INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTIONICRP ref 4832-8604-9553
2012 November 22

Report of ICRP Task Group 84 on Initial Lessons Learned fromthe Nuclear Power Plant Accident in Japan vis-à-vis the ICRP
System of Radiological Protection
In June 2011 ICRP Task Group 84 was established on Initial Lessons from the NPP
Accident in Japan vis-à-vis the ICRP System of Radiological Protection.
Most ICRP Task Groups are formed for the purpose of developing recommendations or
guidance to be published in the Annals of the ICRP, and report to an ICRP Committee.
Task Group 84 was exceptional in that it reported directly to the ICRP Main Commission,
and was asked to develop recommendations to inform the programme of work of ICRP.
The Task Group, led by ICRP Vice-chair Abel González, identified issues and maderecommendations relevant to the ICRP system of radiological protection related to theefforts carried out to protect people against radiation exposure during and after the accident
at the Fukushima Daiichi nuclear power plant in Japan. Approximately half of the membersof the Task Group were experts from Japanese authorities, research institutes, anduniversities, with the rest being ICRP Main Commission and Committee members.
The report of the Task Group was accepted by the ICRP Main Commission on October 31,
2012 during the ICRP Main Commission meeting held in Fukushima City, Japan. As the title
suggests, rather than trying to identify 'lessons learned', the following summary report
identifies issues and makes recommendations to the ICRP Main Commission. The report
does not necessarily reflect the opinions of ICRP, but serves as an important input into theidentification and prioritisation of actions for ICRP.
ICRP is already taking action based on some of the issues identified and recommendations
made by the Task Group. These issues and recommendations will continue to influence the
ICRP programme of work for years to come.
The Task Group compiled a considerable amount of detailed information not reflected inthis summary. The Main Commission has encouraged the members of the Task Group to
publish this information in the open literature.

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Summary Report of ICRP Task Group 84
Issues Identified from the NPP Accident in Japan andRecommendations to Improve the System of Radiological Protection
Abel J. González (Chairman), Argentine Nuclear Regulatory Authority, Argentina; Makoto Akashi,
National Institute of Radiological Sciences (NIRS), Japan; John D. Boice Jr., Vanderbilt University
and National Council on Radiation Protection and Measurements, USA; Masamichi Chino Japan
Atomic Energy Agency (JAEA), Japan; Toshimitsu Homma, JAEA, Japan; Nobuhito Ishigure
Nagoya University, Japan; Michiaki Kai, Oita University of Nursing and Health Sciences, Japan;
Shizuyo Kusumi, ex-Nuclear Safety Commission, Japan; Jai-Ki Lee, Hanyang University, Korea;
Hans-Georg Menzel, CERN, Switzerland; Ohtsura Niwa, Fukushima Medical University, Japan;
Kazuo Sakai, NIRS, Japan; Wolfgang Weiss, Federal Office for Radiation Protection, Germany;
Shunichi Yamashita, Nagasaki University and Fukushima Medical University, Japan; and, Yoshiharu
Yonekura, NIRS, Japan. (Elena Buglova, head of the Incident and Emergency Centre of theInternational Atomic Energy Agency, and Christian Streffer, former ICRP Commissioner and ICRP
Committee 2 Chairman, reviewed the work of the Task Group and provided invaluable advice, andJan Pentreath, Chairman of ICRP Committee 5, reviewed references to environmental protection.)

Following the Fukushima accident, ICRP convened a Task Group to identify issues arising from theaccident with respect to the ICRP system of radiological protection. While the affected people werelargely protected against radiation exposure and no one incurred a lethal dose of radiation (or adose sufficiently large to cause radiation sickness), many radiological protection issues were raised.
ICRP, therefore, considered it important to summarize the issues identified following thisextraordinary accident. Eighteen issues were identified as needing attention, outlined below.
Relevant ICRP Recommendations were scrutinized, issues were collected and suggestions for
ICRP were compiled.
The issues considered in this report have been assembled in an arbitrary order. It is important torecognize that many of the topics discussed in the current report had already been noted before theMarch 2011 accident as requiring further analysis.
