Japan's Nuclear Reactor Crisis:
by DR. ROBIN MCFEE
March 17, 2011
Shout “radiation” and you have effectively yelled “shark” to a group of beachgoers. The impact is chilling, stunning and can cause panic of epic proportions in a NY minute.
Of all the issues we face as a society, few have been as polarizing as the issues surrounding all things ‘nuclear’ … from weapons to reactor power.
The events in Japan resurrect images of “China Syndrome,” “Chernobyl” and “Three Mile Island.” Terms such as “meltdown” and “nuclear fire” are filling the sound-bite driven news airways. Sales of KI are going through the roof as worried Californians, even Americans on the East Coast try to take protective action. Even the current Surgeon General failed to discourage the purchase of such products when first asked. Kinda reminds us of the duct tape and plastic sheeting recommendations post 911. Such strategies may give the illusion of taking action; alas they are as useful as tinkling up a rope.
I’ve been involved in WMD preparedness for many years – from the trenches to policy level, and advised a broad array of agencies and professionals, including entities working on newer antidotes, as well as written extensively about the threat of a radiological event, and how to prepare for one. In fact the entire spectrum of radiological risks – from simple dispersive devices, to nuclear reactor damage to nuclear weapons in the hands of rogue regimes - remain high on my list of concerns for the US. And truth be told, our preparedness is in a state of serious disrepair.
The recent guidance, or lack thereof, from Washington and the leaders tasked with advising, informing, calming the public has been disheartening, as has the state of our national, regional and local preparedness in terms of responding to radiological events. The current Japan nuclear situation raises many questions, including what are the risks to planet earth, some of which remain unanswered. Our leaders should be gauging the level of concern within the US and responding accordingly. Clearly we don’t live in the land of ‘should’ given the performance of our leaders so far. Yet Japan serves as a reminder to us in the United States that we had better remedy our stalled response efforts in this arena.
Several colleagues have asked me* if they should purchase KI to have on hand. Others have wondered if they should avoid purchasing food products from Japan. I have bigger concerns – when are we going to reenergize our preparedness efforts as pertains to radiation, when are we going to leaders in this administration who are worthy of the trust placed by the American Public, when are we going to have an administration that addresses the public with a unified message that actually is based upon sound scientific/medical practice, and when are we going to have a President who will calm the nation in times of angst, who will communicate to the nation a vision, a strategy in terms of what can and is being done to protect the US?
Instead we get folks at various health departments giving mixed messages, and a US Surgeon General who has to amend within 24 hours of her initial exhortations, which were interpreted as tacit approval about people buying KI under the rubric that they (the public) must feel they are doing something. This is wrong! The message has lead to KI sales going through the roof; companies unable to keep up with the demand. And do we know if all the KI products – Internet and local stores – are of high quality? KI can cause allergic reactions, stomach problems, thyroid problems, and other adverse events.
Anyone with the most basic knowledge about public health, toxicology, medications, radiation sickness and the role KI plays in a nuclear response – in other words, the physician who was appointed to be the nation’s physician…i.e. the Surgeon General – should know better. And her handlers should have prepped her better to voice a sound message. I can all but guarantee the two Surgeons General I have great respect for - C Everett Koop and David Satcher, even your humble correspondent would have immediately come out and stated the following:
“I can appreciate our nations’ concern about possible radiation threats from the situation in Japan. We are taking this very seriously, monitoring levels and assessing what risk if any this might place Americans from Hawaii and Alaska to the Continental US. From our experiences, and in enlisting the expertise of the nation’s best physicists, Japan will likely manifest in elevated but not toxic levels in soil and air from different radioactive elements. Many of you have expressed interest in buying KI pills for your family. Potassium Iodide or KI is not a treatment for radiation sickness, nor does it prevent illness from nuclear accidents, except from radioactive Iodine. And the only organ it protects is the thyroid! It is NOT a cure for radioactivity. And at this point, no one in the US has received higher doses of radioactivity than what we all experience every day from flying, chest X Rays, cigarette smoking, or laying in the sun. Japan is not currently a threat to the US, and the side effects from taking KI are far more immediate than any possible benefit for anyone at this moment in time, including potential thyroid damage. And if, IF there appears to be a threat from radioactive Iodine or any element from Japan or elsewhere, we will make certain our people have the critical information, and if necessary, medications. But there is no reason to buy, hoard or take KI or any other treatment for radiation illness.”
