Japan Earthquake and Tsunami, March 2011

EXPERT COMMENTARY

U.S. Preparedness for Catastrophic Nuclear Power Plant Accidents and the U.S. Capacity to Protect Children With Appropriate Availability of Potassium Iodide
Dr. Irwin Redlener
Washington, March 29, 2011

I join Congressman Edward Markey today to highlight my concerns on overall U.S. readiness for the possibility of a catastrophic nuclear power plant accident and to underscore the particular failure to protect children by appropriate availability of potassium iodide (KI) needed to prevent cancer in those who could be exposed to a radioactive iodine. It is clear that the probability of such a disaster is low, but the events in Japan have demonstrated that we must be prepared for a range of disasters we would hope never occur.

Less than three weeks ago the world witnessed yet another major disaster that in a matter of minutes destroyed communities, displaced hundreds of thousand of people and claimed thousands of lives. We have seen this before. Last year’s earthquake in Haiti, floods in Pakistan and New Zealand, and many other natural catastrophes were a stark reminder of unpredictable violence that can occur almost anywhere on the planet.

But there was something different about the chain of events that struck the northeastern coast of Japan.

First, the unfolding of natural disasters: There was the sheer power of the earthquake centered just off-shore that reached an astonishing 9.0 on the Richter scale, followed by hundreds of aftershocks, many of which themselves were large enough to be called powerful.

That initial quake was immediately followed by the horrifying specter of a 30-foot-high tsunami that wiped out lives and communities, causing an enormous evacuation of hundreds of thousands of survivors to inland shelters.

Second, an enormous humanitarian crisis: Once in the shelters, the problems of logistics and supplies of food, water and medicines became apparent and remain increasingly problematic.

Third, because of secondary complications related to the catastrophic natural events, the Fukushima nuclear power generators began to fail, manifest by rising temperatures, explosions and significant radiation release. This is a story that, as we speak, continues to evolve, but has managed to reawaken global fears – warranted or not – of radiation, deep concerns about the overall safety and security of nuclear energy and a flurry of nerve-racking mixed messages from the Japanese government and Fukushima’s private sector owners.

Meanwhile, nobody can predict for sure whether a full-scale melt-down will occur, and, if it does, how much consequent release of significant radiation will occur over a broad swath of inhabited territory, in Japan and beyond.

Whatever the eventual outcome, this will be considered one of the earliest examples of a complex megadisaster, where a major, life-threatening industrial or infrastructure failure has combined with a natural catastrophe.

Beyond the sympathy and grief we share with Japan and its citizens, there are important observations we in the United States must make. And among the reasons the events in Japan have raised deep concerns about the state of preparedness in the U.S. is that on March 10, one day prior to the record-breaking earthquake, Japan was considered to be the most prepared nation on the planet, especially when it came to earthquakes and tsunamis.

Their citizens understand the risks and practice the proper responses. Unlike Americans, they have a national plan and their citizens have embraced – not rejected – the value of being prepared as a necessary responsibility.

The fact that many concerns have arisen about the effectiveness of the Japanese government in responding to the disaster gives us pause because (a) that nation is, as is our own, economically and technologically highly developed, and (b) far more prepared than the United States.

That’s why the question ‘what if it happened here?’ is so germane to Americans.

Representative Markey has called this press conference to focus in on one of the more important aspects of nuclear plant disaster preparedness that has lurched into the spotlight since problems at the Fukushima plants emerged.

As a public health professional and as a pediatrician, I share his concerns.

Not only am I generally concerned about the United States’ general capacity to plan for and respond to very large-scale disasters, but I am deeply worried that our specific ability to assure the safety of nuclear power plants in the U.S. is at best questionable. Too many plants, including (and especially) Indian Point just north of New York City, are older-generation facilities located in places vulnerable to earthquakes and other natural disasters.

