ML22129A128

Technical Session - T6 - Exacting the Science of Emergency Preparedness - Transcript

ML22129A128
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Issue date:	03/08/2022
From:	Office of Nuclear Security and Incident Response
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UNITED STATES OF AMERICA

NUCLEAR REGULATORY COMMISSION

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34TH REGULATORY INFORMATION CONFERENCE (RIC)

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TECHNICAL SESSION - T6

EXACTING THE SCIENCE OF EMERGENCY PREPAREDNESS

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TUESDAY,

MARCH 8, 2022

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The Technical Session met via Video-

Teleconference, at 3:00 p.m. EST, Todd Smith, NSIR,

presiding.

PRESENT:

TODD SMITH, Senior Level Advisor for Emergency

Preparedness, Division of Preparedness and

Response, NSIR/NRC

TOMOHIKO MAKINO, Director for International

Cooperation, Japan Cabinet Office

GREG LAMARRE, Head, Radiological Protection and Human

Aspects of Nuclear Safety, OECD Nuclear Energy

Agency

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TRISTAN BARR, Section Head of Planning, Outreach,

Exercises and Training, Nuclear Emergency

Response and Preparation, Health Canada

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P R O C E E D I N G S

(3:00 p.m.)

DR. SMITH: Good afternoon, good morning

and good evening. I'm Todd Smith, Senior Level

Advisor for Emergency Preparedness and Incident

Response in the office of Nuclear Security and

Incident Response at the NRC.

And welcome to this session on exacting

the science of emergency preparedness. In

radiological emergency preparedness, preparing for

tomorrow is our constant work. It's what we do. And

whether we're learning it from the past or looking to

the future, emergency preparedness is constantly

evolving. And as you'll learn in this session, it's

an international effort.

With me today is a distinguished panel of

colleagues from around the globe. I'm joined by Dr.

Tomohiko Makino, Director for International

Cooperation at the Cabinet Office for the government

of Japan.

Dr. Makino's contributions include

extensive experience in the fields of emergency

preparedness, resilient health systems, disaster

response, global health diplomacy and biosecurity.

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Mr. Greg Lamarre, head of the Division of

Radiological Protection and Human Aspects of Nuclear

Safety at the Nuclear Energy Agency.

Mr. Lamarre has over 30 years of

experience as a systems engineer and providing world-

class technical expertise as a leader in military

government and international organizations.

Mr. Tristan Barr, head of the Planning,

Outreach, Exercises and Training Section within the

Radiation Protection Bureau of Health Canada.

Mr. Barr has expertise in radiation

detection, characterization, dosimetry, radioactive

waste management and emergency response.

Rounding out this panel will be myself.

Starting my ninth year here at the NRC. All of which

time I've had the pleasure working on emergency

preparedness regulation, oversight and research.

And I'll add that this group of panelists

holds a combined total of 12 graduate and

undergraduate degrees spanning the fields of

medicine, chemical and nuclear engineering, biology,

health, physics and business. This is a very

knowledgeable panel and we will have time for your

questions at the end.

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So as you listen to today's

presentations, please submit your questions.

In this session, we're going to take a

closer look at how the science of emergency

preparedness has evolved to prepare us for tomorrow.

To set the stage for this discussion, we need to start

with a look at the challenges that have faced us

yesterday and still face us today.

So it's appropriate that we lead off with

a discussion on the impact that the Fukushima Daiichi

accident has had on emergency preparedness in Japan.

I'll now turn it over to Dr. Makino. Tomo.

DR. MAKINO: Thank you, thank you very

much for that introduction. And it's my great, great

pleasure to be here NRC and have a chance to introduce

what Japan has experienced through the Fukushima

Daiichi accident.

So they have done a lot to diverse our

policies but there are also some things they haven't

done well. So this session, we'll introduce some of

the issues and the concerns they caused in front of

you. So next slide, please.

At the first slide and the last location

is a picture. So they, here on the right side, this

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shows how long this process and how many time the

people travel, migrating.

So the village, entire village moves one

place to the other and then they, they are actually

contaminated. Then they are have to travel out of

that place.

So over about 100 kilometers travel that

may also make the committee (inaudible). Next slide,

please.

This shows the, some of the areas are

still restricted and the people cannot come back. And

the figure on the left, right, below, shows the people

who returned back to their original places.

The blue column are the people who

traveled out, inside the prefecture and who came back

who are stay away our area for years. But the orange

column, those who traveled beyond the prefecture

border are less likely to come back. That means

their repatriation is another issue. Next one,

please.

That describes the stable element

distribution. At that time, the government

stockpiled but not distribute the stable iodines.

Then the decision of the local governments to

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urgently distribute are. And then they, after some

of those areas where the people received the stable

iodine urgently and were advised to take.

But the people didn't take because of

their concern about the side effect or the concern

about the next big emergency may happen. So just

take it with them.

But education or good communication

(inaudible) of the urgent distribution of the

iodines. These are the, some of the problems but the

big challenge was a long application of process of

the hospitalized people. So next slide please. Next

slide, please.

So the picture on that right is a queue

of the people, senior citizens, who get on a bus.

Then these senior citizens who travel so long way

that is shown in the right lower picture.

And I show you because of the missing

information or missing communication from the

government, the bus travels to north to west and then

eventually far south. That is several hundred

kilometers travel journey which caused about 40

patients' death within a month. That was a very big

tragedy of that long, evacuation, urgent evacuation

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procedure.

But the quick lesson is that evacuation

is risky but please proceed to the next slide, Slide

6.

This picture here also shows that staying

is also risky. Sheltering, the shelter in place

order was also issued leaving a 30-kilometer radius

from Fukushima Daiichi. So there are many hospitals

who are advised for shelter in place orders.

