Radiation Emergency Preparedness Research Articles

Evaluation of emergency nurses’ knowledge of medical response in nuclear and radiological emergencies : a cross-sectional study

BackgroundEvaluating emergency room nurses’ knowledge of radiation protection, health effects, and decontamination procedures is crucial for preparedness in nuclear and radiological emergencies. This study aims to evaluate the level of knowledge among emergency nurses in Saudi Arabia regarding medical responses to nuclear and radiological emergencies.MethodsA multicenter cross-sectional study was conducted via a self-structured questionnaire with 15 true‒false questions divided into three domains, namely, radiation protection measures, radiation health effects, and decontamination procedures, each with five items and a possible score of 1 point per correct answer. The collected data were analyzed via descriptive and inferential statistics. The study followed the STROBE checklist for methodological rigor.ResultsA total of 594 emergency nurses participated in this study, with the majority being young (64.50% aged ≤ 30), female (68.69%), bachelor’s degree-holding (67.68%), single (63.64%), having ≤ 4 years of experience (56.06%), working in public health facilities (88.89%), and lacking training in medical response (85.35%). The mean knowledge scores for participants were highest for radiation exposure effects (3.27 ± 0.91), followed by radiation protective measures (2.32 ± 0.99), and lowest for decontamination procedures (1.46 ± 1.07). Overall knowledge was measured at a mean score of 7.06 ± 1.68, with 97.47% of the nurses categorized as having poor knowledge level. Nurses in private hospitals scored higher (7.77 ± 1.82) than those in public hospitals (6.97 ± 1.65) on overall mean knowledge (P = 0.034). Concerning findings include emergency nurses’ misconceptions about the protection provided by dense materials, the effectiveness of increasing distance from a radiation source, and prioritizing decontamination of victims over life-saving measures. Additionally, they were unaware of the immediate symptoms following radiation exposure and misunderstood that the primary threat in a radioactive bomb event is the explosion rather than the radiation itself.ConclusionThis study revealed poor knowledge among emergency nurses regarding medical responses to radiation emergencies and highlighted the critical need for enhanced and standardized training in radiation emergency preparedness among nurses. The gaps in knowledge identified in this study could significantly impact the effectiveness of healthcare responses in radiation emergency scenarios. Therefore, targeted educational interventions and policy changes are recommended to address these shortcomings.

An Overview of Appropriate Medical Practice and Preparedness in Radiation Emergency Response.

Radiation emergencies involving high doses of nuclear radiation pose significant risks from exposure to ionizing radiation in various scenarios. These situations include transportation accidents involving radioactive materials, occupational exposure, nuclear detonations, dirty bombs, and nuclear power plant accidents. In addition to the immediate risks of acute radiation syndrome (ARS) and related diseases, long-term exposure can increase the risk of other health issues such as cardiovascular disease and cancer. Vulnerable populations, including pregnant women and children, face particular concern due to potential impacts on their health and the health of unborn babies. The severity of ARS depends on several factors such as radiation dose, quality, dose rate, exposure uniformity, and individual biological responses. Bioindicators are biological responses or markers that help assess the severity and effects of radiation exposure on an individual. Bioindicators can include physical symptoms such as nausea, vomiting, and diarrhea, or laboratory tests such as changes in blood cell counts and gene expression that can help in assessing and treating exposed individuals. Additionally, early prodromal symptoms such as vomiting, diarrhea, and erythema can provide important clues for diagnosis and treatment. Developing a comprehensive plan for radiation emergencies is vital for safeguarding public health, infrastructure, and the environment. First responders play a critical role in establishing safety perimeters, triage, and coordination with various stakeholders. Education and training are essential for medical personnel and the public. This article provides general recommendations and identifies challenges to effective radiation emergency preparedness and response.

