Contents:

ABSTRACT
GUEST EDITORIAL
PREFACE 5
EXECUTIVE SUMMARY 8
1. INTRODUCTION 17
BACKGROUND 17
Security of Radiation Sources 17
Radiation-Related Malevolence 18
AIM OF THE REPORT 19
INTENDED AUDIENCE 21
2. CHARACTERIZING THE SITUATION 22
POTENTIAL SCENARIOS 22
Threat 22
Initiators 23
Common Features 24
SPECIAL FEATURES 25
Location 25
Public Perception 25
Source Term Characterization 26
Covert Situations 26
Public Sentiment 27
Advance Warning 27
Criminal Investigation 28
Challenges 29
PLANNING 29
"All-hazard” Planning 30
Disaster Management 31
Medical Preparedness 31
Psychological Issues 32
Exercises 33
EXPOSURE 34
Quantification 34
Pathways 36
INITIAL REACTION 38
Reacting to an Explosion 38
Reacting to an IND 38
RESPONSE PHASES 39
Rescue and Early Actions 39
Recovery 40
Restoration 40
LINKS 40
3. POTENTIAL HEALTH EFFECTS ATTRIBUTABLE TO RADIATION EXPOSURE 42
BIOLOGICAL HEALTH EFFECTS 42
Deterministic effects 42
Stochastic effects 43
Prenatal exposure effects 43
Other issues with pregnant women and children 45
Special considerations for INDs 45
Summary of Biological Health Consequences 46
PSYCHOLOGICAL HEALTH EFFECTS 46
Distress 47
Fear of Cancer and other Health Effects attributable to Radiation 47
4. PROTECTING RESPONDERS 48
OCCUPATIONAL PROTECTION APPROACH 49
Occupational Dose Guidelines 50
OCCUPATIONAL PROTECTION TECHNIQUES 52
Managing Field Exposures 52
Protective Clothing 53
Respiratory Protection 54
5. PROTECTING THE PUBLIC 54
RESCUE PHASE (IMMEDIATE ACTIONS) 54
Controlling access and spread of contamination 55
Immediate care of people with traumatic injuries 56
Triage Dose Assessment 58
Psychological triage and disposition 59
Respiratory protection 60
RESCUE PHASE (URGENT ACTIONS) 60
Personal Decontamination 60
Sheltering 61
Evacuation 64
Iodine Prophylaxis 66
RECOVERY PHASE 68
Refined Dose Assessment 68
Biological assays 68
Temporary Relocation and Resettlement 70
RESTORATION PHASE 71
Cleanup 71
Management of Radioactive Waste 73
Radioactive Residues 74
Discontinuation of Protective Actions 75
Final dose assessment 76
SUMMARY OF DOSE CRITERIA FOR PROTECTING THE PUBLIC 77
Generic Optimized Protection Levels 77
Operational Levels 78
CONTROLLING CONTAMINATION OF CONSUMER GOODS 78
Basic Criteria 79
International consensus on radiological criteria for radionuclides in commodities 80
Radionuclides in Bulk Amounts of Materials 80
Radionuclides in Foods 81
Radionuclides in Water Supplies 82
Control in the Affected Area 84
Control Outside the Affected Area 84
PARTICULAR SITUATIONS 84
Handling Situations with "Hot Particles” 84
Handling Contaminated Corpses 85
6. MEDICAL INTERVENTION 87
ESSENTIAL ELEMENTS OF MEDICAL TREATMENT 87
OTHER IMPORTANT MEDICAL ISSUES 89
Identification of radionuclides 89
Secondary treatment centers 89
Biodosimetry 90
Skilled personnel 90
Training Medical Personnel 91
Long term follow-up 91
7. COMMUNICATION 92
REFERENCES 94
ANNEX I: TERMINOLOGY 99
ANNEX II: POTENTIAL SCENARIOS 110
Malicious Intent 110
Unannounced Events 110
Thefts 110
Radiation Exposure Devices 111
Radioactive Dispersion Devices 111
Site-Specific Radioactive Contamination 112
Radioactive Contamination of Food and Water Supplies 113
Attacking Nuclear Facilities 113
Improvised Nuclear Devices 114
ANNEX III: MEDICAL ISSUES 115
PLANNING FOR PUBLIC HEALTH & MEDICAL INTERVENTION 115
Threats 115
Unannounced Events 115
Irradiation 115
Contamination of food and water supplies 116
RDDs 117
Attack upon a nuclear facility 117
RELEVANT INFORMATION FOR IMMEDIATE MEDICAL PROGNOSIS AND INITIAL TREATMENT OF RADIATION EFFECTS ATTRIBUTABLE TO EXTERNAL RADIATION 117
Prodromal phase of acute radiation syndrome 119
Change of lymphocyte counts in the initial days of acute radiation syndrome depending on the dose of acute whole body exposure 121
Latent phase of acute radiation syndrome 121
Findings of critical phase of acute radiation syndrome following whole body exposure 122
Principal therapeutic measures for acute radiation syndrome according to degree 123
Onset time of clinical signs of skin injury depending on the dose received 123
THERAPIES FOR INTERNAL CONTAMINATION 124
Blocking, diluting and displacement agents 124
Reduction of gastrointestinal absorption 126
Chelating agents 127
THERAPIES FOR EXTERNAL EXPOSURE 128
Prevention and treatment of infections 129
Maintenance of fluid and electrolyte balance 129
Specific treatments of bone marrow depression 130
Radioprotective agents 133
ANNEX IV: PSYCHOLOGICAL ISSUES 134
COMMUNICATION BETWEEN CARE PROVIDERS AND PATIENTS 136
DEBRIEFING 138