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Follow-up of Persons Exposed to Radiation and Radioactivity Niel Wald, M.D. and Michael Kuniak, D.O. Dept. of Environmental & Occupational Health University.

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Presentation on theme: "Follow-up of Persons Exposed to Radiation and Radioactivity Niel Wald, M.D. and Michael Kuniak, D.O. Dept. of Environmental & Occupational Health University."— Presentation transcript:

1 Follow-up of Persons Exposed to Radiation and Radioactivity Niel Wald, M.D. and Michael Kuniak, D.O. Dept. of Environmental & Occupational Health University of Pittsburgh, Graduate School of Public Health Pittsburgh, PA 15261

2 Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up 2. Examples of Prompt Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

3 192 Iridium Shipping Incident H.P. Participants included: K.Z. Morgan, Oak Ridge National Laboratory R. Zimmerman, Phoenix Technology Corp. B.J. Porter, Louisiana Bureau of Radiation Control M.D. Participants included: N. Wald, University of Pittsburgh C. Huguley, Emory University W. Jensen, George Washington University C.A. Paulsen, University of Washington

4 Normal Source Position in C 10 Cask

5 69lb 192 Iridium Source Exchanger Source Position on Return to Vendor 14R/Hr

6

7

8

9 Source Position at Ryan Airport for about 56 hours

10

11

12 Magnitude of the Accident Exposure Locations: Sender and Receiver Sites: 2 Airline Freight Depots: 3 Aircraft: 2 Passengers: 157 Med. exam and CBC: 154 Worst Case Dose: 7 rads Airline and freight employees: 48 Med. Exam and CBC: 48 Chromosome studies: 11 Sperm Counts: 53 ___ Total persons: 205

13 Lesson Learned In a population exposure event, M.D. must initiate triage independent of firm H.P. information to assess possible injury and to meet psychological needs, but the latter is of great value as soon as available.

14 Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up 2. Examples of Prompt Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

15 454-2

16 Location of Goiania, Brazil 451-1

17 Goiania Accident Source 137 Cs teletherapy source capsule: Physical form: CsCl hygroscopic powder with blue fluorescence as it absorbed moisture. Radioactivity:50.9 TBq (1375Ci) Dose m:4.56 Gy/hr (456 rad/hr)

18 451-3

19 Goiania Medical Disposition 580-9

20 Goiania Casualty Burial 412-3

21 Goiania Local Injury 454-5

22 Goiania Contaminated Areas 451-2

23 Goiania Population Screening 55-3

24 Goiania Accident Magnitude People monitored:112,000 Chromosome analyses:110 Roads monitored:2,000 Km Remediation workers:755 Above DL: 38 (Highest: 10 mSv CDE) Homes contaminated: 85 Demolished: 7 Vehicles contaminated:50 Radwaste created:3, L drums

25 Lessons Learned Lack of awareness of the detrimental health effects of radiation exposure can impede its recognition on the part of patients and medical practitioners until much damage is done. The alert M.D. who faces an unusual public health problem must find a collaborating H.P. to evaluate its possible radiogenic origin and if confirmed, to help deal with it.

26 Presentation Outline 1. Definitions: Early vs. Long-term Follow-up 2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Early Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

27 Chernobyl: Healthcare Resources Used Local medical facilities 400 special medical brigades –M.D., H.P., etc. 15,000 health workers –2,000 M.D.’s, 4,000 nurses, med students, etc 213 mobile laboratories Special hospitals (Kiev, Moscow)

28 Chernobyl: Healthcare Procedures Medical Examinations 1,000,000 persons Dosimetric & lab tests 700,000 (216,000 children) Inpatient care32,000 persons (12,000 children) Iodine prophylaxis5,400,000 persons (1,700,000 children)

29 Lessons Learned In the USSR highly organized Civil Defense, Health system, Military and other government resources were quickly mobilized. In the US less centralized resources might currently have more difficulties, although the maturation of the Homeland Security Agency should facilitate such a response.

