This report has been made free to download by the ICRP.
This report discusses the emergency preparedness we may wish we had put in place if we find ourselves responding to a severe nuclear accident that has resulted in very high doses to some members of the public and has rendered some areas uninhabitable and others problematic. It argues that in that situation you need mature systems to share complex information with individuals and communities, the ability to retain their trust and allow them to make important life-choices while also having in place polices and resources to support the business, social and family life in areas blighted by radioactive contamination. It then discusses the problem in some depth and with clarity while skating over the difficultly with providing solutions.
This publication updates and supersedes Publications 109 and 111. It also supersedes the recommendations published previously in Publications 40, 63, and 82.
The executive summary starts “Large nuclear accidents result when there are significant releases of Radioactive material into the environment, impacting widespread areas and affecting extensive populations. They are unexpected events that profoundly affect individuals, society, and the environment. They generate complex situations and legitimate concerns, particularly regarding health, for all those affected by the presence of undesirable sources of radioactivity”.
I wonder if the use of “legitimate concerns” is fully justified. The two big accidents we all know about, Chernobyl and Fukushima, have had societal and individual impacts well beyond those suggested by our understanding of harm radiation causes to living tissue. It is either the unreasonable concerns about radiation that are causing the problems or our understanding of radiation and the basis of our use of the art of radiological protection in emergency planning that is faulty.
Interestingly the executive summary also states “The Commission recommends that plans should be prepared in advance to avoid severe and long-term consequences following a nuclear accident. Such preparedness plans should comprise a set of consistent protective actions, adapted to local conditions at nuclear sites, taking into account the societal, environmental, and economic factors that will affect the impact of the accident and its response”. I believe that this is suggesting that you go beyond the preparation to rapidly introduce shelter, evacuation and thyroid blocking and that you use locally set trigger points rather than the national ERLs.
The Commission see the response to a large nuclear accident in three phases and relate them to exposures situations thus:
Figure 1 Phases and exposure situations
The report states that a “Large nuclear accidents affect all dimensions of individual and social life” with concern about the health effects of radiation being the major concern but the situation is complex and includes “social, psychological, environmental, educational, cultural, ethical, economic, and political factors associated with the consequences of the accident”. It asks for particular attention to be paid to the needs of “some vulnerable groups, particularly pregnant women, children, people with regular/ specific medical care, and elderly people”.
You could argue that the wide range of impacts listed above would not occur if it were not for the contamination and the concern about health effects. Do you tackle the excessive concern or the results of that concern? In the real world, you probably need to do both.
The report takes a couple of pages to review the effects of radiation on human health.
On societal consequences it opens with “The sudden presence of radioactive contamination is perceived as undesirable, illegitimate, and dangerous, and generates a desire to get rid of it. This presence in the living environment of humans profoundly upsets the well-being of individuals and the quality of life of affected communities. It raises many questions, concerns, and fears; generates numerous views; and worsens conflicts. Some residents will choose to stay in affected areas, when this is allowed, and others will leave. Among those who leave, some will return and others will relocate permanently. This can significantly affect community life and demographics, with a notable decrease in the number of inhabitants, especially young people, as illustrated after the Chernobyl and Fukushima accidents”.
And later “Beyond the widespread fear of radiation in all sectors of the population, sociological studies have also revealed: a collapse of trust in experts and authorities; disintegration of families and social ties; apprehension about the future, particularly for children; and a progressive feeling of loss of control over everyday life. All of these consequences affect the well-being of people and pose a threat to their autonomy and dignity”.
The negative image of the affected areas, a reluctance to visit and a rejection of the people living there and any goods produced there continuous to blight the affected area and constrain social dynamics.
The economic impacts can be profound. Local agriculture is likely to suffer. Radiological contamination may affect critical infrastructure. All this has an impact on local businesses and employment, as well as key public services such as government services, security institutions, medical facilities, financial systems, public health services, and education facilities. For local companies their staff, workplaces, products, and image can all be affected. Change in the local demography, as the young and anxious abandon the area, is another factor influencing the overall economy of affected areas.
