Draft Report to E B Anderson, Subject: Report of June 16, 1958, Y-12 Accident

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FOR OFFICIAL USE ONLY - NOT FOR PUBLICATION 7OSc:bYO AP! INTERIM REPOXT OF THE The following copies of t h i s report have been made and are being 33 t o ACC industrial physicians 16 to ORINS consultants These FrepUbliCatiOn draft copies are being distributed for suggestions and criticism. Marahall Brucer, M.D., Post 3 f f i c e Box 117, Oak Ridge, Tennessee, The document will be rewritten for ?lease send your suggestions t o

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The Acute Radiation Syndrome in Nan Metabolic Data on Y-12 Patients Clinical Course of Y-12 Patients Hematology of Y-12 Patients Urine Analysis Xeport Elizabeth Xona (3BIP!!s Special Training Division) Oak Xidge Institute of Nuclear Studies, Inc. Oak Ridge, Tennessee

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The Clinical Story Chainnan, The Medical Division This is an interim report, digest the information w e have gathered. states my impressions of what might happen in future peacetime industrial explosion, nor am I concerned with the possible low doses that might be "potential" hazards in routine operations, Neither am I concerned with the results of biological experiments. Iam concerned i n this report only * with what probably has happened and what probably will happen in future industrial accidents where there is a serious but brief exposure to radiation, This is a prediction based upon inadequate evidence. It should be interpreted as such. There has been insufficient time to The first part of the report The report also contains brief summaries of the 44 days of These summaries are by the physicians i n charge of the I am not concerned here with what might happen i n an atom bomb The results of this investigation are printed in a series of twenty 3-dimensional charts, This was done purposely because w e are considering both the dose and time factors in their relationship to a third "obvious" available to any physician unaided by unusual laboratory procedures. it had t o be something thata physician is asked about by the victims To be included, the clinical sign had t o be a common one of the accident, their families, other physicians, and the press.

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Description of t h e Accident The Y-12 accident occurred in the early afternoon of June 16, 1958. An employee of the Union Carbide Company was filling a fifty - five gallon drum with cIean (?> water i n order to dissolve a residue of enriched uranium. This is a normal procedure inthe uranium recovery operation. The same operation was done many times before by t\is particular employee and always with complete safety. However, on this particular occasion, there was a sufficient amount of enriched uranium so that as the water was added, a geometric configuration was reached that allowed the enriched uranium t o reach a critical level and the drum began t o act as a reactor. As it reacted the power level increased, the amount of heat produced increased, and t h e volume of water quickly began t o "boil." boiling destroyed the necessary geometrical configuration for critical it y. TZle reaction ceased, and it stopped boiling. As it cooled off a critical conformation was again reached. The drum again went critical causing it again to boil and t o automatically shut itself off. This oscillation was repeated every few seconds. Both neutrons and gama rays were produced and the fission products resulted in a continuous build-up of gama-ray intensity. Since water vas constantly flowing into the container, it soon diluted the material beyond that required for a critical reaction. Shortly after the first gam rays were produced the radiation alarm sounded. me employee who was filling the container with water was standing a few feet from the drum alternately watching a meter and the filling process. Tho employees were fixing a duct about twenty feet from the source of activity. Two other employees were fixing a pipe about fifteen

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feet from the source of activity. was standing on the floor, and the other was mounted on a ladder. the employees was much higher on his ladder than t h e o t h e r one was on his. The employee filling the drum noticed ablue flash and a yellow haze, heard the alarm and probably was the first to leave the area. Two of the other employees saw a blue glow but this may have been a reflection. noticed a haze throughout the area, heard the alarm, and left the area, but not quite so rapidly as the first man. I n both pairs of workers, one of the men Three other employees were inthe area but at a considerable distance from the source of activity. The doses they received were probably inthe 20 to6C rad range; they had no signs o r symptoms of radiation effects and are no longer considered in this report; no other persons received sign if i - that is summarized i n Table I. dose t o these patients vas inan order of magnitude greater than that described i n Case 5in the Los Alamos report, but less than that described i n Case 4 of the Los Alamos report. The five men who were closest to the accident had a dosimetry. I n general, it appears that the biological