30 Presentation Outline 1. Definitions: Early vs. Long-term Follow-up 2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Early Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

31 Presentation Outline 1. Definitions: Early vs. Long-term Follow-up 2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of EarlyPreparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

32 Nuclear Weapons Test, Nevada 91-B

33 91-C

34 Estimated Civilian Casualties within 2000 Meters of the Hypocenter, by City 92-B METERSNUMBER PERCENTAGE OF THOSE EXPOSED Hiroshima: TOTAL 6,230 24,950 45,270 67, , ,240 21,910 53,030 79, Nagasaki: TOTAL 30,900 14,320 6,500 51,770 3,580 6,950 4,690 15,

35 Types and Magnitude of Injury Among Survivors Causing Factor Type of Injury Injured Survivors (%)* Injury Reported to Distance of: Blast Trauma, Mechanical meters HeatBurns meters Ionizing Radiation Radiation injury meters * Total exceeds 100%, since many had multiple injuries. 98-A

36 Atomic Bomb Casualty Commission 91-J

37 ABCC Medical Program Purpose : –Compilation of Medical data about Hiroshima and Nagasaki A-bomb survivors to quantitate radiation effects. –Statistical analysis of medical data. Scope: –Clinical data collection by: Adult medical project Pediatric medical project Ophthalmology project Hematology project Pathology project Clinical laboratory project –Biostatistical analysis 93-F

38 ABCC Pediatric Study Patient 93-H

39 ABCC Leukemia Study Patient (Hiroshima Red Cross Hospital) 96-E

40 A-Bomb Survivors by Age and Sex 98-B

41 1950 City Residents Proximal Distal Non- exposed 2, ,000 meters 0 - 2,000 meters Nonexposed Master Sample (Proper Part) Master Sample (Proper + Reserve) 92-F

42 ABCC Shielding Program Purpose: –Compilation of sufficient historical data about Hiroshima and Nagasaki A-bomb survivors to permit calculation of individual radiation dosages when dosimetry is available. Scope: –Location of exposed individuals. –Description of shielding structures. –Preparation of three-dimensional maps of cities. –Collection of bomb detonation conditions, height of burst, weather, etc. –Shielding measurements using sources. 93-A

43 ABCC Shielding Study 93-B

44 ABCC Shielding Study E39

45 Early DOSE/DISTANCE curves used for ABCC Patient Exposure Estimation Hiroshima Rads Nagasaki Distance from hypocenter (meters) 94-F

46 ABCC/ORNL Ichiban Dosimetry Project Purpose: –Compilation of experimental dosimetry data which when used with ABCC shielding information, will permit calculation of individual radiation dosages of A-bomb survivors. Scope: –Determination of angular distribution of radiations. –Radiation shielding by Japanese houses Plane slab experiments Parametric study of houses –Determination of air dose. –Calculation of doses for ABCC cases and documentation of IBM cards. 92-E

47 Correlation Program Purpose: –Correlation of dose and medical effects data. –Preparation of interim and final reports. Scope: –Dose-effect correlations including: Acute radiation death Premature aging Shortened life-span Epilation Cataracts Acute hematological changes Leukemia Carcinogenesis Genetic effects 95-F

48 Lesson Learned Effect of Delayed Database Startup Resident in Same City (1960) Migrated from City ( ) No. of people in city at time of bomb 92-D Died of acute effects of bomb (1945) Survived acute effects of bomb (to 1946) Died and migrated from city ( ) 1950 city residents Died ( )

49 Radiation Risk Estimation Using A-bomb Survivor Data In the 1950’s, survivors of the A-bombings were interviewed and gave detailed reports of their location at the time of bombing and their experience afterward. The Atomic Bomb Casualty Commission (ABCC), now the Radiation Effects Research Foundation (RERF), made very detailed engineering drawings of the survivor location. These drawings are used to determine the ground range and the shielding to assign organ doses from the dosimetry system. Members of Life Span Study (LSS) are followed for cancer incidence and mortality. A cohort of LSS, the Adult Health Study (AHS) undergo biennial clinical examinations for health effects studies. Statistical analysis of dose-dependent frequency is used to estimate radiation risk