1. Inferring radiation risks (and the misunderstanding of nominal risk coefficients)
In the aftermath of the accident, claims were raised by groups and the media that the actual risk ofradiation exposure is much higher than the nominal risk coefficients recommended by ICRP. In
particular, the dose and dose-rate effectiveness factor used by ICRP for estimating radiation risk at
low doses were questioned in the media, notably, during a television show with a wide viewing
audience in Japan.
The substantial biological, epidemiological, and ethical foundations supporting the basic notion of
the nominal risk coefficients used for radiological protection purposes were misunderstood by the
public at large in Japan, and the media unfortunately contributed to this misunderstanding. The
concept of a dose and dose-rate effectiveness factor (DDREF) was notably not understood; in part
because its wording is somewhat convoluted, even in English, but particularly after translation into
Japanese and other languages. Following a review of the biological and epidemiological informationon the health risks attributable to ionising radiation, the new ICRP Recommendations reconfirm
previous estimates of the combined detriment due to excess cancer and heritable effects, which2

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remain unchanged at around 5% per sievert of effective dose. This value is coherent and consistent
with international estimates of radiation risk, e.g. the estimates of the United Nations ScientificCommittee on the Effects of Atomic Radiation, and the claims that radiation risks have been
underestimated by ICRP are thus not substantiated.
2. Attributing radiation effects from low dose exposures
Since the accident, hypothetical estimates of future casualties due to the accident have been made.
They oscillated between some tens of cases in the peer reviewed literature to half a million inreports by the media. These alarmist and unfounded theoretical calculations have caused severe
emotional distress in the Japanese population.
The epistemological limitations of the sciences of radio-biology and radio-epidemiology, and theirinfluence on the attribution of health effects to low-dose exposure situations are often ignored. A
clear explanation of these limitations is essential for demonstrating the reasons why collective
effective doses aggregated from small notional individual doses should not be used to attributehealth effects to radiation exposure situations, neither retrospectively nor prospectively.
Notwithstanding, it may be necessary for decision-making bodies to ascribe nominal radiation risks
to prospective exposure situations and impose radiological protection measures even at low doses,
in part for reasons of social duty, responsibility, utility, prudence and precaution.
3. Quantifying radiation exposure
In the aftermath of the accident, the quantities and units used for quantifying radiation exposure ofindividuals in terms of radiation doses have caused considerable communication problems; theseinclude the following: the differences between the quantities have not been well explained and are not wellunderstood even by educated audiences;
 the distinction between the quantities used in the radiological protection system and theoperational quantities used for radiation measurement is even more difficult to understand inpart due to semantic problems; the use of the same unit for the quantities equivalent dose of an an organ and effective dose
without always specifying which quantity is used has enhanced confusion further; the lack of a formal quantity for a radiation-weighted dose for high doses (such as aneffectiveness-weighted to distinguish from the radiation weight factor) was, fortunately, not
an issue in this accident but continues to be an unresolved issue; and,
 there is very little understanding for why there are so many different quantities used inradiation protection, not only many dosimetric quantities but also many radiometric quantities(such as activity and activity concentration).
There are great difficulties to communicate radiological information to non-experts and the public atlarge using the ICRP system and its quantities. This is a consequence of the rather intricate conceptbehind the system of quantities which uses more than one quantity (organ (equivalent) doses andwhole body (effective) dose) and combines physical exposure data with scientific data on radiation
risk for organs and tissues. In other words, the system and the quantities have shown to be well
suited for operational radiation protection but they are much less suited for communication with nonexperts, particularly in emergency situations.
An important confusion has been triggered by the fact that the quantities equivalent dose (to anorgan or tissue) and effective dose have a common unit, the sievert. The problem seems to havebeen particularly relevant in the reporting of thyroid doses from the accident and is related to thefact that incorporation of radioactive iodine leads to radiation exposure almost exclusively to the3INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION
thyroid. Usually the equivalent dose is the relevant quantity for reporting organ doses but, if thedose is reported indicating only the unit, it can easily be confused with effective doses. The
confusion created by not specifying the dose quantity when giving numerical values in terms of Sv
merits a careful analysis of possibilities to improve the situation.
