Balancing the risk of the evacuation and sheltering-in-place options: a survival study following Japan's 2011 Fukushima nuclear incident

Seasons of smoke and fire: preparing health systems for improved performance before, during, and after wildfires

Increased frequency, intensity, and duration of wildfires are intensifying exposure to direct and smoke-related hazards in many areas, leading to evacuation and smoke-related effects on health and health systems that can affect regions extending over thousands of kilometres. Effective preparation and response are currently hampered by inadequate training, continued siloing of disciplines, insufficient finance, and inadequate coordination between health systems and governance at municipal, regional, national, and international levels. This Review highlights the key health and health systems considerations before, during, and after wildfires, and outlines how a health system should respond to optimise population health outcomes now and into the future. The focus is on the implications of wildfires for air quality, mental health, and emergency management, with elements of international policy and finance also addressed. We discuss commonalities of existing climate-resilient health care and disaster management frameworks and integrate them into an approach that addresses issues of financing, leadership and governance, health workforce, health information systems, infrastructure, supply chain, technologies, community interaction and health-care delivery, before, during, and after a wildfire season. This Review is a practical briefing for leaders and health professionals facing severe wildfire seasons and a call to break down silos and join with other disciplines to proactively plan for and fund innovation and coordination in service of a healthier future.

Resilient design in nuclear energy: Critical lessons from a cross-disciplinary analysis of the Fukushima Dai-ichi nuclear accident

This paper presents a multidisciplinary analysis of the Fukushima Dai-ichi Nuclear Power Plant accident. Along with the latest observations and simulation studies, we synthesize the time-series and event progressions during the accident across multiple disciplines, including in-plant physics and engineering systems, operators' actions, emergency responses, meteorology, radionuclide release and transport, land contamination, and health impacts. We identify three key factors that exacerbated the consequences of the accident: (1) the failure of Unit 2 containment venting, (2) the insufficient integration of radiation measurements and meteorology data in the evacuation strategy, and (3) the limited risk assessment and emergency preparedness. We conclude with new research and development directions to improve the resilience of nuclear energy systems and communities, including (1) meteorology-informed proactive venting, (2) machine learning-enabled adaptive evacuation zones, and (3) comprehensive risk-informed emergency planning while leveraging the experience from responses to other disasters.

Symposium on disaster-related deaths after the Fukushima Daiichi Nuclear Power Plant accident

Disaster deaths can be classified into direct and indirect deaths. Direct deaths are those caused by the direct physical effects of disasters, such as earthquakes, tsunamis, and radiation exposure. Indirect deaths are those caused by secondary health effects such as emergency evacuation, relocation, evacuation environment, disruption of health care delivery services, and psychosocial effects. In addition, in Japan, the term disaster-related deaths refers to indirect deaths in accordance with the disaster condolence payments system, which provides relief for bereaved families. On 11 March 2011, the Great East Japan Earthquake exposed several issues related to disaster-related deaths in Japan. Therefore, on 1 February 2022, a symposium on disaster-related deaths hosted by this study was held on the website. The symposium discussed the issues and challenges associated with disaster-related deaths for future disaster preparedness. The authors introduced the concept of 'shaking' at the symposium by defining 'shaking' as 'the repeated changes in the social and living environment that worsen health conditions, regardless of the disaster'. It was also pointed out that vulnerable populations are more likely to experience more pronounced health effects. This generalised concept of 'shaking' associated with disaster-related deaths suggests that it is important to anticipate disasters before they occur to take specific preventive measures, targeted at vulnerable populations. This study found that disaster-related deaths in Japan create several problems in terms of future radiation disaster preparedness and medical countermeasures. In the future, there will be a need to examine the relevance of the issues of disaster-related deaths identified as a result of this symposium for future radiation disaster preparedness.

Characteristics of Patients Transported by Doctor-Requested Helicopters After Japan's 2011 Nuclear Incident

OBJECTIVES

This study examined the characteristics of severe patients after the Great East Japan Earthquake in 2011.

METHODS

Cases in the Futaba area were extracted using the dispatch database of the doctor helicopter and flight-nurse records from March 11, 2008, till March 10, 2014. The period before March 11, 2011, was defined as 'pre-earthquake' and the period after March 11, 2011, as 'post-earthquake' to compare the recorded data.

RESULTS

Of the 128 total recorded cases, 78 were dispatched during the pre-earthquake period and 50 during the post-earthquake period. The number of patients with physical trauma following the earthquake included 4 patients (33.3%) in 2011, 7 patients (43.7%) in 2012, and 13 patients (59.1%) in 2013. However, the increase in number of requests was not statistically significant (P = 0.33). All 4 incidents of physical trauma in 2011, and 3 out of 7 incidents in 2012, occurred at the power plants. A total of 4 incidents occurred at decontamination worksites in 2013.

CONCLUSIONS

It is of primary importance for hospitals to anticipate physical trauma cases during the reconstruction phase following a disaster, and develop a system for patients with physical trauma in the short- and long-term.

