Transcript Planning for Wide Area Radiological Emergency Response

Planning for Wide Area
Radiological Emergency
Response
What South Carolina Can Learn
From Fukushima
Wide Area Radiological Preparedness Framework
• Assumption: an event has contaminated a
metropolitan center or a large (tens to hundreds
of square miles) area with long-lived radioactive
isotopes requiring the evacuation and
displacement of a large population for months to
years.
• What are the public health consequences?
• How can the medical/public health community
respond?
Rad Resilient City: A Preparedness Checklist for Cities to Diminish Lives Lost from Radiation after a
Nuclear Terrorist Attack
Topographic map of the surveyed area including Fukushima and its adjacent prefectures;
contour maps of depositions for 131I, 129 mTe, and 134,136,137Cs; and activity ratios for
129mTe/137Cs, 131I/137Cs, and 129mTe/131I.
* As of April 1,
2012, 87,000
residents still
subject to
evacuation orders;
47,000 more
residents
voluntarily
evacuated.
Kinoshita N et al. PNAS 2011;108:19526-19529
©2011 by National Academy of Sciences
Oconee NS – three reactors
Catawba NS – two reactors
HB Robinson NS – one reactor
VC Summer NS – one reactor
Plant Vogtle – two reactors
under construction – six more
Existing plans for response to releases from Fixed
Nuclear Facilities (FNFs)
• Evacuation of up to ten miles from plants, depending on
wind and weather
• Sheltering
• Controls on food crops, dairy production out to fifty miles
• Exposure limits
• Distribution of potassium iodide
Potassium Iodide
• What is KI?
• Potassium iodide (also called KI) is a salt
of stable (not radioactive) iodine. Stable
iodine is an important element needed by
the body to make thyroid hormones. Most
of the stable iodine in our bodies comes
from the food we eat.
• http://www.bt.cdc.gov/radiation/ki.asp
Potassium Iodide
• What does KI do?
• Following a radiological or nuclear event,
radioactive iodine may be released into the air and
then be breathed into the lungs. Radioactive
iodine may also contaminate the local food supply
and be ingested through food or through drink.
• In the case of internal contamination with
radioactive iodine, the thyroid gland quickly
absorbs it. Radioactive iodine absorbed by the
thyroid can then result in thyroid disfunction or
cancer. Non-radioactive KI acts to block
radioactive iodine from uptake into the thyroid
gland, thus protecting the thyroid from injury.
Potassium Iodide
• What KI cannot do:
– KI cannot prevent radioactive iodine from
entering the body.
– KI cannot reverse the health effects caused
by radioactive iodine once damage to the
thyroid has occurred.
– KI cannot protect the body from radioactive
elements other than radioactive iodine—if
radioactive iodine is not present, taking KI is
not protective.
– KI cannot protect other organ systems
Annex 6 to SCORERP
• Prepositioned stocks of KI
– In county health departments serving
populations within 10 miles of nuclear plant
– Stocks for institutionalized individuals and
emergency workers
– KI has been distributed by the utilities to
households within the 10 mile Emergency
Planning Zones
Oconee NS – three reactors
Catawba NS – two reactors
HB Robinson NS – one reactor
VC Summer NS – one reactor
Plant Vogtle – two reactors
under construction – six more
• Types of radiation
– Gamma
• Similar to x-rays
• Penetrates deeply
– Beta (electrons)
• Penetrates millimeters – dermal or epithelial
exposure
– Alpha
• Least penetrating, but alpha emitters tend to
concentrate in organs, bones
• Not usually a factor in FNF exercises, but could
have been a factor at Fukushima
I-131 emits beta radiation.
• Radiation units
– Curies or Becquerels: disintegrations per
second
– Roentgen: radiation absorbed in air,
measured by ionization
– rads or Grays: Radiation absorbed dose
– rem (Roentgen Equivalent Man) or Sievert:
Effective dose, Equivalent dose, Dose
Equivalent
Very roughly speaking: One rad, one rem, one
centiGray, and 10 milliSieverts have the same
physiological effect.
• Half life
– Each radioactive isotope has a characteristic
half life: the length of time it takes for half of
the original amount to decay
– Rule of thumb: after 10 half lives have
passed, the amount remaining is one millionth
of the original amount
– I-131 has an eight day half life
– The half life of the contamination is an issue
primarily for recovery and reentry.
