Issues and Recommendations Associated with
Radiation Protection after Fukushima Daiichi Nuclear Power
Plant Disaster

28 November 2014
Japan Health Physics Society

Japan Health Physics Society

CONTENTS
1. Introduction
1.1 Objective
1.2 Fundamental policy in the elaboration of recommendations
2. Review of responses after accident from the viewpoint of radiological protection
2.1 Review on basis of investigative reports(1) Environmental radiation monitoring(a) Radiation monitoring on land
 Measurements of ambient dose rate, airborne dust, environmental samples and soils,
and aircraft monitoring Tap-water Agricultural and livestock products
 Foods
 Forests and subsoils of rivers and lakes(b) Coastal sea area monitoring Sea water, subsoils of ocean and sea products(2) Prediction of diffusion of radioactive materials(a) System for Prediction of Environmental Emergency Dose Information (SPEEDI) Utilization and dissemination of information yielded by SPEEDI up to March 15
 Utilization and dissemination of information produced by SPEEDI from March 16
onward Relationship between SPEEDI calculation results and evacuation measures(b) Simulation system on the diffusion of radioactive materials in the ocean(3) Evacuation of residents(a) Criteria and zones of evacuation and stay in house(b) Communication of measures of evacuation and stay in house(c) Implementation and cancellation of measures of evacuation and stay in house(d) Designation of deliberate evacuation zone and specific spots recommended forevacuation(4) Radiation exposure(a) Radiological protection criteria
 Criteria for administration of stable iodide
 Screening levels
 Criteria for contamination of soil, etc.
 Criteria for food and beverages
 Protective criteria for temporary entry into restricted zones
 Dose criteria for emergency work(b) Radiation exposure of residents
 Estimation of thyroid equivalent dose of radioactive iodine by simple measurement
 Internal dose assessment by whole body counter (WBC) External dose assessment by personal dosimeters External dose estimation on the basis of behavior survey(c) Radiation exposure of plant recovery workers
 Reservations of personal dosimeters, WBCs and protective tools, and administration1

Japan Health Physics Societyof stable iodine in emergency works
 Measuments and assessments of personal dose in emergency work(5) Communication to the public(a) Understanding of low dose radiation exposure(b) Mental health care(c) Communication through mass media and internet(d) Information delivery to oversea countries(6) Nuclear emergency preparedness(a) Nuclear emergency preparedness system and responses of relevant organization after
accident(b) Opportunity of revision of nuclear emergency preparedness for complex disasters(earthquake, tsunami, and nuclear accident)
2.2 Issues raised in the first JHPS recommendations
2.3 Issues and recommendations raised at the JHPS symposia(1) Special Symposium on the second Fukushima project (25 May 2013)(2) Special Symposium II on the second Fukushima project (22 February 2014)
2.4 Arrangement of issues
3. Recommendations from the viewpoint of radiological protection
3.1 Recommendations for protection of the public
3.2 Recommendations for protection of workers
4. Final remarks
References
Appendix I Voice record at Special Symposium of the Japan Health Physics Society on
the second Fukushima project (25 May 2013)
Appendix II Voice record at session 2 in Special Symposium II of the Japan Health
Physics Society on the second Fukushima project (22 February 2014)2

Japan Health Physics Society
1. Introduction
1.1 Objective
Soon after the Fukushima Daiichi nuclear disaster following the Great East Japan
Earthquake and subsequent tsunami, Japan Health Physics Society (JHPS) established a Q&A
section on our website and answered questions from the public in our capacity as a group ofradiation protection experts. In addition, we held symposia on measures for dealing with thenuclear disaster and their criteria on 16 June 2011 and on exposure to radiation among thegeneral public on 12 August 2011. We also held a session on the Fukushima Daiichi nuclear
disaster at the 44th JHPS Annual Meeting on 18 October 2011 to deepen understanding andpromote discussion about various topics related to the disaster. On 17 December 2011, we
also held a comprehensive symposium on measures for dealing with the Fukushima nuclear
disaster from the viewpoints of radiation exposure assessment and radioactive waste
management, focusing on internal exposure, to comprehensively discuss the Society’s
activities carried out over the year following the earthquake. After online consultation with
the JHPS members over a period of about one month, we completed a report of the first set ofrecommendations entitled “Issues Associated with Radiation Protection after Fukushima
Daiichi Nuclear Power Plant Disaster - Responses of and Recommendations from Japan
Health Physics Society -” (the first JHPS recommendations) and released it to the domestic
society on 17 April 2012. This first report was translated into English and presented at the13th International Congress of the International Radiological Protection Association(IRPA13); it was the JHPS statement to the international academic society (See Fig. 1.1.1). In
the final remark in the first recommendation report, there is the message “We will endeavor tofurther the study of health physics and radiation protection through future discussion andprovide useful references for local residents and administrative organizations. In the near
future, we will carefully analyze the actual state of the Fukushima area to propose
recommendations in cooperation with overseas associated societies such as the Asian andOceanic Association for Radiation Protection (AOARP), the International Radiation
Protection Association (IRPA), and the Health Physics Society in the US.”During the 2012 fiscal year, investigative reports were released by the Investigation
Committee on the Accident at the Fukushima Nuclear Power Stations of Tokyo ElectricPower Company (Governmental Final Report, 23 July 2012; Interim Report, 26 December2011), the National Diet of Japan Fukushima Nuclear Accident Independent Investigation
Commission (National Diet Report, 5 July 2012), the Independent Investigation Commission
on the Fukushima Nuclear Accident (Nongovernmental Report, 27 February 2012), and theTokyo Electric Power Company (TEPCO report, 20 June 2012). These reports have clarified
the facts of the accident, and recommendations were made towards the prevention ofrecurrence and minimization of the damage. However, some knowledgeable person pointed
out the necessity of reviewing these investigative reports from the viewpoint of an expert in
the field of radiological protection, which is the foundation of our societies’ existence,
because radiological protection experts did not fully engage in the investigative committees.
Moreover, in section 2 “Recapitulation of Major Issues” in chapter VI “Wrap-up andRecommendations”, it is recommended that “The government, nuclear operators, nuclear
plant manufacturers, research institutions, academies, and all such stakeholders (relevantorganizations) involved in nuclear power generation should take active roles in investigating
the accident and in fact analyses, and continue, in their respective capacities, their
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comprehensive and thorough investigations of the remaining unresolved problems.” In thissense, JHPS, involving many radiological protection experts, has a responsibility to continue
making recommendations associated with radiological protection related to the Fukushima
Daiichi nuclear disaster.
Under such circumstances, JHPS established a new project for making comprehensive
recommendations on radiological protection, and decided to review how radiologicalprotection measures after an accident should be carried out on the basis of concrete facts
clearly described in the investigative reports and opinions collected at the JHPS symposia,
and in elaborate comprehensive reports on the second set of recommendations encompassing
the first set of recommendations.

Fig. 1.1.1 Issues Associated with Radiation Protection after Fukushima Daiichi Nuclear
Power Plant Disaster - Responses of and Recommendations from Japan Health Physics
Society - (The first set of recommendations)
1.2 Fundamental policy in the elaboration of recommendations
In the elaboration of the recommendations, emphasis was placed on the viewpoint of how
we should evolve the current radiological protection system overseeing various radiologicalprotection measures in an emergency on the basis of concrete facts clarified frominvestigative reports and the JHPS symposia. The recommendations were described so as toindicate the direction in which the radiological protection system should move toward in the
future, utilizing JHPS’s connections with many radiological protection experts.
JHPS is the only Japanese association that participates in the International RadiologicalProtection Association (IRPA). JHPS must not monopolize the contents of therecommendations within Japan and has the responsibility to continuously strive to share therecommendations with radiological protection experts overseas. For this reason, we decided
to elaborate the second set of recommendations on the assumption that JHPS will translate thesecond set of recommendations into English in the same way as the first set and disclose the4Japan Health Physics Society
recommendations to the world.
On the basis of the above policies, the second set of recommendations were elaborated
keeping in mind that the recommendations are not only for the Japanese government,
regulatory organizations and specific experts in radiological protection; they must also be
understood by experts worldwide from each standpoint and be able to be utilized
independently. For this reason, we constructed this report in the following manner. Chapter 2
includes issues identified by referring to and reviewing investigative reports and summarizes
various radiological protection measures to be implemented in an emergency so that experts
overseas can correctly understand concrete facts with regard to responses after the accident.
Chapter 3 includes recommendations related to radiological protection for the public andworkers. Chapter 4 contains the final remarks.

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2. Review of responses after accident from the viewpoint of radiological protection
2.1 Review on basis of investigative reports, etc.
In this report, the following investigative reports are reviewed. Please note that we havetranslated the Nongovernmental Report into English, as it was originally published inJapanese only.
 Investigation Committee on the Accident at the Fukushima Nuclear Power Stationsof Tokyo Electric Power Company, Interim Report, 26 December 2011,[Governmental Interim Report] 1)
 Investigation Committee on the Accident at the Fukushima Nuclear Power Stationsof Tokyo Electric Power Company, Final Report, 23 July 2012, [Governmental
Final Report] 2)
 National Diet of Japan Fukushima Nuclear Accident Independent Investigation
Commission, Report, 5 July 2012, [National Diet Report] 3)
 Independent Investigation Commission on the Fukushima Nuclear Accident, Report,
27 February 2012, [Nongovernmental Report] 4)
 Tokyo Electric Power Company, Fukushima Nuclear Accident Analysis Report, 20
June 2012, [TEPCO Report] 5).
Regarding “dose estimation results due to intake of foods” and “external dose assessment
using personal dosimeters” that are not involved in the above 5 reports, the following
information in Japanese is referred to. Please note that we have translated theNongovernmental Report into English, as it was originally published in Japanese only.
 Estimation of radiation exposure due to intake of foods (in Japanese), 30 October
2011, [the Ministry of Health, Labour and Welfare (MHLW) HP (30 Oct. 2011)]
6)

 Measurement results of amount of intake of radioactive materials from foods (inJapanese), 11 March 2013, [MHLW HP (11 Mar. 2013)] 7)
 Fukushima Health Management Survey (in Japanese), the 1st meeting of the study
team on health effects on the residents from the Fukushima Daiichi Nuclear Accident,
30 November 2012, [Nuclear Regulation Authority (NRA) HP] 8)
 Exposure dose obtained in the present stage (in Japanese), 26 April 2012
[Fukushima Prefecture HP] 9)
 Measurement results of personal dosimeters (glass badge) (in Japanese), 17 January
2012 [Fukushima city HP] 10)
The cited parts associated with concrete facts from investigative reports are described
below in small font in the order of the above five investigative reports. The source of citation
is indicated by the abbreviation in brackets [ ]. Important parts of the concrete facts inrelation to the radiological protection related issues are underlined.

