Doing more good than harm should be central to accident management
by: Adelaida Sarukhan, Deborah Oughton, Thierry Schneider and Elisabeth Cardis on behalf of the SHAMISEN consortium
What to do – and what not to do – in case of a future nuclear accident? How to improve the health surveillance of affected populations without creating unnecessary anxiety? Serious accidents at nuclear power plants have been rare, but their stories can help us answer these questions and teach us how to prevent or mitigate the effect of future nuclear catastrophes. This was precisely the goal of SHAMISEN, a European-funded project whose final conclusions we attempt to resume here.
Throughout the 18-month project, participants from nineteen European and Japanese institutions, together with experts from countries including the USA, Russian Federation, Ukraine and Republic of Belarus, reviewed lessons learned from past nuclear accidents (mainly Chernobyl and Fukushima) to identify what worked -or did not work- during the immediate, early and late phases of the accident. They also drew lessons from the experiences of populations directly affected by the Chernobyl accident (the Sami reindeer herders in Norway and the general Belarusian, Ukrainian and Russian population), and current activities with communities after the Fukushima accident in Japan.
These “lessons learned” provided the bases for a series of recommendations to improve the preparedness and response to nuclear accidents, and the health follow-up of affected populations. In addition, ethical issues and economic implications of the response were also considered, and a consultation process with stakeholders was conducted throughout the project in order to maximize the relevance and impact of the recommendations.
The final result of the project is a document with 28 recommendations to improve the preparedness, early and intermediate response, and recovery phase of a radiation accident (i.e. before, during and after), as well as 7 general principles that are also applicable to other types of accidents and disasters, including the overarching ethical principle of doing more good than harm. The recommendations can broadly be divided according to the activity: radiation dose assessment, evacuation and sheltering, health surveillance, epidemiology, and communication and training.
What to do before, during and after a radiation accident
The attached infographic summarizes the key messages of these recommendations. One major message is the need for a holistic approach when considering the overall well-being of a population: the impact of a nuclear accident goes way beyond direct radiation effects and includes considerable psychological, social and economic consequences that negatively affect the health of populations. Importantly, the psychological impact of a radiation accident (or any other accident) can be mitigated if the autonomy and dignity of affected populations is respected and if they are engaged in decision making.
Planning “in times of peace” is fundamental and includes a continuous cycle of training medical staff and other professionals, establishing or improving disease registries in order to measure changes in disease incidence after an accident, defining responsibilities in advance, preparing and risk communication plans, as well as evacuation protocols and routes (i.e. if, how and who should be evacuated). Indeed, analysis of the Fukushima response revealed the importance of balancing the risk of radiation exposure with other health risks associated with the evacuation process (especially among the elderly or critically ill patients) before giving evacuation orders. As previous emergencies show, creating a relationship of mutual trust between authorities, media and the public is the most important element in conveying messages to the latter. This in turn requires providing timely, updated and reliable information on the situation and the potential risks while accepting the uncertainty related to any emergency.
In this sense, the Fukushima experience has also highlighted the importance of “local facilitators” in helping to establish a dialogue between experts and affected communities during the recovery phase of the accident. This dialogue allows the latter to take informed decisions (for example on the food they consume or whether they return to their homes) and slowly regain control of their lives. Information and counselling is also an important element of health screening procedures, which should be offered to affected populations on a voluntary basis. However, studies to determine the long-term effect of the accident on the incidence of diseases such as cancers should only be launched if informative and sustainable over time. Again, the participation of affected populations with regard to health surveillance should be encouraged in order to improve the relevance, efficiency and acceptability of these interventions.
