Preparing for a “dirty bomb” attack: The optimum mix of medical countermeasure resources

Background: In radiological emergencies with radionuclide incorporation, decorporation treatment is particularly effective if started early. Treating all people potentially contaminated("urgent treatment") may require large antidote stockpiles. An efficacious way to reduce antidote requirements is by using radioactivity screening equipment. We analyzed the suitability of such equipment for triage purposes and determined the most efficient mix of screening units and antidote daily doses.Methods: The committed effective doses corresponding to activities within the detection limits of monitoring portals and mobile whole-body counters were used to assess their usefulness as triage tools. To determine the optimal resource mix, we departed from a large-scale scenario(60,000 victims) and based on purchase prices of antidotes and screening equipment in Germany, we calculated efficiencies of different combinations of medical countermeasure resources by data envelopment analysis. Cost-effectiveness was expressed as the costs per life year saved and compared to risk reduction opportunities in other sectors of society as well as the values of a statistical life.Results: Monitoring portals are adequate instruments for a sensitive triage after cesium-137 exposure with a high screening throughput. For the detection of americium-241 whole-body counters with a lower daily screening capacity per unit are needed. Assuming that 1% of the potentially contaminated patients actually need decorporation treatment, an efficient resource mix includes 6 monitoring portals and 25 mobile whole-body counters. The optimum mix depends on price discounts and in particular the fraction of victims actually needing treatment. The costeffectiveness of preparedness for a "dirty bomb" attack is less than for common health care, but costs for a life year saved are less than for many risk-reduction interventions in the environmental sector.Conclusion: To achieve economic efficiency a high daily screening capacity is of major importance to substantially decrease the required amount of antidote doses. Among the determinants of the number of equipment units needed, the fraction of the potentially contaminated victims that actually needs treatment is the most difficult to assess. Judging cost-effectiveness of the preparedness for "dirty bomb" attacks is an issue of principle that must be dealt with by political leaders.

Estimation of radiation-induced health hazards from a“dirty bomb”attack with radiocesium under different assault and rescue conditions

In the case of a terrorist attack by a“dirty bomb”,blast injuries,external irradiation and the incorporation of radioactivity are to be expected.Departing from information about the radiological attack scenario with cesium-137 in the U.S.National Scenario Planning Guide,we estimated the radiological doses absorbed.Similar calculations were performed for a smaller plume size and a detonation in a subway.For conditions as described in the U.S.scenario,the committed effective dose amounted to a maximum of 848 mSv,even for very unfavorable conditions.Red bone marrow equivalent doses are insufcient to induce acute radiation sickness(ARS).In the case of a smaller plume size,the ARS threshold may be exceeded in some cases.In a subway bombing,doses are much higher and the occurrence of ARS should be expected.The health hazards from a dirty bomb attack will depend on the location and the explosive device.The derived Haddon matrix indicates that preparing for such an event includes education of all the medical staff about radiation effects,the time lines of radiation damages and the treatment priorities.Further determinants of the outcome include rapid evacuation even from difficult locations,the availability of a specific triage tool to rapidly identify victims at risk for ARS,the availability of an antidote stockpile and dedicated hospital beds to treat seriously irradiated victims.