Occupational Medicine

Occupational Medicine 2006 56(3):180-186; doi:10.1093/occmed/kql013

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IN-DEPTH REVIEW

Intervention in the event of a radiation emergency: the basis for UK planning

Mary Morrey

Environmental Assessments Department, Centre for Radiation, Chemical and Environmental Hazards – Radiation Protection Division, Health Protection Agency, Chilton, Didcot OX11 0RQ, UK

Correspondence to: Mary Morrey. e-mail: mary.morrey{at}hpa-rp.org.uk

	Accidents and exposure pathways

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
Accidental releases from nuclear reactors have the potential to be very large (but would not necessarily be so) and would be likely to comprise mainly noble gases and particles of fission products such as iodine-131 (which may also be released in vapour form) and caesium-137. Accidental releases could occur at hospitals, sites making or storing commercial radioactive products, or sites using industrial radiography sources. Such releases are likely to comprise only a limited number of radionuclides in relatively small quantities. However, the larger releases postulated for some of these sites could still require a response to protect members of the public. Finally, there is the possibility of an accidental release overseas requiring protective measures in this country.

Releases may occur to the atmosphere or to water bodies. In general, releases to water bodies provide a longer timeframe in which to determine an appropriate response, and so the main focus of this paper is on emergency planning for releases to atmosphere.

Following a release to atmosphere, people may be exposed to radiation from five main exposure pathways:

(i) external radiation from material in the dispersing plume,

(ii) internal radiation from material breathed in as the plume passes,

(iii) external radiation from material deposited in the environment,

(iv) internal radiation from material ingested in contaminated food and

(v) internal radiation from material initially deposited on the ground and subsequently resuspended into the air and breathed in.

Additional exposure pathways, such as external exposure from material deposited on skin and exposure to radionuclides washed through drains into the sewerage system, may also be important in some situations.

	Options for response

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
Measures to protect people following an accidental release may be divided into three broad categories:

(i) emergency measures,

(ii) food and water measures and

(iii) recovery measures in areas where people live, work or spend time (‘inhabited areas’).

Emergency countermeasures are implemented immediately before or during the release or shortly following it, in order to reduce or avoid short term, relatively high exposures. There are three primary emergency countermeasures. Firstly, sheltering provides protection from inhalation and external irradiation, the amount of protection depending on the air-tightness and solid construction of the building. Secondly, evacuation, if carried out in advance of the release, has the potential to avoid all exposure from the plume, and from other exposure pathways until the evacuees return to the area. Evacuation carried out once the release is in progress will result in additional exposure from the plume while people are in transit (compared with sheltering). Thirdly, stable iodine prophylaxis (taking stable iodine tablets) provides protection only against exposure of the thyroid to intakes of radioactive iodine. If the appropriate dose is taken within a few hours of the release starting, most of the potential thyroid exposure can be averted.

Food (and water) countermeasures include both measures applied directly to foods and agricultural measures aimed at reducing the activity concentrations in foods produced. Food countermeasures are applicable during both the emergency phase and the later phases of response to an accidental release. This is because some foods, such as milk from cows grazing outdoors and green vegetables grown in the open, may become contaminated very quickly. In addition, once the ground is contaminated, unless measures are taken to reduce the activity concentrations in foods, then contamination of the food chain may continue for many years, depending on the circumstances and the radionuclides involved.

Recovery measures in inhabited areas are intended for application once the release has ended and the cause of the release ‘made safe’. These are measures that aim both to reduce exposures over the longer term and to enable life to return to ‘normal’. They generally fall into three categories: decontamination (i.e. the removal and subsequent disposal of contamination), fixing and shielding of contamination (to reduce exposure from it) and restricted access (reducing the time people spend in a contaminated area or building). Relocation is the complete removal of people from an area, i.e. an extreme form of restricted access.

	The scientific basis for response

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
For exposures up to a few hundred millisieverts, a linear, no-threshold dose-response relationship for stochastic health injuries is widely assumed. This is not a proven relationship, but is generally considered to be a cautious basis on which to develop intervention strategies. Both the linear and the no-threshold assumptions have profound implications for emergency response, as will be discussed.

