Paper THE ACCIDENT AT THE FUKUSHIMA DAIICHI NUCLEAR POWER PLANT IN 2011 Takako Tominaga, Misao Hachiya, Hideo Tatsuzaki, and Makoto Akashi* Abstract—A huge earthquake struck the northeast coast of the main island of Japan on 11 March 2011, triggering a tsunami with more than 10‐m-high waves hitting the area. The earthquake was followed by numerous sustained aftershocks. The earthquake and aftershocks left almost 16,000 people dead and more than 2,800 missing (as of 11 March 2014). The earthquake affected the Fukushima Daiichi Nuclear Power Plant (NPP) of Tokyo Electric Power Company (TEPCO), causing serious damage to the NPP and resulting in large amounts of radioactive materials being released into not only controlled areas but also the environment. Damage was caused to the cooling systems of the NPP, although they automatically shut down after the earthquake. The trouble with the cooling systems led to hydrogen explosions and core meltdown. The major nuclides released on land were 131I, 134Cs, and 137Cs. The release of these radioactive materials resulted in contamination of first responders and workers and also a high ambient dose of radiation around the NPP. The local hospital system, including that for radiation emergency medicine, was dysfunctional. Hospitals that had been designated as radiation emergency facilities were not able to function because the earthquake and tsunami had caused damage to their facilities; some of these were located within a 20-km radius of the NPP and in the evacuation areas. Local fire department personnel were also ordered to evacuate. Fukushima prefecture changed the screening level required for decontamination from 13,000 to 100,000 cpm, with decontamination by wiping being performed for over 13,000 cpm. However, as hospitals and fire departments had to abide by lower levels than that of the prefecture for receiving or transporting contaminated patients, these personnel could not accept or transport contaminated people from the NPPs. In addition, hospitals not designated as radiation emergency facilities would not receive patients from the NPPs because of concerns about the health effects of radiation. From this disaster, it was learned that basic knowledge of radiation and its effects is extremely important for health care providers. Health Phys. 106(6):630–637; 2014 Key words: accidents, nuclear; contamination; emergency planning; transportation
*Radiation Emergency Medical Assistance Team (REMAT), National Institution of Radiological Sciences (NIRS), Chiba, Japan. The authors declare no conflicts of interest. For correspondence contact: Makoto Akashi, Executive Director, National Institute of Radiological Sciences, 4‐9‐1 Anagawa, Inage-ku Chiba-city, CHIBA, 263‐8555 Japan, or email at [email protected]. (Manuscript accepted 2 January 2014) 0017-9078/14/0 Copyright © 2014 Health Physics Society DOI: 10.1097/HP.0000000000000093
INTRODUCTION IN AN accident or disaster, medical care by medical staff at local hospitals and first response by first responders, such as local fire fighters and emergency medical technicians (EMT), are provided. Regarding radiation accidents/ disasters, a major problem arises from the fact that there are few medical professionals or first responders with experience in caring for victims of radiation accidents because such occurrences are so rare. Moreover, emergency responders and physicians are lacking in knowledge regarding radiation exposure and contamination with radioactive materials because radiation emergency medicine has not been included in their educational curricula. Also, radiation cannot be felt, smelled, or tasted, nor does it induce immediate signs/symptoms after exposure. Therefore, a radiation accident, besides causing medical and environmental effects, can also result in psychological and social problems. Therefore, education and training based on science and lessons learned from past accidents are essential for the practice of radiation emergency medicine, since the application of clinical medicine is based on these lessons. The Great East-Japan Earthquake on the Pacific coast of the main island of Japan occurred on 11 March 2011. The resulting tsunami caused serious damage to the Fukushima Daiichi Nuclear Power Plant (NPP) operated by the Tokyo Electric Power Company (TEPCO). This led to dysfunction of the NPP, and large amounts of radioactive materials were released from its reactors. The accident at this NPP also revealed a number of problems in terms of the medical response to nuclear disasters. Since the criticality accident at Tokai-mura in Ibaraki Prefecture in 1999, it has been thought prudent to prepare a system for radiation emergency medicine. In Japan, the National Institute of Radiological Sciences (NIRS), local governments with nuclear facilities (such as NPP), and other organizations have introduced a training system for radiation emergency response for medical professionals. For this accident, however, insufficient knowledge of radiation and or misunderstandings led to inappropriate medical response of hospitals and the transportation of patients. Many
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residents were subjected to discrimination and prejudice at hospitals where staff were not trained for radiation emergencies. This paper will introduce the various problems triggered by this accident at the NPP, focusing on the system of radiation emergency medicine and its consequences. The Great East-Japan Earthquake and the accident at TEPCO Fukushima Daiichi NPP An earthquake measuring 9.0 on the moment magnitude scale (according to the Japanese Meteorological Agency) struck the Pacific coast of eastern Japan at 14:46 on 11 March 2011 (JMA 2011). The Great East-Japan Earthquake triggered a tremendous tsunami, and numerous sustained aftershocks followed. The affected areas of the tsunami extended from Chiba to Aomori prefectures; damage was caused along 450 km of the northeastern coast of the main island (Honshu) of Japan. The earthquake and tsunami resulted in 15,884 deaths and 2,633 missing (as of 11 March 2014) (NPA 2014). The earthquake caused damage to the NPP located approximately 16 km southwest of its epicenter (Fig. 1). This NPP consisted of six boilingwater reactors (BWR), reactor units (Units) 1 to 6, with a total generating capacity of 4,696 MW. At the time the earthquake occurred, Units 1, 2, and 3 were in operation, and Units 4, 5, and 6 were undergoing scheduled periodic inspections. Among them, Reactor Unit
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4 was undergoing a major renovation, and all the nuclear fuel had already been transferred from its reactor pressure vessel to the spent-fuel pool. Reactors generate heat after the chain reaction is stopped because of radioactive decay of unstable isotopes and fission products. After shutdown, the temperature of a reactor core is still high before reaching a cold-shutdown level. Nuclear fuel rods that have reached a temperature of cold shutdown typically require another several years of water-cooling in a spent-fuel pool before they can be safely transferred to dry-storage casks. Soon after this earthquake, operating Units 1, 2, and 3 automatically shut down with all the control rods remaining inserted in the reactor cores, and the emergency generator system came online to control the cooling systems. However, one of the two connections to off-site power for Units 1–3 failed because of the earthquake (TEPCO 2012). There were two emergency diesel generators for each of Units 1–5 and three for Unit 6. Unfortunately, the earthquake was followed approximately 50 min later (15:41) by a huge tsunami (13 to 15 m height) that topped the plant’s 5.7 m seawall, flooded the basement of the turbine buildings, and disabled the emergency diesel generators located there. Consequently, approximately 1.8 1016 Bq of 134Cs, 1.5 1016 Bq of 137 Cs, and 1.6 1017 Bq of 131I were released into the atmosphere (NISA and JNES 2011).
Fig. 1. Locations of Fukushima prefecture and the Fukushima Daiichi Nuclear Power Plant (NPP) of Tokyo Electric Power Co. (TEPCO). Fukushima prefecture is located in the southern part of the Tohoku (northeast) district, on the main island (Honshu) of Japan, facing the Pacific Ocean to the east. The NPP is located about 230 km from Tokyo. The hypocenter of the earthquake was located 130 km East-South-East (ESE) off Oshika Peninsula at a depth of 24 km. www.health-physics.com
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Medical system for response to radiation emergencies in Fukushima prefecture Because of the experience of the criticality accident in Ibaraki prefecture in 1999, the establishment of a well organized response system for radiation emergency medicine had been believed to be essential in Japan. At the end of 2010, the country had 54 operational nuclear reactors for electricity generation. Prior to the Fukushima accident, the response system for radiation emergency medicine had already been established in 19 prefectures with nuclear facilities or adjacent to nuclear facilities in neighboring prefectures. Under this system, the treatment of patients involved in radiation accidents is performed at three levels: primary level in hospitals near nuclear facilities; secondary level in local general hospitals; and tertiary level by more equipped and advanced hospitals (NSC 2008). Primary and secondary facilities have been designated by the local governments of the areas where the nuclear facilities are located, and the NIRS and Hiroshima University have been designated as tertiary hospitals in the East and West Blocks of Japan, respectively, by the national government. Hospitals at the primary level were expected to provide first-aid treatment, primary assessment of contamination with radionuclides, and removal of contamination from the body surface. Therefore, these hospitals had to be equipped with radiation detectors such as survey meters and the minimum requirements for decontamination. Secondary level hospitals provide medical and radiological triage, decontamination, and treatment of local radiation injuries and whole body exposure, and also initiate treatment for internal contamination. As well as being a tertiary hospital, NIRS has also been designated as the national center of radiation emergency medicine in Japan, providing direct or consultative services to local governments and hospitals including Hiroshima University in the event of an actual radiation incident. Fukushima prefecture has designated six facilities as primary-level hospitals for radiation emergency: Minamisouma City General, Futaba Kosei, Ono Prefectural, Imamura, Fukushima Rosai, and Iwaki Kyoritsu hospitals
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(Table 1, Fig. 2). Fukushima Medical University (FMU) has a secondary-level hospital for radiation emergencies. As Futaba Kousei, Ono Prefectural, and Imamura hospitals were located within a 20‐km radius from the Daiichi NPP, staff and patients of these hospitals were asked to evacuate. Moreover, these hospitals had also suffered damage mainly by the earthquake. Hydrogen explosion of 14 March 2011 Failure in sufficiently cooling the fuel rods inside the reactors resulted in not only bare exposure of the rods to the inside atmosphere of the reactor but also a chemical reaction between the fuel rod cladding, a metal tube that covers the fuel rods, and steam, generating a substantial amount of hydrogen. The cladding was damaged by the high temperatures, causing the fuel rods to release radioactive materials. These radioactive materials and hydrogen gas were thought to have been released with steam from the reactor pressure vessel (RPV) into the primary containment vessel (PCV). Moreover, it was also believed that via areas such as the seals on the head of the PCV that were exposed to high temperatures, gas had leaked into the reactor building. At Units 1 and 3, the leaked hydrogen accumulated in the upper portion of the reactor building, causing explosions. The first hydrogen explosion occurred in the reactor building of Unit 1 at 15:36 on 12 March 2011 and the second one in the reactor building of Unit 3 at 11:01 on 14 March 2011. In the second explosion, 11 workers, including four members of the Japanese Self Defense Forces (JSDF), were injured. These four JSDF members were brought to local headquarters at an off-site command center located about 5 km from the NPP. Since these four JSDF members were heavily contaminated with radionuclides and a radiation level of 1 mSv h−1 was detected at 10 cm from the surface of the protective gear of two of them, after decontamination, these two were transferred to FMU in Fukushima city, located about 78 km from the local headquarters. One of them was treated at FMU. Fortunately, the other patient was not in serious medical condition, but he was internally contaminated with radioactive iodine
Table 1. Primary-level hospitals for radiation emergency in Fukushima prefecture. These hospitals were designated as primary-level hospitals by Fukushima prefecture before the accident on 11 March 2011. Distances from the NPP were calculated along roads using the Yahoo map. Name of hospital Minamisouma City General Futaba Kosei Ono Prefectural Imamura Fukushima Rosai Iwaki Kyoritsu
Location
Distance from Daiichi NPP
Minamisouma city Futaba town Okuma town Tomioka town Iwaki city Iwaki city
28 5 4 11 50 50
km km km km km km
Activity Active Closed due to evacuation Closed due to evacuation Closed due to evacuation Active Active
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Fig. 2. Hospitals for radiation emergency in Fukushima prefecture. Before the accident, six hospitals were designated as medical facilities for primary-level radiation emergencies, and FMU was a secondary-level hospital for radiation emergencies. Ono Prefectural, Futaba Kosei, and Imamura hospitals were located within 20 km of the Fukushima Daiichi NPP.
and cesium. He was then transferred to NIRS by JSDF helicopter for further evaluation of contamination and injury diagnosis. Staff at NIRS could accept this contaminated patient smoothly. Two of four JSDF members were treated at a clinic at Fukushima Daini NPP after decontamination at the local headquarters. The other seven workers were brought to the Fukushima Daini NPP, located about 15 km south of the Fukushima Daiichi NPP, by ambulance and a TEPCO vehicle, since a doctor and a nurse were on duty and two ambulances were available there (Fig. 3). A nurse and a radiation protection officer from NIRS at the local headquarters moved to the clinic at the Daini NPP to support medical care and to advise on radiation protection. Four of the seven were treated at the Daini NPP, and the other three needed further treatment at a hospital. Two of them had been decontaminated at the Daini NPP, but the level of contamination on the skin was higher than 100,000 cpm as measured by GM survey meter. Since one of them also had suspected bone fractures, at 19:27 TEPCO asked an ambulance to carry him to a hospital; the ambulance arrived at the Daini NPP at 20:55. However, the ambulance staff stated that they were unable to take him to a hospital, since the contamination level was over their own cut-off criteria for transportation, and there was no hospital to accept contaminated patients. At that time, by telephone, one
of the authors actually discussed this transportation issue with the ambulance staff. After the discussion, they finally agreed that they would transport them if any decontamination could be provided. Since a hospital in Koriyama-city, 82 km from the Daini NPP, agreed to accept these three patients, the ambulance left the Daini NPP at 21:56 for the hospital, followed by a car with two NIRS experts. Before arriving at the hospital, however, the ambulance was informed by the hospital that these patients could not be received. Therefore, these three patients then had to be decontaminated at a temporary decontamination station in Koriyama-city. Even after the decontamination procedure, however, contamination still remained, and the hospital refused to accept the contaminated patients. These three patients were finally received by FMU, 41 km from the hospital in Koriyama city, at 8:25 in the morning of the next day (15 March 2011), more than 21 h after the second explosion. Numbers of DMAT and magnitude of damage in affected prefectures facing the Pacific Ocean The hypocenter of this earthquake was approximately 70 km east of the Oshika Peninsula of Miyagi prefecture (Fig. 1). Iwate, Miyagi, Fukushima, and Ibaraki prefectures are located on the Pacific coast of the main island (Honshu) of Japan. A Disaster Medical Assistance Team
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Fig. 3. Route of transportation of three workers injured and contaminated with radioactive materials at a hydrogen explosion on 14 March 2013. Seven of 11 workers injured and contaminated in the hydrogen explosion were brought to the Fukushima Daini NPP (2F). The staff of NIRS at the local headquarters (LHQ) went to see them at the clinic at 2F. Three workers needed further treatment at a hospital. Two of them were decontaminated at 2F, and after discussion, these three workers were transported to Koriyama-city, 82 km by road from the Daini NPP, after further decontamination at a temporary decontamination station. Since these patients could not be received at the intended hospital in Koriyama-city, they were transported to and received by FMU, 42 km from the hospital, in the morning of 15 March, 2011. Road distances were calculated using the Yahoo Map®.
(DMAT) consists of a group of medical and co-medical personnel designed to provide medical care during a disaster or other event. Based on the Basic Act on Disaster Control Measures, DMATs are activated by the Ministry of Health, Labor and Welfare (MHLW) in Japan. Earthquakes and tsunamis cause not only death and lifethreatening injuries but also have a tremendous impact on the public and infrastructure in affected areas. The authors compared the numbers of DMATs that had been sent to each of these prefectures and those of destroyed buildings and houses by the earthquake and tsunami (Table 2) (JMA 2011; Koido et al. 2011). Miyagi prefecture had the greatest damage among these prefectures; as many as 237,996 buildings and houses were either completely or partially destroyed. The damage in Fukushima
prefecture was greater than that in Iwate prefecture, although the number of DMATs sent to Fukushima was less than that to Iwate. Education and training of ambulance staff in Fukushima prefecture Of course, even before the accident, NIRS and other organizations related to radiation emergencies provided opportunities for training and education to medical professionals and first responders. From these events and experiences, it became perfectly clear that re-education and training, focusing on precise knowledge and understanding of radiation protection and contamination control of patients during transportation, were urgent. To provide correct information and knowledge on radiation, NIRS sent
Table 2. Damage caused by earthquake/tsunami and number of Disaster Medical Assistance Teams (DMATs) sent to prefectures facing the Pacific ocean in northeastern Japan (NPA 2013; Koido et al. 2011). Prefecture
No. of completely destroyed buildings/housesa
No. of partially destroyed buildings/housesa
No. of DMATs dispatched
Iwate Miyagi Fukushima Ibaraki
18,370 82,889 21,167 2,623
6,558 155,107 72,947 24,196
138 131 73 28
a
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However, such attendees usually have limited knowledge concerning radiation, which leads to misunderstandings and a certain level of anxiety if not outright fear. In Japan, the system for radiation emergency medical preparedness was intensively revised after the criticality accident in 1999 at Tokai-mura (Akashi et al. 2001). However, the recent accident at the TEPCO Fukushima Daiichi NPP uncovered many problems in the medical response systems. Upon the hydrogen explosion, the local ambulance initially refused to transport the contaminated workers to a hospital because the levels of contamination were higher than the cut-off level for transportation of the fire department, and no hospital could be found to receive them. Finally, these workers were transported by ambulance and admitted to FMU at Fukushima city via Koriyama city, almost 120 km from the accident site. However, almost a whole day was needed until they could be accepted by the hospital. Fukushima prefecture had changed the screening level required for formal decontamination from 13,000 cpm for beta and gamma emitters to 100,000 cpm according to the International Atomic Energy Agency (IAEA) manual, which was equivalent to a dose rate of almost 1 μSv h−1 at a distance of 10 cm (IAEA 2006). One of the problems is that some fire departments and hospitals for radiation emergency in Fukushima prefecture still had the lower levels of cutoff criteria for accepting or transporting contaminated patients. In hospitals, there are several medical and non-medical professionals working: medical doctors, nurses, radiological or medical technologists, and administration office personnel. The second problem is that there was no agreement for accepting contaminated patients among these professional groups in some of the hospitals for radiation emergencies. Even if medical doctors had made the decision to accept these contaminated patients at their hospitals, they would still not be accepted without agreement of other medical professionals and/or non-medical personnel. Since this radiation accident was a combined disaster of both earthquake and tsunami, damage was caused to lifelines, which was also a reason for the difficulty of accepting patients in
experts on radiation emergency to these fire departments in Fukushima prefecture (Table 3). These training courses contained drills such as practice for receiving contaminated patients in ambulances and understanding the health effects of radiation from patients. In addition, the role of the health physicist in radiation safety was emphasized. Divisions of the fire department in the Futaba area were located within 20 km from the NPP and also suffered damage by the earthquake and tsunami (Fig. 4). Since they were asked to evacuate, they had to relocate their department and divisions (Namie, Tomioka, and Kawauchi). On the other hand, these same fire departments had to organize the preparedness for transporting patients with accidental exposure to radiation and or contamination with radioactive materials, especially when these patients also had life-threatening diseases or injuries. However, no public ambulance could get to the NPP because of concerns about the health effects of radiation, whereas almost 2,000 persons were still actively involved in emergency work at the NPPs every day after the earthquake. DISCUSSION Radiation is a unique external stress because it cannot be detected by human senses, and it does not cause immediate signs or symptoms. Moreover, there is no report showing that radiation exposure and/or contamination with radioactive materials alone has resulted in immediate death if not accompanied by other life-threatening disease or injury. Humans may not become aware of the occurrence of a radiological and nuclear incident unless an elevated level of radiation is detected by some device or information is provided by those who do have such instrumentation. In addition, radiation exposure may lead to late effects, including cancer, in the long term. Therefore, the health effects of radiation exposure are a major concern not only for the public but also for first responders and medical personnel regardless of the dose received. On the other hand, radiation can be monitored or measured even on-site or in an ambulance if an appropriate device is used.
