Koichi Tanigawa · Rethy Kieth Chhem Editors Radiation DDDDDDDiiiiiiisssssssaaaaaaasssssssttttttteeeeeeerrrrrrr MMMMMMMeeeeeeedddddddiiiiiiiccccccciiiiiiinnnnnnneeeeeee Perspective from the Fukushima Nuclear Accident Radiation Disaster Medicine Koichi Tanigawa (cid:129) Rethy Kieth Chhem Editors Radiation Disaster Medicine Perspective from the Fukushima Nuclear Accident Editors Koichi Tanigawa Rethy Kieth Chhem Department of Emergency and Critical Care Division of Human Health Medicine International Atomic Energy Agency Hiroshima University Vienna Hiroshima Austria Japan ISBN 978-3-319-02215-4 ISBN 978-3-319-02216-1 (eBook) DOI 10.1007/978-3-319-02216-1 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2013955234 © Springer International Publishing Switzerland 2014 This work is subject to copyright. 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This book is intended for educational and informational purposes only and should not be construed as medical advice. Information in this book is not a substitute for professional diagnosis or treatment. Please consult your physician before beginning any course of action based on the topics covered in this book. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword “Radiation emergency medicine,” in the modern sense of the word, began in Japan with the reception, triage, and overall medical management of three victims from the Tokai-mura criticality accident in 1999. Following this event, Japan’s radiation emergency medical preparedness and response system had been drastically restruc- tured. It was the system unique to Japan, coincident with its Emergency Medical Services (EMS) system, and comprised the echelon of facilities and care from pri- mary to tertiary. At the same time, a well-structured training program has been actively carried out since 2001, targeting medical, EMS personnel, local offi cials, and others for the fi rst response to radiological emergencies. The assumed worst scenario was that of the Three Mile Island Nuclear Power Plant accident. One draw- back was that the system as well as training and even the drills were in effect only in localities where the nuclear facility was located. Thus, the system could have been termed that of “radiation emergency medicine.” Then the Fukushima Daiichi Nuclear Power Plant accident occurred, combined with the earthquake and subsequent tsunami. Admittedly, it caused great confusion in the immediate medical response because it was far beyond what had been expected and planned. However, the medico-social responses in Fukushima were nothing really new but something revisited. Things similar to what has been done in Fukushima in terms of disaster medical response were fi rst practiced in the Chernobyl disaster in the former Soviet Union in 1986 and thereafter and then in the 1987 Goiania accident in Brazil. Namely, there were various radioprotective measures for the public and the environment on an extremely large scale where some medical involvement was inevitably required: sheltering, evacuation, stable iodide administration, radiation survey, decontamination, food and water restriction, relocation, etc. Thus, the medical management of the various aspects of a nuclear disaster in its acute stage such as practiced in these events can be defi ned as “radiation disaster medicine.” It is not just “radiation emergency medicine” but encompasses the medical involvement in those activities unique to nuclear disaster in addition to common issues with other disasters. Theoretically it can be considered as the on-scene appli- cation of knowledge and skills, among others, in emergency medicine, disaster medicine, radiology, psychiatry, and public health. In actuality, however, we have not discussed or studied systematically this area of the comprehensive medico- social response to a combined natural and nuclear disaster. v vi Foreword From the Tokai-mura criticality accident experience, we learned that the human network established ahead of time was crucially important to better deal with the diffi cult situation since the human resources in this fi eld were scant. Most authors of this book have known each other through this human network and are credible experts small in number. There are a few textbooks or manuals on radiation emergency medicine; how- ever, they are not always based on the actual experience, have not stood the test of time, and usually presuppose an intact medical system. In a sense, this book is the fi rst effort of its kind. This book is not just a textbook but contains the actual descriptions of what responders and others had to do or what they have found at various points in time and at various places during and after this unprecedented, most severe nuclear accident in history. A nuclear accident causes far greater sociopsychological effects than other disasters, and it is well known that equal emphasis should be placed on psychological and physical health care of the affected. Physicians and medical personnel may be driven to play the key role in commu- nicating with the public in the relevant and timely fashion to alleviate their anxiety and fear. These two important aspects of the medical response to a nuclear disaster are well described in this book, and the chapters serve as a good reference. Readers can better understand what actually happens in a radiation