Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

131, canned milk or other milk products that can be stored for a few months will not have
any residual radioactive iodine and may be consumed.
Short-Term Evacuation Versus Sheltering
Decisions and actions to prevent radiation exposure must “do more good than harm.” In
other words, the benefit to health effects from dose reduction by using protective actions
should more than offset the socioeconomic disadvantages of the protective actions.
Evacuation is an effective countermeasure to the presence of radiation and may prevent
exposure to children. The decision to evacuate should take into account the potential
disruption and actual risk. Area evacuations can result in increased risk of exposure if a
plume already exists or if evacuation is to a location with a higher risk of exposure. Also,
casualties can result from the evacuation process, and negative psychological effects can
occur. Ideally, the evacuation would begin before the passage of any radioactive material
carried in a dispersal cloud. Evacuation is almost always indicated if the projected
average effective dose is likely to be >0.5 Sv (50 rem) within a day.
Variables affecting the pattern of radioactive material distribution include the time of day
and year, the elapsed time since the accident, the size of the accident, and meteorological
data to include wind patterns. Again, when deciding whether to evacuate or shelter in
place, it is not recommended that predetermined levels alone be used for the decision.
Basing the decision on these levels alone might lead to socioeconomic, physical, and
psychological hardships that outweigh the benefits of lower exposure. For example,
during the TMI accident, the Governor of Pennsylvania recommended that those
members of society most vulnerable to radiation—namely, pregnant women and preschool-age
children within a 5-mile radius of the plant—leave the area. Studies done
more than 10 years after the TMI accident found that many residents still showed
psychological symptoms of stress. Most vulnerable to stress were the mothers of young
children and those who had been evacuated. Symptoms included somatic complaints,
anxiety, and depression, posttraumatic stress disorder symptoms and physiological
symptoms, hypertension, and higher levels of norepinephrine, epinephrine, and cortisol.
Persistent fears and anxiety were found that centered on the fact that the residents had
been living close (within 5 miles) to the source of such potentially catastrophic danger
years earlier.
The evacuation after the Chernobyl accident was poorly planned and chaotic. The 45,000
residents of Pripyat, the city closest to the power plant, were evacuated during a 3-hour
period 36 hours after the accident occurred and were not allowed to return to their homes.
Ninety thousand more people were evacuated over the next few days, clearing a 30-km
zone around the power plant. Thousands of farm animals were slaughtered because there
was no longer anyone to tend to them. The evacuees often were relocated to areas that
were openly unreceptive and even hostile to them. Preliminary reports suggest that
women pregnant at the time of the accident were more likely to have stress symptoms
than others evacuated during the accident. Children evacuated to Kiev were more likely
to report frequent headaches, chronic illness, and poorer overall health.
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