LESSONS LEARNED FROM THE
Fukushima Nuclear Accident
FOR IMPROVING SAFETY OF
U.S. Nuclear Plants
Committee on Lessons Learned from the Fukushima Nuclear Accident for
Improving Safety and Security of U.S. Nuclear Plants
Nuclear and Radiation Studies Board
Division on Earth and Life Studies
NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract/Grant No. NRC-HQ-12-G-03-0002 between the National Academy of Sciences and the U.S. Nuclear Regulatory Commission. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-27253-7
International Standard Book Number-10: 0-309-27253-X
Library of Congress Catalog Card Number 2014954121
Cover images: (Front) Satellite image of the Fukushima Daiichi Nuclear Power Station taken on March 14, 2011, while the accident was still in progress. The Unit 1 reactor building (lower-left corner of image) was damaged by a hydrogen explosion at 15:36 (3:36 P.M.) Japan Standard Time on March 12. The Unit 3 reactor building (building with steam plume near center of image) was damaged by a hydrogen explosion at 11:01 the day the image was recorded. The Unit 4 reactor building, which is still intact in this image, would be damaged by a hydrogen explosion at 06:14 the next day (March 15). (Back) Satellite image of the harbor-front of the Fukushima Daiichi Nuclear Power Station showing extensive damage from the tsunami. Also shown is a seismogram of the Great East Japan Earthquake recorded at the Oshika K-Net Station (MYG011) in Miyagi Prefecture. Satellite image courtesy of DigitalGlobe©2014.
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Copyright 2014 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
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COMMITTEE ON LESSONS LEARNED FROM THE
FUKUSHIMA NUCLEAR ACCIDENT FOR IMPROVING
SAFETY AND SECURITY OF U.S. NUCLEAR PLANTS
NORMAN P. NEUREITER, Chair, American Association for the Advancement of Science, Washington, D.C.
B. JOHN GARRICK, Vice Chair, Independent Consultant, Laguna Beach, California
ROBERT A. BARI, Brookhaven National Laboratory, Upton, New York
PERCY M. BEARD, JR., Institute of Nuclear Power Operations (retired), Atlanta, Georgia
JAN BEYEA, Consulting in the Public Interest, Lambertville, New Jersey
M. QUINN BREWSTER, University of Illinois at Urbana-Champaign
MICHAEL L. CORRADINI, University of Wisconsin–Madison
RICHARD S. DENNING, The Ohio State University, Columbus1
VIJAY K. DHIR, University of California, Los Angeles
MICHAEL W. GOLAY, Massachusetts Institute of Technology, Cambridge
BARBARA L. HAMRICK, University of California, Irvine Medical Center
SHELLEY A. HEARNE, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and Big Cities Health Coalition, National Association of County and City Health Officials, Washington, D.C.
PAUL A. LOCKE, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMES E. MATHESON, SmartOrg, Menlo Park, California
NAJMEDIN MESHKATI, University of Southern California, Los Angeles2
THOMAS G. MOSER, Osprey Global Solutions, Wilmington, North Carolina
ARTHUR T. MOTTA, Pennsylvania State University, University Park
JOHN A. ORCUTT, Scripps Institution of Oceanography, University of California at San Diego, La Jolla
EMILIE M. ROTH, Roth Cognitive Engineering, Menlo Park, California
JOSEPH E. SHEPHERD, California Institute of Technology, Pasadena
ELIZABETH Q. TEN EYCK, ETE Consulting, Inc., Great Falls, Virginia
MARK H. THIEMENS, University of California, San Diego3
FRANK N. VON HIPPEL, Princeton University, Princeton, New Jersey
_______________
1Separated from committee on November 21, 2012.
2Resigned from committee on June 12, 2013.
3Resigned from committee on July 26, 2012.
LORING A. WYLLIE, JR., Degenkolb Engineers, San Francisco, California
Technical Advisor
NAJMEDIN MESHKATI, University of Southern California, Los Angeles4
Staff
KEVIN D. CROWLEY, Study Director
OURANIA KOSTI, Senior Program Officer
DANIEL POMEROY, Postdoctoral Fellow (December 10, 2012, to September 1, 2013)
DARLENE GROS, Senior Program Assistant
________________
4Effective July 10, 2013.