50 Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up 2. Examples of Prompt Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

51 Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up 2. Examples of Prompt Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

52 TMI Health-Related Research 1.TMI Census/Population Registry 2.Mother/Child Registry 3.Radiation Dose Assessment Study 4.Epidemiologic Surveillance System Epidemiologic Data Base Development 364-7

53 TMI Health-Related Research Epidemiological Data Base Development PROJECTPURPOSERESULTS TMI Census/ Population Registry June years (PA Dept. of Health, US Census Bureau, US PHS/CDC) To develop population profile and registry Interview data from 35,930 persons living within 5 miles of TMI Mother/Child Registry years (PA Dept. of Health) To develop a retrospective cohort of 4,000 Mother/child pairs Maternal radiation dose estimates, stress measures, child perinatal findings documented for long- term epidemiologic study 398-1

54 The TMI Cohort and Its Dataset 35,946 residents in the Three-Mile Island 5 mile area. US Census Bureau, CDC and PA Dept. of Health did a door to door survey of everyone in cohort 257 variables, including age, smoking status, etc. are included in the dataset

55 Population Database Dosimetry

56 Population Database Dosimetry

57 Cohort in 5 Mile Radius

58

59 Epidemiological Data Base Development (continued) PROJECTPURPOSERESULTS Radiation Dose Assessment ( , University of Pittsburgh) Individual dose assessment in 5 mile population over 10 day accident, pregnant women in 10 miles+ thyroid and skin doses Max. possible 5 mi. dose = 175 mrem, Avg. max. = 25 mrem, Max. likely 80 mrem, Avg. likely = 9 mrem 64% evacuated, more young, female, better educated, having pre-school children Epidemiologic Surveillance in PA ( present, PA Dept. of Health) Baseline health information system for populations within 20 miles of the 6 PA nuclear power plants Natality, mortality and morbidity data base developing to assess impact of any health-threatening events 398-2

60 TMI Health-Related Research 1.Pregnancy Outcome 2.Congenital/Neonatal Hypothyroidism 3.Infant Mortality 4.Health Updates of TMI Population and Mother/Child Registries Bio-Medical Studies

61 Low Level Radiation and the Long-Term Follow-up of the Residents of the Three Mile Island Accident Area: 1979-l998 Evelyn Talbott, Dr. P.H. Jeanne Zborowski, Ph.D. Ada O.Youk, Ph.D. Departments of Epidemiology and Biostatistics Graduate School of Public Health April 8, 2003

62 Distribution of TMI Cohort by Vital Status and Gender: l998

63 Methods (Relative Risk Regression cont.) The outcomes of interest were: All malignant neoplasms Cancer of the Bronchus, Trachea and Lung Cancer of the Breast (females) Cancer of the Lymphatic and Hematopoietic Tissue (excluding Chronic lymphocytic leukemia and Hodgkin’s Disease) Cancer of the Central Nervous System All Heart Disease Exposure variables were natural background radiation, maximum and likely ( radiation Potential confounders included smoking and education

64 Conclusions of Talbott et al. This ~ 20-year follow-up within the TMI cohort provided no consistent evidence that radioactivity released during the nuclear accident has had any significant impact on the overall mortality experience of the residents Overall cancer mortality in the TMI cohort was similar to the surrounding three county area However, several elevations persist and certain potential dose-response relationships (lympho- hematopoietic tissues, breast cancer) cannot be definitively excluded

65 Lessons Learned Negative results can be of great value in allaying public distress and associated stress symptoms Prompt initiation of the impacted population census facilitates and adds credibility to the long-term follow-up

66 Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up 2. Examples of Prompt Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

