The REAC/TS Experience with Fukushima Response

Transcription

1 The REAC/TS Experience with Fukushima Response Steve Sugarman, MS, CHP, CHCM Health Physics Project Manager Cytogenetic Biodosimetry Lab Coordinator REAC/TS Erik S. Glassman, MS, CCEMT-P Operations Planner NSEMP Oak Ridge Institute for Science and Education

2 REAC/TS The Radiation Emergency Assistance Center/Training Site A response asset of the US Department of Energy (DOE), National Nuclear Security Administration (NNSA) Part of the Oak Ridge Institute for Science and Education (ORISE) Expertise in the medical management of radiation incidents Specific areas: medicine, health physics, biological dosimetry

3 REAC/TS Missions 24/7 Radiation Medicine advice and consultation Health Physics radiation dose assessments Deployable Emergency Response Teams (ERT 1 & 2) for on-scene assistance Physician Health Physicist Nurse/Paramedic

4 Domestic & International Deployment Capability CONUS deploy w/in 4 hours OCONUS deploy w/in 6 hours International Collaboration: World Health Organization (WHO) Collaboration Center and member of the Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) Member of International Atomic Energy Agency (IAEA) Response and Assistance Network (RANET)

5 Cytogenetic Biodosimetry Radiation dose to circulating lymphocytes Dicentric chromosome is the marker Dicentric frequency related to radiation dose via dose curve

6 Education Related to the Medical Management of Radiological Incidents (Typical Year) 8 REM 3.5 day courses 2 ARM 4.5 day courses 3 HP 4.5 day courses 2 Pre-hospital 1.5 day courses 3 specially designed courses provided locally ( days) 3 offsite courses for DOE facilities (1-2 days) 10 offsite courses for private entities Multiple invited presentations/lectures Multiple international courses

7 General Communication Issues with Radiation Incident Response

8 Risk Perception Real Risk does not equate to Perceived Risk does not equate to Acceptable Risk

9 Public Education

10 REAC/TS Fukushima Involvement

11 Earthquake and Tsunami March 11, 2011 a magnitude 9 earthquake struck epicenter near the island of Honshu meter (~ ) wave hit the retaining walls of the NPP (~ 6m/20 ) Operating reactors shut down High water affected auxiliary power systems

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13 REAC/TS Fukushima Response (Mar Apr, 2011) REAC/TS received the first call on 11 March 2011 REAC/TS was available 24/7 and responded to over 200 calls for assistance/information from government, public, and media within the first few weeks Over 500 s generated early on in the response Limited number of REAC/TS personnel authorized to speak (message control)

14 REAC/TS Provided Assistance/Advice to: Domestic and international entities Members of the general public and media Occupational health, GP, etc., physicians Corporate management DOD, DOE, DOS, DHHS, NRC, various state government officials Japanese gov t public health officials

15 Typical Questions from the Public Is it safe for me to be in Japan? Is it safe for my family/friends in Japan? Do I need to take KI and when should I take it (from people in US and in Japan)? I just took a KI pill when should I take another one? (a US citizen in Texas, for example). Where do I get KI? Does my company need to evacuate employees? Where/how can I, or my employees, be screened to rule out contamination?

16 Typical Guidance Provided by REAC/TS Follow local public health guidance Provided diagnosis/treatment guidelines per IAEA, NCRP,CDC,FDA,NRC and the REAC/TS pocket guide/website. No real or significant potential for acute health effects outside of exclusion area Consult with a physician before doing anything not advised by public health officials The Medical Aspects of Radiation Incidents

17 Assistance Provided to Government Officials Assistance on radionuclide contamination screening methods Assistance in development of screening criteria and action/triage levels Advise related to the use of potassium iodide (KI), i.e.: when/how to use KI if it s needed Advice related to the use/availability of Prussian Blue for intakes of cesium

18 Observations/Lessons Learned Calls were received at all hours due to the time difference between Japan (and other locations) and Oak Ridge, TN (EST) Not surprisingly, there was a general fear of radiation among the public and within the medical response community There is a need for education on medical response to radiological incidents within the medical community and within all federal and state government offices

19 Observations/Lessons Learned The media plays a major role, not only in dissemination of information, but in shaping public opinion Various communication skills are essential in relaying accurate information to the media, the public, and medical personnel in language that is accurate, yet understandable to the intended audience

20 Media Examples: Some good, some not so much. This is a HUGE challenge!

21 Published: Tuesday, April 8, 2003 Anti-radiation Pills Are Urged for Children Households, schools and child-care centers near nuclear power plants should keep potassium iodide pills on hand to protect children from thyroid cancer in the event of a release of radiation, the American Academy of Pediatrics has recommended. Children are especially vulnerable to the effects of radiation, in part because they are closer to the ground, where fallout settles and because their bodies absorb and metabolize substances differently, the pediatrics academy said.

22 By Mimi Hall, USA TODAY U.S. scraps plan for antiradiation pills Updated 1/29/ :30 AM WASHINGTON The federal government will not give antiradiation pills to millions of people who live 10 to 20 miles from a nuclear plant because there are more effective ways to protect people in case of an accident or terrorist attack, the White House said Monday. (Name Deleted) holds a pack of potassium iodide tablets in (Name Deleted) bought anti-radiation pills for his family and employees in case of a radiation emergency. The president's top science adviser concluded Monday that there are more effective ways of protecting Americans during a nuclear crisis.

