Arifumi Hasegawa

Health effects of radiation and other health problems in the aftermath of nuclear accidents, with an emphasis on Fukushima

437 nuclear power plants are in operation at present around the world to meet increasing energy demands. Unfortunately, five major nuclear accidents have occurred in the past--ie, at Kyshtym (Russia [then USSR], 1957), Windscale Piles (UK, 1957), Three Mile Island (USA, 1979), Chernobyl (Ukraine [then USSR], 1986), and Fukushima (Japan, 2011). The effects of these accidents on individuals and societies are diverse and enduring. Accumulated evidence about radiation health effects on atomic bomb survivors and other radiation-exposed people has formed the basis for national and international regulations about radiation protection. However, past experiences suggest that common issues were not necessarily physical health problems directly attributable to radiation exposure, but rather psychological and social effects. Additionally, evacuation and long-term displacement created severe health-care problems for the most vulnerable people, such as hospital inpatients and elderly people.

The great East Japan earthquake of March 11, 2011, from the vantage point of blood banking and transfusion medicine.

BACKGROUND The Great East Japan Earthquake of March 11, 2011, and subsequent tsunami took nearly 20 000 lives in Tohoku, the northeastern part of Japans main island. Most victims were either carried away by the tsunami or drowned. The ability to collect blood was disrupted on the Pacific coast of Tohoku. Inland areas were less affected, but allogeneic blood collected in Tohoku is tested at the Miyagi Red Cross Blood Center (Miyagi Center) in the coastal city of Sendai. Miyagi Center was damaged and could not test for 2 months. OBJECTIVES The aims of this study are as follows: (1) to assess transfusion practice at 8 disaster response hospitals in Tohokus Fukushima Prefecture, for equal intervals before and after March 11, 2011; (2) to report activities related to blood collection and distribution in response to the disaster; and (3) to describe the Great East Japan Earthquake in the context of other disasters. METHODS Data were collected through a survey of transfusion services at 8 major disaster response hospitals, communication at transfusion conferences, and literature review. RESULTS Transfused patients and units transfused were about 70% and 60% of normal in the surveyed hospitals because this was a disaster of mass casualty rather than mass injury, and patients requiring chronic care were evacuated out. A nationally coordinated effort allowed excess blood collected outside Tohoku to be transported in, despite infrastructure damage. CONCLUSION Japans national system of blood collection and distribution responded effectively to local needs after the Great East Japan Earthquake. Disasters such as Japans 3.11 should guide discourse about emergency preparedness and centralization of services.

Emergency Responses and Health Consequences after the Fukushima Accident; Evacuation and Relocation

The Fukushima accident was a compounding disaster following the strong earthquake and huge tsunami. The direct health effects of radiation were relatively well controlled considering the severity of the accident, not only among emergency workers but also residents. Other serious health issues include deaths during evacuation, collapse of the radiation emergency medical system, increased mortality among displaced elderly people and public healthcare issues in Fukushima residents. The Fukushima mental health and lifestyle survey disclosed that the Fukushima accident caused severe psychological distress in the residents from evacuation zones. In addition to psychiatric and mental health problems, there are lifestyle-related problems such as an increase proportion of those overweight, an increased prevalence of hypertension, diabetes mellitus and dyslipidaemia and changes in health-related behaviours among evacuees; all of which may lead to an increased cardiovascular disease risk in the future. The effects of a major nuclear accident on societies are diverse and enduring. The countermeasures should include disaster management, long-term general public health services, mental and psychological care, behavioural and societal support, in addition to efforts to mitigate the health effects attributable to radiation.

Establishment and implementation of an effective rule for the interpretation of computed tomography scans by emergency physicians in blunt trauma