In spite of the learned difficulties, it should be emphasized that the quantities and units of the ICRP
system of radiation protection have a record of successful application in practical radiation
protection. They might not be well suited for communication, and probably for decision making inemergency and post-emergency situations. A strict and consequent application of a simplified dose
reporting (e.g., organ dose, effective dose) could help to improve the situation in cases of
emergencies. It should be remembered and stressed that the ICRP protection quantities have notbeen introduced for (individual or collective) risk assessment but for planning radiation protection in
the low dose range and for verifying compliance with individual dose restrictions.
4. Assessing the importance of internal exposures
Internal exposures, namely radiation exposure to radionuclides incorporated into the body, havebeen a source of debate among the public and the media and also in some scientific circles inJapan. For a given (organ or effective) dose, internal exposures appear to be perceived as moredangerous than the same exposure from external sources.
There is compelling scientific evidence that radiation risk depends on the amount of dose received,
and not on whether that dose is delivered from outside or inside the body, but this is largely ignoredby the media and the public. ICRP considers that for a given radiation dose the same radiation risk
should be expected, whether irradiation is from outside or inside the body. For a given dose, the
ICRP system of protection is more conservative for internal than for external exposures; for theformer it limits the committed dose rather than the dose actually incurred.
5. Managing emergency crises
Available international guidance address a number of issues usually arising from the emergency
crisis that follows from a serious accident involving large releases of radioactive materials into theenvironment. However, it seems to have been scarce for those managing the crisis created by theaccident. The issues of concern included the following: the management of an emergency exposure situation created by a prolonged release ofradioactive substances from multiple units rather than by an acute release from single unit
(as it was usually expected from a nuclear accident);
 the extendibility of the emergency planning zones in order to follow a changing situation;
 the prioritization of emergency protective measures;
 the planning for lifting emergency protective measures; and,
 when, why and how an emergency exposure situation should become an existing exposure
situation.
In sum, those handling the crisis have difficulties with the application of the international guidance
available for managing the emergency exposure situation. There were problems associated with the
protracted period of release and with extending emergency planning zones (this issue is importantduring the emergency response phase but it may not be a matter of the principle of radiologicalprotection but rather of regulatory policy). Prioritizing emergency protective measures was anotherissue of concern. The absence of quantitative recommendations for lifting emergency protective
measures continues to create significant problems.
Many specific issues for crisis management following a serious accident need to be addressed moreclearly in ICRP Recommendations, including: the management of the unique emergency exposure
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situation created by the prolonged (rather than acute) release from the accident; the consequent
need of extendibility of the emergency planning zones and of prioritization of emergency protective
measures; and, finally and significantly, the lifting of emergency protective measures and the transit
from the emergency exposure situation to an existing exposure situation.
6. Protecting rescuers and volunteers
The adequacy of the occupational radiological protection recommendations for workers who are notcustomary ‘radiation’ workers has been questioned. In the aftermath of the accident, these workers
have included:
 rescuers, namely specialized saviours aimed at working to remove people from dangerous
or distressing situations even at their own risk, including members of defence forces, firefighters, etc.; and, volunteers, namely people who freely offer to help in the aftermath of an accident rather thanin the early phase.
There was some confusion on how to deal with rescuers and volunteers. For the rescuers, the dose
limit for occupational exposed ‘normal’ workers had to be increased by the authorities after theaccident, thus creating a credibility issue. For the volunteers, there was confusion on what type ofdose restriction should be applied, which was increased by the fact that some volunteers were
inhabiting the area, and were therefore already subjected to doses relatively elevated due to theaccident, and other volunteers were coming from outside the area (and the additional dose received
because of their volunteered work can be very different for these two groups).
