Describe the differences between a radiation incident and a traditional hazardous materials incident.

151

Weapons of Mass Effect— Radiation Hank T. Christen Paul M. Maniscalco Harold W. Neil III

• Describe the differences between a radiation incident and a traditional hazardous materials incident.

• Define the three types of radiation.

• Differentiate between the terms dose and exposure.

• Describe the distinction between acute and delayed effects of radiation exposure.

• Explain the difference between radiation exposure and contamination.

• Outline the first responder considerations in a radiological terrorism incident.

Objectives

10

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152 Homeland Security: Principles and Practice of Terrorism Response

Introduction

Radiation is effective as a weapon of mass effect be- cause of its long-term consequences and psychological effect on victims and the community. The word radiation immediately generates mental images of hideous and doomed casualties. This chapter provides an explana- tion of radiation and the types and hazards of radiation exposure. First responders need to understand the basics of radiation physics and protective measures to operate safely and effectively at a radiation attack or accident. Additional topics include the use of radiation as a terror- ism weapon, the medical effects of radiation, and tactical considerations and critical factors related to an effective response to a radiation incident.

Radiation incidents are a special type of hazardous materials incident because of several common factors, including internal exposure pathways, contamination concerns, decontamination techniques, and personal pro- tective equipment (PPE) requirements. These factors share commonality with chemical and biological threats.

Basic Radiation Physics Radiation travels in the form of particles or waves in bun- dles of energy called photons. Some everyday examples are microwaves used to cook food, radio waves for radio and television, light, and X-rays used in medicine.

Radioactivity is a natural and spontaneous process by which the unstable atoms of an element emit or ra- diate excess energy in the form of particles or waves. These emissions are collectively called ionizing radiation. Depending on how the nucleus loses this excess energy, a lower energy atom of the same form results, or a com- pletely different nucleus and atom are formed.

Ionization is a particular characteristic of the radia- tion produced when radioactive elements decay. These radiations are of such high energy that they interact with materials and electrons from the atoms in the material. This effect explains why ionizing radiation is hazardous to health and provides the means for detecting radiation.

An atom is composed of protons and neutrons contained in its nucleus. The only exception is the natu- rally occurring hydrogen atom, which contains no neu- trons. Protons and neutrons are virtually the same size. Electrons, which are much smaller than protons and neutrons, orbit the nucleus of the atom. The chemical behavior of an atom depends on the number of protons, which are positively charged, and the number of elec- trons, which are negatively charged. Neutrons, which have no electric charge, do not play a role in the chemical behavior of the atom.

Special placards are required when transporting certain quantities or types of radioactive materials. In

facilities that use radioactive materials, the standard radioactive symbol is used to label the materials for identification (CP FIGURE 10-1). Placard information is useful when responding to an accident involving ra- dioactive materials. However, in a terrorist attack, there are no labels or placards to identify the hazards involved.

Alpha, beta, and gamma energy are forms of radiation (FIGURE 10-1). Because alpha particles contain two protons, they have a positive charge of two. Further, alpha particles are very heavy and very energetic compared to other com- mon types of radiation. These characteristics allow alpha particles to interact readily with materials they encounter, including air, causing much ionization in a very short dis- tance. Typical alpha particles travel only a few centimeters in air and are stopped by a sheet of paper.

Beta particles have a single negative charge and weigh only a small fraction of a neutron or proton. As a result, beta particles interact less readily with material than alpha particles. Beta particles travel up to several meters in air, depending on the energy, and are stopped by thin layers of metal or plastic.

Like all forms of electromagnetic radiation, the gamma ray has no mass and no charge. Gamma rays interact with material by colliding with the electrons in the shells of atoms. They lose their energy slowly in material and travel significant distances before stopping. Depending on their initial energy, gamma rays can travel from one to hundreds of meters in air and easily go through people. It is important to note that most alpha and beta emitters also emit gamma rays as part of their decay processes.

Radiation is measured in one of three units as noted. A roentgen is a measure of gamma radiation. A radiation-absorbed dose (RAD) is a measurement of absorbed radiation energy over a period of time. Radiation dose is a calculated measurement of the amount of energy deposited in the body by the radiation to which a person is exposed. The unit of dose is the roentgen equivalent man (REM). The REM is derived by taking into account the type of radiation producing the exposure. The REM is approximately equivalent to the RAD for exposure to external sources of radiation. Detecting and measuring external radiation levels are critical at the scene of a radiation incident.

Radiation Measurements

It is equally important to develop an understanding of the dangers associated with different levels of exposure. Response agencies should develop policies regarding PPE and acceptable doses for emergency responders.

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These policies should be consistent with agency risk assessments and PPE standard operating procedures.