Table 3. Training courses for fire departments by NIRS in Fukushima prefecture. Training courses were introduced at fire departments of Fukushima prefecture by NIRS after the accident. Fire Department Futaba area Soma area Iwaki area Fukushima city Aizuwakamatsu, Kitakata, and Minamiaizu areas Shirakawa area Date area
Date
No. of participants
Experts from NIRS
21 – 22 Sep 2011 3 – 4 Oct 2011 28 Oct 2011 28 – 29 Nov 2011 2 Feb 2012 3 Feb 2012 16 Mar 2012
83 50 32 80 147 51 50
4 3 4 5 4 4 4
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Fig. 4. Location of fire departments in Fukushima prefecture before the accident. In Fukushima prefecture, there are 12 fire departments: Fukushima city, Date, Adachi, Koriyama, Sukagawa, Shirakawa, Kita, Aizuwakamatsu, Minamiaizu, Soma, Futaba, and Iwaki. Fire departments where the training course was introduced (●) or not (○) by NIRS and divisions of the Futaba fire department () are presented (see also Table 3). The Futaba fire department and its divisions of Namie and Tomioka have now been temporarily relocated.
hospitals. This accident has clearly revealed the need for non-medical staff as well as all medical professionals to possess basic knowledge of radiation exposure and contamination with radionuclides. Without this basic knowledge among personnel, even a well organized system would not function effectively. In Japan, NPPs have been built at the seaside because of the need, at least in part, for cooling-water systems. Since primary hospitals were located near the nuclear facilities, medical staffs were also asked to evacuate. Moreover, some of them suffered damage from the earthquake and tsunami, rendering these primary-level hospitals nonfunctional. In the Tohoku district, which is located in the northeast of the main island of Japan, many DMATs were sent to hospitals and first aid care centers in the affected areas. However, the number of DMATs sent to Fukushima prefecture was less than to Iwate prefecture, which had less damage in terms of houses and buildings, whereas
Fukushima prefecture was located closer to the Tokyo metropolitan area, where many DMATs were ready to be dispatched. The reason remains unclear. When an earthquake measuring 6.8 struck the NiigataChuetsu region of Japan on 16 July 2007, it caused damage to the Kashiwazaki-Kariwa NPPs, the biggest NPP site in the world. A small amount of radioactive material was released into the air and sea; no significant radiological effects were detected in the environment or among the public, nor was any damage caused to the NPP monitoring system, although public infrastructure was affected. However, most DMAT members who had been sent from local governments without nuclear facilities to hospitals and first aid care centers at the NPP site were concerned about the effects of radiation because they lacked adequate knowledge about radiation (Akashi et al. 2010). The reason for the smaller number of DMATs in Fukushima may be related to concerns about radiation by the members, although
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REFERENCES
a more detailed study will be required. Recently, it has been emphasized that a medical response to radiation emergencies should be included in the general hospital-based disaster plan. Education and training for radiation emergencies are critical for all members who might be involved in a medical response to a disaster, since potential sources for radiation accidents are everywhere in daily life. On the other hand, what we also have to learn is that education and training are not always perfect. Therefore, the rapid access system to experts by phone or other means and the more effective system for sending experts on-site are also required, whereas the number of experts is limited. To the authors’ knowledge, there are few reports about significant effects of radiation exposure to health care providers receiving contaminated patients (Miller and Erdman 2004; IAEA 2005; NCRP 2005). However, there is one study that suggests that there may be rare situations where special precautions are necessary, even while managing a contaminated victim’s life-threatening injuries (Smith et al. 2005). The health physicist can provide information as well as evaluate the true extent and potential impact of any contamination present. If these procedures can be carried out properly, appropriate medical activities will take place in a safe and timely manner. From the experience gained from the accident at Tokai-mura, Japan, in 1999, the former Nuclear Safety Commission (NSC) of the Japanese Government clearly stated the roles of health physicists for radiation safety in emergencies in the Medical Guidelines for Radiation Emergency, issued in 2001 and revised in 2008 (NSC 2008). According to these guidelines, health physicists for radiation safety at NPPs or related companies have to accompany patients to hospitals in order to transport them smoothly and gain acceptance by hospitals. Moreover, they have to be trained for emergencies. With recommendations from these health physicists or experts in radiation protection, the dose and its rate from contaminated patients can be monitored during transportation, and contamination control can also be performed, even if knowledge of radiation is insufficient. It is vital that correct information about radiation exposure be provided prior to any possible accidents. Psychological and social problems can be prevented or at least minimized. We have learned again from the Fukushima accident that exact knowledge concerning radiation exposure is absolutely essential.
Akashi M, Hirama T, Tanosaki S, Kuroiwa N, Nakagawa K, Tsuji H, Kato H, Yamada S, Kamata T, Kinugasa T, Ariga H, Maekawa K, Suzuki G, Tsujii H. Initial symptoms of acute radiation syndrome in the JCO criticality accident in Tokai-mura. J Radiat Res 42 (Suppl):S157–S166; 2001. DOI: 10.1269/jrr.42.S157. Akashi M, Kumagaya K, Kondo H, Hirose Y. Concerns of disaster medical assistance team (DMAT) members about troubles at the nuclear power plant: experience from the Niigata– Chuetsu–Oki earthquake, 16 July 2007, in Japan. Health Phys 98:804–809; 2010. DOI: 10.1097/HP.0b013e3181ac924a. International Atomic Energy Agency. Generic procedures for medical response during a nuclear or radiological emergency. Vienna: International Atomic Energy Agency; 2005. International Atomic Energy Agency. Manual for first responders to a radiological emergency. Vienna: International Atomic Energy Agency; 2006. Japan Meteorological Agency. Information on the 2011 off the Pacific Coast of Tohoku Earthquake [online]. Tokyo: JMA; 2011. Available at www.jma.go.jp/jma/en/2011_Earthquake/ Information_on_2011_Earthquake.html. Accessed 10 July 2013. Koido Y, Kondo H, Ichihara M, Kohayagawa Y, Henmi H. Research on the DMAT response to the 2011 East Japan Earthquake. J Nat Inst Public Health 60:495–501; 2011. Miller K, Erdman M. Health physics considerations in medical radiation emergencies. Health Phys 87(Suppl):S19–S24; 2004. National Council on Radiation Protection and Measurements. NCRP Commentary No. 19, Key elements of preparing emergency responders for nuclear and radiological terrorism. Bethesda, MD: National Council on Radiation Protection and Measurements; 2005. Nuclear and Industrial Safety Agency, Japan Nuclear Energy Safety Organization. The 2011 off the Pacific Coast of Tohoku Pacific Earthquake and the Seismic Damage to the NPPs [online]. Tokyo: NISA and JNES; 2011. Available at www.meti.go.jp/press/2011/10/20111020001/20111020001. html. Accessed 10 July 2013. National Police Agency. Damage situation and police countermeasures associated with 2011Tohoku District: Off the Pacific Ocean Earthquake [online]. Tokyo: NPA; 2014. Available at www.npa.go.jp/archive/keibi/biki/higaijokyo.pdf. Accessed 11 March 2014 (in Japanese). Nuclear Safety Commission of Japan. Medical guidelines for radiation emergencies. Tokyo: NSC; NSCRG: T-EP-II.05; 2008. Smith JM, Ansari A, Harper FT. Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device. Health Phys 89:513–520; 2005. DOI: 10.1097/01. HP.0000175444.30788.75. Tokyo Electric Power Company. The Great East Japan Earthquake and current status of nuclear power stations [online]. Tokyo: TEPCO; 2012. Available at www.tepco.co.jp/en/nu/ fukushima-np/f1/images/f12np-gaiyou_e_1.pdf. Accessed 10 July 2013.