ACİL SERVİS PERSONELLERİNİN KİMYASAL, BİYOLOJİK, RADYASYON VE NÜKLEER ACİLLERE HAZIRLIK DÜZEYLERİNİN DEĞERLENDİRİLMESİ

Purpose: The aim of this study is to determine the chemical, biological, radiation, and nuclear (CBRN) emergency preparedness levels of emergency department (ED) personnel. Materials and Methods: This cross-sectional descriptive survey study was conducted with 49 emergency department personnel (emergency medicine specialists, emergency medicine research assistants, nurses, and nursing staffs) working in the ED of a university hospital through face-to-face. The questionnaire was created by the researchers and consisted of 5 demographic and 30 CBRN preparation information, 12 questions questioning the previous practice and educational status of CBRN subjects. The preparedness level of the participants was determined by evaluating the CBRN preparedness level responses. Results: The Cronbach's Alpha reliability index obtained for the CBRN scale was obtained as α=0,856 for the whole scale and this value shows that the reliability of the whole scale is at a good level. The mean preparedness level score of the ED personnel is 59,7 (min-max:24-81). The mean CBRN preparedness level score of emergency medicine specialists (38) was found to be lower than the other groups. The number of those who received training on CBRN situations and medical management of cases during their professional training (bachelor-master- doctorate education) is 18 (36,7%). Most of the participants didn’t participate in any CBRN exercise during their professional life (n=43, 87,8%). Conclusion: ED personnel's preparations for CBRN emergencies are insufficient. Their participation in training and exercises for the medical management of CBRN cases is low. Our study can be used as a tool to determine the CBRN preparations of ED personnel.

Some observations on perceptions of radiation risks in the context of nuclear power plant accidents.

As highlighted by public reactions to accidents at nuclear plants in the past, such as those that occurred in Chernobyl (1986) and Fukushima (2011), and from numerous opinion surveys, there are considerable differences or gaps between how the public and radiation experts perceive the risks from radiation. Even within the community of experts, radiation risk perception differences can be present. The reasons for differences in radiation risk perceptions between the public and experts are complex and involve sociological, ethical and behavioural aspects of society. This presents significant challenges to authorities in trying to improve radiation risk communications targeted at the public within the context of radiation emergency preparedness planning. Of particular importance is to make the communications more citizen-centred than heretofore by having meaningful two-way communications and dialogue with the public. It is emphasised that such strategies should take into account and address the significant mental health and socio-economic impacts of such accidents on affected populations. In particular, the mental health impacts are inadequately addressed by current international radiation protection recommendations reflecting their long established emphasis only on physical health effects. This approach is no longer acceptable or justified.

The NERIS roadmap: research challenges in emergency preparedness, response and recovery

NERIS as a European Platform on Preparedness for Nuclear and Radiological Emergency Response and Recovery (EPR&R) has developed a roadmap setting out the key research challenges for radiation emergency preparedness, response and recovery. Research projects in this field have been summarised to demonstrate how important areas of development have been identified and addressed. Radiation EPR&R has a continuous need to evolve to meet societal demands, but also to keep pace with scientific and technological developments and opportunities and so the NERIS research priorities as published in the Strategic Research Agenda (SRA) are kept under review. Three challenge areas have been identified covering the topics of radiological impact assessment, protective action strategies and establishing a transdisciplinary and inclusive framework for emergency preparedness, response and recovery. The importance of these challenge areas and the underlying key topics for NERIS have been mapped across to the Joint Radiation Protection Roadmap developed by the consortium of European radiation research platforms known as MEENAS. The war in Ukraine triggered a new round of revision of the SRA that resulted in the identification of four topics as new or revised challenges for the NERIS community. These updated challenges are: (1) optimisation of management strategies for the transition and recovery phase, (2) uncertainty quantification, data assimilation and monitoring strategies, (3) inverse modelling, and (4) lessons identified from Ukraine and implications for emergency preparedness. These four areas will form the priority research areas for the NERIS community to help advance radiation emergency preparedness to meet current challenges and needs that have been identified.

Development and Validation of a New Tool to Measure Performance Knowledge and Communication Skill of Multidisciplinary Health Science Learners on Radiation Emergency Preparedness and Response Management.

