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Nuclear Power Plant / Nuclear Reactor Incidents General Information Emergency Planning and Response Radioisotopes in the Plume and Recommendations for Potassium Iodide Countermeasure Responder Willingness to Serve During Radiation Disasters References
General Information The core of a nuclear reactor (including those found in nuclear power plants), contains large amounts of highly radioactive material. There are various kinds (designs) of nuclear reactors. Site safety is enhanced by many factors including Stainless steel core around the radioactive material Very thick concrete walls of the containment building Highly trained staff Detailed security precautions and procedures Adherence to formal, detailed incident response plans Requirements to practice these response plans regularly Nuclear power plant accidents information sheet for the general public (HHS/CDC) top of page
Emergency Planning and Response The Emergency Planning Zone (EPZ) Definition: the area surrounding a nuclear power plant for which plans required by the NRC have been made in advance to ensure that prompt and effective actions are taken to protect the health and safety of the public in case of an incident The Nuclear Regulatory Commission (NRC) has described 2 EPZs Plume Exposure Pathway EPZ: within a 10 mile (16.1 km) radius of the nuclear power plant where potential exposure could be from any or all of the following sources Whole-body external exposure to gamma radiation from the passing plume and from deposited material Thyroid exposure through inhalation from the passing plume Committed effective dose equivalent exposure to other critical organs through inhalation Ingestion Exposure Pathway EPZ: within a 50 mile (80.5 km) radius of the nuclear power plant where potential exposure could be from any or all of the following sources Ingestion of contaminated water or foods, such as milk, fresh vegetables, and aquatic foodstuffs, may result in increased risk of radiation-induced cancer to the thyroid, bone marrow, and other organs Generalized Protective Action Areas for Nuclear Power Plant Incident
(Source: EPA PAG Manual 2017 (PDF - 1.48 MB), See Figure 4-1, page 54. See also entire PAG Manual section on Intermediate Phase: Relocation and Dose Reduction) If a release of radioactivity occurs, response managers will recommend public health protective actions. Depending on the circumstances, these actions could include Evacuation from areas at risk of being significantly contaminated by the plume Sheltering-in-place (intake ventilation off, windows closed) to avoid the radioactive plume Interdiction of contaminated or potentially contaminated food Use of medical countermeasures If a serious release of radioactivity occurs, there is likely to be a window of time before it starts, so that the response plan can be implemented. Radioisotopes released into the air after an incident could contain alpha, beta and gamma radiation Workers close to the reactor could be affected by External exposure to highly radioactive materials within the reactor External contamination by radioactivity released and dispersed locally in the plume Internal contamination by radioactivity released, dispersed locally, and then ingested, inhaled, and/or incorporated The general public could be affected by External contamination by radioactivity released and dispersed widely in the plume Internal contamination by radioactivity released, dispersed widely, and then ingested, inhaled, and/or incorporated Routine preparedness signs in regions potentially at risk after a nuclear power plant incident might look something like the one below which was photographed in Solomons Island, Maryland, September 2016
Selected key documents Key Federal Document with Recommendations about Reactor Accidents and Use of Potassium Iodide (KI) (PDF - 7.41 MB) (FEMA, FRPCC October 23, 2007) Official name of document: "Interagency Technical Evaluation Paper for Section 126(f) of the Bioterrorism Act of 2002". Document was prepared by the Potassium Iodide (KI) Subcommittee of the Federal Radiological Preparedness Coordinating Committee. Key sections important for medical responders include Dose and Health Effects Fission products important to offsite consequences Reactor accident exposure pathways Emergency Preparedness and Nuclear Power Plants Thyroid physiology Evidence based information about Use of Potassium Iodide Communicating During and After a Nuclear Power Plant Incident (US Government Interagency Nuclear Detonation Response Communications Working Group, June 2013) Nuclear/Radiological Incident Annex to the Response and Recovery Federal Interagency Operations Plan (PDF - 3.38 MB) (US Government Interagency, 2016) top of page
