Special Submission NUCLEAR AND RADIOLOGICAL SECURITY AND SAFETY (PROGRAM AREA COMMITTEES 3 & 5)—SESSION Q&A
Questions for Drs. Coleman & Chen Q: No mention is made of the planning and care of children—triage, medications, IV fluids, etc. Can you address this special population? Coleman: The presentation had limited time. Children and special populations are considered in plans. Requirements look at medical countermeasures, drugs, and support needed to administer them as part of the planning process. The various needs and means of addressing them depend on issues such as stockpiling versus vendor-managed inventory and setting priorities across the broader U.S. need. Q: How do we counteract public distrust of authority (including distrust by first responders) on radiation/ radioactivity risk? Coleman: There will likely always be some component of this. I think having subject matter experts available along with the decision maker and to communicate information as the process unfolds will help bolster confidence. Dealing with uncertainty is not easy for the public or for officials, but good communications and timely conveyance of information can help. We have prepared a decision-maker’s guide to help them get up to speed on complex issues, realizing that government leaders such as mayors and governors will likely have limited scientific background. Q: There is an assumption of a device yield of 10 kilotons (kT) for an improvised nuclear device. Given rogue states, is there planning for devices of much higher yield? Coleman: The models are generally for a non-state sponsored size incident. Models are used for planning, recognizing that the actual incident will be different, but the model was reasonable for planning and exercising. Q: How have you tested your communication tools? Did you have a systematic testing methodology to ensure clarity for your audience of decision makers? What is the science behind your communication tools,
0017-9078/15/0 Copyright © 2014 Health Physics Society DOI: 10.1097/HP.0000000000000248
including the decision-maker’s guide, which is to be released this month? Coleman: There is a risk communication group that was part of the process that produced the Planning Guidance (Office of Science and Technology Policy). They have the appropriate expertise. In Japan, we had town hall meetings, which were very useful for feedback. Q: Post-Chernobyl, a U.S. marrow transplant surgeon, who was used to very precise doses in patients and did not realize the uncertainty in doses/responses of accident victims, actually “killed” some of Chernobyl’s first responders by overaggressive treatment with marrow transplant. This is a sensitive topic, but the doctors you have identified in cancer treatment centers need to know this lesson! How will you reach this audience? Coleman: There are certainly lessons learned from past incidents. What is key is that dose estimates will guide initial decisions, but the ongoing expert medical management is key to optimal management of each person. Radiation Emergency Medical Management (REMM) has guidance, the Radiation Injury Treatment Network provides the medical information on REMM, and its members are available for consultation. So, ongoing assessment should help determine who might need a transplant and who will be managed by medical management using transplantation only if medical management indicates it is necessary based on how the person responded to treatment. Q: I think you have overstated the “cancer risk” for survivors of an accident/detonation with radiation exposure based on Japanese atomic bomb survivors—barely detectable increase in cancer risk in 80,000 people. How do the calculated excess cancer risks for a population of 100,000, who just survive an acute exposure, compare to the estimated baseline cancer risk? Despite its reputation, radiation is a rather poor carcinogen. Can you address the underlying assumptions which have gone into your risk assessment? Coleman: I didn’t comment on cancer risk, but this is a very valid point. I agree it is often overstated. Having subject matter experts who can communicate and be engaged in appropriate dialogue is important. Q: As economic impacts may be larger than health impacts, should more insurance be required of industry? Chen: This is obviously a policy issue. We are sure the responsible government agencies will be evaluating the www.health-physics.com
170
Copyright © 2014 Health Physics Society. Unauthorized reproduction of this article is prohibited.
