Long-Term Health Monitoring of Populations Following a Nuclear or Radiological Incident in the United States Proceedings of a Workshop (2019) / Chapter Skim
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2 Planning for a Radiation Registry
2 Planning for a Radiation Registry
Pages 19-50
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said that, as a consequence, there is little understanding within the emergency management community and in particular among those organizations that will be involved in recovery operations about what the "perfect" recovery plan would look like and what it takes to get the long-term recovery work done.
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Linking immediate response to long-term follow-up 5. Implementing radiation dose threshold as an inclusion criterion 6.
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Dose above a No threshold level as an inclusion criterion? Major contributions Understanding of health effects of radiation; fundamental information for radiation risk assessment and radiation protection standards worldwide Workshop presenter Dr.
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Exposure above a Only for group e threshold level as an inclusion criterion? Major contributions Information on doses to the exposed populations Workshop presenter Dr.
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Exposure above a No threshold level as an inclusion criterion? Major contributions Concerns of over-diagnosis following thyroid screening; magnitude of mental health effects following the accident and needed resources for individual support Workshop presenter Dr.
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Sub-cohort G3: 1,075 professionals who dealt with contaminated material or patients internally and externally exposed to Cs-137 and also neighboring population of contaminated areas. There is no dosimetry for this group Exposure above a Yes threshold level as an inclusion criterion?
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Major contributions Important contribution to the literature on respiratory and mental health conditions of enrollees; link affected participants to services Workshop presenter Dr. Mark Farfel, New York City Department of Health and Mental Hygiene Title a.
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Exposure above a N/A threshold level as an inclusion criterion? Major contributions Victim advocacy and support; free resources, including counseling and spiritual care referrals; technical assistance with applying for online services; free legal services Workshop presenter Jeff Quinn, Southern Nevada Health District Title U.S.
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Members of these groups participated in advisory boards for the World Trade Center Health Registry and provided input on the type and scope of data collected.
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, and others delivered a consistent message that the need for a radiation registry depends on how the affected populations perceive the risk they incurred following their exposure to radiation and not the actual risk. Experience with previous radiation incidents has demonstrated that psychological impacts affect the plans for population monitoring.
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Those were • Medical monitoring of those who exhibited clinical symptoms related to ARS • Public health monitoring of those affected4 • Access to health care for those affected • Research on radiation health effects • Financial compensation for victims • Social recognition of the tragedy • Outreach to those affected such as updates on new scientific and medical developments or new programs or policies relevant to the incident 3 Two presenters shared annual costs for their registries: the Fukushima Health Manage ment Survey costs $20–$30 million per year and the World Trade Center Health Registry costs about $7 million per year. 4 See Chapter 1 for the three distinct groups of members of the public that may require health monitoring following a nuclear or radiological incident through a radiation registry.
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acknowledged that currently the roles and responsibilities for setting up long-term health monitoring following a nuclear or radiological incident are ill-defined.
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The main argument in favor of this ap proach was that a major nuclear or radiological incident such as an IND detonation would likely have multi-jurisdictional, statewide, or even multi-statewide consequences as potentially millions of
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However, state and local health departments that do not have the resources would rely on the federal government to set up and maintain the radiation registry. Indeed, the New York City Department of Health and Mental Hygiene, one of the largest public health agencies in the United States, took the lead in 2002 in setting up and maintaining the World Trade Center Health Registry with initial financial and administrative support from the Federal Emergency Management Agency (FEMA)
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Mr. Pickett noted that only recently have public health experts become involved in the emergency preparedness program of the Pennsylvania Department of Health despite the state's history with responding to the Three Mile Island nuclear power plant accident in 1979.
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• Identify people who are contaminated externally or internally and need to be decontaminated and those who are exposed. • Collect information of potentially affected populations for possible inclusion in a radiation registry.
