Medical management of victims contaminated with radionuclides after a “dirty bomb” attack

Abstract

A wide spectrum of scenarios may lead to radiation incidents and the liberation of radioactive material. In the case of a terrorist attack by a “dirty bomb”, there is a risk of mechanical and thermal trauma, external irradiation, superficial contamination and incorporation of radioactive material. The first treatment priority must be given to the care of trauma patients with life-threatening injuries, as the health effects of radiation occur with latency. Radionuclide incorporation will lead to a longer-lasting irradiation from inside the body, associated with a higher risk of stochastic radiation effects (e.g., occurrence of tumors) in the long run. It must be expected that victims with potentially incorporated radionuclides will far outnumber trauma patients. The elimination of radionuclides can be enhanced by the administration of decorporation agents such as (Ca) Diethylenetriaminepentaacetic acid (DTPA) or Prussian blue, reducing the radiological burden of the body. There is still no consensus whether decorporation treatment should be started immediately based only on a suspicion of radionuclide incorporation (“urgent approach”) or if the results of internal dosimetry confirming the necessity of a treatment should be awaited, accepting the delay caused by the measurements and computations (“precautionary approach”). As the therapeutic effectiveness may be substantially decreased if treatment initiation is delayed only by several days, depending on the radionuclide, the physicochemical properties of the compounds involved and the route of absorption, we favor an “urgent approach” from a medical point of view. In doubt, it seems justified to treat victims by precaution, as the adverse effects of the medication seem minimal. However, in the case of a high number of victims, an “urgent treatment approach” may require a large number of daily doses of antidotes, and therefore, adequate investments in preparedness and antidote stockpiling are necessary.

Acute and late effects of combined internal and external radiation exposures on the hematopoietic system

“…Since there is considerable potential for a combined exposure from both external irradiation and internal contamination, for example, as has been seen in workers in the nuclear industry (Fournier et al 2016), as well as in populations affected by radiological or nuclear accidents (Taira et al 2011;Sakamoto-Hojo 2018) or explosions (Shin and Kim 2009;Rump et al 2018), we performed a study in which we investigated the delayed effects on the hematopoietic system from these two modalities, assessing outcomes both independently and in combination. Groups of mice were exposed to a sublethal dose of external 6 Gy radiation (TBI group), a single IP administration of 100mCi of 137 Cs (hot-Cs group) or a combination of the two modalities (TBI þ hot-Cs group).…”

“…Scenarios that might result in inappropriate bone marrow exposures include nuclear or radiological emergencies, such as the detonation of a 'dirty bomb', which could result in not only acute external irradiation, but also the risk of internal contamination from the inhalation and/or ingestion of radioactive particulates (Shin and Kim 2009;Rump et al 2018). Documentation of the specific effects of internal radioisotope incorporation on the hematopoietic system is sparse (Synhaeve et al 2016;Burdo et al 2018) and, more importantly, the effects from a combined injury of both external irradiation and internal contamination are, as far as we aware, unknown.…”

In vitro assessment of cobalt oxide particle dissolution in simulated lung fluids for identification of new decorporating agents

“…Accidental internal or cutaneous contamination of workers may thus arise (Davis et al, 2007;Le Guen and Ansoborlo, 2005). In addition to the risk of exposure for workers in the nuclear industry, 60 Co has been identified as a potential candidate for use in a "dirty bomb" (Rump et al, 2018). Such a device could lead to the contamination of a great number of victims by fallout of radioactive dusts.…”

“…To fulfill the recommendations of the European directive 2010/63/EU, the principles of the "3Rs" (Replacement, Reduction and Refinement) must be considered systematically at all times when animals are used for scientific purposes. These principles were first proposed by Russell and Burch (Russell and Burch, 1959). They are currently proposed as the key strategies of a systematic framework aimed at achieving human use of any drugs.…”

New Approaches for Quantitative Reconstruction of Radiation Dose in Human Blood Cells

“…The main concern to human health in the event of a nuclear attack or radiation event would be an urgent need for assessing and reconstructing the dose to which hundreds or thousands of individuals were exposed [1][2][3] . Many methods are currently being tested for radiation biodosimetry, including well-known methods based on chromosomal damage, that may take days to complete in a high-throughput manner 4,5 ; but also methods that can help to make timely rapid decisions about exposure/dose such as gene expression that have time-to-result within hours.…”