Special Submission c PROGRAM AREA COMMITTEES 3 & 5
requisite policy changes on economic impact in response to the post-Fukushima lessons learned. NCRP Report No. 175 will strongly advocate that such issues be addressed in the optimization process for long-term recovery. Q: You talked a lot about Fukushima and its problems with decontamination. However, the Chernobyl accident, which occurred 27 y ago, was more severe than Fukushima. What lessons can be learned from the Chernobyl accident? Chen: NCRP Report No. 175 will draw heavily from lessons learned from past incidents, including Chernobyl. Several important attributes in response recovery have been evaluated from the Chernobyl nuclear accident. Examples include the decontamination technology for treating soils and agricultural lands heavily contaminated with 173Cs as well as other issues regarding recovery. However, we must be cognizant that optimization is a site-specific process for decision-making, thus regional differences, such as land use, resource availability, demography, culture, and other socio-political factors, should all be considered. Thus, other appropriate and applicable lessons could be applied to the Fukushima accident based on past events. Q: How do you envision documenting the basis for decisions made during recovery given the extensive involvement of stakeholders in the decision-making? Chen: We strongly believe in knowledge retention and, therefore, advocate for the development of a global information repository to continuously fortify our experience and improve future responses to similar incidents.
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Given that a long-term recovery will be locally and community focused, we can collectively gather and record the common issues and attributes that are available for such an effort. The broad information base can range from local anecdotes to major decision making on broader community issues such as temporary radioactive storage or disposal. Documenting such an extensive database may require a concerted effort both nationally and internationally. Q: Did you take into consideration the new 2013 (interim final) PAG Manual? Chen: The schedule of NCRP Scientific Committee (SC) 5‐1 happened to be running in parallel to the U.S. Environmental Protection Agency’s (EPA) development of the revised Protective Action Guide (PAG) Manual; thus, the circumstances did not permit cross referencing. However, it must be pointed out that the two documents were developed with different objectives. While the PAG Manual is intended to provide federal guidance on the response actions throughout all phases of a nuclear or radiological event, the NCRP document focuses primarily on the “how to” issues that are specifically pertinent to the decision making in late-phase recovery. Nonetheless, based on our initial evaluation, it is believed that the two independently developed documents will turn out to be quite consistent and complementary to each other.
www.health-physics.com
Copyright © 2014 Health Physics Society. Unauthorized reproduction of this article is prohibited.
■■
Questions for Drs. Coleman & Chen Q: No mention is made of the planning and care of children—triage, medications, IV fluids, etc. Can you address this special population? Coleman: The presentation had limited time. Children and special populations are considered in plans. Requirements look at medical countermeasures, drugs, and support needed to administer them as part of the planning process. The various needs and means of addressing them depend on issues such as stockpiling versus vendor-managed inventory and setting priorities across the broader U.S. need. Q: How do we counteract public distrust of authority (including distrust by first responders) on radiation/ radioactivity risk? Coleman: There will likely always be some component of this. I think having subject matter experts available along with the decision maker and to communicate information as the process unfolds will help bolster confidence. Dealing with uncertainty is not easy for the public or for officials, but good communications and timely conveyance of information can help. We have prepared a decision-maker’s guide to help them get up to speed on complex issues, realizing that government leaders such as mayors and governors will likely have limited scientific background. Q: There is an assumption of a device yield of 10 kilotons (kT) for an improvised nuclear device. Given rogue states, is there planning for devices of much higher yield? Coleman: The models are generally for a non-state sponsored size incident. Models are used for planning, recognizing that the actual incident will be different, but the model was reasonable for planning and exercising. Q: How have you tested your communication tools? Did you have a systematic testing methodology to ensure clarity for your audience of decision makers? What is the science behind your communication tools,
0017-9078/15/0 Copyright © 2014 Health Physics Society DOI: 10.1097/HP.0000000000000248
