsing buildings."
"Exposed skin and hair should be cleansed
with soap and water repeatedly until the
dosimeter readings are minimal."

Phone numbers:
Where can I get more information?

For more information about radiation and emergency response, see the Centers for Disease Control and Prevention's website at http://www.bt.cdc.gov or contact the following organizations:
• CDC at 800-CDC-INFO
• 1-800-BE-READY
• World Health Organization, Radiation and Environmental Health Unit at www.who.int/ionizing_radiation/en
• The Conference of Radiation Control Program Directors at 502-227-4543
• The Environmental Protection Agency, Radiological Emergency Response Team
• The Nuclear Regulatory Commission Office of Public Affairs can be contacted at 301-415-8200
• The Federal Emergency Management Agency (FEMA) can be reached at 202-646-4600
• The Radiation Emergency Assistance Center/Training Site at 865-576-3131
• The U.S. National Response Team

• The U.S. Department of Energy (DOE) at 800-DIAL-DOE

 

Frequently Asked Questions About a Nuclear Blast
Radiation Emergency Instructions for Individuals & Families
With the recent threats of terrorism, many people have expressed concern about the likelihood and effects of a nuclear blast. The Centers for Disease Control and Prevention (CDC) has developed this fact sheet to describe what happens when a nuclear blast occurs, the possible health effects, and what you can do to protect yourself in this type of emergency.
What is a nuclear blast?
A nuclear blast, produced by explosion of a nuclear bomb (sometimes called a nuclear detonation), involves the joining or splitting of atoms (called fusion and fission) to produce an intense pulse or wave of heat, light, air pressure, and radiation. The bombs dropped on Hiroshima and Nagasaki, Japan, at the end of World War II produced nuclear blasts.
When a nuclear device is exploded, a large fireball is created. Everything inside of this fireball vaporizes, including soil and water, and is carried upwards. This creates the mushroom cloud that we associate with a nuclear blast, detonation, or explosion. Radioactive material from the nuclear device mixes with the vaporized material in the mushroom cloud. As this vaporized radioactive material cools, it becomes condensed and forms particles, such as dust. The condensed radioactive material then falls back to the earth; this is what is known as fallout. Because fallout is in the form of particles, it can be carried long distances on wind currents and end up miles from the site of the explosion. Fallout is radioactive and can cause contamination of anything on which it lands, including food and water supplies.
What are the effects of a nuclear blast?
The effects on a person from a nuclear blast will depend on the size of the bomb and the distance the person is from the explosion. However, a nuclear blast would likely cause great destruction, death, and injury, and have a wide area of impact.
In a nuclear blast, injury or death may occur as a result of the blast itself or as a result of debris thrown from the blast. People may experience moderate to severe skin burns, depending on their distance from the blast site. Those who look directly at the blast could experience eye damage ranging from temporary blindness to severe burns on the retina. Individuals near the blast site would be exposed to high levels of radiation and could develop symptoms of radiation sickness (called acute radiation syndrome, or ARS). While severe burns would appear in minutes, other health effects might take days or weeks to appear. These effects range from mild, such as skin reddening, to severe effects such as cancer and death, depending on the amount of radiation absorbed by the body (the dose), the type of radiation, the route of exposure, and the length of time of the exposure.
People may experience two types of exposure from radioactive materials from a nuclear blast: external exposure and internal exposure. External exposure would occur when people were exposed to radiation outside of their bodies from the blast or its fallout. Internal exposure would occur when people ate food or breathed air that was contaminated with radioactive fallout. Both internal and external exposure from fallout could occur miles away from the blast site. Exposure to very large doses of external radiation may cause death within a few days or months. External exposure to lower doses of radiation and internal exposure from breathing or eating food contaminated with radioactive fallout may lead to an increased risk of developing cancer and other health effects.
How can I protect my family and myself during a nuclear blast?
In the event of a nuclear blast, a national emergency response plan would be activated and would include federal, state, and local agencies. Following are some steps recommended by the World Health Organization if a nuclear blast occurs:
If you are near the blast when it occurs:
• Turn away and close and cover your eyes to prevent damage to your sight.
• Drop to the ground face down and place your hands under your body.
• Remain flat until the heat and two shock waves have passed.
If you are outside when the blast occurs:
• Find something to cover your mouth and nose, such as a scarf, handkerchief, or other cloth.
• Remove any dust from your clothes by brushing, shaking, and wiping in a ventilated area, however, cover your mouth and nose while you do this.
• Move to a shelter, basement, or other underground area, preferably located away from the direction that the wind is blowing.
• Remove clothing since it may be contaminated; if possible, take a shower, wash your hair, and change clothes before you enter the shelter.
If you are already in a shelter or basement:
• Cover your mouth and nose with a face mask or other material (such as a scarf or handkerchief) until the fallout cloud has passed.
• Shut off ventilation systems and seal doors or windows until the fallout cloud has passed. However, after the fallout cloud has passed, unseal the doors and windows to allow some air circulation.
• Stay inside until authorities say it is safe to come out.
• Listen to the local radio or television for information and advice. Authorities may direct you to stay in your shelter or evacuate to a safer place away from the area.
• If you must go out, cover your mouth and nose with a damp towel.
• Use stored food and drinking water. Do not eat local fresh food or drink water from open water supplies.
• Clean and cover any open wounds on your body.
If you are advised to evacuate:
• Listen to the radio or television for information about evacuation routes, temporary shelters, and procedures to follow.
• Before you leave, close and lock windows and doors and turn off air conditioning, vents, fans, and furnace. Close fireplace dampers.
• Take disaster supplies with you (such as a flashlight and extra batteries, battery-operated radio, first aid kit and manual, emergency food and water, nonelectric can opener, essential medicines, cash and credit cards, and sturdy shoes).
• Remember your neighbors may require special assistance, especially infants, elderly people, and people with disabilities.
Is a nuclear bomb the same as a suitcase bomb?
The ?suitcase? bombs that have been described in new stories in recent years are small nuclear bombs. A suitcase bomb would produce a nuclear blast that is very destructive, but not as great as a nuclear weapon developed for strategic military purposes.
Is a nuclear bomb the same as a dirty bomb?
A nuclear blast is different than a dirty bomb. A dirty bomb, or radiological dispersion device, is a bomb that uses conventional explosives such as dynamite to spread radioactive materials in the form of powder or pellets. It does not involve the splitting of atoms to produce the tremendous force and destruction of a nuclear blast, but rather spreads smaller amounts radioactive material into the surrounding area. The main purpose of a dirty bomb is to frighten people and contaminate buildings or land with radioactive material.
Would an airplane crash in a nuclear power plant have the same effect as a nuclear blast?
While a serious event such as a plane crash into a nuclear power plant could result in a release of radioactive material into the air, a nuclear power plant would not explode like a nuclear weapon. There may be a radiation danger in the surrounding areas, depending on the type of incident, the amount of radiation released, and the current weather patterns. However, radiation would be monitored to determine the potential danger, and people in the local area would be evacuated or advised on how to protect themselves.
Do I need to take potassium iodide (KI) if there is a nuclear blast?
Local emergency management officials will tell people when to take KI. If a nuclear incident occurs, officials will have to find out which radioactive substances are present before recommending that people take KI. If radioactive iodine is not present, then taking KI will not protect people. If radioactive iodine is present, then taking KI will help protect a person's thyroid gland from the radioactive iodine. Taking KI will not protect people from other radioactive substances that may be present along with the radioactive iodine.

http://www.bt.cdc.gov

 

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