Radiation Exposure Devices Guidance for Responders This presentation presents generic guidance to the first-responder community for response to a radiation exposure device. As with any guidance, it should be evaluated to see how it may fit into the jurisdictions’ response protocols. This presentation should take approximately 45 minutes. There is a tabletop exercise that is part of this package. The tabletop exercise should take no more than 1 hour to conduct. The total package presentation time, with questions and answers, should be approximately 2 hours +/-. It would be useful to have copies of the U.S. Department of Energy flat sheet for radiological response along with copies of the wallet card for emergency responders. These documents and other reference materials can be found at http://hps.org/hsc/response1.html. An instrument or two, such as an electronic dosimeter and a meter with an end-window GM and/or a pancake GM along with a couple of sources (e.g., lantern mantle, smoke detector), will be useful to demonstrate the use of instruments. Map photo and mark up used for an full field exercise conducted by the IAEA in Slovenia 2010 by Tom O’Connell. Prepared by the Homeland Security Committee RED Rev 08 AUG 2011 RED Rev 00 April 2010

Learning Objectives (1) Describe a radiation exposure device (RED) and its potential hazards. Identify visual indicators to recognize the presence of an RED. Identify initial actions applied by emergency responders due to the presence of an RED. The learning objectives are limited to the basics of RED response. There are a total of six learning objectives in this presentation. The objectives describe a risk-based response approach. The presentation will also describe how the command phases may flow between various response entities such as first response, medical, regulatory, and law enforcement. The potential risks and hazards to responders are identified. Most important is what these sources may look like, how we know they are there, and the actions to take once they are discovered. If a longer training session is desired, a basic radiological health presentation can be added to the training. One can be found at http://www.umt.edu/research/eh/ppt/newbasicfirstresponder-tomO.ppt and http://www-pub.iaea.org/MTCD/publications/PDF/EPR-FR-eLearning/main.htm Photo by Tom O’Connell RED Final 2012

Learning Objectives (2) Identify and list the types of radiation survey meters utilized to initially detect the presence of and measure the dose rates from an RED. List actions taken by health care providers to recognize that an individual has been exposed to a large dose of radiation. Discuss medical actions to be taken when it has been determined that an individual has been exposed to a large dose of radiation. Other than intelligence information on the potential location of an RED, radiation survey/detection meters would be employed to locate the specific site of an RED. In past uses of REDs (there have been documented cases of malicious use of radioactive materials to expose people) the majority of the cases were discovered by the medical community. Since a number of these cases were found in the medical setting, we can quickly see how many disciplines would need to be involved to locate the source of the radiation exposure to a person presenting to the health care system. Guidance to the health care providers is identified. Sources of information are the Radiation Emergency Assistance Center/Training Site (REAC/TS) (http://orise.orau.gov/reacts/) and the International Atomic Energy Agency (http://www-ns.iaea.org/tech-areas/emergency/iec/frg/default.asp?s=1&l=1 and http://www-pub.iaea.org/MTCD/publications/PubDetails.asp?pubId=7213). RED Final 2012

Lesson Plan Presentation on radiation exposure device— background and response actions Presentation on meters used to detect the presence of radioactive materials Review of job aid for responders Hand out flat sheet job aid (http://hps.org/hsc/response1.html). The flat sheet flows from the side without the HPS and DOE logos on the bottom. As you look at the job aid, the flow is from top left to bottom right. Review and discuss the Initial Response actions, then look at placards and signs. Mention that these are for legally shipped packages and that most likely you will not see placards or labels on REDs, but these are warning signs if the source was stolen from a legal shipment or storage device. Turn the sheet over and discuss the basic radiation protection principles. With your instrumentation and the small exempt sources, demonstrate distance and shielding concepts. Discuss and demonstrate the differences between contamination and exposure. Emphasize that if someone is injured, deal with the injury. In most cases, the sources used for radioactive REDs will be more of an exposure hazard than a contamination hazard because most of the stronger sources are sealed in an encapsulation. The types of sources will be discussed in other slides. Photo by Tom O’Connell RED Final 2012