67 Chernobyl: All-Union Register Contaminated area: residents, transients, mitigation workers Children & grandchildren of above Evacuees from contaminated area Total: now about 600,000 persons

68 Chernobyl: All-Union Register Name, date & place of birth, sex residence Location where radiation exposed and duration State of health (by history) Pregnancy status before and/or after exposure onset Pregnancy outcome and child data Cause of death (adult, child, newborn) Therapy received (iodine prophylaxis, hospitalization) Registration Card Data

69 Chernobyl: All-Union Register Radiation exposure features of locale Individual’s exposure and contamination extent Thyroid radioiodine burden Personal dosimetry (bioassays, whole body counter and/or other measurements) Dosimetry Card Data

70 Chernobyl: All-Union Register Registration and dosimetry cards compiled by local authorities. Maintained at clinic. Copies to Republic’s Ministry of Public Health and to USSR Ministry of Public Health. Exam frequency based on 1st exam results and dose assessment. Protective and mitigating measures considered also.

71 Chernobyl All-Union Register “ Long-term programmes for the medical and biological monitoring of the population are being established….The measures taken….include the establishment of a register of all those exposed to radiation.” “The prepared programmes take account of the experience of other countries (the Three Mile Island programme; the IAEA meeting in Yugoslavia and so on).” Part II, Annex USSR State Committee on the Utilization of Atomic Energy: The Accident at the Chernobyl’ Nuclear Power Plant and its Consequences. IAEA Experts’ Meeting, August 1986, Vienna, pp Lesson Learned

72 Presentation Outline 1. Definitions: Early vs. Long-term Follow-up 2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Early Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

73 28 March 1979 Initial Condition - TMI at 97% Power The Accident –Secondary plant malfunction causes turbine trip and reactor scram –After pressure transient, PORV (relief valve) fails to close –Based on incorrect diagnosis, operators interrupt high pressure injection –Loss of coolant continues for 2 1/2 hours –Core uncovery and severe overheating result The Consequences –Massive fuel damage –Release of much radioactive water and gas to plant structures –Hydrogen burn in containment –Damage to plant instrumentation and control equipment –Minor off-site releases of radioactivity –Widespread public confusion and fear

74 TMI Dose Assessment Releases: Noble gases: 2.4x x10 6 Ci Radioiodine: Ci Doses: Individual: Maximally exposed: ~100mrem Average dose within 50 miles: 1.5mrem Population: Within 50 miles: person-rem

75 Estimated Potential Health Impact of TMI Radiation Release on 50 mile Population (2.2 Million People, 3,300 person-rem) Natural Radiation Incidence Attributable CANCER Fatal 325, ( ) Non-fatal 216, ( ) GENETIC 1 st Generation 78,000 ( ) All Generations 0.7 ( )

76 Post-TMI Accident Self-evacuation

77 Media Views 266-1

78 Media Views 266-3

79 Media Views 266-6

80 Media Views

81 Media Views 266-7

82 TMI Health-Related Research Psycho-Behavioral Studies PROJECTPURPOSERESULTS Health Behavioral (Stress) Studies (July , PA Dept of Health) Analysis of local residents’ TMI crisis reactions and 3, 9 and 18 month restudies 2,100 person telephone survey showed major impact in early few weeks, some persistence over following year. Most in younger, more educated, married females living within 15 miles of TMI Mental Health Study of High Risk Groups ( , University of Pittsburgh) Measurement of mental health impact on TMI workers, area mothers with small children and mental health clinic patients TMI mothers had higher incidence of depression lasting over a year. No difference from controls in other two groups 398-5

83 TMI Psycho-Behavioral Studies (continued) PROJECTPURPOSERESULTS Residential Mobility Study ( , PA Dept. of Health) Analysis of local residents’ TMI crisis reactions and 3, 9, and 18 month restudies 15% of high mobility people moved because of TMI. Replaced by demographically similar people with significantly more positive attitudes toward TMI Health Economics Study ( , Pennsylvania State University and NRC) Measurement of economic costs related to physical and mental health impact of TMI on 5 mi. population Estimated costs of about $200,000 incurred through workdays lost, physician visits and increased cigarette, alcohol and tranquilizers in 10 months after the TMI accident 398-6

84 Sources of Response Decisions and Public Information NRC GPUPA NRR TMI Governor DOEOff. Admin. NEST HEWPEMA BNL FDA Env.Res. ORNL CDC Health LRL NIHPolice BAPL EPANat. Guard FEMAAudit. Gen.

