By Stephen Spotswood
NATIONAL HARBOR, MD — A year after a massive earthquake occurred off the coast of Japan, resulting in a large tsunami that caused nuclear-plant meltdowns, the U.S. military is creating a database to help track possible radiation exposure for troops who participated in relief efforts and for servicemembers and their beneficiaries who were stationed or living in Japan at the time of the disaster.
The massive earthquake struck the coast of the Tohoku region of Japan on March 11, 2011, and resulted in extensive damage. The tsunami caused a number of nuclear accidents, including a meltdown at three reactors in the Fukushima Nuclear Power Plant in the Futaba District of Fukushima Prefecture.
The U.S. military supported Japan in its disaster relief efforts in what was known as Operation Tomodachi, the Japanese word for “friends.”
A local woman carrying water bowed in thanks to Marines with the command element, 31st Marine Expeditionary Unit, who were on the way to assist with Operation Field Day here. The operation was a debris-clearing and cleanup project designed to open harbor access and area roads on the isolated island. Photo by Marine Capt. Caleb Eames.
An Unprecedented Mission
The earthquake left 13,000 dead, 15,000 missing and caused about $5 billion in damage — an estimate that is likely far too low.
The earthquake was a unique event for the U.S. military, in that it had never faced a disaster of such complexity.
“It was a trifecta. We had the earthquake; we had the tsunami; and, secondary to all of that, we had the water damage, the lack of power, and the reactor emergency,” explained Cmdr. Juliann Althoff, MD executive to the Deputy Surgeon General at the U.S. Navy Bureau of Medicine and Surgery.
While ostensibly the mission was to help the Japanese government with supplies, infrastructure repair and cleanup, there was little the U.S. military could contribute.
“They honestly didn’t need that much help from us,” Althoff said at the recent Military Health Systems Conference. “Their capacity was unbelievable.”
A lot of the focus was on the approximately 70,000 U.S. military medical beneficiaries living near the reactor sites, she said. “How are we going to keep these people safe? How are we going to track them over time and make sure they’re doing OK? This part of the mission was about force health protection.”
The Fukushima meltdown created a 120-mile radius warm zone around the reactor. While the incident amounted to a very low-level radiation threat, the severity initially was unknown.
“Nobody knew how bad it was. Nobody knew how bad it was going to be. It happened in a foreign country, so we didn’t have any control over the disaster,” Althoff said. “This was unprecedented. There was nothing on the shelf that we could grab, pull down and open up and it would tell us what to do.”
It required getting guidance out to servicemembers and their families, and coordinating that guidance with what was being distributed by the Japanese government to their citizens. It also required determining if the groundwater was safe and creating guidance for nucleotide levels in the water.
Marines participating in Operation Tomodachi are checked for radiation at Naval Air Facility Atsugi, Japan. (U.S. Marine Corps photo by Cpl. Patricia D. Lockhart/ Released)
By the end of the operation, it required the cooperation of several command structures, including: U.S. Pacific Command, the various military services, the Department of Energy, the Environmental Protection Agency, Naval Reactors and the U.S. Embassy in Japan.
It was a collaboration that required a good deal of negotiation and discovery of how to work together. “How would we communicate with one voice? This wasn’t easy, and it took time,” Althoff said.
This was one of the key lessons learned from the incident, she noted. “We need to act early and do it with one voice. Giving one message to the population is really important. And you can’t put policy out without educating people about that policy.”DoD Launches Database for Personnel in Japan During 2011 Earthquake Nuclear Meltdowns
Tracking the Radiation
The two radionuclides of concern were radioiodine and radiocesium. The former has a very short half-life (eight days), but cesium has a half-life of 30 years.
During the relief operation, however, DoD was able to directly monitor 8,380 serviceberry plants for radiation levels. Very little detectable activity was discovered.Of those monitored, 98% were below baseline, and the 2% who were above baseline had a maximum of 25 millirems (mrem)equivalent to about 2.5 chest X-rays.
U.S. Navy Petty Officer 2nd Class Robert Bannister removed mud sediment from behind a damaged building in Hachinohe, Japan, March 17, 2011. Sailors from Naval Air Facility Misawa and its tenant commands were assisting with cleaning up the tsunami-damaged city. Photo by Petty Officr 2nd Class Devon Dow, US Navy.
The radiation levels came down dramatically after the first month, plateauing and creating a new background level of radiation in Japan. Where before the background level was 105 mrem per year, that level is now around 170 mrem per year. This is still much lower than the U.S. population’s average background radiation exposure, which is 310 mrem annually — most of which comes from radon exposure and cosmic radiation, excluding medical exposures.
Pointing out the many incidences where environmental exposure has led to health concerns for servicemembers later in life, Congress has directed DoD to create a database of servicemembers and their beneficiaries who could have even the smallest chance of exposure.
As a result, when the majority of Operation Tomodachi was winding down, the office of Craig Postlewaite, MD, DoD’s deputy director of force health protection and readiness, was just beginning its work in earnest.
All evidence suggested there had not been enough radiation exposure to create health effects, but DoD officials realized that any amount of reasonable doubt could lead to fingerpointing in the future.
“We knew that the first woman who gave birth to a child with a birth defect — this incident would be claimed to be responsible,” Postlewaite said. “We knew the database needed to withstand scrutiny, whether by Congress or watchdog agencies. We had to do this right.”
Most of DoD’s population was at least 150 miles from the reactor accident, and the wind at the time was primarily westerly, which meant that it was blowing away from the major U.S. installations.
Airborne radiation monitoring occurred at most of those installations and the major U.S. ships at sea. Individuals who actually had performed duties in the hot zone had been identified and could be tracked.
“We had a very effective accountability system,” Postlewaite said. “Most individuals [about 70-75% of DoD personnel] can be associated with a predominant location.”
The goal of the Operation Tomodachi Registry is to make it as comprehensive as possible in order to answer any questions that might be asked. This means including data on who was affected and where they were at the time, individual radiation data, ambient radiation exposure data and medical record data.
The registry will be used for medical treatment and diagnosis, inquires and exposure-related allegations, epidemiological health outcomes studies, medical surveillance and claims adjudication.
The first phase of the registry is scheduled to be completed this month. This is the dose assessment and recording phase — the creation of location-based radiation dose estimates for land-based population centers.
The second phase of the registry, which would have individual dose estimates completed for all individuals with personal dosimetry and internal monitoring data, is set to be complete in December 2012.
Much of this information, though not personal medical data, will be available online. DoD is constructing a public website that should be up sometime this month, Postlewaite said. “We’re making it in such a way to accommodate future exposure registries that may come to pass.”
The process for tracking the DoD’s most serious adverse medical events is “fragmented, impeding the Defense Health Agency’s (DHA) ability to ensure that it has received complete information,” according to a new review.
With a long history of point of care testing at both of its predecessor organizations, the Walter Reed National Military Medical Center (WRNMMC) laboratory services staff were keenly aware of the advantages of using portable testing devices to obtain rapid patient assessments.