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• W2037429360 abstract "Arguing against the Proposition is Eric G. Hendee, M.S. Mr. Hendee completed his graduate and clinical training at the University of Wisconsin, Madison, where he served as a clinical physicist and Assistant Professor through the University of Wisconsin, LaCrosse. He is currently the Chief Physicist in Radiation Oncology at Waukesha Memorial Hospital, WI, and is certified by the American Board of Radiology in Therapeutic Radiological Physics. He has served on the Wisconsin expert panels for decontamination and hospital response to radiation emergencies. He is also chair of the recently formed AAPM working group on Medical Response to Radiation Incidents. Unplanned radiation exposures include smaller incidents, uncontrolled sources, and serious accidents.1 The radiation emergency assistance center/training site (REAC/TS) in Oak Ridge, TN maintains an extensive database of radiation incidents involving significant radiation exposures.2 The associate director of REAC/TS, Doran Christensen states, “We have information in the REAC/TS Registries that have over 2,000 cases from around the world over the past 60 years. In that Registry, we have no history of a medical worker receiving a significant dose of ionizing radiation or having been significantly contaminated with radioactive materials while caring for victims of radiological or nuclear incidents.”3 The largest dose on record for an emergency healthcare provider at REAC/TS was 2.49 mSv.4 The majority of incidents have occurred with primary responders receiving very little dose and do not show justification for an increased limit. Determining health risks to emergency workers from exposure to radioactive sources is difficult due to nonuniform dose distribution and many other factors. However, if one knows that a radioactive source is involved, appropriate protective measures can be taken. Accidents involving significant risk of radiation exposure are extremely rare. The best example would be Chernobyl. This has been called the “most serious accident in the history of the nuclear industry” by the IAEA.5 Of the 200 000 workers called to contain the contamination, the average dose was 100 mSv.5 Acute radiation syndrome was diagnosed in 134 cases and 28 individuals died. Do we advocate an occupational dose limit that allows for this, or do we realize that in certain cases all the rules go out the window? Many agencies have advocated the use of “turn back” doses.1 Some have even listed this as a function of how many potential lives would be saved. Receiving a dose of to save 10 000 lives is a pretty good exchange no matter what is, but implementation of this would be difficult at best. Should the person turn back if you estimate only 500 people saved? If you are going to save 10 000 people, why have a limit at all? If a firefighter reaches that new limit, will they really walk away? At what point do you just list what limit is safe and then leave the rest to the conscience of the individual? Many people in many careers save lives—radiologists and cardiologists for example. On rare occasions they come close to the legal radiation dose limit (varying by specialty and training, of course). Do we increase the legal limit because it may save more lives? You could take this argument to silly extremes. Popular magazines are full of estimates of deaths attributed to particulates and air pollution from coal power plants. One recent estimate is that 20 000–30 000 premature deaths per year can be attributed to our nation's use of coal.6 According to this argument, the annual occupational limit for nuclear power plant workers should be raised if this would result in more power produced via nuclear means. Occupational limits should be based on safety, not on occupation. If a dose is considered unsafe for an individual in one profession, why would it be considered safe for an individual in a different profession? “I will never allow personal feelings, nor danger to self, deter me from my responsibilities as a firefighter.”7 In an emergency involving first responders arriving on the scene, their training and experience will determine their actions. As evidenced by the above statement for firefighters, this will focus on the safety of others, even when there is potential for personal harm. For an event involving radiation, it is unrealistic to expect that their mission should be any different from what it would with fire or any other hazard. By nature of being first responders, little to no information would be available regarding radiation exposure levels at the scene. It is also unlikely they would have time or resources to monitor exposure in the initial phases of a response. An awareness of the possible presence of radiation would certainly encourage the principles of time, distance, and shielding, but this is the common theme for most situations they face. The risk level associated with radiation should be consistent with other risks in an emergency in that it should pertain primarily to short-term consequences, with less concern for long-term effects. Setting a level based on occupational dose limits is potentially counterproductive to the mission of first responders. These limits (50 mSv/year, 5 mSv/year ALARA) are designed for those who work with radiation regularly as part of their job so as not to significantly increase the lifetime risk of cancer. This does not apply to infrequent exposures of first responders in an emergency where lives and property are at risk. However, acute radiation effects