INTERNATIONAL CO-OPERATION FOR MEDICAL PREPAREDNESS AND RESPONSE TO RADIATION EMERGENCIES

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INTERNATIONAL CO-OPERATION FOR MEDICAL
PREPAREDNESS AND RESPONSE TO RADIATION
EMERGENCIES

• Module XXIII

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Radiation accidents 1944-2001

• 1944-2001 420 radiation accidents leading to
  significant overexposure of at least one person
  when Egt0.25 Sv, Hskingt6 Sv, or Hother organgt0.75
  Sv
• Of 3000 overexposed persons, 133 fatalities
  registered
• Fatalities include 28 operators and firemen who
  died of acute radiation disease in Chernobyl
  accident in April 1986

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Conventions for international collaboration in
radiation accidents

• The basis for co-operation International
  Conventions (26 Sept 1986) on Early notification
  of a nuclear accident and on Assistance in case
  of a nuclear accident or radiological emergency
  prepared by IAEA in co-operation with government
  experts of its 62 Member States and
  representatives of 10 international organizations
  in August-September 1986
• Conventions have 87 and 82 parties respectively,
  as of 1 March 2002. Besides three international
  organizations FAO, WHO WMO acceding to
  them, 84 and 79 Member States have, respectively,
  ratified them

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IACRNA
IAEA
IAEA
WMO
WHO
OCHA
FAO
EC
NEA
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Emergency Response System (ERS) and
International Nuclear Event Scale (INES)

• According to the Conventions Member States
• provide the IAEA with immediate information on a
  nuclear accident and
• mutually assist each other in case of a nuclear
  accident or radiological emergency
• The IAEA co-ordinates the ERS and has elaborated
  the International Nuclear Event Scale, INES, used
  for rating nuclear events in the early
  notification

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Responsibilities of IAEA

• FOCAL POINT
• Emergency Response System (ERS)
• International Nuclear Event Scale (INES)
• NOTIFICATION
• Inform States and organizations on accident
• Notify upon request to minimize consequences
• ASSISTANCE
• Disseminate information on resources, methods,
  techniques, calculation of consequences
• Transmit and co-ordinate assistance on request

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Co-operation of IAEA with WHO

• CO-OPERATION for
• Application of Conventions
• Actions aimed at
• medical and public health response to radiation
  emergency or nuclear accident
• medical preparedness and assistance
• Joint publications and training activities
• PARTICULAR RESPONSIBILITY of WHO
• Organize network of WHO Collaborating Centres,
• Provide procedures for medical assistance

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International assistance in medical response

• Depends on
• number of exposed persons
• severity of exposure
• types of accidental exposure, which may be
• exposure of the public, workers, patients
• external exposure only
• external or internal radioactive contamination
• combination of external and internal exposure
• combination of radiation exposure and other
  injuries

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REMPAN

• Radiation emergency medical preparedness and
  assistance network
• For promotion of radiation emergency medical
  preparedness and for practical assistance and
  advice to countries in a case of overexposure
  from any source of radiation, WHO established
  REMPAN in 1988

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REMPAN

• In March 2002
• 14 REMPAN centres in Armenia, Australia,
  Finland, France (2), Germany, Japan, Russian
  Federation (4), United Kingdom, Ukraine and USA,
  and 2 liaison institutions in Brazil and India.
• These 16 institutions are located in 12 countries
  on 4 continents

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Major roles of REMPAN in radiation emergency

• to provide assistance and advice in medical
  management of exposed individuals
• to provide medical team for on-site emergency
  treatment
• to transfer (if possible and necessary) severely
  exposed patients to collaborating centres for
  specialized medical care
• to assist with facilities and staff for medical
  investigations and treatment

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Major roles of REMPAN in radiation emergency

• to assist in development of measures necessary to
  limit health effects
• to follow up medical supervision and treatment
• to assist in developing procedures to strengthen
  countries ability to manage such accidents
• to circulate information relating to medical
  management of radiological accidents to Member
  States

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Types of REMPAN assistance

• Human resource specialists
• Each WHO collaborating centre, including liaison
  institutions, has a few dozen experts or more,
  including many doctors. Other specialists are
  health physicists, radiologists, radiochemists

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Types of REMPAN assistance

• Recruitment of experts
• WHO and IAEA invite experts from collaborating
  centres and also from other institutions, if
  necessary and requested by affected Member State
• Specialized teams
• WHO (in co-operation with IAEA) can organize
  multinational teams to render medical assistance
  on site

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Types of REMPAN assistance

• Equipment
• Portable equipment for radiation monitoring of
  humans and environmental objects for use on site
  
• Medical services
• WHO collaborating centres can help with
  diagnosis, prognosis, treatment and follow-up of
  persons exposed to radiation and other
  accompanying factors - both in affected country
  and at centres themselves

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Types of REMPAN assistance

• Clothing
• Special clothing for medical personnel
• Scientific services
• Expertise may be provided for biological dose
  assessment and reconstructing circumstances of
  overexposure (in co-operation with IAEA)
• Transportation
• WHO collaborating centres provide advice or
  render practical assistance for transportation of
  affected persons

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Practical co-operation of IAEA, WHO, EC and MSs
in medical management of radiation accidents

• Notification - information on accident,
• Preparedness - plans for prevention
  diagnosis
• Intervention - actions for emergency aid,
  treatment, decontamination,
  decorporation
• Reparation - follow-up and rehabilitation,
• Training - of medical staff in health effects
  of
• radiation and radiopathology
• training courses, symposia, fellowships

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Examples of international co-operation

• Numerous examples of joint assistance for
  radiological accidents most known cases are
  Chernobyl and Goiania
• After Goiania accident of 1987, leading radiation
  medicine scientists were recruited by IAEA and
  WHO to provide medical and radiological
  consultations on site

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Examples of international co-operation

• International studies on childhood thyroid cancer
  in population affected by Chernobyl radioiodine
  releases in iodine deficient areas up to 500 km
  around NPP

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Dissemination of information

• IAEA and WHO regularly
• organize joint conferences
• prepare joint publications (also in co-operation
  with other international organizations, such as
  EC, UNSCEAR, OECD/NEA , ILO)
• present, discuss and disseminate information on
  health effects of exposure to radiation
• publish lessons learned to prevent and better
  manage radiological and nuclear accidents

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International co-operation for medical management
of radiation accident in Lia, Jan-Feb 2002
LIA
SANTREDIA
KAHISHI
ZUGDIDI
MATKOJI
POTI
LILO
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International collaboration to compile lessons
learned from medical management of recent
radiation accidents

• The 1st EAGM (Expert Advisory Group Meeting) on
  medical follow-up of Georgian patients (soldiers)
  accidentally exposed to radiation in Lilo
  conducted by IAEA in Vienna in Sept 1999
• Two joint IAEA-WHO expert meetings on medical
  follow-up of six significant recent radiation
  accidents at WHO-HQ (Geneva, 1-3 Oct 2001) and
  WHO/REMPAN Centre (Ulm, 8-9 Nov 2001)
• Joint technical document has been approved for
  publication in 2002, to distribute to medical
  specialists and institutions responsible for
  treatment of radiation accident cases in Member
  States