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You are the part-time local health director in a small community. You are called with the news that an unknown person or group has introduced radiologic material into the town’s water processing plant. Radioactive iodine is found in the water. What do you do? What do you tell your patients?

As described in the previous chapter, terrorists could use nuclear material in one of a half dozen scenarios: detonation of a nuclear weapon, detonation of an IND, sabotage of a nuclear power facility, or more probably, RPSs or RDDs. This chapter summarizes the known health effects from exposure to nuclear materials.

Although neither the detonation of a thermonuclear device, an atomic bomb, nor an attack on a nuclear reactor would go unnoticed, the use of RPSs and RDDs may not readily be detected as radioactivity and cannot be detected by our senses. Exposure from an RPS or from an RDD would only be known once symptoms of radiation-related illnesses began or by detection using sensing devices such as a Geiger counter.

Minimizing the health effects of radiation exposure is consequence of three factors: time, distance, and barrier. There is a dose-dependent relationship for the time of exposure and the amount of radiation absorbed that directly impacts health effects. Similarly, exposure decreases exponentially and proportionally to the distance from a radiation source. Physical barriers, even if not leaded, provide an effective shield. The denser the shielding, of course, the more protection afforded.

Radiation exposure comes from a wide range of natural and manmade sources. Most naturally occurring atoms (e.g., thorium, uranium, radium) that exist in the earth exist at thermodynamically low-energy levels and are quite stable. The few that are unstable, (e.g., uranium) attempt to become stable by releasing energy from their nuclei in the form of radiation. There are internal body deposits of radiation in living cells, including potassium-40, carbon-14, radium, and others. External cosmic rays originate in outer space and exposure to them increase twofold in mountainous regions, and even more at jet aircraft altitudes. Human exposure to natural radiation is greater in that area of the earth’s crust rich in radioactive elements. X-rays from medical diagnostics and treatment are the largest source of artificial ionizing radiation exposure. Additional exposures occur from cigarettes, radioactive material in building materials or bedrock, radon gas, and phosphate fertilizers. Production, regulatory, and construction workers in the nuclear industry are exposed, although stringent monitoring requirements are in place. Medical, emergency response, and first-responder personnel may inadvertently be exposed to radiation before they are aware that a nuclear terror event has transpired.

Radiation injuries result from three basic methods of exposure: irradiation, external contamination, and internal contamination. The location and severity of injury are influenced by these routes of exposure. Irradiation is radiation exposure from an external source without physical contact with the body. Irradiation from x-rays, gamma rays, neutrons, or alpha or beta particles may be ...

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