What You Should Know about the Emotional Impact of Radiological Terrorism with an RDD ("Dirty Bomb")
Radiological terrorism is the intentional use of radiological materials to cause physical and psychological damage to a civilian population. The terrorist seeks to attack the basic sense of security and well-being of the general public through inflicting physical injury, loss of life, and destruction of property. A radiological attack may be overt, with the terrorist announcing the release, or it may be covert, where the attack becomes clear only after people become ill following exposure.
Radiological terrorism involves the dispersion of radiological material to contaminate people. This can be accomplished by using an RDD, a radiological dispersion device ("dirty bomb"), which refers to (1) placing radiological material with a conventional bomb that explodes and disperses the radioactive materials over a limited area (determined by the weather, nature of the material, and so forth); or (2) placing radioactive materials in a place where people come into close contact with the materials. Radiological terrorism is not the same as nuclear terrorism, in that a nuclear detonation or explosion involves a large geographical area and a different kind of radiation.
There are numerous possible radioactive sources for a dirty bomb, as radioactive material is used in medical centers, laboratories, and industrial plants. Radiological agents dispersed into fine particles can affect the body by two primary processes. The first is "internal contamination," which involves either inhalation (the breathing in) of contaminated material or ingestion of contaminated food or water. The second is "external contamination," which refers to radiation absorbed by the skin.
Unlike some biological agents, radiological effects are not contagious and do not result in an epidemic. Those who have radiological contaminants on their clothing or bodies, however, can contaminate other people. Commonly, those that have been exposed to these materials are "decontaminated" by removing their clothing and washing away the radiological residue from the skin with water. Decontamination is an effective emergency response strategy and is the cornerstone of the response to radiological dispersion events (accidental or terrorist) conducted by first responders and hospitals.
The psychological effects of a terrorism event are magnified to the extent that people misjudge their actual medical risk or confuse an RDD with a nuclear detonation. In a previous worldwide accident with radiological materials, those who believed they were exposed, but who had no known actual exposure, had long-term psychological effects. Medical effects, beyond the injuries of the conventional explosion, may include what is known as "acute radiation syndrome" (ARS). This syndrome results from exposure to large doses of radiation over a short period of time. The severity of symptoms (vomiting, diarrhea, headache, loss or altered consciousness, and elevated temperature) depends upon the dose of exposure to radiological material.
Radiation is odorless and invisible, so it is hard to gauge one's level of exposure and health risk. The ability of these invisible agents to cause injury varies widely depending upon three main factors: time, distance, and shielding. Time refers to how long the person was in direct contact with the radiological material; distance refers to how close the person was to the radiological source; and shielding refers to any barrier between the person and the material. After the release of an RDD, there may be plume of radiological materials in the air, so emergency officials may instruct individuals to "shelter in place" in a car or building (an example of shielding) for some period of time. The building or structure becomes a physical barrier from the materials as they settle on the ground. This is thought to be a highly effective strategy to protect the public, but may be contrary to the impulse of people to flee an area that is contaminated. In some situations, fleeing may actually cause increased risk, whereas staying "sheltered in place" may significantly reduce or prevent any injury. The length of time required for sheltering in place can vary, and families should follow emergency directives from official sources for what to do in an actual event.
One incident that highlighted the mental health impact of radiological accidents on a population took place in Goiana, Brazil. Discarded radioactive medical equipment resulted in 249 individuals being contaminated and four dying. Concern spread throughout the city, and the government screened about 125,000 persons for possible exposure. Of the first 60,000 screened, 5,000 individuals had psychosomatic symptoms that mimicked those of radiological exposure. However, based on careful review, none of those 5,000 had actually been exposed to the materials (i.e., they were at a safe distance).
This highlights the potential psychological effects of radiological terrorism, and suggests that when people are confused about their actual health risks, some will assume incorrectly that they have been exposed and will develop physical reactions. Whether or not a person is physically exposed, many in such an event will be psychologically "exposed."
The fact that about 5,000 people—who had no exposure and were not at medical risk—sought emergency medical treatment, led them to be referred to as "the worried well." This term now refers to people who have no health problems, but are convinced that they are ill. "Worried well" was an unfortunate and inaccurate term to use at the time, since these Brazilian residents—though not exposed to the radiological materials—were exposed to terrifying media images. As their fears were understandable, given the lack of general knowledge of radiological agents and their effects at the time, the use of the term "well" hardly seems appropriate.
The response of the citizens of Brazil illustrates the profound psychological impact of radiological agents, which are unfamiliar, terrifying, and potentially lethal. Up until recently, the public, emergency responders, and health care professionals were relatively uninformed about the nature of radiological terrorism and they were ill prepared to manage potentially large numbers of victims. There is evidence that people tend to overestimate their personal risk from unknown threats.
Children are of special concern because their higher breathing rates and physical proximity to the ground—where agents may be more concentrated—make them more vulnerable to inhaled radiological agents. Children may be at greater risk from radiation itself, and mothers of children under 18 may be at increased psychological risk as they harbor worries over their children's health for many years. Children may also be at increased risk from the hypothermia that can result from the decontamination process.
The goals of terrorists are only accomplished if (1) they succeed in undermining a nation's confidence in its ability to protect its citizens, and (2) if citizens change their behavior and daily life in response to fears. Our state, local, and federal agencies are making strides toward reducing the threat of radiological terrorism. US government resources, including the Department of Homeland Security, the Health Resources and Services Administration Hospital Preparedness Program, and the Centers for Disease Control and Prevention/Pubic Health Preparedness Program, along with the American Red Cross and others, are working to improve the capacity of first responders and emergency response agencies to respond to radiological terrorism. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 has resulted in funding to help states build their local public health departments and hospitals, the largest public health and emergency medical care investment in our history.
For more information on radiological agents see these resources from the Centers for Disease Control and Prevention: