Fallout Shelter Management Course for MMRS Medical Facilities

1. Fallout Shelter Management Course for MMRS Medical Facilities August 2006

2. Fallout Shelter Management CourseDisclaimer/Waiver of Liability The use of or adaptation of any materials or any presentation techniques by any entity and/or individual signifies that the user and/or adaptor understands the inherent risks involved and further assumes any and all liability that may result. The City of _________, _________, the _________ County Commission, and the _________ Emergency Management Agency express that reasonable care and good faith were exercised in development of the materials and presentation techniques; nevertheless, use of these materials or presentation techniques is at the sole risk and liability of the user. The City of _________, _________, the _________ County Commission, the _________ County Emergency Management Agency, and the federal government specifically disclaim any and all responsibility or liability for any damages to person or property resulting from the use of these materials or presentations. Materials and presentation techniques include any materials and/or presentations, outline instructions and actions which are generally accepted as typical for recovery from the detonation of a nuclear weapon or dispersal of radiological isotopes. However, the conditions created by such events cannot be foreseen, thus, any entity and/or individual implementing the instruction materials may suffer property damages as well as serious injury up to and including death.

3. Housekeeping -Parking & building access -Classroom -Refreshments -Restrooms -Schedule: breaks and session lengths -Smoking -Outlines/course materials -Student manuals -Test -Graduation & certificate

4. Introduction 1.0 hour Module 1, Public vs. Medical Fallout Shelters 3.0 hours Module 2, Organizing for Survival 3.0 hours Module 3, Managing Critical Resources 3.0 hours Module 4, Review and exercise 1.5 hours Test & Evaluation .5 hours TOTAL 12.0 hours Course Plan

5. The SPH Nursing Division has been approved by the _________ State Nurses Association (_SNA) and the _________ Board of Nursing (_BN) to provide: 7.2 CEUs for nurses for completion on August 30 7.2 CEUs for nurses for completion on August 31 (14.4 CEUs total) Physicians, Administrators and others will receive a Certificate of Attendance CEUs for Nurses

6. Pre-course Survey • Yes No • 1. I want to survive a nuclear attack. ____ ____ • 2. Survival from a nuclear attack is possible. ____ ____ • 3. The Government has made all necessary preparations to protect me . ____ ____ • 4. Protection against nuclear weapon effects is possible. ____ ____ • In a nuclear war, the earth will be destroyed. ____ ____ • In a Fallout Shelter, purposeful leadership is as important as protection • from radiation or food and water. ____ ____ • 7. Combining my skills and resources with those of others will enable us • to survive. ____ ____ • 8. How long will lethal radiation last? 1 week ____ • 1 month ____ • 1 year ____ • forever ____ • How long will it take to regain our present standard of living? 1 week ____ • 1 month ____ • 1 year ____ never ____ • 10. What portion of our population will be alive 1-year after an attack? 75-100% ____ 50-75% ____ 25-50% ____ 0-25% ____

7. Fallout Shelter Management in the 21st Century This is not refighting the “Cold War” but adapting to the threat of global terrorism and the spread of nuclear weapons to nations who will use them if they get them. The Department of Homeland Security (DHS), under the Metropolitan Medical Response System (MMRS) established a three-phased program against attack with Biological and Chemical agents and Nuclear/Radiological attack. MMRS requires _________ County to be capable to respond to an attack, postulating a small-yield (10 KT) weapon, and/or a Radiological Dispersion Device (RDD; incorrectly called “Dirty Bomb”) that produces: - 7,500 immediate deaths - 25,000 contaminated victims (10,000 acute & 15,000 moderate) - 100,000 displaced persons Having and using Fallout Shelters would minimize these casualties.

8. Course Objectives • Upon completion of the course, you will be able to: • 1. Know what a Fallout Shelter is and how it protects people. • 2. List the three principles of radiation protection and how they are embodied in a Fallout Shelter. • Know the Duties of a Fallout Shelter Manager and how the Shelter would operate within the _______ County Shelter System. • Know how to create a shelter staff and organize the shelter population. • Integrate Fallout Shelter & staff operations with medical facility operations. • 6. Operate a Fallout Shelter during the three phases of shelter life. • 7. Know the importance of an orderly preparation for life in the post- attack recovery period. • 8. Describe the emergency, expedient plans for stocking, equipping and • upgrading the protection of Fallout Shelters.