It shouldn’t have to take a physician from FSM’s stable of writers to craft a medical message for Team Obama.
Yes people want to, NEED to feel like they are doing something. But let it be a ‘no harm’ something or a something with a purpose! Where is our leadership in the US, where is our Surgeon General, or dare I say POTUS to allay fears, to explain what the threats are, etc?
Our Secretary of Energy should have helped Americans understand the threat in plane terms. He is a noted scientist. Instead he spends minutes during an interview saying what amounts to ‘we don’t know yet’ … not exactly inspiring!
Oh, and the guy residing at 1600 might have wanted to put together a panel of scientists respected from both sides of the political spectrum and introduced them in a nationwide telecast that explains what is going on, separates the myths, mystique and mumbo jumbo from the reality of reactor events. Instead he is shooting hoops, and spending time trying to pick the Final Four for March Madness. The only “madness” I see is POTUS and his again ill prepared team (recall the early days of swine flu) fumbling stumbling and bumbling from one global crisis to another, when both Americans and the world sit hoping for some leadership out of Washington. Clearly hope is not a strategy. Remember these events during election time in 2012.
We at Family Security Matters recognize that your concerns are important and should be addressed. In the interest of trying to provide some basic information to the FSM reader, and allay concerns, what follows is a primer on radioactivity, radiation threats and treatment. Please understand it is a very basic overview; I’ve written entire chapters on radiation terrorism that take up almost 50 pages single spaced!
[PS I could easily allow you to skip what follows if you recognize a couple points.
First – radioactivity is not a new concept. Science and medicine understand it pretty well.
Second – there are some pretty effective therapies to treat radiation, providing the dose isn’t extreme, and you receive treatment early.
Third – the Japan reactor event, as Chernobyl, will likely have some effect on milk and agriculture as radioactive materials appear in air, the soil and water, resulting impact in the region and perhaps farther away. But that effect won’t be realized in terms of the food chain for days, weeks, months, years. While this Chernobyl food effect was felt as far as Scandinavia, the long term health effects have been negligible. No reason to expect much difference from Japan. That said, products from Japan that are now hitting the grocer’s shelves are safe to eat!]
Fukushima Daiichi reactor complex, Japan.
Radiation threats can be separated by intent – terrorism and non terrorism related, i.e. natural disasters, mishandling of materials.
Nuclear Terrorism - Radiation Threat Vulnerabilities
Nuclear terrorism is defined as use of radioactive material in various forms to produce maximum disruption, panic, injury, and fear in the general population.
There are several forms of threat that could result in a radiological event.
Five categories of terrorist threat can be considered:
1. Simple Radiological Device (SDR) sometimes referred to as a Simple Dispersal Device (SDD)
2. Radiological Dispersal Device (RDD)
3. Nuclear Reactor Sabotage
4. Improvised Nuclear Device
5. Nuclear Weapon
The most plausible threat would be an SRD or RDD, because hundreds of thousands of radioactive sources are available in industry and medicine around the world.
Simple radiologic devices (SDR) - Simple Dispersal Devices (SDD) - Radiation exposure devices (RED)
Use of an SRD, SDD or RED is the deliberate act of placing a high-energy source or spreading radioactive material in a highly populated area, such as an airport, train station, port, or sports venue, to expose people to various levels of radiation.
Cesium (Cs) is one of the most likely radioactive materials to be used in an SRD/SDD or RDD. It is widely available and utilized industrially. Other radionuclides include Americium, which can be found in smoke detectors, and Iridium.
Especially problematic is the stealth with which SDD could be deployed. If not announced as a weapon, no one would know about the device until patients presented with a variety of symptoms. Unless the clinician considered radiation – and this is unlikely in the early stages of illness based upon the level of radiation knowledge and preparedness among health care workers, and the results of the Litvinenko case where he was initially misdiagnosed – appropriate management will be delayed.