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Japan Health Physics Society(1) Environmental radiation monitoring
Radiation monitoring data obtained after a nuclear accident provides significant
information for designating evacuation areas to restrict radiation exposure of residents andareas, from which to restrict food, beverages, and the shipment of agricultural products,
and for estimating the amount of discharged radioactive materials to understand the detailsof the accident. The aim of radiation monitoring after a nuclear accident can be categorized
into land area monitoring (including aircraft monitoring of air radiation dose rates at aheight of 1 m from ground level and the accumulation of radioactivity in the land surface,and monitoring of tap water and food) and coastal sea area monitoring. The daily
monitoring of inhabited areas is a significant target of disaster measures. Coastal sea area
monitoring, however, became an important target of radiation monitoring after the Great
East Japan Earthquake and subsequent tsunami, since the Fukushima Dai-ichi Nuclear
Power Station (NPS) faces the sea, most of the radioactivity released into the air fell into
the sea, water contaminated with a high level of radioactive materials was discharged
through cracks in the concrete, and approximately ten thousand tons of water contaminatedwith a high level of radioactive materials was intentionally discharged into the sea to free
up storage space for high-level contaminated water. An overview of how the radiation
monitoring was carried out and the issues identified are described below.
(a) Radiation monitoring on land
 Measurements of ambient dose rate, airborne dust, environmental samples and soils,
and aircraft monitoring
Descriptions about measurements of ambient dose rate, airborne dust,
environmental samples and soils are given in [Governmental Interim Report] and[National Diet Report] in the following way.
a. Role sharing among the central government, local governments, and nuclear power
operators before the accident occurred
The “Basic Disaster Prevention Plans” created by the Central Disaster Management Council
stipulates that the radiation monitoring at the nuclear disaster should be undertaken by local
governments; and that the Ministry of Education, Culture, Sports, Science and Technology(hereinafter referred to as "MEXT"), operators, and designated public institutions including the
National Institute of Radiological Sciences (hereinafter referred to as "NIRS") and Japan Atomic
Energy Agency (JAEA), should support the emergency monitoring of local governments bymobilizing both a mandatory emergency monitoring workforce and all necessary equipment todisaster-stricken areas.
According to the "Nuclear Emergency Response Manual" (hereinafter referred to as the "NE
Response Manual", after the declaration of a nuclear emergency, a radiation monitoring teamfrom the Nuclear Emergency Response Local Headquarters (“Local NERHQ” ) of Japanese
Government should collect and arrange radiation monitoring data. Such data will provide thebasis for establishing which areas will be evacuated of all residents, as well as determining where
the consumption of food and drink by the residents is to be restricted or forbidden. Moreover, theNE Response Manual stipulates that if a nuclear accident has occurred at a commercial reactor,
the local NERHQ should provide a comprehensive summary of all monitoring data to theSecretariat of the Nuclear Emergency Response Headquarters (hereinafter referred to as the"METI-NERHQ), which is located at the Emergency Response Center (ERC) of the Ministry of
Economy, Trade and Industry (“MITI”), and that the NERHQ Secretariat should provide this data
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to the Cabinet Secretariat of the Nuclear Safety Commission (hereinafter referred to as the"NSC"), as well as all other designated administrative agencies.
The Fukushima regional disaster prevention plan stipulates that the Fukushima prefectural
government should implement monitoring tasks even during normal times, that they should makeprovisions to take swift countermeasures if they receive a report of any unusual state of affairs
based on the Act on Special Measures Concerning Nuclear Emergency Preparedness, and thatthey should make an effort to be well-positioned to implement emergency monitoring. This
includes the need to work out a radiation monitoring strategy, prepare and maintain radiation
monitoring facilities and equipment, secure all required radiation monitoring personnel, andensure cooperation among relevant organizations.
The Fukushima prefectural government has monitoring posts established in twenty-four
locations based on the Fukushima regional disaster prevention plan. Moreover, the Fukushima
prefectural government constantly observes the radiation levels in the surrounding areas of thenuclear power station, which are measured through the monitoring posts operated byEnvironmental Radioactivity Monitoring Centre (hereinafter referred to as the "Monitoring
Center"), which is adjacent to the emergency preparedness and response center (hereinafterreferred to as the "Off-site Center"). The prefectural government has a total of thirteen
monitoring cars for all relevant organizations including the off-site center. In addition, the local
government's analytical equipment includes four germanium semiconductor detectors as well as
NaI scintillation detectors located within the Monitoring Center.
Concerning nuclear operators' roles in monitoring, the Basic Disaster Prevention Plans
stipulates that nuclear operators should prepare and maintain all the required measuring
equipment (for each nuclear operator's facility), including site border monitoring posts, portable
type measuring instruments and stack monitors in order to ensure that monitoring results arereported accurately when a specific incident occurs, and that nuclear operators should continue
monitoring at site borders in order to notify the Nuclear Emergency Response Local
Headquarters of any monitoring results.
Based on this stipulation, the Nuclear Operator Emergency Action Plan" of the Tokyo ElectricPower Company (hereinafter referred to as "TEPCO") stipulates that the health physics team of
the Emergency Response Center, which is to be established at the Emergency Response Control
Room in the Seismic Isolation Building of the power station, should be in charge of monitoring
activities if an accident occurs at either the TEPCO Fukushima Dai-ichi Nuclear Power Station(hereinafter referred to as the "Fukushima Dai-ichi NPS") or the TEPCO Fukushima Dai-ni
Nuclear Power Station (hereinafter referred to as the "Fukushima Dai-ni NPS"). With regard tomonitoring equipment, TEPCO has eight monitoring posts, 14 stack monitors (two stackmonitors for each stack), six liquid discharge monitors, and one monitoring car (located at the
Fukushima Dai-ichi NPS).
Government's NE response manual stipulates that the monitoring data collected by the Local
NERHQ is to be released to the public. The Local NERHQ radiation monitoring team shall createpress releases on emergency monitoring for press conferences. The Local NERHQ public
relations team shall deal with the press and all PR presentations and answer reporters' questions,while maintaining close contact and cooperation with the Local NERHQ administrative team, theSecretariat of the NERHQ and the PR groups of the emergency response headquarters of various
local governments. In addition, TEPCO shall publish all data collected through the monitoring
posts and stack monitors installed in each power station on its homepage.
This section mainly describes monitoring activities concerning the decisions the Government
makes to limit the extent of any hazards.

b. The primary monitoring activities that were conducted outside the premises of the
Fukushima Dai-ichi NPS after the accident
As a result of the earthquake and the ensuing tsunami damage, 23 of the 24 monitoring posts
the Fukushima government had installed in the prefecture were rendered inoperative, the sole
exception being the one installed at Ono station. In addition, due to severe earthquake damage,8

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two of the four germanium semiconductor detectors that had been installed at the Monitoring
Center were rendered inoperative.
The Fukushima prefectural government discussed the possibility of monitoring being
conducted via monitoring cars starting on March 11, 2011. They determined, however, that it
might be too risky to conduct monitoring at night with caved-in roads and widespread power
failure. Instead, they started the monitoring early in the morning of March 12, 2011.
Also, following the nuclear accident on March 11, 2011, the Ministry of Education, Culture,
Sports, Science and Technology decided to dispatch monitoring cars to the Off-site Center,pursuant to the National Basic Disaster Prevention Plans. However, it was sometime late in theevening of March 12 that they actually issued directions for their dispatch. It was around 11:20
the next day on March 13 that their professional support members arrived at the Monitoring
Center.
From March 13, staff from the Fukushima local government as well as the national
government used the monitoring cars, working together to conduct monitoring activities such asmeasuring radiation doses in the air, collecting dust suspended in the atmosphere, environment
samples and soil samples based on the radiation monitoring strategy developed by the staff of theMonitoring Center and accepted by the Local Emergency Response Headquarters (Local
NERHQ). The collected samples were analyzed using the two germanium semiconductor
detectors, located at the Monitoring Center. The results of the analysis were reported to the Local
NERHQ located at the adjacent off-site center.
The initial monitoring activities did not work out as intended due to a host of reasons
including hazardous road conditions from earthquake damage, flat tires, vehicles that had fallen
into cracks in the ground and fuel shortages. In addition, as described in Chapter III 5(1) b5, it
was difficult to consolidate the monitoring data for sharing with the Secretariat of theGovernment Nuclear Emergency Response Headquarters (NERHQ) and other agencies since theOff-site Center had very limited means of communication due to widespread power failure.
The Local NERHQ and the Prefectural Nuclear Emergency Response Center have played acentral role in conducting monitoring activities since March 15, when the Local NERHQ that had
been located at the Off-site Center, was moved to the Fukushima Prefectural Office.
[Governmental Interim Report] Chapter V 1 (1)MEXT started to discuss monitoring by aircraft in order to do survey a wide area from around
March 12 and released its "MEXT Aircraft Monitoring Action Program" on March 25. On thesame day, with the cooperation of the Japan Aerospace Exploration Agency (JAXA), an
independent administrative organization, the Ministry measured the levels of radiation in the air
beyond 30km from the Fukushima Dai-ichi NPS. In response to a request from MEXT, the Self
Defense Forces measured the concentration of radioactive materials in airborne dust particles
above Fukushima Prefecture between March 24 and April 1.
In addition, the Japanese and US Governments met to start discussing how the two nations
could cooperate to conduct aircraft monitoring in a U.S.-Japan conference (hereinafter referred toas the "U.S.-Japan conference"), which began around the end of March. Previously, the UnitedStates Department of Energy (DOE) had independently conducted aircraft monitoring after the
nuclear accident. Two subsequent joint U.S.-Japan aircraft surveys were conducted.
[Governmental Interim Report] Chapter V 1 (2)c. Problems in utilizing the monitored data
After the tsunami’s onslaught on March 11, the loss of electric power placed the Fukushima
Dai-ichi NPS in a crisis situation. The Reactor Unit 1 building explosion the next day (March 12)
heightened the fears of nearby residents regarding airborne radioactive substances. In such asituation, if explanations to the resident population are to be persuasive, they absolutely must bebacked up by monitored data. However, during the first five days of the emergency situation, thelocal NERHQ at the Off-site Center experienced a quake-induced telecommunications
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breakdown, hindering its response to the monitored data. What could be done about themonitored data during this period was that the NERHQ secretariat released only some of the datait had received.
In the midst of a situation where the local NERHQ was not functioning, and when highradiation dose levels were being registered at Hirusone in Namie-machi during the night ofMarch 15, a clear-cut delineation of roles had still not been established for evaluating those kindsof high readings and disclosing information about them. Competent personnel were at a loss on
how to proceed. It was only beginning on March 16 that the Government delineated roles for thebodies responsible for monitoring data, and that the Ministry of Education, Culture, Sports,
Science and Technology (MEXT) compiled and released the data to the public.
This shows how the emergency response during the initial stages of the accident was confusedin its use and management of monitored data. The disclosure of obtained monitored data wasespecially problematic — the Government did not demonstrate a readiness to quickly disclose it,
and even when a disclosure was made, only fragments of part of the information were released.
Because the Chief Cabinet Secretary was giving press conferences on a regular basis on mattersthat included an evaluation of monitored results, the NSC did not disclose the results ofmonitored data assessments until March 25.
The fact that the competent authorities did not take proactive steps to disclose information on
monitored results would seem to indicate a mindset that gave little priority to the lives anddignity of residents who were incurring harm and damage from the dispersion and contaminationof radioactive substances, and gave little regard to the importance of disclosing data. Factors
leading to these failings include: (i) local disaster readiness systems and evacuation plans had
been drawn up only for form’s sake, without a realistic vision of the type of situation local
residents would face if a major nuclear accident were to emit large quantities of radioactive
substances; and (ii) the competent authorities had no deep-seated awareness of the importance of
telling residents about the various risks in the event of a major accident at a nuclear power plant,
beginning with what they would desperately desire — as their need would grow for information
to help them understand the situation they would find themselves in, they would want theauthorities to disclose that information rapidly.
[Governmental Interim Report] Chapter VII 5