Radiation levels are measured with survey instru- ments designed for that purpose (FIGURE 10-2). Survey instruments usually indicate units of R/hr where R stands for either RAD or REM. The unit R/hr is an exposure (or dose) rate. An instrument reading of 50 R/hr means re- sponders exposed for 1 hour will receive a 50-RAD dose. Dividing the unit determines the exposure for shorter or longer periods of time (e.g., a 30-minute exposure results in a 25-RAD dose). An exposure (or dose) rate can be compared to a speedometer. A speed of 80 miles per hour means traveling 1 hour to go 80 miles. Traveling for half an hour at that rate covers a distance of 40 miles.

Some instruments measure radiation dose over a period of time. These instruments are comparable to an odometer, which measures total miles traveled regardless of the speed. Handheld survey instruments may have this capability, but they are more useful in an emergency situation for measuring the exposure rate. Radiation do- simeters are useful for measuring the exposure received over time (FIGURE 10-3).

Responders must wear dosimeters during opera- tions in any radiation hot zone or suspected radiation environment. Dosimeters should be checked frequently to determine the exposure received by on-scene first responders. Medical personnel should conduct final

dosimeter checks during postdecontamination medical evaluation.

Survey instruments and dosimeters have limitations because some instruments measure only beta and gamma radiation, not alpha radiation. The capability to measure alpha radiation is a requirement. It is important to de- velop a maintenance and inspection program that ensures instruments and dosimeters are properly functioning. Survey instruments, like all electronic devices, require inspection and recalibration by certified technicians at specified intervals. Survey instrument batteries must also

FIGURE 10-1 Alpha, beta, and gamma radiation.

Gamma

Alpha

Beta

FIGURE 10-2 A radiation detection device.

FIGURE 10-3 Dosimeters stay on the responder throughout an incident.

It is critical that responders detect and measure radia- tion levels and exposure at an attack or accident.

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154 Homeland Security: Principles and Practice of Terrorism Response

be checked and replaced when necessary. Dosimeters must be zeroed and checked on a regular basis.

Internal Radiation Exposure

For internal radiation exposure, the terms RAD and REM are not synonymous. It is important for first responders to know whether an internal exposure hazard exists and how to protect themselves by using PPE, including respirators. However, first responders should not be concerned with measuring internal radiation because internal exposure assessment is complicated due to the large number of factors involved. Some of these factors are the chemical form of the material, the type of radiation emitted, how the material entered the body, and the physical charac- teristics of the exposed person. Months of assessment may be required to determine an internal dose. Common methods for assessing internal exposure are sampling of blood, urine, feces, sweat, and mucus for the presence of radioactive material. Special radiation detectors measure the radiation emitted by radioactive materials deposited within the body. By considering the results of these mea- surements along with the characteristics of the material and the body’s physiology, a measurement of radiation dose from internal sources is made.

Characteristics of Radiation

Despite the similarities to hazardous materials incidents, radiation incidents have a unique characteristic that first responders must understand. Namely, radiation expo- sure may occur without coming in direct contact with the source of radiation, which is a primary difference between chemical and biological incidents. A chemical or biological agent exposure occurs when a material or agent is inhaled, ingested, injected, absorbed through the skin, deposited on unprotected skin, or introduced into the body by some means.

Radioactive materials are naturally occurring or manufactured and emit particle radiation and/or elec- tromagnetic waves. Contrary to popular science fiction, radioactive materials do not glow and do not have spe- cial characteristics making them readily distinguishable from nonradioactive materials. This means responders cannot detect or identify radioactive materials using the five human senses.

Radiation emitters may be liquid, solid, or gas. For example, radioactive cobalt, or cobalt-60, has the same chemical properties and appearance as nonradioactive cobalt. Radioactive water, known as tritium, cannot be readily distinguished from nonradioactive water. The difference lies in the atomic structure of the mate- rial, which is responsible for the characteristics of the material.

To understand the mechanism for radiation ex- posure, an explanation of radiation is necessary. Radiation is often incorrectly perceived as a mysterious chemical substance. Radiation is simply energy in the form of invisible electromagnetic waves or extremely small energetic particles. Waveforms of radiation are X-rays and gamma rays. Radiation is emitted by X-ray machines and similar equipment commonly found in medical and industrial facilities (FIGURE 10-4). Alpha, beta, and gamma are different types of radiation that have different penetrating abilities and present differ- ent hazards.

FIGURE 10-4 Radiation is emitted by medical equipment such as com- puted tomography scans.

Responders must wear personal dosimeters when op- erating in or near any radiation hot zone.

Radiation exposure can occur without direct contact with a radioactive source.

Radiation cannot be detected by human senses.