Radiologic dispersal device (RDD)
In an RDD, explosives are attached to a radioactive isotope and detonated. This can result in large areas of local environmental contamination, as well as patients being contaminated. RDDs, though not posing the risk of devastation associated with thermonuclear devices, can never the less spread radioactive materials. The materials integrated in an RDD could be in several forms: gas, aerosol, solid, particulate, liquid, or other. RDDs use conventional explosives, for example, TNT, dynamite, plastic explosives, or others, to pulverize or vaporize radioactive materials and thus spread them. This is commonly called a “dirty bomb.” Radioactive materials that could be used in such devices are the same as those that could be used in SDD above. However RDDs as terror weapons would be highly effective; the explosion causing serious physical injuries from blasts, schrapnel/flying debris and thermal injuries in addition to the threat of radiation toxicity. Moreover the psychological impact of “radiation” in addition to the terror associated with a bombing would be highly effective.
Cs137 has been identified as a potential radiation source for such a “dirty” bomb or RDD. Treatment available for Cs? Yes. Prussian Blue. (Please don’t stockpile it at home!)
The most common type of incident of concern involving a nuclear reaction would be the disruption of the cooling system for the reactor core of nuclear fuel. Loss of coolant accidents (LOCA) can result in failure to cool a reactor core allowing it to reach temperatures at which the nuclear fuel and associated assembly melts (hence the term “meltdown”). The cause may be a pipe break, valve failure, or pump failure that interrupts cooling. Reactors generally are now designed to avoid a LOCA by automatic insertion of control rods to shut down the reactor before criticality occurs and sets the stage for a “meltdown.” LOCAs may result in the release of radioisotopes such as Sr90, Cs137, and I131 to name a few. Medical management of workers or other individuals near the site of a reactor incident with release of radioactive materials may require immediate care for medical conditions, surgical conditions, and thermal burns. If a plume were allowed to escape the reactor facility and containment structure, it would drift with the current wind conditions, flowing with the current wind conditions and direction. Airborne, ground, environmental, animal, and human contamination could occur in the plume’s path as with a nuclear weapon detonation. The impact from Chernobyl as a result of the plume effect reached into Scandinavia and beyond.
The Chernobyl reactor incident resulted because several safety systems were bypassed while a set of experiments with the reactor were performed. There were two explosions, with fires and meltdown of the reactor core, leading to serious widespread contamination of the environment. The primary radioactive isotopes responsible for health problems were Cs137 and I131. Considering the gravity of the accident, it is commendable that the actions of the response team led to low overall mortality.
The reactor in Japan faces some challenges including running out of water in the cooling pools the places where spent fuel (radioactive material processed and packaged in specialized ways to allow reactors to work). Without adequate cooling, these fuel sources decay and heat that still is emitted. Fuel rods get damaged, more leakage of radiation. Outer shells can catch fire, outside a containment zone. Steam around the rods allows hydrogen from chemical reaction. Hindenburg may be overstated. But anyone who has made Hydrogen pop in a chemistry lab, knows the potential when there is a lot of the stuff.
The rods on fire, melting does not mean that there will be a meltdown to the center of the earth! The planet is not about to become one gigantic conflagration because of Japan’s reactor damage.
Improvised nuclear device
Former CIA Director John Deutch has said, “The chilling reality is that nuclear materials and technologies are more accessible now than at any other time in history.” Example: The former Soviet Union has admitted that it can’t account for numerous suitcase size 1-kiloton thermonuclear devices. Depending on the yield, the devastation of a nuclear bomb ranges from the devastating to the unthinkable The proliferation of nuclear and radiological materials and the technology to deliver these toxic materials has made the potential military or terrorist use of ionizing radiation (IR) weapons increasingly likely. Terrorist groups, including Aum Shinrikyo, al-Qaeda and Chechnyan extremists, have expressed interest in obtaining such weapons.
An improvised nuclear device, if successful, could produce a nuclear yield similar to that of Hiroshima and Nagasaki, with release of radiation, blast, and thermal pulses together with significant radioactive fallout. In reality, a terrorist organization might be able to produce a partial yield, producing less effect. The conventional explosive would detonate and blow the device apart, resulting in environmental contamination with weapons material, such as plutonium or uranium.
Construction heretofore of such a device has been considered highly difficult because of sophisticated engineering and expertise required. More recent studies conducted by Harvard University and projects assessing the threat of nuclear terrorism have come to the conclusion that a capable, well funded and organized group could make, deliver and detonate at least a crude nuclear bomb capable of incinerating the center of any major city in the world, if the necessary fissile materials were obtained (think Iran).
