The Rise and Fall of Paternalism in Radiation Protection

1. The Rise and Fall of Paternalism in Radiation Protection Health Physics Society 56th Annual Meeting, West Palm Beach, Florida TPM-E.4, Tuesday, June 28, 2011 Daniel J. Strom, Ph.D., CHP Pacific Northwest National Laboratory Strom@PNNL.gov +1 509 375 2626 Link to Abstract Link to Menu

2. Outline Motivation: Who’s responsible for safety? The current radiation protection paradigm Failures of the current paradigm Empowering the protectee Conclusions 2

3. Motivation 3

4. Radiation Protection Is the profession concerned with protecting humankind and the environment from the harmful effects of ionizing radiation known as “health physics” in some countries Because technologies that produce radiation have significant benefits, protection must be provided without “just saying no” Radiation protection professionals must collaborate with users of radiation and radioactive materials to ensure safe practices 4

5. Traditional Hierarchy of Radiation Protection Societal Norms and Values UNSCEAR Science Academies Sources and Effects of Ionizing Radiation Philosophy ICRP, NCRP, etc. Recommendations: Justification, ALARA, Dose Limits Quantities and Units ICRU, ISO, IEC, ANSI, IAEA, etc. Measurements Governments Treaties National Competent Authorities Normative Standards Regulations: Licensing, Inspection, Enforcement Professional or Performance Standards IAEA, IATA, ILO, INPO, JCAHO, etc; Banks, Insurers, Manufacturers Licensee, Employer and Owner Radiation Protection Programs Protectors Employers and Health Care Providers Protectees Workers Public Patients Entities Needing Protection Environment Patient Families 5 5

6. Traditional Hierarchy of Radiation Protection Protector Parent Protectee Child This paternalistic system does not empower the protectee to protect herself or himself 6

7. Who Is Empowered to Act? • the United Nations and governments • legislators • regulators • managers • engineers and health physicists • workers • health care professionals • law enforcement personnel • first responders • individual members of the public 7

8. Individual members of the public • Can take many of the same actions to protect themselves and their families as can workers and managers • Additional choices • where to live • remediate dwellings if they have high radon levels • make appropriate risk-management lifestyle choices (such as not smoking) • not to have needless medical exposures • elective whole-body CT scans in the absence of symptoms • repeated radiological exams by different health-care providers • prepare for and respond to accidents and emergencies by sheltering in place or evacuating and by stocking and using potassium iodide if needed • In some circumstances, individual and familial protection needs may not be met by the traditional system of radiation protection 8

9. Individual members of the public • Empowered to protect by • their own self-interest • their responsibility to keep their families safe (especially parents caring for children) • education and training • accurate information about the radiological situation and what actions they can take • Disempowered by • ignorance • apathy • fear • paternalism of the traditional paradigm 9

10. How are individuals or groups empowered to take protective actions? Done for or to individuals • Many sources of empowerment • treaties, laws, regulations, recommendations, and guidance • administrative procedures • design, creation, and maintenance of engineered barriers • medical care • education and training • provision and use of personal protective equipment • posting and labeling • self-preservation Done by individuals 10

11. Empowering the Protectee to be the Protector: 11

12. 10 Principles and 10 Commandments of Radiation Protection 12

13. Protectors must… • Have quantitative, or at least qualitative, knowledge of the potential or actual radiological situation • Understand • what principles and commandments they are empowered to enact • what resources are needed for successful protection • Be able to judge what is reasonable, in the sense of optimization, and when protective action is unnecessary • Protectors may have to account for • individual differences in either susceptibility to effects of radiation • age, sex, and pregnancy status are significant risk factors • need or desire for protection • triage following an accident or radiological attack may result in differing efforts for decontamination 13

14. Empowering protectee to be protector: Civil Defense • USA during the 1950s • Natural extension of protection against aerial bombardment experienced during World War II • Civil Defense (CD) organization created to protect the public from a nuclear attack • CD provided training, information, and radiological survey instruments to organizations and individuals • CD empowered individual members of the public to protect themselves and their families in situations to which the government could not conceivably respond effectively • One hallmark slogan of that era taught to schoolchildren was “duck and cover” 14