Radioisotopes in the Plume and Recommendations for Potassium Iodide Countermeasure Radioiodines Can travel over long distances in air after release and settle to the ground Can be inhaled or ingested from the water supply or food chain except for foodstuffs that were encapsulated/sealed/canned prior to the event See Figure 1 illustration of exposure to Iodine-131 through ingestion. Primary health threat from a release is likely to be from radioiodines and I-131 particularly, although other radioiodine isotopes are possible. Heath effects No short term acute health effects Potential longer term health effects could develop if there is sufficient internal contamination and incorporation of radioiodine by the thyroid gland. These late effects could include Hypothyroidism, with special consequences in infants and children Thyroid cancer, particularly in younger individuals Radioiodine is not concentrated in organs other than the thyroid. Prophylaxis (before the exposure) and treatment (after the exposure) to radioactive iodine Administration of non-radioactive potassium iodide (KI) or other iodine substances blocks the thyroid from accumulating radioactive iodine, thereby minimizing/avoiding subsequent risks. KI is most effective if given a few hours before exposure, but it is also effective if given within several hours after exposure. The need for prophylaxis and/or treatment with KI will be determined by officials managing the event, and instructions to the general public will be given based on the assessment of risk. KI should be taken only on the advice of emergency management officials, public health officials, or a personal physician. Time Line of Potassium Iodide Distribution Policies in the US Other radioisotopes might be released, with possible health effects only if an individual receives a high enough dose Cesium-137 (and Cesium-134) List of radionuclides likely to be found in nuclear reactors and spent reactor fuel, but not necessarily in a plume released after an incident. Even if some radioactive material were measured in air, surface water, and/or rain water, the concentration is expected to be below that of public health concern. List of radionuclides/fission products important to offsite consequences (See Table 1-2, page 22 of this pdf document) (PDF - 7.41 MB) (FEMA, FRPCC October 23, 2007) Monitoring radionuclides in drinking water and food: routinely and after a release Figure 1. Internal Exposure to Iodine-131 Through Ingestion
Adapted from Radioactive Iodine (I-131) and Thyroid Cancer — An Education Resource (PDF - 791 KB) (HHS/National Cancer Institute/Division of Cancer Epidemiology and Genetics) top of page
Responder Willingness to Serve During Radiation Disasters Balicer RD, Catlett CL, Barnett DJ, Thompson CB, Hsu EB, Morton MJ, Semon NL, Watson CM, Gwon HS, Links JM. Characterizing hospital workers' willingness to respond to a radiological event. PLoS One. 2011;6(10):e25327. [PubMed Citation] Sheikh S, McCormick LC, Pevear J, Adoff S, Walter FG, Kazzi ZN, Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States. Clin Toxicol (Phila). 2012 Jan;50(1):34-8. Epub 2011 Dec 19. [PubMed Citation] Becker SM, Middleton SA. Improving hospital preparedness for radiological terrorism: perspectives from emergency department physicians and nurses. Disaster Med Public Health Prep. 2008 Oct;2(3):174-84. [PubMed Citation] Veenema TG, Walden B, Feinstein N, Williams J. Factors Affecting Hospital-based Nurses' Willingness to Respond to a Radiation Emergency. Disaster Med Public Health Prep. 2008 Dec;2(4):224-9. [PubMed Citation] top of page
References General information 1. The Science of Responding to a Nuclear Reactor Accident: Summary of a Symposium (National Academies Press, 2014) 2. Coleman CN, Blumenthal DJ, Casto CA, Alfant M, Simon SL, Remick AL, Gepford HJ, Bowman T, Telfer JL, Blumenthal PM, Noska MA, Recovery and Resilience After a Nuclear Power Plant Disaster: A Medical Decision Model for Managing an Effective, Timely, and Balanced Response, Dis Med Pub Health Prep 2013;7(2),2013. [PubMed Citation] 3. Zwolinski LR, Stanbury M, Manente S. Nuclear power plant emergency preparedness: results from an evaluation of Michigan's potassium iodide distribution program. Disaster Med Public Health Prep. 2012 Oct;6(3):263-9. [PubMed Citation] 4. Christodouleas JP, Forrest RD, Ainsley CG, Tochner Z, Hahn SM, Glatstein E. Short-Term and Long-Term Health Risks of Nuclear-PowerPlant Accidents. N Engl J Med. 2011 Jun 16;364(24):2334-41. [PubMed