Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-18T17:37:16.974Z Has data issue: false hasContentIssue false
  • English
  • Français

Recovery and Resilience After a Nuclear Power Plant Disaster: A Medical Decision Model for Managing an Effective, Timely, and Balanced Response

Published online by Cambridge University Press:  04 April 2013

C. Norman Coleman ,
Daniel J. Blumenthal ,
Charles A. Casto ,
Michael Alfant ,
Steven L. Simon ,
Alan L. Remick ,
Heather J. Gepford ,
Thomas Bowman ,
Jana L. Telfer  and
Pamela M. Blumenthal
...Show all authors
C. Norman Coleman*
Affiliation:
Office of the Assistant Secretary for Preparedness and Response, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
Daniel J. Blumenthal
Affiliation:
National Nuclear Security Administration, Department of Energy, Washington, DC, USA
Charles A. Casto
Affiliation:
Nuclear Regulatory Commission, Rockville, Maryland, USA
Michael Alfant
Affiliation:
American Chamber of Commerce in Japan, Tokyo, Japan
Steven L. Simon
Affiliation:
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
Alan L. Remick
Affiliation:
National Nuclear Security Administration, Department of Energy, Washington, DC, USA
Heather J. Gepford
Affiliation:
Nuclear Regulatory Commission, Rockville, Maryland, USA
Thomas Bowman
Affiliation:
Division of the Strategic National Stockpile, Centers for Disease Control and Prevention, Atlanta, GA, USA
Jana L. Telfer
Affiliation:
Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA, USA
Pamela M. Blumenthal
Affiliation:
Department of Housing and Urban Development, Washington, DC, USA
Michael A. Noska
Affiliation:
Food and Drug Administration, Silver Spring, Maryland, USA
*
Address correspondence and reprint requests to C. Norman Coleman, MD, 9609 Medical Center Drive, Room 3W102, Rockville, MD 20850 (e-mail [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents. (Disaster Med Public Health Preparedness. 2012;0:1-10)

