ICRP Publication 96

ABSTRACT GUEST EDITORIAL PREFACE EXECUTIVE SUMMARY 1.INTRODUCTION BACKGROUND Security of Radiation Sources Radiation-Related Malevolence AIM OF THE REPORT INTENDED AUDIENCE 2.CHARACTERIZING THE SITUATION POTENTIAL SCENARIOS Threat Initiators Common Features SPECIAL FEATURES Location Public Perception Source Term Characterization Covert Situations Public Sentiment Advance Warning Criminal Investigation Challenges PLANNING "All-hazard" Planning Disaster Management Medical Preparedness Psychological Issues Exercises EXPOSURE Quantification Pathways INITIAL REACTION Reacting to an Explosion Reacting to an IND RESPONSE PHASES Rescue and Early Actions Recovery Restoration LINKS 3.POTENTIAL HEALTH EFFECTS ATTRIBUTABLE TO RADIATION EXPOSURE BIOLOGICAL HEALTH EFFECTS Deterministic effects Stochastic effects Prenatal exposure effects Other issues with pregnant women and children Special considerations for INDs Summary of Biological Health Consequences PSYCHOLOGICAL HEALTH EFFECTS Distress Fear of Cancer and other Health Effects attributable to Radiation 4.PROTECTING RESPONDERS OCCUPATIONAL PROTECTION APPROACH Occupational Dose Guidelines OCCUPATIONAL PROTECTION TECHNIQUES Managing Field Exposures Protective Clothing Respiratory Protection 5.PROTECTING THE PUBLIC RESCUE PHASE (IMMEDIATE ACTIONS) Controlling access and spread of contamination Immediate care of people with traumatic injuries Triage Dose Assessment Psychological triage and disposition Respiratory protection RESCUE PHASE (URGENT ACTIONS) Personal Decontamination Sheltering Evacuation Iodine Prophylaxis RECOVERY PHASE Refined Dose Assessment Biological assays Temporary Relocation and Resettlement RESTORATION PHASE Cleanup Management of Radioactive Waste Radioactive Residues Discontinuation of Protective Actions Final dose assessment SUMMARY OF DOSE CRITERIA FOR PROTECTING THE PUBLIC Generic Optimized Protection Levels Operational Levels CONTROLLING CONTAMINATION OF CONSUMER GOODS Basic Criteria International consensus on radiological criteria for radionuclides in commodities Radionuclides in Bulk Amounts of Materials Radionuclides in Foods Radionuclides in Water Supplies Control in the Affected Area Control Outside the Affected Area PARTICULAR SITUATIONS Handling Situations with "Hot Particles" Handling Contaminated Corpses 6.MEDICAL INTERVENTION ESSENTIAL ELEMENTS OF MEDICAL TREATMENT OTHER IMPORTANT MEDICAL ISSUES Identification of radionuclides Secondary treatment centers Biodosimetry Skilled personnel Training Medical Personnel Long term follow-up 7.COMMUNICATION REFERENCES ANNEX I: TERMINOLOGY ANNEX II: POTENTIAL SCENARIOS Malicious Intent Unannounced Events Thefts Radiation Exposure Devices Radioactive Dispersion Devices Site-Specific Radioactive Contamination Radioactive Contamination of Food and Water Supplies Attacking Nuclear Facilities Improvised Nuclear Devices ANNEX III: MEDICAL ISSUES PLANNING FOR PUBLIC HEALTH & MEDICAL INTERVENTION Threats Unannounced Events Irradiation Contamination of food and water supplies RDDs Attack upon a nuclear facility RELEVANT INFORMATION FOR IMMEDIATE MEDICAL PROGNOSIS AND INITIAL TREATMENT OF RADIATION EFFECTS ATTRIBUTABLE TO EXTERNAL RADIATION Prodromal phase of acute radiation syndrome Change of lymphocyte counts in the initial days of acute radiation syndrome depending on the dose of acute whole body exposure Latent phase of acute radiation syndrome Findings of critical phase of acute radiation syndrome following whole body exposure Principal therapeutic measures for acute radiation syndrome according to degree Onset time of clinical signs of skin injury depending on the dose received THERAPIES FOR INTERNAL CONTAMINATION Blocking, diluting and displacement agents Reduction of gastrointestinal absorption Chelating agents THERAPIES FOR EXTERNAL EXPOSURE Prevention and treatment of infections Maintenance of fluid and electrolyte balance Specific treatments of bone marrow depression Radioprotective agents ANNEX IV: PSYCHOLOGICAL ISSUES COMMUNICATION BETWEEN CARE PROVIDERS AND PATIENTS DEBRIEFING