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:
Readiness: Before an Act of Radiological Terrorism
- Consider having a Family Preparedness Plan similar to what you would have if you lived in an area prone to earthquakes, tornadoes, seasonal wildfires, or other natural disasters. Your Family Preparedness Plan should include:
- An Emergency Supply Kit.
- A Family Communications Plan.
- Fill out and carry a Family Preparedness Wallet Card so that key phone numbers are handy.
- Make sure your child knows names and phone numbers of local and long distance family or friends.
- All family members knowing their child's school emergency plan and the after-school program plan.
- All family members knowing their community's emergency plan.
- Children's sense of being protected comes from a predictable daily routine and the consistent presence of caretakers. The more you can adhere to normal day-to-day patterns, such as bed and mealtimes, the safer your child will feel.
- Be prepared to limit your child's exposure to repetitive and frightening media images that are broadcast during a disaster. While you may gain important information from watching television, you also risk needlessly traumatizing your child.
- Learn about steps you may need to take, such as personal cleaning and handling of clothing. Use this link for more information about decontamination: http://emergency.cdc.gov/radiation/selfdecon_wash.asp
- Learn about the likely emergency response strategies that your community might use such as "shelter in place," evacuation, or decontamination. For more information, please see:
- Learn about the capacity of your community's emergency medical system to provide rapid medical treatment to children.
- Learn about your children's school and afterschool care plans for emergencies involving intentional or accidental release of toxic chemicals, including what school officials will do and what they expect of parents during such an event.
Response: During an Act of Radiological Terrorism
- Contact your primary care provider, your local emergency room, your local or state departments of public health, or the Centers for Disease Control and Prevention at http://www.bt.cdc.gov/radiation/index.asp.
- Use the above sources to assess the risk to you, your family, and your community by finding out the specific radiological event release type. Be prepared for possible delays in the identification of the exact radiological agent. You will want to know:
- How the agent is being transmitted to the population.
- Where and when the attack occurred.
- How one can protect self and family.
- What are specific recommendations of your community's Department of Public Health, hospital, or emergency management agency.
- What are procedures the government is planning to use, such as decontamination and shelter in place or evacuation.
- Follow-through on public health recommendations.
- Limit children's viewing of television without the presence of an adult who can interpret information and calmly answer questions. Adults should also guard against excessive media exposure, as reports about the risks can be confusing and anxiety provoking.
- Use the information you gain from your research to answer your children's questions. Remember that children need varying amounts of information depending upon their age. Take time to talk calmly and openly when they show interest or concern.
- Listen to your younger children's worries, but give them just enough information to answer their questions.
- School age children will need you to correct misinformation they have heard at school and from friends. Also they will be reassured by knowing their school's safety plans.
- Adolescents will have a more sophisticated understanding of terrorist threats, but might not accurately assess the real dangers, and might be hesitant to limit their social activities. Older teenagers might start to think about their potential involvement in the military.
- Activate your personal support system: talk to your neighbors, friends, and religious or civic leaders. Taking care of yourself will enable you to take better care of your loved ones.
- Remember: in the case of a radiological attack, you must be exposed to the radiological materials to become ill. No exposure, no illness.
- How will the school or afterschool care communicate with you should an event occur.
- How and to where children will be evacuated.
- How "sheltering in place" will occur, if needed.
- How reunification between parents and children will take place; where and how children can be picked up.
- What the school's steps are for seeking medical care.
- What the provisions for the children with special needs are in the event of evacuation or "sheltering in place."
- How the school or program will communicate with parents in the event of an emergency.
Recovery: After a Radiological Attack
A radiological attack most likely will not have a clear beginning or ending. Decontamination of buildings or homes may go on for quite a long time. What will linger—beyond the physical results of radiological terrorism—will be the psychological impact: the undermining of our national confidence and the continuing fear of another attack. Individuals will feel more helpless to protect their loved ones. Children will question whether their parents and teachers can keep them safe.
After an act of terrorism or natural disaster, most families can be expected to recover over time, particularly with the support of relatives, friends, and organizations. The length of recovery will depend on how frightening the experience was, whether evacuation from home was necessary, and the extent of injury or loss. Some families will return to their normal routines fairly quickly, while others will have to contend with ongoing medical issues, the loss of a loved one, or other results of the attack.
Children's functioning will be influenced by how their parents cope during and after the event. Children often turn to adults for information, comfort, and help. Parents and teachers should try to remain calm, answer children's questions honestly, and respond as best they can to requests.
In the days following an act of radiological terrorism, continue to monitor yourself and your family. If anyone appears to have persistent fears, sadness, anger, irritability, or acting-out behaviors, seek an evaluation from a mental health professional with expertise in posttraumatic stress.
