Description: 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 radiat

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