The purpose of the study was to design, develop, and validate a newer tool on radiation emergency preparedness responses (RadEM-PREM IPE tool) to measure communication, knowledge, performance skills in multidisciplinary health science learners. The study design is a prospective, single centric, pilot study. Five subject experts designed, analyzed, and selected items of the instrument for relevant content and domain. Psychometrics that the tool assessed were content validity, internal consistency, test-retest reliability, and intraclass correlation coefficient. Twenty-eight participants completed test-retest reliability for validation of 21 sorted out items calculated percentage of agreement >70% I-CVI/UA (item content validity index with universal acceptability) and S-CVI/UA (scale content validity index with universal agreement method). Items with percentage agreement >70% and I-CVI over 0.80 were kept, ranged from 0.70 to 0.78 were revised, and below 0.70 were rejected. Items with kappa values ranging from 0.04 to 0.59 were revised and ≥0.74 were retained. Internal consistency assessed using Cronbach's alpha was 0.449. Positive correlation between attitude and communication (r = 0.448), between performance and communication (r = 0.443) were statistically significant at 0.01 level. Overall, intraclass correlation coefficient for all the measures is 0.646, which is statistically significant at 0.05 level (P < 0.05). Study concludes that the RadEM-PREM IPE tool would be a new measuring tool to assess knowledge, performance, and communication skills of interprofessional radiation emergency response team learner's evaluation.

Examining radiation emergency preparedness among the citizens of Busan, South Korea: Based on the IDEA framework

Developing a comprehensive radiation emergency preparedness plan is as crucial as effectively communicating it to the public. This study used a survey of citizens in Busan, South Korea, where seven nuclear power plants (NPPs) are located in close proximity, to examine their radiation emergency preparedness levels. Specifically, on the basis of the internalization, distribution, explanation, action (IDEA) model, this study investigated the public's risk perceptions, frequent and trusted communication sources, and awareness of the radiation emergency preparedness plan designed by their local government. Results showed that all these variables are significantly associated with individuals' radiation emergency preparedness levels. Finally, the theoretical and practical implications of the results are discussed.

Quantitative analysis of International Health Regulations Annual Reports to identify global disparities in the preparedness for radiation emergencies

ObjectivesRadiation emergencies are rare but can have minor confined effects to catastrophic consequences across the large geographical territories. Geographical disparities in the preparedness for radiation emergencies can negatively impact public-safety...

Knowledge on radiation emergency preparedness among nuclear medicine technologists

This study aimed to assess the knowledge of nuclear medicine technologists (NMTs) in radiation emergency preparedness and response operations and their willingness to participate in such operations. A survey was developed for this purpose and distributed to NMTs in Saudi Arabia. Sixty participants responded with a response rate of 63.31%. Based on the overall radiation protection knowledge related to emergency response, NMTs can perform radiation detection, population monitoring, patient decontamination, and assist with radiological dose assessments during radiation emergencies. There were no significant differences in the knowledge on the use of scintillation gamma camera (P = 0.314), well counter (P = 0.744), Geiger counter (P = 0.935), thyroid probes (P = 0.980), portable monitor (P = 0.830), or portable multichannel analyzer (P = 0.413) and years of experience. Approximately 44% of the respondents reported receiving emergency preparedness training in the last 5 years. Respondents who reported receiving training were significantly more familiar with the emergency preparedness resources (P = 0.031) and more willing to assist with radiation detection or monitoring in the event of nuclear reactor accident (P = 0.016), nuclear weapon detonation (P = 0.002), and dirty bomb detonation (P = 0.003). These findings indicate the importance of training and continuing education in radiological emergency preparedness and response, which increase the willingness to respond to radiological accidents and fill the gaps in NMTs’ knowledge and familiarity with response resources.

Global Disparities in the Preparedness for Radiation Emergencies

Background: Radiation emergencies are rare but can have minor confined effects to catastrophic consequences across the large geographical territories. Geographical disparities in the preparedness for radiation emergencies can negatively impact public-safety and delay protective actions. We examined such disparities using the global and regional radiation preparedness data from the revised annual International Health Regulations (IHR) datasets. Methods: We used IHR State Party Annual Reporting (SPAR) tool and its associated health indicators developed to mitigate public health-risk from radiation emergencies. Using the most recent (2019) SPAR database developed for radiation emergencies, along with 12 other cross-sector indicators, we examined the disparities among World Health Organization (WHO) state and region-wide capacity scores for operational preparedness. Findings: Based on the analysis of the 2019 annual reporting datasets from 171 countries, radiation emergency was one of the top 3 global challenges with an average global preparedness capacity of 55%. Radiation emergency preparedness capacity scores showed highest dispersion score amongst all 13 capacities suggesting higher disparities for preparedness across the globe. Only 38% of the countries had advanced functional capacity with ≥80% operational readiness, with 28% countries having low to very-low operational readiness. No geographical regions had ≥80% operational readiness for radiation emergencies, with 4/6 geographical regions showing limited capacity or effectiveness. Interpretation: We found major global disparities for the operational preparedness against radiation emergencies. Collaborative approaches involving the public health officials and policymakers at the regional and state levels are needed to develop additional guidance to adapt emergency preparedness plans for radiation incidents. Funding Information: This research was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo and Roswell Park Comprehensive Cancer Center, and by Roswell Park and National Cancer Institute under award number P30CA016056. UCS is supported by KO8HL131987 and RO1HL152090 Award from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI). SP received support from NIH/NHLBI (Award Numbers R21HL154028 and RO1HL150266). Declaration of Interests: None.