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Medical Effects of Radiation

Radiation energy can be deposited in the body during the exposure process regardless of the form or source. The amount of energy deposited in the body by a radiation source varies widely. It depends largely on the energy of the radiation, its penetrating ability, and whether the source of radiation is located outside or inside the body. Radiation exposure from a source outside the body is known as external exposure. Radiation exposure from a source within the body is known as internal exposure.

Consider the example of the radioactive cobalt, or cobalt-60, source discussed earlier. A person located within a few meters (the distance depends on the strength of the source) of the cobalt-60 source is exposed to the gamma radiation emitted from the source without di- rectly touching the source. This is an external exposure. If the source becomes damaged, the cobalt-60 could leak from the container. In order to cause an internal expo- sure, the cobalt-60 has to enter the body via inhalation, ingestion, or some other means.

Another important concept involving radioactive materials is demonstrated with the cobalt-60 source. Radioactive contamination is the presence of radioactive material in a location where it is not desired. Radioactive contamination results from the spillage, leakage, or other dispersal of unsealed radioactive material. The presence of radioactive contamination presents an internal expo- sure hazard because of the relative ease of radiation en- tering the body. There may also be an external exposure hazard depending on the radioactive material involved. Any location where radioactive material is deposited becomes contaminated. The contamination spreads by methods including air currents, water runoff, and per- sons touching the source and cross-contaminating other objects and areas by touch or walking.

The effects of radiation exposure on responders vary depending on the amount of radiation received and the route of entry. Radiation can be introduced into the body by all routes of entry and through the body by irradia- tion. Victims can inhale radioactive dust from nuclear fallout or a dirty bomb, or they can absorb radioactive liquid through the skin. In the body, radiation sources

irradiate the person internally rather than externally. Some common signs of acute radiation sickness are listed in TABLE 10-1. Additional injuries such as thermal and blast trauma, trauma from flying objects, and eye injuries occur from a radiological dispersal device (dirty bomb) detonation or a nuclear blast.

First responders should be aware of radiation’s health effects and risks because a radiation incident presents both internal and external exposure hazards that may be significant. The fundamental question is how much radiation is too much? A substantial number of scientists and academics argue that any exposure is dangerous and extraordinary precautions are necessary to minimize exposure. At the other end of the spectrum, many scientists and academics argue that some radiation exposure is necessary to life and perhaps even beneficial. In essence, responders must have a healthy respect for radiation and its associated dangers.

High levels of radiation exposure cause serious health effects to occur. These effects are called prompt or acute effects because they manifest themselves within hours, days, or weeks of the exposure. Acute effects in- clude death, destruction of bone marrow, incapacitation of the digestive and nervous systems, sterility, and birth defects in children exposed in utero. A localized high exposure can result in severe localized damage requir- ing amputation of the affected area. These effects are clearly evident at high exposures such as an atomic bomb detonation or serious accident involving radioactive ma- terials. These effects are seen at short-term exposures of about 25 RAD and above. The severity and onset of the effect are proportionate to the exposure. Effects of radiation exposure that are not manifest within a short period of time are called latent or delayed effects. The most important latent effect is a statistically significant increase in the incidence of cancer in populations ex- posed to high levels of radiation.

The health effects of low exposures are not obvious and subject to debate in scientific and academic circles. Low exposures do not cause obvious bone marrow dam- age, digestive effects, nervous system effects, cancer, or birth defects. To minimize risks, occupational dose lim- its for persons working with radiation are 5 REMs per

TABLE 10-1 Common Signs of Acute Radiation Sickness

Exposure Effects

Low exposure Nausea, vomiting, diarrhea

Moderate exposure First-degree burns, hair loss, death of the immune system, cancer

Severe exposure Second- and third-degree burns, cancer, death

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156 Homeland Security: Principles and Practice of Terrorism Response

year. This is not a dividing line between a safe and unsafe dose; it is a conservative limit set to minimize risk. This is why scientists and safety professionals advocate an approach based on a healthy respect for radiation.

Radiation Accidents

Most radiation accidents encountered by emergency medical personnel generally involve transported radio- active materials or radiation-emitting devices used in an industrial or institutional setting. Other incidents include the accidental or deliberate misuse of radioactive materi- als. Industrial accidents cover a range of situations from activities within nuclear power plants, isotope production facilities, materials processing and handling facilities, and the widespread use of radiation-emitting measurement devices in manufacturing and construction.

Institutional accidents generally involve research laboratories, hospitals and other medical facilities, or academic facilities. Generally, the victim was directly involved in handling the material or operating a radi- ation-emitting device. Transportation accidents occur during the shipment of radioactive materials and waste. However, due to stringent regulations and enforcement governing the packaging and labeling of radioactive ma- terial shipments, few of these incidents pose any serious threat to health and safety.