Acknowledgments—We thank Aki Yamamoto for her excellent assistance with this manuscript.
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*Radiation Emergency Medical Assistance Team (REMAT), National Institution of Radiological Sciences (NIRS), Chiba, Japan. The authors declare no conflicts of interest. For correspondence contact: Makoto Akashi, Executive Director, National Institute of Radiological Sciences, 4‐9‐1 Anagawa, Inage-ku Chiba-city, CHIBA, 263‐8555 Japan, or email at [email protected]. (Manuscript accepted 2 January 2014) 0017-9078/14/0 Copyright © 2014 Health Physics Society DOI: 10.1097/HP.0000000000000093
INTRODUCTION IN AN accident or disaster, medical care by medical staff at local hospitals and first response by first responders, such as local fire fighters and emergency medical technicians (EMT), are provided. Regarding radiation accidents/ disasters, a major problem arises from the fact that there are few medical professionals or first responders with experience in caring for victims of radiation accidents because such occurrences are so rare. Moreover, emergency responders and physicians are lacking in knowledge regarding radiation exposure and contamination with radioactive materials because radiation emergency medicine has not been included in their educational curricula. Also, radiation cannot be felt, smelled, or tasted, nor does it induce immediate signs/symptoms after exposure. Therefore, a radiation accident, besides causing medical and environmental effects, can also result in psychological and social problems. Therefore, education and training based on science and lessons learned from past accidents are essential for the practice of radiation emergency medicine, since the application of clinical medicine is based on these lessons. The Great East-Japan Earthquake on the Pacific coast of the main island of Japan occurred on 11 March 2011. The resulting tsunami caused serious damage to the Fukushima Daiichi Nuclear Power Plant (NPP) operated by the Tokyo Electric Power Company (TEPCO). This led to dysfunction of the NPP, and large amounts of radioactive materials were released from its reactors. The accident at this NPP also revealed a number of problems in terms of the medical response to nuclear disasters. Since the criticality accident at Tokai-mura in Ibaraki Prefecture in 1999, it has been thought prudent to prepare a system for radiation emergency medicine. In Japan, the National Institute of Radiological Sciences (NIRS), local governments with nuclear facilities (such as NPP), and other organizations have introduced a training system for radiation emergency response for medical professionals. For this accident, however, insufficient knowledge of radiation and or misunderstandings led to inappropriate medical response of hospitals and the transportation of patients. Many
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residents were subjected to discrimination and prejudice at hospitals where staff were not trained for radiation emergencies. This paper will introduce the various problems triggered by this accident at the NPP, focusing on the system of radiation emergency medicine and its consequences. The Great East-Japan Earthquake and the accident at TEPCO Fukushima Daiichi NPP An earthquake measuring 9.0 on the moment magnitude scale (according to the Japanese Meteorological Agency) struck the Pacific coast of eastern Japan at 14:46 on 11 March 2011 (JMA 2011). The Great East-Japan Earthquake triggered a tremendous tsunami, and numerous sustained aftershocks followed. The affected areas of the tsunami extended from Chiba to Aomori prefectures; damage was caused along 450 km of the northeastern coast of the main island (Honshu) of Japan. The earthquake and tsunami resulted in 15,884 deaths and 2,633 missing (as of 11 March 2014) (NPA 2014). The earthquake caused damage to the NPP located approximately 16 km southwest of its epicenter (Fig. 1). This NPP consisted of six boilingwater reactors (BWR), reactor units (Units) 1 to 6, with a total generating capacity of 4,696 MW. At the time the earthquake occurred, Units 1, 2, and 3 were in operation, and Units 4, 5, and 6 were undergoing scheduled periodic inspections. Among them, Reactor Unit
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4 was undergoing a major renovation, and all the nuclear fuel had already been transferred from its reactor pressure vessel to the spent-fuel pool. Reactors generate heat after the chain reaction is stopped because of radioactive decay of unstable isotopes and fission products. After shutdown, the temperature of a reactor core is still high before reaching a cold-shutdown level. Nuclear fuel rods that have reached a temperature of cold shutdown typically require another several years of water-cooling in a spent-fuel pool before they can be safely transferred to dry-storage casks. Soon after this earthquake, operating Units 1, 2, and 3 automatically shut down with all the control rods remaining inserted in the reactor cores, and the emergency generator system came online to control the cooling systems. However, one of the two connections to off-site power for Units 1–3 failed because of the earthquake (TEPCO 2012). There were two emergency diesel generators for each of Units 1–5 and three for Unit 6. Unfortunately, the earthquake was followed approximately 50 min later (15:41) by a huge tsunami (13 to 15 m height) that topped the plant’s 5.7 m seawall, flooded the basement of the turbine buildings, and disabled the emergency diesel generators located there. Consequently, approximately 1.8 1016 Bq of 134Cs, 1.5 1016 Bq of 137 Cs, and 1.6 1017 Bq of 131I were released into the atmosphere (NISA and JNES 2011).