But the staff members could not stay

because of the disrupted social function. Like

school closure or no groceries in the community. So

the right figure shows that the number of the

healthcare staff members decreased after early fate

of the emergency.

Some hospitals retained the staff members

but some couldn't get a sufficient number of the staff

members. Then as is shown in left figure of Slide

6, the survival of the patient inside the hospital

where shelter in place order was issued also

decreased. So the staying inside the area of a

natural disaster is also risky. That's all on this

slide. So please proceed to the next slide. Slide

7, please.

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Fukushima after a decade. This is my

personal addition from listening to the local people

and my observation. So they ask about learnings.

One, that the urgent evacuation is very risky and led

to the 40 deaths of its evacuees.

But shelter in place is also challenging.

That this can disrupt the social function and then

the people cannot stay there for long time. Maybe

one will be maximum.

The third bullet, the certified disaster-

related deaths, that means this is not due to the

immediate earthquake or tsunami, but those residents

who requested that the area to the accident are pretty

much bigger in Fukushima compared to other

prefectures where the incidents are much bigger.

That means the long-term effects is

severe for such a large-scale evacuation otherwise.

The fourth bullet. Community was disrupted because

of the prolonged evacuation and then the people went

back to the community and who traveled inside that

area for work or just migrated. There are very

different types of the people were there.

So getting a good consensus to reveal the

community has become a big issue over there. And

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then people are from different positions so even the

radiological decay, but mental barrier may stay there

to split the community. These are the station in

Fukushima. Next slide, please. Slide 8, please.

In terms of the emergency response and

management, there are really many lessons. Such as

unexpected situation or unplanned stations or staff

are not skilled.

In order to overcome these three big

challenges, government took actions. Next slide,

please. Slide 9, please.

Before Fukushima, user and safety

authorities somewhat mixed in the left figure. So

after Fukushima, governments, they restructured the

authorities between two. And it's safety and

community.

And the other on the right is the user or

promoter of the nuclear energy. So as to divide

these two or three pieces. Next slide, please.

National legal framework for the nuclear

emergency was actually built in 1999, pre-event. But

it didn't assume such a combined existence but the

nuclear existence was triggered by the mass

existence.

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So that special arrangement for nuclear

emergency was revised and then that establishment of

the Nuclear Regulatory Authority and also the Nuclear

Regulatory Authority requested to build the EPR

Guide. Next slide, please. Slide 11, please.

So the nuclear, based upon the new EPR

Guide, each local governments are requested to build

their device or renewed emergency response plan. So

each site has a combined local government responding

time which is called as Regional Emergency Responses.

These needs to get approval by the

committee led by the prime minister. So far, these

little regions have EPR plans are approved. And

there are four sites operating right now. Next slide,

please.

Let me introduce three examples of the

newly introduced protective actions on the sheltering

facilities. One is the site number 12 sheltering

facilities with radiological protections.

So after the emergency event, some

buildings, including the responding office buildings

to the emergency didn't work well. Stuff like

windows are broken by the earthquake and then the

radiological plumes came inside. Then that building

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couldn't be used for response.

People were up and moved to their special

prefecture government 60 kilometers away. So after

Fukushima, key buildings such as responding buildings

and the safety for patients to be sheltered inside

are equipped with these possibilities.

Like airtight and the pressurization and

the filtration to make the air clean to be placed

inside the buildings. This is a pressurization

facility. These facilities are subsidized by the

national government. Next slide, please. That's

13.

So the stable iodine blocking

methodology. So the confusion is that the people

will not be clear about whether to take the iodine or

not. And those are in need of pre-distribution.

So after Fukushima, local governments

started to pre-distribute the stable iodine to the

government out to the local residents. But that

process did not just mail or send. But the

government needs to hold town hall meetings to

provide information to the residents.

What is the right timing to take and what

is the effectiveness of the stable iodine? And

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communication of these outlets. These are the

changes after Fukushima.

Now, let me introduce some drill and

training programs. Responding staff members of the

government are more, just public office are rotating

from different ministries and governments.

So the different drills and the training

programs are mainly targeted for these responding

officers of the operation centers. The various

training programs, like lectures, seminars and this

special sessions and the drills that test the actual

procedures to go on.

The key drill is at the head of the drill

box. And that's NEDPD. So let me go over that

drill. Next slide, please. Slide 15, please.

Thank you.

For the NEDPD, a Nuclear Energy Disaster

Prevention Drill is an annual, large-scale drill lead

by the national government. The feature of this

drill is to invite the prime minister and the

political leaders as well as the local residents.

About 1,000 people joining.

The scenario is open so it is not that

much for testing the decision making but good for

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checking the procedure to implement the protective

actions.

(inaudible) the commitment.

So the next slide, Slide 21, is the

medical drill that the healthcare staff members with

the PPE and are ready to see the contaminated

patients. These are the pictures of our national

drill.

So the last section of my presentation is

about our lessons and the responses to the COVID-19

pandemic. And now we are on Slide 22.

Thank you, thank you. I'm very sorry for

the sessions. After seeing the COVID-19, some of the

challenging station. How to balance the two risks.

From November of 2020, we issued a kind of guide to

the local governments to think about how to balance

the two risks. Especially in the station of

counting, evacuation counts or in doing

transportation.

The question was whether to ventilate or

not. So to stay on the principle to ventilate but

try to ventilate during the time that the

radioactivity is not there. Next slide, please.

Slide 23, please.

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And as a side, the COVID-19 response was

that they told us what we should do during this

situation. Especially the good lesson from the

COVID-19 was what are the essential number of the

people to respond.

