The role of the Radiological Health Program in a WMD event potentially involving radioactivity, and preparing for such an event.

The three most recognized areas of potential weapons of mass destruction (WMD) include chemical, biological and nuclear. Nuclear materials are usually thought of in terms of a nuclear bomb, and as such this area has had less attention then chemical and biological methods. Nuclear weapons generally require large containers, heavily shielded, and highly visible delivery systems (airplanes, trains, trucks, or ships). Weapons grade fissionable material is generally more difficult to obtain than chemicals and a small amount cannot be used to grow effective quantities of an agent as might be achieved with biological organisms. All of this leads to the mis-conception that a nuclear approach to terrorism is unlikely to occur.

Most people seem to be aware that exposure to radiation can have major short term effects, including death. Radiation exposures also have long term latent effects that may not appear until decades after the event. There are effects on unborn babies so that the damage has very long term destructive potential. These widespread impressions carry with them the potential for major psychological impact when using any kind of nuclear material, regardless of the actual numbers of short term casualties that result.

There has been much discussion regarding suitcase sized nuclear weapons that have been developed, and could be transported in small aircraft or an automobile. When strategically placed, as in a sports area during an event, under an important bridge, or in an area where radioactive contamination effects can be maximized such as a large city water supply this could feasibly be an effective terrorist device. A nuclear device detonated within an oil processing plant might amplify its destructive effects while disrupting the availability of a critical resource. Still, the greatest value to terrorists of these relatively small devices is likely to be the psychological effects, as is true of other methods.

Nuclear bombs are not necessary in order to achieve the destructive effects sought from a terrorist action. There have been several recent instances where fissile grade plutonium, believed to be of (former) Soviet origin was intercepted en route to third world destinations. Russia, the Ukraine, and other former Soviet states have these materials and very poor controls to prevent theft and sale of the materials. The coincident economic problems in these countries provide strong motivation for some to sell the materials in a black market. Even more abundant is the nuclear waste from reactors in the United States, Asia, the Middle East, and Europe which have potential for biological effects if released. As a result, one could obtain significant quantities of cesium-137, with a half life of 30 years, and deliver it by small aircraft for dispersal over a populated area to cause contamination of buildings, water supplies, farm products, livestock and people sufficient to cause major problems. Subsistence lifestyles would be no protection when fish, wild game and snow field water sources are contaminated. The thirty year half-life would make half the material persist until 2030, and one-fourth of it would still be active when five year old survivors were ready for retirement. A one gallon paint can would carry a tremendous amount of this material, which could be easily shielded to protect the pilot while traveling to the area where it is to be dispersed. The specific activity for cesium-137 is 87 Curies per gram. One gallon of this material could hold more than 300 MegaCuries of this material in pure form, which would produce an exposure rate in excess of one billion rads per hour. In areas where drainage allowed for concentration of the material nearby persons could experience lethal exposures. Cesium-137 is taken up in muscles. Other bountiful radioactive wastes that could be used include radioiodine-131, (half life 8 days) which is concentrated in the thyroid gland and strontium-90 with a half life of 28 years which is incorporated into bone. Sufficient quantities of these agents could cause ablation of the thyroid gland, cancers, and acute radiation syndrome in the exposed population. No bomb is necessary, and no high technology is required to prepare and deliver the materials. The delivery of such materials would be relatively silent, and there is no way to de-activate their radioactive properties. Even a large fire, which could kill confined biological organisms or destroy certain kinds of chemicals will not destroy the radioactivity and may well aid in the dispersal of the activity as it is carried downwind in smoke.

The radiation detection systems in place in Alaska would be unlikely to warn of such an event until well after the materials had become entrenched into various city systems and substantial amounts consumed by the population. Unlike the monitoring conducted during the Japanese criticality incident last fall, during Chernobyl, and other such external events radiation delivered from within the state would not be detected at the time when detection is most critical. We would not have the luxury of observing diluted quantities of fall out several days after the event occurred. Although some biological effects may not be as immediate as with a chemical or biological agent, due to the latent effects of radiation exposure, the long term effects could be disastrous. Still, there would be no building destroyed, no loud and obvious detonations. Contaminated water supply lines would be rendered unusable for decades. In addition, the loss of a market for contaminated (or perceived to be contaminated) sea foods, timber and tourist destinations would create state wide economic disaster for Alaska even in areas of the state not directly targeted by terrorists.

If a terrorist group wanted to maximize the effects of a nuclear incident in Alaska they would choose Anchorage, Fairbanks, or Juneau as the target, and simultaneously use a biological or chemical agent to divert attention. Our real time radiation monitors are sparse and hot particle detectors require a week for processing. There is very little radiation detection equipment available to EMS responders, according to data collected last fall, and fewer trained individuals. While the teams respond to a biological or chemical event they are likely to unknowingly be dispersing radioactive materials and trying to treat patients for what was perceived to be biological or chemically induced illness. This failure to recognize radiation exposure symptoms enables the contamination to become more thoroughly intermixed within the community prior to discovery. If radiation monitors are not used at the onset of ANY kind of incident the potential for early discovery is small. Once exposed, victims of radiation exposure cannot be administered anti-biological medications for treatment, and neutralization procedures for chemical agents would not be effective. Treatment to reduce radiation effects must be prompt and organ specific. The greatest effectiveness would be achieved with prophylactic preparation, but unlike diseases where immunization well prior to the event can effectively minimize victim numbers, with radiation there is a short, time critical period when measures must be taken. This is complicated by the fact that Alaska is a crossroads city for international travel, and radiation contamination could be easily transferred to aircraft traveling worldwide, unless the hazard was quickly identified and its spread effectively controlled. Another complicating factor is that we have no nuclear reactors or reactor waste facilities in Alaska, and no radiology training programs for physicians. This means that there is less likelihood of recognition by the average physician who does not expect to see such cases in Alaska and probably has never treated radiation injuries. There are a few radiation oncology physicians whose skills would be essential in the staging process following a nuclear event.

Unfortunately, assertions by our U.S. Secretary of State that the United States and Russia are thousands of miles apart are incorrect, as any Alaskan can tell you. A well financed third world country or terrorist group might conceivably persuade officials on “the other side” to allow them to gain access to the U.S. via an Alaskan gateway, using small water craft or aircraft of non-military dimensions. Once inside our borders many scenarios are possible.

There is a clear need to incorporate an adequate nuclear detection and response capability into the overall EMS plan in Alaska. This will necessarily require that when any event occurs the area will be monitored for possible concomitant radioactivity. This monitoring requires 24 hour a day real time radiation detection systems, trained responders, and appropriate response gear. A radiation response plan must be developed that is integrated into the overall EMS response plan.