NUCLEAR AND RADIATION STUDIES BOARD
ROBERT C. DYNES, Chair, University of California, San Diego
BARBARA J. MCNEIL, Vice Chair, Harvard Medical School, Boston, Massachusetts
JOHN S. APPLEGATE, Indiana University School of Law, Bloomington
DAVID J. BRENNER, Columbia University, New York
MARGARET S. Y. CHU, M.S. Chu & Associates, LLC, Albuquerque, New Mexico
MICHAEL L. CORRADINI, University of Wisconsin–Madison
TISSA H. ILLANGASEKARE, Colorado School of Mines, Golden
CAROL M. JANTZEN, Savannah River National Laboratory, Aiken, South Carolina
ANNIE B. KERSTING, Glen T. Seaborg Institute, Lawrence Livermore National Laboratory, Livermore, California
MARTHA S. LINET, National Institutes of Health, Bethesda, Maryland
FRED A. METTLER, JR., New Mexico VA Health Care System, Albuquerque
NANCY JO NICHOLAS, Los Alamos National Laboratory, Los Alamos, New Mexico
LAWRENCE T. PAPAY, PQR, LLC, La Jolla, California1
DANIEL O. STRAM, University of Southern California, Los Angeles
RICHARD J. VETTER, Mayo Clinic (retired), Rochester, Minnesota
SERGEY V. YUDINTSEV, Russian Academy of Sciences, Moscow
Staff
KEVIN D. CROWLEY, Director
JENNIFER HEIMBERG, Senior Program Officer
OURANIA KOSTI, Senior Program Officer
TONI GREENLEAF, Administrative and Financial Associate
LAURA D. LLANOS, Administrative and Financial Associate
DARLENE GROS, Senior Program Assistant
ERIN WINGO, Senior Program Assistant
________________
1Deceased on July 28, 2014.
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Acknowledgments
The successful completion of this study would not have been possible without the cooperation and assistance of a very large number of organizations and individuals. The committee would especially like to thank the following organizations and individuals for providing logistical support, advice, and assistance during this study:
U.S. Nuclear Regulatory Commission, which sponsored the study and provided information on the agency’s post-Fukushima activities and actions. The committee would especially like to thank former Executive Director of Operations Bill Borchardt and staff in the Japan Lessons-Learned Division, Office of Nuclear Reactor Regulation: David Skeen, Rob Taylor, Bill Reckley, and Kevin Witt. Mr. Witt served ably as the agency’s liaison to the committee and was effective in responding to the committee’s many requests for information.
U.S. Embassy in Tokyo, which assisted the committee with logistical arrangements for its meeting in Japan: former Ambassador John Roos and embassy staff Jeffrey Miller and Jen Ladlein.
Government of Japan for its full cooperation with the National Academy of Sciences (NAS) on this study and for providing technical and logistical assistance:
• Japanese Embassy in the United States: Ambassador Kenichiro Sasae, former Ambassador Ichiro Fujisaki, embassy staff members Takashi Toyota and Akira Tsugita, and former staff member Seiichi Shimasaki.
Embassy staff responded effectively to the committee’s many requests for information and logistical support.
• Atomic Energy Commission of Japan: former Chairman Shunsuke Kondo.
• Japan Atomic Energy Agency: former President Atsuzuki Suzuki.
• Japan Science and Technology Agency: Center for Research and Development Strategy (CRDS) Director General Hiroyuki Yoshikawa; CRDS Deputy Director General Tateo Arimoto; Principal Fellow Kenkichi Hirose; and Washington, D.C. representative Takashi Ohama.
• Nuclear Regulation Authority: Commissioner Toyoshi Fuketa and staff member Masahiro Aoki.
National Graduate Institute for Policy Studies (Tokyo) for cosponsoring and supporting the committee’s meeting at the institute’s facilities in Tokyo: President Takashi Shiraishi and faculty members Tateo Arimoto, Kiyoshi Kurokawa, and Atsushi Sunami.
Science Council of Japan for assisting with the identification of technical experts for the committee’s meeting in Tokyo: President Takashi Onishi and Vice President Fumiko Kasuga.
