Guest Editorial

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In the wake of the terrorist attacks on the US World Trade Center, the subway systems in Spain and Japan, embassies, nightclubs, and hotels, authorities have become acutely aware of a need to re-assess existing philosophies and assumptions. This report examines the changes that need to be made to existing radiation emergency planning and protection so that it is applicable to terrorist events.

There are several clear and unique lessons from the recent attacks. The first of these is the intent of terrorists to stage multiple events simultaneously. Previously, most radiation emergency plans were directed towards a single event. The second factor, which is new in radiation protection, is the concept of suicide scenarios. A third lesson is that we can no longer rely on historical factors such as the probability of failure rates of various components to predict the likelihood of an event. Terrorists deliberately choose improbable or unexpected events. The fourth lesson is the realisation of a terrorist event combining multiple hazardous agents. Thus, planning for a radiological incident alone is an outmoded concept and authorities need to be able to recognise and respond to a situation where there is a combined chemical, biological, and radiological hazard.

A final lesson is that emergency planning cannot be static. As plans are developed for detection devices and stockpiles to neutralise biological and chemical threats, we must assume that the terrorists will simply move on to other ideas and we might expect the radiological threat to grow.

Much has been written about ‘dirty bombs’, but this is only one of several forms that nuclear terrorism may take. While we instinctively expect to know when a terrorist event has occurred, this is not necessarily the case. A powdered radioactive material could be spread in a populated area and the terrorists could just wait until it had been spread by foot traffic and discovered incidentally. This could certainly cause great concern and economic damage, but is unlikely to represent a significant public health threat.

One of the major points to emerge from this report is that prevention of exposure is much more practical and effective than medical treatment post exposure. In the event of a large release of radioactivity into the environment, sheltering, control of the food chain, and, if necessary, evacuation can result in dose reduction or protection factors of up to 100. In contrast, with current medical treatment of both external exposure and internal contamination, survival or dose reduction can be affected by a factor of about 2 or 3. A major exception to this is the use of potassium iodide in the event of release of radioiodine from a reactor or nuclear weapon.

Currently, many governments are assessing various drugs that might be useful, and decisions are being made about their potential efficacy, legality, cost, and need for stockpiling. The need for rapid and automated assessment of radiation doses to individuals, particularly first responders, has also become clear.

This report also recognises the major psychological impact of terrorism combined with the fear of radiation. It will be necessary to provide the public with timely and accurate information. Experience with radiation accidents has shown that if a few hundred people are actually contaminated, often over 100,000 have presented to be checked for contamination. These ‘worried well’ are likely to overwhelm both local resources and local hospitals.

This report includes a much more detailed examination of issues discussed above, guidance, and a template that will allow the reader to begin to examine the situation in a particular country or setting. This report is the first step in a longer process. The reader should not assume that this document can be placed on the shelf until there is a radiological attack and then be used to provide all the answers.