1. CBRNE Bomb Medic Lt. Steven M. Albright Paramedic / SC-EMS.com

2. CBRNE Chemical Biological Radiological Nuclear Explosive 3. CBRNE Definition The American Heritage Dictionary Chemical A substance with a distinct molecular composition that is produced by or used in a chemical process Biological Of, relating to, caused by, or affecting life or living organisms Radiological The use of ionizing radiation for medical diagnosis, especially the use of x-rays in medical radiography or fluoroscopy The use of radiation for the scientific examination of material structures Nuclear Of, using, or possessing atomic or hydrogen bombs Explosives Things that go BOOM!!! (But you already know that) 4. Method of Delivery CBRNE as it pertains to Bomb Medics 5. High Explosives - Bursting Device Biological/Chemical Sprayer High Explosives would most likely be utilized to deliver radiological material over a wide geographical area Bursting devices would most likely utilize a low energy delivery system (deflagration) to distribute chemical or biological agents which are sensitive to heat and pressure Chemical and/or Biological sprayers could also incorporate a compressed gas system or mechanical means to disperse the material 6. Simulated Devices 7. Dirty Bombs Radiological Dispersal Device 8. What is a Dirty Bomb? The term dirty bomb is most often used to refer to a Radiological Dispersal Device (RDD) In reality, a dirty bomb is any explosive device that incorporates chemical, biological or nuclear material in its design with the intent to cause adverse health effects by dispersal of the material upon detonation. 9. Dirty Bomb Radiation Dispersal Weapon Weapon of Mass Disruption Uses conventional explosives to disperse radioactive debris Used to create terror and economic damage but causes little physical blast damage Considered the easiest manageable WMD Contain and remove persons from contaminated area Remove and bag clothing Shower decontamination Avoid internal contamination (inhalation, ingestion or injury) 10. Radiological Dispersal Device Consists of two main ingredients High Explosives Nuclear Material Might possibly be shielded to minimize detection 11. Nuclear Material 12. What is Radioactivity? Radioactivity is the property or condition of some elements that results in the spontaneous transformation, or decay, of the nucleus of an unstable atom As the unstable atom tries to change to a stable state, it releases excess energy in the form of radiation Substances that undergo this transformation process are called radioisotopes, or more generally, radioactive materials Once the substances are processed into a usable form, such as pellets or powder, they are called radioactive sources 13. What are Isotopes? Ninety-two naturally occurring elements make up all substances on Earth. In addition, scientists have made more than another dozen elements Each element has unique chemical properties Each element comes in different forms, called isotopes, which differ in their nuclear properties from the original element but have the same chemical properties All isotopes within an elements family contain the same number of protons, but have different numbers of neutrons 14. What are Isotopes? The number of protons determines the chemical properties, and the combined number of neutrons and protons determines the nuclear properties In general, isotopes are either stable or unstable Unstable isotopes are called radioisotopes because they emit radiation and decay to either other unstable or stable isotopes Radioactive sources are made from radioisotopes Knowing the type, energy, decay rate, and amount of radiation of particular radioisotopes helps to characterize the security risk posed by a radioactive source 15. What is Ionizing Radiation? Ionizing radiation, which has the ability to strip electrons from atoms and break chemical bonds, leading to possible human cell damage, comes in three types: alpha, beta, and gamma. Alpha radiation is a stream of alpha particles, each with a helium nucleus consisting of two protons and two neutrons. Beta radiation is the emission of high-speed electrons or their positively charged counterparts (positrons). Gamma