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The REAC/TS Experience with Fukushima Response Steve Sugarman, MS, CHP, CHCM Health Physics Project 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

REAC/TS Ø Ø Ø The Radiation Emergency Assistance Center/Training Site A response asset of REAC/TS Ø Ø Ø 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

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

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

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

Education Related to the Medical Management of Radiological Incidents (Typical Year) Ø Ø Ø Education Related to the Medical Management of Radiological Incidents (Typical Year) Ø Ø Ø Ø Ø 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 (3. 5 – 4. 5 days) 3 offsite courses for DOE facilities (1 -2 days) 10 offsite courses for private entities Multiple invited presentations/lectures Multiple international courses

General Communication Issues with Radiation Incident Response General Communication Issues with Radiation Incident Response

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

Public “Education” Public “Education”

REAC/TS Fukushima Involvement REAC/TS Fukushima Involvement

Earthquake and Tsunami Ø Ø March 11, 2011 a magnitude 9 earthquake struck – Earthquake and Tsunami Ø Ø March 11, 2011 a magnitude 9 earthquake struck – epicenter near the island of Honshu 13 -15 meter (~ 43’-50’) wave hit the retaining walls of the NPP (~ 6 m/20’) Operating reactors shut down High water affected auxiliary power systems

REAC/TS Fukushima Response (Mar – Apr, 2011) Ø Ø REAC/TS received the first call REAC/TS Fukushima Response (Mar – Apr, 2011) Ø Ø 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 emails generated early on in the response Limited number of REAC/TS personnel “authorized” to speak (message control)

REAC/TS Provided Assistance/Advice to: Ø Ø Ø Domestic and international entities Members of the REAC/TS Provided Assistance/Advice to: Ø Ø Ø 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

Typical Questions from the Public Ø Ø Ø Ø Is it safe for me Typical Questions from the Public Ø Ø Ø Ø 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?

Typical Guidance Provided by REAC/TS Ø Ø The Medical Aspects of Radiation Incidents Follow Typical Guidance Provided by REAC/TS Ø Ø The Medical Aspects of Radiation Incidents 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

Assistance Provided to Government Officials Ø Ø Assistance on radionuclide contamination screening methods Assistance Assistance Provided to Government Officials Ø Ø 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

Observations/Lessons Learned Ø Ø Ø Calls were received at all hours due to the Observations/Lessons Learned Ø Ø Ø 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

Observations/Lessons Learned Ø Ø The media plays a major role, not only in dissemination Observations/Lessons Learned Ø Ø 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

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

Anti-radiation Pills Are Urged for Children Published: Tuesday, April 8, 2003 Households, schools and Anti-radiation Pills Are Urged for Children Published: Tuesday, April 8, 2003 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.

U. S. scraps plan for antiradiation pills By Mimi Hall, USA TODAY Updated 1/29/2008 U. S. scraps plan for antiradiation pills By Mimi Hall, USA TODAY Updated 1/29/2008 10: 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 2002. (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.

Why Iodine Tablets Come Out When Radiation by Scott Hensley Threatens March 14, 2011 Why Iodine Tablets Come Out When Radiation by Scott Hensley Threatens March 14, 2011 4: 24 PM 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…

Testing for Radiation in Japan March 15, 2011 http: //video. foxnews. com/v/4586356/testing-for-radiation-in-japan/ (accessed: 3/4/13 Testing for Radiation in Japan March 15, 2011 http: //video. foxnews. com/v/4586356/testing-for-radiation-in-japan/ (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 m. Sv 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 m. Sv (2000 mrem). The lowest annual doses are just over 0. 5 m. Sv (500 mrem). The arithmetic mean is 3. 11 m. Sv (311 mrem). 68%, or about 2. 1 m. Sv (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.

Bill Nye Explains the Fukushima Situation Date: Mar 18, 2011 http: //video. foxbusiness. com/v/4593029/bill-nye-explains-the-fukushima-situation/ Bill Nye Explains the Fukushima Situation Date: Mar 18, 2011 http: //video. foxbusiness. com/v/4593029/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.

Similarities to Other Major Radiation Incidents? Similarities to Other Major Radiation Incidents?

Examples of Major Radiation Incidents Ø Ø Ø Three Mile Island (1979): Minimal health Examples of Major Radiation Incidents Ø Ø Ø 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

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

When Communicating… Ø Ø Ø Tell the truth Keep it simple, but accurate Avoid When Communicating… Ø Ø Ø 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)

IMPLICATIONS FOR PLANNING FOR FUTURE INCIDENTS ERIK GLASSMAN , MS, CCEMT-P IMPLICATIONS FOR PLANNING FOR FUTURE INCIDENTS ERIK GLASSMAN , MS, CCEMT-P

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

Response to AIDS: Different, but Similar Ø Ø Discovered in 1981, a lack of Response to AIDS: Different, but Similar Ø Ø 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

Fear and Misunderstanding Commitment to help staff non-hospital, field medical facilities by incident and 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% Biological Incident 56% 53% Contagious Epidemic 56% 49% Radiological Incident 52% 45% Lanzilotte, S. , “Hawaii Medical Professionals Assessment”, Hawaii Medical Journal, Vo 1 61. August 2002

More Supporting Data Health Care Workers’ Ability and Willingness to Report to Duty During 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): 378 -88.

How We Begin To Fix This Ø Ø Ø Pre-messaging – Intended to ensure How We Begin To Fix This Ø Ø Ø 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

Contact Information Steve Sugarman, MS, CHP, CHCM Health Physics Project Manager Cytogenetic Biodosimetry Lab Contact Information Steve Sugarman, MS, CHP, CHCM Health Physics Project Manager Cytogenetic Biodosimetry Lab Coordinator REAC/TS steve. [email protected] orau. gov (865)576 -3131 Erik Glassman, MS, CCEMT-P Operations Planner Oak Ridge Institute for Science and Education erik. [email protected] orau. gov (202)955 -3650

Thank You! Thank You!