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Li C, Alves Dos Reis A, Ansari A, Bertelli L, Carr Z, Dainiak N, Degteva M, Efimov A, Kalinich J, Kryuchkov V, Kukhta B, Kurihara O, Antonia Lopez M, Port M, Riddell T, Rump A, Sun Q, Tuo F, Youngman M, Zhang J. Public health response and medical management of internal contamination in past radiological or nuclear incidents: A narrative review. ENVIRONMENT INTERNATIONAL 2022; 163:107222. [PMID: 35378442 PMCID: PMC9749825 DOI: 10.1016/j.envint.2022.107222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 05/03/2023]
Abstract
Following a radiological or nuclear emergency, workers, responders and the public may be internally contaminated with radionuclides. Screening, monitoring and assessing any internal contamination and providing necessary medical treatment, especially when a large number of individuals are involved, is challenging. Experience gained and lessons learned from the management of previous incidents would help to identify gaps in knowledge and capabilities on preparedness for and response to radiation emergencies. In this paper, eight large-scale and five workplace radiological and nuclear incidents are reviewed cross 14 technical areas, under the broader topics of emergency preparedness, emergency response and recovery processes. The review findings suggest that 1) new strategies, algorithms and technologies are explored for rapid screening of large populations; 2) exposure assessment and dose estimation in emergency response and dose reconstruction in recovery process are supported by complementary sources of information, including 'citizen science'; 3) surge capacity for monitoring and dose assessment is coordinated through national and international laboratory networks; 4) evidence-based guidelines for medical management and follow-up of internal contamination are urgently needed; 5) mechanisms for international and regional access to medical countermeasures are investigated and implemented; 6) long-term health and medical follow up programs are designed and justified; and 7) capabilities and capacity developed for emergency response are sustained through adequate resource allocation, routine non-emergency use of technical skills in regular exercises, training, and continuous improvement.
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Affiliation(s)
| | | | - Armin Ansari
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Zhanat Carr
- World Health Organization, Geneva, Switzerland
| | | | - Marina Degteva
- Urals Research Center for Radiation Medicine, Chelyabinsk, Russia
| | - Alexander Efimov
- State Unitary Enterprise Southern Urals Biophysics Institute of Federal Medical Biological Agency, Ozyorsk, Russia
| | - John Kalinich
- Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, USA
| | - Victor Kryuchkov
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - Boris Kukhta
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - Osamu Kurihara
- National Institutes of Quantum and Radiological Science and Technology, Chiba, Japan
| | - Maria Antonia Lopez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnolόgicas, Madrid, Spain
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Quanfu Sun
- National Institute for Radiological Protection, Beijing, China
| | - Fei Tuo
- National Institute for Radiological Protection, Beijing, China
| | | | - Jianfeng Zhang
- National Institute for Radiological Protection, Beijing, China
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Harrison J, Smith T, Fell T, Smith J, Ham G, Haylock R, Hodgson A, Etherington G. Collateral contamination concomitant to the polonium-210 poisoning of Mr Alexander Litvinenko. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:837-851. [PMID: 28726678 DOI: 10.1088/1361-6498/aa80f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mr Litvinenko died on 23 November 2006, having been poisoned with polonium-210 on 1 November, with evidence of a previous poisoning attempt during October 2006. Measurements of 210Po in urine samples were made for a large number of people to determine whether they may have been contaminated. In the majority of cases, measured levels were attributable to the presence of 210Po from normal dietary sources. For a small number of cases, elevated levels provided evidence of direct contamination associated with the poisonings. For one individual, while estimated doses were below thresholds for irreversible organ damage, a notably increased risk of cancer can be inferred. The use of the chelating agent, unithiol, to increase 210Po excretion in this case was only moderately effective in reducing doses received.
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Affiliation(s)
- John Harrison
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon, OX11 0RQ, United Kingdom. Oxford Brookes University, Faculty of Health and Life Sciences, Oxford, OX3 0BP, United Kingdom
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Brainard J, Hunter PR. Contextual Factors Among Indiscriminate or Large Attacks on Food or Water Supplies, 1946-2015. Health Secur 2016; 14:19-28. [PMID: 26889577 PMCID: PMC5076485 DOI: 10.1089/hs.2015.0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This research updates previous inventories of malicious attacks on food and water and includes data from 1946 through mid-2015. A systematic search of news reports, databases, and previous inventories of poisoning events was undertaken. Incidents that threatened or were intended to achieve direct harm to humans and that were either relatively large (more than 4 victims) or indiscriminate in intent or realization were included. Agents could be chemical, biological, or radionuclear. Reports of candidate incidents were subjected to systematic inclusion and exclusion criteria as well as validity analysis (not always clearly undertaken in previous inventories of such attacks). We summarize contextual aspects of the attacks that may be important for scenario prioritization, modelling, and defensive preparedness. Opportunity, and particularly access to dangerous agents, is key to most realized attacks. The most common motives and relative success rate in causing harm were very different between food and water attacks. The likelihood that people were made ill or died also varied by food or water mode and according to motive and opportunity for delivery of the hazardous agent. Deaths and illness associated with attacks during food manufacture and prior to sale have been fewer than those in some other contexts. Valuable opportunities for food defense improvements are identified in other contexts, especially food prepared in private or community settings.