9. 1. Fill the shelter rapidly and orderly to capacity. 2. Protect the shelter against weapons effects. 3. Satisfy basic human needs: Air; Water; Sanitation & Hygiene; Sleep; Food; Psychological and Medical support. 4. Establish a Shelter Organization and Schedule to carry out all activities. 5. Maintain order and uphold the highest social standard of society. 6. Train the shelter population for post-attack living. 7. Keep morale high. 8. Prepare for in-shelter emergencies. 9. Prepare for both temporary and permanent shelter exit. 10. Work with hospital management to continue medical operations. Duties of the Fallout Shelter Manager

10. A nuclear attack may: be on all major urban, industrial, economic, transport, communications & military targets. be only on selected targets such as military bases with offensive weapons. be a single up to a few dozen detonations on specific or random targets. be on armed forces outside the United States, e.g. the far East; the Mid East; Europe; the Balkans; naval forces at sea or air battles. be an act by a non-state, i.e. a terrorist group such as Al Qadea. be threatened to bring about a military or political result or to bend the will of the people. involve a detonation (fission/fusion) or release via an RDD involve nations or armed forces other than the United States. occur all in one attack – or recur over weeks, months, even years. Nuclear Attack in the 21st Century

11. Evacuation Feasible if completed before fallout/contamination arrives. Area would have to be small and time adequate. Detonation effects (blast/thermal/EMP) may impede evacuation. Evacuees may be exposed and/or contaminated. Shelter In Place Critical facilities that can not evacuate, e.g., hospitals, must continue to operate. Necessary if fallout/contamination will arrive before evacuation complete Fallout Shelters needed to protect against high level radiation/detonation. Shelter-in-place (not necessarily Fallout Shelter) near RDD/very low level. Shelter stay would range from a few days to 2 weeks. Authorities outside affected area can organize rescue/evacuation effort. Shelterees may be exposed and/or contaminated. Protective Options

12. Evacuation Feasible only if all staff and patients/clients can evacuate before fallout/contamination arrives and operations transferred to an alternate facility. Shelter In Place Necessary if operations can not be transferred or if staff & clients can not evacuate. Necessary if needed to support operations of other response agencies. Must have Radiological Monitoring & Exposure Control capabilities Critical Facilities may be used to shelter families of the staff. Critical Facilities will not be used to shelter the general public. Protective Options: Critical Facilities

13. Module 1 Public vs. Medical Fallout Shelters Fallout Shelter Management Course

14. The Fallout Shelter is the core of the _________ County Population Protection Program. The mission of the Fallout Shelter Manager: Protect the lives of as many people as possible and assist them to enter the post-attack world well enough in mind and body to begin reconstruction of society. In MMRS Medical Facilities with Fallout Shelter space, enable medical operations during high level radiation conditions. Within the Fallout Shelter, the Shelter Manager works as an extension of city or county government. Fallout Shelter Management Course

15. _________ Co. has more than 150 federally surveyed and approved Public Fallout Shelters. Total capacity is 000,000+ persons. MMRS medical facilities - _________have a combined capacity of 00,000 spaces reserved for medical operations and sheltering of staff, patients and their families, not for public sheltering. _________ has reserved a few federally surveyed and approved Fallout Shelters for use in Direction and Control, Medical and Recovery operations. Some of these are privately owned. Hundreds of privately owned Tornado/Fallout shelters exist. A number of unsurveyed but potential shelters exist that could augment existing federally surveyed and approved Fallout Shelters. Fallout Shelter Profile

16. Fallout Shelters protect against radiation based on the size, mass and location or site of the building and its surroundings. Fallout Shelters are not intended to protect against other (blast, heat) effects of a nuclear detonation, explosions or Chemical & Biological Agents. Such a capability may exist in a building due to its size, mass & location. Fallout Shelters are not intended for use after use of a RDD (but may be). Contamination from a RDD can be expected to cover a few up to a few hundred acres with low-level radioactive material; A nuclear detonation may affect large areas (10-100 sq. miles) damaged by direct effects and 100s to 1,000s of sq. miles with radioactive fallout. Fallout Shelter Program Overview, Cont’d

