Broken Arrow - Plutonium Deposition Registry Board Proceedings, 26-28 October 1966 (Palomares, Spain)

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DEPARTMENT OF THE AIR FORCE AIR FORCE LOGISTICS COMMAND First Annual Meeting

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First Annual Meeting PLUTONIUM DEPOSITION REGISTRY BOARD PURPOSE: To review results of bio-assay data collected in support of Palomares Broken Arrow operation, and related matters. PLACE: Room B-98, USAF Hospital Wright-Patterson, Air Force Logistics Command, Wright-Patterson AFB, Ohio. The Surgeon General for Medical Research Registry Board Members Command Surgeon, Hq AFLC Los Alamos Scientific Laboratory Medical Director, Hanford Occupational Health Foundation Commander, USAF Hospital Wright-Patterson Preventive Medicine Division, Office of The Surgeon General Dept of the Army, Wash DC

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Office of the Director, Submarine & Radiation Medicine Div Dept of the Navy, Wash DC Commander, USAF Radiological Health Laboratory Chief, Special Laboratory of Nuclear Medicine & Biology Veterans Administration Hospital, Omaha Nebr Chief, Bionucleonics, Office of the Surgeon General Director, Division of Nuclear Medicine Walter Reed Army Institute of Research, Wash DC Radiation Safety Officer Deputy Director, Division of Operational Safety Atomic Energy Commission, Germantown, Md Health Physics Department Mound Laboratory, Miamisburg Ohio Department of Medicine, USAF Hosp • Office of the Director of Nuclear Safety

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Office of the Director of Nuclear Safety USAF Radi Health Lab, Wright-Patterson AFB Ohio OIC Film Dosimetry Section USAF Radi Health Lab, Wright-Patterson AFB Ohio Radiation Safety Officer National Naval Medical Center, Bethesda Md Health Physics Department Mound Laboratory, Miamisburg, Ohio Pacific Northwest Laboratory, Richland Wash Medical Branch, Division of Biology & Medicine Chief, Special Activities Branch USAF Radi Health Lab, Wright-Patterson AFB Ohio

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On behalf of the Surgeon General and the United States Air Force Medical Service, I want to add my welcome to the participants in this first meeting of the USAF Plutonium Deposition Registry Board. The Air Force is particularly grateful to those of you from our sister military services, the Atomic Energy Commission, the Veterans Adminis tration, and the civilian scientific community who have consented to serve as members or as consultants to this board. The large number of observers at this meeting is also gratifying to us. It indicates the continuing interest in Plutonium-239 inhalation and internal deposition, and further reinforces our belief that establishing and maintaining this permanent registry and its associated board, are, indeed, essential. For those of you who are visiting Wright-Patterson Air Force Base for the first time, I would urge you to visit the USAF Radiological Health Laboratory, if your time permits. This laboratory is unique in being the only military laboratory within the free world exclusively devoted to handling all laboratory.aspects of occupational radiological health. In addition, the Radioisotope Clinic here in the hospital, the Nuclear Engineering Test Facility reactor on the other side of the base, and the various component laboratories of the USAF Aero space Medical Research Laboratories are also worth visiting. In terms of personnel, the Air Force has concentrated a pool of its finest talent in health physics, applied radiobiology, reactor technology, and nuclear medicine here at Wright-Patterson, in support of these various labora tories and their headquarters. Little needs to be said about the more dramatic aspects of the Broken Arrow of last January 17. In the nine months which have elapsed since that tragic day, "Palomares" has become virtually a household word, at least, within the military. Television news coverage and special programs in the first three months following the accident were widely viewed. Reams of articles concerning this Broken Arrow have poured from the popular press, and as recently as last month The Reader’s Digest magazine published an excellent 35-page special feature on this subject, in lieu of its usual best-seller condensation. A Broadway play on Palo mares and the missing bomb is (or was) scheduled to go into production this coming winter, (Who, one wonders, will be cast in the role of Dr.