The ICRP system of occupational protection is not specifically tailored to workers who are not‘radiation’ workers but who nevertheless may be highly exposed to radiation in specificcircumstances, a notable example being the ‘rescuers’ that intervened in the accident. The system
was not conceived for people who are willingly taking high risks for saving lives or other charitableendeavour. The system is even less tailored to volunteer workers, namely, casual helpers in an
emergency. Moreover, no clear policy exists for making a distinction between volunteers from theaffected area and volunteers from outside the affected area.
7. Responding with medical aid
A number of medical management issues arose in the aftermath of the accident. These included thefollowing: problems related to an accident as a combined disaster; questions on personnel involved in emergency medicine; dealing with people’s contamination, including the selection of a screening level forcontamination and the consequences of the removal of clothing ; the role of health physics experts for radiation safety during emergencies ; the appropriate model core curriculum in medical schools ; risk communication; and,
 medical preparedness, including drills and exercises.
Many lessons on medical management have been learned from the accident. Some of the more
relevant lessons are the following:the complexity of disasters including damage to nuclear or radiological facilities, particularlyin the case of earthquakes, increased the need for multidisciplinary measures in the medical
response to such disasters;

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drills and exercises for medical radiological emergency should be carried out using
scenarios that include a radiological/nuclear event caused by extreme natural events suchas earthquakes and tsunamis;
medical professionals should have basic knowledge on the phenomena of radioactivity andradiation, on their effects and, particularly on contamination with radionuclides;
basic knowledge of radiation and its effects is extremely important for physicians, nurses,
radiation technologists, and first medical responders, because all of these professionals
might be involved in case of a radiological emergency medical response; and,the potential of damage to lifelines as well as the monitoring and/or calculation system forradiation in case of an earthquake requires intense focus and vigilance.

8. Justifying necessary but disruptive protective actions
Like in other similar situations, some of the decisions taken after the accident in order to protect the
public were extremely disruptive and caused significant social harm. For instance, evacuating
people from their homes is a measure that it is prone to cause serious disturbance to normal publiclife. Questions have arisen on whether some of these measures are justified, in the sense that they
really produce more good than harm.
While the radiological protection principle of justification is usually applied to the introduction of newsources of radiation, which are expected to increase exposure of people, the principle is equallyapplicable to the introduction of disruptive protective actions, which are expected to decrease theexposure of people. In the immediate emergency situation and in the long-term existing exposure
situation, people can only justify disruptive protective actions from the perspective of the benefit
obtained from the protective action.
Applying justification in an emergency situation such as that triggered by the accident is particularly
difficult. For instance, decisions on whether or not to evacuate people from areas of elevated but nothigh doses can present difficult dilemmas. If people remain they will incur some radiation doses andincrease their plausibility of radiation induced harm in the future; if they are evacuated such aplausibility will disappear but they will certainly incur the actual detriments associated to theevacuation itself.
Further guidance on the application of the justification principle in these demanding situations would
be welcomed. It should be recognized, however, that one problem with justification is that‘balancing’ good and harm is not confined to issues associated with radiation exposure. Other nonradiation-related benefits and detriments arising from the protective action must also be considered,thus going far beyond the scope of radiological protection.
9. Transiting from an emergency to an existing situation
There have been some difficulties for transiting from the emergency exposure situation created by
the accident to the existing exposure situation that will remain in the long term. A main difficulty
seems to be how to define and decide when the emergency exposure situation is terminated andthe existing exposure situation starts.
Transiting from the emergency exposure situation caused by the accident to an existing exposure
situation in the accident aftermath has caused doubts in the Japanese authorities. It is felt in Japanthat it would be easier and clearer to judge when the emergency exposure situation shifts to an
existing exposure situation if the ICRP recommendations were clearer and more quantitative.

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10. Rehabilitating evacuated areas
A clear lesson from the Chernobyl accident was that it was, and continues to be, extremely difficult
to rehabilitate an area evacuated as a result of a nuclear accident. A large intergovernmental project
was required to tackle this problem after that accident. A similar situation is occurring in the areas of
the Fukushima Prefecture that were evacuated due to the accident.