17. The Shelter Manager must: Assume command rapidly Act with authority Delegate authority Organize people into task teams to meet needs Refrain from personal over involvement with shelterees. Establish priorities Set a schedule Be an example of model shelteree behavior Recognize the changing needs of the shelterees Keep people informed Motivate people In critical and medical facilities, integrate operations with COO. Principles of Leadership

18. Entry The time from opening until a routine is established. Routine A daily living pattern exists along with training & preparation for post-shelter living; medical operations resume. Emergence The period from when preparations are complete and it is safe to exit to begin work of reconstruction until people can leave shelter permanently. Medical operations expand. The Three Phases of Shelter Stay

19. Fallout Shelter Areas in MMRS Medical Facilities –

20. The Shelter Manager may be faced with life-threatening emergencies and must plan to cope with them. Examples are: Structural damage to the shelter from a nearby detonation. Fire in the shelter. Dangerously high radiation levels. Severely high temperatures and humidity. Oxygen and Carbon Dioxide imbalance in the shelter. Depletion of essential supplies. Disease and injury among staff, patients & families. Unrest, anxiety, crime or defiance of order or authority. Shelter Emergencies

21. 1. Have the Radiological Monitor locate, by use of monitoring instruments, the best protected areas in the shelter. 2. Keep the people in the shelter until outside radiation rates are low enough to leave safely. 3. Keep the shelter, people and supplies from being contaminated. The Shelter Manger’s Responsibilities in Radiological Protection

22. Conventional explosives produce - Heat - Blast/Shock and are measured in tons of explosive force. Radiation Dispersion Device, RDD or “Dirty Bomb” - May use conventional explosive to spread radioisotope - Radioisotopes may be placed or spread without any explosion! - No fission involved – just exposure/contamination. Nuclear explosions produce - Heat - Blast/Shock - Initial Nuclear Radiation - Electromagnetic Pulse (EMP) and - Residual Nuclear Radiation or Fallout and are measures in Kilotons (1,000s of tons) or Megatons (1,000,000s of tons) of explosive force. Nuclear Vs. Conventional Weapons

23. Nuclear Weapons produce effects in a time sequence. In order of occurrence and duration, they are: Initial Nuclear Radiation - less than 1 second Electromagnetic Pulse (EMP) - first few seconds Heat - few to 90 seconds Blast/Shock - up to 60 seconds Residual Nuclear Radiation or FALLOUT - diminishes very rapidly at first, then slowly over . . . hours, days, weeks, years . . . Weapon Effects

24. Weapons Effects video

25. Weapon Effects, Cont’d

26. Where does the Energy Go?

27. The Electromagnetic Spectrum

28. Effects Across the Electromagnetic Spectrum

29. Elements are substances that can not be broken down into simpler substances by chemical means. There are 116 identified elements; each has unique properties. An atom is the simplest unit an element can be divided into and still keeps its unique properties. Atoms which emit ionizing radiation are said to be radioactive. Ionizing radiation produces charged particles, ions, in anything it strikes. It damages molecules in both living cells and inanimate mater. Radiation refers to all sources of energy emissions, such as visible light, radio and sound waves as well as ionizing radiation. Understanding Radiation & Radioactivity

30. Nuclear or Ionizing Radiation

31. Alpha Particles - Largest, heaviest and most highly charged type of radiation - Least penetrating; stopped by 1 sheet of paper or single layer of clothing. - Range 3-7 inches in air - Normally, only an Internal Contamination Hazard Beta Particles - Smaller, lighter, faster & less charge than Alpha (equivalent to an electron) - Moderate penetration; about 0.05” in flesh, about 0.10” of Aluminum - Range 10 feet in air - Internal more than an External Contamination Hazard Types of Radiation

32. Types of Radiation, Cont’d Gamma rays - Least charged - Most penetrating; stopped by dense, thick shielding (e.g., 8” of lead) - Range 1 mile in air - Both an Internal and External Contamination hazard Neutrons - Ejected from the nuclei of atoms - Very penetrating - Range 3000’ in air - ONLY radiation type that makes other matter radioactive!

33. Gamma X Rays 1 “unit” of damage Beta Particles 1x Neutrons 2-10x Alpha Particles 20x Biological Injury Caused by Radiation

34. Biological Effects of Ionizing Radiation Level of Biological Important Radiation Effects Organization Molecular Damage to enzymes, DNA, RNA, etc. and interference to biological pathways Cellular Damage to cell membranes, nucleus, chromosomes, etc. Inhibition of cell division, cell death; transformed to malignant state. Tissues & Damage and disruption to intestinal tract, bone marrow, Organs capillaries, thyroid, central nervous system, etc. Cancers induced. Whole Body Radiation ‘Lifeshortening’ & death. Populations Changes in the genetic characteristics of individuals.