85 Media View 266-5

86 Early Psychological Stress Reducers –One responsible decision maker –One public communicator –Realistic appraisal and clear communication of problem –Credible action plan and adequate resources to accomplish it –Pre-emergency education

87 NRC’s TMI Advisory Committee I. History Origin Charge II. Some Major Issues Addressed Funding for Decontamination TMI-1 Restart Worker Radiation Exposure Health Studies III. Effectiveness View of NRC View of GPU View of Public

88 Origin of the TMI Panel 510-4

89 TMI Panel Charter 510-5

90 TMI Panel Charter 510-7

91 The proposed bill stipulated that the panel consist of twelve members selected by the Commission as follows: 1.Three members shall be appointed from among persons representing agencies of the State of Pennsylvania; 2.Three members shall be appointed from among persons representing local government authorities in the vicinity of Three Mile Island nuclear reactor; 3.Three members shall be appointed from among persons representing the scientific community; and 4.Three members shall be appointed from among persons having their principal place of residence in the vicinity of the Three Mile Island nuclear reactor

92 A TMI Advisory Panel Meeting 510-8

93 NRC’s TMI Advisory Committee I. History Origin Charge II. Major Issues Addressed Funding for Decontamination TMI-1 Restart Worker Radiation Exposure Health Studies III. Effectiveness View of NRC View of GPU View of Public

94 UNITED STATES NUCLEAR REGULATORY COMMISSION Charter for Advisory Panel for the Decontamination of Three Mile Island, Unit 2 Official Designation –Advisory panel for the decontamination of Three Mile Island, Unit 2 Objectives and Scope of Activities and Duties –The panel consults with and provides advice to the Commission on major activities required to decontaminate and safely clean-up the TMI-2 facility Time Period –The Committee will be utilized during the period public views on clean-up issues at Three Mile Island are required

95 Cleanup Cost Issues

96 Cleanup Cost Issues

97 Cleanup Cost Issues

98 Cleanup Cost Issues In conclusion, given the long-term serious hazards posed by TMI-2, the lack of funding from any source to undertake a serious and expeditious clean-up effort, and the lack of an effective commitment on the part of the NRC, we are forced to conclude that the failure to make sufficient and timely progress toward decontamination constitute threats to the public health and safety. The commission’s action, or lack of action, in permitting this condition to exist and to continue constitutes a violation of the fundamental requirement of the Atomic Energy Act - protection of the public health and safety. We believe the Commission has both a moral and a legal duty to act immediately to insure that the clean-up of TMI-2 proceeds expeditiously in order to eliminate this threat to the public

99 Issues: Operational Challenges

100 Issues: Operational Challenges

101 Issues: Operational Challenges

102 Issues: Operational Reality

103 TMI-2 Cleanup Doses Clean-Up Estimate: 13, ,000 Person- REM Actual Collective Dose: 2742 Person-REM (through 1986)

104 TMI-2 Worker Clean-Up Doses YearPerson-remMaximum Worker Dose (rem) Total: 2742(Clean-Up Estimate: 13,000-46,000 Person-rem)

