FUKUSHIMA Lives on the Line

144Fukushima Medical University’s Emergency Medical Care for Radiation Victimsaddition of staff from Nagasaki University, Hiroshima University, and the Nuclear Safety Research Association.Radioactive material was confirmed to have spread into Fukushima City, with radioactive cesium contaminating the ground from March 15 to 17 and again on March 22, but no new material entered afterwards. During this period, preparations were made for an estimated 100 patients needing radiation decontamination treatment. Eventually, the scale of the incident was not par for the course, but facilities were prepared at gymnasiums, pools, among others that were being used as convalescence space; space was also secured by removing parked vehicles. Also, preparations were made for treating contaminated workers from the power plant and evacuees in need of care. In addition, responses were simulated for when and how to administer stable iodine to those living in Fukushima City and plant workers who might be in need of treatment for high-level (more than 1 Sv) radiation exposure. It was far beyond our expectations when the readings for full-body Geiger counters rose above the limit values; this was due to environmental contamination in the soil around the FMU radiation ward (the full-body counters had been prepared to test internal radiation exposure) (cf. also WBC, Part 3, Chapter 5). Several measures were being taken for the first time, and we proceeded while receiving advice from the Japan Radiological Society, the Japanese Society of Nuclear Medicine, the Japanese Association for Acute Medicine, and others through numerous emails and telephone calls.We continued with various simulations aimed at handling the possible repercussions of the nuclear accident; however, from April, the criticality of the situation reduced. Nevertheless, airborne radiation continued to receive a good deal of attention due to the radioactive cesium embedded in the soil. In addition to our work addressing the contamination, we now had to handle the difficult problem of assessing radiation levels.The goal of the FMU radiation medicine emergency response unit was focused primarily on medical care for the plant workers, who would plausibly have high-level radiation exposure or high-concentration radiation contamination. As the seriousness of the situation diminished, we were able to turn some of our attention to examining and managing the health care of the fire fighters and Emergency Medical Technicians (EMTs) who were working alongside us. These exams, conducted even today, are being expanded to a range beyond fire department officers to encompass police and civil servants, who enter the hazardous zones as part of their work.Recently, numerous reports and comments have been circulating from an array of individuals connected to media organizations. These reports have been a cause of consternation with their free opinions and conflicting claims of “danger from ambient radiation” versus “safety at current levels.” In mid-May, the Japan Radiological Society held a meeting for its Safeguarding Commission in that professional opinions were assembled. FMU participated in the event as an ad hoc member. An official statement from the Commission on “fundamental approaches to radiation exposure stemming from the nuclear disaster” was announced in early June.*6When August arrived, we were contacted by a local municipality that had been contaminated by the radiation. Although it was not our area of expertise, we felt it was our duty to respond to queries from our local neighbors and, to this day, we provide advice with the help of consultation from Fukushima City and Date City. As part of this experience, we have realized that the central government’s policies and opinions have not been reaching these local municipalities, and a considerable amount of time and effort is necessary for information to trickle down and educate residents of the area.Future Challenges for Emergency Radiation MedicineAlthough presently radiation is not being released from the power plant, there is a high possibility that it might. Going forward, there is a myriad of challenges surrounding responses to additional radiation emissions, how and where to administer stable iodine, how to communicate information on the emissions, and how to convey instructions to remain indoors, evacuations, among others. Moreover, the emergency manuals need to be revised and training exercises based on them need to be held. In particular, it is vital to expand the scope of training and that of participants.In the future, issues surrounding radiation exposure in the general population, over and above power plant workers, will be a major task to address. However, other tasks also remain, such as providing information and advice to citizens, working at risk communication to ease anxiety over radiation exposure, devising strategies for assessing and explaining external radiation doses (using, for example, so-called “glass badges” that passively collect radiation information), creating strategies for assessing and explaining internal radiation doses (using white blood cells (WBC) as a measure), and addressing the matter of psychiatric health care.