People are destabilised by the complexity of the situation, both in the immediate response and in the longer term and may have many questions. “People affected by a nuclear accident can feel anguish, dismay, discouragement, helplessness, dissatisfaction, frustration, and anger. Many affected people report feeling a lack of control over their individual living and working conditions, and this is linked to a high level of psychological stress”. This can result in psychological and psychosomatic disorders.
Almost as an aside the report states that “Studies reported an elevated rate of depression and post-traumatic stress disorder among the responders who were directly confronted by the disaster scene, potentially inducing a threat to their lives”. I think the report could have aided clarity by better splitting the discussion about responders from that about affected members.
“Studies have also reported that people who are confronted with radioactive contamination in their daily lives, even if only a small amount, and evacuees facing poor living conditions with no clear view about their future are more vulnerable to anxiety, stress, and depression”.
Parents with young children, especially those in contaminated areas, are particularly vulnerable to anxiety with negative impact on their health and the on the family unit.
Change in lifestyle and reduced circumstances are also stressors.
Experience has shown that “shortly after an evacuation, vulnerable populations such as patients in hospitals and the elderly in care homes are particularly susceptible to hypothermia, dehydration, and the worsening of pre-existing conditions. These can lead to increases in mortality. Meanwhile, children living in evacuation centres are more prone to infectious diseases due to overcrowding and stress caused by inadequate facilities. They can also be affected psychologically, with the subsequent development of emotional problems. Verbal abuse and bullying of evacuated children can form an additional source of stress”.
“In the intermediate and long-term phases, those who remain in the contaminated areas, as well as those subject to temporary relocation, can experience a range of long-lasting physical health effects due to their changes in lifestyle, including obesity, diabetes, cardiovascular and circulatory diseases, hypertension and chronic kidney disease due to poor diet (e.g. lack of fruit and vegetables), lack of exercise, substance abuse, and restricted access to medical facilities or opportunities to seek treatment. Furthermore, restrictions on outdoor play due to the presence of radiation can lead to higher levels of obesity in children”. None of these effects are directly due to ionising radiation.
Figure 2 The Optimisation Process
The standard picture to show how reference levels help reduce dose over time is reproduced below.
Figure 3 The role of RLs in the optimisation process
The concept is that you set a reference level and then try to identify those people whose predicted dose is above that level and concentrate on measures to reduce their dose. This is expected to further reduce the doses to some of the people already below the reference level and the dose distribution shifts to the left. It is suggested that after time the reference level is reduced and further steps considered.
What this cosy picture misses is that each engineered reduction in the dose distribution, as opposed to reduction with time as the radioactivity decays or weathers, is accomplished by the imposition of another protective action or by a decontamination exercise that affect people who already experience low doses. Each these have costs; financial costs and lifestyle costs. How can we be sure it is worth it?
The Commission recommends including, where feasible, the views of all relevant stakeholders to decide the level of ambition to be achieved by selecting a given reference level. A laudable but difficult ambition.
The report has a long section (Section 3.2) on the need to understand the dose uptake of the public in the short, medium and long term which entails an understanding of the initial distribution of deposited radioactivity, the migration of radioactive material in the environment and food chains and the habits of people before and after the event. Understanding this, and the limitations of the results, is a major undertaking and requires specialist experience and knowledge.
The effort and resources required to triage the public to identify those that would benefit from medical treatment, decontamination or counselling might be significant (and the process may be a significant stressor of the population).
The report states that “Measurement data should be collected centrally and made available as soon as possible to all relevant organisations in charge of managing the early and intermediate phases in order to assist them in making decisions on protection. For the sake of accountability and transparency, the Commission recommends that this information should be shared with members of the public, accompanied by a clear explanation, while respecting the protection of personal information”.
In section 3.3, the report identifies that “Individuals who may be involved in the response to an accident are diverse in terms of their status: emergency teams (e.g. firefighters, police officers, medical personnel), workers (occupationally exposed or not), professionals and authorities, military personnel, and citizens who volunteer to help”.
The report suggests treating non-responders on-site in the same manner as the off-site population (shelter, evacuate and thyroid block) but “those who are involved in the early-phase response should be managed as responders, applying the principles of justification of decisions and optimisation of protection.