The assumption of a no-threshold dose-response relationship means that it is not possible to specify a dose below which no risk to health will occur. The principles underpinning emergency planning therefore need to deal with the question, ‘How much risk should countermeasures be planned to avert?’ There cannot be a single, absolute answer to this question, since the level of risk which is averted must be related to the extent of undesirable consequences (‘harms’) of the countermeasure (e.g. the disruption caused). In other words, the assumption of a no-threshold dose-response relationship means that radiation protection is based on the concept of trade-offs, of balancing beneficial and harmful consequences. Moreover, it leads to the conclusion that the level of risk which should be averted by countermeasures varies, depending on the sum of all the anticipated consequences of the countermeasure.

The assumption of a linear dose-response relationship means that (over the range of dose that the assumption holds) incremental risks resulting from different sources of exposure may be considered independently. An increment of dose of 100 µSv carries with it the same incremental risk to an individual regardless of whether that individual's total exposure from all sources is 0.5 or 50 mSv. It therefore follows that the balancing of risks against benefits can be meaningfully carried out for individual countermeasures as well as for a complete intervention strategy. Clearly, these conclusions are appropriate only for doses in the range over which the linear, no-threshold dose-response relationship is assumed to apply. At whole body doses above 1 Gy received within a day or two, serious deterministic health injuries may be observed. These injuries are associated with dose thresholds below which they do not occur. Moreover they are deterministic, in that the exposure and the resulting injury are directly linked and observable in a single individual. For these injuries it is possible to determine a ‘safe’ level of exposure, and, therefore the concept of balancing risks and benefits is less relevant. In major accident situations, the need to trade risks and benefits may still be required in this dose region, if the trade-off is between incurring a number of non-fatal, but deterministic, injuries and saving life.

	Principles for intervention

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
The following sections provide an overview of these concepts and show how the UK emergency planning guidance has been derived from them.

The principles for intervention adopted in the United Kingdom [1] follow directly from the scientific basis for emergency response, as discussed above.^* They are that:

(i) a countermeasure should do more good than harm (i.e. be ‘justified’),

(ii) countermeasures should be implemented to achieve the most good (i.e. be ‘optimized’) and

(iii) every effort should be made to keep exposures below the thresholds for serious deterministic injuries (i.e. 1 Gy whole body over one or two days).

In practice, for the protection of the public, off-site doses are most unlikely to exceed the thresholds for serious deterministic injuries, and so the third principle is rarely limiting. The first two principles underline the importance of considering all the consequences of a countermeasure, and ensuring that the affected population will receive a net benefit if it is implemented.

These principles are similar to those underpinning the regulation for practices i.e. human activities, such as industrial processes, that can give rise to radiation exposures. However, whereas those for practices apply to management of the practice, those for intervention apply to the countermeasures. This difference between practices and intervention is significant, because it can result in very different risks being considered tolerable in the two situations. In the case of practices, an individual's existing exposure from radiation will be increased by operation of the practice, and so it is right that significant benefits are achieved from that practice to offset the increased risk. In the case of intervention the exposure exists already. Any intervention measures undertaken to reduce this exposure will result in some harmful consequences to the individual. It is necessary to ensure that any benefit achieved by the intervention outweighs harmful consequences. Where the disruption and monetary cost involved would be very significant, a correspondingly high reduction in exposure would be required to make the action justified. For intervention after an accident, the undesirable consequences can be very high, particularly if it is necessary to evacuate a large number of people. Therefore, the intervention levels (ILs) specified for intervention after accidents are higher, and often significantly higher, than the dose limits applied to members of the public for practices (for whole body exposure, the annual dose limit for members of the public is 1 mSv/year).

For exposures below the thresholds for serious deterministic injuries, it is not possible to specify a general level of unacceptable risk (or a dose limit): what is intolerable depends upon the scale of disruption, etc, necessary to reduce the risk.

Finally, if dose criteria are developed for initiating intervention measures, then these criteria refer to the dose averted, as a result of implementing the measures. Doses received before measures are implemented, or despite the measures, will be received whether or not the intervention is carried out. They are therefore not consequences of the measures and not of direct relevance to the balance of harm against benefits. This is clearly very different from the situation for practices, where the total dose received by an individual from all practices is an important quantity, for which regulatory limits have been set.

	Intervention levels

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
The balancing of harm and benefits is a process which necessarily involves subjective judgement. Where intervention measures may affect large numbers of people, it is important that subjective judgements are made within a widely agreed framework. For this reason, national and international organizations have published generic guidance on dose criteria for intervention, particularly for intervention following accidents.

