title: Nuclear disasters and health: lessons learned, challenges, and proposals.
abstract: Past nuclear disasters, such as the atomic bombings in 1945 and major accidents at nuclear power plants, have highlighted similarities in potential public health effects of radiation in both circumstances, including health issues unrelated to radiation exposure. Although the rarity of nuclear disasters limits opportunities to undertake rigorous research of evidence-based interventions and strategies, identification of lessons learned and development of an effective plan to protect the public, minimise negative effects, and protect emergency workers from exposure to high-dose radiation is important. Additionally, research is needed to help decision makers to avoid premature deaths among patients already in hospitals and other vulnerable groups during evacuation. Since nuclear disasters can affect hundreds of thousands of people, a substantial number of people are at risk of physical and mental harm in each disaster. During the recovery period after a nuclear disaster, physicians might need to screen for psychological burdens and provide general physical and mental health care for many affected residents who might experience long-term displacement. Reliable communication of personalised risks has emerged as a challenge for health-care professionals beyond the need to explain radiation protection. To overcome difficulties of risk communication and provide decision aids to protect workers, vulnerable people, and residents after a nuclear disaster, physicians should receive training in nuclear disaster response. This training should include evidence-based interventions, support decisions to balance potential harms and benefits, and take account of scientific uncertainty in provision of community health care. An open and joint learning process is essential to prepare for, and minimise the effects of, future nuclear disasters.
authors.affiliation: Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan. Electronic address: ohtsuru@fmc.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Ohtsuru
authors.affiliation: Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanigawa
authors.affiliation: Education Center of Disaster Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kumagai
authors.affiliation: Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan.
authors.forename: Ohtsura
authors.initials: O
authors.lastname: Niwa
authors.affiliation: Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Takamura
authors.affiliation: Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Midorikawa
authors.affiliation: Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nollet
authors.affiliation: Department of Radiation Medical Sciences, Nagasaki University, Nagasaki, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Radiation Medical Science Center, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ohto
authors.affiliation: Cambodia Development Resource Institute, Phnom Penh, Cambodia.
authors.forename: Rethy K
authors.initials: RK
authors.lastname: Chhem
authors.affiliation: Centre for Public Health, Queens University Belfast, Royal Hospitals, Belfast, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Clarke
mesh_terms: D004189:Disaster Planning / Q000379:methods*; D004190:Disasters; D004781:Environmental Exposure / Q000517:prevention & control; D006801:Humans; D055848:Nuclear Power Plants; D011634:Public Health; D011835:Radiation Protection / Q000379:methods; D018788:Radioactive Hazard Release / Q000523:psychology; D018570:Risk Assessment