Disaster Preparation: Lessons from Japan

Abstract

On 11 March 2011, the earthquake and tsunami in Japan claimed thousands of lives, disrupted the lives of hundreds of thousands, and destroyed regional power and transportation infrastructure. Backup systems intended to maintain cooling for three operating nuclear reactors and the spent-fuel pools failed. Experts in various technical fields from Japan, the United States, and around the world worked to understand and mitigate the consequences of unplanned releases of radioactivity. As a team of U.S. health and medical subject matter experts deployed to Japan in the early days after the tsunami, we have identified the elements that remain most challenging in preparing for future disasters. ![Figure][1] Support. The U.S. Navy delivers relief supplies to an evacuation center in northern Japan. CREDIT: MASS COMMUNICATION SPECIALIST 1ST CLASS BEN FARONE, US NAVY/WIKIMEDIA COMMONS Given the reality of the uncertainty in the physical state of the Fukushima reactors, the ability to make accurate predictions based on models was limited. We found that the absence of such information led to suspicion by the public that data were not being reported. Information was being provided by a variety of sources, including international news media. Cultural differences and national sovereignty must be understood and respected when determining how to present, disseminate, and discuss information. Although the public was justifiably concerned about possible radiation health effects, we believe that lack of understanding of radiation and its effects resulted in unnecessary fear. The misunderstanding extended to the purpose of potassium iodide (KI), which should not be distributed indiscriminately, but rather used to protect those with active thyroids, particularly infants, young adults, and teens who are at risk from the exposure resulting from internal contamination. There was also uncertainty about the best KI dosage and administration schedule, partly because Japanese dosage guidance differed from that provided by the United States. Fortunately, in this case KI prescriptions were reduced to very few people, primarily those working close to the reactors. We also observed differences in risk tolerance. Compared with those far from the site, a local population may choose to accept a modestly greater risk from low-level radioactive contamination in order to restore their economy and way of life. Cultural differences also may alter the acceptable level of risk (such as the amount of iodine normally contained in the diet) or how to balance risk and benefit. Less stringent requirements can be acceptable for adults, compared with infants and children, although conflicting protective action guidelines create public confusion. When evacuation is initiated, it is crucial to identify the criteria that must be met before residents are permitted to return. Each decision requires the assessment of competing risks at a time when outcomes are uncertain. For example, initially imposing a travel warning and limiting entry of people and removal of food products from a 50-mile zone around the radiation source were sensible. However, there are risks in mass movements of people, including transportation accidents, trauma from disrupting lives, separating people from their normal support structure (including care for chronic medical conditions), and diverting personnel who might be needed elsewhere. If evacuation is maintained for too long, there can be serious health (including mental health), family, and economic consequences. In rapidly evolving situations, scientists who advise decision-makers must think like clinicians and make decisions based on the best information available at the time. 1. The contents in this manuscript are from the authors and do not represent U.S. government policy or opinion. [1]: pending:yes