Facing the Terror of Nuclear Terrorism

It isn't enough to train safety professionals to deal with the technical issues of chemical, biological, or radiological incidents.

OCCUPATIONAL health and safety professionals may be well trained to deal with risks in the workplace, but are we prepared to deal with risks that may confront our own families?

With the sniper attacks in the Washington, D.C. metro area during October 2002, daily risks outside of the workplace took on new meaning. Children were afraid to go to school, women feared shopping, and men were afraid to pump gas. Rampant anxieties led to cancellation of outdoor activities, and travelers postponed plans to visit Washington. Everyone was nervously looking for white vans and suspicious people lurking in the shadows as they feared becoming the next victim. Despite major efforts to develop homeland security, law enforcement officers seemed powerless against the random sniper slayings. Hundreds of thousands no longer felt safe in their own neighborhoods.

The training of safety professionals to deal with chemical, biological, or radiological incidents is mainly devoted to technical issues. While members of the psychological or counseling professions may know how to handle the fears of terrorism, they seldom know much about the technical issues. The development of domestic preparedness and emergency response capabilities will need to address both the technology and the terror of terrorism.

At radiation safety workshops, I like to ask, "Which will be the most difficult part of a nuclear incident, technical issues or those involving people?" The participants always conclude dealing with people's fears will be the greatest challenge. On June 10, when U.S. Attorney General John Ashcroft announced the arrest of a terrorist with plans to build a "dirty bomb," he told the news media that panic would be the most devastating effect.

Dirty Bombs
Ashcroft's announcement resulted in widespread news media reports explaining that a dirty bomb is a weapon using conventional explosives laced with radioactive material. Detonated in a city center, it would not cause massive destruction or fatalities but could contaminate thousands of people, trigger mass panic, and wreak enormous economic damage.

The media also said the Nuclear Regulatory Commission reports 300 missing radioactive sources a year, leading to the implication such materials may be readily available to terrorists. NRC Chairman Richard A. Meserve said, "Concern is for psycho-social effects. The terrorist's greatest weapon is fear."

Thousands of safety professionals in the United States are trained in the technology of radiation protection. With the increased potential for nuclear terrorism, many first responders also are receiving training on how to deal with nuclear incidents as part of homeland security initiatives. Most of the training, however, is geared toward technical aspects of radiation. Such training focuses on questions such as:
1) What is radiation?
2) What are the effects of radiation?
3) How can we measure radiation? and
4) What can we do to protect ourselves from radiation?
Relatively little training is directed toward dealing with the psychological aspects or the terror of nuclear terrorism. Consequently, the country is much better prepared to deal with the radiological aspects of a nuclear incident. The question of greater importance may be, "Are we prepared to deal with the terror of nuclear terrorism?"

What is Terror?
At some point in our lives, all of us are faced with great terror or fear. This may occur momentarily as we see ourselves confronting death in a situation of imminent disaster, such as in the moments of screeching tires just before an automobile crash. Terror also may be protracted over long periods as a lingering fear or dread of some impending disastrous consequence.

For example, in October 2002 the Washington sniper held the region in terror as many people feared they could be the next victim. The goal of terrorism is to create terror--when that occurs, the terrorist has won. Because of the sniper people were afraid to pump gas, to go shopping, to walk outside. Schools were locked down with students kept inside the school buildings all day. Outdoor sports activities were canceled. Anxieties were rampant as people wondered who would be next to fall to the sniper's bullet. As the sniper claimed more and more victims, overwhelming fears caused radical changes in daily routines as people tried to anticipate and avoid being the next one.

Is Radiation a Good Choice for Terrorism?
Radiation is an ideal choice for terrorism because it invites public fears, perceptions, and images of consequences, such as:
1) Fearful images of consequences, such as cancer and death.
2) Dread and expectations of catastrophic consequences.
3) No way to know whether you have been exposed.
4) If you know, it may be too late.
5) You don't know what will happen, but you know it will be bad.
6) Possible effects on children and future generations.
7) Possible long-term harm to property and property values.
8) No control and no escape.

Is America a Good Place for Terrorism?
How much risk can we tolerate? Can we afford to worry about small risks? Which risks do we worry more about: anthrax, flying, heights, spiders, or radiation? Which ones do we not worry about: driving, smoking, being overweight, or cholesterol? What is the probability of radiation effects versus the perceptions of disaster? What are the risks that actually kill versus the risks we worry about?