Two dimensional array of MPPC and CsI(Tl) for radiation monitoring prototype

An effcient radiation and position monitoring system is useful for preliminary security inspection and radiation emergency preparedness and response. A high sensitivity and effective monitoring system is needed for these applications. In this study, two position-sensitive prototypes were proposed by using of 8 Multi Pixel Photon Counters (MPPC) and coupled to the cesium iodide with Thallium (CsI(Tl)) scintillator. This inorganic scintillator was chosen for its output wavelength compatibility with MPPC, slightly hygroscopic, high photon transmission, and input energy. For both prototypes, eight MPPCs with di_erent con_gurations were used to obtain active areas of 2.0 × 2.4 cm2 and 2.5 × 4.5cm2, respectively. The prototype has been tested with radioactive (Tl-204 and Co-60). The intensity received by each MPPC’s readout will be recorded using Extended Analogue SiPM Integrated ReadOut Chip (EASIROC) module. Our test showed that both prototypes were sensitive to both beta and gamma sources and were able to reliably determine the sources’ positions. It was shown that the first prototype had greater resolution and performance than the second prototype. This studies may help to improve radiation detection system which is suitable for homeland security, medical field and scanning system.

A Global Collaboration for Community-Based Disaster Preparation and Health Promotion: Fukushima to Zuunbayan in Mongolia.

Excessive radiation exposure has adverse effects on health. In Fukushima, psychological issues such as anxiety are still affecting people nine years after the Fukushima nuclear power plant accident in 2011. In light of the lessons learned from Fukushima communities, a joint Japanese and Mongolian research team introduced a community program to the Zuunbayan district in Mongolia, which is located near a uranium deposit, to promote good health by strengthening radiation emergency preparedness. The program, which commenced in 2017, aimed to increase community participation, education, information dissemination, and capacity of community preparedness. After two years a monitoring study showed that, out of 227 respondents, the proportions who thought that any level of radiation was dangerous decreased from 53.3% in 2017 to 33.9% in 2019. Moreover, half of the respondents knew that there were safe and unsafe radiation levels and that their community was safe. This global collaboration demonstrated that a lesson learned from a disaster can be applied to other countries and changed people's recognition and behavior toward good health and disaster/emergency preparedness.

Nordic Cooperation in the Nuclear Safety Sector: High, Low, or Differentiated Integration?

Nordic cooperation has been depicted as eroding due to the increased importance of EU-related cooperation and integration. However, scholars propose that longstanding Nordic networks, grounded in professions and located in the state administration, may prove to be more robust toward external changes. This article discusses this proposal by looking at Nordic cooperation between the national radiation protection and nuclear safety authorities in Iceland, Denmark, Norway, Sweden, and Finland. The article maps behavioural perceptions of agency staff based on a dataset of 37 interviews to illustrate if the cooperation between the Nordic authorities is characterized by high integration, low integration, or differentiated integration within the nuclear safety sector. The study finds that the cooperation is differentiated between the highly integrated areas of radiation protection and emergency preparedness, and the less integrated areas of nuclear security and safeguards. To account for variation, the data indicates the importance of path dependency and portfolio.

Update on guest editorial, “Radiological safety and radiation emergency preparedness” (Radiat Prot Environ 2020;43:1-5)

Update on guest editorial, “Radiological safety and radiation emergency preparedness” (Radiat Prot Environ 2020;43:1-5)

Radiological safety and radiation emergency preparedness

Radiological safety and radiation emergency preparedness

Off-site Emergency Planning at UK Nuclear Licensed Sites.