Radiation Exposure Device Radiation Exposure Device (RED) A device intended to expose people to significant doses of ionizing radiation without their knowledge Constructed from partially or fully unshielded radioactive material(s) Placed in public settings (subways, malls, etc.) and usually hidden from sight Definition: Radiation exposure device (RED): also called a "hidden sealed source." An RED is a terrorist device intended to expose people to significant doses of ionizing radiation without their knowledge. Constructed from partially or fully unshielded radioactive material, an RED could be hidden from sight in a public place (e.g., under a subway seat, in a food court, or in a busy hallway), exposing those who sit or pass close by. If the seal around the source were broken and the radioactive contents released from the container, the device could become a radiological dispersal device (RDD), capable of causing radioactive material contamination. (Radiation Emergency Medical Management) RED Final 2012 RED Rev 00 April 2010

Radiation Exposure Device (cont.) International effort to improve security of sources of radioactive material Regulations on use and storage Programs to identify and collect orphan sources Customs and Border Controls Some radioactive materials of concern 241Am, 252Cf, 60Co, 137Cs, 192Ir, 226Ra, and 90Sr There is an effort internationally to tighten the security around the use of radioactive materials. Information on these international efforts can be found in IAEA documents at the following links: http://www-pub.iaea.org/MTCD/publications/PubDetails.asp?pubId=7568 http://www-pub.iaea.org/MTCD/publications/PubDetails.asp?pubId=7806 http://www-ns.iaea.org/security/itdb.asp?s=4. Prior to presentation, review the three IAEA reference documents and discuss the IAEA’s efforts and your countries’ efforts. For United States efforts, see http://www.epa.gov/rpdweb00/source-reduction-management/recovery.html. For IAEA Nuclear Security Series No. 5, Identification of Radioactive Sources and Devices detail, see http://www-pub.iaea.org/MTCD/publications/PDF/Pub1278_web.pdf. Photo by Tom O’Connell RED Final 2012 RED Rev 00 April 2010

Radiation Exposure Device (cont.) Reference documents for radioactive materials of concern: IAEA Nuclear Security Series No. 5 IAEA Dangerous Quantities of Radioactive Material (D-Values) IAEA Nuclear Security Series No. 6, Combating Illicit Trafficking in Nuclear and Other Radioactive Material There is an effort internationally to tighten the security around the use of radioactive materials. Information on these international efforts can be found in IAEA documents at the following links: http://www-pub.iaea.org/MTCD/publications/PubDetails.asp?pubId=7568 http://www-pub.iaea.org/MTCD/publications/PubDetails.asp?pubId=7806 http://www-ns.iaea.org/security/itdb.asp?s=4 Prior to presentation, review the three IAEA reference documents and discuss the IAEA’s efforts and your countries’ efforts. For United States efforts, see http://www.epa.gov/rpdweb00/source-reduction-management/recovery.html. For IAEA Nuclear Security Series No. 5, Identification of Radioactive Sources and Devices detail, see http://www-pub.iaea.org/MTCD/publications/PDF/Pub1278_web.pdf. RED Final 2012 7 RED Rev 00 April 2010 7

Radiation Exposure Device (cont.) Radioactive materials of interest are used in: Medical diagnosis (usually short half-life). Cancer treatment (long half-life). Industrial radiography (medium half-life). Construction (medium half-life). Sterilization of medical products (long half-life). Gauges (long half-life). Radioactive materials are used in various industries across the world. Sources are used in medical diagnosis and treatment and industrial and research settings. Short half-life is defined, for this discussion, as less than 8 days; medium: 8 days to 1 year; and long: 1 year to 1,600 years. Photo by Tom O’Connell RED Final 2012 RED Rev 00 April 2010

Brief History of RED Use 1993—Russia. A radioactive substance, probably cesium-137 (and/or cobalt-60), was planted near the director of a packing company. 1 death. 1995—Russia. A cesium-137 source had intentionally been placed in a door pocket of a truck. The driver was exposed for 5 months. 1 death. Radiation exposure devices have been used to expose people to radiation. There are a number of case studies that describe the use of REDs for malicious intent. See the following websites for more information: http://www.johnstonsarchive.net/nuclear/radevents/index.html http://www.nti.org/threats/radiological/ RED Final 2012 RED Rev 00 April 2010