The goal of terrorism is fear. Is fear a factor in our daily lives? Does terrorism make us angry? What is the basis of anger or outrage?

What Drives Anger?
Psychologists have identified a sequence of motivations for anger as follows:

Anger < Fear/Images < Hurt/Sadness < Want

Behind our anger is a fear. Everyone who gets angry is afraid of something. Fears are driven by images of unacceptable consequences. Behind the fear are hurt and sadness. Behind all of this is a want. When someone is angry, there is something he wants. The underlying want and the sequence of motivations for fear and anger are usually outside the awareness of the angry person. He just knows he is angry and feels his anger is justified by the circumstances. The motivations for anger can be identified by the question, "What's so bad about that?"

This question cannot be used while the person is still angry, because an angry person can see only the present circumstances justifying his outrage. Later, another person can ask the question repeatedly to peel away the many layers of motivations and gently lead the person to realize the real basis for the anger and fears.

Radiation Phobia
A compulsive and persistent fear of radiation could be a phobia. A person with radiation phobia will always answer the question, "What if . . . ?" with the most extreme consequence she can imagine. The phobic person's feelings and thoughts spiral downward into more and more extreme consequences related to the question, "What if . . . ?"

For some people, just the word "radiation" is enough to trigger that downward spiral. The phobic person will make decisions and take actions according to her fears of the consequences at the end of the downward spiral. Thus, her reactions are about "What if?" rather than "What is!"

The phobic person will worry about many questions, such as:
1) What if I am exposed to radiation?
2) What if I get contaminated?
3) What if my children are exposed?
4) Will I be able to have children and will they be healthy?
5) What if my property gets contaminated?

Phobic persons will have fearful expectations of extreme consequences related to radiation. For example, the author presented an eight-hour class on radiation safety to a group of about 20 men in a large industrial plant where coatings are applied to paper. By coincidence, most of these men were also volunteer firemen. I posed a scenario for their response. This involved a roll of paper breaking loose, crashing to the floor, knocking down a krypton-85 density gauge, and pinning a worker by his leg nearby. The workers were asked what action they would take. Without hesitation, all agreed they would write off the pinned worker as doomed. All they needed to know was that a damaged radiation gauge was nearby. (By the way, the workers had already been informed about the properties of krypton-85 gas.)

What Should You Tell the Phobic Person?
The phobic person will make decisions and react according to his views of the consequences of "what if" rather than "what is." Therefore, telling a phobic person "what is" about a radiation event will not necessarily lead him to different conclusions or demands for protection. Telling him, "The radiation exposure rates are low and you do not need to be afraid," is not likely going to help him. He will not believe you and will doubt your motivation for telling him something contrary to his own fears and beliefs.

For instance, while presenting radiation safety training to a group of assembly-line workers who make gas chromatographs, I found the workers who install the nickel-63 detector cell assemblies were washing their hands with caustic bench-top cleaner. One worker lifted his hands to show they were red, swollen, cracked, and flaking from the corrosive cleaner. I tried to explain the radionuclide is plated on the inside of the detector cells, which are then installed in a larger assembly by another worker. The workers on the assembly line handle only the larger assembly and wear vinyl gloves. The chance of getting any radioactive material on their hands is zero.

I advised the workers to stop using the caustic cleaner. However, a phone call two months later to the RSO indicated the workers were still using the caustic cleaner. Apparently, the workers' fears of "what if?" and their images of the consequences of getting radioactive material on their hands were more powerful then the technical information I provided.

Remember, the phobic person is responding to fears/images, hurt/sadness, and a want that are out of her awareness. The basis for phobias (fears and images) can be identified again by repeatedly asking the question, "What's so bad about that?" It may be necessary to ask this question several times (five to 10) to get to the real bottom line.

Images and Fears
Since the horrible destructive forces of atomic bombs were demonstrated in Japan, the world has linked radiation with terrifying consequences. For many people, radiation brings up terrible images of death and devastation that must be avoided at all costs. I use a favorite scenario to help people become of aware of the power of images. The scenario invites people to image they are driving on a highway and coming up behind a large truck bearing a radioactive materials placard. As they approach the truck, they notice the truck is doing something strange.