Unfortunately, the response planning for a potential serious problem, where large amounts of radiation might be released, has been inadequate on many levels. And two of the most serious flaws in the planning for a disaster at Indian Point, shared by many other operating plants in the U.S., are:

First, unrealistic and infeasible evacuation plans. The very idea of a 10-mile limit for evacuation plans seems to be a decision made on the basis of cheaper and easier planning, rather than reality-based predictions of expected radiation patterns. How can we possibly reconcile the U.S. government’s order to keep U.S. citizens 50 miles from the damaged Japanese plants with the mere 10-mile disaster radius for our own nuclear facilities?

Second, our children are not adequately protected. Removing children from harm’s way is certainly a primary objective. But assuring timely distribution and administration of potassium iodide to children about to be exposed or just exposed to radioactive iodine, I-131, is an essential step. While some experts argue that getting out of harm’s way, being very careful about ingesting potentially I-131-contaminated foods is a sufficient step, few could make the case that KI should not be provided and appropriately administered.

But the existing plans for the delivery, distribution, stock-piling and administration of KI to potentially at-risk children is erratic to the extreme. Some communities are doing a reasonable job here, but most are not even close.

And KI myths are rampant.

- KI is not a general panacea for all things radioactive. It does nothing for the long-lived radiation from Cesium 137 and nothing for the lethal gamma radiation that can initially be generated over a short distance from a major accident.

- KI is far less important for fully mature adults than for growing children and pregnant women. It is the active thyroid glands of growing humans that rapidly absorb radioactive iodine which, once there, can result in significant increases in thyroid cancer later in life.

- KI is relatively quite safe, but in order to be effective it must be administered just before or within hours of exposure to the radioactive version of this element.

And there are indeed lessons to be learned with respect to this public health threat from the aftermath of the horrendous accident at Chernobyl, Ukraine, in 1986. According to Laurie Garrett, senior fellow for global health at the Council on Foreign Relations: Thirteen years after the Chernobyl disaster, the incidence of pediatric thyroid cancer was 52 times the region’s pre-1986 level. In Belarus, it was 113 times higher than the country’s pre-1986 diagnosed incidence of thyroid cancer. In the immediate area surrounding Chernobyl [the thyroid cancer incidence level is] more than 500 times the pre-1986 levels.

In spite of its many promises at a time when the world needs to dramatically reduce its dependence on fossil fuels, there is much that needs to be done to make sure that nuclear power does not present the risks to population health that is currently the case.

One step that we must take immediately, in the context of making workable, effective response plans in the event of a catastrophic emergency, is to safeguard and protect our youngest citizens.

And this critical goal must include comprehensible, feasible, tested and publically acceptable plans to make sure that no child is without immediate access to KI if and when the need arises.

Finally, the availability of KI and of appropriate response planning should not be a matter of geographic or political good fortune. Proper responses that protect every child in the aftermath of a disaster should be mandatory, not a matter of where he or she happens to live.

Gauging the US Risk of Radioactive Exposure from the Japanese Reactors
Dr. Robert Kanter

With reports that radioactive particles have been released from the damaged nuclear power plants in Japan, some North Americans have begun asking whether there is any danger here, and whether they should take protective measures. News accounts describe Americans currently seeking supplies of potassium iodide to protect against thyroid radiation injury [Rockoff JD; Wall Street Journal 3/15/11]. What do Americans need to know about potassium iodide and radiation exposure?

A nuclear power plant accident may release various radioactive isotopes, including a radioactive form of iodine. Iodine, whether or not radioactive, accumulates in our thyroid glands as part of the normal production of iodine-containing thyroid hormone. The medication, potassium iodide, loads the thyroid with normal iodine, reducing the subsequent uptake of radioactive iodine. Thus, taken before or immediately after absorbing radioactive iodine by inhalation or ingestion, potassium iodide reduces toxic effects on the thyroid.

Thyroid cancer is the main risk after exposure to radioactive iodine, and children are particularly vulnerable. In the immediate vicinity of a nuclear accident, public health authorities would recommend protective use of potassium iodide, especially for children (http://www.bt.cdc.gov/radiation/ki.asp). However, potassium iodide does not protect against other toxic effects of radiation. Evacuation or sheltering in place is crucial for those living within 10-20 miles of a nuclear power plant disaster.