Nuclear emergency planning arrangements in the UK are continually kept under review. This work proposes to outline how experience from nuclear exercises and undertaking emergency response duties can be based on radiological knowledge of specific sites and utilised in the future. In 2014, the UK regulator, the Office for Nuclear Regulation (ONR) revised their principles for the determination of off-site emergency planning areas around nuclear sites where predetermined countermeasures and other protection measures are applied to protect those people who may be affected by a radiation emergency. The revised principles also enhanced communication from the nuclear site operators and local authorities to the public. This updated ONR's application of the UK Radiation (Emergency Preparedness and Public Information) Regulations 2001 (REPPIR) http://www.hse.gov.uk/radiation/ionising/reppir.htm, which includes details of minimising potential doses to the public, as well as assessment and reassurance, linked to other concurrent risks such as flooding. ONR undertakes site-specific assessments of each operators' hazard identification and risk evaluation, which include consideration of whether the public might receive a significant radiation dose in the year following the emergency (excluding countermeasures in the first 24 hours). In defining the areas for off-site emergency planning, practical and strategic factors are then considered, which include other local non-nuclear emergency planning arrangements and experience, and whether local geographic and demographic aspects could aid public credibility and confidence.

The Role of the Regional Centres for Radiation Protection in Radiation Emergency Preparedness in Germany

The structure and tasks of the German network of the Regional Centres for Radiation Protection established by the Institute of Radiation Protection and the network's role within the national emergency response system are being described.

Lessons from Chornobyl: Considerations for Strengthening Radiation Emergency Preparedness in Ukraine.

The response to the accident at the Chornobyl Nuclear Power Plant was analyzed. Measures taken in the early and late period after the accident were considered, and achievements and mistakes were estimated. The legal framework for dose estimation and registration and treatment of radiation effects were described. Disseminating scientific information to the public is critical to preventing early and remote radiation effects.

The harmonization process to set up and maintain an operational biological and physical retrospective dosimetry network: QA QM applied to the RENEB network

Purpose: The European Network of Biological and Physical Retrospective Dosimetry ‘RENEB’ has contributed to European radiation emergency preparedness. To give homogeneous dose estimation results, RENEB partners must harmonize their processes.Materials and methods: A first inter-comparison focused on biological and physical dosimetry was used to detect the outliers in terms of dose estimation. Subsequently, trainings were organized to improve both tools dose estimation. A second inter-comparison was performed to validate training efficiency. Simultaneously, based on ISO standards, a QA&QM manual on all dosimetry assays was produced which states a common basis and harmonized procedures for each assay. The evaluation of the agreement of RENEB partners to follow the QA&QM manual was performed through a questionnaire. The integration of new members into the network was carried out in the same way, whatever the assays.Results: The training courses on biological and physical dosimetry were judged to be successful because most of the RENEB members’ dose estimates improved in the second inter-comparison. The QA&QM manual describes the consensus for the minimum requirements and the performance criteria for both dosimetry assays. The questionnaire revealed that the whole network capacity currently can manage between 15 and 3800 samples once.Conclusion: The methodology used to harmonize all dosimetry practice within the network RENEB was highly successful. The network is operational to manage a mass casualty radiation accident for immediate dose assessment.

Radiobioassay performance evaluation of urine and faeces samples for radiation emergency preparedness

ABSTRACTIn the event of a radiation emergency, it is necessary to assess intake and radiation dose for the internally contaminated casualties. This paper provides relatively rapid and simple procedures of bioassay. Faeces samples were ashed to improve sample homogeneity. Gamma spectrometry was used for radioactivity measurement. The measured results, including activity of the biosamples and associated uncertainty, were evaluated for traceability based on ANSI N42.22 and bias and precision based on ANIS/HPS N13.30. For all urine customary exercise samples, measurement results of 60Co and 137Cs were in good agreement with NIST values within 5% and satisfied ANSI N42.22 and ANIS/HPS N13.30 acceptance criteria. In contrast, the uncertainty of 57Co was quite large and the activity differed from the NIST value by 18%. For the urine emergency preparedness exercise, all measured results agreed well with NIST values, with less than 10% difference. Synthetic faeces samples included 54Mn, 60Co, and 134Cs. The activity of 60Co was different from the NIST value by 9%, whereas the results for 54Mn and 134Cs were within 3.2%. The measurement procedures given in this study can be applied to assess intake of radionuclides and resulting radiation dose to casualties.