Emergency Planning Society – Ripples workshop

I attended the Emergency Planning Society’s Human Aspects Group’s workshop entitled “The Ripple Effects of Major Incidents” in Cardiff on 16th November 2017. The speakers were people with first-hand experience of responding to support those affected by major incidents or of being caught up in them themselves.

This workshop was about the people affected by an event and the practical and emotional support they may need at the time of the incident and afterwards. They may need help coming to terms with their experiences and with their losses. This is a process that could take many years.

This was unusual territory for me. I used to be a responder at site or company strategic level in the nuclear industry where, in exercises, the news that a Reception Centre had been set up was a satisfying tick in a box that required no further thought. To be fair to us we had other things to keep us busy.

Why “Ripples”?

It is easy to underestimate the number of people affected in an incident. For example, in a terrorist event, there are the injured that need immediate care and some who will need continuing support to cope with “life changing injuries” – a highly sanitised term for some dreadful outcomes.

Beyond the physically injured are the witnesses. Those who experience things that most of us never will; traumatic things that can lead to severe mental scars that affect every aspect of life. People who, because of their experiences, are too scared to walk along the High Street or be in a public space. People who suffer repeated flash-backs and who feel survivor-guilt. People who can’t sleep well. These are life defining phobias and conditions. Children cannot access education, adults cannot cope in the workplace. This can result in a downward spiral of increasing anger, dependency and/or despair.

There are the families of the dead, families of the injured and families of the traumatised. All have their lives changed for the worst and have to come to terms with those changes.

There are people who narrowly avoided being a direct victim. People how didn’t catch that train for a trivial reason, people who didn’t go to that concert, people who live in the next tower block along (or indeed a tower block in a distant town or city).

There are the people who responded to the incident; professionals such as the police and medical personnel, but also the bystanders who come forward to give spontaneous help. Some of these will need emotional support to help them process their experiences.

There are the people who have lost their homes or their livelihoods, either permanently or temporarily, as a result of the event and need timely practical support.

Experiences of response

Some of the speakers reported their experience of responding in the first hours and days after serious incidents and explained the role of the Families Liaison Officer and charities.

In one event an apparent lack of coordination and leadership resulted in badly designed and managed survivor and community support which quickly resulted in anger and recrimination. Later improvements in the responders’ performance improved matters but, by then, a lot of damage had been done to the relationship between the community and the authorities.

Another report of a different response was more positive. A difficult situation requiring a lot of rapid decisions, some of which stood the test of time whereas some didn’t. A lot of learning already revealed and more to come as the analysis progresses. Interestingly and encouragingly the speaker described their recovery plan as being based on the national guidance and broadly successful.

A stitch in time saves nine

A few themes emerged from the presentations and discussion.

The support on the ground for those immediately affected needs appropriate design and competent management. In the first few hours the care needed will be largely medical for a number of people and the immediate needs of comfort, shelter and sustenance for maybe more people.

Within hours to days those affected may need wider support. They may be separated from their cash, credit cards and their travel season tickets. Without immediate help they risk an escalation of consequence – jobs, or at least earnings, lost as they can’t get to work. Education disrupted for children who can’t get to school.

Loss of other documents, such as passports and identification, can quickly become a problem for some and, without the correct support and advice, they may struggle to hold their own.

Businesses may be suffering, particularly if they are based inside police cordons.

These problems can be solved. We heard from Victim Support and from the British Red Cross on the services they offer and their experiences with things that went well and things that took longer to get right. It is possible to mobilise quickly. There are individuals and organisations with experience in supporting affected communities. Each time they are called upon they can be expected to get better, if the conditions on the ground, resources and coordination allow.

A number of big questions were posed:

  • How do you identify the needs of those affected and break through established procedures and budgets to provide help in a timely manner?
  • What do you do if a Category 1 responder is failing to cope? (or indeed any component of the response?)
  • What do you do with gifts in kind (which can be in overwhelming quantities and of a wide range of suitability)?
  • How do you coordinate and get the best out of spontaneous volunteers?
  • How do you manage social media in a positive way?