Rehabilitating evacuated areas, e.g. relocating evacuated people back to their homes, constructing
residential habitats for both returning refugees and new residents, has proved to be extremely
difficult. In fact, evacuees from the regions designated by the Japanese government as ‘difficult toreturn’ should be relocated at least for some years. However, it is expected that those regions may
be rehabilitated in the not too distant future. At that time, people including part of the relocatedpopulation may want to move into the region despite the fact that that the exposure might still besomewhat elevated. Questions arising in this case are: what is the category of the exposure
situation, what is the type of exposure, and consequently how should the exposure be controlled?
The ICRP Recommendations have apparently produced some confusion among members of the
public subjected to evacuation. It seems that they are interpreted as indicating that returning to theirhomes is a planned exposure situation and, therefore, they shall be subjected to the ICRP
recommended dose limit of 1 mSv/y for planned exposure situations. While the ICRP
Recommendations are not explicit on how to handle this type of situation, it might be considered
implicit that returning from a temporary evacuation leads to an existing exposure situation.
11. Categorizing public exposures due to an accident
Emergency exposure situations are defined as situations that may occur during the operation of aplanned exposure situation, or from a malicious act, or from any other unexpected situation, andrequire urgent action in order to avoid or reduce undesirable consequences. Exposure under aradiological emergency is an emergency exposure situation, and according to the ICRP
recommendations should be controlled with reference levels. Implicit to this situation is the fact that
restrictions on doses that were in place in the planned exposure situation before the accident,
specifically the relevant regulations on dose limitations, are “suspended” or “relaxed” to makecertain important and unavoidable actions possible, or to allow people to stay in the affected areas
with exposure above the “normal” dose limits without violating the principles of protection i.e. toprevent the occurrence of deterministic effects and to reduce the risk of occurrence of stochastic
effects to as low as reasonably achievable taking into account the prevailing circumstances.
The exposure of the public being delivered during an emergency could conceptually be treated as
an existing exposure situation from the beginning and consequently no concepts such as transition
from an emergency exposure situation to an existing one would really be needed. However, thetime frame and the controllability of the source differ between emergency and existing exposure
situations. Protective actions must be implemented urgently and in a timely manner to maximize
effectiveness in an emergency exposure situation, generally on the basis of estimated doses. In theexisting exposure situation, planning protective actions can only be done on the basis of goodknowledge of the actual conditions of exposure to control the pathways, and often based on
measured individual doses.
12. Restricting individual doses of members of the public
As the accident released large amounts of radioactive materials into the habitat, the issue on how to
restrict doses to members of the public became crucial. In terms of radiological protection theevacuation and food restrictions that were adopted at the time by the authorities effectively reduced
the dose received by people living in the affected area. In selecting the reference levels in some7

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areas under a de facto emergency exposure situation, the authorities tried to follow the situationbased approach recommended by ICRP. In deriving the criteria, the regulatory authority selected areference level of 20 mSv/y, while the dose limit for planned exposure situations was (and continues
to be) 1 mSv/y.
However, people living in the affected areas were confused with the logic behind the restrictions
applied to individual doses, in what was perceived as a mixture of the pre-emergency, emergency
and post-emergency protection policies. The fact that the reactor conditions continued to be notcompletely stable for a long time was not helpful. A state of uncertainty arose among the public atlarge, and also among authorities, on the individual dose restrictions recommended for public
protection, fundamentally between the dose limit of 1 mSv/y and the various reference levels goingup to 100 mSv.
There seems considerable discrepancy in understanding the dose value of 1 mSv/y. The generalpublic and society at large tend to regard a dose above this value dangerous and consequently thiscreates a lot of complications in coping with radiological events.
Decisions on the levels used for restricting public doses are naturally controversial because they
involve judgments on individual acceptability of risks. The issue becomes exceptionally difficult in aradiological emergency, where doses are difficult to control but people expect to be particularly well
protected. The logic behind different levels of restrictions according to the prevailing circumstances
is difficult to grasp and accept not only by the public but also by the competent authorities.