• Dose Response
– Response to exposure to ionizing radiation
depends on many factors including:
• Energy deposition (alphas most strongly absorbed,
followed (roughly) by neutron, beta, gamma)
• Organ(s) absorbing the dose
• Rate of deposition
• Age at exposure
• Acute vs stochastic effects
– High dose delivered quickly may cause
observable effects: nausea, vomiting,
hematologic changes, etc
– Lower dose exceeding regulatory limits
probably will not cause observable acute
effects but may cause cancer
– Radiogenic cancers are indistinguishable from
other cancers
• Risk vs Dose Response
– Difficult to extrapolate risk estimates derived from
data on relatively high acute exposures in case of
the Japanese atomic bomb survivors Life Span
Study (LSS) cohort to low dose, or chronic
exposure situations
– there is inadequate statistical power to
quantify risk below about 0.1 Gy [10 rem]. This
is about 100 times the annual whole-body, lowLET dose to an average individual from natural
background.
EPA Radiogenic Cancer Risk Models and
Projections for the U.S. Population (EPA 402-R11-001, April 2011), pp. 3-4
• In a lifetime, approximately 42 of 100
people will be diagnosed with cancer from
causes unrelated to radiation. The
calculations in the BEIR VII report*
suggest approximately one cancer in 100
people could result from a single exposure
of 100 mSv [10 rem] of low linear energy
transfer (low-LET) radiation.
• Adapted from *Biological Effects of Ionizing
Radiation VII: Health Risks from Exposure to Low
Levels of Ionizing Radiation, (The National
Academies, 2005)
• Medical Management of Individuals
Exposed to Ionizing Radiation: A
Layman’s Summary
– Treat the physical injuries first
– Slightly exposed individuals may need
psychological support but any medical effects
will be stochastic and years down the road
– Highly exposed individuals are expectant but
may benefit from palliative care
– Patients in between may benefit from
supportive treatment, chelating agents,
treatment for neutropenia; highly resourceintensive
Wide Area Radiological Preparedness Framework
• Assumption: Because major emergencies are
infrequent, specific models or tools designed
in advance will likely be out of date and
inappropriate when needed; therefore, this
Framework describes a general methodology to
be applied for prioritization purposes.
• “No plan of operations extends with any
certainty beyond the first contact with the
main hostile force.”
Von Moltke, “On Strategy”
Japanese Experience
September 30, 2011
TOKYO — Despite continued fears over radiation levels, Japan lifted
evacuation advisories for an area spanning five towns and cities around a
tsunami-ravaged nuclear power plant on Friday, the first such move since
multiple fuel meltdowns at the site led to a substantial radiation leak and
forced more than 100,000 surrounding residents to flee.
…
A 12-mile exclusion zone will remain in place around the nuclear power plant,
Fukushima Daiichi, which the government is working to bring under control.
The worst contaminated areas close to the plant are
likely to remain uninhabitable for decades, government
officials have acknowledged.
New York Times
Japanese Experience
The Yomiuri Shimbun
Since the start of the crisis at Tokyo Electric Power Co.'s fukushima No. 1
nuclear power plant, hundreds
of doctors and nurses have
resigned from nearby facilities, according to a survey by an
association of Fukushima Prefecture hospitals.
Their departures have resulted in some hospitals in the prefecture
suspending nighttime emergency care and other treatment services, the
association said.
Daily Yomiuri Online, Oct 4, 2011
http://www.yomiuri.co.jp/dy/national/T111003004497.htm
Japanese Experience
Via The Daily Yomiuri: Fleeing crisis takes deadly toll on elderly / 77
Fukushima evacuees died within 3 months. Excerpt:
Nearly 80 elderly people who were evacuated from nursing homes near the
Fukushima No. 1 nuclear power plant died within three months of the
accidents at the plant that forced them to move, according to a Yomiuri
Shimbun survey.
The 77 deaths are more than triple the 25 recorded at
the nursing homes during the corresponding period
last year.
Officials at the homes believe many of this year's deaths resulted from a
decline in physical strength caused by moving far from the nursing homes
and living in an unfamiliar environment. Many of the people who died had
struggled to adapt to their new living conditions, the officials said.
Daily Yomiuri Online, July 3, 2011
Japanese Experience
The Yomiuri Shimbun
FUKUSHIMA--More than 70 percent of households from Narahamachi,
Fukushima Prefecture, say their health has deteriorated during their time as
evacuees, according to a recent survey by the Narahamachi municipal
government.