(inaudible) but also the questions are

that nobody was (inaudible) and it's not easy to say

whether that is good between stay or move. Stay and

shelter in place or evacuate. So after all, we are

all still on a long wait to keep improving our

emergency responses. Thank you very much.

DR. SMITH: Thank you, Tomo. You made

clear in your presentation that the challenges that

you faced are multi-dimensional. And the reality of

the situation goes beyond just radiological impacts.

Specifically, the social disruption and

stigmatization reminds us there are human and

societal dimensions to consider. It also indicates

the need to integrate the social sciences into

planning and response. And recognizing this, we'll

now turn to Greg Lamarre to discuss how might we

integrate non-radiological health impacts into the

field of radiological protection. Greg?

MR. LAMARRE: Thanks very much, Todd.

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And good evening, everyone, from Paris. I'm very

happy to be here and thank you very much to the NRC

for this opportunity for us to present some of the

work of the Nuclear Energy Agency and some of our

groups.

As it says, the title of the presentation

is NEA progress to-date on those non-Radiological

health impacts of protective actions from recognition

to mitigation.

Hopefully I can build on some of what

you've heard in Tomo's presentation as well. And

also complement what I know Tristan is going to talk

about.

I've got the pleasure of giving the

presentation but I'd like to also call out my

colleagues, Jatienne Garnier-Laplace, Jan-Hendrik

Kruse. And also a couple very important people

within our community. Matthias Zhringer who is

the chair of our working party on nuclear emergency

matters. And Thierry Schneider, the chair of CRPPH.

The work that I'm going to talk about

over the next 15 to 20 minutes is largely based upon

the work of two expert groups. The expert group on

non-radiological public health aspects, EGNR, and

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the expert group on recovery management.

So maybe just to make a little bit of a

plug here, EGRM has got a launch event later in May,

23rd of May, in order to launch its report.

And then there's also going to be an in-

person workshop in October in Paris when we can

start to hopefully meet face to face again. So

please keep your eyes open for both of those events.

Next slide, please.

So just very quickly on the Nuclear

Energy Agency for those of you that aren't familiar.

We founded in 1958, 34 member countries plus a number

of strategic partners, 8 high-level standing

technical committees. You can see them along the

right-hand side.

The work that I'm talking about is under,

sort of the middle pilar there, CRPPH. And some of

the expert groups that report up to that.

A real myriad of working parties, expert

groups and the like. 24 international projects. In

the organization approximately 110, 120 strong with

supports across all of those different committees

and working parties. Next slide, please.

So to get into the heart of the

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presentation, I think we can all confirm that

internationally, much has been learned from the

tragic events at Fukushima Daiichi over the last ten

plus years.

I think we can also probably all agree

that a lot of the work in the early stages of that

led to some very significant improvements in the

engineering and design of the plants when we look at

robustness, the defense against external events and

the like.

What we've done now with the support and

direction of our member states is really pivoted and

turned our attention to some of the other aspects

related to emergency preparedness and response.

And I'll talk to you now a little bit

about where we're going on some of the psychosocial

pieces. I think Tomo mentioned quite well in his

presentation that when you look at the impacts of an

accident like Fukushima, it goes much beyond the

radiological consequences.

And I think we're also all very aware

that although radiation induced illnesses, deaths are

very, very minimal if not nil, that some of those

psychosocial impacts due to evacuation and some of

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the other decisions that were made had a much more

profound impact.

And it's with that in mind that we move

forward to our expert groups in work in this area.

We've also realized through our collective

investigation that not only does work need to be done

there but the decision makers are not yet

sufficiently equipped to move from what has

traditionally been a radiation protection-centric

approach, i.e. trying to avert certain dose, perfect

protective action levels that are dose centric to one

that has a more comprehensive approach to the

protection of health and wellbeing in the broader

sense.

And it's with that in mind that the NEA

has moved forward. Next slide. Slide 4.

So a little bit of background. As I

mentioned, non-radiological consequences of nuclear

or radiological accidents are complex. And they're

multidimensional in nature with human and societal

dimensions at its core.

That makes it all the more challenging.

They are a combination of direct health consequences

and indirect public health consequences of those

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protective strategies.

We've learned through the work of the

expert group on non-radiological consequences and

recovery management that management needs to reassess

the risks of the protective actions to reflect a more

holistic and inclusive approach throughout the entire

cycle of an emergency.

Among many lessons, some have been well

documented. For instance, there's a need to consider

specific actions for vulnerable groups. Elderly,

children and parents, pregnant women.

Clearly, one size cannot fit all. And a

lot of those demographic specificities need to be

considered in the strategy.

We need to proactively consider balancing

the risk of immediate evacuation against the possible

benefits of sheltering in place with continuous care.

And what's required for continuous care also needs to

be considered within your strategy.

And I'll talk further about this later on

in the presentation. The need to further promote

stakeholder engagement in a collaborative, inclusive

manner from preparedness to recovery, all the way

through in order to achieve the best possible

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outcomes. Next slide, please.

So how to proceed. Many of you may be

aware, perhaps others are not. Last year we

published a Fukushima Daiichi Ten Years On report.

If you haven't had the opportunity to look at it, I

strongly suggest that you do. It's available by a

link on our NEA website.

It looked over the last ten years and the

compendium of work that's gone on from the nuclear

regulatory communities, the committee on safety of

nuclear installations, CRPPH came up with nine

recommendations on future areas for improvement and

how the international community can help.

Some of those have to do with more

advanced research. Some of them have to do,

obviously, with fuels and physics and some of the

science of engineering design.

The ones that I want to talk to you about

a little bit here are Recommendation 6 and 7.