Keywords

nuclear power plantdisaster resiliencedisaster recoverymedical decision model
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 7 , Issue 2 , April 2013 , pp. 136 - 145
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Coleman, CN, Simon, SL, Noska, MA, Telfer, JL, Bowman, T. Disaster preparation: lessons from Japan. Science. 2011;332: 1379.Google Scholar
2.Simon, SL, Coleman, CN, Noska, MA, Bowman, T. Response of the US Department of Health and Human Services in protecting civilian Americans in Japan during the Fukushima nuclear crisis. Health Physics. 2012;102:570-579.Google Scholar
3. Incident Command System website. http://www.fema.gov/incident-command-system. Accessed March 4, 2012.Google Scholar
4.Federal Emergency Management Agency. National Response Framework. Washington, DC: Federal Emergency Management Agency; January 2008. http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.Google Scholar
5.Federal Emergency Management Agency. National Disaster Recovery Framework: Strengthening Disaster Recovery for the Nation. Washington, DC: Federal Emergency Management Agency September 2011. http://www.fema.gov/pdf/recoveryframework/ndrf.pdf.Google Scholar
6. Community and Regional Resilience Institute website. http://www.resilientus.org/about-us/definition-of-community-resilience.html. Accessed March 4, 2012.Google Scholar
7.Piore, A. Planning for the black swan. Sci American. 2011;304:49-53.Google Scholar
8.World Health Organization. The Great East Japan Earthquake. Geneva, Switzerland: World Health Organization March 11, 2011. http://www.wpro.who.int/publications/docs/japan_earthquake.pdf.Google Scholar
9.Ohnishi, T. The disaster at Japan's Fukushima-Daiichi nuclear power plant after the March 11, 2011 earthquake and tsunami, and the resulting spread of radioisotope contamination. Radiat Res. 2012;177:1-14.Google Scholar
10. International Commission on Radiological Protection (ICRP). Application of the commission's recommendations for the protection of people in emergency exposure situations (No. 109); 2009. http://www.icrp.org/publications.asp. Accessed March 4, 2012.Google Scholar
11. International Commission on Radiological Protection (ICRP). Application of the Commission's Recommendations to the Protection of People Living in Long-term Contaminated Areas After a Nuclear Accident or a Radiation Emergency (No. 111); 2009. http://www.icrp.org/publications.asp. Accessed March 4, 2012.Google Scholar
12.Butler, KM, Cool, D. Answer to question 8900 submitted to “Ask the Experts.” McLean, VA: International Commission on Radiological Protection; March 25, 2010. http://www.hps.org/publicinformation/ate/q8900.html. Accessed March 4, 2012.Google Scholar
13. International Atomic Energy Agency. Manual for First Responders to a Radiological Emergency. Vienna, Austria: International Atomic Energy Agency; October 2006: http://www-pub.iaea.org/MTCD/publications/PDF/EPR_FirstResponder_web.pdf. Accessed March 4, 2012.Google Scholar
14.Bromet, EJ, Havenaar, JM, Guey, LT. A 25 year retrospective review of the psychological consequences of the Chernobyl Accident. Clinical Oncol. 2011;23:297-305.Google Scholar
15.Chandra, A, Costa, J, Meredith, LS, etal. Understanding Community Resilience in the Context of National Health Security: A Literature Review. Santa Monica, CA: RAND Corp; 2010. http://www.rand.org/pubs/working_papers/WR737.html. Accessed March 4, 2012.Google Scholar
16. American Heart Association. Advanced cardiovascular life support—classroom. American Heart Association website. http://www.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/AdvancedCardiovascularLifeSupportACLS/Advanced-Cardiovascular-Life-Support---Classroom_UCM_306643_Article.jsp. Accessed March 4, 2012.Google Scholar
17.Coleman, CN. Understanding Cancer: A Patient's Guide to Diagnosis, Prognosis, and Treatment. Baltimore, MD: Johns Hopkins University Press; 2006.Google Scholar
18. Department of Energy website. http://www.energy.gov/. Accessed March 4, 2012.Google Scholar
19. National Nuclear Security Administration website. http://nnsa.energy.gov/aboutus/ourprograms/emergencyoperationscounterterrorism/respondingtoemergencies. Accessed March 4, 2012.Google Scholar
20. National Atmospheric Release Advisory Center (NARAC) website. https://narac.llnl.gov/. Accessed March 4, 2012.Google Scholar
21. Interagency Modeling and Atmospheric Assessment Center (IMAAC) website. https://imaacweb.llnl.gov/web/signIn.html. Accessed March 4, 2012.Google Scholar
22. Federal Radiological Monitoring and Assessment Center (FRMAC) website. http://www.nnsa.energy.gov/aboutus/ourprograms/emergencyoperationscounterterrorism/respondingtoemergencies/consequencemanagem-1. Accessed March 4, 2012.Google Scholar
23. Radiation Emergency Assistance Center/Training Site (REAC/TS). Oak Ridge Institute for Science and Education website. http://orise.orau.gov/reacts/. Accessed March 4, 2012.Google Scholar
24. US Environmental Protection Agency. Protective Action Guides (PAGs). http://www.epa.gov/radiation/rert/pags.html. Accessed March 4, 2012.Google Scholar
25. US Environmental Protection Agency. Radiation Protection. Washington, DC: US Environmental Protection Agency. http://www.epa.gov/radiation/. Accessed March 4, 2012.Google Scholar
