Open Access Open Access  Restricted Access Subscription or Fee Access

Analysis of the antidote requirements and outcomes of different radionuclide decorporation strategies for a scenario of a “dirty bomb” attack

Alexis Rump, MD, PhD, MHBA, Daniela Stricklin, PhD, Andreas Lamkowski, MD, Stefan Eder, MD, Michael Abend, MD, PhD, Matthias Port, MD, PhD

Abstract


Objective: In radiological emergencies, there is a risk of radionuclide incorporation. The radiological doses absorbed can be reduced by decorporation treatment. Antidote requirements depend on the scenario and treatment strategy (“urgent approach”: immediate treatment of all patients with possible incorporation; “precautionary approach”: treatment only after confirmation of incorporation). We calculated the number of daily antidote doses for different scenarios and the differences in outcome for both treatment strategies.

Design: The number of potentially contaminated victims was varied from 1,000 to 60,000 (a maximum that might seem plausible for “dirty bomb” scenarios in Germany), the proportion of patients actually needing decorporation treatment from 0.1 percent to 100 percent, the radioactive screening capacities from 250 to 2,500 people/day and treatment duration from 10 to 90 days. The outcomes were assessed as total statistical lifetime saved assuming an inhalation of 1 mCi cesium-137 and the achievable dose reductions by a Prussian Blue treatment.

Results: Assuming 1 percent of the potentially contaminated people actually needing treatment, applying an “urgent approach” the requirements for 1,000 victims range from 1,100 to 3,400 and for 60,000 victims from 489,000 to 4,400,000 daily doses, depending on treatment duration and screening capacities. The “urgent approach” is associated with larger stockpile requirements than the “precautionary approach”, up to several hundred times in large-scale scenarios if the proportion of people actually needing treatment is low. The impact of the screening capacities is particularly important in large-scale scenarios, a low proportion of people needing treatment and extended treatment duration. The outcome is better for an “urgent approach” particularly in large-scale scenarios and low screening capacities.

Conclusions: If only a small fraction of the victims actually needs treatment, their timely identification by enhancing screening capacities may be the most efficacious way to reduce antidote requirements. In large-scale scenarios, it might be necessary to abandon the medically preferable “urgent approach” for an antidote-sparing “precautionary approach”.

 


Keywords


radiological emergency, dirty bomb, radionuclide incorporation, decorporation treatment, antidote stockpile, screening capacities, outcome

Full Text:

PDF

References


Von Winterfeldt D, Rosoff H: A risk and economic analysis of dirty bomb attacks on the ports of Los Angeles and Long Beach. Risk Anal. 2007; 27(3): 533-546.

Edsall K: Radiological and nuclear incidents and terrorism. In Walter FG (ed.): Advanced Hazmat Life Support (AHLS) Provider Manual. Tucson: University of Arizona Emergency Medicine Research Center & American Academy of Clinical Toxicology, 2003.

Stricklin D, Millage K, Rodriguez J, et al.: Plutonium-238/239 decorporation model. Technical Report DTRA-TR-15-03. Fort Belvoir VA: Defence Threat Reduction Agency, 2014a.

Stricklin D, Millage K, Rodriguez J, et al.: Americium-241 decorporation model. Technical Report DTRA-TR-15-02. Fort Belvoir VA: Defense Threat Reduction Agency, 2014b.

Rump A: Kombinationsverletzungen im Medizinischen A-Schutz: Prioritäten-orientierte Behandlungsgrundsätze. Wehrmed MSchr. 2014; 58(5): 146-151.

Roessler G: Why Po-210? Health Phys News. 2007; 35(2): 1-9.

Weickhardt U: Der Strahlenunfall. Informationsschrift zur Behandlung von Strahlenverletzten. Luzern: Schweizerische Unfallversicherungsanstalt Arbeitsmedizin, 2001.

Rump A, Lamkowski A, Eder S, et al.: Nutzen und Grenzen der internen Dosimetrie nach Strahlenunfällen. Notfall Rettungsmed. 2016a; 19: 115-121.

Flora SJS, Pachauri V: Chelation in metal intoxication. Int J Environ Res Public Health. 2010; 7: 2745-2788.

Frenzel N, Pieper B, Abend M: Antidottherapie nach Radionuklid-Inkorporation bei radiologischen Bedrohungsszenarien. Wehrmed MSchr. 2009; 53: 301-305.