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Thompson J, Rehn M, Lossius HM, Lockey D. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:521. [PMID: 25323086 PMCID: PMC4422304 DOI: 10.1186/s13054-014-0521-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required.
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Affiliation(s)
- Julian Thompson
- London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK.
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway. .,Field of Pre-hospital Critical Care, Network of Medical Sciences, University of Stavanger, Kjel Aarholmsgate 41, 4036, Stavanger, Norway.
| | - Hans Morten Lossius
- Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway. .,Field of Pre-hospital Critical Care, Network of Medical Sciences, University of Stavanger, Kjel Aarholmsgate 41, 4036, Stavanger, Norway.
| | - David Lockey
- London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK. .,School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK.
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Wilson T, Chang A, Berro A, Still A, Brown C, Demma A, Nemhauser J, Martin C, Salame-Alfie A, Fisher-Tyler F, Smith L, Grady-Erickson O, Alvarado-Ramy F, Brunette G, Ansari A, McAdam D, Marano N. US screening of international travelers for radioactive contamination after the Japanese nuclear plant disaster in March 2011. Disaster Med Public Health Prep 2013; 6:291-6. [PMID: 23077272 DOI: 10.1001/dmp.2012.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
On March 11, 2011, a magnitude 9.0 earthquake and subsequent tsunami damaged nuclear reactors at the Fukushima Daiichi complex in Japan, resulting in radionuclide release. In response, US officials augmented existing radiological screening at its ports of entry (POEs) to detect and decontaminate travelers contaminated with radioactive materials. During March 12 to 16, radiation screening protocols detected 3 travelers from Japan with external radioactive material contamination at 2 air POEs. Beginning March 23, federal officials collaborated with state and local public health and radiation control authorities to enhance screening and decontamination protocols at POEs. Approximately 543 000 (99%) travelers arriving directly from Japan at 25 US airports were screened for radiation contamination from March 17 to April 30, and no traveler was detected with contamination sufficient to require a large-scale public health response. The response highlighted synergistic collaboration across government levels and leveraged screening methods already in place at POEs, leading to rapid protocol implementation. Policy development, planning, training, and exercising response protocols and the establishment of federal authority to compel decontamination of travelers are needed for future radiological responses. Comparison of resource-intensive screening costs with the public health yield should guide policy decisions, given the historically low frequency of contaminated travelers arriving during radiological disasters.
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Affiliation(s)
- Todd Wilson
- U.S. Centers for Disease Control and Prevention,1600 Clifton Rd NE, Atlanta, GA 30329, USA.
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le Polain de Waroux O, Cohuet S, Bishop L, Johnson S, Shaw K, Maguire H, Charlett A, Fraser G. Prevalence of and risks for internal contamination among hospital staff caring for a patient contaminated with a fatal dose of polonium-210. Infect Control Hosp Epidemiol 2011; 32:1010-5. [PMID: 21931252 DOI: 10.1086/661913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Alexander Litvinenko died on November 23, 2006, from acute radiation sickness syndrome caused by ingestion of polonium-210 (²¹⁰Po). OBJECTIVE The objective was to assess the prevalence of and risk factors for internal contamination with ²¹⁰Po in healthcare workers (HCWs) caring for the contaminated patient. SETTING Hospital. PARTICIPANTS HCWs who had direct contact with the patient. METHODS We interviewed 43 HCWs and enquired about their activities and use of personal protective equipment (PPE). Internal contamination was defined as urinary ²¹⁰Po excretion above 20 mBq within 24 hours. We obtained risk ratios (RRs) for internal contamination using Poisson regression. RESULTS Thirty-seven HCWs (86%) responded, and 8 (22%) showed evidence of internal contamination, all at very low levels that were unlikely to cause adverse health outcomes. Daily care of the patient (washing and toileting the patient) was the main risk factor (RR, 3.6 [95% confidence interval (CI), 1.1-11.6]). In contrast, planned invasive procedures were not associated with a higher risk. There was some evidence of a higher risk associated with handling blood samples (RR, 3.5 [95% CI, 0.8-15.6]) and changing urine bags and/or collecting urine samples (RR, 2.7 [95% CI, 0.8-9.5]). There was also some evidence that those who reported not always using standard PPE were at higher risk than were others (RR, 2.5 [95% CI, 0.8-8.1]). CONCLUSIONS The sensitive quantitative measurement enabled us to identify factors associated with contamination, which by analogy to other conditions with similar transmission mechanisms may help improve protection and preparedness in staff dealing with an ill patient who experiences an unknown illness.
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Mackie P, Sim F. Be prepared. Public Health 2010; 124:303-4. [DOI: 10.1016/j.puhe.2010.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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