Commercial and private aircraft accidents may in- volve radioactive materials that are usually radio-phar- maceuticals carried as cargo or radioactive instrument components, but these sources seldom pose a serious exposure risk. Accidents involving military aircraft gen- erally pose no increased risk because radioactive weap- ons are sealed, shielded, and protected against accidental detonation or accidental release.

There have been several international incidents where radioactive materials were unknowingly re- leased by individuals who were unaware of the hazards. Improperly or illegally discarded radiation sources have been opened by scrap dealers and others, causing serious contamination and lethal exposure to many people.

EMS and fire/rescue agencies responding to a radia- tion incident must remember that expedient delivery of appropriate victim medical treatment, including trans-

port to a hospital, is a priority. Treating the victim’s medical condition is a priority.

Responders usually learn that radiation is involved by the following:

  1. They are advised by dispatchers based on caller information.
  2. They are advised on arrival by other respond- ers such as police or fire officials that radioactive materials are present at the scene.
  3. They are advised by victims that they were con- taminated or exposed.
  4. They determine from observations of the incident site that contamination or exposure is a possi- bility. Visual sources include signs, placards, or documents such as shipping papers.

Information regarding the source of the radia- tion, type of radioactive material, and exposure time is valuable data that should be gathered at the scene. It is important that EMS personnel consider the distinc- tion between exposure and contamination. Responders should remember there is a minimal chance of encoun- tering a radiological incident that is a serious threat to their health and safety. While accidents involving small amounts of radioactive material may occur in industry or commerce, incidents involving high levels or danger- ous amounts of radiation are unusual and rarely occur outside the surveillance of qualified experts.

Contaminated victims should be treated using ap- propriate medical protocols. These victims are not radio- active, but they present a hazard to medical personnel if they are not decontaminated. EMS responders should take steps to minimize personal and vehicle contamina- tion by using agency-approved decontamination proce- dures when radiation is known or suspected. Receiving medical facilities must also initiate appropriate decon- tamination procedures prior to the victim entering the emergency department to ensure that buildings and oc- cupants are not contaminated.

External Radiation Exposure Victims exposed to a high dose of radiation generally present no hazard to other individuals. The victim is not radioactive and is no different than a patient exposed to diagnostic X-rays. An exception to this rule is victims ex- posed to significantly high amounts of neutron radiation because persons or objects subjected to neutron radiation may become radioactive. Such activation is extremely rare and this is noted for information purposes only.

External Contamination Externally contaminated victims present problems simi- lar to encounters with chemical contamination. External

Treating a victim’s medical condition is a priority.

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contamination usually means the individual has con- tacted unconfined radioactive material such as a liquid or powder or airborne particles from a radioactive source. Containment of the material to avoid spreading the contamination is important. People or objects coming in contact with radiologically contaminated victims or objects are considered contaminated until proven oth- erwise. Implementing isolation techniques to confine the contamination and protect personnel is a primary objective.

Internal Contamination Externally contaminated victims may receive inter- nal contamination by inhalation, by ingestion, or by absorption through open wounds. However, internal contamination is not usually a hazard to the individu- als around the victim. The most common type of inter- nal contamination is inhalation of airborne radioactive particles deposited in the lungs. Absorption through the skin of radioactive liquids or the entry of radioac- tive material through an open wound is also possible. There may be little external contamination, but the vic- tim suffers the effects of exposure from the ingested or absorbed radioactive material. This means an injured person contaminated both internally and externally with radioactive material should be decontaminated, treated using universal precautions, transported, and evaluated for exposure by qualified medical experts.

External contamination may be eliminated or re- duced by removing clothing and using conventional cleansing techniques on body surfaces, such as gentle washing and flushing that does not abrade the skin surface. However, internal contamination cannot be removed or treated at the incident scene.

Radiological Terrorism

The Oklahoma City federal building and World Trade Center bombings, the subway poison gas attack in Japan, the use of chemical and biological agents during the Gulf War, and other incidents highlight awareness of the potential for terrorist acts involving weapons of mass effect. The deliberate dispersal of radioactive material by terrorists is another potential source of contamination and/or exposure that must be considered.

A weapon of mass effect incident in which chemi- cal, biological, or radiological materials are released by explosives can cause significant numbers of casualties and create widespread panic. Such situations require that steps are taken to protect responders and facilities against unnecessary exposure. In any terrorist incident that produces mass casualties and extensive damage, the first consideration should be determining whether a chemical, biological, or radiological agent was involved. The presence of a hazardous material with the accompa- nying prospect of contamination and exposure drasti- cally alters the approach that should be taken by medical service personnel.

