Lessons learned from Fukushima Daiichi Nuclear Power Plant Accident Koichi Tanigawa

1. Lessons learned from Fukushima Daiichi Nuclear Power Plant Accident Koichi Tanigawa Department of Emergency and Critical Care Medicine*1 Radiation Emergency Medicine Promoting Center*2 Hiroshima University

2. Nearly 20,000 people were killed in the disaster, most of them lost their lives by tsunami. • In Iwate, Miyagi and Fukushima, 78.9% of all hospitals were severely damaged. • In Iwate, the tsunami reached up to the fourth floor of a hospital, more than 100 medical staff and patients were rescued by SDF. • The remaining hospitals provided medical care for more than two thousands injured in the initial 3 days after the quake. • Disruption of communication network was so devastating that some areas were left isolated in spite of vast amount of medical needs. • This natural disaster was accompanied by a severe nuclear accident.

3. 3/11 3/12 3/13 3/14 3/15 3/16 3/17 Number of patients admitted to Ishinomaki Red Cross Hospital in Miyagi during the first week after the earthquake

4. Due to loss of all communication, hospitals and medical facilities in some areas were left isolated. Although many disaster medical assistance teams were dispatched to the disaster strcken areas, they could not reach those who most needed medical care. • People who lost their home were displaced to live in shelters for a long period of time. Providing medical care for elderly and those with chronic illnesses were the priotized issues in the early phase of the post-disaster.

5. Loss of power, communication 10 km zone Loss of function of the control center Evacuation of all residents, patients and medical personnel Futaba Kosei Hp H Fukushima Nuclear disaster management center Ｏ Fukushima Daiichi NPP Fukushima Pref. Ono Hp H Collapse of radiation emergency medical system Imamura Hp H Off-site center Ｏ Primary radiation emergency hospital H Fukushima Daini NPP

6. Chronological order of events in Fukushima

7. Fukushima Pref. Gov. Fukushima Medical Univeｒsity (FMU) 8 Hospitals, 1240patients 17nursing facilities, 983patients Off site center (Command center) Fukushima Pref. Radiation emergency Hospital NHK Hiroshima

8. In the Fukushima Daiichi Nuclear Power Plant accident, what we have seen, • difficulties in reallocating patients forced them to stay in the confined space of the transporting vehicles for long hours. • patients died during or soon after evacuation. • On the other hand, • no significant contamination was found in the evacuated patients from the 20-km area despite the fact that 48 hours had already passed since the first explosion. These facts suggest the effectiveness of indoor sheltering for protection from radioactive plumes.

9. Therefore, we conclude that, • In contrast to physical injuries caused by collapse of buildings or tsunami, radiation itself does not create any immediate life-threatening conditions. Rather, ill-prepared evacuation may increase the health risk of hospitalized patients or the elderly. • In the case of nuclear disasters, therefore, evacuation for these vulnerable people should be carefully performed with medical arrangements.

10. Medical responses for patients who suffered injuries following the explosion of No. 3 reactor on March 14th Fukushima city Fukushima Daiichi (No.1) Nuclear PP １Ｆ Fukushima Medical Univeｒsity (FMU) H Fukushima Daini (No.2) Nuclear PP 2Ｆ H H March 14th H １Ｆ FMU, NIRS, etc Ｏ Nuclear Disaster Management Center H 2Ｆ Ｊ March 15th J-village FMU Nuclear Disaster Management Center Ｏ March 16th Fukushima Daini (No.2) Nuclear PP H closed radiation emergency Hp H H partially functioned radiation emergency Hp Iwaki city H available radiation emergency Hp

11. As for emergency medical systems, • difficulties in finding hospitals to provide care for injured workers with contamination were observed. Fortunately, non of them suffered life-threatening injuries. However, collapse of radiation emergency hospitals may have resulted in preventable death for those with severe trauma. • Therefore, • more hospitals are required to provide emergency care for patients with radiological contamination, considering combined disasters such as earthquakes and nuclear accidents.

12. 9:00, March 15 21:00, March 15 Fukushima Iwaki Simulated radiation levels at 9:00 and 21:00 on March 15th, when massive radioactive materials were released from the No. 2 reactor of the Fukushima Daiichi Nuclear Power Plant. South-west spread of radioactives was observed at 9:00 (left). In the evening, however, the distribution shifted toward the north-west area due to changes in the wind direction (right). The bottom bars indicate radiation levels (μSv/h).

13. μSv/hr Serial changes of radiation levels at 7 sites in Fukushima prefecture from March 12th through 23rd. This graph was depicted using the data reported by the Fukushima Prefectural government on March 24th .

14. Report of the national government and the Energy Ministry of USA, May 6th. Estimated accumulation doses of Cs-134 and 137 (Bq/m2) Date Soma Fukushima Iitate Kawamata Minamisoma Nihonmatsu Namie Katsuraomura Motomiya Futaba Tamura Okuma Kohriyama Tomioka Kawauchimura Naraha Hirono Iwaki Chernobyl 1,480,000Bq/m2<: Closed Zone 555,000Bq/m2<: Permanent Control Zone

15. The medical teams were exposed to radiation risk, • due to lack of information on radiation. • We should understand the patterns of spread of nuclear plumes. Nuclear plume does not spread in a concentric fashion. It spreads discontinuously and changed its direction quickly by wind direction, geographic, and weather. • Therefore, we need • more monitoring devices and posts in place. Information on radiation should be readily available for all personnel involved.

16. Fukushima Pref. Fukushima Pref. Gov. No death from irradiation No death from explosions However, evacuation was accompanied by loss of life!! Off site center (Command center) Fukushima Pref. NHK Hiroshima

17. Shimane Pref. Fukushima Pref. Gov. Off site center (Command center) 30hospitals, 3800patients 83nursing facilities, 3144patients NHK広島

18. Residents have no protections themselves in nuclear disasters • Local government assumes responsibility in preparation and countermeasures for disasters • Prefectural and National government support the efforts made by the local government • Take wind direction into consideration in evacuation • Evacuation facilities should be equipped with monitoring systems and medical supports should be readily available • Establish detailed plans for evacuation in advance. Look into distribution of population, available vehicles, routes and estimate time required for evacuation. In particular, set up specific plans for nurseries, schools, and hospitals as well as for elderly. Yamamoto S, Preparedness for nuclear disasters: Roles of local government and individuals. Katsura publishing Co. 1993

19. Summary Evacuation from 20 km zone was accompanied by loss of life. On the other hand, sheltering was quite effective to avoid nuclear plume. Because irradiation itself does not pose any immediate life-threatening conditions, well planned evacuation should be considered. Significant difficulties were encountered to determine hospitals for evacuated patients. Admitting facilities should be designated in advance. Education for medical personnel and students should be emphasized and Radiation emergency medical system needs to be refined. Due to lack of information, medical teams were exposed to radiation risk. Nuclear plume does not spread in a concentric fashion. It spreads discontinuously and changed its direction quickly by wind direction, geographic, and weather. More monitoring posts should be in place and information on radiation should be readily available for citizens. Proper knowledge on radiation mitigates health risks, overcomes misunderstandings and prejudice for evacuees. We should prepare for combined disasters, i.e. nuclear accidents following a disasteror terrorist attacks. Local residents are the core member of the system, and the local government should assume responsibilities in developing plans.