They are then asked three questions: 1) What would you do? 2) Why would you do that? And 3) What's so bad about that? In a class of cardiologists, one doctor said he would go by the truck quickly. Asked why, he said, "The truck might tip over!" He was then asked, "So what?" He said, "Radioactive materials might spill on the road!" He was again asked, "So what?" He replied that he might get some on him. He was then asked the most important question: "What's so bad about that?" He was quiet for a moment and then suddenly said, "Oh my God, I will melt!" Let's be honest, if any of us felt we would melt if exposed to radiation, would we not take some action to avoid radiation?

I conclude this exercise by noting that nothing happens to the truck and ask the audience why they decided to go by quickly or to back off when nothing happened. At this point, everyone realizes the decision to act was based on images and not reality. In fact, taking such actions to avoid anticipated dangers is normal for everyone. Good common sense would tell us it is prudent to take precautions when danger is anticipated, before something bad happens. Thus, avoiding the truck could be considered just good defensive driving practice. The truck exercise, however, illustrates how what are seen to be prudent and sensible actions are motivated more by fearful images than reality.

Melting From Radiation
The image of melting from radiation is memorialized in Hiroshima at the Peace Memorial Museum. This museum contains a darkened alcove with life-size wax figures depicting the destructive forces of the atomic bomb with devastation, smoke, and flames in the background.

Standing in front of this terrible tableau are several wax people with long shreds of flesh dripping from their arms. They appear to be melting. Of course, we know the shredding flesh was more likely the consequence of heat. The people were literally cooked. However, these life-size figures portray an image of the consequences of radiation that will be forever imprinted on the minds of the thousands of schoolchildren who visit this museum every day. These images are so real, graphic, and powerful that it is unlikely anyone will stop to consider whether they portray thermal or radiation effects.

Because of the powerful images of bad consequences of radiation imprinted in our minds forever, radiation is an ideal tool for terrorism. People are often especially fearful of how radiation may affect their children, whether they will be able to have more children, and whether those future children will be disfigured or harmed in some way. People also worry about the consequences of radiation that may affect their property. News stories about dirty bombs in June 2002 predicted contaminated land would not be habitable for generations.

Fear of radiation is primarily about images because few people have ever had any experience with it. Has anyone ever had any physical sensation related to a radiation exposure while the exposure was happening? Unfortunately, radiation does not cause any sensation like a jolt from touching electrical wires, or pain from touching a hot pan, or the shock of the impact from falling to the ground. Without actual experience, we have to rely on consequences portrayed in photos or stories by the media.

Our five senses give us no warning of radiation exposures, so many people consider radiation a sinister, unknown source of danger. They feel defenseless and conclude that if radiation is there, it is bad. No amount of radiation is safe. Radiation is deadly because it causes cancer.

How do people decide to fear or not to fear? What is safe? What will happen if they are exposed to radiation? We naturally want to avoid risk to protect ourselves, our families, and our society. We especially try to avoid risks when we have doubts--and many people have doubts about radiation. However, when people instinctively assume radiation equals cancer and death, something is missing, namely the steps from cause to effect.

Steps from Cause to Effect
To answer the question "what is the risk?" or "is this safe?" a safety professional must answer several detailed questions. These include:
1) What are the properties of the radioactive material, does it emit alpha, beta, or gamma radiation, and what are the form and quantity of the material?
2) Where are the radioactive materials located?
3) How are the materials contained?
4) How will the radioactive materials move in the environment?
5) What are the exposure conditions, i.e. direct gamma, ingestion, inhalation?
6) How much radiation energy is deposited in the body, and where?
7) What is the expected health risk based on historical evidence of radiation effects?

Because of difficulties in explaining answers to these questions for evaluating the steps from cause to effect, news media have adopted an approach of describing the consequences of exposure to radiation with only two words--deadly radiation. These two words can be considered both a risk assessment and a risk communication. Unfortunately, the media have used the words "deadly radiation" for so long that people expect death as a consequence of radiation exposure without any consideration of the steps from cause to effect. Thus, people often conclude the only assurance of safety is to have no exposure to radiation.

Will the Truth Prevail?
Radiation safety professionals often have difficulties when they provide the scientific or technical truth about a radiation issue and then find the public not believing or accepting their technical conclusions. Such public reactions can be explained by the difference between hazard and outrage, according to Dr. Peter Sandman.

