Intervention for Chronic and Emergency Exposure Situations The Medical Management of Radiation Injuries Psychological Effects Lecture IAEA Post Graduate Educational Course in Radiation Protection and Safety of Radiation Sources

Module X.8 - The Medical Management of Radiation Injuries2 Introduction l Importance of psychological impact of radiation accidents has been in the past underestimated l This lecture will n explain the nature and causes of psychological effects in radiation emergency n describe the symptoms of psychological stress caused by the accident n present elements for management of psychological consequences of the accident

Module X.8 - The Medical Management of Radiation Injuries3 Content l Medical consequences of the radiation accidents l Psychological consequences of radiation accidents l What is psychological stress caused by the accident l What can we do about stress l Management of psychological effects l Summary

Module X.8 - The Medical Management of Radiation Injuries4 Psycho-social Effects and Radiation Accidents l Psycho-social effects of an radiation accident can far outnumber any direct effects l The wide spread public anxiety and pessimism in Chernobyl accident appeared to be out of all proportions to th eradiation induced health effects l In accident management it is therefore necessary to take these effects into account

Module X.8 - The Medical Management of Radiation Injuries5 Medical Consequences of Radiation Accidents l Health effects directly related to radiation exposure n Deterministic n Stochastic l Health effects indirectly related to radiation exposure n Caused by the accident per se n Caused by the intervention

Module X.8 - The Medical Management of Radiation Injuries6 Health Effects Directly Related to Radiation Exposure l Not related to awareness of exposure or to subjective perception of risk l Can be prevented or reduced by protective actions which minimise public exposure

Module X.8 - The Medical Management of Radiation Injuries7 Health Effects Indirectly Related to Radiation Exposure l Can far outnumber any direct effects l Can affect hundreds of thousands l Can last for many years l Do not correlate well with actual exposure but with subjective perception of risk l Protective actions to reduce exposure may be counterproductive with respect to such effects

Module X.8 - The Medical Management of Radiation Injuries8 Why Do People Fear Ionising Radiation? l Unknown threat l Can not be seen or felt l Conflicting information in mass media l Contradictory data from different “scientists” l Use of “radiation theme” in economical and political discussions l Long term consequences of radiation exposure l Lack of education among general public, physicians and other professionals l Social understanding of any situation involving the term “radiation” is negative

Module X.8 - The Medical Management of Radiation Injuries9 Psychological Effects l Psychological effects include n Psychic suffering n Changes in risk perception n Modification in individual and social behavior

Module X.8 - The Medical Management of Radiation Injuries10 Psychological Effects (Cont’d) l Major accidents showed that affected people n Believe in the threat to their health n Doubt what has been reported about accident and resulted doses n Got modification in the life style n Have somatic complains n Got substance abuse (alcohol, tranquilizers, sleeping pills)

Module X.8 - The Medical Management of Radiation Injuries11 The Severity of Psychological Reactions l The severity depends on: n Factors related to the accident: ssuddenness, intensity, duration, available social support etc. n Factors related to individual: spast experience, personal loss, perception of threat, personal coping abilities etc.

Module X.8 - The Medical Management of Radiation Injuries12 What Is Psychological Stress Caused by the Accident? l A normal reaction to abnormal event l Unusually strong psychical and emotional reactions experienced in the face of an accident could interfere with one’s ability to function during or after the event l In some cases these reactions can turn into post traumatic stress disorder l New diagnostic entity “chronic environmental stress disorder” has been proposed

Module X.8 - The Medical Management of Radiation Injuries13 Stress Reactions – Physical l Early n Nausea n Muscle tremors n Sweating n Dizziness n Chills n Increased heart rate n Increased blood pressure n Hyperventilation l Late n Fatigue n Increased use of alcohol and drugs n Exaggerated startle response n Sleep - related difficulties Physical

Module X.8 - The Medical Management of Radiation Injuries14 Stress Reactions – Cognitive l Early n Confusion n Difficulty making decisions n Impaired thinking n Difficulty problem solving n Memory loss n Calculation difficulties n Difficulty to remember names l Late n Decreased attention span n Poor concentration n Memory problems n Flashbacks Cognitive

Module X.8 - The Medical Management of Radiation Injuries15 Stress Reactions – Emotional l Early n Anxiety n Anger n Fear n Irritability n Guilt n Overwhelmed n Grief n Hopelessness l Late n Feeling abandoned n Resentment n Feeling alienation n Withdrawal n Numbness n Depression Emotional

