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.
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.
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
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