radiation consists of highly energetic light, and differs from alpha and beta radiation in that it is massless and uncharged. It often accompanies the emission of alpha or beta radiation from a particular radioisotope 16. Radioactive Material Americium-241 Californium-252 Cesium-137 Cobalt-60 Iodine-129/131 Iridium-192 Plutonium Radium-226 Strontium-90 Uranium 17. Americium-241 (m'-ersh'-uh m) Americium-241 metal has a white and silvery luster, at room temperature Used in smoke detector manufacturing Used as a portable gamma ray source for use in radiography Gram quantities of 241 Am emit intense gamma rays which create a serious exposure problem for anyone handling the element Mode of Decay alpha particles & gamma radiation Half Life 432.2 years 18. Californium-252 (kal-uh-fawr-nee-uh m) Californium-252 is a rare earth element, unknown color, but is suspected of having a white and silvery luster, at room temperature Californium-252 has several medical and industrial applications, including its use in cancer therapy It is also used to detect explosive devices in airline luggage Gram quantities of 252 Cf emit alpha particles and is a very strong neutron emitter (one microgram spontaneously emits 170 million neutrons per minute) Mode of Decay alpha particles & neutron emission Half Life 2.65 years 19. Cesium-137 (s'z-uh m) Cesium-137 is one of the most common radioisotopes used in industry Cesium-137 is produced in nuclear explosions and during the breakdown of uranium in fuel elements Principle source of radiation in the exclusion zone around Chernobyl after the 1986 meltdown Used in moisture density gauges, leveling gauges, thickness gauges, and well logging devices Used in medical therapy to treat cancer Mode of Decay beta & gamma radiation Half Life 30.17 years 20. Cobalt-60 (koh-bawlt) Cobalt-60 is produced in linear accelerators or as a byproduct of steel exposed to neutron radiation Cobalt-60 is a hard brittle grey metal with a bluish tint Used in leveling gauges, thickness gauges, in cold pasteurization (gamma rays kill bacteria in food) and in industrial radiography Used in medical therapy to treat cancer Mode of Decay beta & gamma radiation Half Life 5.27 years 21. Iodine-129/131 (ahy-uh-dahyn) Iodine 129 and Iodine 131 are produced by the fission of uranium in nuclear reactors or plutonium in nuclear weapon detonation Because of its short half life, Iodine-131 is used extensively in nuclear medicine Iodine's chemical properties make it easy to attach to molecules for imaging studies Iodine-129 has little practical use, but may be used to check some radioactivity counters in diagnostic test equipment Mode of Decay beta & gamma radiation Half Life (I-129) 15.7 million years Half Life (I-131) 8.06 days 22. Iridium-192 (i-rid-ee-uh m) Iridium-192 is a shiny silvery-white very dense metal that will not rust Iridium-192 is produced from non radioactive Iridium in a nuclear reactor Used in industrial gauges that check welding seams Used in medical therapy, in the form of tiny seeds about the size of a grain of rice, to treat cancer Mode of Decay beta & gamma radiation Half Life 74 days 23. Plutonium (ploo-toh-nee-uh m) Plutonium is a silvery-grey metal that becomes yellowish when exposed to air Plutonium is created from uranium in nuclear reactors by bombarding special fuel rods containing uranium with neutrons Plutonium-239 is used to make nuclear weapons or combined with uranium to produce nuclear fuel rods Most dangerous when inhaled (limited effect on GI tract via ingestion) Mode of Decay alpha particles Half Life (Pu-238) 87.7 years Half Life (Pu-239) 24, 110 years Half Life (Pu-240) 6,564 years 24. Radium-226 (rey-dee-uh m) Radium-226 is almost pure white, but readily oxidizes to turn almost black in color Radium-226 was formerly used to paint watch dials Radium-226 is a naturally occurring radioisotope, formed by the decay of uranium- 238 Gram quantities of 226 Ra emit alpha particles and gamma radiation Mode of Decay alpha Particles, gamma radiation and ultimately decays into radon gas Half Life 1600 years 25. Strontium-90 (stron-shee-uh m) Strontium-90 is a shiny silvery metal that rapidly turns yellow