Brief History of RED Use 2002—China. Iridium-192 used in an attack on a business rival. The iridium-192 was placed above the ceiling panels in the hospital office of the rival. 1 death and another 74 staff members of the hospital had injuries. Radiation exposure devices have been used to expose people to radiation. There are a number of case studies that describe the use of REDs for malicious intent. See the following websites for more information: http://www.johnstonsarchive.net/nuclear/radevents/index.html http://www.nti.org/threats/radiological/ Photo by Tom O’Connell RED Final 2012 10 RED Rev 00 April 2010 10

Some Radiation Basics Radioactive materials emit energy in the form of radiation. Types of radiation released when a radioactive material decays may include alpha, beta and/or gamma, and neutrons. Radioactive materials may emit more than one type of radiation. From an external exposure hazard, the most penetrating types are gamma and neutron, followed by beta and then alpha radiation. To frame out the threat and the response, let’s start by identifying some of the basic radiation terms used when discussing an RED. Understanding these basics will allow us to protect ourselves and the public and to isolate the threat to minimizing the exposure of additional people to the radiation source. Mention that most radioactive materials emit more than one type of radiation. Example: 241Am found in smoke detectors emits mainly alpha radiation, but also emits gamma radiation. Instructor demonstration: This would be a good time to use the meters and sources you have to demonstrate their use in the finding the presence of radiation. RED Final 2012 RED Rev 00 April 2010

Some Radiation Basics (cont.) From an internal exposure hazard, the most hazardous type is alpha, followed by beta and then gamma radiation. If a radioactive source is encapsulated, it most likely cannot be easily dispersed. Past history indicates that most REDs used were encapsulated sources. Victims were exposed to ionizing radiation; however, they were not contaminated with the radioactive material. In cases where the encapsulation has been breached, there has been contamination. To frame out the threat and the response, let’s start by identifying some of the basic radiation terms used when discussing an RED. Understanding these basics will allow us to protect ourselves and the public and to isolate the threat to minimizing the exposure of additional people to the radiation source. RED Final 2012 RED Rev 00 April 2010

Radiation Effects on Humans At lower levels of penetrating gamma radiation exposure, the human body has a tendency to repair the damage. Exposure to background radiation would be an example of chronic low levels. Image from NCRP Report No. 160, Ionizing Radiation Exposure of the Population of the United States (2009) NCRP Report No. 160 (2009) RED Final 2012 RED Rev 00 April 2010

Radiation Effects on Humans From external penetrating gamma At higher exposure levels, the human body may not be able to repair the damage. Acute Exposures (whole body) Effects Blood cell changes occur around 50 rem (0.5 Sv) Nausea and vomiting begin around 70 rem (0.7 Sv) LD 50/60: 450 rem (4.5 Sv) without medical intervention Highest dose in Chernobyl survivor was 870 rem (8.7 Sv) There are a number of variables that make people more or less affected. See http://emergency.cdc.gov/radiation/ for more radiation emergency information. The consequences of radiation exposure to cells and tissues are highly variable, including both acute effects (e.g., delay in cell division, cell death) and late effects (e.g., cataracts, mutagenesis, carcinogenesis, etc.). Tissues vary in sensitivity to radiation; various tissues, in order of most to least sensitive, are lymphoid, gastrointestinal, reproductive, dermal, bone marrow, and nervous system. The response to radiation of self-renewing tissues is dynamic and influenced by tissue-specific transit times. Also review the presentations found at http://hps.org/hsc/responsemed.html for more specific information. The LD 50/60 is the lethal dose at which 50 percent of those exposed to that dose will die within 60 days. RED Final 2012

Potential Sources of Radioactive Material Black market Stolen Abandoned Unsecured Illegally obtained The instructor should read and review this IAEA document to give the participants information on the extent of radioactive source movement: http://www.iaea.org/newscenter/features/radsources/pdf/fact_figures2007.pdf Also, for more recent information please see http://www.nti.org/analysis/reports/nis-nuclear-trafficking-database/ on the Nuclear Threat Initiative website. Photos by Tom O’Connell RED Final 2012