A review of the data suggests that the mean lethal dose of whole body radiation necessary to kill by 60 days 50% of people exposed is between 3.25 Gy and 4 Gy, without supportive medical care. Survivors of Hiroshima had estimated doses of less than 3 Gy.
As an aside, NO ONE expects the citizens of Japan or in any other country to experience doses anywhere near these levels from the recent reactor damage. People will have elevated levels in excess of background, but that is a far cry from life threatening or hospital necessitating exposures.
Today’s nuclear weapons are far more sophisticated than the kiloton bombs detonated over Hiroshima and Nagasaki, with destructive power in the megaton or higher category.
Never the less, detonation of such devices in populated areas could result in tens, even hundreds of thousands of deaths. Physical trauma and thermal burns are the immediate hazards to life and limb. Immediate deaths will not be the result of exposure to ionizing radiation. Patients not immediately near the epicenter who might survive may require treatment for physical injuries, thermal injuries, as well as radiation-induced injuries and illnesses. It must be recognized that a nuclear weapon explosion as with all explosions, creates enormous blast forces, which are the primary destructive force, along with thermal energy and radiation energy.
RADIOACTIVITY AND IONIZING RADIATION
Now before I put you back into high school chemistry class trauma or glaze over, I promise this won’t be a discourse on heavy formulas and the stuff of brain fry! But some basics to demystify radioactivity are in order…..
Radiation is the emission and propagation of energy through a medium or space in the form of waves or particles; there are a variety of types of radiation within the electromagnetic spectrum, most of which do not have the energy to cause ionization. Radioactivity occurs because the nucleus of the atom is unstable, resulting in emission of energy.
The periodic table of elements contains over 100 elements; these are the building blocks for all substances on earth. Each element has an atomic structure consisting of a nucleus, electrons, neutrons and protons. Elements may occur in several forms called isotopes that differ in their nuclear properties.
Isotopes may be either stable or unstable; the latter are referred to as radioisotopes because of the radioactive decay occurring in the basic structure which underpins the instability. There are thousands of radioactive sources.
Radioactive chemicals or isotopes within the element can also demonstrate toxic properties beyond radioactivity. There are forms of cesium and compounds including that element that can cause burns, or explode on contact with water.
Of note, unlike traditional chemical toxicants, radiation cannot be diluted with water to neutralize the toxicity. Water may create distance or pose limited shielding for relatively weak particles but it cannot detoxify radiation. It is effective, especially with soap in decontamination procedures to wash off particles from patients.
Knowing the decay rate (1/2 life), energy, amount and type of radiation associated with a particular isotope (radioisotope) is necessary to characterize the level of risk that a weapon or source hazard poses to human health.
Knowing the dose that an individual was exposed to and the duration of exposure is critical to determining if toxicity will occur.
It is important to recognize that an exposure to radiation is not a death sentence! WE are ALL exposed to radiation – if we fly, get X Rays, smoke, eat bananas. Yes bananas are radioactive – it is on the order of magnitude of about 1 billionth of that from medical radioactive cobalt sources!
Ionizing Radiation (IR)
When we talk radioactivity we are talking IR.
Ionizing radiation is a form of energy that has the potential to remove electrons from other atoms. For example, in IR, by stripping a negative electron from an atom, an “ion pair” is created—an electron and a positively charged atomic remnant. This process of “ionization” creates instability in molecules, the most important of which from a medical perspective is cellular genetic material - deoxyribonucleic acid (DNA). Ionizing radiation can also damage cells by the hydrolysis of water to form highly reactive “free radicals” which can propagate tissue destruction by chemical reactions.
Not all IR is the same. Within this category are several types of IR; the differences among types of ionizing radiation relate to their energy and charge. Their respective properties determine tissue toxicity: deeply ionizing radiation can penetrate cells, tissues, or organs as they deposit energy along their tracks.
While the type of IR and resulting range of penetration vary, they also determine the nature of the absorber or barrier necessary to block their respective energy. This is the basis for shielding.
Penetration is determined by the circumstance – tissue/host type, distance from source and shielding, which have implications in terms of health threat, type of personal protective equipment (PPE) required and prognosis. If you double your distance from the source, you effectively make your exposure ¼ the original…distance is an important concept in protection.