- Fear and worry about their safety or the safety of others, including pets
- Fear of separation from family members
- Clinging to parents, siblings, or teachers
- Worry that another attack will come
- Increase in activity level
- Decrease in concentration and attention
- Withdrawal from others
- Angry outbursts or tantrums
- Aggression to parents, siblings, or friends
- Increase in physical complaints, such as headaches and stomachaches
- Change in school performance
- Long-lasting focus on the attack, such as talking repeatedly about it or acting out the event in play
- Changes in sleep patterns
- Changes in appetite
- Lack of interest in usual activities, even playing with friends
- Regressive behaviors, such as baby-talk, bedwetting, or tantrums
- Increase in risky behaviors for teens, such as drinking alcohol, using substances, harming themselves, or engaging in dangerous activities
What You Can Do to Help Your Child
Parents should spend time talking to their children, letting them know that it is okay to ask questions and to share their worries. They should answer questions briefly and honestly, and be sure to ask their children for their opinions and ideas. Issues may come up more than once, and parents should remain patient and open to answering the same questions. Although it will be hard finding time to have these conversations, parents can use regular family mealtimes or bedtimes to talk. They can let children know what is happening in the family, at their school, and in the community. For younger children, after talking about the attack, parents might read a favorite story or have a relaxing family activity to help them feel more safe and calm.
To help children's recovery, parents should:
- Be a role model. Try to remain calm, so your child can learn from you how to handle stressful situations.
- Monitor adult conversations. Be aware of what adults are saying about the attack. Children may misinterpret what they hear and be unnecessarily frightened.
- Limit media exposure. Protect your child from graphic images of the attack, including those on television, on the internet, and in the newspaper.
- Reassure children they are safe. You may need to repeat this frequently, even weeks after the attack. Spend extra time with them, playing games outside, reading together indoors, or just cuddling. Be sure to tell them you love them.
- Calm worries about their friends' safety. Reassure your children that their friends' parents are taking care of them, just the way they are being taken care of by you.
- Tell children about community recovery. Reassure children that things are being done to help those who got sick. Tell them that the government is taking steps to make sure people are protected against future attacks.
- Take care of your children's health. Help them get enough rest, exercise, and healthy food. Be sure they have a balance of quiet times and physical activities.
- Maintain regular daily life. Even in the midst of disruption and change, children feel more secure with structure and routine. As much as possible, keep to regular mealtimes and bedtimes.
- Maintain expectations. Stick to your family rules about good behavior and respect for others. Continue family chores, but keep in mind that children may need more reminding than usual.
- Encourage children to help. Children cope better and recover sooner if they feel they are helping out. Give them small clean-up tasks or other ways to contribute. Afterward, provide activities that are not related to the attack, such as playing cards or reading.
- Be extra patient once children have returned to school. They may be more distracted and need extra help with homework for a while.
- Give support at bedtime. Children may be more anxious at times of separation from parents. Spend a little more time talking, cuddling, or reading than usual. (You will want to start the bedtime routine earlier so children get the sleep they need). If younger children need to sleep with you, let them know it is a temporary plan, and that soon they will go back to sleeping in their own beds.
- Keep things hopeful. Even in the most difficult situation, it is important to remain optimistic about the future. Your positive outlook will help your children be able to see good things in the world around them. This will help get them through even the most challenging times.
- Seek professional help if your child still has difficulties more than six weeks after the attack.
Therapy for Children
- Family involvement
- Awareness of developmental level and cultural/religious differences
- Assessment of preexisting mental health problems and prior traumas and loss
- Explanation and normalization of the child's psychological reactions to the attack
- Teaching ways to manage reactions to reminders of the attack
- Teaching problem-solving and anger management skills as needed
- Helping to maintain normal developmental progression
What Parents Can Do to Help Themselves
- Take care of yourself physically. Eat healthily, get enough sleep, and get proper medical care.
- Support each other. Parents and other caregivers should take time to talk together and provide support as needed.
- Put off major decisions. Avoid making any unnecessary life-altering decisions during this stressful post-attack period.
What Teachers Can Do to Help Their Students
- Take care of yourself emotionally. You and your family may have had a stressful experience and may have suffered losses and stresses like those of your students. To be able to support them, you must have support yourself.
- Take care of yourself physically. Eat healthily, get enough sleep, and get proper medical care.
- Communicate with others. Make sure that you and your fellow teachers schedule ongoing times to talk together and give each other support. Teachers might consider covering for each other, if something comes up that must be taken care of.
- Put off major decisions. Avoid making any unnecessary life-altering decisions during this stressful, post-attack period.
- Put aside the time to take care of the personal needs of your own family. Even though you may be very committed to your students, take special time with your own family members or friends.
- If you have a lot of emergency-related responsibilities, talk with your school administrators about temporarily altering your work schedule.