Learning points:

  • Social media is both a blessing and a curse. We heard of social media platforms being set up by individuals or organisations that attempted to help those affected but which attracted advertisements from the likes of Funeral Directors and Claims Lawyers, abusive messages or were used by journalists as source material for unauthorised articles. But we also heard of the real value of enclosed systems that could be set up on platforms such as Yammer and had a debate about who should manage them for the years that they might be needed – currently the police manage some.
  • Mobile phones allow families and friends to reunite without support. This does mean that the facilities set up to help reunite families see a higher proportion of bad news to good compared to the expectations of some years ago.
  • Nurses trained in the SWAN end of life care techniques and the police Family Liaison Officers can provide emotional and practical support for the bereaved.
  • It takes planning, experience and considerable resources and skill to set up the ideal range of support facilities for those affected in different ways by an event. Getting it wrong can quickly lead to worsening experiences, anger and lasting harm for individuals and communities.
  • The media can intrude upon facilities for survivors and family and friends. They should be controlled but helped to get appropriate material for their needs.
  • It is important to gather and understand data on the types of people affected and their needs as these change with time and there are humanitarian and reputational drivers to keep the gap between needs/expectations and delivery small.
  • Mutual support groups within those affected can be very useful to some people trying to cope in the aftermath of trauma. The ability to discuss matters such as poor sleep, anxiety, and availability of therapy with similarly affected people can be very positive.
  • People displaced from their homes and temporarily settled elsewhere benefitted from a single facility where they could access a range of help (CAB, Banks, Social Services etc.) but also greatly benefited from the opportunity to meet and chat with their neighbours (photos of sofas and coffee tables in the middle of a Sports Hall).
  • It is important to try to work with social media rather than against it – In Manchester there was a social media campaign for a vigil in support of the victims and defiance of the perpetrators. Enabling this, and supporting other such moves, was seen to be very positive.
  • Support may be required for many years after the event and includes, in addition to individual support, such things as organising ceremonies on key anniversaries and organising permanent memorials, both of which require careful attention to the wishes of those affected – which may not all be the same.
  • Donations in kind and in cash can be overwhelming, can take considerable resources to manage and can lead to incriminations and anger if not done to everyone’s satisfaction.
  • There is a need for some kind of Advocacy Service for the survivors of terrorism to ensure that they get the support they require. This includes practical help to cope with physical injuries, help with the mental injuries, financial support and help to build a life and access education and work that takes survivors’ trauma into account. (In an ideal world this would not be needed because the background social support should be managing).

Closing remarks

There were two very moving first-hand reports from survivors of terrorists’ attacks. Both exhibited anger at the inadequacies of support they have been offered in the UK, which compares badly to some other countries, and which clearly let them both down badly.

Something is broken. Survivors are not getting the support they need. It is clearly of concern to the emergency planning community and we should not think that our job is done when the final police cordon is removed. We have some level of responsibility to ensure that those caught up in an emergency are cared for in an appropriate manner.

Dealing with urgent and continuing medical needs is the remit of the emergency services and National Health Service although organisations such as CitizenAid have identified a role for prepared bystanders. The setting up and managing facilities to cope with the practical needs of those affected within the first hours and days of the event is quite clearly, I think, part of an emergency response and within the remit of emergency planning. Guidance is clear about responsibilities.

However, it could be argued that the longer term care of people with severe physical injury, with psychological harm and permanently displaced from their homes is not within the emergency planning and response remit. The UK should be doing better in these areas but our role in making it happen is, as an organisation, probably limited to raising concerns with the authorities and, as individuals, calling to account those in authority and those with responsibility in these areas – if we could only identify them.

A few of the attendees were from Social Care and Health roles in local government. It is a pity that there was no senior representative from central government or from the mental health world as defining and solving the problem is probably beyond our pay grades and their views would have been valuable.

© Keith Pearce, 20/11/2017

K.I.Pearce asserts his right to be recognised as the author of this document.

A restatement of the natural science evidence base concerning the health effects of low-level ionizing radiation.