26. Nuclear Regulatory Commission (NRC) website. http://www.nrc.gov/. Accessed March 4, 2012.Google Scholar
27. Office of the Assistant Secretary for Preparedness and Response (ASPR) website. http://www.hhs.gov/open/contacts/aspr.html. Accessed March 4, 2012.Google Scholar
28. Centers for Disease Control and Prevention website. http://www.cdc.gov/. Accessed March 4, 2012.Google Scholar
29. US Department of Health and Human Services. Public Health Emergency (PHE) website. http://www.phe.gov/preparedness/Pages/default.aspx. Accessed March 4, 2012.Google Scholar
30. Radiation Emergency Medical Management (REMM) website. http://www.remm.nlm.gov/. Accessed March 4, 2012.Google Scholar
31. US Food and Drug Administration. Radiation Safety. Silver Spring, MD: US Food and Drug Administration. http://www.fda.gov/newsevents/publichealthfocus/ucm247403.htm. Accessed March 4, 2012.Google Scholar
32. US Food and Drug Administration. Food Facility Registration and U.S. Agent Requirements. Silver Spring, MD: US Food and Drug Administration; July 2004. http://www.fda.gov/Food/FoodSafety/FoodContaminantsAdulteration/ChemicalContaminants/Radionuclides/ucm078341.htm#guides.Google Scholar
33. US Department of Agriculture. Radiation Safety. US Department of Agriculture website. http://www.usda.gov/wps/portal/usda/usdahome?contentidonly=true&contentid=radiation_safety.html. Accessed March 4, 2012.Google Scholar
34. National Security Council website. http://www.whitehouse.gov/administration/eop/nsc/. Accessed March 4, 2012.Google Scholar
35.Nuclear Regulatory Commission. Emergency Planning Zones (EPZs). Washington, DC: Nuclear Regulatory Commission. http://www.nrc.gov/about-nrc/emerg-preparedness/about-emerg-preparedness/planning-zones.html. Accessed March 4, 2012.Google Scholar
36. Preparedness directorate; protective action guides for radiological dispersal device (rdd) and improvised nuclear device (IND) incidents. Fed Register. 2006;71(1):174-180. http://ogcms.energy.gov/71fr174.pdf.Google Scholar
37. Borchardt RW. U. S. Environmental Protection Agency revisions to the protective action guidance manual. Washington, DC: US Environmental Protection Agency; June 9, 2011. http://www.nrc.gov/reading-rm/doc-collections/commission/secys/2011/2011-0078scy.pdf. Accessed March 17, 2012.Google Scholar
38. Centers for Disease Control and Prevention. Radioisotope Brief: Iodine-131. Atlanta, GA: Centers for Disease Control and Prevention; August 18, 2004. thttp://emergency.cdc.gov/radiation/isotopes/pdf/iodine.pdf. Accessed March 4, 2012.Google Scholar
39. American Thyroid Association. Toxicity of KI. American Thyroid Association website. http://www.thyroid.org/?s=toxicity. Accessed March 4, 2012.Google Scholar
40.US Nuclear Regulatory Commission. Incident Response Plan. NUREG-0728. Washington, DC: US Nuclear Regulatory Commission; April 2005. http://www.nrc.gov/about-nrc/emerg-preparedness/respond-to-emerg/ml050970236.pdf. Accessed March 4, 2012.Google Scholar
41.Land, CE. Estimating cancer risks from low doses of ionizing radiation. Science. 1980; 209(4462):1197-1203.Google Scholar
42.Brenner, DJ, Doll, R, Goodhead, DT, etal. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. PNAS. 2003;100(24):13761-13766.Google Scholar
43.National Research Council (NRC). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: National Academy Press; 2006. http://www.nap.edu/catalog.php?record_id=11340#toc.Google Scholar
44.Hall, EJ, Giaccia, AJ. Radiobiology for the Radiologist, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.Google Scholar
45.Christodouleas, JP, Forrest, RD, Ainsley, CG, Tochner, Z, Hahn, SM, Glatstein, E. Short-term and long-term health risks of nuclear-power-plant accidents 2011. N Engl J Med. 2011;364:2334-2341.CrossRefGoogle Scholar
46.The National Academies. Report in Brief: BEIR VII: Health Risks from Exposure to Low Levels of Ionizing Radiation. Washington, DC: National Academy Press; 2006. http://dels-old.nas.edu/dels/rpt_briefs/beir_vii_final.pdf.Google Scholar
47.Simon, SL, Bouville, A, Land, CE. Fallout from nuclear weapons tests and fallout risks. Am Scientist. 2006;94:48-57.Google Scholar
48.Coleman, CN, Adams, S, Adrianopoli, C, et al. Medical planning and response for a nuclear detonation: a practical guide. Biosecur Bioterror. 2012;10:346-371.Google Scholar
49.Gilbert, E, Land, C, Simon, SL. Health effects from fallout. Health Physics. 2002;82(5):726-735.Google Scholar
50. US Department of State. International travel information. US Department of State website. http://travel.state.gov/travel/cis_pa_tw/cis_pa_tw_1168.html.Google Scholar
51.Deyle, R, Eadie, C, Schwab, J, Smith, R, Topping, K. Policies for guiding planning for post disaster recovery and reconstruction. In: Planning for Post-Disaster Recovery and Reconstruction. Washington, DC: American Planning Association; 1998. http://www.fema.gov/pdf/rebuild/ltrc/fema_apa_ch3.pdf.Google Scholar
52. Department of Defense. Joint Publication (JP-5): Joint Operation Planning. Fort Belvoir, VA: Defense Technical Information Center; August 11, 2011. http://www.dtic.mil/doctrine/new_pubs/jp5_0.pdf. Accessed March 4, 2012.Google Scholar
53.Sunstein, CR. Risk and Reason: Safety, Law, and the Environment. Cambridge, UK: Cambridge University Press; 2002.Google Scholar