3.5.3 Fukushima’s initial emergency monitoring response
Fukushima Prefecture was unable to promptly conduct emergency monitoring, as the
emergency monitoring equipment was unusable. Some posts had been washed away by thetsunami and communication lines had been severed by the earthquake; only one of the 24
monitoring posts was functioning normally following the accident. The mobile monitoring posts
could not be used until March 15 due to damage to the communications networks. Monitoringcars were also unavailable due to a lack of fuel.
1) The intended role of municipal governments in emergency monitoring
Data from environmental radiation monitoring is tremendously important in determining
evacuation zones and providing evacuation guidance. The inability to acquire such data
significantly impacted the implementation of protective measures for residents.
According to the Fukushima Prefecture regional disaster prevention plan, the prefecture is toestablish and maintain monitoring posts and secure monitoring personnel. The plan states that
following the declaration of a nuclear emergency situation, the prefectural government is tocompile emergency monitoring results and communicate the results to personnel dispatched to
the Off-site Center.

2) Inadequate initial data collection
In accordance with the Basic Plan for Emergency Preparedness and the Fukushima Prefecture
regional disaster prevention plan, Fukushima Prefecture established 24 monitoring posts in the
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prefecture and monitored the data at the Environmental Radioactivity Monitoring Center ofFukushima Prefecture. The prefecture also built a system for publicizing this data on its website
and other channels. However, four of the 24 monitoring posts were washed away by the tsunami
and another 19 were unable to transmit data due to severed communication lines. This meant that
there was only one normally functioning monitoring post, making it impossible for Fukushima
Prefecture and the national government to gather the necessary data from environmental radiation
monitoring.
Staff from the Environmental Radioactivity Monitoring Center established two transportable
monitoring posts, beginning from the early morning of March 12. However, the center was
unable to collect data until March 15 due to communication failures in cellular phones used indata transmission.
The Prefectural Nuclear Emergency Response Headquarters conducted monitoring, starting in
the early morning of March 12, using prefectural monitoring cars equipped with diverse data
retrieval and analysis features. However, difficulties obtaining fuel halted opera-tions on March
13. When the officials withdrew from the Off-site Center on March 15, there was no choice but
to leave their equipment behind, including the empty monitoring cars.
Emergency monitoring was launched in Fukushima Prefecture using emergency support
personnel and equipment sent from other prefectures that were hosting nuclear power plants. The
monitoring results were to be reported to the Environmental Radioactivity Monitoring Center but,as the radio signal would not reach the center from distances over 10 km, personnel had to return
to a location within the signal range, hampering prompt data collection. As mentioned in 3.2.3, 3,
since the prefecture was unable to secure adequate assistance from MEXT, sufficient emergency
monitoring was not generally carried out in the initial response.
[National Diet Report] Chapter 3, 3.5.3

Descriptions about aircraft monitoring are given in [Nongovernmental Report] inthe following way.
6. Aircraft monitoring was not utilized
Regarding the significantly important environmental monitoring to clarify the diffusion
situation of radioactive materials, Department of Energy (DOE) of the United States analyzed theradiation dose around the Fukushima Dai-ichi NPS and disclosed the estimated values on 22
March 2011 on the basis of data obtained using a U.S. armed forces drone over more than 40hours from 17 to 19 March and measuments on the ground. Japan had also prepared an aircraftsurvey system, but the first measument was not carried untill 25 March. The operation could not
be done in the earlier stage?
According to “Guidance of environmental radiation monitoring”, there are some merits inaircraft monitoring, for example, “It is an effective means for determining protective measures torapidly clarify the regions affected by the diffused radioactive plume and estimate the magnitudeof the release of radioactive materials by travelling through the radioactive plume in aircraft” and“the release and diffusion of radioactive materials can be investigated in the no-entry regions
rapidly and broadly avoiding excess radiation exposure of passengers by keeping a long distancefrom the NPS”.
The Nuclear Safety Technology Center (NUSTEC) has developed and maintained an aircraftsurveillance system, and SPEEDI was operated by a team using a simplified survey system onboard a helicopter that moved a team from the Self-Defense Forces from Rokkasyo village in
Aomori prefecture. The simplified aircraft survey system is “for the purpose of clarifying the
diffusion of radioactive materials released from a nuclear facility in the first-step monitoring that
requires rapidness immediately after an accident at a nuclear facility”. “The system consists ofportable equipment to measure the radiation dose rate”. “By making the system portabe, easymeasurement using this system with good portability and transported as a carry-on baggage in a
municipality’s helicopter for emergency use became possible without selecting a type of aircraft”.
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However, the NUSTEC hurriedly traveled to Fukushima prefecture by truck since most of all
helicopters were being utilized for rescue activities for the damage of the earthquake and tsunami.
Finally, the date of arrival was 14 March. On 15 March, the NUSTEC went near the Fukushima
Daiichi NPS by using a Self-Defense Forces helicopter with measument equipment, but there
was no way except for returning. Moreover, after that, the NUSTEC unavoidably remained onstandby because no helicopter could be chartered from the Self-Defense Forces owing to thegreat number of missions. Monitoring was started on 25 March using a helicopter chartered froma non-governmental organization and a Cessna plane chartered from the Japan Aerospace
Exploration Agency (JAXA). The NUSTEC had equipment for detailed aircraft monitoring, butthey had to alter the helicopter to load it. The detailed aircraft monitoring could not be carried out
until the preparation was completed on 6 April.
Some people say that it was more technically difficult to use the aircraft monitoring results for
the SPEEDI retrospective estimation rather than to use the monitoring results on the ground. It
was simultaneously clarified that there were gaps between the United States and Japan in terms
of preparedness and techniques for aircraft monitoring. Regarding the technical aspects, Mr.
Hosono, the Nuclear Accident Minister, said “The aircraft monitoring system of the U.S.DOE iseasier to use in the process of monitoring. The AMS [aircraft monitoring system] was used in theactual analysis, but the system for visualizing a map in the United States is more appropriate.
Frankly, I think that even now, the aircraft monitoring system of the U.S.DOE is used rather thanthe AMS in Japan, which indicates there is a gap in the technology.” The equipment for detailed
monitoring in the United States could be used without altering the airplane; in contrast, that inJapan required a particular specification. For the research and development of the preparedness
plan for crisis response, it is necessary to be aware of the practical use of the equipment assumingthat various situations may occur in an emergency or crisis.
[Nongovernmental Report] Part 2 Chapter 5 Section 6