IntroductionComputed tomography (CT) can detect subtle organ injury and is applicable to many body regions. However, its interpretation requires significant skill. In our hospital, emergency physicians (EPs) must interpret emergency CT scans and formulate a plan for managing most trauma cases. CT misinterpretation should be avoided, but we were initially unable to completely accomplish this. In this study, we proposed and implemented a precautionary rule for our EPs to prevent misinterpretation of CT scans in blunt trauma cases.MethodsWe established a simple precautionary rule, which advises EPs to interpret CT scans with particular care when a complicated injury is suspected per the following criteria: 1) unstable physiological condition; 2) suspicion of injuries in multiple regions of the body (e.g., brain injury plus abdominal injury); 3) high energy injury mechanism; and 4) requirement for rapid movement to other rooms for invasive treatment. If a patient meets at least one of these criteria, the EP should exercise the precautions laid out in our newly established rule when interpreting the CT scan. Additionally, our rule specifies that the EP should request real-time interpretation by a radiologist in difficult cases. We compared the accuracy of EPs’ interpretations and resulting patient outcomes in blunt trauma cases before (January 2011, June 2012) and after (July 2012, January 2013) introduction of the rule to evaluate its efficacy.ResultsBefore the rule’s introduction, emergency CT was performed 1606 times for 365 patients. We identified 44 cases (2.7%) of minor misinterpretation and 40 (2.5%) of major misinterpretation. After introduction, CT was performed 820 times for 177 patients. We identified 10 cases (1.2%) of minor misinterpretation and two (0.2%) of major misinterpretation. Real-time support by a radiologist was requested 104 times (12.7% of all cases) and was effective in preventing misinterpretation in every case. Our rule decreased both minor and major misinterpretations in a statistically significant manner. In particular, it conspicuously decreased major misinterpretations.ConclusionOur rule was easy to practice and effective in preventing EPs from missing major organ injuries. We would like to propose further large-scale multi-center trials to corroborate these results.

A strategy for a rapid radiological screening survey in large scale radiation accidents: a lesson from an individual survey after the Fukushima Daiichi nuclear power plant accidents.

AbstractTo establish a strategy for a rapid screening survey of surface contamination among a large number of people after nuclear power plant (NPP) accidents, the authors analyzed the measured surface contamination of subjects. From 12 March through 25 March 2011, a screening survey was conducted in a hospital on 336 subjects who had stayed within a 50-km radius of the Fukushima Daiichi NPPs. The count rates from measuring points of each subject were measured and compared in association with individual characteristics such as survey timing, gender, age, and distance between their location and the Fukushima Daiichi NPPs. The count rates from the head, hands, and clothes of subjects were correlated to the survey timing and distance by multiple regression analyses. When subjects were divided into two-by-two groups of survey timing and distance, the count rates from hands were not significantly different from those of the head and clothes. However, the count rates from the shoes of the subjects, excluding one group, were significantly higher than those of the other points. In addition, the count rate from a married couple showed a significant correlation. These findings suggest that measurement of at least two regions, such as one hand and one shoe, can be used as representative survey data in order to save surveillance time for a large number of people.

Lexical analysis suggests differences between subgroups in anxieties over radiation exposure in Fukushima

Abstract Although many experts have attempted communication about radiation risk, fears about radiation exposure stemming from the Fukushima Daiichi Nuclear Power Plant accident remain deeply rooted. The characteristics of the anxiety vary with social background, which makes it difficult to alleviate with one approach. Our ultimate goal is therefore to create risk-communication materials tailored to various groups with differing social backgrounds. Towards that end, the purpose of the present study was to clarify potential factors associated with radiation-related anxieties within these groups. After obtaining informed consent, we conducted focus group interviews (FGIs) with Fukushima residents from various social groups, including evacuees, emergency responders, government personnel, medical staff, and decontamination workers. We obtained narrative comments specifically related to the following two themes: (i) lessons learned (at work or home) in light of one’s position in society, and (ii) health issues. After transcribing the comments, we examined potential factors associated with radiation-related anxieties using both quantitative and qualitative study methods simultaneously, using the KH Coder software and the Steps for Coding and Theorization (SCAT) method respectively. FGIs were undertaken with 141 persons. Categories, words and storylines extracted in this study might indicate potential anxieties that are unique to each group, but our analysis also suggested that some anxieties were common to all groups. We expect to continue the analyses and, ultimately, to establish group-tailored risk-communication materials for achieving our final goal of adapting and better managing risk-communication efforts to help people deal more effectively with the scientific, technological and societal changes that came about after the disaster.

Body Surface Contamination Levels of Residents under Different Evacuation Scenarios after the Fukushima Daiichi Nuclear Power Plant Accident

Abstract Body surface contamination levels should be correlated with inhaled actual thyroid doses during evacuation following the Fukushima Daiichi nuclear power plant (FDNPP) accident. Evacuees and residents were screened for body surface contamination using a Geiger-Mueller survey meter. The authors obtained 7,539 individual screening data sheets as well as gamma-spectrometry data from measurements made on clothing of two subjects by using a germanium spectrometer. Body surface contamination levels were analyzed in four residential groups during two different periods: 12–14 and 15–17 March 2011. Contamination levels during 12–14 March in the Tomioka/Okuma/Futaba/Naraha group were very low, indicating that residents evacuated before the radioactive plume reached their towns on 12 March. In contrast, levels in the Namie and Minamisoma groups were higher than those in the other groups in both periods, indicating that these residents were exposed to plumes twice on 12 and 15–16 March. The plume on 12 March was enriched with short-lived radionuclides: averaged proportions of radioactivity (relative to 131I) from 132Te, 133I, and 137Cs measured in clothing from two subjects were 2.3, 1.1, and 0.1, respectively, after correction for physical decay by 12:00 on 12 March. These proportions are similar to those (relative to 131I) from 132Te and 137Cs in dust sampled by a high-volume air sampler in the zone 20 km from the FDNPP on 12 March: 1.9 and 0.1, respectively. These data indicate that the relative contribution to inhaled thyroid dose of short-lived radionuclides in radioactive plumes released on 12 March could be as much as 37.5% in 1‐y-old children.