when exposed to air Strontium-90 is a byproduct of the nuclear fission of uranium and plutonium Strontium-90 emits a beta particle with no gamma radiation The heat generated by strontium-90's radioactive decay can be converted to electricity for long-lived, light-weight power supplies Limited use in bone cancer due to its calcium like properties Mode of Decay beta radiation Half Life 29.1 years 26. Uranium (yoo-rey-nee-uh m) Uranium is a naturally-occurring element found at low levels in virtually all rock, soil, and water When refined, uranium is a silvery white, weakly radioactive metal. Uranium metal has very high density, 65% more dense than lead The main use of uranium, in the civilian sector, is to fuel commercial nuclear power plants When it is depleted (DU), uranium is used by the military as shielding and also in parts of bullets and missiles Mode of Decay alpha particles Half Life (U-235) 700 million years Half Life (U-238) 4.47 billion years 27. The Threat According to "Commercial Radioactive Sources: Surveying the Security Risks," Occasional Paper No. 11, 01 Sept 2005 the top seven radioisotopes, that would pose inherent radiological security risks, are americium-241, californium-252, cesium-137, cobalt-60, iridium-192, plutonium-238, strontium-90 and radium-226 Radium-226, because it is naturally occurring, is not subject to the licensing rules governing the other reactor-produced radioisotopes. These radioisotopes (except for certain restrictions on plutonium, americium, and californium) can be exported to almost all countries (except for Iran, Iraq and NK) OP No. 11 can be viewed at www.cns.miis.edu 28. Suitcase Nukes 29. Description Compact & Portable 24 x 16 x 8 Yield - 20 tons up to 5 kilotons Consensus among the experts is that this device would yield approximately 1 kiloton 30. One Kiloton Yield 31. Radiation Effects 1kt 32. The Flash Last several millionths of a second Causes temporary blindness from indirect exposure Causes permanent blindness (Choriretinal Burns) if looking directly at the flash 33. Flash-to-Bang (Min:Sec) Rangeto GroundZero (Miles) :05 1.1 :10 2.2 :15 3.5 :20 4.5 :25 5.5 :30 6.7 :45 9.9 1:00 13.7 1:15 16.8 1:30 19.9 1:45 23.0 2:00 26.7 2:15 29.8 2:30 32.9 3:00 39.8 4:00 52.8 5:00 65.9 10:00 130 15:00 200 30:00 400 IlluminationTime (seconds) Yield Lessthan1 1to2KT 1 2.5KT 2 10KT 3 22KT 4 40KT 5 60KT 6 90KT 7 125KT 8 160KT 9 200KT 10 250KT 12 325KT 14 475KT 16 700KT 20 1MT 24 1.5MT 27 2MT 40 5MT 55 10MT 75 20MT Nuclear Detonation Distance & Yield Estimates 34. Initial Radiation Total radiation released during the first 60-100 seconds of detonation Represents 10% of weapons energy Source of neutron radiation Consists of a neutron particle 10 times more destructive to biologicals than gamma rays 35. Fireball Reaches temperatures of millions of degrees Fahrenheit Converts all matter into gaseous form Lasts no longer than 30-90 seconds A 100KT Blast Ground burst visible for 400+ miles 36. Thermal Radiation Lasts less than one minute and travels at the speed of light Represents 35% of the weapons energy Consists of two pulses: Short duration UV pulse (eye damage) Visible and infrared (ignites combustibles material, skin burns, eye injury) 37. Blast Effect Represents 50% of weapons energy Consists of 3 phases for ground bursts: Positive Overpressure Blast winds Negative Overpressure 38. Blast Effect 39. Ionizing Radiation Alpha Particles Beta Particles Neutron Particles Gamma Rays 40. Ionizing Radiation Alpha Particles Source: Plutonium, Uranium, & other alpha emitting radioactive elements Shielding: Paper, Skin Hazard: Internal contamination only 41. Ionizing Radiation Beta Particles (electrons) Source: Radioisotope decay Shielding: Clothing Hazard: Internal and skin contamination 42. Ionizing Radiation Gamma Rays Source: Radioisotope decay following Beta decay Shielding: Concrete, lead Hazard: Whole body irradiation contamination only 43. Ionizing Radiation Neutron Particles Source: Nuclear detonations & Nuclear power plants Shielding: High hydrogen content (water) Hazard: Whole body irradiation 44. The Golden Rule Time Distance Shielding/Shelter 45. Time Radioactive Decay The 7-10 