The following isssues can be raised in association with Radiation monitoring on
land.
Radiation monitoring on land – unexpected effects on means of transportationand communication
 Radiation monitoring on land could not proceed following the previously
determined emergency preparedness plan owing to unexpected effects due toroad damage, widespread power failure, fuel shortages in monitoring cars,
damage to communications networks, and delay in the preparation ofhelicopters.
Radiation monitoring on land – monitoring posts washed away andcommunication lines severed Four of the 24 monitoring posts established by Fukushima Prefecture were
washed away by the tsunami and another 19 were unable to transmit dataowing to severed communication lines, which resulted in 23 monitoring
posts being inoperable.
 Tap-water
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Descriptions about tap water monitoring are given in [Governmental Interim
Report] and [Nongovernmental Report] in the following way.
f. Restriction of tap water intake
With the exception of the Index developed by the NSC (300Bq/kg for radioactive iodine and
200Bq/kg for radioactive cesium), no provisional regulation value has been defined for tap water.
On March 18 of the same year, 170Bq/kg of radioactive iodine was detected in tap water that
had been collected in Fukushima-city on March 16. In response to this, the MHLW started to
discuss developing criterion values for tap water just as they had for food and beverages. On
March 19, the MHLW notified all municipalities of "Measures to be taken for tap water to protect
citizens from radiation exposure resulting from the Fukushima Dai-ichi NPS and Fukushima
Dai-ni NPS," which included: (i) refraining from drinking tap water exceeding index values
indicated by the NSC (300Bq/kg of radioactive iodine, 200Bq/kg of radioactive cesium); (ii) tap
water may be used for domestic use without any concern; and (iii) drinking tap water is not
restricted if there is no access to alternative drinking water.
This notice did not mention drinking water for infants. Subsequently, more than 100Bq/kg ofradioactive iodine was detected in tap water in Fukushima-city. On March 21, the MHLW
notified municipalities to the effect that water suppliers should promptly inform citizens to
refrain from providing tap water to infants if their tap water exceeded 100Bq/kg of radioactive
iodine.
Additionally, the monitoring of tap water was strengthened. On March 18, MEXT notified all
local governments of the "Strengthening of monitoring of environmental radioactivity levels
nationwide in an emergency at the Fukushima Dai-ichi NPS and Fukushima Dai-ni NPS" to theeffect that nuclide analysis of clean water (tap water) should be performed and the results should
be reported to MEXT. Moreover, on March 21, the MHLW asked all local governments toprovide the ministry with tap water monitoring information that had been requested by MEXT as
well as any additional tap water monitoring information, if available.
Subsequently, based on the results of that monitoring, the MHLW asked municipalities torestrict the intake of tap water if their tap water supply was found to contain levels exceeding theindex value.
On April 4 of the same year, based on up-to-date monitoring results, the MHLW issued a"Future monitoring policy on radioactive materials in tap water," in which monitoring policy,
intake restrictions and guidelines for lifting restrictions were stipulated (this policy was revisedon June 30 of the same year, based on the premise that the effects of the Fukushima Dai-ichi NPS
accident were going stabilize.
[Governmental Interim Report] Chapter V 1 (1)Water contamination and drinking restrictions
On March 15, the MHLW—noting “the necessity of imposing restrictions on the consumptionof water, including drinking water”—announced to all regional governments that the Nuclear
Emergency Response Headquarters would make all decisions on the matter in accordance with
the Nuclear Emergency Act. In the announcement, there were guidelines for restricting food andwater consumption that would serve as input for the headquarters’ decisions in establishing
restrictions. On March 18, MEXT requested that all regional governments test the tap water intheir localities and report the results to MHLW for purposes of assessing the progress ofmonitoring activities in various regions. On March 19, regarding the monitoring results of the tap
water found to exceed the guideline level for restricting food and water consumption, MEXT
issued the following notification: (1) Consumption of water found to exceed guidelines should be
reduced. (2) Using this water for other purposes in daily life is not problematic. (3) In the absenceof any alternative source of drinking water, the water may be consumed.
Announcements of actual consumption restrictions were made by local water bureaus in cityand regional governments. For example, in Tokyo water restrictions were imposed between
March 23 and 24, and in the town of Iitatemura in Fukushima Prefecture water restrictions were13

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in place between March 21 and April 1 (and until May 9 for nursing infants).
(Omission)
3. Examples of the detection of radioactive material in tap water exceeding the regulatory
value (Tokyo and Fukushima)
This example is about the intake of tap water where radioactive materials are detected beyond
the regulatory value. Regardng tap water, the government or municipality cannot take enforced
action on behalf of consumers, which is different from the case of the above-mentioned
agricultural and livestock products. Therfore, the final judgment on whether or not to drink tap
water is left to the individual including a balance among the other health risks. The contaminationof tap water and the restriction of intake have already been mentioned above. The two findings in
the Tokyo Metropolitan area and Iidate village in Fukushima prefecture are described below.
The Waterworks Bureau in the Tokyo Metropolitan area announced on 23 March thatradioactive iodine 131 was measured at 9 o’clock on 22 March in the Kanamachi filtration plantexceeding the temporary regulation value for tap water for an infant (The measured value was
210 Bq/kg, the temporary regulation value for infants was 100 Bq/kg). Simultaneously, theyissued advice to refrain from providing tap water to infants in the region of the twenty-threewards of Tokyo and the Tama area. On 24 March, they announced that it was safe to provide tap
water to infants because the concentration decreased to 79 Bq/kg, which was below theregulation value.
Meanwhile, since bottled water could not be obtained in many areas, there were severe cases
in which people ultimately had to decide for themselves whether to drink tap water including
radioactive materials or to refrain from drinking water and whether or not to continue breast
feeding out of concern regarding the transfer of radioactive materials from mother to child. The
Tokyo Metropolitan area distributed 240,000 plastic bottles of water to the regions affected by
the notification to refrain from drinking tap water (especially for families with infants).
Government and scientific society announced their views and technical advices on the intakeof tap water by infants and pregnant women. In an announcement from the MHLW on 21 March,
to refrain from drinking tap water when the radioactivity level exceeded the temporary regulationlevel unless alternative drinks could be ensured. On 24 March, three scientific societies (Japan
Pediatric Society, Japan Society of Perinatal and Neonatal Medicine, and Japan Society forPremature and Newborn Medicine) provided advice on the hazards of providing mineral water toinfants and refraining from drinking water in comparison with the dangerousness of radiation in ajoint statement. On the same day, in the presentation of the Japan Society of Obstetrics andGynecology, pregnant women were cautioned regarding the risk of refraining from drinking
water.
The radioactivity concentration in each filtration plant including Kanamachi gradually
decreased after 25 March. From early April, the concentration in every filtration plant wascontinuously less than the lower detection limit (the lower detection limit differs from place toplace, but is approximately 1 Bq/kg).
Next, the case of Iidate village in Fukushima prefecture is described below. On 21 March,
Iidate village in Fukushima prefecture announced that 965 Bq/kg of radioactive iodine was
detected in tap water (the date of the sampling was 20 March). This value exceeded thetemporary regulation value of 300 Bq/kg (100 Bq/kg for infants). In response to this, Iidate
village residents were instructed to refrain from drinking tap water. After that, the measured value
decreased. In the inspection results announced on 2 April and sampled on 28 March, theradioactivity concentrations in all three filtration plants (Hanatsuka, Takisita and Tajiri) were lessthan 100 Bq/kg. The restriction regarding the drinking tap water was cancelled on 1 April except
for infants and that for infants was cancelled on 9 May.
Regarding tap water, the government or municipality cannot take an enforced action to restrict
its supply and intake. Therefore, it was necessary for individuals to judge the trade-off between
the risks of drinking water including low levels of radioactive material and not drinking water.
The government should have suggested appropriate information as the basis for making judgment
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and carried out proper risk communication.
Moreover, in the case of Iidate village, the instruction to restrict drinking of tap water wascontinued for a long time (ten days) compared with Tokyo metropolitan and the restriction for
infants was kept for more than one and a half months. In addition to the above-mentioned risk
communication, this case should be examined from the viewpoint of whether or not acountermeasure of distributing drinking water is necessary (particularly for families including
infants) and whether the period untill the cancellation of the restriction instruction regarding theintake of tap water is appropriate. In particular, for the latter viewpoint, after the measurement
results of radioactivity concentration firstly decreased to less than 100 Bq/kg on 26 March(sampled on 24 March) in Hanatsuka and Takishita filtration plants and on 30 March (sampled on
29 March) in Tajiri filtration plant, the concentration continuously decreased. Since almost all themeasurement results were below the lower detection limit after 11 April (the lower detection limit
varied among equipment and measurement conditions, but was approximately 5 - 15 Bq/kg), it ispossible that the restriction period should have been shorter considering the other risks of therestricted intake of water.
[Nongovernmental Report] Part 1 Chapter 2 Section 2

The following isssues can be raised in association with tap water monitoring.
Tap water monitoring – communication method with publicAfter notification on 23 March 2011 to refrain from providing tap water toinfants in the 23 wards of Tokyo and the Tama area, the radioactivity
concentration in tap water on 24 March decreased to below the regulation
value. For this reason, it was announced that tap water may be used without
any concern, including for infants. However, since mineral water could not
be obtained in many areas, there were actually severe cases whereby people
ultimately had to decide for themselves whether to drink tap water
including radioactive materials or to refrain from drinking water andwhether or not to continue breast feeding owing to concern of transferring
radioactive materials from mother to infant.