Hazard is the technical evaluation of risk as defined by experts based on an analysis of the steps from cause to effect. Outrage is the basis for public reactions based on perceptions of radiation risks, trust, control, dread, feelings, familiarity, fairness, and other factors.

How would you complete the statement, "If only . . . !"? Here are some possibilities:
1) "If only people understood radiation the way we do."
Is the answer better education for the public?

2) "If only people were more rational and logical."
Do irrational emotions lead to extreme reactions?

3) "If only people did not have such strange perceptions of radiation risks."
People need to deal with "what is" rather than "what if."

What is the truth in any of these statements or questions? The answer is that they all reflect common views among technical people who rely on logical analysis for making decisions. Thus, they may be true to those technical people, but they may not be true for the other half of the population that relies on feelings for making decisions.

Is Fear a Factor for First Responders?
Will our own fears factor into our responses to a nuclear incident? How do we handle our own response to "what if?" What if we make a mistake? What if people get exposed to radiation? What if we don't protect people the way they want? Because of our actions or decisions, what will happen to our credibility, reputation, trust, competence, caring, professional status, career, income, etc.?

How will responders to a nuclear incident handle their own fears? The answer is usually, by conservatism. We probably will take more precautions than may be absolutely necessary in order to be assured we are conservative on the side of safety. For example, the first responders to a nuclear incident, such as fire or police personnel, may cordon off, restrict, or evacuate a very large area around the incident. Once an exclusion zone is established, even knowledgeable specialists in radiation safety may not be allowed to enter. Thus, those who might best help may be restricted on the basis of the fears of the first responders.

For example, two years ago in Olney, Md., a man was inspecting a newly purchased antique cabinet in his garage. Inside he discovered a small metal cylinder with a faded radiation label. He called 911. The first responders immediately cordoned off all of the neighborhood streets and evacuated all nearby houses. Three hours later, someone finally checked the object with a radiation meter and found no signal. The cylinder was empty.

Helping Those with Fears
Dealing with fears is not accomplished by trying to change people's minds. A better way is to begin with what people already think or believe and work backward to science and understanding. This means asking lots of questions to determine people's feelings and images about radiation effects.

The challenge is how to communicate in the form of questions rather than giving answers. People value their own answers more than the answers of experts. When the expert gives data, it may help to ask the audience whether the data are believable. An even better way is to present new information by show-and-tell to demonstrate the properties of radiation and the principles of radiation safety: time, distance, and shielding.

Gaining Public Attention and Credibility
Our brain filters what we see, hear, feel, and smell. It forwards only a few items to our awareness to prevent overloading. What gets our attention? Normally, we are more likely to pay attention to something we value, something unique, something that threatens, or something that entertains. Advertisers certainly know what gets attention. You'll notice in the news that most news is bad news, because that gets attention.

In a nuclear incident, however, the public's attention already will be focused by the fear of consequences of radiation exposures. In such incidents, the bigger challenge may be to establish credibility. People may not hear the best information provided by experts if that information does not match what they believe or the images they have of radiation consequences. Because people learn by relating new information to experience or insights they already have, new information is helpful only if it is presented in terms the audience can relate to or can verify by the members' own experience.

The most helpful response to questions about radiation may be opposite to the normal approach of technical experts, which is to present factual information. A better approach may be to hear the feelings first. People are asking questions because of their fears of radiation consequences. Therefore, checking out perceptions, fears, and images may be the best place to start. This means asking many questions rather than giving answers. Hearing the feelings also helps to establish rapport and credibility. Identifying with the perceptions of radiation risks can be very helpful. Another option is to share personal experience. The last step is to provide factual information.

Summary
As America prepares for homeland security and the response to terrorism, more occupational safety professionals may find themselves called upon to deal with terror in their own neighborhoods. While thousands of safety professionals are well trained technically to deal with many types of terrorism, they may not be well prepared to deal with the greater challenge, namely the terror of terrorism.

Dealing with terror requires hearing and responding to people's feelings before providing technical answers. For safety professionals to be most effective in dealing with terrorism, they can benefit from more training on how to deal with terror.

This article originally appeared in the May 2003 issue of Occupational Health & Safety.

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