In the United Kingdom, the National Radiological Protection Board (NRPB) [now the Radiation Protection Division (RPD) of the Health Protection Agency (HPA)^**] published Emergency Reference Levels (ERLs) for the three emergency countermeasures of sheltering, evacuation and the distribution of stable iodine [2,3]. These ERLs were determined from consideration of the major factors which are likely to influence the balance of harm and benefit in a particular situation, and for particular countermeasures. These factors can be grouped into three categories: health factors, monetary cost factors and social factors. Three beneficial factors have been identified: averted individual, collective risk and the reassurance provided by taking action. The harmful factors include disruption, the risks incurred by the countermeasures and the monetary cost involved. Some of these factors are, at least in principle, directly quantifiable (e.g. monetary cost), while others (e.g. disruption) are not so easy to quantify. Even for the less easily quantified factors it is possible to determine their relative importance between different protective strategies. For example, a strategy requiring the evacuation of one household for a few hours will, in general, lead to much less disruption than the evacuation of a large village for several days.

The difficulty for such advice is that this advice is generic and must be both flexible and specific. Flexibility is required to enable the guidance to be directly applicable to a wide range of accidents and post-accident situations. If the advice is too vague, it will be of little practical use in specific situations. NRPB tackled this problem by providing numerical guidance in a two-tier system of upper and lower ERLs [2]. A pair of ERLs is given for each major type of countermeasure. For anticipated averted doses in excess of the upper ERL, it is advised that the countermeasure should always be implemented, unless there are overriding reasons to the contrary (e.g. risk of serious injury caused by evacuation in treacherous conditions). In other words, except in very extreme circumstances, it is most unlikely that the countermeasure would not be justified for this level of dose averted. For anticipated averted doses less than the lower ERL, it is advised that it is unlikely that the countermeasure would ever be justified. The appropriate IL for a specific accident situation is that which would maximize the net benefits from implementing the countermeasure. NRPB judged that this optimum IL will, in general, lie between the appropriate upper and lower ERLs, the exact level being dictated by the circumstances of the accident.

	Emergency countermeasures

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
Based on consideration of the relative importance of the harms and benefits arising from the countermeasure, it was judged that, following an accident, the optimum IL for sheltering would be likely to lie in the region of a few to a few tens of millisieverts, while that for evacuation would be somewhat higher, in the region of a few tens to a few hundreds of millisieverts (averted dose). Similarly, it was judged that the optimum IL for distributing stable iodine would be in the region of a few tens to a few hundreds of millisieverts thyroid dose. From a scientific perspective, it is not meaningful to evaluate these dose ranges more precisely than this, for three reasons. First, it is difficult to quantify some of the factors relevant to the balancing of the beneficial and harmful consequences of the countermeasure. Second, because NRPB's advice applies to a wide range of accident situations, there can be no precise upper and lower bounds on what the optimum IL should be; it will always be possible to postulate a ‘better’ or ‘worse’ scenario which would result in the optimum IL being outside the recommended range. Third, it will never be possible to predict accurately the doses which will be averted by a countermeasure following a specific accident. In advance of the accident occurring, it is not possible to predict the precise impact the accident will have. Once one has occurred, emergency countermeasures will need to be taken on a faster time-scale than it would be possible to analyse many detailed measurements, so at the time of initiating emergency countermeasures the precise doses to be averted will not be known. Decisions will instead be taken on rough estimates of doses and on trigger levels, developed as part of the emergency plan.

While it is not meaningful to define the dose ranges more precisely from a scientific standpoint, it is important for practical reasons that firmer guidance is provided. It is difficult either to develop an emergency plan or to respond in an emergency if the criteria for intervention are not clearly specified. Therefore, NRPB specified numerical ERLs for emergency countermeasures (see Table 1). They are deliberately highly stylized (based on the number 3) to emphasize the lack of precision which lies behind them. They are also specified as ranges of factors of 10. This reflects the difficulty of estimating doses averted to better accuracy than this immediately following an accident, and it makes the ERLs easily memorable. However, it is important that not too much significance is attached to the exact numerical values. A set of ERLs based on the number 2 or on the number 5 could equally well have been specified, with equal justification. The precise numbers were specified solely as a planning and administrative aid, not as an indication of what is safe and ‘not safe’.