“The justification of decisions that may affect the exposure of responders should be taken in light of the status of the damaged installation and its possible evolution, as well as the expected benefits in terms of avoidance or reduction of offsite population exposures and contamination of the environment”.
“Overall, these decisions should aim to do more good than harm; in other words, they should ensure that the benefit for the individuals concerned and society as a whole is sufficient to compensate for the harm they may cause to the responders”
The report recognises that it may be hard to predict the doses to responders in situations where sources are out of control, particularly in the early stages where there is very little dose characterisation. It suggests that a reference level of 100 mSv may be appropriate for responders but “would be justified only under extreme circumstances”. Levels above this would be exceptional, reserved for life saving and to prevent further degradation of the facility.
This section is adequately covered by any organisation working within the REPPIR-19 regulations.
The report also suggests that those likely to be involved in the off-site response such as emergency services. Medical staff and bus drivers should be identified in advance and trained to appropriate levels of understanding.
Section 3.4.1 describes and justifies the early phase protective actions of shelter, evacuation and temporary relocation, thyroid blocking, decontamination of people, precautionary foodstuffs restrictions and those in the intermediate phase; temporary relocation, foodstuff management, management of other commodities, decontamination of the environment, management of business activities. It is a clear and competent description of the situation but does not add greatly to the body of knowledge.
Section 3.4.3 “The co-expertise process” is more interesting. It recommends a “process of co-operation between experts, professionals, and local stakeholders aims to share local knowledge and scientific expertise for the purpose of assessing and better understanding the radiological situation, developing protective actions to protect people and the environment, and improving living and working conditions”.
“From an ethical point of view, the co-expertise process focuses on the restoration and preservation of human dignity, which is one of the core values of the system of radiological protection (ICRP, 2018). More particularly, the process can be seen as reflecting inclusiveness, which is the procedural value behind the concept of stakeholder involvement. Beyond that, it allows the implementation of empathy (i.e. it provides the experts with opportunities to immerse themselves in and to reflect upon the experiences, perspectives, and contexts of others), which in turn helps find suitable and sustainable protective actions”.
Figure 4 Working with the community
The report suggests that being transparent about the monitoring programme, what is measured, why and what it means in terms of dose paths helps people by “taking into account radiological criteria and comparison with other situations of radiological exposure”.
This openness and discussion can then extend into the realm of identifying, implementing and managing protective actions with those directly affected feeling some ownership and understanding of the decision-making process rather than being on the receiving end of “expert” pronunciations.
“Protective actions implemented during the early and intermediate phases should be lifted, adapted, or complemented when authorities and stakeholders consider that these actions have achieved their expected effect, or when their continued application is no longer justified (i.e. cause more harm than good in the broadest sense)”. This is now known to be harder than expected and needs the coordination and support of various organisations and, of course, the public.
At high levels of residual contamination there may be difficult decisions to make about preventing populations returning to the area. A slightly gentler outcome would be to allow people back to collect valuables and precious materials but not to stay. Paragraph 175 discusses the conditions that might need to be mat before you allow people to live in a highly contaminated area.
The report (Section 4) suggests that the long-term phase has started when you’ve agreed that the facility is secured and decisions have been made about the long-term future of the area. At this stage the rehabilitation of the living and working conditions and the interaction of individual and community is complex. Management based on radiological principles and criteria was not sufficient to respond to the challenges.
“Experience has shown that large differences in levels of exposure may exist between neighbouring communities; within families in the same community; or even within the same family according to diet, lifestyle, and occupation. These differences generally result in a skewed dose distribution where a few individuals receive a larger exposure than the average”. This requires people in the area to be supported and informed of the factors that contribute to their radiation dose “not only to ensure adequate protection against the radiation, but also to guarantee sustainable living and working conditions, including respectable lifestyles and livelihoods”.
Section 4 covers the radiological characterisation in the long term and the protective actions that might be appropriate.
“The protective actions available for the long-term phase are many and varied, ranging from removing the contamination present in the environment (decontamination and waste management) to implementing collective and self-help protective actions to control external and internal exposures (management of food products, dietary advice)”.