This paper has the stated aim of restating the evidence available on the health effects of low level ionizing radiation. It reports that it is known that high levels of radiation are detrimental to the health of organisms including humans but that it is less clear at low levels (low doses or doses delivered at a low rate) with some arguing that current radiological protection standards are too lax and others arguing that they are too severe.

The authors penned a draft review of the data which they discussed at a one day workshop. Here they classified the data sets according to their view of the strength and consistency of the evidence presented. The review was revised and then circulated to a wider circle of experts in the low level radiation field for comment and further revision.

I particularly like figure 2 of the paper (available as a download) which shows a number of datasets of measured effect against dose. It is clear that there is a trend for effect to increase with dose but much less clear that this trend is well behaved at low levels. This figure and the paper summarises the issue nicely. What is happening at low dose and low dose rates?

ResmodelThe diagram shown is figure 3 from the paper. It shows a number of different potential risk models that can be compared to the data. These include the linear no threshold model (LNT), which postulates a straight line through the origin and the linear with threshold, which postulates that there is a level of dose below which no harm is experienced. The former is used by ICRP and a number of other international authorities as a plausible and conservative assumption. The threshold argument also has its proponents who believe that LNT leads to excessive spend on pointless dose avoidance.

Hormesis is an interesting one. It is based on the suggestion that small amounts of radiation can be good for you.

The caption to the diagram states that “at sufficiently low doses, all models are consistent with available datasets”.

The paper provides a brief discussion of a number of studies:

  • Variations in natural background in different places across the world;
  • Acute high level exposures;
  • Low level exposures;
  • The Japanese life span study (recognised as the “gold standard” for learning);
  • Chernobyl workers and exposed members of the public;
  • Fukushima;
  • Workers;
  • Medical exposures;
  • In-vitro studies.

It provides a number of interesting headlines for each category but, deliberately refuses to come to any conclusion.

This is a useful and interesting paper resulting from some careful and systematic work. I am grateful to the authors for producing it and I recommend it as a good read.

Reference: McLean AR et al. 2017. A restatement of the natural science evidence base concerning the health effects of low-level ionizing radiation. Proc. R. Soc. B 284: 20171070. http://dx.doi.org/10.1098/rspb.2017.1070

The First Three Years of Katmal Limited

LogoOver the three years since I started to work independently I have had some interesting and challenging work and certainly had a good variety. I’ve spent a lot of time on my computer at home revising, updating and restructuring existing documents for customers or writing new ones on a wide range of topics including the application of new technology to emergency response, reviewing and summarising regulation and guidance, proposing new strategies and proposing systems for classifying emergency structures, systems and components. I’ve also done some mathematical modelling in support of ALARP cases for new facilities. The documents I’ve helped to prepare have gone for internal information/discussion, to regulators, to safety committees and to public web-sites.

I’ve sat in client’s basements extracting information from their IT. I’ve worked in clients offices alongside their full time team consulting with their internal responders and writing and managing training exercises. I’ve travelled the length of England and Scotland supporting and documenting workshops with local authorities, emergency responders, government departments and regulators. I’ve attended meetings with regulators, helping customers move projects forward.

I’ve also spent a lot of time keeping up to date with developments around the world and maintaining a Facebook page and a blog about the things that interest me.

I’ve published a book aimed at telling members of the public a bit more than can be fitted into the REPPIR leaflets about what they might be asked to do to protect themselves during a nuclear accident (Shelter, evacuation, stable iodine and food restrictions) and why these work. This is available as a paperback and as a Kindle file. The trickle of sales (approaching 40!) is fun to watch but is not enough to keep my family in comfort. I’ve been considering further books but have not had the discipline to complete a second one yet. I’ve satisfied my ambition to publish a book if not my ambition to publish a bestselling and useful book.

In UK nuclear emergency planning the big concern at the moment seems to me to be the forthcoming revision of REPPIR. The EU BSSD come out in 2013. The Consultation came out a few weeks ago. The regulations are due next year. There are no signs of draft regulations. That timing does not bode well. The consultation document is unclear on many aspects of the new regulations. My developing thoughts on the Consultation are collected in a blog. You are welcome to join the discussion there.