View this table: [in this window] [in a new window]   Table 1. ERLs recommended by NRPB/RPD

 
In 2001, and following new guidance from World Health Organization (WHO) [4], a UK Working Group reviewed NRPB's advice on stable iodine prophylaxis and made recommendations [5]. The main conclusion was to emphasize the relatively higher risk of young children to radioiodine and therefore the need to afford young children priority in any arrangements for the distribution of stable iodine tablets. The Working Group also recommended that NRPB consider reducing the ERLs for stable iodine prophylaxis to 10 and 100 mGy, in line with WHO guidance. NRPB/RPD has been reviewing these recommendations and options for revising its advice in some depth and has recently published a consultation document on the HPA website (www.hpa.org.uk).

	Food bans

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
The NRPB guidance does not include ERLs for food and water. This is because the Council of the European Communities has issued Regulations [6–8] which specify maximum permissible levels of activity concentrations of radionuclides in food (and water) after an accident. These Council Food Intervention Levels will become legally binding on European Community States following a future accident and apply to all food marketed. Unlike the ERLs for emergency countermeasures, a single IL is given; any food contaminated above this level is banned, while food contaminated at lower levels is acceptable for consumption. Flexibility is introduced in a different way. The Regulation requires that the specified levels are implemented by member states immediately following an accident, but that the appropriateness of these levels should be urgently reviewed and, if necessary, revised levels subsequently adopted. NRPB [9] has published guidance on the radiological implications of applying these maximum levels following an accident.

	Recovery countermeasures

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
The experience of the former Soviet Union concerning the problems involved in the longer term following a major accident demonstrated that more detailed consideration needed to be given to these issues than was the case prior to the accident at Chernobyl in 1986. The problems seem to stem from the potentially very large harmful consequences which can result from the imposition of long-term countermeasures (in terms of disruption, anxiety, monetary cost, employment opportunities, etc) and the demands of the public both for guarantees of safety and that life should return to normal as soon as possible following an emergency. By ‘safety’, many people mean, with exposures below the annual dose limits for members of the public. However, following a major accident, it may be very difficult and costly, in the short term, to reduce environmental levels so that no individual will receive an annual dose in excess of 1 mSv/year.

It is also clear, both from experience of the accident at Chernobyl and from other major accidents/disasters, that immediately following an accident, large volumes of information and advice will be both sought and offered by many people. If those managing the emergency cannot provide prompt authoritative advice on the basic protective actions which will be taken in the longer term and the criteria which will be adopted for these, then there is a serious danger of losing control of the situation. Therefore, although a delay in decision making for a few weeks or even months (depending on the radionuclides present) may not substantially affect the doses that people receive in the longer term after an accident, the need to provide early, authoritative advice will make it extremely difficult for objective decision criteria to be developed after an accident has occurred.

In close consultation with other relevant organizations and government departments, NRPB/RPD has developed advice on the longer term response to an accident (i.e. countermeasures implemented once there is no further threat of release and all emergency countermeasures have been implemented) [10,11]. This advice recognizes the need to involve all affected populations in decisions on the recovery strategy, and to evaluate a wide range of factors, of which radiation risks are only one component.

	Emergency planning and response

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
In order for an emergency plan to be effective, it must be clear and straightforward to follow. One specific response is unlikely to be the ideal response for all possible accidents and circumstances. However, a complex plan providing for many different responses, depending on the exact accident and circumstance, is likely to be difficult to follow and so introduce unwanted delays. Emergency plans therefore provide a single, robust response for application to most envisaged accidents and circumstances, with an indication of flexibility in case of accidents and circumstances for which it is not appropriate. It is recognized that the response is unlikely to be precisely optimum for any specific accident. However, this disadvantage is offset by the advantages of a fast response facilitated by a clear and straightforward emergency plan.

An emergency plan is developed in order to reduce the time it would take to respond to an accident. The plan therefore includes site-specific ILs expressed in directly measurable quantities, so that countermeasures can be triggered without the need for complex calculations or lengthy discussions. It may be recognized, with hindsight, that a better response could have been devised, but it is likely that if this ideal response were sought at the time of the accident, a delay would be introduced which would result in a lower level of protection of the public than that provided by the emergency plan.