The US Nuclear Regulatory Commission [Document No. 11-046; www.nrc.gov] advises that the long distance from the accident in Japan makes harmful effects from radiation very unlikely in North America. In the present Japanese crisis, public health authorities in the US and Canada warn that the side effects for North Americans taking potassium iodide would outweigh its negligible benefits. Occasional side effects experienced by patients taking potassium iodide include allergic reactions, nausea, vomiting, and diarrhea. For more information on potassium iodide click here.

Dr. Robert Kanter is a senior investigator and affiliated faculty at the National Center for Disaster Preparedness. He is also the Professor of Pediatrics & Director of Pediatric Critical Care Medicine, Department of Pediatrics – SUNY, Upstate Medical University, Syracuse NY.

Eight Key Immediate Public Health Concerns:
Japan Earthquake and Tsunami & Relevance for U.S. Planning

An event of the magnitude of the Japanese earthquake and tsunami is not unexpected. Disasters occur regularly, even if we can’t predict when or where they will happen with any certainty. Within the past decade alone the world has witnessed the World Trade Center Attacks in 2001, Indian Ocean tsunami in 2004, Hurricane Katrina in 2005, the Chinese Szechuan earthquake in 2008, the Haitian and Chilean earthquakes, major flooding in Pakistan in 2010, the New Zealand earthquake in Christchurch last month, and others.

All of these disasters should be seen as “megadisasters,” defined as catastrophic events that overwhelm local capacity response efforts to rescue survivors and treat victims, protect local infrastructure or prevent social chaos.

Some countries are better prepared than others for such catastrophic events – they have instituted policies and programs to mitigate or prevent some of the damaging effects; they have developed substantial formal and informal rescue and response systems and can readily accommodate and productively deploy outside help; and they have made significant investments in the recovery and resilience of their infrastructure, their markets, and their citizens.

As Japan and the international community respond to today’s events, the following list represents some of the public health issues that may arise in the immediate days and weeks after such a disaster. It should noted that these are the very same issues which need to be incorporated in the disaster planning for any nation, including the U.S.

First and foremost is the acute survival window for trapped or injured survivors. In routine, day-to-day contexts, most developed countries seek to treat everyday trauma patients within the “Golden Hour,” the first 60 minutes after an injury has occurred. In a disaster setting, when rescue efforts may be significantly hampered by access issues, overwhelming numbers of patients, and severely disrupted facilities, this survival window may extend to 72 hours. Failure to mount sufficient rapid urban search and rescue efforts following the devastating earthquake in Haiti may have resulted in at least 100,000 excess fatalities.
Events such as the Japanese earthquake raise environmental issues related to the availability of potable water and the stability of water sources, the security of wastewater treatment and sanitation facilities, the multiple pathways for contamination of food supplies, and the subsequent susceptibility to communicable diseases such as vibrio cholera.
Critical infrastructure failures, such as the widespread destruction of the electrical power grid, or more catastrophically, a nuclear power plant meltdown, could lead to significant secondary consequences. These consequences could even be more devastating than the original hazard if the affected area was left uninhabitable as a result of radiological contamination, or if the contamination extended beyond the initially affected area in to other ecosystems.
Large segments of the population are more vulnerable than others to the effects of such a catastrophic event. Vulnerabilitymay be related to a group’s dependency on others for their safety and well-being (such as children and the elderly, or institutionalized populations such as those in long-term care facilities, hospitals or in prisons); to their inability to get out of harm’s way (such as the physically disabled or those without access to transportation resources); or to particular susceptibility to disease (such as those with chronic health problems or immunological conditions such as HIV/AIDS).
Catastrophic events may lead to long-lasting psychological, behavioral and emotional issues. Individuals can experience acute mental health effects during and immediately following a major disaster. For many others the possibility of long-term post-traumatic stress disorder can manifest months or years later. Oftentimes there are interventions that can reduce or soften some of these mental health effects.Psychological first aid can be made available to responders and survivors who may be affected by what they have witnessed and experienced, and more advanced therapeutic measures can be offered to those suffering acute, clinical reactions. Even more helpful may be broad social interventions that assist affected populations in returning to a semblance of normalcy, maintaining normal routines, and engendering a sense of self-efficacy and self-determination rather than helplessness.
Citizen readiness can reduce some of a disaster’s most serious consequences, including the public health impacts. Although citizen preparedness is often popularly characterized as a practical matter of having supplies of batteries, food, and water, it is equally comprised of personal attitudes, knowledge, and planning – it’s not only what you have, but what you know and how you think. A prepared citizenry may be more capable of moving quickly out of harm’s way, adapting to a period of scarce public resources, and capitalizing on alternative resources such as networks of family and friends. Highly-trained citizens can operate effectively as first responders in a disaster, particularly during those critical early hours when formal response organizations are still mobilizing.
System readiness encompasses those governmental and institutional efforts to prevent, respond to, or recover from a catastrophic event. From a public health perspective, systems have to be prepared to address the ordinary as well as the extraordinary needs of their citizens. Health care supply chains of trained providers, supplies, and medications have to be equally prepared to handle chronic diseases, childbirth and preventive care as they are crush injuries, specialized surgical capabilities, and unusual infectious disease outbreaks. In the immediate picture, health care facilities and emergency response systems generally could be severely disabled.
All megadisasters have a significant regional and national impact. An event of the magnitude of the Japanese earthquake and tsunami quickly extends beyond the immediately affected area. A surge of displaced and fearful people will likely move in to surrounding areas seeking food, shelter, and help. As resources and services in the affected area are destroyed or disrupted, neighboring regions will be compelled to provide some of these goods and services. The impact on host communities can be substantial, and result in such system demands that the host citizenry can face critical shortages as well. Regional planning and coordinated activity are essential in such a circumstance.