Fig. 1. Locations of Fukushima prefecture and the Fukushima Daiichi Nuclear Power Plant (NPP) of Tokyo Electric Power Co. (TEPCO). Fukushima prefecture is located in the southern part of the Tohoku (northeast) district, on the main island (Honshu) of Japan, facing the Pacific Ocean to the east. The NPP is located about 230 km from Tokyo. The hypocenter of the earthquake was located 130 km East-South-East (ESE) off Oshika Peninsula at a depth of 24 km. www.health-physics.com
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Medical system for response to radiation emergencies in Fukushima prefecture Because of the experience of the criticality accident in Ibaraki prefecture in 1999, the establishment of a well organized response system for radiation emergency medicine had been believed to be essential in Japan. At the end of 2010, the country had 54 operational nuclear reactors for electricity generation. Prior to the Fukushima accident, the response system for radiation emergency medicine had already been established in 19 prefectures with nuclear facilities or adjacent to nuclear facilities in neighboring prefectures. Under this system, the treatment of patients involved in radiation accidents is performed at three levels: primary level in hospitals near nuclear facilities; secondary level in local general hospitals; and tertiary level by more equipped and advanced hospitals (NSC 2008). Primary and secondary facilities have been designated by the local governments of the areas where the nuclear facilities are located, and the NIRS and Hiroshima University have been designated as tertiary hospitals in the East and West Blocks of Japan, respectively, by the national government. Hospitals at the primary level were expected to provide first-aid treatment, primary assessment of contamination with radionuclides, and removal of contamination from the body surface. Therefore, these hospitals had to be equipped with radiation detectors such as survey meters and the minimum requirements for decontamination. Secondary level hospitals provide medical and radiological triage, decontamination, and treatment of local radiation injuries and whole body exposure, and also initiate treatment for internal contamination. As well as being a tertiary hospital, NIRS has also been designated as the national center of radiation emergency medicine in Japan, providing direct or consultative services to local governments and hospitals including Hiroshima University in the event of an actual radiation incident. Fukushima prefecture has designated six facilities as primary-level hospitals for radiation emergency: Minamisouma City General, Futaba Kosei, Ono Prefectural, Imamura, Fukushima Rosai, and Iwaki Kyoritsu hospitals
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(Table 1, Fig. 2). Fukushima Medical University (FMU) has a secondary-level hospital for radiation emergencies. As Futaba Kousei, Ono Prefectural, and Imamura hospitals were located within a 20‐km radius from the Daiichi NPP, staff and patients of these hospitals were asked to evacuate. Moreover, these hospitals had also suffered damage mainly by the earthquake. Hydrogen explosion of 14 March 2011 Failure in sufficiently cooling the fuel rods inside the reactors resulted in not only bare exposure of the rods to the inside atmosphere of the reactor but also a chemical reaction between the fuel rod cladding, a metal tube that covers the fuel rods, and steam, generating a substantial amount of hydrogen. The cladding was damaged by the high temperatures, causing the fuel rods to release radioactive materials. These radioactive materials and hydrogen gas were thought to have been released with steam from the reactor pressure vessel (RPV) into the primary containment vessel (PCV). Moreover, it was also believed that via areas such as the seals on the head of the PCV that were exposed to high temperatures, gas had leaked into the reactor building. At Units 1 and 3, the leaked hydrogen accumulated in the upper portion of the reactor building, causing explosions. The first hydrogen explosion occurred in the reactor building of Unit 1 at 15:36 on 12 March 2011 and the second one in the reactor building of Unit 3 at 11:01 on 14 March 2011. In the second explosion, 11 workers, including four members of the Japanese Self Defense Forces (JSDF), were injured. These four JSDF members were brought to local headquarters at an off-site command center located about 5 km from the NPP. Since these four JSDF members were heavily contaminated with radionuclides and a radiation level of 1 mSv h−1 was detected at 10 cm from the surface of the protective gear of two of them, after decontamination, these two were transferred to FMU in Fukushima city, located about 78 km from the local headquarters. One of them was treated at FMU. Fortunately, the other patient was not in serious medical condition, but he was internally contaminated with radioactive iodine
Table 1. Primary-level hospitals for radiation emergency in Fukushima prefecture. These hospitals were designated as primary-level hospitals by Fukushima prefecture before the accident on 11 March 2011. Distances from the NPP were calculated along roads using the Yahoo map. Name of hospital Minamisouma City General Futaba Kosei Ono Prefectural Imamura Fukushima Rosai Iwaki Kyoritsu
Location
Distance from Daiichi NPP
Minamisouma city Futaba town Okuma town Tomioka town Iwaki city Iwaki city
28 5 4 11 50 50
km km km km km km
Activity Active Closed due to evacuation Closed due to evacuation Closed due to evacuation Active Active
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Fig. 2. Hospitals for radiation emergency in Fukushima prefecture. Before the accident, six hospitals were designated as medical facilities for primary-level radiation emergencies, and FMU was a secondary-level hospital for radiation emergencies. Ono Prefectural, Futaba Kosei, and Imamura hospitals were located within 20 km of the Fukushima Daiichi NPP.
and cesium. He was then transferred to NIRS by JSDF helicopter for further evaluation of contamination and injury diagnosis. Staff at NIRS could accept this contaminated patient smoothly. Two of four JSDF members were treated at a clinic at Fukushima Daini NPP after decontamination at the local headquarters. The other seven workers were brought to the Fukushima Daini NPP, located about 15 km south of the Fukushima Daiichi NPP, by ambulance and a TEPCO vehicle, since a doctor and a nurse were on duty and two ambulances were available there (Fig. 3). A nurse and a radiation protection officer from NIRS at the local headquarters moved to the clinic at the Daini NPP to support medical care and to advise on radiation protection. Four of the seven were treated at the Daini NPP, and the other three needed further treatment at a hospital. Two of them had been decontaminated at the Daini NPP, but the level of contamination on the skin was higher than 100,000 cpm as measured by GM survey meter. Since one of them also had suspected bone fractures, at 19:27 TEPCO asked an ambulance to carry him to a hospital; the ambulance arrived at the Daini NPP at 20:55. However, the ambulance staff stated that they were unable to take him to a hospital, since the contamination level was over their own cut-off criteria for transportation, and there was no hospital to accept contaminated patients. At that time, by telephone, one
of the authors actually discussed this transportation issue with the ambulance staff. After the discussion, they finally agreed that they would transport them if any decontamination could be provided. Since a hospital in Koriyama-city, 82 km from the Daini NPP, agreed to accept these three patients, the ambulance left the Daini NPP at 21:56 for the hospital, followed by a car with two NIRS experts. Before arriving at the hospital, however, the ambulance was informed by the hospital that these patients could not be received. Therefore, these three patients then had to be decontaminated at a temporary decontamination station in Koriyama-city. Even after the decontamination procedure, however, contamination still remained, and the hospital refused to accept the contaminated patients. These three patients were finally received by FMU, 41 km from the hospital in Koriyama city, at 8:25 in the morning of the next day (15 March 2011), more than 21 h after the second explosion. Numbers of DMAT and magnitude of damage in affected prefectures facing the Pacific Ocean The hypocenter of this earthquake was approximately 70 km east of the Oshika Peninsula of Miyagi prefecture (Fig. 1). Iwate, Miyagi, Fukushima, and Ibaraki prefectures are located on the Pacific coast of the main island (Honshu) of Japan. A Disaster Medical Assistance Team
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Fig. 3. Route of transportation of three workers injured and contaminated with radioactive materials at a hydrogen explosion on 14 March 2013. Seven of 11 workers injured and contaminated in the hydrogen explosion were brought to the Fukushima Daini NPP (2F). The staff of NIRS at the local headquarters (LHQ) went to see them at the clinic at 2F. Three workers needed further treatment at a hospital. Two of them were decontaminated at 2F, and after discussion, these three workers were transported to Koriyama-city, 82 km by road from the Daini NPP, after further decontamination at a temporary decontamination station. Since these patients could not be received at the intended hospital in Koriyama-city, they were transported to and received by FMU, 42 km from the hospital, in the morning of 15 March, 2011. Road distances were calculated using the Yahoo Map®.