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Twelve Clinical Factors The 3-dimensional charts that follow are based not only on our own experience with t h e Y-12 accident victims, but on t h e experience of Cronkite and Bond inthe Marshallese incident, Xempelmann inthe Loa Alamos incident, and Gerstner's review of a l l known accidents. From these experiences and the results reported in the literature, it is possible t o get a general impression of what happens after radiation accidents i n man. There are also many hints of what might happen from the many animal studies that have been done on radiation effects. Wen 80 there is still insufficient experience t o give more than t h e most general kind of summary data. me following references were helpful in caring for the patients: Brucer, M. Future Accidents i n Oak Ridge: Plans f o r Nedical Care. Mimeographed. Distribution to A X. Ionizing Badiation on m a n Beinge. and Americans accidentally exposed to radiation from fallout and a discussion of radiation injury in the human being. A report on the Yershallese Gerstner, Herbert B. Vil it ary and Civil Defense Aspects of the Acute Radiation Syndrome i n Man. School of Aviation Medicine, USAF, LRandolph AFB, Texas, 58-6, November 1957. i n Fan, i n Proceedings of the International Conference on the Peaceful Uses of Atomic Energy. Vol. 11, United Nations, New York, 1956, Hasterlik, R. 3. and fia ri nell i, L. D. Physical Dosimetry and Clinical Observations on Four Human Beings Involved i n an Accidental Critical Assembly &cursion, i n Proceedings of the International Conference on t3e Peaceful Uses of Atouic Zneriry. Vol. 11, United Nations, New Pork, 1956, pp. 25-34. (From t 3 e ksrgonne Cancer Research Hospital, Chicego, and the Argonne National Laboratory.) Hayes, Daniel E'- 0, Sumnary of Accidents and Incidents Involving Radiation i n Atomic Energy Activities, June 1945 through December 1955. USAEC

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Syndrome: A Study of Nine Cases and a Review of the Problem. Ann. A Study of Ten Cases and a Review of the Problem. of Patients. School of Aviation Kedicine, USAP, 57-70, k??rch 1957. A Summery of Transportation Incidents i n Atomic Energy Activities, 1949-1956.

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All the following charts are in three dimensions, One dimension is the dose received by the patient,the second is the time i n days after the accident; neither variable is sufficiently constant or predictable to describe i n terms of accurate units, Therefore, the charts are drawn purposely so that they cannot be read as definitive data. it means the effective clinical impression, and on still others it refers to a definite count. any of the 3-dimensional surfaces be considered more than an approximation. The third axis on the 3-dimensional graph is the variable An arbitrary 100 percent is taken as the height of On some graphs this means the incidence of the event, on others However,in no case can the level of the Zax is on me dose is given in arbitrary units, This was done after considerdocuments is an attempt t o combine an absorbed dose figure (which is unknown) witha Relative Biological Effectiveness (also highly unknown). Tfie use of this compounded inaccuracy based upon tU3E's that have little or nothing t o do with human physiology, caused a considerable amount of confusion during the early hours after the accident. The "rem" unit that is still being used i n some official A t least four people (supposed t o be responsible for clinical care) interpreted the stated rem unit in a t least four different ways, In the first few days after the accident, there m unit was dropped completely by everybody who had anything t o do with the clinical care of the patients, and the units were given i n rads. The rad unit has many faults.In the first place w e have no rad Secondly, w e have no cert a i nequivalent for mixed neutron irradiation. gam spectrun:, nor a good estiniate of the gamma exposure. The roentgen