Rule The 7-10 Rule For every seven multiples of time, there is a 10 fold decrease in radiation If the initial radiation shows 1000 R/hr At 7 hours it will show 100 R/hr At 49 hours, it will show 10 R/hr At 343 hours (14 days), it will show 1 R/hr 46. Distance What is a safe Distance? The farther away people are from a radiation source, the less their exposure. How close to a source of radiation can you be without getting a high exposure? It depends on the energy of the radiation and the size (or activity) of the source. Distance is a prime concern when dealing with gamma rays, because they can travel long distances . Alpha and beta particles don't have enough energy to travel very far. As a rule, if you double the distance, you reduce the exposure by a factor of four. Halving the distance, increases the exposure by a factor of 47. Shielding Alpha radiation is stopped by clothing or paper Beta radiation is stopped by a thin sheet of aluminum or heavy clothing (bunker gear) Gamma radiation is the most penetrating. A good rule of thumb to stop over 90% of gamma radiation is.. 24 inches of solid brick 28 inches of hollow concrete blocks filled with sand 3 feet of packed earth (4 feet if loose) 7 inches of steel 4 inches of lead 48. Units of Measure 49. Units of Measure Rad [R] (Radiation Absorbed Dose) 1 Rad = 100 ergs of energy deposited in 1 gram of material. Rem (Roentgen Equivalent in Man) Rems = Rads times a biological factor for different types of radiation (Man = 1) Gray [Gy] is the System International (SI) unit 1 Gy = 100 Rads (has replaced the Rad) Sievert [Sv] is the SI unit in terms of Rems 1 Sv = 100 Rems (has replaced the Rem) 50. Radiation Monitors There are several brands of radiation monitors on the market and each brand has several models designed for specific functions The ideal radiation monitor for the bomb medic would be a pocket or key chain device that can be carried on your person at all times!! 51. Exposure & Treatment 52. Normal Exposures Sleeping next to human - 0.1 mR Flying in aircraft - 0.5 mR 3-mile Island accident - 1.5 mR Exposure to smoke detectors - 3.5 mR/yr Working in capitol building - 20 mR Cosmic rays & terrestrial sources - 25 mR/yr Medical diagnostics - 93 mR/yr Radon - 200 mR/yr Smoking tobacco - 280 mR/pack yr Radiation worker - 5000 mR/yr Decrease in sperm count - 15 R 53. Radiation Sickness Rad Dose vs. Clinical Findings 5-25 Asymptomatic. Conventional blood studies are normal. Chromosome aberrations detected. 50-75 Asymptomatic. Minor depressions of white cells and platelets detectable in a few persons, especially if baseline values established. 75-125 Minimum acute dose that produces symptoms (anorexia, nausea, vomiting, fatigue) in about 10-20% of persons within 2 days. Mild depression of white cells and platelets in some persons. 54. Radiation Sickness Rad Dose vs. Clinical Findings 125-240 Symptomatic course with transient disability and clear hematologic changes in a majority of exposed persons. Lymphocyte depression of about 50% within 48 hours. 240-340 Serious disabling illness in most persons with about 50% mortality if untreated. Lymphocyte depression of about >75% within 48 hours. 350 LD 50 for mass casualty situation. 55. Radiation Sickness Rad Dose vs. Clinical Findings 450 LD 50 for isolated individual exposure. 500+ Accelerated version of acute radiation syndrome with GI complications within 2 weeks, bleeding and death in most exposed persons. 5000+ Fulminating course with cardiovascular, GI, and CNS complications resulting in death within 24-72 hours. 