If I were a local authority I would be concerned about the onus to determine the appropriate scope of the plan possibly being placed on my organisation albeit in consultation with others (paragraph 84).

There is a lack of clarity about scoping emergency schemes particularly with regard severe accidents and its application to sites below the REPPIR threshold. Talk of assuming 100% release is surprising to say the least (Table 4).

As a Health Physics professional I’m surprised and disappointed that, even with the resources of a government department, the authors of the consultation cannot clearly articulate what a Constraint or Reference Level is nor give confidence that these terms will be correctly applied in the new regulation (see paragraph 45 for a poor explanation of a Reference Level).

I’m looking forward to getting myself up to speed with the new regulations and will be available to help local authorities, operators, regulators and government departments understand and apply them.

I hope that in the future I will continue to find varied projects to work on across the industry but the life of an independent contractor is a precarious one so this is far from certain. More work welcome, contact keith.pearce@katmal.co.uk.

 

Customer graphic
Some of Katmal Limit’s customers

 

IAEA Energy, Electricity and Nuclear Power Estimates for the Period up to 2050

The IAEA have just published their Energy, Electricity and Nuclear Power Estimates for the Period up to 2050. These are obtained by looking at all nuclear power reactors in operation, in build and in planning across the world and making best estimate, pessimistic and optimistic estimates of the electricity they might be expected to generate up to 2050.

The highlights reported include:

  • There were 448 operational nuclear power reactors in the world at the end of 2016, with a total net installed power capacity of 391 GW(e).
  • An additional 61 units with a total capacity of 61 GW(e) were under construction.
  • During 2016, ten new nuclear power reactors with a total capacity of 9531 MW(e) were connected to the grid, and three reactors with a total capacity of 1405 MW(e) were retired.
  • In 2016, construction began on three new units that are expected to add a total capacity of 3014 MW(e).
  • Nuclear power accounted for about 11% of total electricity production in 2016.
  • Coal still leads as the major source for electricity generation across the world with natural gas growing.
  • Hydropower and renewables grew to 24.8% in 2016 compared to 11% nuclear electricity production.
  • World energy consumption is expected to increase by 18% by 2030 and by 39% by 2050, at an annual growth rate of about 1%.
  • More than half of the existing nuclear power reactors are over 30 years old and are scheduled to be retired in the coming years.

ELECTRICITY PRODUCTION BY ENERGY SOURCE IN THE COMBINED REGIONS OF NORTHERN, WESTERN AND SOUTHERN EUROPE IN 2016

Emergency Services Show 2017

Emergency Services Show 2017, NEC, Birmingham 21 September 2017

This show filled a large hall at the NEC with nearly 500 exhibitors and several small lecture theatres providing short presentations.

The highlights of my day there included two talks and some interesting developments that are described below.

Luana Avagliano and Ben Platt gave a presentation on Resilience Direct. I was interested that her advice was to think of the most extreme outcome and prepare for that. This is increasingly a theme in government emergency planning/resilience which is replacing the concept of planning in detail for the worst reasonably foreseeable event (itself pretty bad and of low probability) and in less detail for the extreme events (extendibility). The loss of this “proportionality” makes emergency planning much more expensive.

Her other theme was the importance of recovery. It is true that we used to plan in detail for initiating an emergency response (when to call people, who to call, what to tell them, where to collect them together, and their roles and responsibilities including initial actions). The idea being that once they were up and running they’d manage the initial issues and then move into recovery when the time was right. As time went on the “recovery” bit became a bit more visible and was tested to an extent. However, recent events have shown that the media, and then the public, are unmerciful towards any perceived failure to make the victims comfortable in the hours, days and weeks following an event and that a swift return to the old normality is considered a minimum expectation. It is right to give this area attention. Community resilience is about getting back to normality as quickly and as painlessly as practical no matter what the shock.

Ben spoke about the new lessons learned processes being added to the Resilience Direct platform. They appear to be well thought out and comprehensive.