From paper to actions
The next step is to ensure that the final recommendations document produced by SHAMISEN reaches different stakeholders, including the scientific community, national authorities (such as health and civil protection), the European Commission and International organisations (such as WHO) so that they contribute to inform protocols and policies aimed at improving health and living conditions of populations potentially affected by radiation accidents
The ‘CONCERT-European Joint Programme for the Integration of Radiation Protection Research’ under Horizon 2020 is operating as an umbrella structure for the research initiatives jointly launched by the radiation protection research platforms MELODI, ALLIANCE, NERIS and EURADOS. Based on the platform SRAs and joint programming, CONCERT will develop research priorities, trying to seek further input from society and stakeholders. It will reach out to engage the wider scientific community in its projects, aiming to answer the needs in radiation protection for the public, occupationally exposed people, patients in medicine, and the environment.
Within CONCERT two major open RTD calls have been launched; the first one in 2016 and the other one in 2017.
The CONFIDENCE Project, funded under the H2020 CONCERT project, will perform research focussed on uncertainties in the area of emergency management and long-term rehabilitation. It concentrates on the early and transition phases of an emergency, but considers also longer-term decisions made during these phases. The project brings together expertise from four European Radiation Protection Research Platforms (NERIS, MELODI, ALLIANCE and EURADOS) and also from Social Sciences and Humanities, such that it can address the scientific challenges associated with model uncertainties and improve radioecological predictions and emergency management (NERIS and ALLIANCE), situation awareness and monitoring strategies (EURADOS), risk estimation in the early phase (MELODI), decision making and strategy development at local and national levels (NERIS) including social and ethical aspects (NERIS and Social Sciences and Humanities).
The work-programme of CONFIDENCE is designed to understand, reduce and cope with the uncertainty of meteorological and radiological data and their further propagation in decision support systems (including atmospheric dispersion, dose estimation, foodchain modelling and countermeasure simulations models). Consideration of social, ethical and communication aspects related to uncertainties is a key aspect of the project activities. Improvements in modelling and combining simulation with monitoring will help gaining a more comprehensive picture of the radiological situation and will clearly improve decision making under uncertainties. Decision making principles and methods will be investigated, ranging from formal decision aiding techniques to simulation based approaches. These will be demonstrated and tested in stakeholder workshops applying the simulation tools developed within CONFIDENCE. A comprehensive education and training programme is fully integrated with the research activities.
Scientists from the 31 partner organisations* from 17 European countries have met in Karlsruhe February 16 and 17, 2017, for the kick-off meeting of the project. Details of the work plan were refined and first steps defined. Links were identified with other ongoing projects (e.g. TERRITORRIES, also funded under the CONCERT project) and the project partners are very happy to share methods and results with their colleagues.
*KIT (Germany), BFS (Germany), NERC-CEH (United Kingdom), CEPN (France), CIEMAT (Spain), EPA (Ireland), EEAE (Greece), HMGU (Germany), IRSN (France), Mutadis (France), NMBU (Norway), NRPA (Norway), University of Zurich (Switzerland), DH PHE (United Kingdom), DTU (Denmark), RIVM (Netherlands), SCK-CEN (Belgium), STUK (Finland), UMIL (Italy), VUJE (Slovakia), KNMI (Netherlands), APA (Portugal), Dialogik (Germany), University of Warwick (United Kingdom), IST (Portugal), REC (Slovenia), DLO RIKILT (Netherlands), University of Extremadura (Spain), Met Office (United Kingdom), MTA EK (Hungary), NMI (Norway)
Further information can be found on the CONFIDENCE web page.
The TERRITORIES project has been selected for funding following 1st CONCERT Transational Call, topic 2 (Reducing uncertainties in human and ecosystem radiological risk assessment and management in nuclear emergencies and existing exposure situations, including NORM). Eleven partners* are involved in this 3-year-project (2017-2019). All of them were represented at the kick off meeting in Paris gare de l'Est on 27th of January.
