Response to Fukushima NPP Accident - Medical Response in Korea -
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1 2013 IAEA-ASAN Response to Fukushima NPP Accident - Medical Response in Korea - Seung-Sook Lee, MD, PhD Director General National Radiation Emergency Medical Center (NREMC) Korea Institute of Radiological & Medical Sciences (KIRAMS) SEOUL, KOREA National Radiation Emergency Medical Center Korea Institute of Radiological & Medical Sciences
2 South Korea is the geographically closest country to Japan. Wind is the prevailing westerlies ( 偏西風 ). ling 1,000Km
3 Contents National plan for radiation emergency preparedness in Korea Introduction of medical preparedness system in Korea Medical response to Fukushima NPP accident in Korea National Radiation Emergency Medical Center Korea Institute of Radiological & Medical Sciences
4 Nuclear Reactors & RI industry in Korea Nuclear Reactors in Operation(23) Nuclear Reactors under Construction (9) Nuclear Reactors under Consideration (8) - Nuclear power plants are providing 38% of the national power supply RI -- Concentrated in Metropolitan Areas Uljin SEOUL 46% (1,982) 17% (748) Wolseong Yonggwang Kori
5 Radiation Emergency Medical Network in Korea NARMED-Net (National Radiation Emergency Medical Network) KIRAMS 10 primary medical centers near NPP 12 secondary centers over Korea
6 Emergency Levels in NPP White Emergency (Site area Emergency) Radiation effects limited inside the building where the accident takes place. Blue Emergency (Site area Emergency) Radiation effects limited inside the plant area. Red Emergency (General Emergency) Radiation effects reach beyond the plant area. Every excerxise is performing on red emergency basis.
7 National Countermeasure System for Radiation Emergencies in Korea General Committee for Safety Management Prime Minister Relevant Authorities General HQ for Radiation Emergency Management International Organizations Minister of NSSC REPORT COMMAND COMMAND ADVICE COMMAND ADVICE COMMAND ADVICE Local HQ for Radiological Emergency Management Nuclear Industrial HQ for Radiological Emergency Management HQ for Technical Support of Nuclear Safety President of KINS HQ for Medical Support President of KIRAMS COMMAND REPORT COMMAND REPORT COMMAND REPORT On-site for Radiological Emergency Management On-site Medical and Technical Contingent SUPPORT
8 Organization of Medical Support HQ for Medical Support NREMC/KIRAMS HQ for Medical Support Briefing room Competent Authorities On-site contigent for medical support Primary/Secondary local medical centers On-site medical support team - Dispatched from KIRAMS (Emergency response A team) HQ for expanded floor medical support Floor medical support team (Emergency response B, C team) Technical support team Administrative support team Hospital-based medical support KIRAMS Primary/Secondary local medical centers Technical advisory committee (24 hour Emergency Call Services)
9 On-site Medical Response Flow Life threatening injury Field Triage Not seriously injured or uninjured Transfer to the Nearest Emergency Medical Center Noncontaminated Joint Emergency Medical Center Contamination Survey Contaminated On-site General Emergency Clinic Local Government Registration Area Non contaminated Uninjured On-site Radiation Emergency Clinic KIRAMS Contaminated Injured Emergency Shelter (School or Convention Center) Transfer to the Designated Emergency Medical Centers
10 Organization combined efforts of the government and medical professionals to establish the most 5 effective Act on national physical response protection system of nuclear to radiation facilities emergencies and countermeasure for radiation emergency enacted Constructed the national radiation emergency medical system including NREMC and 18 local centers (2004) 22 local centers (2013) Primary centers (10) - Local hospitals near NPP (7) - Military hospitals (3) Secondary centers (12) - Major Univ. Hospitals (10) - Major Military Hospitals (2)
11 KIRAMS Research center NREMC Korea cancer center hosp
12 NREMC is efficiently supported by KCCHc KIRAMS Korea Institute of Radiological and Medical Sciences Research Center (RIRAMS) - radiation biology - cancer biology - development of radiopharmaceuticals National Radiation Emergency Medical Center (NREMC) - established in HQ of nation-wide network for radiation medical countermeasure - radiation effect clinic - isolation ward for contamination Korea Cancer Center Hospital (KCCH) - leading cancer center since specialized ca. depts. - education & training - clinical & translational research National Radiation Emergency Medical Center Korea Institute of Radiological & Medical Sciences
13 KIRAMS Synergy NREMC KCCH (hospital) Research center Know-how from oncologists (ARS is similar to side effect of radiotherapy or chemotherapy) Hospital facilities and personal resources radiation biology radiation beam animal experiments health physicists
14 NREMC National radiation emergency medical center Division of Radiation Emergency Care Division of Planning & Research Medical service team Health physics tam Biodosimetry team global affairs team Administration & planning team Emergency preparedness response & education team ARS therapeutic research team Low-dose radiation research team liaison institute of WHO (since 2004)
15 Major Functions of NREMC Medical management Education & Training National Network Dosimetry R&D International Cooperation
16 Characteristics of Korean System - Radiation Emergency Medical Network - Designated in national law national network system, role of KIRAMS/NREMC Financial support by central government Centralized system of national network even distribution of resources even opportunities for education & training easy to quality control possible to distant support by other sites balances for national/military/private institutes NREMC as a part of radiation-oriented specialized institute synergy with cancer hospital and radiation research center