 Agricultural and livestock products
Descriptions about Shipping restrictions and monitoring of agricultural andlivestock products are given in [Governmental Interim Report], [Governmental
Final Report], [National Diet Report] and [Nongovernmental Report] in thefollowing way.
g Shipping restrictions
The National Basic Disaster Prevention Plan stipulates that the national government shallconduct research on the radioactivity contamination of food and beverages to determine effective
and useful measures and, if necessary, instruct relevant organizations to restrict the shipment
and/or intake of any contaminated food and beverages.
On March 15, a high concentration of radioactive material was detected in weeds that had
been collected (refer to b above). On March 17 of the same year, the NERHQ started a discussion
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on measures to be taken for contaminated food and beverages.
On March 19 and 20, radioactive material exceeding the temporary regulation value was
detected in: (i) raw milk from Fukushima prefecture; (ii) spinach from Ibaraki, Tochigi andGunma prefectures; and (iii) leafy vegetables from Gunma prefecture. In response to this, on
March 21, head of the Government Emergency Response Center provided the leaders of the
Fukushima, Ibaraki, Tochigi, and Gunma prefectural governments with instructions to restrict
shipment based on Paragraph 3, Article 20 of the Act on Special Measures Concerning Nuclear
Emergency Preparedness, of (i) raw milk from Fukushima prefecture, and (ii) spinach and leafy
vegetables from Ibaraki, Tochigi and Gunma prefectures. Additionally, on March 22, it was
discovered that a high concentration of radioactive material was detected in some vegetablesfrom Fukushima Prefecture. On March 23, the Government Emergency Response Center
provided the head of Fukushima prefectural government with instructions to restrict the shipment
and intake of certain vegetables. Subsequently, instructions to restrict shipment were successively
issued.
Subsequently, on April 4 of the same year, the NERHQ issued a notice for "Strategies formonitoring planning, shipping restrictions and abolishing shipping restrictions on the basis ofproducts and regions" for the following reasons: many municipalities asked the NERHQ to
restrict shipment on a per-region basis rather than on a per-prefecture basis, and the NERHQ
determined that it was necessary to establish requirements to abolish shipping restrictions. This
notice states that: (i) shipment of a product shall be restricted if it is anticipated that a significant
quantity of the product exceeds a temporary regulation value within a wider range of regions andintake of a product shall be restricted if a significantly high concentration of radioactive material
is detected in the product; (ii) regions shall be established on a per-prefecture-basis, however,regions shall be established on a per-block basis if the relevant prefectural or municipal office canafford to manage and maintain them; and (iii) shipping restrictions shall be lifted on a per-regionbasis by dividing a prefecture into more than one region, monitoring shall be performed weekly
on a per-region basis in more than one municipality, and if inspection findings register below
provisional limit values three consecutive times, then restrictions shall be lifted if an application
is made by the relevant municipal office.
From the same day, each of the municipalities planned and performed monitoring of food andbeverages according to the policy described above. The NERHQ instructed them to restrict
shipment or lift shipping restrictions accordingly.
It was discovered that lower levels of radioactive iodine were detected in food and beverages
while radioactive cesium exceeding provisional regulation values was detected in some foodproducts. Based on this finding, on June 27 of the same year, the NERHQ revised their previous
policy, which had gone into effect on April 4 of the same year, to include the following newprovisions: (i) a product with limited shipping time shall be monitored at least three days before
it is due to be shipped; and (ii) restrictions on shipment shall be lifted according to the following
conditions: restrictions on shipment based on the detection of radioactive iodine shall be
managed as per the conditions described above while restrictions on shipment based onradioactive cesium shall be managed on a per-region basis; and restrictions on shipment shall be
lifted if all monitoring results gathered from more than three locations per municipality within
the previous month are below provisional regulation values.
On August 4 of the same year, the NERHQ revised their notice of "Monitoring planning,developing shipping restrictions and abolishing shipping restrictions on the basis of products andregions" for the following reasons: radioactive cesium exceeding provisional regulation values
was detected in beef, and the time for harvesting rice was approaching (refer to Section h(b)above).
h Other problems concerning shipping restrictions(a) Farm animals (cattle) feed
On March 19 of the same year, MAFF provided cattle farmers with a "Notice on farming
management" (hereinafter referred to as "Notice on Farming Management") via prefectural
governments in the Tohoku and Kanto districts to the effect that in order to prevent or reduce
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contamination of livestock products with radioactive material, cattle raised in regions where
airborne radiation levels higher than normal have been detected shall be fed with hay from grassthat has been cut, gathered and stored prior to the date of the nuclear accident in Fukushima
Prefecture and stored indoors beyond that date; drinking water for cattle shall be kept in a sealed
water tank to prevent falling dust particles from entering; and cattle will not be sent to graze until
further notice.
Additionally, on April 14 of the same year, MAFF provided cattle farmers with a notice via
prefectural governments in the Tohoku and Kanto districts to the effect that in order to prevent or
reduce the contamination of cattle with radioactive material via farm coarse feed (including
pasture grass and straw), a provisional permissible value of radioactive material contained infarm coarse feed (including pasture grass and straw) would be established, and that values ofradioactive material contained in farm coarse feed that is produced hereafter shall, if used for
cattle, be below the prescribed provisional permissible value.
Additionally, on August 1 of that year, prior to the upcoming rice and wheat fall harvest
season, MAFF notified all prefectural governments that in order to prevent contamination of
cattle with radioactive material via rice bran and wheat bran, a provisional permissible value ofradioactive material contained in farm coarse feed as well as in cattle feed including rice bran andwheat bran shall be established. MAFF also notified all prefectural governments that the use,
production, or distribution of cattle feed exceeding provisional permissible values shall be
avoided.
(b) Measures for beef
On July 8 of the same year, radioactive cesium exceeding the temporary regulation value(500Bq/kg) was detected in beef shipped from Fukushima Prefecture. Subsequently, radioactive
cesium exceeding the temporary regulation value was detected in beef shipped from prefecturesother than Fukushima Prefecture.
The root of this problem was that the Notice on Farming Management was only addressed tocattle farmers. The Notice was not communicated to grain farmers, who produced rice straw.
Furthermore, information and guidance provided to cattle farmers was inadequate and it was
discovered that cattle farmers had fed their cattle rice straw that had been stored outdoors andmost likely contaminated with radioactive material.
On July 19, the NERHQ instructed the Fukushima prefectural government to restrict theshipment of commercial cattle and subsequently, on August 2, instructed the Miyagi, Iwate, andTochigi prefectural governments to restrict the shipment of commercial cattle.
On August 4 the NERHQ updated their notice on "Strategies for monitoring planning,developing shipping restrictions and abolishing shipping restrictions, on the basis of products andregions" (established on April 4 of the same year, revised on June 27 of the same year (refer to
Section g above)) and agreed to partially lift shipping restrictions based on the premise that all
cattle or all cattle farms would be tested.
On and after August 19 of the same year, the local governments that had been instructed torestrict the shipment of beef developed a policy to test and ship commercial cattle, and submitted
an application to the NERHQ requesting that shipping restrictions be lifted. In response to theirrequest, the NERHQ lifted shipping restrictions on commercial cattle that had been raised andmanaged according to the government policy for testing and shipping commercial cattle.
(c) Measures for rice harvested in 2011
On April 8 of the same year, the head of the NERHQ obtained a transfer coefficient (0.1) ofradioactive cesium transferred from soil to unpolished rice based on the results of analyses
performed by the National Institute for Agro-Environmental Sciences on rice fields and harvested
rice. The NERHQ issued a policy to the effect that the upper limit of radioactive cesium shall be
5,000Bq/kg so that the concentration of radioactive cesium contained in unpolished rice would be
below the provisional regulation value (500Bq/kg) pursuant to the Food Sanitation Act, and thatplanting restrictions should be ordered to prohibit the planting of rice seedlings in regions whereradioactive cesium contained in freshly harvested rice would most likely exceed the provisional
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regulation value.
On April 22, the NERHQ issued a planting restriction order to the head of the Fukushima
prefectural government to restrict the planting of rice seedlings within a 20km radius of the
Fukushima Dai-ichi NPS as well as in deliberate evacuation zones and emergency evacuation
preparation zones.
In August of the same year, MAFF released a plan to conduct a two-stage research process dueto the following circumstance: rice is a staple food, a large amount of rice is grown and eaten in
Japan and there are various types of distribution systems in Japan. In the first stage, prior to theupcoming rice fall harvest season in 2011, a preliminary survey should be conducted to study thetrends in the concentration of radioactive material. In the second stage, a main survey should be
conducted to determine whether or not shipping restrictions are required after the rice harvest. In
the main survey, the provisional regulation value was not exceeded in any region. However, on
and before November 30 of the same year, radioactive cesium exceeding the provisional
regulation value was detected in unpolished rice (not tested by direct sampling in the main
survey) that was produced in Fukushima-city (formerly Oguni-village) and Date-city (formerly
Oguni-village and Tsukidate-village). In response to this situation, the NERHQ instructed the
Fukushima prefectural government to restrict the shipment of rice produced in these
aforementioned regions in 2011.
[Governmental Interim Report] Chapter V 1 (1)(c) Measures for rice harvested in 2011
On April 8, the NERHQ set the transfer factor of radioactive cesium transferred from soil to
unpolished rice at 0.1 based on the results of analyses performed by the National Institute forAgro-Environmental Sciences on rice fields and harvested rice. The NERHQ issued a policy tothe effect that the upper limit of radioactive cesium shall be 5,000Bq/kg so that the concentrationof radioactive cesium contained in unpolished rice would be below the provisional regulation
value (500Bq/kg) pursuant to the Food Sanitation Act, and that planting restrictions should beordered to prohibit the planting of rice seedlings in regions where radioactive cesium containedin freshly harvested rice would most likely exceed the provisional regulation value.
On April 22, the NERHQ issued a planting restriction order to the Fukushima prefectural
government to restrict the planting of rice seedlings within a 20km radius of the Fukushima
Dai-ichi NPS as well as in deliberate evacuation zones and emergency evacuation preparation
zones.
In August, the MAFF released a plan to conduct a two-stage research process due to thefollowing circumstance: rice is a staple food, a large amount of rice is grown and eaten in Japanand there are various types of distribution systems in Japan. In the first stage, prior to theupcoming rice fall harvest season in 2011, a preliminary survey should be conducted to study thetrends in the concentration of radioactive materials. In the second stage, a main survey should be
conducted to determine whether or not shipping restrictions are required after the rice harvest. In
the preliminary or the main survey, the provisional regulation value was not exceeded in any
region. On November 16, however, radioactive cesium exceeding the provisional regulation
value (500Bq/kg) was detected in unpolished rice (from the rice field not covered by direct
sampling in either the preliminary survey or the main survey) produced in Fukushima City
(formerly Oguni Village).
As rice containing radioactive cesium beyond the provisional regulation value was found after
the completion of the main survey, the Fukushima prefectural government from November
conducted an emergency survey covering all of the 23,247 rice farmers in (i) former Oguni
Village in Fukushima City (the area where rice with radioactive cesium in excess of theprovisional regulation value was found for the first time after the completion of the main survey),(ii) areas that include “specific spots recommended for evacuation” and other areas, and (iii)
areas where even a tiny amount of radioactive cesium was detected. The emergency survey foundrice containing radioactive cesium beyond the provisional regulation value from rice kept by 38
rice farmers. Most of contaminated rice was concentrated in certain areas of Fukushima City and18