Recommendation 6 involves stakeholder involvement and

risk communication and the need to promote

stakeholder involvement approaches to enhance

community engagement and society resilience. And I

think that has a lot to do with what we're talking

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about in this session.

Just as an aside, the NEA also, in

recognition of the risk communication part of that

recommendation, is later on this year launching a

first risk communication training course to be hosted

on Slovakia in December.

Recommendation 7 looks at the recognition

of mental health impacts. Important to note that

both these recommendations promote an all-hazards

approach aligned with UN Sendai Framework for

disaster risk reduction. Next slide, please.

So a little bit more about the problem

statement on mental health and psychosocial impacts.

Mental health and psychosocial impacts need to be

better considered in protection strategies for

preparedness, response to and recovery from the

events.

The work within the expert groups also

drew largely on the World Health Organization

framework for mental health and psychosocial support.

Radiological and nuclear emergencies have provided

some high-level guidance across these areas.

It is realized that more work is required

to prepare decision makers to move from, once again,

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a radiation centric approach to a more holistic

approach that looks at the overall health and well-

being.

It's also very important to realize that

one size does not fit all. As a stakeholder, needs

and expectations are very circumstance, population,

demographic dependent.

Optimization and decision-making for

overall public well-being must integrate the social,

cultural and other relevant factors. And I'll talk

in the next few slides about how we're going to try

to address that. Slide 7, please.

So Action 1, action-oriented solution.

Stakeholder dialogue through the emergency cycle.

Some of what we're looking to do is exploring possible

options to improve decision-maker's responses to

stakeholders' needs and concerns by involving

stakeholders in the protection strategy.

By starting at the preparatory phase to

develop mutual trust that is central to the success,

drawing on existing frameworks such as the ICRP co-

expertise approach that is highlighted at a high

level on the right-hand side. That brings together

people, experts, NGO's decision makers to facilitate

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radiological protection culture dissemination.

And the dialogue will provide people with

the knowledge on health risks and radiation exposure.

The am I safe, how safe is safe enough and methods to

put into perspective potential deleterious effects of

protective actions allowing informed protection

decisions. The ability of the stakeholders to be

involved in that risk benefit consequence decision

making process. Next slide, please.

In order to support this, obviously

member countries are also looking for us to assist in

the development of tools and data to support these

dialogues.

Such tools and data are necessary to

balance the health risks of radiation exposures

against the health risks from protective actions and

their subsequent disruption of normal life as Tomo

mentioned in his presentation.

Data on mental health and psychosocial

consequences of actions such as evacuation,

sheltering, relocation, societal disruption can be

documented from other disasters and brought into the

conversation.

And it's also, we're also promised, we're

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very heartened to see good progress being made in a

number of NEA countries. I know Tristan's going to

talk about that being done at Health Canada. We're

also aware that our partners at the US NRC have moved

very boldly forward in this area as well. Next

slide, please.

So ongoing work and next steps. So NEA

member counties are committed to bring forth

practical, actionable guidance to advance

preparedness, response and recovery using this

multidimensional approach with human and societal

dimensions at the core.

NEA expert groups that I've mentioned

previously, continue to work on operationalizing the

World Health Organization framework. First, by

developing national-level guidance on how to better

prepare for recovery with health and wellbeing being

supported, being one objective of recovery.

And by preparing the translation of the

framework into a series of operational action sheets

on mental health and psychosocial support during

preparedness, response and recovery.

Those action sheets are under development

right now, action sheets on training of first-line

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respondents, how to distribute educational material

to the communities on mental health and psychosocial

support. And other supporting material like that.

That work continues.

The ultimate goal is to evolve beyond the

optimization of radiological protection to the

optimization of well-being. Ultimately, testing and

validating of these new approaches and tools using

national and or international exercises will be key.

And I would also like to highlight that

we're well advanced on planning of the INEX-6

exercise. That will happen in 2023, 2024. That

we'll hopefully be able to put to action some of this

new learning. Next slide, please.

Just a little bit more on ongoing and

complimentary work. We're in the midst of planning

our third stakeholder involvement workshop entitled,

Optimization in Decision-making.

That we'll get to the key of this

decision-maker paradigm and how to most effectively

involve the stakeholders in the decision-making

process.

It's been determined that a series of

webinars will be held in 2022 starting in June and

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going through the fall. And then that the actual

workshop itself will be held likely here in Paris the

first part of 2023.

The program committee has been convened

and is looking at the specific objectives listed at

the bottom. Improving the common, practical

understanding of what optimization decision making

means. Increasing the consideration of inclusive

stakeholder involvement to optimize the decision

making. And ultimately, developing a foundation for

generic multidimensional framework to support

optimization for policy and regulatory decision

makers.

I think with a successful outcome to this

workshop, this could really be important pillar as

well for us to build upon as we advance science of

emergency preparedness and response.

And next slide, I think, is the last one.

Yes, thank you very much for your attention and happy

to answer any questions at the end. Over to you,

Todd. Thank you.

DR. SMITH: Thank you for sharing that,

Greg. I'm really glad to be part of the work the

NEA's doing in the area of non-radiological health

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impacts along with Tristan.

For those of you who have joined us

today, I do apologize if you missed anything in the

slides. I will remind you that all the presentations

will be available on the RIC website for your review

after the session.

Greg, getting back to what you discussed,

I appreciate that in your presentation you provided

not only a concise problem statement but you also

proposed action-oriented solutions. You spoke of the

need to develop mutual trust and to be ready to dialog

with people who want to know what are the risks and

want to know am I safe.

You also spoke of the work that is

required to prepare decision makers. And you

proposed that we develop tools and data to help

optimize protective action decision.