IR comprises alpha and beta particles, gamma and X-rays. Each can harm human tissue. Alpha particles usually do not penetrate intact skin, but can be inhaled, ingested or introduced through damaged skin. Beta particles can penetrate skin, causing burns. Gamma and X Rays readily penetrate skin and require special shielding. Like other toxicants – dose has a predictable effect on the damage inflicted upon a patient.
Various technologies are used to characterize, interpret even identify IR. “Ionization” is the primary basis for locating radioactivity and radioactive materials.
Radioactivity is a naturally occurring phenomenon; we are exposed to small amounts on a daily basis. When a person is exposed to radiation, energy is deposited in the body. Radiation dose refers to the absorption of radiation energy per unit mass of absorber. The amount deposited per unit of weight, using the US conventional term is called the RAD, or radiation absorbed dose; the basic unit of measuring exposure dose is defined as the deposition of 0.01 J of energy into one kilogram of tissue. The System International (SI) unit of measure is the gray (Gy); 1 Gy =100 RAD. The number of RADs a patient has been subjected to allow clinicians to anticipate the potential severity of acute radiation syndrome (ARS) and plan clinical management accordingly. Anything less than 100 rads is unlikely to cause serious effects. Beyond the scope of this intro, be aware that various organ systems – immune, gastrointestinal for example – are effected by different doses.
The risk that a person will suffer adverse health effects from radiation is measured using the unit REM (roentgen equivalent man). The REM quantifies the amount of damage suspected from a radiation exposure. The SI unit is the Sievert (Sv); 1 Sv =100 REM. The REM is adjusted to reflect the type of radiation absorbed and the likely damage produced.
Alexander Litvenenko, who died after ingesting the radioactive substance Polonium-210
The good news – we have a lot more treatment options since 2001.
The bad news - The medical response to radiological threats is one of the least emphasized aspects of medical education in general and of current terrorism preparedness specifically. Radiation sources are ubiquitous and available from industrial, military and medical sources. Providing adequate security for all sources will take time, money and national and international cooperation.
With this new POTUS, preparedness efforts have lagged behind, especially upon the departure of the Bush Administration. What gains we have made since 2001 are at risk of falling. While much of our efforts have addressed the traditional terrorist threats which include improvised nuclear devices (suitcase nukes), simple dispersal devices (SDD - leaving unshielded radioactive materials in public places), actual nuclear weapons (hello Tehran) and radiation dispersal devices (RDD = SDD plus explosives which spread the unshielded radioactive materials). To date there have been numerous events involving SDD.
Going one step further, even within professional preparedness circles and in the aftermath of 9/11 when government initiatives focused on medical vulnerabilities to toxicant threats, of all the categories of weapons of mass destruction (WMD) – whether using the CBRNE (chemical, biological, radiological, nuclear, explosive) or NBC (nuclear, biological, chemical) acronym – radiation is the least taught in professional schools, responder cultures or civil preparedness organizations. Yet a radiological event remains considered one of the most significant preparedness vulnerabilities, especially in terms of knowledge about and responding to such an emergency. To date few health care professionals (HCP) – pre-hospital (emergency medical services - EMS) or hospital based possess the fundamental knowledge or skills to identify, let alone treat a radiation victim; this vulnerability made even more obvious in the aftermath of the high profile assassination of former Russian agent Alexander Litvinenko. He was poisoned with Polonium210.
Moreover most HCP and first responders consider themselves inadequately prepared for radiation events. Consider a recent online poll conducted by the Journal of Emergency Services (JEMS). The question was posed “do you feel prepared to handle victims of a dirty (radioactive material) bomb?” Of the 246 respondents, 82% replied “NO!” Compound this with the fact that most health care facilities remain underprepared – from training to detection equipment to appropriate management materials.
Research continues to demonstrate that many health care facilities lack even the most basic and necessary antidotes suggested by the toxicology community. If the most commonly used antidotes are inadequately stocked, what can be said about the supply of medications critical to treat WMD, especially radiation toxicity?
Managing radiation injuries effectively requires access to specialized equipment and expertise. Once at the health care facility, clinicians must realize patients with radiation injuries can suffer from complex patterns of injury reflective of the tissue and organs damaged as well as trauma. Radiation sickness is progressive and may require acute, critical and long term care throughout the course of illness.
There are several treatments available to manage the radiation poisoned patient - from medications that include Ca DTPA and KI, to Prussian Blue to antacids and water....depending upon the threat. Yet everyone talks KI. Most of these have very specific indications as well as timelines, as most are really only effective within a time window.