56. Acute Radiation Syndrome Acute Radiation Syndrome Must affect a particular system Must be penetrating (alpha and beta not in this category) Most of body must be exposed for Acute Radiation Syndrome 900 to 1000 Rads result in mortality Dose estimate based upon onset of nausea and vomiting from time of exposure 57. Acute Radiation Syndrome Threshold for ARS 25 Rads to 100 Rads Bone marrow depression affects Hematopoietic system (white cell and thrombocytes) chances for sepsis Epithelial system in skin, gastrointestinal, and pulmonary system starts to slough off without production of new cells Cardiovascular system & CNS affects 58. Acute Radiation Syndrome Phases of ARS Prodromal Stage - nausea and vomiting (the sooner the N/V starts, the more acute) Latent Stage - (period of well being) Stem cells inhibited or destroyed Epithelial cell as bone marrow will not be produced Manifest Illness - (normal cells live out their lives without any reproduction) High radiation dose and trauma interact synergistically to increase mortality 59. Acute Radiation Syndrome Skin Effects Epilation (hair loss) Erythema (redness) Pigmentation Dry desquamation (shedding of skin) Treatment: Treat patients symptomatically Prevent and manage infections Electrolytes Ulcerations do not heal well. Lesions do not appear from days to weeks If lesions or burns are noted, they are thermal or traumatic in nature, not a result of radioactivity 60. Radiation Exposure Treatment Guidelines 61. Gas Mask Respirators The first line of defense in the treatment & prevention of any potential exposure whether it is radiological, biological, or chemical is respiratory protection Respirators should be fit tested with an RFT test kit to ensure proper fit with NO AIR LEAKS!! Masks should be fitted with an M95 cartridge to protect against most CBRN inhalation hazards Consider masks that provide for hydration 62. DECON The second line of defense is DECONTAMINATION First Remove all personnel from the area of contamination whether it be Chemical, Biological or Radiological in nature Second Remove and bag all clothing. While the bomb disposal suit might provide some protection from particulate matter it will not protect from particles emitting gamma radiation and may not provide protection from chemical and/or biological infiltration Third - Shower with soap and water Fourth - Shower with soap and water Fifth - Shower with soap and water 63. Acute Radiation Syndrome Decontamination External Contamination - removal of clothing at scene removes 80% - 90% of contaminants Handle foreign objects with care until proven non-radioactive Survey patient and collect samples Radioactive material is usually in the form of dust particles on the body surface/clothing Radiation dose rate from contamination is usually low - but will continue to expose until removed 64. Acute Radiation Syndrome Decontamination Priorities Wounds (irrigate and gently scrub then debride) Thermal burns (gently rinse and change dressing frequently to remove additional contamination) Skin - soap and water, cut hair if necessary DO NOT SHAVE, promote sweating (cover with plastic), use survey meter Cease decontamination when level of radiation is less than twice the background radiation Internal contamination (inhalation, ingestion, wounds) generally does not cause early signs or symptoms and rarely causes ARS (but does increases the risk of cancer) 65. DTPA Diethylenetriaminepentaacetate DTPA is a calcium or zinc salt that is administered to adults suspected of being internally contaminated (inhalation or ingestion) with Americium, Plutonium, Californium and Curium DTPA is given via injection, slow drip or inhalation mist. It works by chelating (bonding) to the radioactive material and is excreted through the urine Contraindications are renal dysfunction or bone marrow depression Side effects include headache, metallic taste in mouth, chest pain and nausea 66. Prussian blue Prussian blue is used to treat Cesium exposure (mainly 137 Cesium) and radioactive thallium Prussian blue works in the intestines by blocking re-absorption and is excreted through the bowel Prussian blue also reduces the half life of Cesium from 110 days to 30 days The dosage is 500mg and is administered orally three times a day for thirty days 67. Potassium Iodide Potassium Iodide is a salt of stable iodine Potassium Iodide (KI) and Potassium Iodate are used to treat radioactive Iodine exposure Radioactive Iodine is quickly absorbed by the thyroid gland. KI acts to block this absorption A single dose of KI protects for 24 hours Adult dosage 130 mg Children 3-18 (8 yrs and >45 kg: 100 mg PO BID >8 yrs and 45 kg: 100 mg BID >8 yrs and 45 kg: Ciprofloxacin 100 mg Q 12 hrs 1015 mg/kg Q 12 hrs >8 yrs and 45 kg: 2.2 mg/kg Q 12 hrs 100 mg BID AND >8 yrs and