Citation] Reviews 1. Lancet series of 14 articles about historical radiation incidents including weapons testing, nuclear detonations and power plant incidents: Japan: from Hiroshima and Nagasaki to Fukushima To coincide with 70th anniversary of the atomic bombs in Hiroshima and Nagasaki, on July 31, 2015, Lancet published 14 articles about the enduring radiological, nuclear and psychological impact of radiation disasters. The excellent series also provides information about public health planning to manage potential future disasters. The goal is to protect the millions of people who live in areas surrounding the 437 nuclear power plants that are in operation worldwide. Citation: Lancet August 2015; 386(9992):405-500. Some, but not all articles, are free. Guidance documents about nuclear power plant operations and accidents 1. Program Manual, Radiological Emergency Preparedness, (DHS/FEMA P-1028, January 2016) The Radiological Emergency Preparedness Program (REP Program) coordinates the National effort to provide State, local, and Tribal governments with relevant and executable planning, training, and exercise guidance and policies necessary to ensure that adequate capabilities exist to prevent, protect against, mitigate the effects of, respond to, and recover from incidents involving commercial nuclear power plants (NPPs). REP Program serves as the principal source of policy and guidance for the FEMA REP Program. REP Program is guided by the standards, criteria, and policy found in applicable laws, regulations, and contemporary emergency preparedness guidance, including the following 10 CFR 50 - Domestic Licensing of Production and Licensing Facilities 10 CFR 52 - Licenses, Certifications and Approvals for Nuclear Power Plants 44 CFR 350 - Review and Approval of State and Local Radiological Emergency Plans and Preparedness 44 CFR 353 - Emergency Management and Assistance / Fee for Services in Support, Review, and Approval of State and Local Government or Licensee Radiological Emergency Plans and Preparedness NUREG-0654/FEMA-REP-1 Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants Provides additional detail to offsite response organizations (OROs) on what FEMA expects them to include in their radiological emergency response plans Provides the Demonstration Criteria that FEMA uses to evaluate the ability of the OROs to implement their radiological emergency response plans, including 16 benchmark planning standards Additional information and guidance to help FEMA staff and OROs perform various REP Program functions (e.g., checklists, templates, references, etc.) 2. Actions to Protect the Public in an Emergency due to Severe Conditions at a Light Water Reactor (IAEA, 2013) 3. The Science of Responding to a Nuclear Reactor Accident: Summary of a Symposium (National Academies Press, 2014) 4. Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents (PDF - 519 KB) (DHS/FEMA, published in Federal Register, August 1, 2008, Z-RIN 1660-ZA02) 5. Contamination Monitoring Guidance for Portable Instruments Used for Radiological Emergency Response to Nuclear Power Plant Accidents (PDF - 233 KB)(FEMA, October 2002) Guidance documents about managing internal contamination 1. Braverman ER, Blum K, Loeffke B, Baker R, Kreuk F, Yang SP, Hurley JR. Managing terrorism or accidental nuclear errors, preparing for iodine-131 emergencies: a comprehensive review. Int J Environ Res Public Health. 2014 Apr 15;11(4):4158-200. [PubMed Citation] 2. Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases (NCRP Report No. 161, Volume II), National Council on Radiation Protection and Measurements, Bethesda, MD, 2010. 3. Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Volume I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008. 4. Management of Persons Accidentally Contaminated with Radionuclides (NCRP Report No. 65), National Council on Radiation Protection and Measurements, Bethesda, MD, 1980. [This document has been superseded by NCRP 161.] 