1. INTERNATIONAL CO-OPERATION FOR MEDICAL PREPAREDNESS AND RESPONSE TO RADIATION EMERGENCIES Module XXIII

2. Module Medical XXIII. 2 Radiation accidents 1944-2001 l 1944-2001 420 radiation accidents leading to significant overexposure of at least one person [when E>0.25 Sv, H skin >6 Sv, or H other organ >0.75 Sv] l Of 3000 overexposed persons, 133 fatalities registered l Fatalities include 28 operators and firemen who died of acute radiation disease in Chernobyl accident in April 1986

3. Module Medical XXIII. 3 Conventions for international collaboration in radiation accidents l The basis for co-operation International Conventions (26 Sept 1986) on “Early notification of a nuclear accident” and on “Assistance in case of a nuclear accident or radiological emergency” prepared by IAEA in co-operation with government experts of its 62 Member States and representatives of 10 international organizations in August- September 1986 l Conventions have 87 and 82 parties respectively, as of 1 March 2002. Besides three international organizations – FAO, WHO & WMO – acceding to them, 84 and 79 Member States have, respectively, ratified them

4. Module Medical XXIII. 4 IACRNA IAEA WHO IAEA OCHA NEA EC FAO WMO

5. Module Medical XXIII. 5 Emergency Response System (ERS) and International Nuclear Event Scale (INES) l According to the Conventions Member States provide the IAEA with immediate information on a nuclear accident and mutually assist each other in case of a nuclear accident or radiological emergency The IAEA co-ordinates the ERS and has elaborated the International Nuclear Event Scale, INES, used for rating nuclear events in the early notification

6. Module Medical XXIII. 6 Responsibilities of IAEA l FOCAL POINT Emergency Response System (ERS) International Nuclear Event Scale (INES) l NOTIFICATION Inform States and organizations on accident Notify upon request to minimize consequences l ASSISTANCE Disseminate information on resources, methods, techniques, calculation of consequences Transmit and co-ordinate assistance on request

7. Module Medical XXIII. 7 Co-operation of IAEA with WHO l CO-OPERATION for Application of Conventions Actions aimed at  medical and public health response to radiation emergency or nuclear accident  medical preparedness and assistance l Joint publications and training activities l PARTICULAR RESPONSIBILITY of WHO Organize network of WHO Collaborating Centres, Provide procedures for medical assistance

8. Module Medical XXIII. 8 International assistance in m edical response Depends on l number of exposed persons l severity of exposure l types of accidental exposure, which may be exposure of the public, workers, patients external exposure only external or internal radioactive contamination combination of external and internal exposure combination of radiation exposure and other injuries

9. Module Medical XXIII. 9 REMPAN Radiation emergency medical preparedness and assistance network l For promotion of radiation emergency medical preparedness and for practical assistance and advice to countries in a case of overexposure from any source of radiation, WHO established REMPAN in 1988

10. Module Medical XXIII. 10 REMPAN In March 2002 14 REMPAN centres in Armenia, Australia, Finland, France (2), Germany, Japan, Russian Federation (4), United Kingdom, Ukraine and USA, and 2 liaison institutions in Brazil and India. These 16 institutions are located in 12 countries on 4 continents

11. Module Medical XXIII. 11 Major roles of REMPAN in radiation emergency l to provide assistance and advice in medical management of exposed individuals l to provide medical team for on-site emergency treatment l to transfer (if possible and necessary) severely exposed patients to collaborating centres for specialized medical care l to assist with facilities and staff for medical investigations and treatment

12. Module Medical XXIII. 12 Major roles of REMPAN in radiation emergency l to assist in development of measures necessary to limit health effects l to follow up medical supervision and treatment l to assist in developing procedures to strengthen countries’ ability to manage such accidents l to circulate information relating to medical management of radiological accidents to Member States

13. Module Medical XXIII. 13 Types of REMPAN assistance Human resource specialists l Each WHO collaborating centre, including liaison institutions, has a few dozen experts or more, including many doctors. Other specialists are health physicists, radiologists, radiochemists

14. Module Medical XXIII. 14 Types of REMPAN assistance l Recruitment of experts WHO and IAEA invite experts from collaborating centres and also from other institutions, if necessary and requested by affected Member State l Specialized teams WHO (in co-operation with IAEA) can organize multinational teams to render medical assistance on site

15. Module Medical XXIII. 15 Types of REMPAN assistance l Equipment Portable equipment for radiation monitoring of humans and environmental objects for use on site l Medical services WHO collaborating centres can help with diagnosis, prognosis, treatment and follow-up of persons exposed to radiation and other accompanying factors - both in affected country and at centres themselves

16. Module Medical XXIII. 16 Types of REMPAN assistance l Clothing Special clothing for medical personnel l Scientific services Expertise may be provided for biological dose assessment and reconstructing circumstances of overexposure (in co- operation with IAEA) l Transportation WHO collaborating centres provide advice or render practical assistance for transportation of affected persons

17. Module Medical XXIII. 17 Practical co-operation of IAEA, WHO, EC and MSs in medical management of radiation accidents l Notification- information on accident, l Preparedness - plans for prevention & diagnosis l Intervention- actions for emergency aid, treatment, decontamination, decorporation l Reparation- follow-up and rehabilitation, l Training - of medical staff in health effects of radiation and radiopathology: training courses, symposia, fellowships

18. Module Medical XXIII. 18 Examples of international co-operation l Numerous examples of joint assistance for radiological accidents: most known cases are Chernobyl and Goiania l After Goiania accident of 1987, leading radiation medicine scientists were recruited by IAEA and WHO to provide medical and radiological consultations on site

19. Module Medical XXIII. 19 Examples of international co-operation l International studies on childhood thyroid cancer in population affected by Chernobyl radioiodine releases in iodine deficient areas up to 500 km around NPP

20. Module Medical XXIII. 20 Dissemination of information IAEA and WHO regularly organize joint conferences prepare joint publications (also in co-operation with other international organizations, such as EC, UNSCEAR, OECD/NEA, ILO) present, discuss and disseminate information on health effects of exposure to radiation publish lessons learned to prevent and better manage radiological and nuclear accidents

21. Module Medical XXIII. 21 LILO POTI MATKOJI ZUGDIDI SANTREDIA KAHISHI LIA International co-operation for medical management of radiation accident in Lia, Jan- Feb 2002

22. Module Medical XXIII. 22 International collaboration to compile lessons learned from medical management of recent radiation accidents The 1st EAGM (Expert Advisory Group Meeting) on medical follow-up of Georgian patients (soldiers) accidentally exposed to radiation in Lilo conducted by IAEA in Vienna in Sept 1999 l Two joint IAEA-WHO expert meetings on medical follow-up of six significant recent radiation accidents at WHO-HQ (Geneva, 1-3 Oct 2001) and WHO/REMPAN Centre (Ulm, 8-9 Nov 2001) l Joint technical document has been approved for publication in 2002, to distribute to medical specialists and institutions responsible for treatment of radiation accident cases in Member States