A radiological dispersal device is any container that is designed to disperse radioactive material. Dispersion is usually by explosives, hence the nickname, “dirty bomb.” A dirty bomb has the potential to injure victims by radioactive exposure and blast injuries. A radiological dispersal device creates fear, which is the ultimate goal of the terrorist. In reality, the destructive capability of a dirty bomb is based on the explosives used. The outcome may be long-term injuries and illness associated with ra- diation and long-term environmental contamination.

The destructive energy of a nuclear detonation sur- passes all other weapons. This is why nuclear weap- ons are kept generally in secure facilities throughout the world. There are nations aligned with terrorists that have nuclear weapons. Yet the ability of some nations to deliver nuclear weapons such as missiles or bombs is debatable. Unfortunately, after the collapse of the former Soviet Union, the security of nuclear devices is question- able. Other nonfriendly nations such as Pakistan, North Korea, and Iran also have nuclear weapons.

Injured victims should be triaged, treated, moni- tored, and decontaminated, if possible, at the scene (FIGURE 10-5). The movement of contaminated or exposed victims to medical facilities poses the substantial risk of contaminating transportation resources, treatment facilities, and staff, which renders these resources unfit for treating other victims. EMS protocols should clearly outline the critical steps when there is notification of a terrorist incident involving a radioactive material. The considerations are the following:

• Dispatching on-shift and off-shift emergency staff to establish on-scene triage, treatment, and transport capabilities.

• EMS collaboration with local and regional med- ical facilities.

• Notification of the state warning point (usually the state emergency operations center) that a radiation attack or accident has occurred. This notification may initiate a federal response.

Victims must be decontaminated if they are externally contaminated by radioactive materials.

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158 Homeland Security: Principles and Practice of Terrorism Response

• Non–law enforcement responders must re- member that a terrorist incident is a criminal act and interaction with law enforcement of- ficials is an integral part of the response contin- uum. No physical evidence should be handled, moved, or discarded without authorization from law enforcement officials. All activities and observations should be carefully and thor- oughly recorded because responders are poten- tial witnesses in criminal proceedings.

Responder Tactical Actions

Refer to Chapter 13, “Personal Protective Equipment,” and review local agency PPE procedures to ensure re- sponders are adequately protected. Note that there are no protective ensembles designed to completely shield responders from radiation. Protective clothing with ap- propriate respiratory protection is effective for protec- tion from alpha or beta radiation; however, there are no ensembles that provide shielding from gamma radiation. The most effective procedures for gamma protection are time, distance, and shielding such as concrete walls.

Time Radiation has a cumulative effect on the body over time. This means that reducing the time of radiation exposure reduces the overall exposure or dose. Every effort must be made to minimize working time in radiological hot zones.

Distance Radiation travel is limited by distance. Doubling the distance from a radiation source reduces the effects to one quarter of the original exposure. For example, a gamma exposure of 100 REM/hr at 5 meters is reduced to 25 REM/hr at 10 meters. Increasing distance from the source is effective with alpha radiation because alpha particles do not travel more than a few centimeters.

Shielding As discussed earlier, the path of all radiation can be stopped or reduced by specific objects called shields. Responders to a radiation incident should always assume they are exposed to the strongest form of radiation and use concrete shielding such as buildings or walls (if practical) to shield themselves. Remember that vehicles and traditional residential/com- mercial construction do not provide adequate shielding against gamma radiation (CP FIGURE 10-2).

Tactical Actions Units responding to a suspected or confirmed radiation incident should initiate the following tactical actions:

  1. Observe explosive protection procedures for ra- diological dispersion devices.
  2. Don appropriate ensembles with respirator pro- tection.
  3. Use the principles of time, distance, and shielding for protection.
  4. Notify the appropriate local and state agencies that a radiation incident is in progress.
  5. Immediately establish a hot zone and enforce safe site entry and egress procedures.
  6. Establish a decontamination corridor with medi- cal surveillance for personnel exiting the hot zone.
  7. Establish a security perimeter a safe distance around the incident scene.
  8. Observe crime scene preservation procedures and collaborate with law enforcement efforts.

FIGURE 10-5 Victims should be triaged, treated, monitored, and decon- taminated, if possible, at the scene.

Time, distance, and shielding are protective measures that reduce radiation exposure.

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Chapter Summary

Radiation is effective as a weapon of mass effect be- cause of its long-term consequences and psychologi- cal effect on victims and the community. Radiation travels in the form of particles or waves in bundles of energy called photons, and alpha, beta, and gamma energy are all forms of radiation. Survey instruments and dosimeters have limitations because some instru- ments measure only beta and gamma radiation, not alpha radiation.