RELATED TRAINING RESOURCES

Aid in Japan: A First-Hand Account

Dr. Kate Uraneck, Senior Medical Coordinator at the Office of Emergency Preparedness and Response in the NYC Department of Health and Mental Hygiene, conducts a lecture on her experience aiding Japan’s recovery effort. She discusses her visit to Japan following the aftermath of the earthquake and tsunami.

Dr. Kate Uraneck is the Senior Medical Coordinator at the Office of Emergency Preparedness and Response in the NYC Department of Health and Mental Hygiene. She has previous experience in medical journalism and graduated from Columbia University’s Graduate School of Journalism. Dr. Uraneck was the keynote speaker at the Columbia Regional Learning Center’s conference held on May 11th, 2011. The conference, Black Monday, was an effort to facilitate regional planning for a simulated radiation incident in Westchester County, NY.

Japan’s Public Health Response: A First-Hand Account

Dr. Robert Bristow, Assistant Clinical Professor of Medicine at the Columbia University Medical Center and affiliated faculty member of the National Center for Disaster Preparedness, conducts a lecture on the situation in Japan following the tsunami and earthquake. He discusses his recent visit to Japan’s health care facilities in the aftermath of the earthquake and tsunami. His conclusions include lessons learned from Japan’s disaster preparedness and response.

Potential Health Effects from Radioactive Emissions

Dr. David J. Brenner, Director of the Center for Radiological Research at the Columbia University Medical Center, provides a 30 minute primer on radiation exposure, addressing the scientific facts and common misconceptions.

His discussion focuses on the damage at the Fukushima Daiichi nuclear power plant as well as the implications of the catastrophe on radiation preparedness efforts in the U.S.

Dr. David J. Brenner, M.Sc, M.A., PhD, D.Sc. is the Higgins Professor of Radiation Biophysics, College of Physicians & Surgeons of Columbia University. He is also the Director of the Center for Radiological Research (CRR), Director of the Columbia University Radiological Research Accelerator Facility (RARAF), and a member of the National Council on Radiation Protection and Measurements (NCRP).