“To restore individual well-being and the quality of community life in the affected areas where people are allowed to reside, there is a need to develop accompanying measures beyond the protective actions themselves. A first objective is to re-establish technical networks (water, electricity, telephone, etc.), infrastructure (roads, railway lines, etc.), and the services necessary for public life (schools, hospitals, post office, banks, shops, social activities, etc.). It is also important to ensure the overall socio-economic development of the territories concerned (establishment of industrial zones; support for the maintenance and establishment of agricultural, industrial, and commercial activities; etc.).”
“In the long-term phase, exposures of people, fauna, and flora are reduced gradually over time due to the combined effects of protective actions and natural processes. As a result, years after a nuclear accident (or even decades in the case of a severe accident), it is advisable to consider whether to maintain, modify, or terminate protective actions.”
Section 5 discusses preparedness planning for a large nuclear accident. It suggests that “For the long-term phase, preparedness aims to identify the societal, environmental, and economic vulnerabilities of potentially affected areas, and to develop guidelines that are sufficiently flexible to cope with whatever happens in reality”.
It further suggests that a prerequisite to preparedness is acknowledging the possibility that a nuclear accident could occur and seeking representation of all stakeholders in preparedness. I think that here the Commission should acknowledge that local, regional and national resilience teams have risk assessments that tell them that, that for example, floods and animal or human disease are far more likely and would be extremely disruptive and that that is where they should devote their preparedness resources rather than on extremely rare (we hope) severe nuclear accidents.
REPPIR-19 does require that severe accidents be considered, albeit in outline, and maybe tested occasionally. This will raise awareness within the responding organisations but is unlikely to push preparedness significant further forward with regard to interacting with an alarmed community.
“Practically, preparedness plans should contain a set of appropriate protective actions and arrangements for implementing them, including reference levels. Provisions for the deployment of necessary equipment for the characterisation of the radiological situation and the implementation of the co-expertise process should also be considered. In addition, specific communication schemes to inform the public and other stakeholders, as well as provisions for the training of those to be involved in the response, should be developed. These plans should be subject to regular exercises involving the various stakeholders”. This looks more like the detailed planning that is undertaken for what used to be called design basis accidents.
Importantly, and realistically, the report states that “The preparation of detailed plans for accident and post-accident management is a national responsibility”. If there were to be a severe accident the aftermath would involve difficult discussions. These would include discussions about which areas to abandon, which areas to allow to return to a controlled usage and which could be returned to normal. Further discussions would then be needed about how much decontamination to attempt and where (children’s playgrounds and schools, public areas, peoples’ gardens and homes?) and about how to avoid economic blight and stress.
The report concludes that “For this purpose, experts and professionals should adopt a prudent approach to manage exposures, seek to reduce inequities in exposures, take care of vulnerable groups, and respect the individual decisions of people while preserving their autonomy of choice. Experts and professionals should also share the information they possess while recognising their limits (transparency), deliberate and decide together with the affected people what actions to take (inclusiveness), and be able to justify them (accountability). The issue at stake is not to make people accept the risk, but to support them to make informed decisions about their protection and their life choices (i.e. respect their dignity)”. That sounds really difficult!
Central government should maybe look at this report closely and see what preparations might be appropriate against the very unlikely severe nuclear accident. The report suggests “for the long term phase, preparedness aims to identify the societal, environmental, and economic vulnerabilities of potentially affected areas, and to develop guidelines that are sufficiently flexible to cope with whatever happens in reality”. This appears to be suggesting applying the tools of Business Continuity Management and Business Disaster Recovery to communities.
Central Government may, for example, decide to have briefing materials ready to educate community influencers such as GPs, local council members, MPs, church leaders, media and teachers so that they can cascade knowledge and understanding and report back the views of the community. This might help kickstart the transparency and inclusiveness and reduce the stage at which the population loses trust in “experts”.
They may decide to produce guidance about what to do if homes, streets and schools are contaminated to a range of levels working out how to allow life as near as normal as possible. A world in which children cannot play in the open will never be a healthy and happy one.
There is no doubt that if such an accident happens we will wish that we had done more work preparing for it (or more work preventing it).