17 Limitations of Korean System - Radiation Emergency Medical Network - Belated start compared to nuclear industry Limited budget for medical preparedness Need to further cooperate with Ministry of Health Need to facilitate with local government
18 Medical Response to Fukushima NPP accident in Korea
19 Activities after the Fukushima accident Real situation of activating the medical countermeasure network Screening for contaminated persons Dosimetry - biological & physical Communication with the public and medical personnel
20 Activating medical network Activating the HQ for medical support (KIRAMS) Mar 12 ~ May 3, 2011 Cooperation with the network hospitals - providing guidelines for medical staffs in the network - suggesting each roles to 21 primary and secondary medical center - on-site dispatch for contamination screening
21 Screening for contamination Population Monitoring by Portal Monitor (March 17 ~ June 7, 2011) at 4 airports (by KINS, KIRAMS and 2 affliated centers) at 4 harbors (by KAERI, Daegu military hosp.) - To check arrivals from Japan - More than 330,000 people screened only 2 persons were detected on cloths (>1uSv/hr) Contamination Check-up at Medical Centers - To check radioactive contamination for the public - No one contaminated with radioactive material until now
22 Medical & Public Services of NREMC Activating OPD radiation-clinic in NREMC and designated medical centers Consultation for the public (NREMC) : providing medical information - 24 hour direct phone call services for consultation : 1,523 - Q&A, FAQ services (NREMC home page, on line portal web sites) : 505 Providing information on radiation health effect from Fukushima accident via mass media (TV, radio, newspaper, journals, etc) : 241 Consensus meeting for medical doctors with different voices (May~July, 2011) -- publishing a consensus document Lectures for medical personnel and the public : 25 <data for Mar 12~Oct 22>
23 Inquiries of NREMC homepage consultation board <2011. Mar 12~Oct 22> Category of contents N % external contamination inspection safety of residence in Japan influx of radioactive materials into Korea safety for contacting emigrants from Japan and Japanese goods health effect of radiation in child, adolescent and pregnant woman relation between radiation exposure and questioner s symptoms urgent requests for news gathering and reference materials biodosimetry and internal contamination bioassay antidote to radiation exposure /
24 Inquiries of NREMC 24hr phone call consultation <2011. Mar 12~Oct 22> Category of contents N % How or where to inspect internal contamination safety of residence in Japan external contamination of radioactive material requests from journalists or broadcasting system antidote to radiation exposure influx of radioactive materials into Korea relation between radiation exposure and questioner s symptoms safety for contacting emigrants from Japan and Japanese goods health effect of radiation in child, adolescent and pregnant woman ,523
25 Contents of response for mass media <2011. Mar 12~Oct 22> Category of contents N % Questions for Influx of radioactive materials into Korea and its health effect Explanations to control unreasonable rumors Health effect of radiation exposure National radiation medical preparedness system Inquiries for KIRAMS & NREMC Information for antidote to radiation exposure Therapy for ARS and internally contaminated persons Inspection for radiation contamination Food safety /
26 Radiation Emergency Clinic : Flowchart
27 Radiation Emergency Clinic : inspection items 2011 External contamination check Internal contamination check (γ) (α,β,γ) In vivo bioassay In vitro bioassay CBC Biodosimetry
28 Radiation Emergency Clinic & Dosimetry 2011 Medical check-up for the Japan travelers - mostly emergency rescuers & journalists, or students - more than 700 people visited NREMC Estimate radiation exposure and risk based on visitors movement line in Japan and estimates from SPEEDI. Medical counseling with specific history (no ARS) Screening external contamination (0/748) CBC (317 tested all WNL) Dicentric chromosome analysis: on demand, 265 tested Whole body counter: 184 tested Urine test (in-vitro bioassay): 57 tested No symptomatic person (!!!except psychological problems anxiety) No internal and external contaminated persons
![Cytogenetic Biodosimetry for Fukushima Travelers [Journal of Radiation Research 53:876 881, 2012] Subjects : 265 Fukushima travelers vs.](/docs-images/78/78424608/images/29-0.jpg "37 non-travelers 226 journalists, 22 rescue workers, and 17 others male(238), female(27) mean age of 38.7yrs (22~68 yrs.) Results background DIC : 234/265 (88.3%) increased DIC : 31/265 (11.")
29 Cytogenetic Biodosimetry for Fukushima Travelers [Journal of Radiation Research 53: , 2012] Subjects : 265 Fukushima travelers vs. 37 non-travelers 226 journalists, 22 rescue workers, and 17 others male(238), female(27) mean age of 38.7yrs (22~68 yrs.) Results background DIC : 234/265 (88.3%) increased DIC : 31/265 (11.7%) [Most have history of medical exposure(ct, PET)]
30 Changes of medical activities after Fukushima accident Fukushima NPP accident Detection of RI in Korea NREMC web site consultation Phone call consultation NREMC clinic visitors Local REMC clinic visitors Biodosimetry (Dicentric chromosome) internal contamination (WBC) Mass media response Biodosimetry result Cesium map Japan MEST weeks
31 There are no evidences to be exposed to radiation from Fukushima NPP accident among Koreans. Psychological problem of the public! Social problems remained!
32 Lessons learned from Fukushima NPP Accident~~ We need Efforts to provide the information for radiation health effect to the public and journalists Cooperation with Ministry of Health : - collaboration with emergency medicine network - education program for general medical doctors Planning for remote medical support from other sites To activate the local government for radiation accident & to reconsider evacuation plan
33
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