Tokyo Electric Power Company (TEPCO) for its full cooperation and support for this study, particularly for providing technical information about the company’s response to the earthquake and tsunami at the Fukushima Daiichi and Fukushima Daini nuclear plants; for arranging and hosting tours of those plants; and for participating in the committee’s meeting in Tokyo: Chief Nuclear Officer and Executive Vice President Zengo Aizawa, General Manager of International Relations and Strategy Group Akira Kawano; Fukushima Daiichi Superintendent Takeshi Takahashi; Fukushima Daini Superintendent Naohiro Masuda; TEPCO’s Washington, D.C., representative Kenji Tateiwa; and the many other TEPCO staff listed in Appendix B. Mr. Tateiwa served effectively as a liaison between TEPCO and NAS staff.
Tohoku Electric Power Company for arranging and hosting the tour of the Onagawa nuclear plant and participating in the committee’s Tokyo meeting: Managing Director Shigeru lnoue; Onagawa Superintendent Shun Tsubata; Deputy Superintendent lsao Kato; staff members Masayoshi Abe and Satoshi Otokita; Washington, D.C., representative Hiroya Shimanuki; and the other Tohoku staff listed in Appendix B.
Nuclear Energy Institute for providing information about the U.S. nuclear industry’s response to the Fukushima Daiichi accident to improve safety of nuclear plants in the United States: President and Chief Executive Officer Marvin Fertel; Executive Director (Fukushima Response) Jim Scarola; Vice President of Nuclear Operations Joe Pollock; and Senior Technical Advisor Steven Kraft. Mr. Kraft provided lead support for the
committee’s information requests and visits to the Oyster Creek Generating Station and Edwin I. Hatch Nuclear Plant.
Institute of Nuclear Power Operations for providing information about the U.S. nuclear industry’s response to the Fukushima Daiichi nuclear accident: President and CEO Robert Willard and Vice President David Hembree.
Southern Company for hosting a tour of the Edwin I. Hatch Nuclear Plant: Site Vice President Dennis Madison, staff member J. Derwood Tootle, and the many other plant staff who supported the plant tour.
Exelon Corporation for hosting a tour of the Oyster Creek Generating Station: Site Vice President Garey Stathes, Plant Manager Russell Peake, and the many other plant staff who supported the plant tour.
Speakers and invited participants at the committee’s information-gathering meetings. These individuals are too numerous to be listed here. Their names are provided in Appendix B.
Other individuals and organizations who provided information and support for this study: Scott Deitchman, Centers for Disease Control and Prevention; Nancy Hedinger, Paula Gotsch, and Kerry Margaret Butch, League of Women Voters of New Jersey; Jaewon Hong, U.S. Food and Drug Administration; Kiyohiko Mabuchi, National Cancer Institute; Alan Morris, Anbex; Damian Peko, U.S. Department of Energy; Andrew Sowder, Electric Power Research Institute; Satoru Tanaka, Atomic Energy Society of Japan; and the World Health Organization, especially María del Rosario Pérez.
Najmedin Meshkati, University of Southern California, who served as a technical advisor to the committee for issues related to nuclear safety culture.
And last, but certainly not least, National Academy of Sciences’ staff for organizing and facilitating this study. Study Director Kevin Crowley and Senior Program Officer Ourania Kosti organized the committee meetings and assisted the committee with report writing and review. They also provided valuable technical and policy insights and perspectives. Postdoctoral Fellow Daniel Pomeroy assisted with research and report writing. Program Assistant Darlene Gros managed the logistics of the meetings, report review, and publication. Senior Program Officer Jennifer Heimberg and Program Assistant Erin Wingo assisted with production of the final report.
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Reviewer Acknowledgments
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the National Research Council in making this published report as sound as possible and will ensure that this report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report:
Brian Atwater, U.S. Geological Survey and University of Washington
Lake Barrett, L. Barrett Consulting
Dennis Bley, Buttonwood Consulting, Inc.
Daniel Blumenthal, U.S. Department of Energy
Robert Budnitz, Lawrence Berkeley National Laboratory
Cynthia Costello, New York State Department of Health
Jeffrey Gabor, ERIN Engineering and Research, Inc.