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2.4.1 Capturing Basic Information Early Two tools aimed to assist with the initial information collection for long-term health monitoring were described at the workshop. The first was the Rapid Response Registry (to be replaced by Epi CASE [Contact Assessment Symptom Exposure]
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supported the collection of only a few critical fields at CRCs be cause of the limited time that those who staff the centers will have with each affected individual following a large nuclear or radiological incident. He noted that during the 2017 Gotham Shield Exercise, his office operated a CRC to monitor potentially exposed individuals, decontaminate those exposed, and subsequently register people for follow-up monitoring, medi cal assessment, or medical management.
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recommended developing a template of essential elements of shareable information that would detail information that can and should be shared among coalition and community response partners. 2.4.2 Screening for Radiation Contamination and Assessing Exposure Following a nuclear or radiological incident, CRCs and other triage locations will be offering screening for radiation contamination (external or internal)
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Kagey echoed the need for more specific federal guidance and argued in favor of incident-dependent but consistent screening criteria for radiation contamination across states so that affected populations feel they receive consistent messaging and treatment. Many recognized that the screening criterion for emergency workers might be different from that of members of the public.
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in monitoring the affected populations. Implementing a radiation dose threshold as an inclusion criterion for a registry implies that a radiation dose is estimated by the registry planners using a common protocol and assigned to the affected members of the public.
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• The Chernobyl State Registry categorizes participants based on whether they participated in clean-up operations; were residents who were evacuated from the 30-kilometer zone during the first 2 weeks after the accident; or were residents of the contaminated areas or children of those people. • The Fukushima Health Management Survey included anyone liv ing in Fukushima Prefecture at the time of the accident including officials registered in Fukushima and individuals who temporarily visited the prefecture.
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Therefore, a threshold as an eligibility criterion may not work for making the community feel safe. He added that if a radiation dose threshold is implemented as an inclusion criterion for a registry, it needs to meet both the community's need to feel safe and the registry planners' goals and available resources.
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He offered as examples the agreement within the radiation protection community in setting thresholds for administering countermeasures to members of the public and in defining acceptable dose to an emergency responder. 2.6 SCREENING FOR DISEASE Populations affected by a nuclear or radiological incident will likely be encouraged by their health care providers to follow the screening recommendations of the U.S.
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) noted that the concerns about over-diagnosis led IARC to convene a multi-disciplinary expert group to develop recommendations on long-term strategies for thyroid health monitoring after a nuclear accident.
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Dr. Ursano said that following a nuclear or radiological incident, some people will experience complete disruption of their lives, loss of friends or family members, or loss of jobs and social ties.
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He also noted that special programs for addressing the psychological effects of an incident on children not only have positive impacts on children's well-being but on the well-being of the community as a whole because they provide some needed reassurance that the community's future is being taken care of. 2.7 PREPARING FOR LONG-TERM COMMUNICATIONS A common theme among the presenters and panelists was the importance of communications and public engagement at different stages of a response to a nuclear or radiological incident.
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said that successful public communication about long-term health monitoring following a nuclear or radiological emergency will be determined by the ability of the communicators to build and maintain public trust from the start of the emergency. Trust-building within communities needs to start early in the response.
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Communicate Clearly the Purpose of the Registry Registry planners need to communicate the purpose of the registry and what incentives (for example, free health care or financial compensation)
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By clearly articulating this information to those who are considering enrolling and periodically to those enrolled, the chance of setting clear expectations is increased. Explain Eligibility for the Registry If participation in the registry is not open to anyone interested but instead is determined by a set of inclusion and exclusion criteria, people who do not meet these criteria but are concerned about the effect of the nuclear or radiological incident to their health will feel that their concerns are neglected and will likely express their dissatisfaction to the registry planners.
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Prepare to Be Viewed as the Overall Incident Communicator Experience with the World Trade Center Health Registry and other registries shows that registry communicators are perceived as communicators for the incident overall. This is because years after the incident, the initial communicators have moved on to different tasks, but the registry operators are committed to a long-term activity.
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Agencies that do not have the capability to d evelop social media monitoring teams in-house can use a virtual operations support team. Plan for Succession of Registry Communicators Given the long-term commitment of a radiation registry (likely decades)
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