Minimizing the Threat Improve international control of materials. Train/equip border and port security. Locate and secure orphaned sources. Seek non-radiological alternatives. Continue research and development of technologies to detect and monitor. Educate public and media. Educate physicians in recognizing acute radiation syndrome and skin burns without thermal or chemical cause. Using the reference materials in the previous slides, discuss how the threat of an RED is being minimized globally. Photo by Tom O’Connell RED Final 2012

Response to an RED Emergency From REMM, http://www.remm.nlm.gov/imagegallery.htm#K Potential RED scenario. The question to pose to the student is: “How do these people know they are being exposed?” The most likely answer is that they would not know unless someone had a radiation detector, they were informed later via media messaging, or they had received enough exposure that they became symptomatic, they went to the hospital, and a doctor recognized the symptoms as being caused by radiation exposure. RED Final 2012 RED Rev 00 April 2010

Response to an RED Emergency Most exposure discoveries have been in response to medical surveillance or by accidentally detecting the radiological signature. Medical professionals (local doctors) are often the first to discover a radiological emergency when they recognize symptoms indicating the possibility of radiation exposure in their patients. RED response would not be a lights-and-siren incident. Seek advice from radiation safety experts. Develop resources during preplanning phase. From IAEA EPR-First Responders 2006 http://www-pub.iaea.org/MTCD/publications/PDF/EPR_FirstResponder_web.pdf It is more likely that the discovery of an incident involving an RED would occur in the medical setting. That is why it is important to educate the medical community on the recognition of radiation-induced injuries. Training for the medical community can be found at the HPS website and REAC/TS. In the preplanning phase for an incident of this type, seek out the radiation expertise that exists in your local communities. This could be a local/state/federal radiation regulatory authority; radiation safety professional in universities, hospitals, and industry; or expertise within your Board of Health or hazmat response assets. RED Final 2012 RED Rev 00 April 2010

Initial Response—Medical From IAEA Report The Radiological Accident in Samut Prakarn http://www-pub.iaea.org/MTCD/publications/PDF/Pub1124_scr.pdf It would be useful for the presenter to review the above document and others to get information on radiation incidents, the medical effects that were observed due to radiation exposure to the sources, and the timeline to observe the effects. RED Final 2012 RED Rev 00 April 2010

Initial Response—Medical Once a victim’s medical symptoms are determined to be due to exposure to radiation, notify: Local public health authorities. Local, state, and/or national (CDC) epidemiology staff. Radiation authority having jurisdiction. Law enforcement. Notification of public health authorities and epidemiology personal will be useful to start backtracking the source of the exposures. Public health authorities are usually in regular contact with health care facilities (hospitals, clinics, and other health care infrastructure facilities) so that they may be able to track simultaneous victims from different facilities presenting the same symptoms. Law enforcement may have/be able to obtain useful classified information and have arresting authority. Photo by IAEA RED Final 2012 RED Rev 00 April 2010

Initial Response—Medical Once a victim’s medical symptoms are determined to be due to exposure to radiation: Survey patient for potential external and internal contamination. Survey health care facility for contamination. Contact REAC/TS for consultation. Develop medical care plan. There may be a chance that the victim has not only been exposed to ionizing radiation from the radioactive source but that he/she has been contaminated with loose radioactive material from a breached source. Surveys and bioassays should be conducted to eliminate or confirm the potential for contamination and/or incorporation of the radioactive material. REAC/TS is an excellent resource for the medical response community. http://orise.orau.gov/reacts/ EMERGENCY NUMBER 865-576-1005 RED Final 2012 RED Rev 00 April 2010

Incident Response Activities Medical staff will reconstruct exposure. Determine dose Determine patient impact from dose Law Enforcement Determine responsible party Conduct forensics Radiation Authorities Notified by local response agencies Subject matter experts Radiation surveys to locate There would be multiple agencies that would be involved in a response to an RED. Each discipline would have responsibilities in different areas, but it is important to have a unified plan and a unified voice. Here is where skills within an incident-management system would be employed. The public information officer would be involved with the messaging to the public through the media. Law enforcement—local, state, and/or federal—would be working an investigation into the incident. All disciplines would be working together in a joint effort to respond. Joint teams of law enforcement and radiation professionals may be formed to help detect radioactive sources and to manage the health physics safety side of an investigation. Photo by Tom O’Connell RED Final 2012 RED Rev 00 April 2010