15. Empowering the Protector: Duck and Cover • “Duck and cover,” meant that if there were a bright flash, children were to duck under furniture and cover their heads • Besides its protection against flash blindness and flying debris, this was excellent advice that could be life-saving for individuals given that initial nuclear radiation persists for 10 or more seconds 15

16. Survivalist Literature • Old Civil Defense literature • Allen Brodsky’s Actions For Survival: Saving Lives in the Immediate Hours After Release of Radioactive or Other Toxic Agents 16

17. Case Studies • Unlicensed radium • Unlicensed radionuclides in wastewater • Chernobyl: Vitaly Eremenko’s Experience 17

18. Unlicensed Radium Mid-1980s, Colorado School of Mines Classroom in 1893 National Historic Landmark 226Ra chemist had worked there 50 years earlier 1.5 mSv/hour in one location at gonad level How much of the building goes in a waste drum? Ra-contaminated asbestos “snow” 20 cm deep in basement No licensee, no regulator, no one to report doses to

19. A Combined Sanitary and Storm Sewer System:King County’s West Point Treatment Plant

20. Sewer Lines Are Generally Buried

21. Sewer Lines Are Generally Buried

22. Pump Station

23. Wet Well at Pump Station

24. Combs Clear Debris from Bar Screens

25. Screenings Go to a Dumpster

26. 60Co Pellets (like at Juarez, 1983)

27. mm- to cm-sized Grit

28. Secondary Clarifier

29. After Leaving Anaerobic Digestion, Biosolids Are Concentrated

30. Concentrated Biosolids Are Collected for Shipment

31. 4-5 48 Tonne (105,000 lb.) Biosolids Trucks/Day • Biosolids shipped east for agricultural application

32. Agricultural Application of Biosolids • 4-5 trucks per day Photo courtesy Michael A. Smith

33. wastewater in pipes on the way to the plant regulator and pumping stations wastewater in the treatment plant slime and coated surfaces in treatment plant screenings in plant screenings in dumpster at disposal site grit in plant grit in dumpster at disposal site biosolids in digesters biosolids in trucks biosolids applied to crops crops eaten resuspended dust from biosolids treated water untreated water (bypass) Potential Exposure Locations

34. Chernobyl: Vitaly Eremenko’s Experience 34

35. Success: The traditional paternalistic paradigm works for developed countries with significant government infrastructure foreseeable uses of radiation and radioactive material energy, propulsion, medicine, research, industry, space travel environmental remediation 35

36. Opportunity:The traditional paradigm fails for clandestine releases Hanford’s Green Run; Chernobyl unregulated sources of radiation exposure orphan sources; indoor radon; medical exposures nuclear or radiological attack war; terrorism developing nations 36

37. Conclusions • Traditional, paternalistic radiation protection paradigm: institutions protecting people and the environment • There are situations in which it doesn’t work or doesn’t work well • There is need for improvement in informed individual protection actions has been demonstrated • People can learn to protect themselves, and we should make that learning happen 37

38. References • Brodsky A. 2009. Actions for Survival. Protections from Nuclear, Chemical and Biological Terrorism. http://www.mjrpublications.com/New-Actions-For-Survival.html • Eremenko VA, Droppo Jr JG. 2006. A personal experience reducing radiation exposures: protecting family in Kiev during the first two weeks after Chernobyl, Health Phys 91(2 Supp):S39-S46 • Hickey EE, Strom DJ. 2005. Technical basis for radiological emergency plan annex for WTD emergency response plan: West Point Treatment Plant. PNNL-15163 Vol. 3. Richland, Washington, Pacific Northwest National Laboratory • Strom DJ. 1996. Ten principles and ten commandments of radiation protection. Health Phys. 70(3):388-393. Available by permission of the journal at http://www.pnl.gov/bayesian/10Principles.pdf • Strom DJ. 2008. "Who's Empowered to Protect? How Are They Empowered? What Do They Need to Know? in Proceedings of the 12th International Meeting of the International Radiation Protection Association, ed. AJ González, IRPA, Buenos Aires. http://www.pnl.gov/bayesian/strom/pdfs/Strom2008F_PNNL-SA-61159_Whos_Empowered_to_Protect.pdf 38