Radiation Emergencies and Public Health: Impacts, Preparedness, Response

In addition to the many important benefits associated with the widespread use of radioactive materials, such as in the fields of health care, industry, and household safety, there is also the possibility of accidents, misuse, or malicious use. Such emergency situations are known as radiation emergencies. No matter what type of radiation emergency occurs—small or large, accident or act of terror—public health professionals and public health agencies and organizations play a central role in assessing and addressing the situation. Thus, it is vital for public health professionals to have some familiarity with the public health issues and challenges posed by radiation emergencies, and with public health’s roles and responsibilities in preparedness and response. Radioactive materials are widely used in the world today. Indeed, considering that the term radioactivity has been in use only since 1898, when Marie Curie coined it, it is remarkable how common radioactive materials have become in modern life. Although electricity production from nuclear power plants is perhaps the most well-known application, millions of radioactive sources are also used in commerce and industry (e.g., weld inspection), agriculture (e.g., radioactive tracers to understand plant biology), education and research (e.g., archaeological dating), household safety (e.g., smoke alarms), and health care (e.g., x-rays, mammograms, angiograms, CT scans, PET scans, cancer treatment). At the same time, it is now well understood that when radioactive materials are not handled carefully and responsibly, when mistakes or failures occur, or when radioactive materials are misused, there can be serious and sometimes long-lasting consequences for public health and the environment. Unintentional releases can occur in a variety of ways, such as a lost or disused radioactive source being broken open, a transportation accident, or a natural disaster impacting a facility that uses radioactive materials. Likewise, an unintentional release can occur through a mishap at a nuclear power facility. Similarly, there are many ways that an intentional release might occur, including from a criminal act, an act of terrorism, or even the action of a hostile nation-state. All of these possibilities could have important public health implications, and all of them need to be taken into account in public health planning, preparedness, and response. In recent years, interest in the public health aspects of radiation emergencies has grown dramatically. One factor was the crisis at the Fukushima Dai-ichi nuclear facility in Japan. One of the world’s largest nuclear generating stations at the time, Fukushima Dai-ichi sustained severe damage as a result of the 11 March 2011 Great East Japan Earthquake-Tsunami Disaster. A second factor that has increased attention to radiological/nuclear preparedness and public health is the worldwide threat of terrorism involving radioactive materials. The threat stems from a thriving global illicit trade in radioactive materials, proliferation of weapons-making know-how, and evidence that some terrorist organizations wish to obtain radiological/nuclear weapons. In all radiation emergencies, public health plays an array of key roles. For example, public health scientists may help develop appropriate steps for people to take to protect themselves, and public health communication researchers may identify the most effective ways to provide the information to different populations. Environmental specialists may check potentially affected areas for contamination, public health laboratories may analyze human samples for the presence of radiological contaminants, and epidemiologists may assess potential health effects. Public health helps determine the safety of food and water and provides advice on the management of contaminated agricultural products. Public health has primary responsibility for screening and following up with populations after an incident and is involved with population decontamination and the identification of appropriate alternate care sites for triage. Public health nurses and others may be involved in organizing the distribution of medical countermeasures. Assessing and responding to the mental health impacts of a radiation emergency is another area in which public health contributes significantly. So, too, is ensuring the safety and health of emergency responders. Finally, public health also assists in fatality management. This list is by no means exhaustive, but it demonstrates that public health science, research, and practice play a role in nearly every aspect of radiation emergency planning, preparedness, and response. This article introduces the reader to this important and rapidly developing field and provides citations to overarching and foundational works, classic and new scholarship, and important works in key topic areas.