Radiation is measured in one of three units. A roentgen is a measure of gamma radiation. A RAD is a measurement of absorbed radiation energy over a period of time. Radiation dose is a calculated measure- ment of the amount of energy deposited in the body by the radiation to which a person is exposed. The unit of dose is the REM.

Despite the similarities to hazardous material inci- dents, radiation incidents have a unique characteristic that first responders must understand. Namely, radiation exposure may occur without coming in direct contact with the source of radiation, which is a primary difference be- tween chemical and biological incidents. Radiation expo- sure from a source outside the body is known as external exposure. Radiation exposure from a source within the body is known as internal exposure. High levels of radiation exposure cause serious health effects to occur.

The Oklahoma City federal building and World Trade Center bombings, the subway poison gas attack in Japan, the use of chemical and biological agents during the Gulf War, and other incidents highlight awareness of the potential for terrorist acts involving weapons of mass effect. It is important to remember that there are no protective ensembles designed to completely shield responders from radiation.

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Wrap Up Chapter Questions

  1. How does a radiation incident differ from a tra- ditional hazardous materials incident?
  2. List and define the three primary types of radia- tion.
  3. Define and differentiate the terms dose and ex- posure.
  4. List and discuss at least five tactical actions at a radiation incident.
  5. Discuss basic medical treatment procedures for each of the following radiation exposures:

External radiation exposure – External contamination – Internal exposure –

  1. Define the protection principles of time, distance, and shielding.

Chapter Project

There is a major international festival in your commu- nity with 50,000 attendees. A bomb detonation gen- erates 95 trauma casualties. An immediate assessment by the hazardous materials team reveals the explosive device was combined with a radioactive material caus- ing radiation exposure and contamination to 50 victims and 20 responders. Discuss the following questions in detail:

  1. What emergency response operational procedures are in effect in your jurisdiction that address this scenario?
  2. Based on this chapter, what protocols and oper- ating procedure should be added to community response plans?
  3. What role does hospital preparedness play in this incident? Consider that many victims will self-present at hospitals or immediate care cen- ters, which circumvents the traditional EMS system.
  4. What are the contamination issues in this inci- dent?
  5. What are the state and federal support agencies available for assistance to your locale in a major radiation incident?

Vital Vocabulary

Alpha particles Heavy and energetic radiation particles consisting of two protons; alpha particles interact readily with materials they encounter, including air, causing much ionization in a very short distance. Atom The smallest unit of an element that contains a nucleus of neutrons and protons with electrons orbiting the nucleus. Beta particles Negatively charged radiation particles that weigh a small fraction of a neutron or proton; beta particles travel up to several meters in air, depending on the energy, and are stopped by thin layers of metal or plastic. Dosimeters Radiation measuring instruments that mea- sure radiation over time. Electrons Negatively charged particles that orbit the nucleus of the atom. Gamma rays High-energy radiation rays that travel significant distances; gamma rays can travel from one to hundreds of meters in air and readily travel through people and traditional shielding. Ionization A characteristic of the radiation produced when radioactive elements decay. Neutrons Particles in the nucleus of an atom that are neutrally charged. Photons Bundles of radiation energy in the form of particles or waves. Protons Positively charged particles in the nucleus of an atom. Radiation A natural and spontaneous process by which the unstable atoms of an element emit or radiate excess energy in the form of particles or waves. Radiation-absorbed dose (RAD) Measurement of ab- sorbed radiation energy over a period of time. Radioactivity A characteristic of materials that produce radiation because of the decay of particles in the nucleus. Radiological dispersal device A device using con- ventional explosives to physically disperse radioactive materials over a wide area. Roentgen A unit of radiation exposure. Roentgen equivalent man (REM) A radiation dose that takes into account the type of radiation producing the exposure and is approximately equivalent to the RAD for exposure to external radiation.

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161

Weapons of Mass Effect—Explosives Hank T. Christen Paul M. Maniscalco

• Discuss the significance of explosive devices in terrorism and tactical violence events.

• List the categories of explosives and their characteristics.

• Outline the basic elements in the explosive train.

• Describe the basic initiating elements in explosive devices.

• Outline the critical safety steps that must be utilized when operating in an environment where explosive devices are suspected or present.

Objectives

11

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162 Homeland Security: Principles and Practice of Terrorism Response

Introduction

One of the first explosives, black powder, was invented by the Chinese in A.D. 600. History has not recorded the first use of explosives for terrorism, but there is little doubt that soon after the invention of black powder, someone used it as a weapon.