Paul Channing from Hampshire Fire and Rescue give a talk on their “safe and sound” programme. This is on online application that asked a few questions (it was designed to take no more than a few minutes) and then based on the answers provides a personalised safety brief. For example if you answer that there are no smokers in the household it doesn’t give the advice on fire safety with regard to smoking. If you have people over 65 in the household it asks more questions and, where appropriate, points to the “safe and well” project that provides advice and practical help to this age range.

This appears to be a well-managed project with a clear focus, targeting the key domestic fire risks, linking to related projects, using focus groups to help with the design, collecting data for feedback and presenting easy to understand customised advice to the user.

The idea of using a short questionnaire in this context; where do you live? What age ranges live there? Risk factors etc. before giving customised advice is obvious once you’ve heard it but clever.

Products

I was impressed by Horizonscan which is a company that offers business continuity training but also offers “Crisis boardroom”, a crisis pack consisting of a large suitcase which, in turn, contains a number of other bags each of which contain laminated Command and Control Boards, individual tabards and name tags, stationary and role aide-memoirs. It appears to provide a complete crisis management tool kit in one bag. The tools themselves seemed to be well thought out, designed and produced.

This would be a good place to start for any Company seeking to introduce business continuity to their board as the tool kit provided looks the part.

I’ve mentioned 999-eye from PageOne before. I think that it is a product that would be useful in the nuclear industry.

I liked the orvecare thermal emergency blanket so much that I bought two, one for my car and one for my wife’s car. It takes up less room than the sleeping bag I used to carry in the boot in winter and can stay there all year. It might one day prove useful.

The AlfaDrop Box does look like a possible candidate for a rapidly deployable “space”. It could be a control room, a shelter, a store, or a change facility – whatever. With the vehicle at about £39k and the boxes from £7k upward you could have one vehicle and many boxes which could be deployed quite quickly. Thunderbirds are go! (See video).

Finally a quick message to the organisers. We all now know that LEDs can make bright lights in a range of colours and can flash. We also know that human ingenuity can think of lots of ways of using them. The exhibition room was full of the damn things making it a quite uncomfortable working environment. Maybe in future limit “lights on” for five minutes every hour?

It is easier to scare than to reassure. The Shamisen project report

The EU-OPERA SHAMISEN project started in December 2015. One driver for this project was the realisation that existing recommendations on nuclear accident dose control had an almost exclusively technical focus which was directed towards the decision making process of experts while failing to consider the impact on the general populations. Both Chernobyl and Fukushima taught us that averting dose is only part of the process of protecting the public; social, ethical, psychological issues are as important, if not more so. What was needed was a set of recommendations that would contribute to health surveillance and related communication with affected populations after nuclear accidents.

The project has now reported (here). It presents a number of recommendations and, for each one, it briefly explains why they make the recommendation, how it can be satisfied and who should take the lead. This is a very good format for this type of document.

Of particular interest to me are:

R7 Build a radiation protection culture between radiation protection experts, healthcare workers, professionals and the general public. This is a very big ask. Radiation Protection is eye wateringly complex and it takes several hours to explain the basics to people with a good science education. The big questions are how are the healthcare workers going to find the time to listen and how are you going to convince the public that they need to devote the time and effort to learning. After an accident in their area I think we’d have their attention but not before. This is a laudable ambition, teaching materials can be written (indeed many good examples already exist) but after that there are no quick wins.

R8 Establish early response and communication protocols with responsibilities and roles clearly laid out. Engage relevant stakeholders in the establishment of these protocols, and prepare the necessary material and channels to communicate with the public (including social media). This is part of the preparedness phase. Much of this is already part of basic emergency plans. Off-site plans invariably list who should be alerted and define the roles and responsibilities of responders. Maybe more could be done to prepare information and discuss how it could be presented to the public on the day of an event and in the days and weeks following an event.

R10 Prepare and facilitate training and education material and resources adapted to healthcare and other professionals, as well as other stakeholders. This is another laudable ambition to pre-position healthcare, community leaders and teachers with suitable knowledge and teaching materials ready to step and inform and reassure the public if the worst happens. Again the problem is one of time and focus. Healthcare professionals have a lot of competing issues to consider as they strive to support the community health.