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We, here today, are concerned with less dramatic but equallysignificant sequelae to the Palomares Broken Arrow. Shortly after the accident it became evident that the plutonium contamination problem in Palomares was going to be far more extensive than initially supposed-- and that, despite protective measures, a large number of military person nel involved in the clean-up operation were receiving or would receive, at least, a fraction of a body burden of Plutonium-239. Concerned individuals in the USAF Medical Service were aware that there was little information in the literature on which to predict medical disability or complications which may arise subsequent to the inhalation and deposition of Plutonium-239 in the lungs and'Other organ systems of man. They were further aware that many medical authorities are of the opinion that less than acceptable body burden, are of biological significance, since permissible burdens as assayed by urinalysis may only vaguely indicate the amount of the isotope which may be deposited in the lungs. They knew that the present acceptable body burden of Plutonium-239 is based on extrapolations from experience •with radium-dial painters and small animals. Until the present, we have not had a group of human exposures of statistically-significant size which we could study, in an attempt to better define the, medical hazards subsequent to inhalation of Plutonium239, and such reports as do appear in the literature for the most part describe chronie occupational exposures. Since Plutonium-239 was not discovered until 25 years ago, no cases have been followed for longer periods of time. While it seemed highly unlikely that any individual involved in the clean-up operation in Palomares had, or would receive, sufficient internal deposition of Plutonium-239 to warrant consideration of clinical treatment, it was felt that the Air Force Medical Service' could be in a precarious position were the question of treatment to arise following any future Broken Arrow. No physician in the Air Force has, to date, ever treated an individual for plutonium deposition. Further, although techniques of treatment are available, there is no unanimity of opinion, even in the civilian scientific community, as to when treatment should be initiated and as to the duration of treatment. . The medicolegal aspects involved in. a large number of military personnel with internal dep9sitipn of Plutonium-239, even though at levels below one body burden, also concerned us. As most of you are well aware, instances pf disease,or injury due to alleged ionizing radi ation exposures during prior’military service,are increasing in frequency True, many such claims are absurd, but all of them require at least minimal investigation in order to forestall further unnecessary, timeconsuming, and esqpensive action over non-valid claims. Some such claims are total frauds, perpetrated for individual publicity, financial

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gain or other factors. As often as not, however, the claims are submitted by well-meaning individuals, who are grasping at straws to explain the origin of their disease. The latest such case in which my staff became involved concerned a schizophrenic beatnik in San Francisco, who was a sometime in-patient at a California State Mental Hospital, During his more lucid intervals, when he would be released on out-patient status, he proved to be an inveterate letterwriter, particularly after he decided that his schizophrenia had been induced by ionizing radiation exposure received during a 4-year tour of duty with the Air Force between 1954-1958. Where and when had he been exposed to this ionizing radiation? In his own words, he had flown over a portion of the State of Nevada en route from Oxnard Air Force Base, near Ventura, California, to a brief TDY at Nellis Air Force Base in Las Vegas, during Operation Plumbob. Review of his records revealed that he had no connection with weapons testing in Operation Plumbob or any other nuclear test. His service, medical record was negative for everything except mumps and athlete's foot, both incurred while in service. I might add that this chap wrote letters to the Atomic Energy Commission, the Veterans Administration, and DASA, before settling on the Air Fdrce as the agency responsible for his recent schizophrenia. With all of the above factors in mind, a small group of USAF j Medical Service officers concerned with nuclear weapon accidents met in Omaha, Nebraska, during a spring blizzard late last March, to review the medical aspects of the Palomares Broken Arrow. It was unanimously decided that the USAF Medical Service needed to develop a detailed and long-range program to provide adequate follow-up and treatment, when and if required, for military personnel with internal plutonium deposition resulting from the Palomares Broken Arrow, asvwell as from any future I weapons or laboratory accidents involving internal deposition of plutonium. I The concept of a Plutonium Depositipii Registry and Registry Board was I felt to be the best approach to conducting this program. The program would have three primary purposes: (1) It would provide adequate follow-up of personnel with internal deposition of plutonium, in order that any possible biological injury would be detected at the earliest possible date, and it •would provide, when required, the best possible treatment to reduce body burdens of Plutonium-239. (2) It would provide the government with complete factual data upon which to evaluate claims for compensation which might