35. Four measurements used to describe radiation, radiation exposure and the damage it can do to living beings. Activity (quantity) Exposure & Exposure Rate (energy) Absorbed Dose & Absorbed Dose Rate (absorbed energy) Dose Equivalency & Dose Equivalency Rate Radiation Measurement Terms/Units

36. Activity (quantity) Term: Curie, Ci Measures decay activity and is expressed as disintegrations per second, DPS or counts per minute, CPM. Alpha & beta radiation rates are typically expressed in CPM 1 Ci = 3.7 billion DPS System International (SI) Term: Becquerel, Bq 1 Bq = 1 DPS (3.7 gBg = 1 Ci) Radiation Measurement Terms/Units

37. Exposure & Exposure Rate (energy) Term: Roentgen, R, R/hr Measures energy of gamma and X-radiation in air. Does not apply to beta or alpha radiation SI Term: Coulomb/Kg, C/Kg/hr Radiation Measurement Terms/Units

38. Absorbed Dose & Absorbed Dose Rate (absorbed energy) Term: RAD, RAD/hr (Radiation Absorbed Dose) Measures energy of any radiation in any mater. SI Term: Gray, Gy, Gy/hr 1 Gy = 100 RAD Radiation Measurement Terms/Units

39. Dose Equivalency & Dose Equivalency Rate Term: REM, REM/hr (Roentgen Equivalent Man) Measures energy of any radiation in people. SI Term: Sievert, Sv, Sv/hr 1 Sv = 100 REM Radiation Measurement Terms/Units

40. For our purposes, 1 R = 1 RAD = 1 REM 1 R/hr = 1 RAD/hr = 1 REM/hr Available radiation measuring instruments are calibrated in CPM and R/hr. SI units not used. Real Life Radiation Measurement

41. Isotope: Activity, pCi (Pico curies) 238U, Uranium 26 226Ra, Radium 120 228Ra, Radium 50 210Pb, Lead 600 210Po, Polonium 200 40K, Potassium 130,000 14C , Carbon 87,000 3H, Tritium 27,700 87Rb, Rubidium 29,000 90Sr, Strontium 2,886 Naturally Occurring, Long-lived Radionuclides in the Human Body • The total radioactivity in the • body is 277,582 pCi. • 10,270 DPS • 887,374,138 disintegrations per day • Each radioactive decay produces a radiation effect. • Sources: Radiation Protection (pages 56, 370), • Shapiro, 1990, Harvard Press.

42. Bananas are a good source of potassium, a very important nutrient. Natural potassium contains 0.0117% potassium-40 (40K) a radioactive isotope. A medium size banana contains about 451 mg of potassium. The amount of 40K in it is 0.0528 mg. This is equivalent to 14 DPS or 0.00037 uCi. The dose equivalent from eating a banana is about 0.01 mREM, sometimes, this is called the “banana equivalent dose.” Sources: Food Values of Portion Commonly Used, 16th edition, Bosen and Church. Chart of Nuclide, F. William Walker et al. Natural Radioactivity in a Banana

43. Medical effects of radiation video

44. High Altitude Air Burst Surface Burst Subsurface Burst Burst Types of Nuclear Detonations

45. Types of Nuclear Detonations High Altitude Air Burst Surface Burst Subsurface Burst (100,000’+) fireball does fireball touches fireball does not not touch surface break surface of Surface ground or water. Not to scale Heat minimal maximized moderate nil Blast nil maximized moderate nil Shock nil nil moderate maximized EMP maximized moderate moderate minimal INR none nil maximized minimal Fallout nil minimal maximized minimal

46. EMP from a High Altitude Burst

47. EMP from High Altitude Bursts

48. Weapon Yield Ground Burst Air Burst *500 KT 4 miles 7 miles 1 MT 5 miles 8 miles 5 MT 8 miles 13 miles Doubling yield does not double the reach. * Average size Russian weapon. The Reach of 500 KT, 1 MT & 5 MT Weapons

49. Weather Patterns

50. Fallout Pattern -Time/Wind effects