R13 Foster participation of stakeholders and communities by engaging them in emergency preparedness, including planning for socio-economic health surveillance and, where appropriate, epidemiology. Again the industry and the government already does a lot in this area with regular meetings with community groups and community group representation on multi-agency emergency planning meetings. This tends to be more about the arrangements to promulgate and alert and support early countermeasures rather than socio-economics and epidemiology. (Having said that health physics is a challenge to teach it must be recognised that it is relatively straightforward compared to epidemiology).

R14 Ensure prompt sharing of accurate and reliable information (e.g., plant conditions, radiation dose, radiation protection actions) between nuclear plant representatives, authorities, experts and the population. The paper has a great quote here; “it is easier to scare than to reassure”. Talking about the tendency of misinformation to quickly fill any gaps in communication it reports that “a recent study found that, during the Zika virus outbreak, the most popular social media health stories were the least accurate”. This isn’t a surprise but it does focus us on the reality of public communication – it is difficult. The authors conclude this section by saying that “the benefits of online information offer the public a unique opportunity to learn about nuclear power, which may outweigh the costs associated with “internet cacophony”.

I find the recommendation R18 Provide support to populations who wish to make their own measurements, recommending reliable equipment and resources (e.g., apps, social media, information centres) that can contribute to the characterisation of population exposure and its evolution a little hard to agree with. Radiation detection is relatively easy. Radiation measurement is quite difficult. Interpretation of radiation measurements in terms of harm is difficult. There could be benefits from providing groups of people immediately affected by the incident with a group EPD to give a quick assessment of their dose during the acute phase, and providing everyone who returns from evacuation with a personal TLD (collected and read by the authorities) to assess their doses systematically. But I would hesitate to encourage unskilled people to wield unfamiliar radiation monitors and use the results to affect their behaviour.

The recovery phase recommendations all have merit and consideration of this document should be included in any recovery phase planning effort.

What do we need to do better as a result of this advice?

I think that the idea of building up radiological protection knowledge capital prior to an event is sensible but difficult. Encouraging healthcare professions, community leaders and people the community might trust such as teachers is always going to struggle against competing calls on their time and attention. Given that other threats such as flu pandemic, other health scares and themes such as mental health, diet and obesity are more likely to impact they are more likely to take the training time of these people. The industry’s outreach and information programmes should continue.

Early response tools, such as briefing material, are often spoken about and nuclear operators tend to have trained Media Technical Briefers to explain the complexities of nuclear accidents and health implications on the day. A review to see if more can be done, particularly with emerging technology and communications channels, should be undertaken periodically.

Summary

This report is well thought out, well presented and valuable. It deserves to be read by nuclear emergency planners and those responders with responsibility for advising and supporting members of the public before, during and after an accident.

Decline or fail – When the nuclear planning local authorities cannot match expectations.

I was interested to learn that the American system has a mechanism to respond to a situation where a nuclear power station cannot get adequate support from the local responders for their off-site plan. Their rules define “decline or fail” as a “situation where State or local governments do not participate in preparing offsite emergency plans or have significant planning or preparedness inadequacies and have not demonstrated the commitment or capabilities to correct these inadequacies in a timely manner so as to satisfy NRC licensing requirements”. (44 CFR 352.1)

An Executive Order enacted by Ronald Regan in 1988 summarises the situation. Chapter and verse can be found in Code of Federal Regulations 44 Emergency Management and Assistance (dated 2002).

The licensee seeks Federal assistance by submitting certification that a decline or fail situation exists to the host FEMA Regional Administrator explaining why assistance is needed and providing documentary proof that they have tried to rectify the situation themselves.

This is reported to FEMA Headquarters and the involved off-site organisations. The State and local governments have 10 days to submit a written report of their views and position and FEMA make a determination about whether or not a decline or fail exist within 45 days of the original communication.

The FEMA Deputy Administrator for the National Preparedness Directorate shall make a final determination as to whether Federal facilities and resources are needed. This process identifies what resources could be called on, the extent and purpose for which they can be called and the limitations on their use.

Interestingly it is assumed that the State and local authorities will contribute their full resources and exercise their authorities in accordance with their duties in a real event.