5. Dose assessment of inhaled radionuclides in emergency situations (Public Health England [PHE], formerly Health Protection Agency [HPA]/United Kingdom and Treatment Initiatives After Radiological Accidents (TIARA) project/European Commission, August 2007) History of radiation incidents Fukushima 1. Lancet series of 14 articles about historical radiation incidents including weapons testing, nuclear detonations and power plant incidents: Japan: from Hiroshima and Nagasaki to Fukushima To coincide with 70th anniversary of the atomic bombs in Hiroshima and Nagasaki, on July 31, 2015, Lancet published 14 articles about the enduring radiological, nuclear and psychological impact of radiation disasters. The excellent series also provides information about public health planning to manage potential future disasters. The goal is to protect the millions of people who live in areas surrounding the 437 nuclear power plants that are in operation worldwide. Citation: Lancet August 2015; 386(9992):405-500. Some, but not all articles, are free. 2. Developments Since the 2013 UNSCEAR Report on the Levels and Effects of Radiation Exposure Due to the Nuclear Accident Following the Great East-Japan Earthquake and Tsunami, A 2015 White Paper to Guide the Scientific Committee's Future Programme of Work. (UNSCEAR) Report Attachments cited in this paper Ongoing updates with latest IAEA information on Fukushima incident 3. Fukushima—Five Years After: Thyroid Cancer (PDF - 199 KB) (NCRP, November 16, 2016, The Boice Report #52) 4. Hasegawa A, Ohira T, Maeda M, Yasumura S, Tanigawa K. Emergency Responses and Health Consequences after the Fukushima Accident; Evacuation and Relocation. Clin Oncol (R Coll Radiol). 2016 Apr;28(4):237-44. [PubMed Citation] 5. IAEA information on Fukushima Nuclear Accident (IAEA) The Fukushima Daiichi Accident Publications List (IAEA) 6. The Science of Responding to a Nuclear Reactor Accident: Summary of a Symposium (National Academies Press, 2014) 7. Tominaga T, Hachiya M, Tatsuzaki H, Akashi M. The accident at the Fukushima Daiichi Nuclear Power Plant in 2011. Health Phys. 2014 Jun;106(6):630-7. [PubMed Citation] 8. Kondo H, Shimada J, Tase C et al. Screening of Residents Following the Tokyo Electric Fukushima Daiichi Nuclear Power Plant Accident. Health Phys. 2013 Jul;105(1):11-20. 9. Gonzalez AJ, Akashi M, Boice JD Jr, Chino M, Homma T, Ishigure N, Kai M, Kusumi S, Lee JK, Menzel HG, Niwa O, Sakai K, Weiss W, Yamashita S, Yonekura Y. Radiological protection issues arising during and after the Fukushima nuclear reactor accident. J Radiol Prot. 2013 Sep;33(3):497-571. [PubMed Citation] 10. The International Workshop on Radiation and Thyroid Cancer (NEA/CRPPH/R(2014)3), Organization for Economic Co-operation and Development, Nuclear Energy Agency, Tokyo, Japan, February 2014. What is known today about thyroid cancer and radiation What has been learned from past nuclear and radiological accidents What actions have and are being taken to assess the potential for thyroid cancer in Fukushima and Japan from the Fukushima accident Relevant aspects of stakeholder involvement and planned activities 11. EPA Information and Resources (EPA) 12. Levels and effects of radiation exposure due to the nuclear accident after the 2012 great east-Japan earthquake and tsunami. UNSCEAR 2013 Report to the General Assembly ,Volume I, Scientific Annex A. See chapter III (page 6-12) for excellent UNSCEAR summary report on the levels and effects of radiation exposure due to the nuclear accident after the 2011 great east-Japan earthquake and tsunami. 13. UNSCEAR Press Briefing on Fukushima, May 31, 2013, YouTube video. Scientific discussion begins at 4 min 45 secs. 14. Health Physics News, The Boice Report #11, Aprils 2013: Summary of the NCRP February 2013 Fukushima Conference (PDF - 155 KB) 15. Gonzalez A, Akashi M, Boice JD, et al. Radiological protection issues arising during and after the Fukushima nuclear reactor accident. J Radiol Prot. 2013 Jun 27;33(3):497-571. [PubMed Citation] 16. Acton JM, Hibbs, M. Why Fukishima was Preventable, Carnegie Endowment for International Peace, 2012 17. Wilson T, Chang F, Berro A, et al. US screening of international travelers for radioactive contamination after the Japanese nuclear plant disaster in March 2011. Disaster Med Public Health Prep. 2012 Oct;6(3):291-6. [PubMed Citation] 18. Akiba S. Epidemiological studies of Fukushima residents exposed to ionising radiation from the Fukushima Daiichi Nuclear Power Plant prefecture--a preliminary review of current plans. J Radiol Prot. 2012 Mar;32(1):1-10. [PubMed Citation] 19. Fukushima Nuclear Reactor Radiation Crisis: A National Review of the U.S. Domestic Public Health and Medical Response (PDF - 1.01 MB) (Association of State and Territorial Heath Officials, May 2012) 20. The Journal of Radiological Protection published a special subsection of the March 2012 issue with 22 excellent articles on the Japanese Fukushima nuclear power plant incident (based on the September 2011 International Expert Symposium in Fukushima: Radiation and Health Risks) J Radiol Prot. 2012 Jun;32(1) (special section) 21. Becker SM. Learning from the 2011 Great East Japan Disaster: insights from a special radiological emergency assistance mission. Biosecur Bioterror. 