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Date City. Based on the survey results, the head of the NERHQ instructed the Governor of
Fukushima Prefecture to restrict the shipment of rice produced in a total of the nine areas, whichwere formerly registered as cities, towns and villages, in the three cities of Fukushima, Date andNihonmatsu, by January 4, 2012.
[Governmental Final Report] Chapter IV 5 (1)a. Establishment of provisional regulation values and shipping restrictions on food
From the middle of the night on March 14, 2011 to dawn of the following day, MHLW andthe Ministry of Agriculture, Forestry and Fisheries commenced studies regarding the necessity of
regulating radioactive materials in food. On March 15, a debate among the related ministers andministry employees was also held in NERHQ.
On the same day, March 15, it was revealed that the environmental sample monitoring
implemented by Fukushima Prefecture had detected iodine 131 (277,000Bq/kg to
1,230,000Bq/kg) and cesium 137 (31,100Bq/kg to 169,000Bq/kg) in weeds at four locations
between 36 km and 46 km from the Fukushima Daiichi Nuclear Plant. In response to this report,
on March 16, the Residents Safety Group in the Secretariat of NHRHQ sought advice from
NSC’s Emergency Technical Advisory Group regarding restrictions on the ingestion of food anddrink; in response to this, NSC’s Emergency Technical Advisory Group gave advice that the
Residents Safety Group should recommend restrictions on the ingestion of home-grownvegetables (excluding root crops, potatoes and vegetables cultivated inside the house) and locally
produced milk obtained on or after March 16, 2011 in areas including northern Iwaki City andfurther north in the Hamadouri region and the Nakadouri region.
On March 17, taking into consideration the advice of the NSC’s Emergency TechnicalAdvisory Group and the discussions it held with NERHQ, MHLW established provisional
regulation values for radioactive materials under the Food Sanitation Act.
The regulations of the Food Sanitation Act take the basic approach of establishing regulation
values, making business operators, including farmers and retailers, primarily responsible for
conducting voluntary measurements prior to sale. When radiation readings above the limit are
confirmed during tests of food on sale in the marketplace, sales of such items by individual
business operators should be prohibited. Prior shipping restrictions are not planned as a general
rule.
Voluntary pre-sales measurements by business operators or measurements done of food, after
it is distributed do not effectively reduce internal exposure. It is necessary to restrict
contaminated food and drink before it is shipped. Measures to restrict the ingestion of food anddrink, etc., as stipulated in the Fukushima Prefecture Regional Disaster Prevention Plan that were
formulated based on the Emergency Preparedness Guide, basically target the region in thevicinity of the accident. However, in this accident, radioactive materials were emitted over a widearea, so it is necessary to construct a legal framework for imposing food and drink shipping
restrictions over a wide area.
NERHQ, rather than Fukushima Prefecture, led the response as stipulated in the Fukushima
Prefecture Regional Disaster Prevention Plan; they decided -- based on the Nuclear Emergency
Preparedness Act – that in case food contaminated in excess of the provisional regulation values
is confirmed in prefectural tests, shipping restrictions should be imposed in the name of theprefectural governor in certain regions, including the region in which food contamination was
confirmed.
Fukushima Prefecture, the Tokyo Metropolitan Government, Tochigi Prefecture, Ibaraki
Prefecture, and Gunma Prefecture commenced monitoring food from March 16 onwards, andMHLW announced 35 cases exceeding the provisional regulation values by March 20. On March21, based on the Nuclear Emergency Preparedness Act, Article 20, Paragraph 3, the head of theNERHQ directed the Fukushima Prefecture governor, the Ibaraki Prefecture governor, theTochigi Prefecture governor and the Gunma Prefecture governor to impose shipping restrictions
on spinach and kakina from Fukushima, Ibaraki, Tochigi, and Gunma prefectures, and milk
produced in Fukushima Prefecture. By March 22, new contamination in excess of the provisional
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regulation levels was reported. On March 23, the head of NERHQ directed the Fukushima
Prefecture governor to impose ingestion restrictions and shipping restrictions on head-type leafy
vegetables, etc. produced in Fukushima Prefecture in addition to the above restrictions, and also
directed the Ibaraki Prefecture governor to impose shipping restrictions on raw milk and parsley
produced in Ibaraki Prefecture.
On April 4, NERHQ released its “Approach to the Establishment and Lifting of Items andZones for Test Plans, Shipping Restrictions, etc.” and as a result, although prefectural boundaries
are used as a general rule when establishing zones for shipping restrictions, it became possible touse units that divide prefectures, such as into municipalities, etc. Due to this change, theprefectures (which are the organizations that actually perform the tests and impose the shipping
restrictions), are able to adopt flexible responses that take into consideration the needs of theresidents/ producers. The approach to establishing and lifting items and zones stipulates that it ispossible for zones in which a directive to impose shipping restrictions has been issued to lift that
directive through an application by the relevant prefecture, on the condition that the food satisfies
the provisional regulation values three times consecutively in the weekly tests. Based on this, on
April 8, NERHQ lifted the directive to impose shipping restrictions for raw milk produced in apart of the Aizu region in Fukushima Prefecture (Kitakata City, Bandai-machi, etc.), as well as
spinach and kakina produced anywhere in Gunma Prefecture.
[National Diet Report] Chapter 4, 4.4.3

Contamination of food and its shipping restriction
On 17 March, the MHLW sent a notification to each municipality not to consume
contaminated foods exceeding the regulation value for meals for the time being since radioactive
materials were released into the environment from Fukushima Daiichi NPS. This notification wasmade on the basis of the Food Sanitation Law and the suggestion to use the "Index for
restrictions on the intake of food and beverages" made by the Nuclear Safety Commission (NSC)
as a temporary regulation value for restrictions of intake and shipping. After that, on 19 March, it
was reported that radioactive iodine 131 exceeding the temporary regulation value was detectedin raw milk produced in Fukushima prefecture and spinaches produced in Ibaraki prefecture.
The first instruction of the shipping restriction was given on 21 March. The target was raw
milk produced in Fukushima prefecture, and spinach and kakina from Fukushima, Ibaraki,
Tochigi, and Gunma prefectures. This countermeasure was communicated to each prefectural
governor by the Prime Minister, who is also director general of the Nuclear Emergency Response
Headquarters on the basis of Paragraph 3, Article 20 of the Act on Special Measures Concerning
Nuclear Emergency Preparedness.
On 23 March, the list of shipping restrictions for foods produced in Fukushima and Ibaraki
prefectures was expanded (some foods from Fukushima prefecture were also the focus of advice
to restrict intake). On 4 April, foods from Chiba prefecture became targets of the shipping
restriction; thus, the area and list of foods were gradually expanded with the detection ofradioactive contamination in each area.
At first, the target areas of the shipping restriction were set prefecture by prefecture, but after
4 April, shipping restrictions could be set and cancelled on the basis of unit area such as cities,
towns and villages partitioning the prefecture. On a basis of an application by the municipal
government, the cancellation of the shipping restriction could be permitted under the condition
that the radioactivity concentration in foods is observed to be less than the temporary regulation
value three times consecutively in the inspection held every week.
On 5 April, the temporary regulation value for radioactive iodine in seafood was notified to allmunicipalities in Japan to prevent the intake of seafood exceeding the regulation value, because
no regulation value had been previously set up in the temporary regulation values and radioactive
iodine was detected in seafood the day before.
On 4 April, the principle for the cancellation of the shipping restriction was provided asfollows: “Cancellation of the shipping restriction is permitted for an area or food item if theradioactivity concentrations measured in the inspections held every one week are less than the20

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temporary regulation value three times consecutively”, which lead to the cancellation of theshipping restriction of spinach and kakina from the whole of Gunma prefecture and raw milk
produced in part of Fukushima prefecture, in accordance with the principle mentioned above.
Even now, foods such as Shiitake mushrooms and rice obtained in the autumn are still under
the shipping restriction because radioactive contamination exceeding the regulation value wascontinuously detected in parts of these regions (as of 12 February, 2012).
(Omission)
2. Example of circulation of beef exceeding the temporary regulation value in the market
without being detected in the inspection
This example is about beef circulating in the market exceeding the regulation value without
being detected in the inspection by authority. The reason was livestock feed given to cows. Thiswas out of the scope of the inspection, and no alternative measure was considered.
On 8 July, Tokyo Metropolitan government announced that radioactive cesium (cesium 134
and cesium 137) exceeding the temporary regulation value specified in the Food Sanitation Law
was detected in edible meat of beef cattle among eleven cows transferred to Shibaura
slaughterhouse from the emergency evacuation preparation area in Minamisoma city in
Fukushima prefecture (the detection result was 2,300 Bq/kg, the temporary regulation value was
500 Bq/kg). This inspection was carried out upon the request by the MHLW on 6 July. On 8 July,strengthening of the monitoring inspection of beef was requested for Fukushima prefecture andits six neighboring prefectures by the MHLW. The following day, the inspection results for theten remaining cows were announced and were 1,530 - 3,200 Bq/kg beyond the temporary
regulation value.
On 11 July, Fukushima prefecture announced that they would urgently carry out an on-site
investigation of all beef cattle farmhouses in deliberate evacuation areas and emergency
evacuation preparation areas. Simultaneously, they announced the results of a radiation survey
carried out for livestock farmhouses in Minamisoma city on 10 July. The targets of the survey
were five kinds of feed (rice straw, oats, grass, feed mixtures and drinking water for livestock).
Among them, radioactive cesium was detected in the the rice straw, the oats and the grass. The
highest radioactivity concentration was 75,000 Bq/kg (17,045 Bq/kg with correction for moisture
content) in the rice straw.
On 14 July, it was clarified that cows provided rice straw containing a high concentration ofradioactive cesium were shipped and distributed from beef cattle farmhouses in Asakawa-cho in
Fukushima prefecture. The Fukushima prefecture requested that all farmhouses in the prefecture
refrain from shipping until urgent on-site investigation was completed on 18 July.
The results of the urgent on-site investigation were released on 18 July. It was clarified that
there were 554 cows that were shipped and fed contaminated rice straw between 28 March and
13 July. In response to this, the Japanese government instructed the restriction of beef cattle
produced in the Fukushima prefecture, not to be shipped to slaughterhouses or transported
outside the prefecture on 19 July. After that, on-site investigations for all beef cattle farmhousesin the prefecture were carried out. In the summary of the investigation results released on 6
August, it was made clear that there were 143 beef cattle farmhouses provided (or that may havebeen provided) rice straw contaminated by radioactive material, and 867 contaminated cows
(slaughtered between 28 March and 15 July) were shipped from 30 of these farmhouses.
The causes of this were that firstly, contaminated rice straw had been provided as feed andsecondly, cows fed contaminated rice straw could not be detected by inspection.
At first, the government instructed farmers to use livestock feed that was obtained before theaccident or stored indoors, and maintain the supply of radioactive-free feed and water, since
livestock feed was under the control of the Ministry of Agriculture, Forestry and Fisheries(MAFF). Moreover, on 14 April, a temporary permissible value for radioactive materials in theoriginal livestock feed was set up and established as a temporary reference not to exceed thetemporary regulation value for milk or beef in the Food Sanitation Law. However, it was notpreassumed to make feed by gathering grass grown in those days although the government21

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responded to the accumulation of radioactive material on the storing feed.
The next example is about the inspection system for beef cattle. Cows shipped and transported
from deliberate evacuation areas and emergency evacuation preparation areas were divided by
the same screening level as that for people using survey meters, that is, decontamination wasneeded if the survey results exceeded 100,000 cpm (there was no case requiring decontamination
among 11,140 cows that underwent screening inspection between 23 April and 11 July, forexample, about 85% were lower than 1,000 cpm and the maximum was 16,000 cpm). However,this type of inspection could only survey on the surface contamination and could not detect
internally accumulated contamination. Therefore, shipping of contaminated beef or cattle could
not be stopped by only screening survey, but beef exceeding the temporary regulation value
would not have been distributed in the market if the inspection after slaughter was sufficiently
carried out.
[Nongovernmental Report] Part 1 Chapter 2 Section 2

The following isssues can be raised in association with Shipping restrictions andmonitoring of agricultural and livestock products.
Shipping restrictions and monitoring of agricultural and livestock products– expansion of contamination due to food chain The Notice on Farming Management was not communicated to grain
farmers, who produce rice straw. Furthermore, the information andguidance provided to cattle farmers were inadequate and it was discoveredthat cattle farmers had fed their cattle rice straw that had been stored
outdoors and was most likely contaminated with radioactive material. This
led to the detection of radioactive cesium exceeding the temporary
regulation value in beef.
Shipping restrictions and monitoring of agricultural and livestock products– measurement method for livestock products Beef fed by contaminated rice straw could not be identified by inspection
after slaughter.

