Dr. Yoichi Watanabe, M.D. Fukushima Red Cross Hospital. Vice President Director General (Dept. of Neurosurgery) Fukushima Red Cross Hospital

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Nuclear Power Plant Accident and the Challenges for the Future Fukushima Red Cross Hospital Dr.

1 The 3 rd Reference Group Meeting on Nuclear & Radiological Emergency Preparedness Oct 27, 2014 Relief Activities Conducted by the Japanese Red Cross Society after the Fukushima Daiichi Nuclear Power Plant Accident and the Challenges for the Future Fukushima Red Cross Hospital Dr. Yoichi Watanabe, M.D. Vice President Director General (Dept. of Neurosurgery) Fukushima Red Cross Hospital

2 The Japanese Red Cross Society (JRCS) The Japanese Red Cross Society (JRCS) is conducting its activities as an auxiliary role to the Japanese Government based on the Geneva Conventions and the resolutions adopted at the International Conference of the Red Cross. The JRCS operates 92 hospitals across Japan and contributes to providing medical needs to communities. The JRCS provides medical relief activities in disasters and organizes about 500 medical relief teams (about 5,000 team members). When a disaster occurs, we decide by ourselves to dispatch the medical relief teams to the disaster hit area and evacuation centers. Team members will provide medical and psychological care.

3 Mt. Bandai ( Erupted in 1888) First non wartime disaster relief activities The monument of the disaster relief activities by JRCS

4 Fukushima Red Cross Hospital Number of beds:349 Regional disaster medical center (disaster base hospital) Number of physicians: 38 full-time physicians, 4 residents Number of nurses: 278 Japanese DMAT:1 team (In March 2011) Patients transported by ambulance: 2,700 2,800 / year Fukushima Red Cross Hospital 62km Miyagi Pref. The Pacific Ocean Fukushima Daiichi Nuclear Power Plant Tochigi Pref. Ibaraki Pref.

5 Great East Japan Earthquake and Tsunami At 14:46, March 11, 2011 Seismic Intensity: 6-

6 At 15:37, March 11, 2011 Tsunami in Minamisoma

9 Fukushima Daiichi Nuclear Power Plant Accident Lost power supply, Cooling water stop, Melt down Explosion at Unit 1 on March 12 Explosion at Unit 3 on March 14

10 Fukushima Red Cross Hospital Relief Activities by Fukushima Red Cross Hospital in Great East Japan Earthquake and Nuclear Power Plant Accident 1.Emergency and disaster medicine 2.Dispatch of 2 DMAT(Disaster Medical Assistance Teams) 3.Dispatch of 77 JRC Medical Relief teams 4.Investigation of Internal Contamination of Fukushima Citizens

JRCS Relief Teams in Fukushima (Daytime, March 12) 12 JRCS relief teams (from the JRCS National Headquarters, Fukushima, Kanagawa, Niigata, Aichi (2), Shiga, Okayama, Hiroshima, Ehime, Kagawa and

11 JRCS Relief Teams in Fukushima (Daytime, March 12) 12 JRCS relief teams (from the JRCS National Headquarters, Fukushima, Kanagawa, Niigata, Aichi (2), Shiga, Okayama, Hiroshima, Ehime, Kagawa and Kochi) Relief activity locations: Shinchi, Soma, Tamura, Koriyama and Kawamata 132,000 evacuees at primary evacuation centers :Relief Team Fukushima Daiichi Nuclear Power Plant Explosion at Unit 1 At 15:36, March 12

12 JRCS Relief Teams in Fukushima (Evening, March 12) 7 JRCS relief teams (from Fukushima, Shiga, Okayama, Hiroshima, Ehime, Kagawa and Kochi) Relief activity locations: Kawamata (Many evacuates from the restricted zone) Needs among the evacuees: Treatment to avoid worsening hypertension Prescription of their regular medications Distribution of iodine tablets Body contamination screening Left for Shiroishi or Ishinomaki :Relief Team GM survey meters were not equipped. Fukushima Daiichi Nuclear Power Plant Residents living within a 20km radius of the power plant -> Ordered to evacuate (at 18:25)

