Perparing for the Worst

October 5th, 2009 by Potato

We’ve been doing some training lately, preparing for the worst. Specifically radiation disaster management. It’s a pretty interesting course, with some good take-home messages.

The first is that dealing with the (terrified) public can often be the hardest and least predictable part of disaster management, and in a radiation disaster situation that can be pretty bad. The public generally has exceptionally poor knowledge of what radiation is, how dangerous it actually is (yes, people have died, but it’s not nearly as dangerous as people are afraid it is), and what the difference between contamination and exposure are. We’re told that we have to explain physics concepts to the public at a grade 6 level, and that can be quite the challenge. Especially when you also have to deal with an attention span of maybe 1 minute. That speaks to me of a need for more general science outreach and education, something I’m all in favour of all the time (aside: notice the “science questions” topic tag — feel free to ask any, as this kinda sorta counts as a scientist working on educating the public ;)

For those of us worried about potential future terrorist attacks, there are a number of frightening scenarios thrown around. That of a dirty bomb or even a full-blown nuclear attack often top the fear lists. However, as our instructor today said, “I hope to hell that nothing happens, but if there is an attack, I hope it is radiological. We have detectors that go ‘beep’ at even very safe levels of background radiation. We can fairly quickly and very reliably screen those who have and have not been contaminated. We don’t have a meter for germs or nerve agents.”

Of course, we have to deal with the fear that the word radiation inspires. Sarin nerve gas is deadlier than the radiation in most dirty bomb scenarios, but thanks to poor delivery the attacks on the Tokyo subway resulted in only about 1000 casualties of some sort (those moderately ill with vision problems) as well as the 12 dead. For every sick person that showed up at a hospital tough, five more “worried well” came in to be checked out. So that’s going to be a huge issue with radiation, and hospitals are somehow going to have to deal with screening and even just corralling the thousands of frightened people.

An even bigger issue to deal with is the fear in the healthcare workers and first responders. Before training, many healthcare workers are afraid of radiation, and wouldn’t want to work on a person coming from a disaster or dirty bomb attack for fear of being contaminated themselves. Fortunately:

No caregiver in the history of radiological accidents has received a medically significant dose of radiation from treating a contaminated patient.

That includes the doctors and nurses who treated the firefighters at Chernobyl. It includes the rescuers at the SL-1 disaster. Now, that’s not to say that the environments can’t be dangerous — many firefighters did get excessive doses from going into the reactor at Chernobyl*. It’s not to say that it can’t happen that someone could get so contaminated that they’d put the rescue crews at risk, but it is exceptionally unlikely, and hasn’t happened yet.

* – a big part of that was poor training and misinformation: many of the figherfighters didn’t know it was a nuclear situation, they didn’t have the proper equipment or procedures in place to protect themselves — I can’t find a reference, but I’ve heard they weren’t even told to strip off their contaminated outer clothes after exiting the reactor. The USSR was too secretive for anyone’s good.

So for medical teams the issue becomes one they’re familiar with: stabilize the patient medically. Airway, bleeding, circulation. Only after those are taken care of do you worry about potential contamination and cleaning it up.

“There are no points for clean corpses.”


4 Responses to “Perparing for the Worst”

  1. nancy (aka moneycoach) Says:

    Good heavens! Here I thought i’d pop by for a little light evening reading and … the 70’s are all coming back to me now! So if I see the Big Mushroom Cloud in the distance, what’s the first thing I should do?

  2. wayfare Says:

    “Of course, we have to deal with the fear that the word radiation inspires.”

    That’s a tough one to overcome – I hear ‘radiation’ and I think of giant ants. Logical? Not particularly. Terrifying? You betcha.

  3. Potato Says:

    Well, we didn’t really cover the mushroom cloud scenario in our course, the reasoning being threefold: a) terrorists might very well get radioactive material (for a dirty-bomb, or a fizzle from the former USSR stores, but not likely a fully-working weapons-grade nuclear device; b) if they did (or a sovereign nation dropped one), the hospital the training was at would probably be vapourized, and c) if it wasn’t, maintaining “physician compliance” would be an issue. Another reason is that there may not be much contamination from such an event (or, if there is fallout, it would be on everything, so learning contamination control procedures wouldn’t help much).

    The big radiation exposure from a mushroom-cloud type event happens essentially instantly (gamma & neutron). It’s also not a medical emergency. Oh, if you got enough of a dose, it’ll kill you — and in a nasty way — but you won’t die now, and by that point there’s nothing you can do about it but score some opiates. Burns, shrapnel, and crush injuries remain the hospital’s priority.

    There may be fallout, and the best defense against that is to evacuate the area. If you do get contamination on you (a big clue would be ash from the blast settling minutes to hours afterwards), get inside, remove your clothes, being careful to roll the fabric away from yourself and go slowly so you don’t flick any dust into the air to breathe in; and shower, scrubbing as much as you can until the skin starts to redden (after that and you’d potentially rub contamination in, so stop). If you suspect you may have injested/inhaled contamination, then it’s time to think about getting it out. Normally, you’d want to get to a hospital for help, but in the mushroom cloud scenario you may be on your own for a little while. In that case, the most likely contaminants that you can do anything about are iodine-131 and uranium. Iodine-131, just like stable iodine isotopes, gets sent to the thyroid by the body: if you can “block” your thyroid by filling the thyroid with non-radioactive iodine, you’ll reduce your chances of getting thyroid cancer down the line. The best way to do that is with potassium iodide tablets, but if you’re not already at a hospital, the next best thing might be to paint a few strips of iodine-based disinfectant (the brown liquid stuff that stings) on the insides of your arms, behind your knees, etc. — the iodine will absorb through the skin. Failing that, iodized salt can help, but not much in an emergency (for the most part, ~80% of the thyroid is blocked already in adults who use iodized salt). For other contaminants, you want to flush them/dilute them by drinking as much (clean) water as you can. Up to 4 L a day, if you can tolerate drinking that much (along with some electrolytes and multivitamins as necessary). For uranium in particular, drinking baking soda dissolved in water can help stimulate the kidneys to flush it, but I can’t remember the chemistry now.

    Fortunately Nancy, I think you should be reasonably safe from terrorism and thermonuclear war up in Yellowknife :)

    Remember, I’m not a doctor, and I’m not trying to provide medical advice, so no lawyering up!

  4. Netbug Says:

    “Well, it looks like where gonna have ourselves a nuclear holocaust. Lookit that mushroom cloud… it’s amazing that something so beautiful… could just melt your face right off.”