105 Panel Challenges Lost

106 Panel Challenges Lost

107 Amended Charter For Advisory Panel for the Decontamination of Three Mile Island, Unit-2 Official Designation –Advisory Panel for the Decontamination of Three Mile Island Unit 2. Objectives and Scope of Activities and Duties –The panel consults with and provides advice to the Commission on major activities required to decontaminate and safely cleanup the TMI-2 facility. The Panel also consults with and provides advice to the Commission on the public’s reactions to plans and the results of studies and review deriving from Federal, State and TMI Public Health Fund efforts regarding the TMI-2 accident. (This activity is to be carried out under the attached criteria.) Time Period –The committee will be utilized during the period public views on cleanup issues at Three Mile Island are required

108 Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up 2. Examples of Prompt Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction

109 NRC’s TMI Advisory Committee I. History Origin Charge II. Major Issues Addressed Funding for Decontamination TMI-1 Restart Worker Radiation Exposure Health Studies III. Effectiveness View of NRC View of GPU View of Public

110 TMI Advisory Committee Assessment: GPU The NRC Advisory Committee on the Cleanup of TMI-2 gave GPU Nuclear the opportunity to explain its activities during the cleanup and plans for TMI-2 in a public forum available to open debate and scrutiny. As the cleanup comes to an end, GPU Nuclear would benefit from continuing these discussions with the community. Decline in newsworthiness and public attention concerning the cleanup a decade after the accident makes the NRC Advisory Committee forum a less effective method and tends to link GPU Nuclear with the events of the accident. However, GPU Nuclear should consider establishing its own mechanisms for regular cooperative interactions with citizen groups including those that have been highly critical of its activities. It should also continue to maintain a multidimensional communications program. The Board believes that the public reaction to the 1979 accident and its aftermath should alert the entire electric power industry to the need for open discourse between the operators of nuclear power plants and the residents of adjacent communities. There is no single approach which will alleviate all fears of risks to health and safety. However, availability of information should improve the knowledge base within the community and serve to build confidence in the management and staff of the utility

111 TMI Advisory Committee Assessment: Member of Environmental Action Group And you, as the panel, are there in place. You’re there for the company, you’re there for the NRC, and you’re there for the community, and you’re there for the public officials, too. I mean, we’re in touch with public officials, both of the city, the county levels. And that networking, that vehicle of the panel in place and that review process is not just today, tonight. That’s a process that is in place that serves a real purpose. And I was one of those people almost ten years ago -- well, over ten years ago who was looking for what kind of a vehicle could be put in place. And I’ve appreciated what the panel has done. I know that you’re serving without pay, and it’s a lot of time and effort. But I would ask, and I ask on behalf of the citizens at large and the people that call our office, that you stay in place at least for another year and look at this again next year at this time and see where we are with PDMS, what’s going on with evaporation and what’s going on with the funding

112 TMI Advisory Committee Assessment: Member of Public I think that another thing that this panel provides is a historical memory. The people -- Not all of you have been on this panel all the time. But enough people have been on for a long period of time that you have a historical memory that if there are problems along the way, you can determine whether they are significant or whether they are something which is not significant. And that’s important, I think, to the public, because the public doesn’t have that kind of background generally to make those kind of judgments. So I think it’s important that we keep a panel

113 TMI Advisory Committee Assessment: Member of Public I would just like to speak briefly in behalf of the panel continuing its activities, because I think over this past ten years, this forum has been the only one in which the media and the public of this area really have gotten a sense of what really is going on in the cleanup. And we come and we ask sometimes dumb questions, and sometimes we ask smart questions. And with the intercession of this body, I think we’ve gotten a lot more information than we ever would have gotten about the accident itself in some cases and about the real problems and the real activities going on in cleanup. I think we know ten times as much about the situation because of your existence, and I hope it continues. Thank you

114 In dealing with the aftermath of any radiation event, the early creation of a mechanism for frequent honest communication and feedback between the “authorities” and the concerned public can help alleviate the prolonged mistrust and anxiety that are integral parts of such an occurrence. Lesson Learned

115 Presentation Outline 1. Definitions: Early vs. Long-term Follow-up 2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Early Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b. Long-term Psychological Stress Reduction


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