13 JRCS Relief Teams in Fukushima (Evening, March 13) 7 JRCS relief teams (from Fukushima, Shiga, Okayama, Hiroshima, Ehime, Kagawa and Kochi) Returned to the Fukushima Chapter office and a meeting was held. Relief teams from other prefecture claimed ; We cannot conduct relief activities in areas where safety cannot be guaranteed. They returned to their local hospitals for their team members safety and left Fukushima. :Relief Team Fukushima Daiichi Nuclear Power Plant Residents living within a 20km radius of the power plant -> Ordered to evacuate

14 JRCS Relief Teams in Fukushima (March 14) All the relief teams from other prefectures left Fukushima and only the Fukushima Red Cross Hospital team remained to provide relief activities. Relief teams left the evacuees behind: Appropriate? :Relief Team Fukushima Daiichi Nuclear Power Plant Residents living within a 20km radius of the power plant -> Ordered to evacuate.

F1 accidents JRCS Relief Teams in Fukushima 3/11 3/12 3/13 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 Fukushima DMAT Fukushima High School Onahama Junior High 2 Fukushima Soma Kawamata Azuma Gym Azuma

15 F1 accidents JRCS Relief Teams in Fukushima 3/11 3/12 3/13 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 Fukushima DMAT Fukushima High School Onahama Junior High 2 Fukushima Soma Kawamata Azuma Gym Azuma Gym Azuma Gym Azuma Gym Azuma Gym Azuma Gym Azuma Gym Azuma Gym National HQ Kanagawa Niigata Aichi 1 Shinchi Shinchi Shinchi Shinchi Left for Shiroishi and Ishinomaki DMAT Azuma Gym Niigata Aichi 2 Shinchi Shiga Soma/Kawamata Okayama Koriyama/ Kawamata Hiroshima Ehime Kagawa Kochi Kawamata Tamura Tamura Tamura L e f t Tokyo Yamanashi Azuma Gym Azuma Gym

16 Response to the 2011 off the Pacific Coast of Tohoku Earthquake by the Japanese Red Cross Society (15) March 19, 2011 (as of 12:00) Disaster Management Division, Disaster Management and Social Welfare Department, Japanese Red Cross Society (Tel ) Response to the 2011 off the Pacific Coast of Tohoku Earthquake by the Japanese Red Cross Society is as follows: Please note that the descriptions and figures of the preliminary report will be updated. 1. JRCS relief teams dispatched as of 14:00, March 19, 2011 Dispatched location Relief activities being conducted Number of relief teams (including deru, etc.) Preparing for relief activities Relief activities completed Total Number of relief teams dispatched to date Hokkaido Iwate 13* Miyagi 27 21* Yamagata Fukushima Ibaraki Tochigi Chiba Nagano Total *1: 1 air ambulance included. *2: 4 trucks loaded with medications included.

17 Reasons for Limited Relief Activities in Fukushima 1. No code of conduct to respond to nuclear disasters 2. Lack of knowledge about radiation emergency medicine 3. Lack of equipment to measure radiation and protective gear Air dose meter, Personal dosimeter, GM survey meter Not equipped On March 26, personal dosimeters began to be distributed to JRCS relief teams Radiation medical specialists from Hiroshima and Nagasaki were dispatched to Fukushima and gave guidance to relief team members Safety guidance: Air dose rate : Contact headquarters for direction at 20 μsv/h Evacuate if it reaches 100 μsv/h Personal dosimeter : Evacuate if it reaches 1 msv