(DMAT) consists of a group of medical and co-medical personnel designed to provide medical care during a disaster or other event. Based on the Basic Act on Disaster Control Measures, DMATs are activated by the Ministry of Health, Labor and Welfare (MHLW) in Japan. Earthquakes and tsunamis cause not only death and lifethreatening injuries but also have a tremendous impact on the public and infrastructure in affected areas. The authors compared the numbers of DMATs that had been sent to each of these prefectures and those of destroyed buildings and houses by the earthquake and tsunami (Table 2) (JMA 2011; Koido et al. 2011). Miyagi prefecture had the greatest damage among these prefectures; as many as 237,996 buildings and houses were either completely or partially destroyed. The damage in Fukushima
prefecture was greater than that in Iwate prefecture, although the number of DMATs sent to Fukushima was less than that to Iwate. Education and training of ambulance staff in Fukushima prefecture Of course, even before the accident, NIRS and other organizations related to radiation emergencies provided opportunities for training and education to medical professionals and first responders. From these events and experiences, it became perfectly clear that re-education and training, focusing on precise knowledge and understanding of radiation protection and contamination control of patients during transportation, were urgent. To provide correct information and knowledge on radiation, NIRS sent
Table 2. Damage caused by earthquake/tsunami and number of Disaster Medical Assistance Teams (DMATs) sent to prefectures facing the Pacific ocean in northeastern Japan (NPA 2013; Koido et al. 2011). Prefecture
No. of completely destroyed buildings/housesa
No. of partially destroyed buildings/housesa
No. of DMATs dispatched
Iwate Miyagi Fukushima Ibaraki
18,370 82,889 21,167 2,623
6,558 155,107 72,947 24,196
138 131 73 28
a
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However, such attendees usually have limited knowledge concerning radiation, which leads to misunderstandings and a certain level of anxiety if not outright fear. In Japan, the system for radiation emergency medical preparedness was intensively revised after the criticality accident in 1999 at Tokai-mura (Akashi et al. 2001). However, the recent accident at the TEPCO Fukushima Daiichi NPP uncovered many problems in the medical response systems. Upon the hydrogen explosion, the local ambulance initially refused to transport the contaminated workers to a hospital because the levels of contamination were higher than the cut-off level for transportation of the fire department, and no hospital could be found to receive them. Finally, these workers were transported by ambulance and admitted to FMU at Fukushima city via Koriyama city, almost 120 km from the accident site. However, almost a whole day was needed until they could be accepted by the hospital. Fukushima prefecture had changed the screening level required for formal decontamination from 13,000 cpm for beta and gamma emitters to 100,000 cpm according to the International Atomic Energy Agency (IAEA) manual, which was equivalent to a dose rate of almost 1 μSv h−1 at a distance of 10 cm (IAEA 2006). One of the problems is that some fire departments and hospitals for radiation emergency in Fukushima prefecture still had the lower levels of cutoff criteria for accepting or transporting contaminated patients. In hospitals, there are several medical and non-medical professionals working: medical doctors, nurses, radiological or medical technologists, and administration office personnel. The second problem is that there was no agreement for accepting contaminated patients among these professional groups in some of the hospitals for radiation emergencies. Even if medical doctors had made the decision to accept these contaminated patients at their hospitals, they would still not be accepted without agreement of other medical professionals and/or non-medical personnel. Since this radiation accident was a combined disaster of both earthquake and tsunami, damage was caused to lifelines, which was also a reason for the difficulty of accepting patients in
experts on radiation emergency to these fire departments in Fukushima prefecture (Table 3). These training courses contained drills such as practice for receiving contaminated patients in ambulances and understanding the health effects of radiation from patients. In addition, the role of the health physicist in radiation safety was emphasized. Divisions of the fire department in the Futaba area were located within 20 km from the NPP and also suffered damage by the earthquake and tsunami (Fig. 4). Since they were asked to evacuate, they had to relocate their department and divisions (Namie, Tomioka, and Kawauchi). On the other hand, these same fire departments had to organize the preparedness for transporting patients with accidental exposure to radiation and or contamination with radioactive materials, especially when these patients also had life-threatening diseases or injuries. However, no public ambulance could get to the NPP because of concerns about the health effects of radiation, whereas almost 2,000 persons were still actively involved in emergency work at the NPPs every day after the earthquake. DISCUSSION Radiation is a unique external stress because it cannot be detected by human senses, and it does not cause immediate signs or symptoms. Moreover, there is no report showing that radiation exposure and/or contamination with radioactive materials alone has resulted in immediate death if not accompanied by other life-threatening disease or injury. Humans may not become aware of the occurrence of a radiological and nuclear incident unless an elevated level of radiation is detected by some device or information is provided by those who do have such instrumentation. In addition, radiation exposure may lead to late effects, including cancer, in the long term. Therefore, the health effects of radiation exposure are a major concern not only for the public but also for first responders and medical personnel regardless of the dose received. On the other hand, radiation can be monitored or measured even on-site or in an ambulance if an appropriate device is used.
Table 3. Training courses for fire departments by NIRS in Fukushima prefecture. Training courses were introduced at fire departments of Fukushima prefecture by NIRS after the accident. Fire Department Futaba area Soma area Iwaki area Fukushima city Aizuwakamatsu, Kitakata, and Minamiaizu areas Shirakawa area Date area
Date
No. of participants
Experts from NIRS
21 – 22 Sep 2011 3 – 4 Oct 2011 28 Oct 2011 28 – 29 Nov 2011 2 Feb 2012 3 Feb 2012 16 Mar 2012
83 50 32 80 147 51 50
4 3 4 5 4 4 4
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Fig. 4. Location of fire departments in Fukushima prefecture before the accident. In Fukushima prefecture, there are 12 fire departments: Fukushima city, Date, Adachi, Koriyama, Sukagawa, Shirakawa, Kita, Aizuwakamatsu, Minamiaizu, Soma, Futaba, and Iwaki. Fire departments where the training course was introduced (●) or not (○) by NIRS and divisions of the Futaba fire department () are presented (see also Table 3). The Futaba fire department and its divisions of Namie and Tomioka have now been temporarily relocated.
