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Table 6 Haddon matrix applied to a dirty bomb attack

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

Phases

Factors

Host (victims)

Agent (terrorists/bombs)

Physical environment (materials/facilities)

Social environment (policies/procedures)

Pre-event (pre-bombing)

None

Gather intelligence and observe potential actors of malevolent acts

Protect the access to sites storing HAZMAT or radioactive material

Ensure the availability of escape and evacuation routes from critical locations

Establish legal restrictions and control for the possession and commerce with radioactive material and components needed for an explosive device construction

Event (bombing and pre-hospital management)

Ascertain rapid evacuation from the scene

Choose the right medical management priorities for treatment and transportation (“treat first what kills first”)

Screen the scene rapidly for further explosive devices (“second hit”) and other technical dangers (e.g. electricity in a subway bombing)

Ascertain the rapid availability of radiation detection devices

Ascertain a sufficient number of vehicles for transportation of critical victims to hospitals as well as vehicles that may become contaminated

Educate and train EMS personnel in basic NRBC protection and medical issues related to radiation

Post-event (after evacuation to a medical care facility)

Ascertain specific triage to evaluate the expected health damages from irradiation and direct patients accordingly

Screen incoming people to the hospital for arms or explosive devices (to avoid “second hits” at hospital)

Ascertain a sufficient number of security personnel at emergency departments in case of panic or assaults to the personnel

Ascertain the availability of sufficient antidotes and screening capacities for radioactivity as well as the logistics for distribution

Ascertain the availability of a sufficient number of beds at specialized hematological wards at the regional/ national level to admit heavily irradiated victims

Ascertain lines of communication from hospitals to medical NRBC experts to seek advice

Educate and train hospital staff on:

1. Self-protection

2. How to avoid secondary contamination

3. The health hazards resulting from radiation

4. Treatment priorities

  1. HAZMAT hazardous materials, EMS emergency medical services, NRBC nuclear, radiological, biological and chemical