Today there are many types of explosives designed for industrial use, military operations, and entertain- ment. All of these explosives are available to people through various means (legal and otherwise) for clan- destine use. Some explosives are made at home with common chemicals using recipes easily accessible to anyone seeking the information.

Explosive devices are effective as weapons of mass destruction or weapons of mass effect for the following basic reasons:

  1. Explosives create mass casualties and property destruction.
  2. Explosives are major psychological weapons because an explosion instills terror and fear in survivors and the unaffected population.
  3. Secondary explosive devices increase the threat level at incidents and complicate law enforce- ment, medical, rescue, and suppression efforts.
  4. The charges can be planted for timed or remote detonation.

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You should be working on this assignment over the course of the semester as you read Marks’s book, “The Origins of the Modern World.” Ideally you should prepare this on your word processor, saving your file frequently, then submit it by copying and pasting content into the submission window.
Compose a book report for Robert Mark’s The Origins of the Modern World. The book report must be at least 750 words in length and will include two sections:
1. A chapter by chapter summary of the contents of the book comprising at least two thirds of the book report. There should be individual chapter headings indicating the material that you are summarizing followed by brief summaries of the contents of that chapter.
2. A critique of the book as a whole. Evaluate the book. Was it effective? Was it coherent? Was it enjoyable? Why or why not? Which arguments in the book were convincing? Which arguments were not convincing? The length of the critique should be no more than one third the entire length of the book report and no less than 100 words.

 

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Write a research paper of AT LEAST five pages. Choose a short story by an author in our anthology that we are not already studying in this course (in other words, somebody NOT on the syllabus) and choose some element of fiction—plot, characters, point of view, setting, or style—about which to write your paper. Please note: for this assignment, we will not be discussing themes. Focus on just one or two of these fiction elements, develop a thesis, and write a researched argumentative paper. Biographical information about the author should ONLY be provided if it is relevant to the thesis of the essay—and even in this case, biographical information should be brief. Make sure that your thesis argues a point and that you support that point throughout the paper. Do not write a book report or simply recap the text—argue a point. Assume that your audience has read the story.

​Your essay MUST be in MLA format. For your assistance, this instruction sheet follows MLA style (e.g., 1-inch margins, no title page). You must use the font Times New Roman, 12 pt, double-spaced—again, as you see here. If you have questions about format, ASK. You may use as many research sources as you feel are necessary, but you must use AT LEAST three critical sources that are NOT internet websites or encyclopedias. These should be books or periodical articles that discuss the main work you are studying (in other words, in addition to your primary text). You may use any of the essays in our anthology IN ADDITION TO your three “outside” critical sources. You MUST cite all of your sources using MLA style (parenthetical is preferred); attach a Works Cited list. If you are unclear on any aspect of citing sources, please ASK. If you fail to cite properly within the body of your essay—in other words, if you plagiarize—you will not pass.

​I STRONGLY ENCOURAGE you to consult with me throughout your writing process, rather than just handing in the paper on the deadline date. You should also use the Writing Studio—in fact, if you visit the Writing Studio for help with this assignment, forward me the email that confirms your visit and you will receive five bonus points! Students who seek guidance produce better papers than those who do not. Please keep in mind that if you fail to meet ANY of the requirements of the assignment—for example, if your paper is only four and a half pages or you use only two critical research sources—you will not earn enough points to pass the assignment, so please follow all instructions carefully.

 

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Purpose
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice intervention used to identify, reduce, and prevent problematic use, abuse, and dependence on substances such as tobacco, alcohol, and illicit drugs. The SBIRT model was incited by an Institute of Medicine (IOM) recommendation that called for community-based screening for health-risk behaviors. The purpose of this assignment is to integrate SBIRT into nursing practice to help stimulate positive change at the individual and population-focused level of care.

Course Outcomes
This assignment enables the student to meet the following Course Outcomes (COs).

CO3: Plan prevention and population-focused interventions for vulnerable populations using professional clinical judgment and evidence-based practice. (PO4, PO8)
CO4: Evaluate the delivery of care for individuals, families, aggregates, and communities based on theories and principles of nursing and related disciplines. (PO1)
Due Date
Submit your completed SBIRT presentation by 11:59 p.m. MT Sunday of Week 6.

Points:
225 points

Background information
SBIRT consists of three major components.

1. Screening—A healthcare professional assesses a patient for concerning behaviors using standardized screening tools. Screening can occur in any healthcare setting.

2. Brief Intervention—A healthcare professional engages a patient in a short conversation, providing feedback and advice regarding concerning behaviors.

3. Referral to Treatment—A healthcare professional provides a referral to resources and/or treatment options and additional services available (Substance Abuse and Mental Health Services Administration [SAMHSA], n.d.)