 Foods
Descriptions about foods monitoring are given in [Governmental Final Report]and [National Diet Report] in the following way.
ⅰThe status of testing of food products
By the end of February 2012 after the nuclear accident, a total of 117,737 specimens of foodproducts were tested and radioactive materials in excess of the provisional regulation value weredetected in 1,162 specimens. The followings can be cited among food products from which thehigh levels of radioactive materials were detected despite a lapse of some significant period oftime after the nuclear accident.

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Japan Health Physics Society(a) Fruits
A total of 2,396 specimens of fruits were tested by the end of February 2012, and radioactive
materials in excess of the provisional regulation value were detected in a total of 28 specimens ofeight items – yuzu (citrus junos), Japanese plums, pomegranates, Japanese medlar, figs, chestnuts,
kiwi fruits and persimmons (all of them produced in Fukushima Prefecture). Of these fruits,
radioactive materials beyond the provisional regulation value were detected in yuzu (citrus junos),pomegranates, chestnuts, kiwi fruits and persimmons even after September 2011. The
contamination of these fruits presumably resulted from radioactive materials attached to theirtrees and leaves immediately after the nuclear accident being translocated to fruits.
(b) Mushrooms
A total of 2,575 specimens of mushrooms were tested by the end of February 2012, andradioactive materials in excess of the provisional regulation value were detected in 165
specimens. Radioactive materials were detected in 122 specimens among them after September
2011, while 80 specimens were picked in municipalities other than Fukushima Prefecture.
It is believed that these mushrooms were contaminated as they absorbed radioactive materials
that became attached to places where mushrooms grew, like withered tree logs used for
cultivation of shiitake mushrooms. Mushrooms are also believed to have the nature prone togather cesium.
(c) Seawater fish
A total of 5,051 specimens of saltwater fish were tested by the end of February 2012, andradioactive materials in excess of the provisional regulation value were detected in 162
specimens. Soon after the nuclear accident, radioactive materials in excess of the provisional
regulation value were detected in species of surface fish in coastal waters, such as sand eels andwhitebaits. However, since radioactive materials beyond the provisional regulation value weredetected in whitebaits caught off Fukushima Prefecture on June 6, 2011, no species of surface
fish with that much of contamination have been found. Later, radioactive materials in excess ofthe provisional regulation value have come to be detected in species of bottom fish in coastal
waters, and they are still being detected in such fish species as of the end of February 2012. In
most cases, contaminated fish has been found in sea areas to the south of the Fukushima Dai-ichi
NPS.
These contamination trends are believed to reflect the phenomena that radioactive materials
discharged from the Fukushima Dai-ichi NPS into the sea have been carried to the south by theocean current (the Oyashio current) and that radioactive materials have moved from the sea
surface to the bottom of the sea in the course of time.
(d) Freshwater fish
A total of 782 specimens of freshwater fish were tested by the end of February 2012, andradioactive materials in excess of the provisional regulation value were detected in 50 specimens.
Radioactive materials beyond that level were detected only in fish living in rivers in Fukushima
Prefecture. Since August 2011, in Lake Akagi Onuma in Gunma Prefecture, located some 190km
in a straight line from the Fukushima Dai-ichi NPS, fish contaminated by radioactive materials inexcess of the provisional regulation value has been found. In the lake in 2012, by the end of
February, radioactive materials in excess of the provisional regulation value have been detected
in 12 out of 19 specimens, including lake smelt caught on January 6 and Iwana mountain trout
caught on January 29.
The contamination of fish in the lake is believed to reflect such things as that freshwater fish
has the property that it cannot discharge radioactive cesium accumulated inside the body so easily
and that since Lake Akagi Onuma is a caldera lake and the turnover of lake water is slow,
radioactive materials tend to remain in the lake.
[Governmental Final Report] Chapter IV 5 (1)23Japan Health Physics Society
Subsequently, every time contaminated food has been discovered through the tests forradioactive materials performed in each region, NERHQ has added regions and items subject todirectives to impose shipping restrictions, or lifted them as appropriate. In the food tests
performed during March 2011, a total of 780 specimens in 15 prefectures were tested, and ofthese radioactivity in 136 specimens exceeded the provisional regulation values. Furthermore,
there were a total of 135,571 tests of food, according to announcements made by MHLW,
between March 18, 2011 and March 31, 2012, and 1,204 of these tests discovered food withradioactivity exceeding the provisional regulation values.
(Omission)c Chaos in the testing systems
After the shipping restrictions on food based on the Nuclear Emergency Preparedness Act
were stipulated, it was decided that each prefecture would create test plans for food. NERHQ
presented the basic approach regarding the items to be tested, the target regions, the frequency of
the tests, etc., and asked each prefecture to formulate its own test plans.
The items the NERHQ said should be tested include the following.
(i) Items in which radioactive materials in excess of the provisional regulation values havepreviously been detected(ii) Items grown outdoors such as spinach, edible chrysanthemum, kakina, etc. and milk andother items that should be used as indices as designated by the national government(iii) Major agricultural commodities, taking into account the production situation(iv) Food distributed in the market(v) Items separately identified by the national government, taking into account the situation ofenvironmental monitoring and other factors
The headquarters indicated that tests should be performed about once a week as a general rule.
However, the NERHQ and the MHLW left the food tests to the test plans of the prefectures, so
the level of the tests varied depending on the prefecture.
The testing equipment and other infrastructure the various prefectures were not adequate at thetime of the disaster, and disparities among regions arose. For example, Fukushima Prefecture
possessed four germanium semiconductor detectors before the accident, but two of them were in
the Okuma Town Environmental Radioactivity Monitoring Center in the evacuation zone, and theremaining two were in the Fukushima Branch of the Environmental Radioactivity Monitoring
Center, so none of them could be used for testing food. Fukushima Prefecture had no department
in charge of performing tests for contamination of food by radioactive materials in theprefecture’s Disaster Provision Main Office, and none of the staff had the know-how necessary to
perform such tests. In Fukushima Prefecture from about March 19, the people in charge from theAgriculture and Forestry Office determined the farmers they would visit for the tests, taking into
consideration the spatial dose and soil contamination concentration, etc., and began thetests.[238] The Agriculture, Forestry and Fisheries Department of Fukushima Prefecture took thelead in arranging testing, but there was no initial system of testing, so it sent a maximum of 50
samples a day to the Japan Chemical Analysis Center, which performed the tests.
On top of this lack of infrastructure, there were also local governments that wereunenthusiastic about performing the tests because of their concerns about the harm to theirreputations, so the level of the tests varied depending on the local government. Considering thisin light of the intent to develop uniform testing systems for wide areas in order to ensure thesafety of the residents, we conclude that there is a problem with these variations among the local
governments.
Some private sector companies moved to perform tests voluntarily. Some retail stores even set
voluntary standards that were lower than the provisional regulation values and the new standard
values, performed tests voluntarily, and did not put food with radioactivity in excess of theirvoluntary standards on their shelves. In response to these kinds of voluntary tests, on April 20,
2012 the Ministry of Agriculture, Forestry and Fisheries released a document titled “Trustworthy
Analyses, etc. for Voluntary Tests of Radioactive Materials in Food” to the heads of food industry
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Japan Health Physics Society
associations, in order to notify them that they should comply with the standard values stipulated
by law in their voluntary tests as well, in order to avoid excessive regulations and confusion at
the consumption stage. In Japan, which is a free country, there is no reason for state organs to
restrict private sector groups that are setting voluntary standards which are stricter than thestandards stipulated by law and exercising voluntary restraint, so this response from the Ministryof Agriculture, Forestry and Fisheries is a fundamental problem. However, this notification was
released to reflect the interests of the producers and the possible harm to their reputation, whichshows the complexity of this problem.
d. Food inspections and the two missing elements
Provisional regulations and actual food inspections failed to account for certain types ofnuclear particles and food products. The following paragraphs illustrate the resulting problems.
(i) Initial provisional regulations did not test for iodine in seafood and for strontium ingeneralThe initial provisional regulations did not apply to seafood containing radioactive iodine. Thiswas because consideration was paid mainly to beverages, leafy vegetables, and dairy products, as
the original index half-life value is short for radioactive iodine. However, on April 4, 2011, 4,080
Bq per kg, a very high concentration of radioactive iodine, was detected in lancefish off the coastof Ibaraki Prefecture. Upon the advice of NSC, on April 5, MHLW applied the same 2,000-Bq/kg
provisional regulation for radioactive iodine in vegetables to seafood.
The provisional regulations also did not set limits on strontium, which is deemed to have astrong effect on the human body. A separate provisional regulation was not provided forstrontium, as, during the initial stage of establishing the index values, it was agreed that sincestrontium mixes with cesium, the ratio of strontium to cesium would be treated as 1:9. For thisreason there were very few tests for strontium. The only measurements existing are four samplesof sardines, lancefish, and anchovies taken by the Fisheries Research Agency (FRA). This
one-time examination did not detect any strontium (detection lower range of 0.02-0.04); however,the lack of strontium testing means concerns by citizens that food was contaminated withstrontium endures.
(ii) Inspections and regulations were applied later for fertilizer, feed, and raw mushrooms
than for agricultural products
On July 8, 2011, cesium surpassing the provisional limits was detected in beef from
Minamisoma City, Fukushima Prefecture, that was processed in Tokyo. The rice straw used as
feed for the cows had been contaminated and the screening method being implemented wasinadequate. It was discovered that the reason for the high cesium levels was that no one noticed
that the beef cattle had been contaminated with radioactive substances. The Ministry ofAgriculture, Forestry and Fisheries (MAFF) on March 19, 2011 had issued a notice entitled,“Managing livestock feed in consideration of the nuclear power plant accident,” in which it
instructed livestock farmers not to give their animals grass or hay that was stored outside after theaccident. However, MAFF did not clarify whether the feed restrictions also pertained to ricestraw. The Fukushima municipal government’s Division of Agriculture, Forestry and Fisheriesalso issued a document on March 29 entitled, “Great East Japan Earthquake and TEPCO
Fukushima Daiichi Nuclear Power Plant accident: Agricultural technology information pertaining
to agricultural goods (Issue V),” in which it instructed farmers to cover rice straw stored outside.
However, this document did not specify feed already stored outside. It was impossible to detect
the contaminated beef beforehand because the government’s instructions were inadequate. This
resulted in the discovery that there were approximately 4,700 cattle sold nationwide (excluding
Okinawa) that had potentially been fed contaminated rice straw.
One lesson learned from the nuclear accident at Chernobyl was that mushrooms are a foodproduct that easily absorbs radioactive substances. Japan from an early stage also detected iodine
and cesium that surpassed provisional regulations in raw shiitake and other mushrooms,
prompting NERHQ to issue orders to restrict shipping. Shipping restrictions continued to be25