Was there an improvement in the years of life lost (YLLs) for non-communicable diseases in the Soma and Minamisoma cities of Fukushima after the 2011 disaster? A longitudinal study

OBJECTIVES

This study aimed to determine cause-specific years of life lost (YLL) changes between predisaster and postdisaster in disaster-affected municipalities, compared with the national average. We estimated the YLL in Soma and Minamisoma cities (the subject area) in Fukushima, Japan, where the tsunami and the nuclear accident hit in 2011.

PARTICIPANTS

We used vital registration records from a national survey conducted between January 2006 and December 2015. We analysed 6369 death data in the predisaster period (2006-2010) and 6258 death data in the postdisaster period (2011-2015).

METHODS

We incorporated vital statistics data as follows: age-based, sex-based and International Classification of Diseases, 10th Revision-based cause-specific deaths and calculated YLLs by ages 0, 40, 65 and 75 and sex for attributable causes of death for heart diseases, cerebrovascular diseases, pneumonia, all cancers and specific cancers; breast cancer, colorectal cancer, leukaemia, lung cancer, stomach cancer and uterine cancer for predisaster and postdisaster in the subject area.

RESULTS

YLL attributed to heart diseases for males showed no decrease and YLL postdisaster was 0.37 years larger than that of the national average at age 0. The difference was -0.17 (95% uncertainty interval: -0.40 to 0.05) years at age 65. It decreased for females; the difference was 0.37 (0.18-0.57) years after the disaster. YLL decrease (that is, difference) in cerebrovascular diseases at age 0 was 0.27 (0.09-0.44) years and 0.18 (0.04-0.32) years; however, the YLLs postdisaster were still 0.24 and 0.25 years larger than those for the national average for males and females, respectively. YLL attributed to cancer did not increase even after the nuclear disaster.

CONCLUSIONS

We specified the causes of death to be reduced in disaster-affected areas in the future. This study emphasised the importance of understanding how the health situation changed for the whole society of the area from a comprehensive perspective, rather than focusing only on small mortality increases.

What's better for our health? Conducting protective actions during a nuclear emergency or accepting a certain radiation dose?

The threat caused by ionising radiation has resulted in the establishment of strict radiation protection guidelines. This is especially true for severe nuclear power plant (NPP) accident scenarios, which may involve the release of significant amounts of ionising radiation. However, we believe that the fine balance between the benefit of a certain protective action (e.g. evacuation) and its risks is not always accounted for properly. Deaths and mental health problems have been associated with protective actions (e.g. evacuation) implemented in the response to the Fukushima Daiichi (NPP) accident in 2011. The protective actions were implemented consistent with international recommendations, to reduce radiation-induced health effects, even though the off-site effective doses were too low to indicate that there would be any discernible radiation-induced health effects. In this paper, we will provide a first step for the development of tools to evaluate the risk of protective actions versus the radiation-induced health risk. Over 50 papers were selected as useful from more than 600 reviewed papers to characterise the health impact of protective actions taken during different emergencies (including, technical and natural emergencies). An analysis was performed comparing the radiation-induced health effects averted by protective actions with the health effects associated with the protective actions. We concentrated our analysis on deaths and mental health problems associated with protective actions compared with the inferred radiation-induced deaths averted by the protective actions. Our analysis is stated in terms of absolute risk (cases per 1000) of health effects to allow for a direct comparison. It indicates that taking protective actions consistent with dose criteria typically used in many countries could result in more excess deaths than the inferred radiation-induced deaths prevented, as well as resulting in mental health problems. We identified that residents of facilities for long stays and the elderly are particularly vulnerable and a significant number of the deaths among the general public are associated with a lack of emergency preparedness provisions.

Long-term observation of mortality among inpatients evacuated from psychiatric hospitals in Fukushima prefecture following the Fukushima nuclear disaster

The debate regarding the need for hospital evacuation and the evacuation distance remains rather chaotic. Furthermore, the relationship between hospital evacuation and the prognoses of psychiatric inpatients has not yet been investigated. We aimed to reveal the association between the long-term prognosis of psychiatric inpatients evacuated immediately following the Fukushima Daiichi Nuclear Power Plant accident and their backgrounds. In this retrospective cohort study, 777 psychiatric inpatients who were immediately evacuated from their hospitals following the accident were included for analysis. Survival time was the primary outcome. We conducted univariable and multivariable analyses to examine the associations between mortality and linear distance of evacuation and different backgrounds, including psychiatric/physical traits. Univariable analysis showed that the estimated survival time among patients was significantly associated with their evacuation distance. A multivariable analysis showed that a longer evacuation distance had a significantly lower hazard ratio (HR) and resulted in lower mortality. In contrast, older patients with physical complications of respiratory disease (International Statistical Classification of Diseases and Related Health Problems 10th revision, J00–99) and genitourinary disease (N00–99) showed a significantly higher HR and had a higher mortality than patients without these complications. To prevent death among elderly psychiatric inpatients with physical comorbidities during disasters, the evacuation destination should be determined taking into consideration the evacuees’ tolerance for long-distance transportation and the availability of post-evacuation care in the destination hospitals.