EARLY STAGE RESPONSES OF INTENSIVE CARE UNITS DURING MAJOR DISASTERS: FROM THE EXPERIENCES OF THE GREAT EAST JAPAN EARTHQUAKE

The present study investigated the role of intensive care units (ICU) during disasters, including the responses of our ICU following the Great East Japan Earthquake on March 11, 2011. Our ICU comprises 8 beds for postoperative inpatients and those with rapidly deteriorating conditions; 20 beds in an emergency unit for critically ill patients; and 17 beds for neonates. It is important to secure empty beds when a major disaster occurs, as was the case after the Great Hanshin Earthquake, due to the resulting large numbers of trauma patients. Therefore, each ICU section cooperated to ensure sufficient space for admissions following the Great East Japan Earthquake. However, unlike the Great Hanshin Earthquake, securing beds was ultimately unnecessary due to the nature of the recent disaster, which also consisted of a subsequent tsunami and nuclear accident. Therefore, air quality monitoring was required on this occasion due to the risk of environmental radioactive pollution from the nuclear disaster causing problems with artificial respiration management involving atmospheric air. The variability in damage arising during different disasters thus requires a flexible response from ICUs that handle seriously ill patients.

Activation Intervals for a Helicopter Emergency Medical Service in Japan

INTRODUCTION Prehospital time is crucial for treating acute disease; therefore, it is important to activate helicopter emergency medical services (HEMS) promptly. We investigated the differences in the activation intervals (the time elapsed from receiving the emergency call to the time of HEMS request) under various conditions to evaluate the current status of HEMS-related prehospital triage in Japan. METHODS We retrospectively investigated activation intervals under exogenous (trauma, n = 553; intoxication, n = 56; and burns, n = 32) and endogenous conditions (acute coronary syndrome [ACS], n = 47; and stroke, n = 173) between January 31, 2008, and January 31, 2012, by reviewing flight records. RESULTS Activation intervals were trauma (14.3 ± 11.5 min), intoxication (10.3 ± 8.6 min), burns (15.0 ± 13.1 min), ACS (17.9 ± 14.6 min), and stroke (19.1 ± 13.1 min). One-way analysis of variance showed a significant difference between exogenous and endogenous groups (P < .001). Post-hoc analysis using Tukeys honestly significant difference test showed significant differences between ACS and intoxication (P < .05), stroke and intoxication (P < .001), and stroke and trauma (P < .001). CONCLUSIONS Endogenous conditions had longer activation intervals, which may reflect a lack of mechanisms assessing their severity. We are considering developing new triage criteria for dispatchers.

Investigation of final destination hospitals for patients in helicopter emergency medical services (doctor-helicopter) in Fukushima Prefecture

PurposeIn using an emergency medical service helicopter with an emergency medicine doctor on board (doctor–helicopter), transporting all patients to the University Hospital (base hospital for the helicopter) could cause a chronic bed shortage at the University Hospital. It is also disadvantageous for patients from distant areas. We investigated whether appropriate hospital selections are being carried out in Fukushima Prefecture.MethodsThe subjects of the study were patients who were transported by doctor–helicopter since the services started. We investigated the medical conditions of patients at emergency scenes, whether they were transported to a hospital inside or outside the region, the means of transportation, and the final destination hospital.ResultsThere were 450 flights, of which 295 were to emergency scenes, involving 307 patients. The majority were trauma patients (191 patients, 62.2%). The final destination hospital was the University Hospital for 104 patients (33.9%); 99 patients (30.3%) were transported to three emergency and critical care medical centers (ECCMCs) in other regions. Most patients were transported to appropriate hospitals in the respective regions. The means of transportation from the emergency scene was by doctor–helicopter in the largest number of cases (223 patients, 72.6%), and the final destination hospital was ECCMCs in 81.6% of cases.ConclusionPatients from emergency scenes are transported by doctor–helicopter to appropriate hospitals in the region, and hospitals in each region are cooperating with the doctor–helicopter operations.