including the decision-maker’s guide, which is to be released this month? Coleman: There is a risk communication group that was part of the process that produced the Planning Guidance (Office of Science and Technology Policy). They have the appropriate expertise. In Japan, we had town hall meetings, which were very useful for feedback. Q: Post-Chernobyl, a U.S. marrow transplant surgeon, who was used to very precise doses in patients and did not realize the uncertainty in doses/responses of accident victims, actually “killed” some of Chernobyl’s first responders by overaggressive treatment with marrow transplant. This is a sensitive topic, but the doctors you have identified in cancer treatment centers need to know this lesson! How will you reach this audience? Coleman: There are certainly lessons learned from past incidents. What is key is that dose estimates will guide initial decisions, but the ongoing expert medical management is key to optimal management of each person. Radiation Emergency Medical Management (REMM) has guidance, the Radiation Injury Treatment Network provides the medical information on REMM, and its members are available for consultation. So, ongoing assessment should help determine who might need a transplant and who will be managed by medical management using transplantation only if medical management indicates it is necessary based on how the person responded to treatment. Q: I think you have overstated the “cancer risk” for survivors of an accident/detonation with radiation exposure based on Japanese atomic bomb survivors—barely detectable increase in cancer risk in 80,000 people. How do the calculated excess cancer risks for a population of 100,000, who just survive an acute exposure, compare to the estimated baseline cancer risk? Despite its reputation, radiation is a rather poor carcinogen. Can you address the underlying assumptions which have gone into your risk assessment? Coleman: I didn’t comment on cancer risk, but this is a very valid point. I agree it is often overstated. Having subject matter experts who can communicate and be engaged in appropriate dialogue is important. Q: As economic impacts may be larger than health impacts, should more insurance be required of industry? Chen: This is obviously a policy issue. We are sure the responsible government agencies will be evaluating the www.health-physics.com
170
Copyright © 2014 Health Physics Society. Unauthorized reproduction of this article is prohibited.
Special Submission c PROGRAM AREA COMMITTEES 3 & 5
requisite policy changes on economic impact in response to the post-Fukushima lessons learned. NCRP Report No. 175 will strongly advocate that such issues be addressed in the optimization process for long-term recovery. Q: You talked a lot about Fukushima and its problems with decontamination. However, the Chernobyl accident, which occurred 27 y ago, was more severe than Fukushima. What lessons can be learned from the Chernobyl accident? Chen: NCRP Report No. 175 will draw heavily from lessons learned from past incidents, including Chernobyl. Several important attributes in response recovery have been evaluated from the Chernobyl nuclear accident. Examples include the decontamination technology for treating soils and agricultural lands heavily contaminated with 173Cs as well as other issues regarding recovery. However, we must be cognizant that optimization is a site-specific process for decision-making, thus regional differences, such as land use, resource availability, demography, culture, and other socio-political factors, should all be considered. Thus, other appropriate and applicable lessons could be applied to the Fukushima accident based on past events. Q: How do you envision documenting the basis for decisions made during recovery given the extensive involvement of stakeholders in the decision-making? Chen: We strongly believe in knowledge retention and, therefore, advocate for the development of a global information repository to continuously fortify our experience and improve future responses to similar incidents.
171
Given that a long-term recovery will be locally and community focused, we can collectively gather and record the common issues and attributes that are available for such an effort. The broad information base can range from local anecdotes to major decision making on broader community issues such as temporary radioactive storage or disposal. Documenting such an extensive database may require a concerted effort both nationally and internationally. Q: Did you take into consideration the new 2013 (interim final) PAG Manual? Chen: The schedule of NCRP Scientific Committee (SC) 5‐1 happened to be running in parallel to the U.S. Environmental Protection Agency’s (EPA) development of the revised Protective Action Guide (PAG) Manual; thus, the circumstances did not permit cross referencing. However, it must be pointed out that the two documents were developed with different objectives. While the PAG Manual is intended to provide federal guidance on the response actions throughout all phases of a nuclear or radiological event, the NCRP document focuses primarily on the “how to” issues that are specifically pertinent to the decision making in late-phase recovery. Nonetheless, based on our initial evaluation, it is believed that the two independently developed documents will turn out to be quite consistent and complementary to each other.
www.health-physics.com
Copyright © 2014 Health Physics Society. Unauthorized reproduction of this article is prohibited.
■■
