Community Hardening: Radiation Melinda Johnson Denver MMRS Program Coordinator melinda.johnson@rmpdc.org
Welcome! � Session Goal: � To understand how one community calculated the risks of radiation exposure and the steps taken to mitigate that risk. � To leave with the knowledge necessary to begin such a program within your community.
Session Objectives � Identify ways to determine community risk of radiation exposure. � Understand what needed services are most at risk to radiation contamination. � Identify ways to protect, prevent, respond and eventually recover from a radiation exposure incident.
Why is this needed? � National Planning Scenarios 1 & 11 � Unknown/uncertain contamination � Self-referring victims � Surreptitious exposure � Radiations of concern � Penetrating/non-penetrating � External vs. internal � Contamination control � Recognition that First Receivers were a gap in planning
Types of Exposures � Radiological Accidents: � Healthcare facilities, specialized imaging centers, medical waste facilities. � Industrial or transportation incidents. � Terrorism Scenarios: � Dirty Bomb � Radioactive Device
Radiological Materials � Millions of radioactive sealed sources are used around the world for legitimate and beneficial commercial applications such as cancer treatment, food and blood sterilization, oil exploration, remote electricity generation, radiography, and scientific research. These applications use isotopes such as Americium-241, Californium-252, Cesium-137, Cobalt-60, Curium-244, Iridium-192, Plutonium-238, Plutonium-239, Radium-226, and Strontium-90. Many of these radiological sources are no longer needed and have been abandoned or orphaned; others are lightly guarded, making the threat of theft or sabotage significant. Currently, there are thousands of civilian locations worldwide with dangerous high activity radioactive sources. � 1,000 curies of radioactivity (about the size of a roll of coins) is all that is needed to make a large radiological dirty bomb.
Step One – Identification of Need � While conducting all hazards planning each region conducts a vulnerability assessment. � This assessment raised our awareness of the numbers of facilities that we knew had radioactive sources – and those whom we only suspected had them. � We realized that should there be a problem with one of those sources, we wouldn’t know, and wouldn’t have been able to respond.
Step Two – What are the Risks? � In examining the sources in our community we also had to think about the realistic risks: � Leaks � Abandoned Sources � Stolen Sources � And less likely – a Terrorist Attack (aka Dirty Bomb) � Who would be impacted? � Infrastructure – Hospitals, government buildings, etc. � EMS � Law Enforcement
Dirty Bomb The term dirty bomb is primarily used to refer to a radiological dispersal device � (RDD), a speculative radiological weapon which combines radioactive material with conventional explosives. Though an RDD would be designed to disperse radioactive material over a large area, a bomb that uses conventional explosives would likely have more immediate lethal effect than the radioactive material. At levels created from most probable sources, not enough radiation would be present to cause severe illness or death. Since a dirty bomb is unlikely to cause many deaths, many do not consider this to � be a weapon of mass destruction. Its purpose would presumably be to create psychological, not physical, harm through ignorance, mass panic, and terror. For this reason dirty bombs are sometimes called "weapons of mass disruption". Additionally, containment and decontamination of thousands of victims, as well as decontamination of the affected area might require considerable time and expense, rendering areas partly unusable and causing economic damage. No dirty bomb has been used, though unexploded devices have been developed. �
Step Three: Deciding what to Do � Once we looked at the risks and decided that yes, we needed to take some action we had to decide WHAT to do. � Strategies include purchasing of pharmaceuticals and equipment, outfitting and training decontamination teams - both hospital and fire based, as well as work with EMS to protect them post-exposure.
Step Four: Setting the Table � Who needs to be there? � Emergency Managers � Toxicologists � Hospitals � Private Sector Partners � EMS � DHS/HHS Grantees (they have the $$) � Law Enforcement (CAIC) � Fire Departments – decontamination response
Step Five: What Can We DO?
Protect � Encourage private sector partners to protect their sources and if possible participate in government programs that assist them with this. � In determining how to best protect a facility from contamination from radiation we elected to use a wall mounted portal radiation device. � Purchase dosimeters for fire and law enforcement.
Equipment � Due to the cost of the equipment we approached our State Homeland Security Grant program and asked for funds to purchase Ludlum area monitors and survey meters.
Stockpiling � There are many differing opinions on stockpiling pharmaceuticals for response to a radiological event. � Where stockpiling is occurring it is without standardized guidance. � Everyone is essentially “doing their own thing” with regard to stockpiling.
Stockpiling � For example, there are 124 MMRS cities in the United States, they have been tasked with stockpiling pharmaceuticals in the event of a disaster, however they have received no guidance on radiation stockpiles and each community is left to it’s own devices and decisions.
The Problem with Stockpiling � The Problem with Stockpiling � Antidotes and treatments are expensive � Have limited shelf-lives � Likely to be used in large quantities, but rarely
The Problem with NOT Stockpiling � Staff Fear – will they want to respond if they are in danger of exposure? � These antidotes are most effective when administered immediately after exposure, or in the case of KI, before exposure. Do you have time to wait to receive the drugs?
The Strategic National Stockpile � A Federally Funded Repository of: � Antibiotics � Vaccines � Immunoglobulins � Chemical antidotes � Radiation antidotes � Antitoxins � Life-support medications � IV administration � Airway maintenance supplies � Medical/surgical items
SNS Push Packages � Strategically located throughout U.S. � Supplement and re-supply state and local public health agencies in the event of a national emergency � The SNS can be shipped anywhere within the U.S. or its territories and should arrive to the scene within 12 hours
Stockpiling Questions � Where should you stockpile? � Local, i.e. Hospitals � Community � Region � National, i.e. Strategic National Stockpile � How much do you stockpile? How do you know you have enough?
Stockpiling Determinations � The decisions of if and how to stockpile medical countermeasures should be made after comprehensive threat and vulnerability assessments are conducted at the national, state, regional and local levels. � These assessments are then combined with the modeling of plausible scenarios. Once combined, these activities can provide an estimate of the number of persons who might be exposed if an even were to occur. � For any stockpiling program to work, activation, distribution and local incident management systems must be in place and exercised.
Stockpiling Determinations � Another helpful tool in determining how much Prussian blue to stockpile is a program developed by Johns Hopkins University called the Electronic Mass Casualty Assessment & Planning Scenarios - EMCAPS. � This tool is free and may be downloaded from: http://www.hopkins-cepar.org/EMCAPS/EMCAPS.html
What did WE do? � We worked with the toxicologists from the Rocky Mountain Poison and Drug Center to determine what our exposure risks were, and what we should stockpile. � We have purchased the following: � Radiogardase (Prussian Blue) � SKKI � Duo Dotes � Cyano kits � Antibiotics
Concept of Operations � We have a risk of radiological exposure. � We have a need to protect valuable assets, i.e. hospitals & EMS from contamination. � If there is contamination we need a way to determine what it is and how to treat it.
Decontamination � In our 10-County Region the two MMRS programs have equipped 5 mass decontamination teams. � Fire Based � Able to respond within 30 minutes � Able to decontaminate large numbers of people � Able to decontaminate equipment � Has an associated HAZMAT team � We have also equipped hospitals with interoperable decontamination equipment and training.
Communications � One reoccurring issue is how to communicate to first-responders that they may have been exposed? � What you do regularly works best. � Use the same mechanism currently in place for infectious disease notification. � If law enforcement or fire are the first to discover radioactivity they notify dispatch who notifies hospitals. If this step fails, the detectors will alarm notifying hospitals.
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