hospitals. This accident has clearly revealed the need for non-medical staff as well as all medical professionals to possess basic knowledge of radiation exposure and contamination with radionuclides. Without this basic knowledge among personnel, even a well organized system would not function effectively. In Japan, NPPs have been built at the seaside because of the need, at least in part, for cooling-water systems. Since primary hospitals were located near the nuclear facilities, medical staffs were also asked to evacuate. Moreover, some of them suffered damage from the earthquake and tsunami, rendering these primary-level hospitals nonfunctional. In the Tohoku district, which is located in the northeast of the main island of Japan, many DMATs were sent to hospitals and first aid care centers in the affected areas. However, the number of DMATs sent to Fukushima prefecture was less than to Iwate prefecture, which had less damage in terms of houses and buildings, whereas
Fukushima prefecture was located closer to the Tokyo metropolitan area, where many DMATs were ready to be dispatched. The reason remains unclear. When an earthquake measuring 6.8 struck the NiigataChuetsu region of Japan on 16 July 2007, it caused damage to the Kashiwazaki-Kariwa NPPs, the biggest NPP site in the world. A small amount of radioactive material was released into the air and sea; no significant radiological effects were detected in the environment or among the public, nor was any damage caused to the NPP monitoring system, although public infrastructure was affected. However, most DMAT members who had been sent from local governments without nuclear facilities to hospitals and first aid care centers at the NPP site were concerned about the effects of radiation because they lacked adequate knowledge about radiation (Akashi et al. 2010). The reason for the smaller number of DMATs in Fukushima may be related to concerns about radiation by the members, although
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REFERENCES
a more detailed study will be required. Recently, it has been emphasized that a medical response to radiation emergencies should be included in the general hospital-based disaster plan. Education and training for radiation emergencies are critical for all members who might be involved in a medical response to a disaster, since potential sources for radiation accidents are everywhere in daily life. On the other hand, what we also have to learn is that education and training are not always perfect. Therefore, the rapid access system to experts by phone or other means and the more effective system for sending experts on-site are also required, whereas the number of experts is limited. To the authors’ knowledge, there are few reports about significant effects of radiation exposure to health care providers receiving contaminated patients (Miller and Erdman 2004; IAEA 2005; NCRP 2005). However, there is one study that suggests that there may be rare situations where special precautions are necessary, even while managing a contaminated victim’s life-threatening injuries (Smith et al. 2005). The health physicist can provide information as well as evaluate the true extent and potential impact of any contamination present. If these procedures can be carried out properly, appropriate medical activities will take place in a safe and timely manner. From the experience gained from the accident at Tokai-mura, Japan, in 1999, the former Nuclear Safety Commission (NSC) of the Japanese Government clearly stated the roles of health physicists for radiation safety in emergencies in the Medical Guidelines for Radiation Emergency, issued in 2001 and revised in 2008 (NSC 2008). According to these guidelines, health physicists for radiation safety at NPPs or related companies have to accompany patients to hospitals in order to transport them smoothly and gain acceptance by hospitals. Moreover, they have to be trained for emergencies. With recommendations from these health physicists or experts in radiation protection, the dose and its rate from contaminated patients can be monitored during transportation, and contamination control can also be performed, even if knowledge of radiation is insufficient. It is vital that correct information about radiation exposure be provided prior to any possible accidents. Psychological and social problems can be prevented or at least minimized. We have learned again from the Fukushima accident that exact knowledge concerning radiation exposure is absolutely essential.
Akashi M, Hirama T, Tanosaki S, Kuroiwa N, Nakagawa K, Tsuji H, Kato H, Yamada S, Kamata T, Kinugasa T, Ariga H, Maekawa K, Suzuki G, Tsujii H. Initial symptoms of acute radiation syndrome in the JCO criticality accident in Tokai-mura. J Radiat Res 42 (Suppl):S157–S166; 2001. DOI: 10.1269/jrr.42.S157. Akashi M, Kumagaya K, Kondo H, Hirose Y. Concerns of disaster medical assistance team (DMAT) members about troubles at the nuclear power plant: experience from the Niigata– Chuetsu–Oki earthquake, 16 July 2007, in Japan. Health Phys 98:804–809; 2010. DOI: 10.1097/HP.0b013e3181ac924a. International Atomic Energy Agency. Generic procedures for medical response during a nuclear or radiological emergency. Vienna: International Atomic Energy Agency; 2005. International Atomic Energy Agency. Manual for first responders to a radiological emergency. Vienna: International Atomic Energy Agency; 2006. Japan Meteorological Agency. Information on the 2011 off the Pacific Coast of Tohoku Earthquake [online]. Tokyo: JMA; 2011. Available at www.jma.go.jp/jma/en/2011_Earthquake/ Information_on_2011_Earthquake.html. Accessed 10 July 2013. Koido Y, Kondo H, Ichihara M, Kohayagawa Y, Henmi H. Research on the DMAT response to the 2011 East Japan Earthquake. J Nat Inst Public Health 60:495–501; 2011. Miller K, Erdman M. Health physics considerations in medical radiation emergencies. Health Phys 87(Suppl):S19–S24; 2004. National Council on Radiation Protection and Measurements. NCRP Commentary No. 19, Key elements of preparing emergency responders for nuclear and radiological terrorism. Bethesda, MD: National Council on Radiation Protection and Measurements; 2005. Nuclear and Industrial Safety Agency, Japan Nuclear Energy Safety Organization. The 2011 off the Pacific Coast of Tohoku Pacific Earthquake and the Seismic Damage to the NPPs [online]. Tokyo: NISA and JNES; 2011. Available at www.meti.go.jp/press/2011/10/20111020001/20111020001. html. Accessed 10 July 2013. National Police Agency. Damage situation and police countermeasures associated with 2011Tohoku District: Off the Pacific Ocean Earthquake [online]. Tokyo: NPA; 2014. Available at www.npa.go.jp/archive/keibi/biki/higaijokyo.pdf. Accessed 11 March 2014 (in Japanese). Nuclear Safety Commission of Japan. Medical guidelines for radiation emergencies. Tokyo: NSC; NSCRG: T-EP-II.05; 2008. Smith JM, Ansari A, Harper FT. Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device. Health Phys 89:513–520; 2005. DOI: 10.1097/01. HP.0000175444.30788.75. Tokyo Electric Power Company. The Great East Japan Earthquake and current status of nuclear power stations [online]. Tokyo: TEPCO; 2012. Available at www.tepco.co.jp/en/nu/ fukushima-np/f1/images/f12np-gaiyou_e_1.pdf. Accessed 10 July 2013.
Acknowledgments—We thank Aki Yamamoto for her excellent assistance with this manuscript.
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