disaster, particularly caused by a major nuclear power plant accident. Readers may also refer to this book as the “ABC” in radiation disaster medicine as they prepare for the worst nuclear disaster scenario. It is hoped that readers will fi nd this a useful reference. Tsurushi , Japan Kazuhiko Maekawa , M.D. Pref ace There are many books available on “Disaster Medicine,” but to the best of our knowledge, there is currently no book available that addresses “Radiation Disaster Medicine.” The idea for this book was born from a discussion between the two edi- tors while attending the “International Academic Conference on Radiation Health Risk Management in Fukushima” held in Fukushima on 25–27 February 2013. The two of us have had frequent interactions with physicians from Fukushima Medical University, Hiroshima University, and Nagasaki University and a few other medical institutions in Japan. We have come to learn that during the initial phase of the accident, physicians and Japan Disaster Medical Assistance Teams provided medical relief in an extremely diffi cult environment; infrastructure including medical, transportation, water and electricity supplies, and communi- cation systems were disrupted. We were impressed by the courage and sacrifi ce demonstrated by frontline responders. They provided emergency services in the midst of the combined disasters, putting their own life at risk, while the extent of radiation risk was still unknown. The book Radiation Disaster Medicine provides an overarching conceptualiza- tion of the problem based on what we have learned from the Fukushima accident in particular which we believe will offer guidance for medical management during the acute phase of a radiation disaster. The concept includes understanding physicians’ roles in radiation disasters (from micro and macro perspectives), imbuing lessons from past radiation disasters, and preparing for future radiation emergencies. No clear defi nition of radiation disaster medicine has been articulated after the Chernobyl and Three Mile Island accidents. The radiation emergency medical sys- tem developed in Japan after the Three Mile Island and JCO accidents did not offer suffi cient breadth or depth to manage the Fukushima accident, which was further complicated by the destruction caused by the combined natural disasters. Thus, many physicians were not suffi ciently prepared to manage the Fukushima accident. This book offers an emphasis on medical and psychological readiness that is essen- tial in mitigating any radiation disasters. Additionally, although no death from acute radiation syndrome was encountered in the Fukushima accident, there were unex- pected casualties during evacuation and marked diffi culties in medical management even though they were unrelated to radiation. An overarching purpose of this book is therefore to broaden the lens, examine the unique challenges that physicians face, and introduce readers to some key institutions in radiation disaster situations. vii viii Preface This book employs a comprehensive approach that includes medical basics and social considerations, covers all levels of emergency care (primary, secondary, ter- tiary), and clarifi es common issues and specifi c considerations in radiation and other disasters. It is to be noted that this book should not be perceived as excluding disaster medical responses for other disasters but that it is especially focused on radiation disasters. Radiation Disaster Medicine is intended for health-care profes- sionals, prehospital emergency care providers, and emergency personnel involved in responses. Through this book, readers can better understand what happens in radiation disaster in order to provide appropriate management and care for those injured, evacuees, and residents. Knowledge of radiation disaster medicine is made up to date for health-care professionals in all fi elds, as well as recommended to be included into medical school curriculum for capacity building. Finally, an expected outcome would be minimization of confusion and misconceptions among emer- gency personnel and residents in the case of another radiation disaster . Hiroshima, Japan Koichi Tanigawa Vienna, Austria Rethy Kieth Chhem Contents 1 Physicians’ Early Response to the Fukushima Daiichi Nuclear Power Plant Accident: Challenges and Lessons Learned. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Rethy Kieth Chhem 2 General Considerations in Radiation Disaster Medicine. . . . . . . . . . 15 Koichi Tanigawa 3 Medical Perspective. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Koichi Tanigawa and Arifumi Hasegawa 4 Disaster Behavioral Health: Psychological Effects of the Fukushima Nuclear Power Plant Accident. . . . . . . . . . . . . . . . 79 Masaharu Maeda and Misari Oe 5 Management Perspective: Structure of Radiation Emergency Response in Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Takako Tominaga, Misao Hachiya, and Makoto Akashi 6 Management Perspective: Structure of Radiation Emergency Response in International Organizations . . . . . . . . . . . . . . . . . . . . . . 99 Azura Z. Aziz and Pisith Phlong 7 Radiation Disaster Medicine Curriculum Revisited in a Post- Fukushima Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Rethy Kieth Chhem, Azura Z. Aziz, and Gregory K. Clancey Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 ix