Leiterer A, Bardot I, Ménétrier F, et al.: Medical countermeasures after a radiological event: An update from the CATO project. Int J Radiat Biol. 2014; 90(11): 1043-1047.

Rump A, Stricklin D, Lamkowski A, et al.: Reconsidering current decorporation strategies after incorporation of radionuclides. Health Phys. 2016; 111(2): 201-208.

Altagracia-Martinez M, Kravzov-Jinich J, Martínez-Núnez J M, et al.: Prussian blue as an antidote for radioactive thallium and cesium poisoning. Orphan Drugs: Res Rev. 2012; 2: 13-21.

Melo DR, Lipsztein JL, Leggett R, et al.: Efficacy of Prussian blue on 137 Cs decorporation therapy. Health Phys. 2014; 106(5): 592-597.

Wood R, Sharp C, Gourmelon P, et al.: Decorporation treatment–medical overview. Radiat Prot Dosim. 2000; 87(1): 51-57.

Ménétrier F, Grappin L, Raynaud P, et al.: Treatment of accidental intakes of plutonium and americium: Guidance notes. Appl Radiat Isotopes. 2005; 62: 829-846.

Autorité de Sureté Nucléaire (ASN): Guide national. Intervention médicale en cas d´évènement nucléaire ou radiologique. Version V 3.6, 2008. Available at https://professionnels.asn.fr/Installations-nucleaires/Guides-de-l-ASN-domaine-des-dechetsradioactifs-et-du-demantelement/Guide-national-d-interventionmedicale-en-cas-d-evenement-nucleaire-ou-radiologique. Accessed January 22, 2017.

Grappin L, Berard P, Beau P, et al.: Exposition aux actinides. Bilan injection de Ca-DTPA dans les centres CEA-Cogema. Rapport CEA-R-6097. Gif-sur-Yvette: Commissariat à l’Energie Atomique, 2006.

Kosow H, Gaßner R: Methods of future and scenario analysis. Overview, assessment, and selection criteria. DIE Research Project “Development Policy: Questions for the Future.” Bonn: Deutsches Institut für Entwicklungspolitik, 2008.

Freudenberg D: Risikoanalyseansätze, Simulation und irreguläre Kräfte. Military Power Revue der Schweizer Armee. 2011; 2: 11-19.

International Atomic Energy Association (IAEA): Radiological emergency response exercise. Medical scenario. Exercise manual. 2005. Available at http://www-pub.iaea.org/MTCD/publications/PDF/eprexert/PDF/MedExManual.pdf. Accessed December 15, 2016.

Homeland Security Council (HSC): Radiological attack–Radiological dispersal devices, Scenario 11. In HSC: Planning scenarios. Executive summaries. Version 2.0, 2004. Available at http://www.globalsecurity.org/security/library/report/2004/hsc-planning-scenarios-jul04_execsum.pdf. Accessed December 15, 2016.

Oberhagemann D: Statische und dynamische Personendichten bei Großveranstaltungen. Technischer Bericht TB 13-01. Altenberge: Vereinigung zur Förderung des Deutschen Brandschutzes e.V., 2012.

Bundesamt für Bevölkerungsschutz und Katastrophenhilfe (ed.): Bausteine für die Sicherheit von Großveranstaltungen. Teil 1. Praxis im Bevölkerungsschutz Band 17. Bonn: Bundesamt für Bevölkerungsschutz und Katastrophenhilfe, 2016.

Wikipedia: Marienplatz (München). Available at https://de.wikipedia.org/wiki/Marienplatz_%28M%C3%BCnchen%29. Accessed December 15, 2016.

Hass-Klau C: The pedestrian and the city. New York London: Routledge Taylor & Francis Group, 2015.

Perez M, Carr Z: Development of stockpiles for radiation emergencies. Report of the Radio-Nuclear Working Group. WHO consultation meeting on development of stockpiles for radiation and chemical emergencies. Geneva: World Health Organization, 2007.

Bundesamt für Strahlenschutz: Behördlich bestimmte Messstellen. Available at https://www.bfs.de/DE/themen/ion/service/inkorporation/messstellen/messstellen.html. Accessed December 15, 2016.

