DIRTY BOMB EXPLOSIONS

OBJECTIVES • Recognize the potential complications from a terrorist attack using a “Dirty Bomb” • Describe the different types of radiation particles and waves

OBJECTIVES • Differentiate between the concepts of radiation exposure and contamination • Describe the management priorities when treating victims of dirty bomb explosions

CASE SCENARIO A bomb explodes inside the lobby of the State of Illinois Building at 9:00AM on a Tuesday. Approximately 30 people are transported to area hospitals immediately with blast injuries. At 9:45 AM the media reports that this was a “dirty bomb” and that individuals in the vicinity of the explosion should “seek medical attention.”

CASE SCENARIO • You have 57 people brought to your ED. Six are casualties brought in by ambulance and the remainder are individuals who were in the vicinity but are not injured.

What is a “Dirty” Bomb?

• A collection of low grade radioactive waste that is dispersed using conventional explosives.

Jose Padilla, aka Abdullah Al Mujahir

TIME Magazine Sunday, Jun. 16, 2002

Things to Consider with a Dirty Bomb • Do we need to decontaminate?

• Is there a risk to ED personnel?

Things to Consider with a Dirty Bomb • What kind of injuries and radiation exposures would be expected?

• What might be long-term consequences of this attack?

Things to Consider with a Dirty Bomb • Do we need to decontaminate?

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Yes. The bomb is intended to disperse radioactive material (radioisotopes).

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Decontamination should ideally be done before the patients enter the ED to prevent contamination of the ED and exposure of ED personnel.

Exposure vs. Contamination

External radiation exposure

External radiation exposure and contamination

Ionizing Radiation • Ionizing radiation includes both rays (X and gamma) and particulate radiation

Particles • Alpha • Beta • Neutrons

Penetration Abilities of Different Types of Radiation

Alpha Particles Radiation Source Beta Particles Gamma Rays Neutrons

Pre-Hospital Management Pre-hospital evacuation is the most critical measure in preventing continued exposure and contamination

Patient Management - Priorities • Standard medical triage and trauma resuscitation are the highest priorities • Radiation exposure and contamination are secondary considerations

Management • Contaminated patient – immediately isolated until monitored & decontaminated • Monitor EMS and ambulance • ABC’s • Cover all wounds • Radiation burns are like sun burns

Decontamination of Wounds • Contaminated wounds: – Irrigate and gently scrub with surgical sponge – Debride surgically only as needed • Contaminated thermal burns: – Gently rinse – Changing dressings will remove additional contamination

Things to Consider with a Dirty Bomb • • • Is there a risk to ED personnel?

If patients have not been decontaminated, then yes. The ED disaster plan should be in place, identifying hot zones and clean zones. ED personnel should wear personal protective equipment.

Things to Consider with a Dirty Bomb • What kind of injuries and radiation exposures would be expected?

– The blast injuries from the conventional explosion are the immediate threat to life – Note that after decontamination has taken place, wounds may still be contaminated with radioactive debris

Specific Therapy Considerations Radionuclide Tritium Iodine-125 or I-131 Cesium-134 or cesium 137 Strontium-89, or 90 Plutonium Therapeutic Approach Dilution (force fluids) KI, or SSKI Prussian blue Decrease abs (antacids), blockage (strontium lactate), displacement (oral phosphate), mobilization (ammonium chloride) Zinc or calcium (DTPA)

Things to Consider with a Dirty Bomb • What might be long-term consequences of this attack?

– Dirty bomb attacks are not likely to produce a large number of immediate casualties beyond those associated with blast injury – They are intended to promote fear of radiation among the population

Key Points • Have a radiation disaster management in place for your hospital • Be prepared for psychological consequences

Dirty Bomb Questions

Question #1 A Dirty Bomb: a. Combines explosives with radioactive material b. Is similar to the Hiroshima atom bomb c. Is laced with pollutants d. Is buried beneath the ground to cause structural damage

Question #2 A Dirty Bomb will most likely cause: a. Massive structural damage to several city blocks within the vicinity of the explosion b. The spread of resistant strains of bacteria c. DNA abnormalities to health care professionals d. Mass public hysteria

This concludes the current presentation.