title: Recovery and resilience after a nuclear power plant disaster: a medical decision model for managing an effective, timely, and balanced response.
abstract: Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents.
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: C Norman
authors.initials: CN
authors.lastname: Coleman
authors.affiliation: National Nuclear Security Administration, Department of Energy, Washington, DC, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blumenthal
authors.affiliation: Nuclear Regulatory Commission, Rockville, Maryland, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Casto
authors.affiliation: American Chamber of Commerce in Japan, Tokyo, Japan.
authors.forename: Michael
authors.initials: M
authors.lastname: Alfant
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Simon
authors.affiliation: National Nuclear Security Administration, Department of Energy, Washington, DC, USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Remick
authors.affiliation: Nuclear Regulatory Commission, Rockville, Maryland, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Gepford
authors.affiliation: Division of the Strategic National Stockpile, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bowman
authors.affiliation: Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jana L
authors.initials: JL
authors.lastname: Telfer
authors.affiliation: Department of Housing and Urban Development, Washington, DC, USA.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Blumenthal
authors.affiliation: Food and Drug Administration, Silver Spring, Maryland, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Noska
mesh_terms: D003142:Communication; D003657:Decision Making; D004189:Disaster Planning / Q000458:organization & administration*; D062406:Fukushima Nuclear Accident; D006801:Humans; D011832:Radiation Injuries / Q000517:prevention & control* / Q000628:therapy; D018788:Radioactive Hazard Release; D055500:Resilience, Psychological; D040841:Resource Allocation / Q000458:organization & administration; D013315:Stress, Psychological / Q000209:etiology