Fortunately, we have Tristan Barr with

us. And he's been giving that a lot of thought. So

he's going to share now with us some ideas, how we

can use science to sharpen our tools. Tristan, the

floor is yours.

MR. BARR: Thanks Todd for that

introduction. In fact, you took the words out of my

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mouth. I was taking notes and was going to refer

back to what Greg said and Tomo. And that will save

me some time in this presentation.

So I wanted to start, just with pointing

out that, well, it says I'm the section head in

planning, outreach, exercises and training. That is

within the Nuclear Emergency Response and

Preparedness Division at Health Canada's Radiation

Protection Bureau.

So we're currently active so in the event

that I get a call, I may have to drop but I hope that

won't be the case for the next 20 minutes.

If you could, I'm sorry, before we go to

the next slide. So I will be presenting on measuring

the psychosocial impacts and the title of the

presentation is A Case for a Non-radiological

Sievert. Which I think speaks to what we've heard

so far.

Namely, Tomo explained some of the risks

associated with the protective actions that we would

normally apply in the radiation or the nuclear event.

And we heard from Greg regarding the things to

consider. In particular the psychosocial and mental

health impacts to be considered.

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So if you go to the next slide, I

reiterate that as the premise for the work that we

are doing. And while this presentation will talk to

the case that we made to develop a non-radiological

sievert, it will also let you know that we failed to

do so.

However, we did manage to develop a

decision-making tool or rather a proof of concept for

a decision-making tool for decision makers that would

allow them, in concept of a protection strategy, to

balance the potential impacts of the mental health

and psychosocial impacts versus the radiological

detriment in the event of an emergency while applying

protective actions.

So the premises that Canada is improving

and formalizing protection strategies for nuclear

emergency response, it's a shared responsibility

amongst the provinces that have nuclear power plants

as well as the federal government.

We recognize that current nuclear energy

response plans are well established and provide clear

guidance on radiation dose thresholds for

implementing protective actions to minimize those

radiation doses.

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And we heard much of the same from Tomo

earlier on. However, we recognize that protective

actions that minimize radiation doses may actually

increase the psychosocial impacts to the affected

population. In particular, the use of evacuation and

or relocation.

In light of COVID-19 lessons, we also, we

note that this highlights how protective actions for

nuclear emergencies, although -- well, protective

actions for nuclear emergencies could cause

additional harm in the event of combined emergencies

such as COVID.

So Tomo discussed this as well, but in

Canada we recommended adjusting the reference levels

in the event of a nuclear emergency for the public to

a 150 millisieverts or 15 rem rather than a hundred

millisieverts over seven days. In order to account

for the potential increase from the spread of COVID

where we communicate or evacuate people into

reception sites.

So as a consequence, we asked the

question, can we develop a unit of psychosocial

detriment to compare to the unit of radiation

detriment.

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So effectively, is it possible to develop

a non-radiological sievert and develop that balancing

mechanism between the risks. Next slide, please.

To do this, we received funding and put

together a team for a research project and for the

development of a decision tool. And the objective

of the research was to attempt to quantify

psychosocial detriment and to develop a decision tool

for emergency decision makers effectively, to balance

radiological and psychosocial detriment.

To do this, we searched, we did a

significant lit review and we searched available

studies and data sets related to aftereffects of

nuclear disasters. And then we looked to develop a

common unit and decision-making tool to compare

radiological effects to psychosocial health. Next

slide, please.

And so we recognize that a current gap,

the one that we're trying to fill, one of the ones

that's been identified, is that challenge that

decisionmakers have in the emergency response to

include psychosocial factors in optimizing and

justifying protective actions that form the

protection strategy. Next slide, please.

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So a summary of our research. And you'll

see underlined that we identified no significant

different. The objective here was we took data from

Statistics Canada and used a model to evaluate the

changes in outcomes measured by psychosocial impacts

between a population that was affected by a disaster

and one that was not.

Now, recognizing that there were

significant cultural differences between the, well,

the Japanese population, medium population. We

looked to do that with Canadian data following

evacuation events in Canada.

So we used the Canadian Community Health

Survey information to evaluate psychosocial impacts

that arise from an evacuation and we used the 2013

Alberta flood data that was available to us.

Specifically, we looked at variables such

as life satisfaction, the time period, specifically

the pre and post flood. We captured population data

by postal code which is similar to a zip code in the

United States, which captures the individual's

proximity to the floods for those affected.

And then we applied control variables.

So we used, these we used to control additional

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factors that we had identified as affecting life

satisfaction such as socioeconomic controls,

demographic controls and physical and mental

disorders. Existing physical and mental disorders.

In the analysis, unfortunately, we

actually found no difference in the data before and

after the flood. Next slide.

So we had to get rid of that model. And

we moved to again look at the literature review and

identify the main factors or the main drivers for

psychosocial impacts.

And from there, we identified that

residence related factors were the key driver. But

there were also significant contributions related to

risk reception and socioeconomic changes.

And the idea that we had was that we could

potentially propose a weighting factor for each of

these key impacts on psychosocial health that would

contribute to an overall psychosocial detriment. If

you'll go to the next slide, please.

For those of you, and I think many of you

are, who are knowledgeable in radiation protection

and health physics, you'll notice that that concept

would be somewhat similar to applying radiation

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weighting factors and tissue weighting factors that

are used to generate the sievert which is that unit

of overall detriment for radiation.

And the idea was to propose the unity of

psychosocial detriment for decision makers that would

allow them to compare radiation dose averted by

protective actions against potential psychosocial

impacts that could be exacerbated by those same

actions. Next slide, please.