A Word on KI
There is NO universal cure all for radiation sickness; treatments are selected for the type of radiation, route of exposure, level of exposure and organ (s) involved. Some do not treat in the sense of cure; for example KI does not treat, it prevents. It is a competitive binding therapy; KI is comprised of a non radioactive iodide. Since the thyroid is highly sensitive to I – whether it is radioactive or not. The theory - if you can load up I receptors on the thyroid with non radioactive I (KI) before they are filled with the radioactive I* that came out of the reactor, that is now in the environment, you can protect the thyroid. Taking these pills is not a substitute for medical care or follow up. It is not a cure. Once the thyroid is loaded up with I*, KI becomes less and less effective over time because it doesn't have as many receptors to fill and the balance between receptors with I* and I becomes less ideal.
Nuclear power has had a pretty impressive safety history compared to coal and coal mining, oil, refining petroleum, and natural gas. The latter mostly go kaboom, kill folks, and the aftermath is usually relegated to a cleanup and rebuild. Nuclear power – radiation..the very mention of these terms bring back memories of desk diving during the Cold War
Three Mile Island though worrisome, was not a Chernobyl and based upon long term studies, has not had the horrific impact on human health that so many worried about. In fact the actual amount of radioactivity released was small and no radiation injuries resulted.
Nuclear supplies about 20% of US energy needs, and about 70% for France. It is a highly regulated industry; deservedly so. Are there concerns? Of course. There are no free rides in life. Every option poses a risk benefit calculation. On the one hand is the enormous benefit of relatively renewable, clean, safe energy. At the other end, when things go bad, nuclear can pose serious problems for a community. But if we are to cut the umbilical cord from the US to OPEC, we must consider every option.
The events in Japan put into specific relief a few critical concerns –
1. A government that continues to lack a strong message, let alone grasp of global threats
Libya and the Middle East, a dwindling economy, Japan’s reactor and what it means to America – All require US leadership, yet POTUS remains quiet, aloof, paralyzed like a deer in headlights
2. Preparedness in general and radiation preparedness specifically, that continue to wane in the United States
I was recently involved as co-designer and evaluator of a multiagency multi area preparedness drill involving radiation as the threat. The effort was laudable by all players; the reach back expertise lacking, the familiarity with radiation detection minimal, and the experience with treating such exposures near non-existent in the early aftermath. We can do better as a nation; we must do better.
3. The need for greater discussion about an effective energy policy
It is worrisome that our Secretary of State said recently that the events in Japan are forcing us to look at our energy policy. Wasn’t that one of Obama’s platforms when he ran for office? Did it take 3 years, a Tsunami and nuclear disaster to drive the energy agenda?
The nuclear reactor in Japan is a mess; radioactivity will get into the environment. It is not the China Syndrome and Armageddon is not around the corner. Will we need to take precautions? Perhaps. Is it too early to ban Japanese products? Yes. Do we need to take KI and other preventive measures? No. But in the absence of true leadership from the White House and others tasked with addressing the concerns of and threats to our nation, people will take matters into their own hands. Those may include approaches, which in the end, could prove more dangerous than the original threat.
Like any health concern, when in doubt, contact your physician. Except in this case, there is no current health concern from Japan. So use the dime to contact your elected officials. It is time to send a message to our leaders that we expect some leadership!
*(Answer to friends – No to the KI, No to avoiding Japanese food)
FamilySecurityMatters.orgContributing Editor Dr. Robin McFee is a physician and medical toxicologist. A nationally recognized expert in WMD preparedness, she is a consultant to government agencies, corporations and the media. Dr. McFee is the former director and cofounder of the Center for Bioterrorism Preparedness (CB PREP) and was bioweapons - WMD adviser to the Regional Domestic Security Task Force Region 7 after 911, as well as advisor on avian and swine flu preparedness to numerous agencies and organizations. Dr. McFee is a member of the Global Terrorism, Political Instability and International Crime Council of ASIS International, and member of the US Counterterrorism Advisory Team. She has delivered over 400 invited lectures since 9-11, authored more than 100 articles on terrorism, health care and preparedness, and coauthored two books: Toxico-Terrorism by McGraw Hill and The Handbook of Nuclear, Chemical and Biological Agents, published by Informa/CRC Press.