As more and more countries move away from fossil fuels and towards alternative energy sources, many are reexamining their approach towards nuclear energy.
Six years after the Fukushima nuclear incident, three decades after the Chernobyl nuclear disaster and nearly four decades after the Three Mile Island nuclear accident, governments are still grappling with the public safety implications of nuclear energy. All three episodes prove that the risks are far from theoretical.
One thing is clear: whatever the cause – whether a natural disaster such as an earthquake followed by a tsunami, a set of human errors or a flawed nuclear facility combined with human error — there are countless sets of circumstances which have the potential of spiraling into a nuclear disaster. History has taught us that no nuclear system is nature-proof, or foolproof.
An analysis of radio-nuclear disasters from the past, such as the 1986 Chernobyl accident in the Ukraine or the 1978 Goiânia incident in Brazil, provides us with some insight about how to begin planning for similar inevitabilities in the future.
What can we expect in any future radio-nuclear accident? Hundreds if not thousands of people would likely be exposed to radiation levels that will have some effects on their health. Many will develop Acute Radiation Syndrome (ARS), while some will suffer combined injuries of trauma and radiation. Others involved will be left to wonder for the rest of their lives how the effects of the exposure to ionizing radiation will affect them. This may well lead to acute psychological stress, influencing their everyday lives – as we see now in the Fukushima Prefecture six years after that 2011 disaster.
These types of analyses of past incidents have led to renewed emphasis on public safety, especially the need for advanced preparations in case of a radio-nuclear crisis.
Though it would be advantageous to establish a doctrine that fits all possible scenarios (and despite the fact that mass casualty scenarios resulting from different causes do share some similarities), there are still profound differences and distinct preparedness gaps between a radio-nuclear event and other types of catastrophes, whether conventional or non-conventional, which warrant unique approaches in preparedness.
Hence, in parallel to risk assessment analyses and meticulous planning of nuclear facilities, decision makers must continue to upgrade response plans for possible nuclear incidents of all types, looking at major and minor components of rescue and relief efforts.
Emergency response plans are prepared on various levels. Federal and state decision makers begin at the strategic level, looking mainly at national consequences and gaps. The different response organizations and agencies typically prepare lower-levels plans, intended to enhance emergency responses in the event of such a disaster, with relevant adaptations to scenarios such as mass casualty events, a fire-related disaster, Chemical, Biological, Radiological and Nuclear (CBRN) defense incidents (with differences between each of the components), or any other natural or man-made disaster.
As with other mass casualty scenarios, these preparations include medical preparedness, such as the stockpiling of approved medical countermeasures (MCMs), ensuring they are kept in a way that will enable prompt handling, shipping and distribution to prevent the effects of radiation on exposed individuals in relevant timeframes.
Governments must also supply funding for research and development efforts to allow for novel, safer and more effective MCMs than what are currently being stockpiled for use by the entire population, including children and pregnant women, which are defined as higher-risk populations.
Medical preparedness also includes defined guidelines and doctrines for first responders, medical personnel and anyone else who is expected to be involved in response efforts. This includes educating and training first responders and hospital staff, purchasing personal protection equipment for first responders, preparing hospitals to cope with such a radio-nuclear disaster, defining relevant medical countermeasures, as well as long-term follow-up plans.
Preparedness efforts should also include evacuation plans for residents living close by to such facilities. Civilian education programs dealing with basic issues of how to react in case of a radio-nuclear catastrophe must also be put in place.
Two major gaps in such preparedness need to be considered by governments assessing their readiness to deal with such disasters.
The first is lack of field dosimetry – meaning that we are currently unable to measure precise levels of exposure to radiation. Without field dosimetry, we cannot define who is in danger of developing ARS and needs to be closely monitored in order to receive early medical intervention.
The second gap regards currently accepted MCMs for ARS. Those MCMs currently stockpiled are helpful, but have limited efficacy, focusing mainly on one subpopulation of blood cells that are relevant in the Hematopoietic Syndrome of Acute Radiation Syndrome (H-ARS). These drugs do help in preventing life-threatening infections, which is one of the hallmarks of ARS.
However, other hematological effects like severe anemia and low numbers of platelets, and effects on other physiological systems and organs may also cause life threatening complications, and the drugs currently available hardly address any of these issues.
In addition, these drugs require large teams of trained personnel and are extremely complex to distribute, likely leading to a less than optimal response.
Several countries throughout the world have completed or are in the process of completing critical preparations for these types of nuclear scenarios. That said, there continue to be remarkable differences in preparedness between such countries, mainly due to differences in their definitions of the risks involved and in the basic approach towards these scenarios (resulting mainly from cultural and economic differences).
For those countries which do see nuclear energy as part of their ongoing national energy strategy, formulating precise and detailed preparedness plans must be an integral part of their programs, for the benefit of all their citizens.
Dr. Arik Eisenkraft is Director of Homeland Defense Projects at Pluristem Therapeutics Inc. and involved in several Israeli start-ups in the field of military medicine. From 2008-2016 he served as Head of the Medicine Branch at the CBRN Protection Division of the Israeli Ministry of Defense where he led the national research and development efforts as well as procurement of MCMs against all CBRN threats, working together with national and foreign governmental departments and agencies, the IDF the Home-Front Command and the Israeli Ministry of Health. His efforts focused on the seeding of new research programs, aimed at developing new MCMs, as well as re-purposing and broadening clinical indications of currently available compounds, and testing cutting-edge technologies for drug delivery methods. From 2000-2008 he served in the CBRN Medicine Branch of the IDF. He’s currently a member of several national professional teams in the field of CBRN Medicine. He has an MD degree from the Sackler Faculty of Medicine, Tel-Aviv University, Israel; a residency in Pediatrics from the Sheba Medical Center, Tel-Hashomer, Israel; and a MHA degree from the Ben-Gurion University of the Negev.