While the current ICRP Recommendations do take account of most of the problems described on
individual dose restrictions, they perhaps fail to convey clearly the assurance for protection under
any circumstance demanded by the public. For instance, it is not clear for the public that thereference levels recommended for dealing with emergencies, while being levels of dose higher thanthe limits used for planned situations, still provide sufficient protection to members of the public. It isalso not clear what the rational is for the numbers recommended by ICRP.
13. Caring for infants and children
The protection of children in the accident aftermath has been of particular concern in Japan andparents are extremely worried about the protection of their offspring. They are suspicious that thelevels of dose applied to the protection of the population as a whole do not provide sufficient safety
for their offspring. They feel the reference level of 20 mSv/y is unacceptably high for children since
1 mSv/y is the established dose limit for the public.
A definite ICRP document with recommendations specifically dedicated to the protection of children
and infants is not available. The relatively small difference between the detriment adjusted nominal
risk coefficient for the population as a whole, which includes children, and those for the adult
population, i.e. around 30%, merits at least further consideration, particularly taking into accountthat new data on radiation risks of children have been recently reported.
14. Considering pregnant women and their fœtuses and embryos
Pregnant women are extremely concerned about the health effects of radiation exposure due to theaccident on themselves and their unborn child. Affording proper protection to fœtuses and embryos
has been controversial and unclear, even at the level of the medical profession. Concerns areespecially high with respect to exposures after uptake of radioactive material.
It seems that, while ICRP recommendations for the protection of pregnant women, fœtuses andembryos are detailed and available, they appear to concentrate on female workers and patients and8

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their fœtuses and embryos. Specific recommendations for female members of the public are notclearly available. This is especially the case for exposures after emergency and existing exposure
situations. In these situations the biokinetic specificities of certain radionuclides have to beconsidered including the biokinetic changes of some radionuclides during the different phases of thedeveloping embryos and fœtuses.
15. Monitoring public protection
Two main issues on monitoring the protection of the public have arisen in the aftermath of theaccident, as follows: what should be the general policy of environmental monitoring after an accident; and,
 why members of the public are not individually monitored while workers receive that benefit.
While recommendations are available on radiation monitoring for the protection of people living inlong term contaminated areas after a nuclear accident, there is a general lack of international
guidance on monitoring the radiological protection of the public in the more immediate aftermath ofan accident. This deficiency creates unnecessary public anxiety.
16. Dealing with ‘contamination’ of territories, rubble and residues, and consumer products
Following the accident, serious problems arose in relation to the presence of radioactive substancesoriginating from the accident in the public domain, including the surrounding environment andconsumer products. This situation caused serious concerns to the population and placed pressure
on the authorities to act.
The fallout of some of the releases from the accident has deposited radioactive substances overlarge territories. The issues for the authorities are whether these territories are ‘contaminated’ andwhether they have to be ‘remediated’ in order to allow their habitation. It seems therefore that there
is a strong connection between the misunderstandings of the concepts of ‘contamination’,‘remediation’ and ‘habitability’. For anxious members of the general public, the issue can besummarized in this simple question: Is it safe for me and my family to live in this territory?
The disposal of ‘contaminated’ rubble (and more so “cleaned up dirt”) is probably one of the mostserious issues in the aftermath of the accident. A fraction of the ‘contaminated’ rubble may contain
substantial amounts of radioactive substances, which may mean that it has to be treated asradioactive waste with the regulations required by relevant international conventions. The main
problem, however, is that most of the rubble is not really ‘contaminated’ but will be so perceived by
the public making its disposal an artificially serious issue.
It is expected that, following significant releases of radioactive substances into the environment, likethose from the accident, products used or consumed by the public, such as foodstuffs, water andnon-edible consumer products, may present slightly elevated levels of radioactive substances
attributable to the accident. While natural radionuclides are present in consumer products becauseof natural processes, the inclusion of artificial radionuclides following accidents is a serious issue
because it is perceived as the more pervasive process of incorporation of radioactivity. Its regulation
has been controversial and not straightforward. In fact, the control of these consumer products is
one of the main unresolved issues of practical radiological protection. It has created (and continues
to create) many problems for Japan in general and for the Fukushima region in particular.