23 by Scott Hensley March 14, :24 PM Why Iodine Tablets Come Out When Radiation Threatens You need a little bit of iodine so the thyroid gland in your neck can make hormones to regulate your metabolism. But your body can't tell the difference between the normal iodine found in salt or seafood and the radioactive variety from a wayward nuclear power station. The supplemental iodine isn't a complete guarantee of protection. A lag in taking the pills after exposure can reduce the supplement's effectiveness, for instance. Also, the iodine pills only offer work against radioactive iodine not other radioactive elements

24 Testing for Radiation in Japan March 15, (accessed: 3/4/13 quotes below are slightly paraphrased) Dr. Steven Garner (Chairman of Radiology, NY Methodist Hospital) demonstrates new device 50 sec mark: The reporter is wearing an electronic dosimeter in the studio It s reading 8+/- μr/hr. The reporter asks, When would you be worried? Response: If this were more than 30. (which is 2.63 msv or 263 mrem/yr.) Note: Per NCRP 160 (2009), page 77 - Approximately 2.5 million Americans receive annual doses from ubiquitous background in excess of 20 msv (2000 mrem). The lowest annual doses are just over 0.5 msv (500 mrem). The arithmetic mean is 3.11 msv (311 mrem). 68%, or about 2.1 msv (210 mrem), is from radon. 3 min, 20 sec mark: It s (Fukushima) a time bomb right now. If it melts down right now, all the people that are within a 10 mile radius, including our servicemen, will be in big trouble.

25 Date: Mar 18, 2011 Bill Nye Explains the Fukushima Situation (accessed: 3/4/13 - quotes below are slightly paraphrased) Bill Nye the Science Guy discusses efforts to cool the fuel rods inside the nuclear reactors at the Fukushima plant. 2 min, 55 sec mark of video: The 50 people (plant workers Fukushima 50) are probably going to suffer, if not immediate radiation sickness and death, certainly some extraordinary health problems in the near future.

26 Similarities to Other Major Radiation Incidents?

27 Examples of Major Radiation Incidents Three Mile Island (1979): Minimal health impacts, large psychological impact Goiania, Brazil (1987): Large scale personnel/environmental contamination, four deaths, initial distrust of responders Samut Prakarn, Thailand (2000): Multiple personnel exposures, no contamination, three deaths, public concern impacts

28 Consequences of Radiation Incidents Physical Potential medical effects due to contamination and/or exposure Psychological Effects on individuals Effects on families/co-workers Effects on the general population Effects on emergency response and health care personnel Environmental Contamination of air, water or land Waste management Impact the food chain Economic Use loss Import/export restrictions Clean-up costs Legal Impact on regulatory agencies Damages and legal costs Medical/legal uncertainties Thailand Goiania Goiania

29 When Communicating Tell the truth Keep it simple, but accurate Avoid acronyms Not everybody has the same perceptions, be flexible If speaking in public, be ready for comments (personal experience)

30 Implications for Planning for Future Incidents Erik Glassman, MS, CCEMT-P

31 Potential Obstacles to Response Plan Implementation Supplies (equipment, etc.) Training (proper response, use of equipment, etc.) Mental preparedness of responders Acceptance of message by public and responders

32 Response to AIDS: Different, but Similar Discovered in 1981, a lack of understanding and tying of the disease to specific population(s) lead to suboptimal diagnosis and treatment within that population(s) Not understanding the cause, actual risk to healthcare providers, and the way the disease spread lead to a reluctance and sometimes outright refusal to treat patients

33 Fear and Misunderstanding Commitment to help staff non-hospital, field medical facilities by incident and Type of Practice Physician (559) Nurse (2775) Natural Disaster 83% 90% Explosion Incident 67% 70% Chemical Incident 59% 59% Biological Incident 56% 53% Contagious Epidemic 56% 49% Radiological Incident 52% 45% Lanzilotte, S., Hawaii Medical Professionals Assessment, Hawaii Medical Journal, Vo1 61. August 2002

34 More Supporting Data Health Care Workers Ability and Willingness to Report to Duty During Catastrophic Disasters (n=6,428, 47 facilities) Willing Able Snow Storm 80% 49% Bioterrorism (smallpox) 61% 69% Chemical Terrorism 68% 71% Explosion Incident (MCI) 86% 83% Environmental Disaster 84% 81% Radiological Terrorism 57% 64% SARS outbreak 48% 64% Qureshi, K, Gershon,R., Gebbie, E., Straub, T, and Morse, S. (2005). Healthcare workers ability and willingness to report to duty during a catastrophic disaster. Journal of Urban Health. 82(3):

35 How We Begin To Fix This Pre-messaging Intended to ensure acceptance of after-event public health messaging Education should begin as part of initial training programs Exercises and training to re-enforce Community specific messaging Specific measures to take care of responders families

36 Contact Information Steve Sugarman, MS, CHP, CHCM Health Physics Project Manager Cytogenetic Biodosimetry Lab Coordinator REAC/TS (865) Erik Glassman, MS, CCEMT-P Operations Planner Oak Ridge Institute for Science and Education (202)

37 rea c/ts Thank You!