A public health perspective on the U.S. response to the Fukushima radiological emergency.

On 11 March 2011, northern Japan was struck by first a magnitude 9.0 earthquake off the eastern coast and then by an ensuing tsunami. At the Fukushima Dai-ichi Nuclear Power Plant (NPP), these twin disasters initiated a cascade of events that led to radionuclide releases. Radioactive material from Japan was subsequently transported to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to cause health effects, but the presence of this material in the environment was enough to require a response from the public health community. Events during the response illustrated some U.S. preparedness challenges that previously had been anticipated and others that were newly identified. Some of these challenges include the following: (1) Capacity, including radiation health experts, for monitoring potentially exposed people for radioactive contamination are limited and may not be adequate at the time of a large-scale radiological incident; (2) there is no public health authority to detain people contaminated with radioactive materials; (3) public health and medical capacities for response to radiation emergencies are limited; (4) public health communications regarding radiation emergencies can be improved to enhance public health response; (5) national and international exposure standards for radiation measurements (and units) and protective action guides lack uniformity; (6) access to radiation emergency monitoring data can be limited; and (7) the Strategic National Stockpile may not be currently prepared to meet the public health need for KI in the case of a surge in demand from a large-scale radiation emergency. Members of the public health community can draw on this experience to improve public health preparedness.

Nuclear power plant emergency preparedness: results from an evaluation of Michigan's potassium iodide distribution program.

BACKGROUND: In 2009, the Michigan Department of Community Health (MDCH) made potassium iodide (KI), a nonprescription radio-protective drug, available by mailing vouchers redeemable at local pharmacies for KI tablets, at no cost to residents living within 10 miles of Michigan's 3 nuclear power plants (NPPs). MDCH conducted an evaluation of this program to determine Michigan's KI coverage and to assess general emergency preparedness among residents living near the NPPs. METHODS: KI coverage was estimated based on redeemed voucher counts and the 2010 Census. Telephone surveys were administered to a random sample (N = 153) of residents living near Michigan's NPPs to evaluate general emergency preparedness, reasons for voucher use or nonuse, and KI knowledge. RESULTS: Only 5.3% of eligible residences redeemed KI vouchers. Most surveyed residents (76.5%) were aware of living near an NPP, yet 42.5% reported doing "nothing" to plan for an emergency. Almost half of surveyed voucher users did not know when to take KI or which body part KI protects. Among voucher nonusers, 48.0% were either unaware of the program or did not remember receiving a voucher. CONCLUSIONS: Additional efforts are needed to ensure that all residents are aware of the availability of KI and that recipients of the drug understand when and why it should be taken. Minimal emergency planning among residents living near Michigan's NPPs emphasizes the need for increased emergency preparedness and awareness. Findings are particularly salient given the March 2011 Fukushima Daiichi Nuclear Power Plant emergency in Japan.

Communicating information in an emergency preparedness pill distribution campaign.

OBJECTIVES: Public health agencies are often tasked with the development and execution of interventions, but the communication strategy and its impact on the effectiveness of an intervention is often not evaluated or incorporated by local and state health agencies. The primary objective of this study was to determine the impact of information from various sources on knowledge about an emergency preparedness public health intervention involving the mass distribution of medicine. METHODS: The study used validated written mail surveys containing 12 simple knowledge-based questions. One-way ANOVA, the Studentized Newman-Keuls (SNK) test, logistic regression, and multiple regression were used to evaluate the data. RESULTS: Reading an educational fact sheet or receiving job training were the highest predictive variables for correct responses on the survey among all groups. Commercial media were found to potentially diminish comprehension among survey respondents. There was significant variability in knowledge among different groups surveyed, ranging from an average of 15% to 74% correct responses on the survey. CONCLUSIONS: This study found that job training and fact sheets that are delivered directly to the intended recipients are very effective at enhancing knowledge among the general public and emergency responders. Conversely, we found that commercial media, such as television, may be detrimental to educating the public about important public health interventions. The internet was not widely used by the survey respondents to obtain information; this raises questions regarding the usefulness of websites for emergency preparedness education.

Assessment of potassium iodide (KI) distribution program among communities within the emergency planning zones (EPZ) of two nuclear power plants.

The primary objective of this study was to evaluate a joint state and local government-sponsored potassium iodide (KI) distribution program in New Jersey. This program is part of a radiological emergency response system for residents living within the Emergency Planning Zones (EPZs) of nuclear power facilities. KI pills and an informational fact sheet were distributed locally at six different public clinics in the summer of 2002. In this study, a mailed survey was developed, pilot tested, and sent to the general public to assess knowledge about KI use. The survey consisted of two groups of people, those who attended a KI distribution clinic and those that did not attend a clinic. There was a statistically significant difference in knowledge among the two groups of survey respondents regarding KI prophylaxis, with a mean of 46% of survey questions answered correctly by those who attended a clinic vs. 15% by those who did not attend. Certain questions were problematic for the public to answer correctly and included potential low compliance with government instructions for taking KI, confusion regarding where the public can obtain KI pills during an emergency, and the lack of awareness on the proper use of KI for children, pregnant women, and persons over the age of 40 y. Additional outreach in these specific areas is warranted. This study also found that there was a highly variable geographic pattern of homes that have a supply of KI pills, with some areas having 60% of the households supplied with pills from the clinic while other areas had as low as 1% of the homes supplied with KI pills.

Nuclear power plant emergencies and thyroid cancer risk. What New Jersey physicians need to know.

In the event of a severe nuclear power plant emergency resulting in the release of radioactive iodine, potassium iodide, a relatively safe and effective salt, may be used as prophylaxis. This article presents a history of thyroid cancer due to radiation exposure and the risks and benefits of potassium iodide prophylaxis.

Enhancing nuclear emergency preparedness: Vermont's distribution program for potassium iodide.

On January 31, 2002, Vermont's health commissioner requested potassium iodide (KI) for individuals in the 10-mile Emergency Planning Zone of the nuclear power facility. Vermont's KI distribution program emphasized public information about the role, risks, and benefits of KI. Predistribution ensured that individuals could receive KI in a 0- to 4-hour time period, to provide maximum protection. Five months after the program began, more than 1,000 individuals had received KI, and 3,000-4,000 KI doses have been distributed in schools. Efforts are ongoing to identify barriers to participation, provide public education, and evaluate KI distribution efforts.