are a concern. Up to around 1000 mSv, the responder may experience acute affects which are not life threatening if correctly managed.8 The training that first responders receive is based on these acute effect levels, on the order of 5–20 times the occupational limits (50–200 times the ALARA limits). For example, the current emergency worker “turn back” guidance from the IAEA is 1000 mSv for life-saving actions, and 500 mSv for actions to prevent severe health effects or injuries.1 The FEMA training center at the Nevada Test site recommends an exposure limit of 250 mSv, and after that it is voluntary.9 The voluntary aspect simply means the responder should be informed of the personal risks above 250 mSv, but that they are able to continue their actions with no specified upper limit. There is no question that first responders should do their best to minimize personal risk in any situation, but it makes no sense to recommend overly conservative occupational radiation exposure levels to individuals with such an important role in time of emergency. NCRP Report 138 states that “special individual exposure guidance, often in excess of exposure limits, is required for emergency response because the benefits associated with establishing control at the scene of a large radiological disaster are so great.”10 Once additional help and proper monitoring equipment arrives on the scene, decisions can be made as to how best to protect both responders and the general public. My colleague's opening statement that (a firefighter) “will never allow personal feelings, nor danger to self, deter me from my responsibilities” describes the courage of a firefighter eloquently. First responders will do whatever it takes to protect others—these are people who run into burning buildings, after all. The fact that firefighters will not allow danger to themselves to prevent them from doing their job is not an argument in and of itself for higher radiation exposure limits. That would be like saying that firefighters do not have to follow established guidelines for personal protective gear because it may slow them down in the performance of their duties. I agree “it is unlikely that a first responder would have time or resources to monitor exposure in the initial phases.” This again would not be an argument for increasing the allowable limit. Why increase a limit that is not likely to be measured until after the fact? I also agree that there is a very small amount of “danger” associated with the current guidelines. However, I am not discussing what dose is “safe” or what dose could be tolerated in a single exposure. If a dose is considered unsafe for an individual in one profession, then why would it be considered safe for an individual in a different profession? Think of the speed limit. People routinely go over the speed limit when trying to rush someone having a heart attack to the hospital. We do not post on our signs “65 unless medical emergency, then 85.” We post the limit that is generally considered to be safe to drive and then deal with exceptions as they occur. Ms. Kitchen raises several questions that I will endeavor to answer. I believe we both share the view that unnecessary radiation exposure to anyone is undesirable. However, the bottom line for emergency responders is when to “turn back” from the scene. I agree that, since the risk to emergency responders is very low, there is no need to increase the limit beyond currently accepted values. These values are those recommended specifically for emergency responders by the IAEA (and others). By her statistics, the acute radiation syndrome (ARS) risk for the 200 000 who responded to Chernobyl was only , while the average exposure (100 mSv) was twice the annual occupational limit (20 times ALARA). While complicated by socioeconomic factors, the increased risk of radiation related death to emergency responders at Chernobyl over 12 years following the incident is on the order of (approximately 200 out of 4000 deaths5). Therefore, a turn back exposure significantly higher than the occupational dose limit corresponds to a very low risk of ARS, and a relatively low increased long-term death risk. Regarding whether or not first responders would walk away, the answer if there are lives at risk is simply no. If it is property at risk, then the decision is more difficult and they will quickly weigh risk versus benefit on the scene with or without radiation measuring equipment and the knowledge to use it. This requires a general understanding of risk associated with what they are about to do, i.e., receive a one-time exposure. This is exactly the point where we list what limit is safe and the rest is left to the conscience of the individual. Confusing the issue with occupational dose limits directed at those who spend an entire career working with radiation will not help them make an informed decision. I wholeheartedly agree with her final point that “occupational limits should be based on safety, not on occupation.” Safety is based on risk, and the risk of a one-time exposure for emergency responders is not the same as the risk associated with occupational exposure. For this reason, the recommended levels are not, and should not, be the same." @default.
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• W2037429360 date "2007-12-11" @default.
• W2037429360 modified "2023-09-27" @default.
• W2037429360 title "Exposure limits for emergency responders should be the same as the prevailing limits for occupational radiation workers" @default.
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