Randall Gauntt, Sandia National Laboratories
Robert Geller, University of Tokyo
David Gertman, Idaho National Laboratory
Sherrell Greene, Advanced Technology Insights, LLC
Dave Klimek, Nexus Technical Services Corporation
Joseph Klinger, Illinois Emergency Management Agency
Shunsuke Kondo, Japan Atomic Energy Commission (retired)
Kiyoshi Kurokawa, National Graduate Institute for Policy Studies
David Lochbaum, Union of Concerned Scientists
Thomas McKenna, International Atomic Energy Agency
Richard Meserve, Carnegie Institution for Science
Randall Mumaw, Boeing Commercial Airplanes
Per Peterson, University of California, Berkeley
William Radasky, Metatech Corporation
Scott Sagan, Stanford University
Craig Sawyer, General Electric Company (retired)
Fred Tollison, Institute of Nuclear Power Operations (retired)
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions and recommendations of this report, nor did they see the final draft of the report before its release. The review of this report was overseen by Marvin Adams, Texas A&M University, and Chris Whipple, ENVIRON. Appointed by the National Research Council, Drs. Adams and Whipple were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were considered carefully. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Contents
S.1 Causes of the Fukushima Daiichi Accident
S.2 Lessons Learned for the United States
1.1 Background on the Study Charge
1.3 Strategy to Address the Study Charge
2 BACKGROUND ON JAPANESE AND U.S. NUCLEAR PLANTS
2.1 Nuclear Plant Design and Operation
2.4 Nuclear Plants in the United States
2.5 Comparison of Japanese and U.S. BWR Plants
3 GREAT EAST JAPAN EARTHQUAKE AND TSUNAMI AND IMPACTS ON JAPANESE NUCLEAR PLANTS
3.1 Great East Japan Earthquake and Tsunami
3.4 Tsunami Hazards at Japanese Nuclear Plants
4 FUKUSHIMA DAIICHI NUCLEAR ACCIDENT
4.1 Time Line for Fukushima Daiichi Accident
4.2 Challenges of Responding to the Accident
4.3 Key Events and Response Actions
5 LESSONS LEARNED: PLANT OPERATIONS AND SAFETY REGULATIONS
5.1 Nuclear Plant Systems, Procedures, and Training
5.2 Nuclear Plant Safety Risks
6 LESSONS LEARNED: OFFSITE EMERGENCY MANAGEMENT
6.1 Radiological Consequences of the Fukushima Daiichi Accident
6.2 Challenges of Responding to the Accident
6.3 Offsite Emergency Response
6.4 Vulnerabilities in Emergency Response in Japan
6.5 Lessons Learned from the Fukushima Daiichi Accident for the United States
7 LESSONS LEARNED: NUCLEAR SAFETY CULTURE
7.1 Background on Nuclear Safety Culture
7.2 Nuclear Safety Culture in Japan
7.3 Nuclear Safety Culture in the United States
A Biographical Sketches of Committee, Technical Advisor, and Staff
D Operation and Support Organizations
D.2 Onsite Emergency Response Center
D.3 Headquarters Emergency Response Center
E Recommendations from Other Organizations
F Regulator and Industry Actions in the United States
G Hydrogen Control in Severe Accidents
G.1 Regulatory Actions Following the Three Mile Island Accident
G.2 Implications of Fukushima Daiichi Accident for Hydrogen Control
H Nuclear Plant Emergency Procedures and Guidelines
H.1 Emergency Operating Procedures
H.2 Severe Accident Management Guidelines
H.3 Extensive Damage Mitigation Guidelines
I Probabilistic Risk Assessment
I.2 Probabilistic Risk Assessment
I.3 Use of PRA in Japanese Nuclear Plants
I.4 Use of PRA in U.S. Nuclear Plants
J.1 Need to More Realistically Model Complicating Situational Factors
J.2 Need to Model the Broader Distributed Response Team
J.3 Need to Consider Temporal, Physical, and Psychological Stressors
J.4 Need for Greater Emphasis on Searching vs. Screening
J.5 Need for Greater Appreciation of People as a Source of Resilience and Recovery