The Federal resources are to take care not to supplant State and local resources and only make good the impact of the decline or fail. FEMA will attempt to recover the costs incurred from the licensee and from the nonparticipating or inadequately participating State or local government.

In the UK REPPIR requires co-operation from various bodies and requires that the off-site plan be reviewed and tested but makes no mention of what happens if off-sites are deemed inadequate.

Protective Action Guides

In the United States the Environmental Protection Agency issues “Protective Action Guidelines” (PAGs) which satisfy the same role that Emergency Reference Levels (ERLs) do in the United Kingdom. The Protective Action Guide (PAG) manual contains radiation dose guidelines that would trigger public safety measures, such as evacuation or staying indoors, to minimize or prevent radiation exposure during an emergency.

The 2017 PAG manual is a significant document (101 Pages) which has chapters devoted to:

  • Early phase protective action guides;
  • Emergency worker protection;
  • Intermediate phase protective action guides;
  • Planning guidance for the late phase.

For the early phase it provides a PAG for shelter in place or evacuation of the public of 10 to 50 mSv projected dose over four days. This is accompanied by a note that suggests that actions should start at 10 mSv projected dose and take whichever action or actions result in the lowest exposure for the majority of the population. This is broadly consistent with IAEA advice and UK practice although the UK ERLs are based on averted dose rather than projected.

 The stable iodine PAG is 50 mSv to the infant thyroid from exposure to radioactive iodine.

Emergency workers should be limited to 50 mSv over the entire response or per year unless there are extreme circumstances (such as saving life or preventing a significant release).

The report warns that: “In the early phase, there may be little or no data on actual releases to the environment and responders may have to rely on crude estimates of airborne releases. Decision time frames are short and preparation is critical to make prudent decisions when data are lacking or insufficient.”

The report suggests that the public should be advised to cover their mouth and nose with “available filtering material” when particulate activity may be present. This advice is not given in the UK.

It is also suggested that where particulate activity is present but below the PAG level the public are advised to “stay indoors to the extent practical” to reduce their dose but make a judgement if they need to go out for any reason. Such advice is apparently given on days when air pollution is forecast to be bad. Again, this is not something I’ve heard mentioned in the UK.

 A discussion about the relative merits of shelter in place and evacuation concludes that “Sheltering-in-place should be preferred to evacuation whenever it provides equal or greater protection. Sheltering-in-place followed by informed evacuation may be most protective”. It reports that populations that are aware of the evacuation alerting mechanisms and plans are more likely to successfully evacuate than unprepared populations and further reports that many areas are improving their communications processes and public training. The need to have special plans for needy groups such as schools, institutions and those without their own transport is noted.

On iodine tablets the report suggests that minimum doses for each age (weight) group is ideal but that, if this is too challenging logistically and in terms of communication, then a full dose can be given to all without great risk.

Interestingly it suggests that adults over 40 years old would only benefit from stable iodine if their projected thyroid dose is of the order of 5 Sv where it can be used to prevent hypothyroidism.

Stable iodine given to pregnant women also protects the foetus but repeat doses should be avoided if possible to prevent foetal thyroid complications. (In the UK it is expected that a single dose of stable iodine will be adequate because either the release will have stopped or the affected members of the public should be evacuated within the 24 hours that the first dose provides protection for).

Breast feeding mothers can reduce the radioiodine in their milk by taking the usual dose of stable iodine. This is useful for reducing the baby’s dose but does not protect them from directly inhaled radioiodine for which a small dose of stable iodine can be administered.

Section 2.3 discusses the process of estimating dose projections based on source terms, atmospheric dispersion and release prognosis. Section 2.4 discusses contamination and environmental monitoring.

Subsequent sections discuss the control and limitation of dose to responders and recovery workers and doses in the later phases of the event, including from food and water, once the release has stopped. Of interest is table 4-2 which summarises a discussion about the circumstances under which people can be allowed back into an area, either for remedial work, use of critical infrastructure, to access business and homes to recover property.

On the whole the advice given in this report is similar to that given in the NRPB’s ERL documents that are used in the UK. It contains some interesting and useful discussion.

“keyhole” countermeasure zones