TERRITORIES targets an integrated and graded management of contaminated territories characterised by long-lasting environmental radioactivity, filling in the needs emerged after the recent post-Fukushima experience and the publication of International and European Basic Safety Standards. A graded approach, for assessing doses to humans and wildlife and managing long-lasting situations (where radiation protection is mainly managed as existing situations), will be achieved through reducing uncertainties to a level that can be considered fit-for-purpose. The integration will be attained by:
This project interlinks research in sciences supporting radiation protection (such as radioecology, human or ecological dose and risk assessments, social sciences and humanities, etc.), providing methodological guidance, supported by relevant case studies. The overall outcome is an umbrella framework, that will constitute the basis to produce novel guidance documents for dose assessment, risk management, and remediation of NORM and radioactively contaminated sites as the consequence of an accident, with due consideration of uncertainties and stakeholder involvement in the decision making process. The results will be widely disseminated to the different stakeholders and accompanied by an education and training programme.
Thus, the eleven partners of TERRITORIES will develop a common coherent guidance with a greater understanding of multiple sources of uncertainties along with variabilities in exposure scenarios, making the best use of scientific knowledge to characterize human and wildlife exposure, integrating this knowledge and know-how to reduce uncertainties and finally taking consideration of social, ethical and economic aspects to make decisions.
*IRSN, lead (France), BfS (Germany), CEPN (France), CIEMAT (Spain), NMBU (Norway), NRPA (Norway), Public Health England (United Kingdom), Belgium Nuclear Research Center (Belgium), STUK (Finland), University of Tartu (Estonia), Mutadis(France)
Further information can be found on the TERRITORIES web page.
The OPERRA (Open Project for European Radiation Research Area) project, launched in June 2013 for four years with the financial support of the European Commission, aims to establish a legal coordination structure and logistics to manage European calls for research projects in radiation protection, in various topics: low-dose risk, radioecology, nuclear emergency and recovery management, and also research activities related to the medical uses of ionising radiation.
OPERRA have prepared the organisation of two competitive calls. The first call was launched at the end of 2013 for projects in low-dose risk research. The second competitive call was launched in 2014 for broader projects in radiation protection research.
In the unlikely yet not impossible case of a future nuclear accident, what do we need to do (or not do) in order to improve the follow-up of affected populations and respond to their needs without creating unnecessary anxiety? This is what the European SHAMISEN project tries to answer. Indeed, as part of the OPERRA European Research project, the SHAMISEN project aims to draw lessons from the Chernobyl and Fukushima accidents and other major nuclear accidents in order to make recommendations for medical and health surveillance of affected populations. These recommendations should improve preparedness for responding to the needs of people affected by previous and possible future radiation accidents, while minimising unnecessary anxiety.
Further information can be found on the SHAMISEN Website.
Beginning of November 2015, HAMRONE started as integral part of the European OPERRA project. It will last for 18 months and consist of six research partners (HMGU, IRSN, KIT, PHE, SCK•CEN, UCEWP) and three advisory organisations (BfS, IAEA, RIVM). HARMONE aims to reduce scientific, methodological and operational gaps identified in the strategic research agendas of the four European Platforms in the area of radiation protection and issued as TOPIC 2 of the OPERRA-2014 Call: “Spatial and temporal environmental modelling and human dose assessment after a nuclear accident”.
HARMONE aims to harmonize and expand the modelling approach of the European decision support systems (DSS) RODOS and C3X/SYMBIOSE. To achieve this goal, the project will deal with many possible release scenarios, environmental characteristics and shortcomings on information in the early phase of an emergency. To adapt the models better to the environmental conditions all over Europe, geographical and climatic influences on regional fishing and farming practice will be assessed. It is then planned to divide Europe into regions with common radioecological characteristics, collect the relevant data and implement them as generic information in the DSS. Aquatic, groundwater, snow melt, forest and terrestrial models in these DSS will be updated with the new data sets and their implementation improved.
Uncertainty analysis of the SYMBIOSE models can be done to identify relevant exposure pathways, parameters and FEP for the different scenarios and regions. Results from this process may suggest improvements in monitoring strategies which are also part of HARMONE. With this information, recommendations for the monitoring of radiological parameters necessary for the DSS after radiological incidents can be developed. Finally, the project will develop a knowledge data base and guidance that allows, according to the first event description, to propose a first management strategy to reduce doses and highlights potential issues for the dose assessment.