König K: Ganzkörpermessungen in Deutschland. GAST–Tagung: 20 Jahre Tschernobyl. Heidelberg, March 15–17, 2006. Available at http://www.fs-ev.org/fileadmin/user_upload/09_Themen/Strahlenschutzthemen_mit_besonderer_gesellschaftlicher_Bedeutung/Nukleare_Unfaelle/Tschernobyl_20/12_k_nigganzk_rpermessungen.pdf. Accessed December 15, 2016.

Fachinformation Radiogardase®-Cs Kaps. Gelbe Liste. Pharmindex, 2015. Available at https://www.gelbe-liste.de/produkte/radiogardase-cs-kaps_253011/fachinformation. Accessed December 15, 2016.

Fachinformation Ditripentat-Heyl®(DTPA). Gelbe Liste. Pharmindex, 2015. Available at https://www.gelbe-liste.de/medikamente/ditripentat-heyl-dtpa_254276/fachinformation. Accessed December 15, 2016.

Rump A, Stricklin D, Lamkowski A, et al.: The impact of time on decorporation efficacy after a “dirty bomb” attack studied by simulation. Drug Res. 2016; 66: 607-613.

Oka T: Application of cost-benefit analysis to the regulation of foodstuffs contaminated with radioactive substances. Jpn J Health Phys. 2012; 47(3): 181-188.

Stather JW, Smith H, Bailey MR, et al.: The retention of 14C-DTPA in human volunteers after inhalation or intravenous injection. Health Phys. 1983; 44: 45-52.

Waller EA, Stodilka RZ, Leach K, et al.: Literature Survey on Decorporation of Radionuclides from the Human Body. Defence R&D Canada – Ottawa Technical Memorandum 2002-042. Ottawa: Defence R&D Canada – Ottawa, 2002.

Rump A, Stricklin D, Lamkowski A, et al.: The incorporation of radionuclides after wounding by a “dirty bomb”: The impact of time for decorporation efficacy and a model for cases of disseminated fragmentation wounds. Advances in Wound Care. 2017; 6(1): 1-9.

Matsuda N, Kumagai A, Ohtsuru A, et al.: Assessment of internal exposure doses in Fukushima by a whole body counter within one month after the nuclear power plant accident. Radiat Res. 2013; 179: 663-668.

République Francaise. Premier Ministre. Secrétariat général de la défense et de la sécurité nationale : Circulaire relative à la doctrine nationale d’emploi des moyens de secours et de soins face à une action terroriste mettant en oeuvre des matières radioactives n° 800/SGDSN/PSE/PPS du 18 février 2011. NOR: P R M D 1 1 0 5 9 7 5 C. Available at http://circulaire.legifrance.gouv.fr/pdf/2011/03/cir_32735.pdf. Accessed December 15, 2016.

Hammitt JK: Risk in perspective. Valuing “lives saved” vs. “life years saved.” Eurohealth. 2008; 14(1): 34-37.

Rump A, Stricklin D, Lamkowski A, et al.: Benefit-cost analysis of radiocesium decorporation by a Prussian Blue treatment and stockpiling. Drug Res. (in press).

Gottron F: Project BioShield: Appropriations, Acquisitions, and Policy Implementation. Issues for Congress. CRS report for Congress. Order Code RL33907. Washington: Congressional Research Service, 2007.

Supplément au journal official de l’Union Européenne. Ted.tenders electronic daily: Avis d’attribution de marché. 2012/S 106-176124. Available at http://ted.europa.eu/udl?uri=TED:NOTICE:176124-2012:TEXT:FR:HTML&src=0. Accessed December 15, 2016.

Supplément au journal official de l’Union Européenne. Ted.tenders electronic daily: Avis d’attribution de marché. Résultats de la procédure de marché. 2016/S 090-159828. Available at http://ted.europa.eu/udl?uri=TED:NOTICE:159828-2016:TEXT:FR:HTML. Accessed December 15, 2016.

Bulletin Officiel des annonces des marchés publics (BOAMP). République Française : Avis d’attribution de marché. Avis no 16-65450 publié le 07.05.2016. Available at http://www.boamp.fr/avis/detail/16-65450/0. Accessed December 15, 2016.




DOI: http://dx.doi.org/10.5055/ajdm.2017.0276

Refbacks

  • There are currently no refbacks.
This site uses cookies to maintain session information critical to the user's experience and environment on this system. Click "Accept Cookies" to continue.
For more details please visit our privacy statement at: Privacy & GDPR