And the outcome was that we found that

the data was not currently available to generate that

non-radiological sievert. Notably, we noted mental

health and psychosocial impacts from nuclear

emergencies have been measured with general and

summary indicators as opposed to indicators that

speak to the particular impacts on psychosocial

health.

We reviewed a paper whose lead author, I

believe, is Todd from the NRC from 2021, that

quantified various non-radiological health effects

from evacuations and relocations. But we noted that

the paper specified that the impacts were not

additive.

So we couldn't effectively make some

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waiting factor out of those numbers to use to compare

to the Sievert. So the overall the conclusion is

that we cannot wait the psychosocial impacts and some

of them to get a Sievert-like unit at this point.

And that in order to do so, we would need

specific studies on the non-radiological health

impacts that measure each health effect and their

combined impact as well.

If you go to the next slide, we can get

to the good news. We still have the objective of

building a decision tool for emergency planners and

emergency managers to balance the psychosocial

impacts and the radiological impacts in an emergency

and while applying protective actions.

So we noted that in the NRC paper, of the

14 psychosocial impacts that were assessed,

depression had the greatest magnitude of impact on

the populations. The prevalence and the impact of

depression following a nuclear emergency with and

without evacuation, relocation was used to model in

the decision tool.

And we note that the prevalence of

depression in a Canadian population following

evacuation was estimated to be 19 percent. And here

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I indicated 28.9 percent in the U.S. And this is

actually an error. And I do apologize.

I think that was the upper bound of the

impact of depression where 19 percent was from the

United States and was the average prevalence. So we

used this number and note that the impact from

depression represents a lower bound of what would be

combined psychosocial impacts.

So again, our model, and I'll present to

you now, is based solely on the impact of depression

following a nuclear emergency leading to a potential

evacuation of location.

And again, this is why I note that this

a proof of concept so as we develop further, we may

look to model impacts into the model but at this

point, we're basing it solely on the potential for

depression.

We also had to use quality adjusted life

years or QALYs to provide a metric for that impact.

And we noted that various QALYs are proposed by

application and may vary from $50,000 to $200,000

U.S. dollars.

And then we pulled radiological

detriments estimated from the U.S. NRC 2014-dollar

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value per rem. So again, given that we were using

QALYs as a metric for the impact of psychosocial

impacts, we needed a dollar value to assign to

radiological impacts and those were pulled form that

2012 NRC paper. Next slide, please.

So in building the decision tool, we had

to establish a life satisfaction quotient which was

pulled from a paper by Redhanz et al, 2015, which

predicts lower life satisfaction with increasing

proximity to a nuclear accident based on the

Fukushima Daiichi evidence and studies.

We estimated costs to unit increases of

life satisfaction that are relative to the starting

socioeconomic conditions before the accident. So

this is based on the liquid view but identifying that

it's the relative change in the socioeconomic

conditions that are one of the key drivers for life

satisfaction.

We then broke down the population

information as well as the socioeconomic levels of

the population by postal code out of Statistics

Canada data.

And we developed what we call a relative

cost ratio. The formula for which you have here.

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And we'll worry with the details. We can extrapolate

it later if we have more time. But what I will show

you is the results of this proof-of-concept model

when applied to one particular scenario.

So if you run the model, you'll note that

it produces actually postal code by postal code

recommendations on whether to evacuate or not based

on the cost ratio that was developed through our

model.

And we have here a graphical

representation of that same information. So you'll

see relative sizes of the populations in each postal

code that was modeled. And this was a total of 97

postal codes that are within the 57-kilometer radius

of one of the nuclear power plants.

And you'll see that there is a line at

one which is that relative cost ratio that we

developed. And in this model, we have a kind of

threshold at distance which turns out to be about 47

kilometers out. You can't really see on the graph.

But would suggest that there's a tipping

point for that cost-ratio balance at 47 kilometers

given the default parameters that we used. Now those

default parameters for any particular evacuation,

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population, location can be changed.

But to specify in this particular case,

the default parameters include that there is zero

dose to evacuees whereas there is a hundred

millisievert or 10-gram potential dose for non-

evacuees.

We use a quality adjusted life year of

$50,000 which is probably on the low end. And as you

increase that, the curve, the slope would get

steeper.

We used a life satisfaction quotient of

minus 0.08 per 3 kilometers distance from the

accident which can be adjusted as well. And we used

the population statistics around the Darlington

Nuclear Power Plant near Toronto, Canada and a

depression prevalence of 19 percent.

So those are just the key parameters that

can be adjusted. Recognizing again, this is a proof

of concept and this is not to say that the distance

at which the cost ratio changes is 47 kilometers.

But we're just starting to play with the

outputs from the model in order to basically beta

test it and come up with a useable decision. Next

slide, please.

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So at this point, we'll talk about the

proposed usage of the tool. So I want to highlight,

again, that this really is a proof of concept for a

decision tool to balance radiological and

psychosocial detriment. It's our first step.

What we hope is that this will have a

significant contribution to evidence-based guidance

on a justified and optimized protection strategy that

would allow us to consider psychosocial impacts in

both planning and decision making.

Additionally, recognizing that most

people assume that nuclear and emergency response

plans are based on radiological detriment. And they

effectively are at the moment.

Proposing a tool that allows us to

compare the psychosocial impacts or mental health

impacts versus the radiological impacts, would be a

key tool to explain to the population why you might

evacuate or why you might not evacuate. And start a

discussion to maybe better understand what

radiological dose represents in terms of risk.

Because currently, I believe that

radiological detriment is overvalued in terms of its

potential risk in the event of a nuclear emergency

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and needs to be discussed with stakeholders before

anything happens so that we can have more educated

discussions going forward. Next slide, please.