Directions
Prior to starting the presentation, you are to read the assigned training.
SBIRT Education. (n.d.). Overview of screening, assessment and brief intervention: A nursing response to the full spectrum of substance abuse retrieved from https://hospitalsbirt.webs.com/nursingsbirt.htm. Here is the direct link: Intervention and Nursing Response article (Links to an external site.)

Choose “Watch On-Demand Recording”
Start at minute 9:08/slide 12 and end at 1 hr 27 sec (slide 80)
Or you may go directly to the YouTube video:

SBIRT Education. (2015, May 10). Overview of SBIRT: A nursing response to the full spectrum of substance use [Video File]. Retrieved from https://www.youtube.com/watch?v=TZvCQUmN8c. Here is the direct link: YouTube Video for Intervention and Nursing Response (Links to an external site.)

Use this BNI checklist for the role play at the end: BNI Checklist (Links to an external site.) SBIRT Education. (n.d.). Brief negotiated interview checklist [PDF Document]. Retrieved from https://hospitalsbirt.webs.com/nursingsbirt.htm

You are encouraged to review the assignment tutorial found at the end of the Academic Integrity Reminder.

Next, choose one addiction or problem to focus on for this assignment from the options below.
Nicotine (all tobacco and electronic nicotine delivery systems)
Alcohol
Drug use (addictive prescription or illicit)
You must be specific to which drug you are choosing
You are required to use one of the problems listed above. Assignments that do not follow the current guidelines or use the required forms or templates will be evaluated for evidence of an academic integrity violation. After the due date, there will be no opportunity for revision or resubmission of assignments that have been uploaded to the submission area. It is your responsibility to submit the correct assignment to the correct submission area.
After you have chosen the addiction/problem, you are to research SBIRT training specific to that addiction/problem. Before starting to work on the presentation, it is vital you understand how SBIRT is used with that particular addiction/problem. You must find at least two scholarly resources (other than readings assigned in the course) and one video resource. Search YouTube for one SBIRT training video from a reputable source that shows a provider using SBIRT with a patient. Watch this video so that you understand the steps of SBIRT.
You may choose to complete this assignment as a PowerPoint poster or PowerPoint multiple slide presentation. Download the SBIRT PowerPoint poster (Links to an external site.) or slide presentation template (Links to an external site.).
Submit the completed PowerPoint poster or slide presentation by Sunday, 11:59 p.m. MT at the end of Week 6.
Length: The poster should be one page with all boxes on template complete. The slide presentation should be no more than twelve slides, not including the title and references slides.
Guidelines
Below are the requirements needed for successful completion of the SBIRT: Screening, Brief Intervention, and Referral to Treatment presentation.

Introduction to the problem and/or addiction: Clearly identify the problem, and discuss specific statistics from your community related to this problem. You may use city or county data. For example, if you choose tobacco use, you should find the tobacco use rate in your city or county. **Please note, this is only an example, you must choose from one of the topic options provided in the guidelines above.**
Problem description: Utilize one scholarly reference (not assigned in this course) to describe this problem/addiction. Discuss reasons why this may be a problem in your community. Cite all sources.
SBIRT description: Utilize at least one scholarly reference different from the one selected for the problem description above, and not assigned in this course, to describe how SBIRT is used with this specific addiction/problem. Identify specific steps and questions that are used.
Video: Locate and describe at least one video that demonstrates SBIRT related to the addiction you chose.
Citation: Cite all sources.
Community resources: Describe at least two available community resources to which you may refer people who have this problem or an increased potential for acquiring this problem. You are to provide the names of these resources and brief descriptions. You may use online resources if community resources are not available.
Conclusion/future implications for nursing: Provide a summary of your findings. Discuss the use of SBIRT in nursing practice.
References: Provide all references for all sources utilized. Use APA format; however, a hanging indent is not necessary.
Best Practices in Preparing PowerPoint
The following are best practices in preparing this presentation.

Review directions thoroughly.
We recommend that you use one of the linked templates. Replace the placeholder text with your own content. Use a black or colored font that is easy to read.
Be creative. You may choose a design (from Design tab) to enhance visual appeal.
Incorporate graphics, clip art, or photographs to increase interest.
Use short bullet points and large font for easier reading. For PowerPoint slides, use no more than eight lines per slide and no more than eight words per line.
Do not use the notes section in the PowerPoint format (they are not visible in Canvas-Speedgrader)
Cite all sources within the slides or poster with (author, year) as well as on the Reference slide or section.
Proofread prior to final submission.
Spell check for spelling and grammatical errors prior to final submission.
Reference

Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). SBIRT: Screening, Brief Intervention, and Referral to Treatment.

References: American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7 ed.). St. Louis, MO: Elsevier.

 

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