2011 Dec;9(4):394-404. [PubMed Citation] 22. Fukushima Daiichi nuclear disaster (Wikipedia) Chernobyl 1. Gilbert W. Beebe Symposium on 30 Years after the Chernobyl Accident: Current and Future Studies on Radiation Health Effects (National Academy of Sciences (NAS), Nov 1-2, 2016, 12 web cast lectures and pdfs of slides) 2. IAEA information about the Chenobyl accident (IAEA) 3. Balonov MI. On protecting the inexperienced reader from Chernobyl myths. J Radiol Prot. 2012 Jun;32(2):181-9. Epub 2012 May 8. [PubMed Citation] 4. Thomas GA (ed.), The Radiobiological Consequences of the Chernobyl Accident 25 Years On - April 2011, Clin Oncol (R Coll Radiol). 2011 May;23(4):229-308. (Note: All 11 articles in this issue are on this topic.) 5. Chernobyl disaster (Wikipedia) 6. See also: History of Radiation Incidents CDC/ATSDR 1. Potassium Iodide (CDC, March 17, 2011) 2. Radiation and Potassium Iodide (CDC, March 18, 2011) 3. Case Studies in Environmental Medicine (CSEM): Radiation Exposure from Iodine 131, Course SS3117. (HHS/ATSDR, November 2002) FDA 1. Frequently Asked Questions on Potassium Iodide (KI) (March 18, 2011, HHS/FDA) 2. Guidance: Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies (PDF - 40 KB) (HHS/FDA, December 2001) 3. Other KI resources including information for infants and small children (HHS/FDA) Nuclear Regulatory Commission 1. Consideration of Potassium Iodide in Emergency Planning 2. Fact sheet on Emergency Preparedness at Nuclear Power Plants (July, 2010) 3. Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants (NUREG-0654/FEMA-REP-1) 4. Student's Corner - Nuclear Reactors 5. Operating Nuclear Power Reactors (by Location or Name) Other Agencies 1. Medical Effectiveness of Iodine Prophylaxis in a Nuclear Reactor Emergency Situation and Overview of European Practices (PDF - 717 KB) (European Commission, Directorate-General for Energy Directorate D - Nuclear Energy Unit D4, Radiation Protection No. 165, 2010) 2. Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident (Committee to Assess the Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident, National Research Council, 2004) 3. Federal Policy on Use of Potassium Iodide (KI) (PDF - 43 KB) (DHS/FEMA document, published in Federal Register January 10, 2002) 4. Guidelines for Iodine Prophylaxis following Nuclear Accidents (PDF - 96 KB) (WHO, 1999) Pediatric issues 1. Pediatric Counter-terrorism Measures (HHS/FDA, 2/2010) See KI information. 2. American Academy of Pediatrics Committee on Environmental Health. Radiation disasters and children. Pediatrics. 2003 Jun;111(6 Pt 1):145566. [PubMed Citation] National Council on Radiation Protection and Measurements (NCRP) 1. Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166), National Council on Radiation Protection and Measurements, Bethesda, MD, 2011. 2. Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (PDF - 1.61 MB) (NCRP Report No. 165), Bethesda, MD, 2010. 3. Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases (NCRP Report No. 161, Volume II), Bethesda, MD, 2010. 4. Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Volume I), Bethesda, MD, 2008. 5. Management of Persons Accidentally Contaminated with Radionuclides (NCRP Report No. 65), Bethesda, MD, 1980. [NCRP 65 has been superseded by NCRP 161.] 6. Cesium-137 in the Environment: Radioecology and Approaches to Assessment and Management (NCRP Report No. 154), Bethesda, MD, 2006. 7. Risk to the Thyroid from Ionizing Radiation (NCRP Report No. 159), Bethesda, MD, 2008. Exposure Assessment Considerations 1. Guidelines for exposure assessment in health risk studies following a nuclear reactor accident. Bouville A, Linet MS, Hatch M, Mabuchi K, Simon SL. Environ Health Perspect. 2014 Jan;122(1):1-5. [PubMed Citation] 2. Kondo H, Shimada J, Tase C et al. Screening of Residents Following the Tokyo Electric Fukushima Daiichi Nuclear Power Plant Accident. Health Physics 2013 July;105(1):11-20.
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Key Guidance Documents A Decision Makers Guide: Medical Planning and Response for a Nuclear Detonation, 11/2017 (HHS/ASPR) New! PAG Manual: Protective Action Guides and Planning Guidance for Radiological Incidents, 1/2017 (EPA) Protecting Responders Following a Nuclear Detonation, 12/2016 (US Government Interagency) Nuclear/Radiological Incident Annex, 10/2016 (US Government Interagency) Field Guide for Health and Safety Officers: Radiological Incidents, 6/2014 (NYC DOHMH) Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166, 2011) Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (NCRP Report No. 165, 2010)
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