So just quickly to point out the next

steps, I would love to share the decision tool with

you but it's not actually finalized and I cannot

distribute it. But we do expect the research report

to be ready for review in March.

I actually received it yesterday and

because of our activation and response to the

situation in the Ukraine, I have not had a chance to

open that email. And then similarly, we expect the

-- we have the tool which is currently in review as

of yesterday.

Going forward, we expect to hold a

Canadian workshop on recovery planning in the fall of

2022 in Ottawa, Ontario, where we would present a

recently published paper which is another tool that

actually addresses something Greg was mentioning.

Which was a guidance on planning for

recovery following a nuclear radiological emergency.

This is geared towards Canadian provinces that have

a responsibility to generate recovery plans but may

be of interest to this audience as well. It's

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available online.

And then to present our research on

psychosocial detriments in the nuclear emergency in

order to accompany that discussion on recovery. And

then introduce the decision tool to balance

radiological and psychosocial impacts for nuclear

emergency response when applying protective actions.

On the last slide I just wanted to

highlight the references that were mentioned

throughout this presentation and thank you for your

time.

DR. SMITH: Well, thank you for that

presentation, Tristan. And again, I do apologize for

those of you following along. There appears to be a

delay in the slides updating. But we'll just keep

moving forward with this discussion.

And please, visit the RIC website to

download these presentations later.

Tristan, that's a very novel idea that

you had and certainly I think an interesting tool

that would seem to have much practical use.

Specifically as you mentioned, in the development of

evidence-based guidance.

I think that evidence-based policy is a

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key component to building trust. If you listened to

our Chairman's opening remarks this morning, you

heard, him talk about a term called truth decay which

is the diminishing role of facts and analysis in

public life.

And how that can lead to a lost trust in

government. And this is something we must pay

attention to in emergency planning because we know

that the foundations of trust have to be established

long before any accident occurs.

Ultimately, that trust translates into

confidence of decision makers and the public to make

informed decisions based on the best available

information.

How do we produce that information? And

how do we get the evidence we need to inform

protective actions. Let me now share how the NRC is

using science to support emergency preparedness and

public protection. Next slide, please.

Emergency preparedness ensures that

protective actions can and will be taken in the event

of a significant radiological release. Within

emergency planning zones, predetermined prompt

protective actions are in place to avoid a reduced

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dose from exposure to radioactive material.

The choice of protective action includes

primarily evacuation and sheltering. NRC

regulations require nuclear power plant operators to

promptly notify offsite authorities and to provide a

protective action recommendation if conditions

warrant.

Offsite authorities consider the

recommendations and will issue protective action

decisions to the public. In the U.S., both the

protective action recommendation and the protective

action decision are informed by the U.S.

Environmental Protection Agency, Protective Action

Guide, or PAG.

PAGs are reference levels for action.

But while PAGs can help decide when to act, it's not

always clear which action to take. There are

practical guidelines that describe how the protection

principles of justification and optimization could be

applied to aid in this decision.

Even so, it's said that selection of

evacuation or sheltering is far from an exact

science. But if that's the case, then we should be

able to exact our science to help decision makers and

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the public make informed decisions. Next slide.

And the NRC is working to support

protective action decisions with science. Just in

the past few years, the NRC has published and

continues to perform analysis to enhance our guidance

and regulations and improve our state of practice.

These analyses are providing the

scientific evidence needed to better inform

protection from radiation in an emergency.

I'll now share a few of the insights from

the studies listed here. Next slide.

Emergency response is broken up into

phases. There is an emergency phase when immediate

decisions are needed. An intermediate phase lasting

weeks to months when releases have been brought under

control and measurement data can be used as a basis

for action.

And a late phase marking the beginning of

recovery which can last for years. As we heard

today, decisions to protect the public continue long

after the emergency phase. To better understand

this, the NRC performed a study of capabilities and

practices in the intermediate phase of a radiological

emergency response.

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We gathered information from state

response organizations and exercise reports and

identified best practices for communicating to the

public, developing partnerships and sharing resources

for monitoring. How to base protection decisions on

science. How to leverage technology to aid and

response and carrying for vulnerable populations,

including animals, throughout the event.

These insights have been gathered to

promote a shared understanding among off-site

response organizations and the public. These insights

were also gathered to improve modeling assumptions

and NRC consequence analysis which can be used to

provide a technical basis for protective action

guidance. Next slide.

In fact, the current basis for protective

action strategies was informed by a detailed

computational study into the benefits of protective

actions known as the PAR study.

A conclusion of the PAR study is that

evacuation should remain a major element of

protective action strategies. Another conclusion is

that the effectiveness of a protective action is

sensitive to the timing of the release in relation to

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the timing of the action.

As such, the NRC requires the use of

evacuation time estimates in the formulation of

protective action strategies. To inform development

of evacuation time estimates, the NRC developed

state-of-the-art microscopic traffic simulation

models of representative rural, coastal and urban

communities, as you see here. And we used these

models to examine a multitude of topics to enhance

our understanding of evacuation dynamics.

The ETE study was then used to update NRC

guidance for development of evacuation time

estimates. The updated guidance reflects the state

of the art in transportation modeling and provides

measures of effectiveness useful for verifying the

adequacy of ETEs.

Updates of the ETEs are periodically

required. A task which all nuclear power plant

licensees are currently performing as part of

required 2020 decennial census updates. The updated

ETEs will then be used to inform protective action

strategies ensuring these strategies ensuring these

strategies are based on the best available

information.

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As part of the ETE study, we also found

ways to better protect our first responders. Some

evacuation plans rely on traffic control officers to

help direct traffic in an emergency. Our study

demonstrated that effective evacuation does not

always require police officers to control traffic at

intersections and that normal means of traffic

control can be just as effective.