Radiation 101: Public Health Risks of Ionizing Radiation

This comprehensive training is conducted by Dr. Eric J. Hall, Professor Emeritus of Radiation Biophysics, Columbia University. Course material was developed by the National Center for Disaster Preparedness in collaboration with the New York City Department of Health and Mental Hygiene (NYCDOHMH).

This training provides a basic overview of the public health risks of ionizing radiation. Topics covered include the difference between ionizing and non-ionizing radiation, differences between exposure and contamination, the biological effects of radiation, and methods utilized to keep exposure as low as reasonably achievable.

Dr. Eric J. Hall, D.Phil., D.Sc., F.A.C.R., F.R.C.R., FASTRO, is the Higgins Professor of Radiation Biophysics and Professor of Radiation Oncology and Radiology, College of Physicians & Surgeons of Columbia University, as well as Radiation Biologist, Radiation Oncology and Radiology Services, The Presbyterian Hospital of New York. He has written five books and has published over 350 papers in the peer review scientific literature.

Disaster Response in Japan: What You Need to Know If You Might Go

This 12 minute training is conducted by Dr. Richard Garfield, RN DrPH, Senior Investigator and Affiliated Faculty of the National Center for Disaster Preparedness, Columbia University

The earthquake, tsunami, and nuclear disaster unfolding in Japan demonstrate the need for special skills among international relief workers assisting in the recovery. Organizations need to consider how they will work with public and private Japanese institutions, and what they’ll need to know and bring.

If your organization is considering assisting in Japan, watch this free, “just in time” presentation to learn about the major needs in Japan now and in the months ahead.

Richard Garfield, DrPH, is an expert on needs assessments in humanitarian crises and monitoring humanitarian recovery. He is also a Professor of Nursing and Public Health, Columbia University.

RELATED REPORTS AND MEDIA

Nuclear Power Plants & Earthquakes in the United States: Populations at Risk
Jonathan Sury

Over one-third of the US population lives or works within 50 miles of a nuclear power plant. Currently, there are 105 operating nuclear reactors at 65 sites throughout the United States. As the map illustrates, only a few power plants are found in regions which have some earthquake risk. The pattern of nuclear reactor sites across the United States show that the Central US is relatively empty compared to the Eastern Seaboard, the Great Lakes, and along the Mississippi River. It is no coincidence that the placement of these power plants follows the population distribution, which has historically followed major waterways and ports. Additionally, the strategic placement of these power plants close to major water bodies also provides the water required to help cool the plant however, the placement near the water’s edge, particularly next to the ocean, increases risk of damage from environmental impacts such as sea-level rise, tsunami, hurricane, or other extreme weather events.

This map shows seismic hazard, nuclear power plant sites, number of reactors per site, and the population contained within a 50 mile radius of each nuclear power plant site. The total US average population contained within all of these 50 mile radii is approximately 117.7 million or 38% of the entire US population. More power plants are seen around the Great Lakes and in the Northeast with a higher occurrence of populations which overlap within the 50 mile catchment of multiple nuclear plants. Nuclear plants in California are visibly vulnerable to earthquake risk with one Southern California plant potentially impacting a population over 5 million. More frequent overlap of nuclear power plants and seismic risk is seen in the Southeast as the seismic hazard appears minimal, though not insignificant. This map is not an analytical tool but allows the user to visualize population size within a 50 mile radius of a nuclear power plant as well as proximity to seismic hazard.

Seismic hazard data is provided by the USGS 2008 United States National Seismic Hazard Maps Project (NSHM). Seismic hazard is displayed as Peak Ground Acceleration (PGA); the greater the PGA, the greater objects will accelerate horizontally thusly experiencing a greater force. This map specifically displays the seismic event PGA of a 10-in-100 (10%) chance of exceedence in a 50-year time period. PGA is generally used in the evaluation of building codes, using the Modified Mercalli Intensity Scale (I-X) PGA can be correlated to potential damage (shown in legend) and perceived shaking. Population counts within a 50 mile radius of each nuclear power plant were calculated using the LandScan 2008 TM 30 arc-second Global Population dataset which is a statistical approximation of ambient or 24-hr day/night average population.

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