Child and Adult Thyroid Monitoring After Reactor Accident
A nuclear power plant accident will cause uncontrolled release of a large amount and complex mixture of radionuclides; however 131I generally makes the largest dose contribution. After the Chernobyl accident, many citizens received thyroid doses exceeding 1 Gy due to radio-iodine intakes and more than 6 000 thyroid cancers (mostly in children) were attributed to radio-iodine intakes. After the Fukushima accident, about 98% of the effective dose received by emergency workers was attributable to radio-iodine intakes.
Following a large scale nuclear accident, or even a small accidental release, citizens will expect to be individually monitored rather than rely on calculated dose. This project focuses on post-accidental 131I measurement in the thyroid, particularly for children.
This project focuses on the monitoring strategies and assessment of thyroid doses resulting from intakes of radio-iodine. Monitoring strategies will address monitoring of children and adults, required capabilities and existing gaps. Strategies will also address harmonization of measurements and dose assessment to be done by national authorities, within the European Union and neighbouring countries.
This project relies on a review of existing European means, on two thyroid measurement inter-comparison circuits, focusing on children, on Monte-Carlo based device calibrations and on the development of emergency oriented dose assessment methods.
Identified gaps such as the children case will be solved and other potential gaps will be revealed.
The main outcome of the project will be guidelines based on practical experience and on the comparison of existing and required means. Guidelines will also benefit from the inputs of the civil society.
Based on the work of the other work packages, on literature review and on the experience of the participants the following guidelines will be made publically available:
The guidelines and the report of work packages will be made publically available on June 2017.
Conclusions will be presented in conference and peer-reviewed articles
This work is funded by the European Commission for 18 months through the OPERRA (Open Project for the European Radiation Research Area, project #604984) project. OPERRA is part of the FP7-Fission-2013 program.
IRSN (France), CIEMAT (Spain), Czech Technical University in Prague (Czech Republic), Gothenburg University (Sweden), IFIN-HH (Romania), IST-ID (Portugal), MTA- CER (Hungary) , Mutadis (France), NCBJ (Poland), Public Health England (UK), RPI (Ukraine), SCK-CEN (Belgium, SÚRO (Czech Republic)
The PREPARE project (2013-2016) aimed to close gaps that had been identified in nuclear and radiological preparedness following the first evaluation of the Fukushima disaster. Among others, the project addressed the review of existing operational procedures for dealing with long lasting releases, cross border problems in monitoring and food safety and further developed missing functionalities in decision support systems ranging from improved source term estimation and dispersion modelling to the inclusion of hydrological pathways for European water bodies. In addition, as the management of the Fukushima event in Europe was far from optimal, a so called Analytical Platform have been developed exploring the scientific and operational means to improve information collection, information exchange and the evaluation of such types of disasters. This was achieved through a collaboration of industry, research and governmental organisations in Europe taking into account the networking activities carried out under the NERIS-TP project.
For further information, please download the dedicated document.
Proceedings related to PREPARE Workshop held in Oslo in January 2014 are published in a special issue of the journal Radioprotection (Vol. 51 - HS n°2 -2016).
The NERIS- TP Project (2011-2014) aimed on the one hand to keep the momentum gained through the European Project EURANOS in establishing a platform where the operational and research community can meet and discuss with all the relevant stakeholders the topics related to emergency response and recovery preparedness and on the other hand to tackle urgent research topics in the area of nuclear emergency response and recovery preparedness. Through a collaboration of industry, research and governmental organisations in Europe, methodological aspects and computational models have been developed to be consistent with recommendations from international bodies such as the ICRP (International Commission for Radiological Protection) and improve Europe’s response by coupling decision support systems with an emergency information system such as the European wide information system ECURIE. Within this project, the NERIS platform was established as a unique place for combined meeting of the research and the operational community.
For further information, please download the dedicated document.
Proceedings related to NERIS-TP Workshop held in Oslo in January 2014 are published in a special issue of the journal Radioprotection (Vol. 51 - HS n°1 -2016).
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