1. Biological Effects of Ionizing Radiation Deterministic effects Case history – Goiânia accident Lecture IAEA Post Graduate Educational Course Radiation Protection and Safe Use of Radiation Sources

2. 2 Introduction - Where did the accident occur? l Goiânia - the Capital of Goiâs State, Brazil l Population - about one million l Accident area - poor section of the city l Facility - abandoned premises of a radiotherapy institute

3. Add module code number and lesson title3 Content l Where did the accident occur l What happened l Information about the source l How the accident was discovered l Main actions taken l Main consequences l Medical management l Therapeutic procedures for the victims at the acute stage l Follow-up of the victims l Lessons learned

4. 4 Overview - What happened? l End of 1985 a private radiotherapy institute moved to new premises, leaving in place a Cs- 137 teletherapy unit without notifying the licensing authority l The former premises were subsequently partly demolished l September 13, 1987 two persons entered the premises, removed the source assembly from the radiation head of the machine l They took the source assembly home and tried to dismantle it l In the attempt, the source capsule was ruptured

5. 5 Information about the source l NuclideCs-137 l Activity (Sept.87)50.9 TBq (1375 Ci) l Chemical formCsCl l Physical formpowder l CsCl mass93 g l Cs-137 mass19.3 g l Physical half-life30 years

6. 6 How the Accident Was Discovered l After the source capsule was ruptured, the remnants of the assembly were sold as scrap to a junkyard l Fragments of the source the size of rice grains were distributed to several families l In five days a number of people were showing gastrointestinal symptoms from exposure to radiation l One of the irradiated persons connected the illnesses with the source capsule, and took the remnants to the public health department l This action began a chain of events which led to the discovery of the accident

7. 7 Main actions taken l Medical triage l Monitoring of the people and survey the environment l Medical treatment of the irradiated/contaminated persons l Actions to bring sources of exposure under control l Decontamination of the main sites of contamination (houses, public places, vehicles, etc.) l Demolition and removal of houses l Removal of contaminated soil l Clear information to the public

8. Basic facts about triage performed Population Triage Period: September 30 - December 21, 1987 Number of persons112,800 Internal/external contamination 129 Contamination of clothes and shoes 120 Persons hospitalized 20 Local radiation injuries 28 Bone marrow depression 17 Acute radiation syndrome 8 Deaths 4

9. Module 5 - Part 29 Radiological triage

10. Module 5 - Part 210 More Statistics l Decontamination of the city: 730 workers required l Number of houses affected: 98 n 41 evacuated n 6 demolished n 53 repaired l Number of public places decontaminated: 58 n pavements, squares, shops and bars l Number of vehicles decontaminated: 64

11. Module 5 - Part 211 The Consequences l Four early fatalities l A large number of persons contaminated l The environment severely contaminated l Large quantities of radioactive wastes generated l Significant economic loss and burden l Substantial psychological impact

12. Module 5 - Part 212 Waste generated l Waste storage site: n 20 km from the city n Designed to accommodate 4,000-5,000m 3 of waste l Types of waste packaging used: n 4,500 metal drums (200L) n 1,400 metal boxes (5 tones) n 10 shipping containers (32m 3 ) n 6 sets of concrete packaging l Volume of waste stored: 3,500 m 3, or more than 275 construction lorry loads

13. Medical Management during the Goiania Accident l Reverse isolation l Dietary management (no uncooked food) l Nail trimming and scrubbing l Local neomycin in nasal cavities l Gut sterilization l Systemic antibiotics l Platelet and RBC infusions l Antiviral

14. Therapeutic procedures during the acute phase of the accident l Managing critical period of the ARS, manifested by bone marrow suppression l Therapy for local radiation injury l Decorporation of cesium-137 l General support and psychotherapy

15. Prussian blue administration l 46 persons received Prussian Blue l Dosage related to internal burden n Initially 3 g/day n Then 4-6 g/day in adults exceeding 5 x ALI n For children initial dose 1-1.5 g/day then 3 g/day for those exceeding 5 x ALI n Some adults with very high burdens received 10 g/day

16. Medical Follow-up of the Goiânia accident victims Status of skin injuries after initial healing n 8 n 8/28 patients required surgery in 1989 n 6/28 patients required surgery in 1990 n 1/28 patients required surgery in ‘91, ‘92, ‘93 1 cancer death (1993), 1 suicide (1992) 1 cancer death (1993), 1 suicide (1992) 5 year follow-up of children 5 year follow-up of children n n n no significant findings (occasional eosinophilia, chronic anemia) n 7 exposed in-utero have no abnormalities n 10 conceived post-accident born with no abnormalities 2 exposed teenage males have fathered children 2 exposed teenage males have fathered children Skin lesions tended to be affected by stress Skin lesions tended to be affected by stress

17. Psychological follow-up of Goiânia accident victims Psychological follow-up of the Goiânia accident victims Psychological alterations Psychological alterations Continuation of some early problems Continuation of some early problems Discrimination from the other people Discrimination from the other people Establishment of illness behavior Establishment of illness behavior Concern about the consequences of the exposure Concern about the consequences of the exposure Stigmatization Stigmatization V ictims blamed for accident by many citizens V ictims blamed for accident by many citizens

18. Module 5 - Part 218 Lessons Learned l Regulatory controls could have prevented this accident l An adequate system of information is essential to avert panic l Emergency workers should be instructed on how to convey information to the population l Response to the psychological impact is a major element of the response strategy

19. Module 5 - Part 219 Lessons Learned (Cont’d) l International assistance can be timely and extremely useful n This should be considered at the planning stage n Customs regulations should be amended to facilitate the import and return of goods n This will accelerate international assistance

20. Add module code number and lesson title20 Summary l This lecture presented materials about Goiânia accident l The following conclusion could be made: n Radioactive sources taken out of the regulatory system can present a serious hazard n Recognition by the general public of the potential danger of radiation sources is an important factor in lessening the likelihood of radiological accident n Good plans can accelerate response and significantly reduce health impacts l Comments are welcomed

21. Add module code number and lesson title21 Where to Get More Information l International Atomic Energy Agency, The Radiological Accident in Goiânia, IAEA Report, IAEA, Vienna (1988) l IAEA Regional Train-the-Trainers Workshop Practical Response to a Radiological Emergency, November, 2000. Slovenia, Training materials l IAEA Training Course at Emergency Medical Preparedness and Response. Medical Education and Inter-Regional Harmonization Program for Nuclear Accident Preparedness. September, 1999, Budapest, Hungary, Training materials