In Japan, the authorities initially issued specific guidelines for food and drink intake restrictions,which differed to both the WHO guidelines (which are lower) and to the Codex Alimentarius (which
are higher). They were modified over time and the different values used were not necessarily helpful
to reduce the level of confusion. In sum, the international regulation of consumer products
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containing radioactive substances is bizarre and it is not surprising that it is causing so much
confusion in the Japanese public and authorities alike.
Some intergovernmental agreements have been reached for dealing with the contamination offoodstuff, drinking water and non-edible consumer products. However, these agreements areincoherent and inconsistent among them. Moreover, there are differences between consumer
products under accident conditions and in normal situations and also between domestic versus
international control and the available guidance is not specific on these issues.
The absence of clear quantitative international guidance for dealing with “contamination” in the
public domain, e.g., for remediating “contaminated” territories, disposing of “contaminated” debris
and rubble, or controlling “contaminated” consumer products, has caused many problems to theauthorities. In aftermath of the accident, this is one of the more important issues to deal with.
17. Recognizing the importance of psychological consequences
The radiation exposure situations created by the accident, probably combined with the outcome ofthe preceding catastrophic earthquake and tsunami, seems to be producing serious psychologicalconsequences in the affected population. The psychological consequences include the same typeof outcomes observed in other similar situations, such as depression, grieving, post-traumatic stressdisorder, chronic anxiety, sleep disturbances, severe headaches, and increased smoking andalcohol use. However, in many areas some other outcomes are observable, such as intense anger,
despair, long-term anxiety about health and health of children and, in particular, stigma anddiscrimination.
A recently published report by Japan’s Reconstruction Agency indicates that the stresses of
personal involvement in the evacuation, management and clean-up related to the Fukushima
nuclear accident have emerged as the biggest factors in ill health for Japanese people.
The accident has reconfirmed that psychological consequences are a major outcome from majorradiation accidents. While they are health effects in their own right, they are basically ignored inradiological protection recommendations and standards. Advance planning for emergencies should
recognise the necessity for dealing with psychological consequences and the concerns that may beengendered for decades following an accident. Responding to the mental health needs of thecommunity as a whole raises many challenges of preparation.
18. Fostering the sharing of information
As has happened in most previous accidents involving radiation exposure, it has been recognizedthat after the Fukushima accident, the communication between the radiological protection experts
and the authorities and between the authorities and the public at large has presented difficulties.
The accident experience reiterated how important communication is in the aftermath of a serious
accident involving radiation exposure of the public. Mistakes in communicating radiation risk andprotection measures to members of the public and the media have been made during previous
accidents and were repeated in this accident.
A number of lessons have been reconfirmed on various issues, including: the relevant role of the media in a serious accident;
 the importance of sharing information with the media regularly;
 as this was the first accident involving social networks, many lessons should be extracted
from this unique experience;
 the significance of involving non-radiation experts in the sharing of information; and,10

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the impact of sharing information with the medical profession and with teachers.

Recommendations
While substantive international guidance is available for tackling the issues addressed by the Task
Group, many lessons can be extracted from the accident experience. The Task Group recommends
that action should be taken by the Commission, to ensure that:
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radiation risk coefficients of potential health effects be properly interpreted;the limitations of epidemiological studies for attributing radiation effects following low
exposures be understood;
any confusion on protection quantities and units be resolved;
the potential hazard from the intake of radionuclides into the body be properly interpreted;
rescuers and volunteers be protected with an ad hoc system;
clear recommendations on crisis management and medical care and on recovery andrehabilitation be available;
recommendations on public protection levels (including infant, children and pregnant womenand their expected offspring) and on related issues (such as, categorizing public exposuresdue to an accident, transiting from an emergency to an existing situation, and rehabilitating
evacuated areas) be consistent and understood;
updated recommendations on public monitoring policy be available;
tolerable contamination levels for consumer products, rubble and residues be defined;
strategies for mitigating the serious psychological consequences arising from radiologicalaccidents be sought; and,failures in fostering information sharing on radiological protection policy after an accident be
addressed with recommendations to minimize such communication lapses.

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