…
Asked why they did not go or had stopped going to a
hospital, 40.7 percent said their usual doctor did not
practice near their current residences, followed by 21.4
percent of households who had no hospitals or clinics near their current
residences.
Daily Yomiuri Online, October 2, 2011
Japanese Experience
Fukushima City began its first decontamination of private properties on
Tuesday, seven months after the worst atomic accident since Chernobyl
spread radioactive materials over eastern Japan.
The first such organised cleanup of peoples' homes by an affected
municipality follows work by various communities in northeast Japan
to decontaminate public areas such as schools, parks and daycare
centres.
…
The government has sought to calm public fears and overcome mistrust of
official radiation surveys, claiming that areas away from the immediate
vicinities of the wrecked plant should be safe.
But concerned citizens armed with their own measuring tools have
been finding small localised 'hot spots' with high radiation levels.
…
The accident has discouraged consumers from buying farm produce from
Fukushima and surrounding regions, following reported cases of
contaminated water, beef, vegetables, tea and seafood.
http://wap.news.bigpond.com/articles/Travel/2011/10/19/Fukushima_city_beg
ins_decontamination.html
Japanese Experience
ONAMI, Japan — In the fall, as this valley’s rice paddies ripened into a
carpet of gold, inspectors came to check for radioactive contamination.
Onami sits just 35 miles northwest of the wrecked Fukushima Daiichi nuclear
plant, which spewed radioactive cesium over much of this rural region last
the government inspectors declared
Onami’s rice safe for consumption after testing just
two of its 154 rice farms.
March. However,
Then, a few days later, a
skeptical farmer in Onami, who
wanted to be sure his rice was safe for a visiting
grandson, had his crop tested, only to find it
contained levels of cesium that exceeded the
government’s safety limit. In the weeks that followed, more than a
dozen other farmers also found unsafe levels of cesium. An ensuing panic
forced the Japanese government to intervene, with promises to test more
than 25,000 rice farms in eastern Fukushima Prefecture, where the plant is
located. New York Times
Japanese Experience
(continued)
More than a dozen radiation-testing stations, mostly operated by volunteers,
have appeared across Fukushima and as far south as Tokyo, 150 miles from
the plant, aiming to offer radiation monitoring that is more stringent and
transparent than that of the government.
“No one trusts the national government’s safety
standards,” said Ichio Muto, 59, who farms organic mushrooms in
Nihonmatsu, 25 miles northwest of the Fukushima Daiichi plant. “The only
way to win back customers is to tell them everything, so they can decide for
themselves what to buy.”
New York Times, Jan 22, 2012
Psychological impact
“Although radiation escaping from a nuclear power plant catastrophe can
increase the risk of many cancers and other health problems, stress, anxiety
and fear ended up in many ways being much greater long-term threats to
health and well-being after Chernobyl, Three Mile Island and other nuclear
accidents, experts said Monday.
“ ’The psychological
effects were the biggest health
effects of all — by far,’ said Fred Mettler, a University of New Mexico
professor emeritus and one of the world’s leading authorities on radiation,
who studied Chernobyl for the World Health Organization. ‘In the end, that’s
really what affected the most people.’ “
Washington Post, early March, 2011
Liberty RadEx
Liberty RadEx (LRE) demonstrated the importance of community recovery
and mass care planning for RDD and for WMD generally. …
Shortage of Radiological Expertise: LRE demonstrated that EPA
does
not have enough professional radiological staff for
long‐term deployment for RDD and IND. Other agencies and
exercises have identified a similar shortage across the Federal Government.
EPA and other federal agencies will need to share and optimize use of
radiological expertise in the event of a RDD or IND. Consideration should be
given to whether industry, university, and state resources (in unaffected
states) can be tapped.
Wide Area Radiological Preparedness Framework
Assumptions
•
Response to a wide-area radiological
emergency will require coordinated responses
from all levels of government and the private
sector.
•
Many activities during the course of
response and recovery will have to be
delegated or conducted on a volunteer, selfhelp basis
Wide Area Radiological Preparedness Framework
•
Assumption: Participation by volunteer
organizations, non-governmental organizations,
private enterprises, public and private
educational institutions, and citizens will be
required to arrive at consensus decisions on
many issues:
–
–
–
–
contamination limits;
clean-up standards;
disposal options for contaminated materials;
recovery and reuse or replacement of contaminated
facilities;
– radiation protection standards for reentry and
reoccupation of contaminated areas;
Wide Area Radiological Preparedness Framework
•
“Stakeholders and Radiological Protection: Lessons from Chernobyl 20
Years After,” Committee on Radiation Protection and Public Health,
Nuclear Energy Agency, Organisation for Economic Co-operation and
Development
Wide Area Radiological Preparedness Framework
Assumptions
•
Sampling and radiological surveys will be
required for the duration of the recovery and
restoration phase. Epidemiological
surveillance of the impacted population will
be required for years.