Visual Clues for Responders Visual Indicators of radioactive sources Labels may be removed/defaced to hinder identification. Visual indicators of various radiation sources and shields that contain and/or could have contained the sources used in an RED It should be noted that these photos are pictures of sources used in their approved shields and/or intended uses. If one were to obtain these devices for use as an RED, labels and markings on the devices may be removed and/or defaced to hinder identification. In addition, the sources may be removed from the device itself. Pictures from IAEA left to right: irradiator device (60Co, 137Cs, 170Tm); radiation labels; heavy shield with radiation symbol; radiation therapy unit for cancer treatments (60Co, 137Cs); industrial radiation sources for well logging and radiography (241Am, 60Co, 137Cs, 192Ir); brachytherapy sources (137Cs, 60Co, 192Ir, 198Au, 125I). RED Final 2012 23 RED Rev 00 April 2010 23

Visual Clues for Responders Visual indicators of various radiation sources and shields that contain and/or could have contained the sources used in an RED Top two photos by T. O’Connell: left is a moisture-density gauge with 137Cs and 241Am; right is a rod containing 137Cs. Bottom three pictures from IAEA: bottom left is a gamma camera with 192Ir, 60Co, and 75Se; middle and bottom right are flow/density/level type gauges with 137Cs. RED Final 2012 RED Rev 00 April 2010

Emergency Responder Actions Response Actions Work with other disciplines to establish command and control of response efforts. Emergency Operations Center notifies other disciplines, including hospitals, public information, etc. If a source is found, using the Emergency Response Guide 2008, initial isolation zone is 75 feet. DO NOT TOUCH! Remember, this is a law-enforcement crime scene. RED Final 2012 RED Rev 00 April 2010

Emergency Responder Actions Response Actions Consider potential for other hazards, such as explosives . . . modify zone as appropriate. Modify zones under the direction of radiological expertise and radiation authority. Request additional resources (hazardous materials response teams, specialists). Support operations at the scene. RED Final 2012 RED Rev 00 April 2010

Emergency Responder Actions Response Actions Acute radiation syndrome signs and symptoms: May not appear shortly after exposure. May take hours to days to develop. Victims may need evaluation if clinical course is unusual or does not respond to medical treatment. Acute radiation syndrome (ARS) may occur if an individual has received a large radiation dose. Usually for ARS, the exposure is from gamma radiation (penetrating) sources and the victim has been exposed over the entire body. There may be situations where the exposure is localized to a specific area of the body due to the orientation of the victim to the source of radiation. A patient may not be symptomatic for hours to days. If a patient does not respond to the prescribed medical treatment (if one has been made) or if the clinical course changes in the next hours to days, the patient should be medically reevaluated. Patients should get this advice from the medical-treatment physicians. Photo by Tom O’Connell RED Final 2012 27 RED Rev 00 April 2010 27

End Section: Presentation on Radiation Exposure Device—Background and Response Actions Questions RED Final 2012

 Health Physics Society* Disclaimer: The information contained herein was current as of 9-April-2012 and is intended for educational purposes only. The authors and the Health Physics Society (HPS) do not assume any responsibility for the accuracy of the information presented herein. The authors and the HPS are not liable for any legal claims or damages that arise from acts or omissions that occur based on its use. *The Health Physics Society is a nonprofit scientific professional organization whose mission is to promote the practice of radiation safety. Since its formation in 1956, the Society has grown to nearly 5,000 scientists, physicians, engineers, lawyers, and other professionals representing academia, industry, government, national laboratories, the Department of Defense, and other organizations. Society activities include encouraging research in radiation science, developing standards, and disseminating radiation safety information. Society members are involved in understanding, evaluating, and controlling the potential risks from radiation relative to the benefits. Official position statements are prepared and adopted in accordance with standard policies and procedures of the Society. The Society may be contacted at 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101; phone: 703-790-1745; fax: 703-790-2672; email: HPS@BurkInc.com. RED Rev 00 April 2010