
Chapter 101 WEAPONS OF MASS DESTRUCTION702
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Incorporation—Refers to the uptake of radioactive material in cells, tissues, or organs.
Contamination must occur for incorporation to occur. Incorporation allows for continued
internal exposure and long-term injury and illness.
12. What are the different types of attacks?
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Environmental exposure (also known as simple radiologic device)—Placement of a
radioactive source in a public location or within the food or water supply. Although many people
would be exposed with this method, very few would likely be significantly contaminated. This
type of attack, however, would generate a significant amount of fear and panic.
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Radiological Dispersal Device (RDD)—a device designed to spread radioactive material
for the purpose of terrorism by using conventional explosives to disperse the radioactive
material; this is referred to as a dirty bomb. Most of the damage caused by this sort of
weapon would be created primarily by the explosion, as the dissemination of radioactive
material would be limited in effect. Exposed or contaminated individuals would be those in
close proximity to the blast area.
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Attack/Sabotage of a nuclear reactor—could lead to significant release of radioactive
material into environment.
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Nuclear bomb—Obviously the most potentially devastating attack. The least likely method
of attack due to strict security measures of existing stockpiles and the money and
technology needed to manufacture a new weapon.
13. Describe the three acute radiation syndromes (ARS).
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Bone marrow (hematopoietic syndrome)—This syndrome is caused by damage to stem
cells in the bone marrow resulting in a reduction in cell lines. Symptoms include bleeding
and infection (low platelets and leukocytes). Usually occurs after exposure to between
0.7 and 10 Gy (70– 1,000 rads).
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Gastrointestinal (GI) syndrome—Irreversible destruction of the GI lining causing nausea,
vomiting, and diarrhea. Survival is extremely unlikely as death is caused by overwhelming
sepsis and electrolyte disturbances. Usually occurs after exposure to between 6 and 10 Gy
(600–1,000 rads).
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Central nervous/cardiovascular syndrome—Symptoms include confusion, seizures, and
coma. Death usually occurs within 3 days as a result of circulatory collapse and increased
intracranial pressure caused by edema, vasculitis, and meningitis. The full syndrome will
usually occur with a dose greater than approximately 50 Gy (5,000 rads) but can occur at
lower levels. This is uniformly fatal and, in a mass casualty situation, such patients should
be triaged to the expectant category.
14. Describe the four stages of ARS.
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Prodromal (Initial) stage: Symptoms include loss of appetite, nausea, vomiting, and diarrhea.
Symptoms occur minutes to days after the exposure. In general, the more rapid the onset of
symptoms, the greater the radiation dose received by the victim and the poorer the outcome.
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Latent period: Resolution of symptoms experienced in the initial stage with the patient
appearing relatively well. Can last hours to approximately 2 weeks.
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Manifest illness stage: Symptoms will vary depending on radiation dose. For doses
ranging from 1 to 8 Gy (100 to 800 rad), symptoms are the result of suppression of the
hematopoietic system (decreased leukocytes and platelets) and include infection and
bleeding. For doses over 8 Gy (800 rads), the primary effects are on the lining of the
intestines leading to diarrhea, fever, sepsis, and electrolyte disturbance.
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Recovery or death: Survival is highly unlikely with doses exceeding 10 Gy (1,000 rad).
15. All these numbers are great, but what is the bottom line?
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Exposure to 1 Gy is the threshold for nausea and vomiting, but no deaths from acute
radiation should occur at this level.
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Exposure to 3.5 Gy will be 50% lethal at 60 days if untreated.
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Exposure to 6.0 Gy is 100% lethal if untreated at 60 days.