Module X.8 - The Medical Management of Radiation Injuries16 Psychological Problems Late l Continuation of some early problems l Concerns about the consequences of the exposure l Discrimination from the other people l Establishment of illness behavior

Module X.8 - The Medical Management of Radiation Injuries17 Changes in Health Behavior of Affected People l Extensive medical examinations have further enhanced worries about current and future effects l Change in illness behaviour and diagnostic behaviour together with vast screening programmes have lead to increase in number of diagnosed diseases in most organ systems

Module X.8 - The Medical Management of Radiation Injuries18 Psychological Stress of Injured Individuals l Patient needs n Comfort, relief of symptoms n Stability and authoritative support n Information n Concern n Hope n Control n Stimulation l Patient problems n Overly scientific approach n Repeated tests, examinations n Photographs n Reactions of others n Too many ‘experts’ n Too much media attention

Module X.8 - The Medical Management of Radiation Injuries19 Medical / Nursing Staff Problems l Fear / anxiety l Isolation by others l Lack of knowledge (medical treatment, long term effects, etc.) l New experiences: n Interactions with “experts,” public officials, reporters, etc. n Loss of autonomy (activities may be monitored / managed by authorities)

Module X.8 - The Medical Management of Radiation Injuries20 What Can We Do About Stress? l Accidents can not be predicted BUT l Psychological reaction to the radiological accident could be prevented / decreased / relaxed using different methods applied before / during / after the accident

Module X.8 - The Medical Management of Radiation Injuries21 Management of Psychological Consequences l To reduce the psychological consequences several measures are available n Medical response n Public health follow-up n Social assistance n Government actions guidelines n Community accountability

Module X.8 - The Medical Management of Radiation Injuries22 How to Reduce Psychological Effects l Have an ongoing information programme l Give clear, simple and timely advice l Give consistent advice (one official point) l Use international guidance l Ensure protective actions are justified l Correct false information l Consider education and counselling

Module X.8 - The Medical Management of Radiation Injuries23 Warning of the Population l Timely warning is one of the most important psychological aspects of dealing with the accidents l Provide to the person a sense of control over the situation l Call for the active attitude to the situation: n Searching process n Preparation for protective actions

Module X.8 - The Medical Management of Radiation Injuries24 Requirements for Warning Message l Consistency l Accurate, timely and complete l Clear l Simple l Sufficient l Concrete l Provided through multiply channels l Frequently repeated

Module X.8 - The Medical Management of Radiation Injuries25 Implications for Health Care Management l Education is needed before, during and after an incident l Debriefing sessions aid in relieving stress and anxiety of staff Education about radiation health effects is urgently needed for health professionals to limit the public health problem of socio-psychological effects

Module X.8 - The Medical Management of Radiation Injuries26 Mitigation of Public Non-radiological Consequences l One of the functional elements in IAEA- TECDOC-953 l Applicable for all planning categories l Should be performed by facility, local or national level n Depending on the particular planning category

Module X.8 - The Medical Management of Radiation Injuries27 Non-radiological Impacts Long Term Protective Actions l Effects on n Mental health n Economic conditions n Employment n Long term needs for social welfare and other non-radiological impacts caused by taking longer term protective actions should be considered

Module X.8 - The Medical Management of Radiation Injuries28 Non-radiological Impacts Capabilities l Establish capability for addressing the public’s concerns and reactions during an actual or perceived nuclear or radiological emergency l Assure that affected people will perceive, understand, believe, personalize, and respond to the warning

Module X.8 - The Medical Management of Radiation Injuries29 Non-radiological Impacts Long Term Monitoring l Before long-term monitoring or other activities are conducted in areas designed for unrestricted use after an accident, ensure the public understands the reasons for these continuing activities (e.g., scientific investigations of behavior of radioisotopes in the environment)

Module X.8 - The Medical Management of Radiation Injuries30 Non-radiological Impacts Compensations l The process used to develop the system of compensation for emergency workers and the public following an emergency (radiation, chemical or other) should be established following careful consideration of the benefits and long- term social, psychological and economic effects

Module X.8 - The Medical Management of Radiation Injuries31 Summary l The nature and causes of psychological effects in radiation emergencies were explained l The symptoms of psychological stress caused by the accident were described l Elements for management of psychological consequences were presented

Module X.8 - The Medical Management of Radiation Injuries32 Where to Get More Information See references on cover page of this lecture