In the event of an accident occurring, the response defined in the emergency plan would be triggered. This ‘buys time’ for a more considered appraisal of the response to be carried out as more information becomes available. Such reappraisal will not delay countermeasures which need to be taken urgently, but will enable better estimates of the impact of the accident and possible countermeasures to be made. It will enable consideration of extending the response envisaged in the plan in the event that the release is much larger than planned for. Generally, decisions to modify the emergency plan during the course of an accident will only be taken if significant modifications are dictated. Minor modifications would be likely to result in delays to the implementation of countermeasures, for very little, if any, increase in benefit. In particular, while a release is continuing, or further releases are threatened, it is prudent to maintain in force all countermeasures already implemented, in case the situation worsens.

	Recovery Working Group

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
The possible need for recovery countermeasures in the longer term after an accident has already been discussed. UK emergency planning arrangements [12] provide for the setting up of a Recovery Working Group (RWG) as soon as it is clear that off-site contamination has occurred. This will be chaired either by the Local Authority or a senior representative from the Environment Agency, as appropriate. The role of the RWG is to

(i) advise on the characterization of off-site contamination,

(ii) identify options for clean-up and waste disposal,

(iii) recommend the best option(s),

(iv) advise on and assess post-recovery monitoring and

(v) advise on the implications of decisions taken in the emergency phase for actions in the recovery phase.

Its membership will include both local and national bodies and can be extended or reduced as appropriate to ensure all the expertise required for advising on recovery decisions is available to it. It is intended that its deliberations would take account of the wishes and concerns of those affected, for example, through public meetings or discussions with local representatives. It is likely that the RWG would continue to function, albeit with changing membership and reduced frequency of meetings for a prolonged period.

	Protection of workers

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
In general, it is not expected that members of the public would be exposed to doses in excess of deterministic thresholds following an accident. It is possible, however, following a very serious accident, that workers, particularly those dealing directly with damaged plant, could be exposed to very high doses. With the exception of those workers unintentionally involved in the accident itself, workers will not be exposed to increased doses unless a decision is taken to allow this exposure. To some extent, therefore, the protection of workers following an accident is more analogous to the situation of practices than that of intervention. This becomes increasingly true with increasing time following the accident; workers involved in long-term clean-up operations are in a very similar situation to workers involved in controlled practices.

NRPB has published advice for the protection of workers which explicitly recognizes the different protection needs of workers compared with those of the public [1,13]. Workers are divided into three categories: those involved in making the plant safe, those involved in implementing measures intended to protect the public in the short term and those involved in long-term clean-up operations. It is recommended that workers in the third category [14,15] should be subject to the full ICRP system of dose limitation for practices. Wherever possible, it is recommended that workers in the first two categories should not be exposed above the annual dose limits for workers. However, it is recognized that the strict enforcement of these limits may not always be appropriate, particularly where additional exposure is required to reduce significantly the health risks to others (e.g. operations to make plant safe, or life-saving actions). This is more likely to apply to workers on the damaged plant than workers involved in implementing public countermeasures. In such circumstances, it is necessary to evaluate and balance the harm and benefits which the proposed exposure would entail. Within the constraints of time available, the proposed operation should be first justified and then optimized, to keep the additional exposure as low as reasonable. Wherever possible, doses in excess of serious deterministic thresholds should be avoided, although life-saving operations may justify exceeding even these.

	Summary

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
The general principles for intervention follow directly from the assumption of a linear, no-threshold dose-response relationship. This means that it is not possible to specify a safe level of dose, only a level which can be tolerated in exchange for certain benefits. The general principles therefore require that the harms and benefits resulting from intervention should be evaluated, and the intervention only undertaken if the benefits outweigh the harm. Where possible, the intervention should be implemented in such a way as to maximize the benefits.

Criteria for intervention following accidents have been recommended nationally and internationally, generally as ILs of dose. UK ERLs are specified in pairs indicating the lowest and highest dose saving, respectively, that might be required in order for a particular countermeasure to be justified in different circumstances. The optimum IL following a particular accident is expected to fall between the levels specified by the ERLs. Examination of potential accidents and consequences for particular operations can help in the identification of ILs that would be optimum in specified circumstances. Site-specific emergency plans should include site-specific ILs and action levels to facilitate a rapid response in the event of an accident.