And this could provide two benefits.

First, police officers can avoid exposure to a

radioactive plume and second, it frees up those law

enforcement resources for other use in an emergency

and where they're most needed. Next slide.

And while evacuations are a common

protective action response to many hazards and are

typically safe and effective, as we've heard, there

are other issues brought on by long displacement.

That is, after the evacuation event, there are

additional stressors unrelated to the hazard that can

lead to negative health outcomes.

While many individual health effects from

a specific evacuation event have been widely studied

and reported in the literature, holistic view of the

risk of prolonged displacement was lacking.

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To bridge this gap, the NRC published a

meta-analysis of the health consequences from

evacuation and relocation across all types of

emergencies. The meta-analysis identified 14

different health effects common to a response to a

variety of events including natural, technological

and manmade hazards.

What we found is that across emergency

events, displaced populations were more likely to

experience a negative health outcome than those who

stayed or returned home.

And we gathered qualitative insights to

look at which populations like children and the

elderly might be more at risk from certain health

effects. An important insight was that radiological

emergencies did not result in outsized health

effects.

Rather, the effect affect size seen in

radiation events was generally similar to other

hazards. This suggests these insights could be

applied to all hazards planning. This also suggests

that it was the disruption of the social ties and

prolonged displacement from home communities that led

to the effects.

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More importantly, it begs the question,

what can we do then to minimize the impacts of

prolonged displacement? Is evacuation always the

right response and what about the alternative of

sheltering in place? Next slide.

Sheltering in place is another protective

action common to many hazards including radiation.

The U.S. EPA's Federal Protection Action Guide Manual

was updated in 2017 with the latest information on

shelter effectiveness for radiological emergencies.

But there's still many questions we can

ask that are open to scientific inquiry. For

example, how is the source term and the

characteristics of the release change the

effectiveness of shelters in providing protection.

Early shelter studies assume that

radiological releases contain large amounts of

radioactive iodine. Mostly in its elemental or

gaseous form. Which was assumed to easily penetrate

a shelter.

But as our knowledge of source terms has

evolved, we know now that iodine is released in many

chemical forms. Many of which are particulates. So

how does the chemical form of a release impact shelter

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effectiveness?

And tomorrow's technology will continue

to look different with accident powered fuels, small

modular reactors, nonlight-water reactor technology.

These advances in technology change our understanding

of what could be released in what form, how much and

when. Which can then change what actions we take.

And we can develop models to examine

shelter effectiveness for tomorrow's technology and

find better ways to implement sheltering in place.

For example, could we use filtered

ventilation to our benefit? Many heating and cooling

systems do not actually need to draw air in from the

outside in order to function. And this suggests that

rather than securing air conditioning systems, we

could use them to help filter out airborne

particulates and maintain livable conditions inside

a shelter.

This could increase radiological

protection and would also avoid shifting the health

risk to environmental concerns like heat exhaustion

or heat stroke on a hot day.

And what can we learn from other fields

of study by looking at how shelters are already being

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used to protect from other hazards like chemical

release, dust storms and other airborne contaminants.

There's lots of data already out there

and the NRC's performing studies to gather this data,

build better models and inform implementation

strategies for sheltering. Next slide, please.

And masks, we've all developed the habit

of wearing our mask for protection and masks are now

a household item readily available for use. The

current guidance suggests that wet towels and

handkerchiefs can be useful to reduce dose. So does

it make sense to wear a mask in a radiological

emergency? If you wear a mask, what is the trade-

off between internal and external dose buildup on the

mask?

At the NRC we have the tools and the

talent in place to answer these questions. We're

using the tools from NRC's Radiation Protection

Computer Code Analysis and Maintenance Program, or

RAMP, to quantify the benefit of wearing a mask and

to understand the tradeoffs.

And this will give the public confidence

that protection habits they've already developed can

be a simple means of protection against radiation.

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Next slide.

And this is what the public wants to

know. Our U.S. Centers for Disease Controls

performed studies in which they've asked the public

what is the information you want to hear. And the

reply was just tell us what we need to know to be

safe. And as you see illustrated here, we can

provide clear, concise messages to decision makers

and the public on simple measures they can take to be

safe in a radiological emergency.

And, by maintaining consistency with the

actions the public would use for other emergencies,

we can build resilient communities ready to respond

to and recover from all hazards including radiation.

So whether it's a tornado, a chemical release, a

pandemic or a radiological event, the simple message

of go inside, stay inside, tune in and the decisions

made for following action can be trusted because

we'll inform these decision with solid evidence from

science. Next slide.

So than you for listening. This

concludes our panel presentations which I trust you

found informative. I also hope you found it

encouraging and you've come away with a better

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understanding of the tremendous efforts underway

across the globe to prepare us for a safe tomorrow.

With that, I think we'll transition to

question-and-answer period.

Okay. First question is a general

question. How do NRC emergency preparedness programs

compare with U.S. Department of Energy's?

That's a great question. I think there's

a lot of similarity between the U.S. NRC and the DOE

in terms of preparedness programs. That information

is publicly available. A lot of it comes down into

the use of hazard assessments to inform the planning

and then it comes down to how we use those hazard

assessments to inform the tools that inform the

planning. Like the size of emergency planning zones

around the hazards.

And it informs the development of the

emergency planning functions that ensure that

protective actions can and will be taken. And I

think in both the DOE and NRC requirements, these

functions are scaled commensurate to the risk of the

facility. So risk-informed approach is used in both.

Question for Tomohiko. A major

criticism about the Fukushima evacuation was the

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number of --

(Whereupon, the above-entitled matter

went off the record at 4:11 p.m.)

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