18 JRCS relief teams Re started relief activities by monitoring radiation doses

19 Relief Activities in the Large Evacuation Center Fukushima City(3/14~6/25) Base:Azuma Gymnasium(max evacuees 2,500 people) Round:City of Fukushima, Nihonmatsu and Motomiya, Kori town The number of patients:4,641people Relief teams:68 teams Fukushima:34,Aomori:5,Yamagata:1, Ibaraki:1, Tochigi:9, Tokyo:1,Kanagawa:5,Niigata:2, Yamanashi:5,Shiga:1,Hiroshima:1, Saga:1,Oita:1,Miyazaki:1,Kagoshima:1 JRC Aizu Wakamatsu JRC Fukushima Fukushima Daiichi Nuclear Power Plant Aizu Wakamatsu City (3/18~6/30) Base:Kawahigashi Gymnasium(maz evacuees 1,000 people) Round:City of Aizu Town of Inawashiro, aizumisato and Aizubange The number of patients: 3,263 peolple Relief teams:51 teams Yamagata:25,Kyoto:0,Shiga:8,Niigata:2,Tochigi:4,Ibarakai:2,Saitama:1 Kanagawa:1,Gunma:1)

20 Exposed Doses in Relief Team members Unit(μSv) March April May Mean Maximum Minimum Total Doses Average daily Total Doses Average daily Total Doses Average daily No. of Subject After March 25,2011 Number of Days:2~4days

21 Proposal from Fukushima Red Cross Hospital Fukushima Red Cross Hospital Education and training on radiation emergency medicine should be included in its disaster medicine training program so JRCS relief teams can understand the basics. If relief teams need to be sent to an area near a nuclear power plant after a disaster occurs: Correct information about released radioactive substances, etc. should be evaluated. At the same time, a system should be established in which relief team members can guarantee their personal safety by carrying an air dosimeter, personal digital dosimeter and GM survey meter to measure radiation levels.

JRCS Safety Measures for Relief Activities under Nuclear Disaster The JRCS established safety measures for its relief teams to conduct relief activities under nuclear disaster. 1.

22 JRCS Safety Measures for Relief Activities under Nuclear Disaster The JRCS established safety measures for its relief teams to conduct relief activities under nuclear disaster. 1. Criteria for cumulative exposure level: 1 msv 2. Procurement of protective equipment and radiation measuring device 3. Training for radiation emergency medicine 4. Established Guidelines for Relief Activities under Nuclear Disasters

23 Mt. Azuma in April, Fukushima City Cherry Blossom and Snow rabbit

were carried out in the staging base (Baji Koen) in

24 Relief activities to support evacuated people s temporary return to their homes in the Hazard Area Relief activities were carried out in the staging base (Baji Koen) in Minamisoma city Staging base (Baji-Koen) Fukushima Daiichi Nuclear Power Plant

25 Roles of relief teams Health management and Medical care to evacuees Grasp of present illness and past history by interview sheets Medical check of elderly people Treatment for sick person

Baggage allowed to bring back : only 2 plastic

26 Preparation of evacuated people Equipment:Protective clothing, Cap, Glove, Mask, Socks, Personal digital dosimeter Moved to near their homes by bus Sojourn time:2 hours Baggage allowed to bring back : only 2 plastic bags Screening of body and baggage after return to the staging base

27 Condition after return to staging base No People required decontamination 486 patients needed medical treatment Heat Illness, Hypertension, Insect bites, Minor trauma

28 Number of dispatched JRC relief teams in this project : 87 teams Number of days : 136 days Fukushima 42 teams First Block : Hokkaido, Tohoku 18 teams Second Block : Kanto, Koshinetsu 27 teams Exposed dose of relief team members in a day (between Fukushima and Minamisoma) May August September November December March 4 5 μsv 3 4 μsv 2 3 μsv

29 Hanamiyama (Mt. flower viewing, Fukushima City)

30 Fukushima Red Cross Hospital Screening for Internal Contamination Using Whole-body Counter (WBC) FASTSCAN manufactured by CANBERRA Count time: 2 minutes Two sodium iodide (NaI) detectors (7.62cm 12.7cm 40.6cm)