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unit is unsatisfactory since in this kind of a mixed neutron-gamma dosimetry w i t h a very wide spectrum of energies it does not have any fundamental meaning, One of t h e lessons that can be learned from t h i s accident is that all dose units should be given i n rads even though it might be necessary t o apply correction factors for the neutron dose. One of the most important subjects the physician must keep i n mind is the dose level that is likely to be lethal. Usually i n most animal experiments this is stated as a n LD-50 dose. I n our experience with leukemia patients treated with total-body irradiation it was already becoming apparent that the stated LD-50 of 450 ris probably too law. However, it appears that this miscalculation is due pri oar i ly to the fact that i n most of the animal experiments and i n the od@naI Japanese atom-bomb studies,a prolonged period of hospitalization was not irmnediately. t o treat the complications) it appears that the LD-50 is modified considerably. Inpatients who receive adequate hospital care immediately after a It might be that the LD-5030 for nonhospitalized case8 is a t Uhen it i s possible to hospitalize the patient (and especially radiation exposure, the LD-50 appears t o be inthe 700 t o 800 rad range for the 30 t o 60 day time limits, When the dose is much higher, up t o 1000 rads and above, death occurs much earlier. Here death seems t o occur i n about the same dose-time relationships as i n nonhospitalized patients. Therefore hoopitnlization and medical care is most effective in ranges of more than 100 rads and ineffective in ranges of more than 1000 rads. future discussions of 3 - 50in humans it is going t o be necessary t o take into account the postradiation treatment of the patient. It should be remembered that in this chart w e are showing the LD-50 only, and w e are showing it a3 a definite cut-off point, This is an

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unreasonable and unrealistic concept, LD-10, 20, 80, 90, and so on, It would appear on poor evidence that the LD-0 is probably i n the 100 t o 200 rad range, and t h a t the LD-100 is more There is also such a thing a8 an

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Probably the only clinical sign that will give the physician any hint of the level of radiation is the nausea and vomiting that occurs shortly after exposure t o radiation, indication of nausea and vomiting, and this (when present) occurs late. A t very high doses nausea and vomiting occur frequently and early, The Under 100 rads there is seldom any relationship of the incidence of vomiting, and the degree of intensity of vomiting and nausea does not appear t o be a linear one, It appears that a t about 200 t o 400 rads there is a rapid increase i n both incidence and severity. With more than 800 rads there is always a high incidence and severe nausea and vomiting. Nevertheless, this is not a clinical sign that can be trusted beyond good clinical judgment. The psychological effects of a severe scare can i n themselves cause vomiting. There are occasional reports of vomiting a t very low doses. mixed inthe same ward room there isa good possibility that much of the vomiting i n low-dose patients might be psychogenic, radiation accidents has been sufficient to instruct people that they should The publicity on Complicating trauma and ugly-looking wounds can themselves cause Vomiting is asign that must be interpreted with cagey clinical Inthe medium-dose range vomiting is a clinical sign that is treated until definitely indicated. The physiological effects of vomiting probably.should not be I t would appear that none of the vomiting that occurs very late i n patients who have received a reasonably large dose of irradiation is due

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tothe radiation itself. not to the irradiation itself. disappears after the first week and does not appear again. not appear t o be apart of the sublethal external irradiation picture. It is, however, reported i n connection with internal contamination. At very high doses diarrhea m y be apart of the symptomatology. Some late vomiting is probably due t o complications, It appears that true radiation vomiting I n general, prolonged, severe, and early vomiting is a serious clinical It probably indicates that a high dose of radiation was receivedsign, by the patient. sign of low dosage. Incidental, late, and Lnfrequent vomiting is probably a

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A decrease i n lymphocytes i n the peripheral blood probably means nothing more than that the patient has been exposed to a significant amount of radiation, Soon (hours) after a radiation exposure, all patients seem t o show a marked decrease inthe lymphocyte count. shows up only a few days later and here the depression appears t o be dose rapidly, levels off ata reasonably high level but does not return t o normal until after many months have passed, lymphocyte count is depressed to a greater extent, levels off, and slmly climbs back t o noma1 after many months. The degree of depression At very low doses, the depression in lymphocyte count occurs I n very high doses the Therefore, the lymphocyte count by itself does not give much uae€ul information in the first few hours after a radiation accident. I f the depression does not go dawn t o very low levels during the first few days after the accident, it probzbly means that the dose of radiation was not ina lethal range. Still,the depth of depression after the first few days i s not a …