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(3) It would provide the medical profession with additional urgently-needed data with which to manage medical problems resulting in future Broken Arrow or laboratory accidents of a similar nature. b Since that meeting in Omaha last March, the Plutonium Deposition Registry and Board have become a reality. As originally conceived, the Board was to be tri-service in nature, with non-voting liaison members from the Atomic Energy Commission, the Veterans Administration, and Defense Atomic Support Agency. However, to expedite establishment of the Registry and the Registry Board, they were created within the Air Force, and the selection of the USAF Radio- • - logical Health Laboratory as the permanent location for the Registry was, of course, an obvious choice since almost all of the plutonium bio-assays following the Palomares Broken Arrow were performed here. Further, the USAF Hospital Wright-Patterson is the single USAF Hospital desig nated as a specialty center in the treatment of occupational disease. Finally, we have a unique, and, for the purposes of this Registry and its Board, a highly-desirable management situation in the Office of the Surgeon, Air Force Logistics Command here at Wright-Patterson Air Force Base, to which both the USAF Radiological Health Laboratory and . this hospital report directly. Colonel Arnold! and his highly-competent staff are deeply involved and personally interested in all aspects .of . occupational medicine. Thanks to their cooperation and administrative support^ establishment of this Registry, and its Board entailed no financial The function of this Registry is, of course, to maintain perma nent records of Plutonium-239 bio-assay and other pertinent laboratory and medical data on all military personnel who have received or who will receive internal deposition of Plutonium-239 above such limit as may be established by the Registry Board. Because it was essential to estab- . iish jsome limit within which the USAF Radiological .Health .Laboratory . might operate in the months prior to formal establishment of this Registry and the initial meeting of the Board, the Air Force.Medical Service uni- : laterally selected a cut-off of 9% of dne body burden of Plutonium-239 as i the level above which personnel would be included in this Registry. This • figure is not irrevocably fixed, and it may be raised or lowered at the discretion of the Registry Board. The Registry will have to maintain permanent contact with individuals included in the Registry, and will, at the request of the Board,- schedule and perform follow-up laboratory pro cedures on these individuals. The administrative problems involved in such permanent follow-up are self-evident in view of the increasing mobility of the civilian population in the United States. In the past few

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months the mobility of military personnel has also proven to be a large problem for the Board. Many of the personnel who received internal deposition of Plutonium-239 in the Palomares clean-up operation have already completed military tours and returned to civilian life. Further, because of the emergency nature of the clean-up operation, large numbers of military personnel were sent to provide assistance in Palomares on emergency temporary duty orders, some of which did not become formal ized on paper until a later date. This has entailed administrative prob lems for the Registry in establishing with certainty the home base of certain personnel on whom urine specimens were forwarded to the labora tory for bio-assay. The current military action in Southeast Asia, the current military withdrawal from France, and the recent withdrawal of tixe Air Force's Strategic Air Command from Spain, have increased the numbers of personnel transfers, and have further compounded the problem of follow-up of personnel involved in the Palomares Broken Arrow. Thus, long-term follow-up of large numbers of personnel cannot be assumed to /be an easy task. The Registry Board will be responsible for determining who shall' be included in the Registry, and what shall be the nature of routine long term follow-up. The Board will determine when treatment for Plutonium239 internal deposition is required, will determine the type of treatment indicated, and will supervise treatment, as required. In the event that an individual on the Registry develops a pathologic process related or potentially related to Plutonium-239 internal deposition, the Board will, insofar as possible, insure that complete postmortem studies are per formed, the exact nature of these studies to be determined by the Board in cooperation with the Radiation Pathology Register of the Armed Forces Institute of Pathology. This Board will be required to make some difficult and farreaching decisions. Fortunately, for the three military services, the Board includes two of the world's most knowledgable scientists in the area of internal deposition of plutonium--Dr ivLangham and Dr. Norwood. I want to extend special appreciation to these two gentlemen for consenting to serve on the Board, in view of their already heavy schedules in their own laboratories and elsewhere in the scientific community. I hope that the data available to them through this Registry will prove of value in the programs and studies underway in their own laboratories . Since this Registry and Board are envisioned as completely "non-partisan", we welcome participation.by, and free exchange of, information with all interested governmental and quasigoveriimental agencies.

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Wright-Patterson AFB as a Nuclear Center Col Arnoldi urged the Board and consultants to consider adopting a common format for the recording of radiation exposure (internal and external) data, and that a central repository be set up to maintain this information and retrieve it as desired. Within limits imposed by operating policies, Col Arnoldi placed at the disposal of the Board, the computer and ancillary facilities of Hq Air Force Logistics Command for whatever use they might, suggest. Because of the unique resources in the nuclear energy field available at WrightPatterson AFB, he urged that this base be considered as a nuclear medicine research and operational center. The USAF Hospital, Wright-Patter son, the Nuclear Engineering Test. Facility, and the USAF Radiological Health Laboratory were singled out as the keystones upon which such a center could be built.

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On 17 Jan 66 a B-52 bomber and KC-135 tanker aircraft collided in flight over or near Spanish territory. The resulting impact permitted the …