• Response, reentry, recovery, and restoration
will take months to years. Response activities
will transition from an initial crisis reaction to midand long-term activities.
Wide Area Radiological Preparedness Plan
• No Victims: An incident the size of an Improvised Nuclear
Device detonation does not allow for the luxury of
narrowly defined responders who rescue victims. Rather,
everyone alive is a survivor who must support other
survivors and the nation in response. The public, private
sector, and even the injured can play important roles in
reducing the burden on traditional response organizations
by using actionable information to guide behavior while
supporting a whole community response.
Key Planning Factors: Response to an IND in the National Capitol Region
Wide Area Radiological Preparedness Framework
•
Organization And Responsibilities
– Local, State, and Federal Agencies
– Volunteer, Nongovernmental, Private Sector, and
Citizen Groups
• Pre-event Planning
• Post-event Planning and Operation
Wide Area Radiological Preparedness Framework
• Concept of Operations
– Short-term (hours to days)
•
•
•
•
•
Discovery of Radiological Event
First Response: Tasks and Goals
Initial Identification of Contaminated Zone
Protective Action Recommendations
Radiological Survey of Exposed Population
–
–
Use of Volunteers
Post-evacuation Radiological Surveys
• Decontamination of Persons and Vehicles (Initial)
– SCORERP Guidance
– Exception to SCORERP
Wide Area Radiological Preparedness Framework
• Concept of Operations
– Short-term (hours to days) (continued)
• Triage and Medical Treatment
–
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Triage
Health Care Delivery
• Sheltering
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–
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Shelter In Place
Pre-designated Shelters
Expanded Shelter Network
• Risk and Health Hazard Communication
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Preplanned Communication Networks
Ad hoc Communication Networks
Information and Protective Action messages
Wide Area Radiological Preparedness Framework
• Concept of Operations
– Intermediate Period (days to weeks)
• Lessons Learned from Fukushima
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–
–
–
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Need for transparency, best available information
Need for practical just-in-time training
Radiological screening and surveys are long-term
Regulatory limits may be impractical
Regulatory limits and official approval may be ignored
• Health Care Facilities
–
–
–
Limited Resources
Need for Training
Medical staff: Use of Volunteers; Displaced staff
Wide Area Radiological Preparedness Framework
• Concept of Operations
– Recovery Period (weeks to years)
• Convening community-based groups to agree on restoration
goals and criteria
• Identifying and prioritizing critical infrastructure for restoration or
replacement
• Risk-Based Remediation Decisions
• Contamination Surveys
• Risk Estimates
• Risk Communication
• Environmental Clearance Committee
• Environmental Clearance Sampling Strategies
• Environmental Clearance: Pre-Incident Planning
• Health Care: Long Term Medical Monitoring
• Repopulate through Public Reassurance and Incentives
• Health Care: Insurance and Medical Records
• Health Care: Accommodating Displaced Medical Professionals
Wide Area Radiological Preparedness Framework
• Some of the questions to be addressed include:
•
If decontamination capabilities are
overwhelmed, what standards will we use and
who will determine them?
•
How do we set priorities for decontaminating
and recovering critical facilities?
Wide Area Radiological Preparedness Framework
•
If facilities begin receiving contaminated
individuals before radiological controls have
been established, what procedures should be in
place? Existing plans assume evacuees will be
monitored and decontaminated before
proceeding to reception centers and treatment
facilities; if this is not possible, how do we
respond?
•
What training should we provide staff for
dealing with possibly contaminated patients and
for working in contaminated areas?
Wide Area Radiological Preparedness Framework
• How can we compensate for the loss of use of
health care facilities?
• How can we accommodate displaced medical
professionals at other facilities?
• How can we incorporate volunteers into the
response organization?
Wide Area Radiological Preparedness Framework
• Draft Annex 5 to the Mass Casualty Plan
• Plan for the first 72 hours, recognizing that
complete response will require months/years
Planning for Wide Area Radiological Emergency Response:
What South Carolina Can Learn From Fukushima
• Questions?
Sam Finklea
[email protected]
(803)898-3734