ERLs are specified for emergency countermeasures. ILs for food have been specified by the Council of the European Communities and the NRPB has published advice on the radiological implications of adopting these levels. In addition, NRPB/RPD has published advice on a framework for decisions on recovery (longer term) countermeasures.

The level of risk which is tolerated in situations of intervention may well be different from that which is tolerated for practices. This is partly because the impact of the harm and benefits is differently distributed in the two situations, and partly because intervention relates to taking action to reduce existing exposure where the cause of the exposure is not under control, while practices involve the increase of existing exposure where the cause is under control. This is particularly true for members of the public following an accident. The protection of workers in this situation is more closely analogous to the situation of practices, since, for the most part, workers will not be exposed unless a decision is taken that this should happen.

	Conflicts of interest

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
None declared.

	Notes

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 
^* Internationally, the International Commission on Radiological Protection [12,15] and the International Atomic Energy Agency [14] have specified similar principles, with the result that most radiation emergency planning worldwide is based within a common framework, albeit with differences in detail between countries.

^** Throughout this paper, the NRPB is cited as the author of much of the UK advice. In April 2005, NRPB merged with the HPA to form its RPD. Existing formal NRPB advice has been endorsed by the HPA, and, unless otherwise stated, advice referenced to NRPB should be understood to be the advice of HPA.

	References

Top Accidents and exposure pathways Options for response The scientific basis for... Principles for intervention Intervention levels Emergency countermeasures Food bans Recovery countermeasures Emergency planning and response Recovery Working Group Protection of workers Summary Conflicts of interest Notes References

 

1. NRPB. Principles for the protection of the public and workers in the event of accidental releases of radioactive materials into the environment and other radiological emergencies. Doc NRPB 1990;1, no. 4; 1–4.

2. NEPLG. Civil Nuclear Emergency Planning: Consolidated Guidance. http://www.dti.gov.uk/energy/nuclear/safety/neplg_guide.shtml (2004, date last accessed).

3. NRPB. Guidance on restrictions on food and water following a radiological accident. Doc NRPB 1994;5, no. 1.

4. WHO. Guidelines for Iodine Prophylaxis following Nuclear Accidents: Update 1999. Geneva. WHO/SDE/PHE/99.6 (1999, date last accessed).

5. UKWG. Stable iodine prophylaxis, recommendations. Doc NRPB 2001;12.

6. EC. Council Regulation (Euratom) No 3954/87 laying down the maximum permitted levels of radioactive contamination of foodstuffs and feedingstuffs following a nuclear accident or any other case of radiological emergency. OJ of the EC. L371/11. Amended by Council Regulation 2218/89. OJ of the EC. L211/1 (1989). 1987.

7. EC. Council Regulation laying down maximum permitted levels of radioactive contamination in minor foodstuffs following a nuclear accident or any other case of radiological emergency. OJ of the EC. L101/17. 1989.

8. EC. Council Regulation (Euratom) No. 770/90 laying down maximum permitted levels of radioactive contamination of feedingstuffs following a nuclear accident or any other case of a radiological emergency. OJ of the EC. L83/78. (1990)

9. NRPB. Emergency reference levels of dose for early countermeasures to protect the public: recommendations for the practical appliction of the board's statement. Doc NRPB 1990;1, no. 4, 5–33.

10. NRPB. Application of emergency reference levels of dose in emergency planning and response. Doc NRPB 1997;8, no. 1, 21–34.

11. Health Protection Agency; Department for Environment, Food and Rural Affairs; Environment and Heritage Service; Scottish Environment Protection Agency; Scottish Executive; Food Standards Agency; Environment Agency. UK Recovery Handbook for Radiation Incidents: 2005. Chilton. HPA-RPD-002 (also EA report number P3-105/SR and DEFRA report number DEFRA/RAS/05.012), 2005.

12. ICRP. Principles for intervention for protection of the public in a radiological emergency. ICRP Publication 63. Ann ICRP 1991;22.

13. NRPB. Intervention for recovery after accidents. Doc NRPB 1997;8, no. 1, 1–20.

14. IAEA. Basic Safety Standards, final edn. Vienna: IAEA Safety, 1996, Series No. 115.

15. ICRP. 1990 Recommendations of the ICRP. ICRP Publication 60. Ann ICRP 1991;21.

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