31 Fukushima Red Cross Hospital Measurement using WBC Detects gamma rays in the body Two possible nuclides currently detected in the body after the nuclear accident: Cs-134, Cs-137 K-40 which exists in the natural environment is always detected Lower limit of detection at Fukushima Red Cross Hospital Cs Bq Cs Bq Lower limit depends on environments (background), where WBC is installed Lower limit depends on WBCs

32 Measurement Spectrum (Cs was detected) Count (count/min) 605KeV 662KeV 796KeV

33 No. of WBC Screening and Measurement Result April 2012 August 2014 Age No. of screened persons Detected Detection rate 2~ % 4~6 1, % Elementary school students Junior high school students High school students % % 2, % 39 years old > 4, % 40 years old 7, % Total: 16, %

34 No. of WBC Screening and Measurement Result April 2012 August 2014 Age No. of screened persons Detected Detection rate 2~ % 4~6 1, % Elementary school students Junior high school students High school students % % 2, % 39 years old > 4, % 40 years old 7, % Total: 16, %

Fukushima Red Cross Hospital Committed Effective Dose of All Screened Persons : Less Than 1mSv Committed effective dose: Cumulative, lifelong dose after an intake of

35 Fukushima Red Cross Hospital Committed Effective Dose of All Screened Persons : Less Than 1mSv Committed effective dose: Cumulative, lifelong dose after an intake of radioactive substances For adults: for 50 years For children: until becoming 70 years old Dose limit for radiation workers: 50mSv per year Dose limit for the public: 1mSv per year

36 Fukushima Red Cross Hospital WBC data suggests that parents with little children were well aware of internal exposure and paid close attention to the intake of food. On the other hand, some of the people aged 40 or over were not so conscious about internal exposure. They ate vegetables grown in their gardens without food testing. This resulted in a difference in the screening data. It is important to continue the screening using WBC and educate people on being more conscious about reducing of internal exposure.

37 Fukushima Red Cross Hospital Currently adverse health effects caused by radiation are less in Fukushima Prefecture. However there are many harmful rumor. Some young people, especially mothers with little children have much anxiety about living in Fukushima Prefecture. At the present time, about 45,000 people have been evacuated outside Fukushima Prefecture. Some family are living separately. Some people in the foreign countries (for example European and even neighboring Korean) misunderstand that All Fukushima have been highly contaminated with radiation and it s dangerous to live in Fukushima Prefecture.

38 Fukushima Red Cross Hospital We hope that you observe the current state of Fukushima Prefecture in this Reference Group Meeting and disseminate the accurate information to all of the world.

39 Fukushima Red Cross Hospital s Challenges for the Future Fukushima Red Cross Hospital Open lectures for the community and health consultations Seminars and trainings about radiation emergency medicine Continuation of the internal exposure screening using WBC Education of people on being more conscious about reducing of internal exposure Dissemination of correct information on nuclear disaster to other countries using the Red Cross network

The JRCS established the Japanese Red Cross Nuclear Disaster Resource Center in October 2013. Main activities: JRCS Nuclear Disaster Resource Center 1.

40 The JRCS established the Japanese Red Cross Nuclear Disaster Resource Center in October Main activities: JRCS Nuclear Disaster Resource Center 1. Develop and disseminate guidelines 2. Information gathering, compiling and sharing through its Digital Archives 3. Inter-organization cooperation both inside and outside the JRCS

41 Mission Statement The mission statement of the Japanese Red Cross Society: We mobilize people who desire to save those who are suffering, and protect the life, health and dignity of human beings in any circumstances.

Great East Japan Earthquake and Tsunami, Fukushima Daiichi NPP Accident (1/5)

Great East Japan Earthquake and Tsunami, Accident (1/5) < About Great East Japan Earthquake and Tsunami > Date and Time: March 11, 2011 14:46 JST Epicenter: Off the Sanriku coast (38 6.2 N, 142 52 E) Depth