Japan Health Physics Society
applied into the fall to raw brick tuft mushrooms and nameko mushrooms with levels ofradioactivity surpassing the provisional limits; however, no measures were implemented for these
raw mushroom varieties. It was not until October 6 that MAFF finally set index values for raw
mushrooms. This delay was caused by the large amount of time that the Forestry Agency required
to actually test for radioactive substance contamination in raw mushrooms.
[National Diet Report] Chapter 4, 4.4.3

The following isssues can be raised in association with foods monitoring.
Food monitoring – regional variations


Food monitoring was left to the test plans of the prefectures, so the levelof the monitoring varied depending on the prefecture. The monitoring
equipment and other infrastructure in the various prefectures wereinsufficient at the early stage after the disaster. Moreover, there were also
local governments that were unenthusiastic about performing monitoring
because of their concerns about the harm to their reputation, so the level ofmonitoring varied depending on the local government.

 Forests and subsoils of rivers and lakes
Descriptions about monitoring of forests and subsoils of rivers and lakes are given
in [National Diet Report] in the following way.
a. Accumulation of radioactive materials in forests
In forests, radioactive materials attached to trees and foliage are transferred to the groundsurface when leaves and branches fall, and together with the radioactive materials that havealready fallen on the ground through rainfall they penetrate into the topsoil, where they are thenabsorbed by tree roots and are incorporated into the cycle of the forest ecosystem. Some of theseradioactive materials will be dispersed from the forests through soil erosion and outflow. The
penetration of radioactive materials into the ground is extremely slow, so the degree of transfer ofthe materials into the groundwater is also extremely low, resulting in extremely small volumes
finding their way into the groundwater. A report stated that in the forests close to the Chernobyl
nuclear power plant, the emission of cesium 137 rom the forest remains less than 1 percent
annually, and other than natural decay due to the radioactive half-life of the radioactive materials)
there has been hardly ny decrease in the radiation concentration. In a study conducted by MEXT
in he forests of Fukushima Prefecture, which measured the volume of radioactive cesiumtransferred due to soil erosion, it was found that the volume of radioactive cesium in the forestthat was transferred over a 1.5-month period was a maximum of approximately less than 0.3
percent, indicating that almost no cesium had been transferred. From this, it can be surmised that,as with the case of the forests close to the Chernobyl nuclear power plant, there is a possibility
that contamination by radioactive materials near the Fukushima plant could be prolonged.
b. Accumulation of radioactive materials in river and lake beds
It is thought that radioactive materials emitted will accumulate not only in forests, but also inriver and lake beds. Radioactive materials that fall to the ground are washed out into rivers andlakes through ground erosion or outflow, and together with silt particles they sink to the beds of26

Japan Health Physics Society
rivers and lakes where they accumulate. This phenomenon was confirmed in the three countries
of Ukraine, Russia and Belarus.
In Japan, following the accident, the Ministry of the Environment implemented a water quality
monitoring survey of public water expanses in Fukushima Prefecture. According to this survey,
measurements at some locations exceeded 10,000 Bq/kg (dry soil) in both river and lake beds.
This figure exceeds the standard value of 8,000 Bq/kg, which is set for specified waste requiring
special management in terms of collection and transport under Article 20 of the Act on Special
Measures Concerning Handling of Radioactive Pollution. Furthermore, continued monitoring hasrevealed that there are highly contaminated places. (See Table 4.5.1-1.)[National Diet Report] Chapter 4, 4.5.1

The following isssues can be raised in association with monitoring of forests andsubsoils of rivers and lakes.
Monitoring of forests and subsoils of rivers and lakes – lack of understandingof the necessity
 The necessity of monitoring forests and subsoils of rivers and lakes was not
sufficiently understood.

(b) Coastal sea area monitoring Sea water, subsoils of ocean and sea products
Descriptions about monitoring for sea water, subsoils of ocean and sea products are
given in [Governmental Interim Report] and [Nongovernmental Report] in thefollowing way.
c The monitoring activities that were conducted within the premises of the Fukushima
Dai-ichi NPS after the accident
Due to the total loss of AC power supplies resulting from the earthquake and the impact of theensuing tsunami, on March 11 the eight monitoring posts that had been installed within thepremises of the Fukushima Dai-ichi NPS and the fourteen stack monitors that had beenconnected to each Unit were all unable to be used to monitor. Thus monitoring activities at the
Fukushima Dai-ichi NPS began at 17:00 on the same day at more than two locations within thepremises of the power station to evaluate changes in the level of radiation dose and estimate thesituation of the power plants using the monitoring car6 that belonged to the power station. The
monitoring results were successively made available to the public on the websites of TEPCO and
NISA.
Afterwards, from March 23, TEPCO installed three temporary monitoring posts within thepremises of the Fukushima Dai-ichi NPS to collect data and published their monitoring resultsfrom March 27. On March 25 and 29, the existing eight monitoring posts, which had been
rendered inoperative, were restored to their former state using a temporary power supply. TEPCO
resumed collecting data by making the rounds once a day from April 1. On April 9, the datatransmission systems of these existing eight monitoring posts were restored to their former states
enabling them to collect and publish data automatically.
At the Fukushima Dai-ichi NPS, TEPCO started collecting and analyzing samples from the27

Japan Health Physics Society
sea near the two water discharge canals on the premises from March 21, when the rubble anddebris created by the tsunami were sufficiently cleared away to allow access to the seashore.
Because seawater was sprayed into the reactor building, and due to rainfall, water contaminatedwith radioactivity may have flowed out into the sea. In addition, for the comparison of data,
TEPCO also started collecting and analyzing samples from the sea near the two water discharge
canals on the premises of the Fukushima Dai-ni NPS.
[Governmental Interim Report] Chapter V 1 (1)Moreover, from March 21, with the cooperation of the Maritime Safety Agency and theFisheries Agency, MEXT monitored the sea area beyond a 30km radius of the Fukushima
Dai-ichi NPS. The geographical scope of the monitoring area was extended because TEPCO had
discharged retained water including low-level radioactive water into the sea on April 4. TEPCO
also conducted coastal sea area monitoring in Fukushima Prefecture and Ibaraki Prefecture in thesea area beyond a 30km radius of the Fukushima Dai-ichi NPS.
[Governmental Interim Report] Chapter V 1 (2)(3) Contamination of seawater, pool water, etc.
a Criteria for bathing areas
On June 7, the Ministry of the Environment began to deliberate on guideline regarding the useof bathing areas in response to the directive from Chief Cabinet Secretary Edano. On June 14, theMinistry held the Roundtable Conference for Radioactive Materials in Bathing Areas to hearfrom experts on radioactive materials. On June 24, on the basis of advice from the NSC Japan,
the Ministry presented a guideline about radioactive materials in bathing areas that indicated: (1)radioactive cesium of 50Bq/liter or less and radioactive iodine of 30Bq/liter or less should beconsidered as the provisional guideline for the summer of 2011; (2) managers of bathing areas
preferably should monitor the concentration of radioactive materials in the water and display the
result on a placard or some other means; (3) managers and users of bathing areas preferablyshould take measures to reduce the effective radiation dose; and (4) managers of bathing areas
preferably should monitor the air radiation dose rate at the beach and the like and caution users
displaying the result on a placard or some other means when an air radiation dose rate higher than
the surrounding area is detected.
[Governmental Interim Report] Chapter V 5 (3)(e) Discharge into the ocean and release of the result
TEPCO started to discharge the water in the centralized RW/B into the ocean at 19:03 on April
4. The discharge was conducted using ten pumps with a capacity of 25 m3 per hour andcompleted the discharge at 17:40 on April 10. TEPCO also started to discharge the subdrainwater in Units 5 and 6 at 21:00 on April 4, and the discharge was completed at 18:52 on April 9.
TEPCO analyzed radionuclides in the discharged contaminated water in the centralized RW/B
and the subdrains of Units 5 and 6 before the discharge and in the seawater before and after thedischarge, and published on April 15 the results in the document "Result of Low Concentration
Contaminated Water Discharge into the Ocean from the Fukushima Dai-ichi NPS.”
That same day, NISA instructed TEPCO to conduct a detailed evaluation on the impact on theenvironment of the water discharge and the other actions. In response to the instruction, TEPCO
compiled the evaluation results of the impact on the environment of the contaminated water
discharge from the centralized RW/B and the other facilities into the ocean, the outflow of thehighly contaminated water at Unit 2 found on April 2, and the outflow of the highly contaminatedwater at Unit 3 found on May 11 based on the estimated amount of the discharged radioactive
materials and the monitoring results. TEPCO then submitted the outcome of the evaluation to
NISA on May 20 as the "Report Concerning the Impact of the Discharged Water whose
Radioactive Concentration Exceeded the Discharge Limits into the Ocean."28

Japan Health Physics Society(Omission)h. Outflow of highly contaminated water around the water intake of Unit 3
At 10:30 on May 11, while the water injection into Units 1 to 3 continued, TEPCO foundwater leaking into a pit that was located in the vicinity of the water intake of Unit 3 and contained
power supply cables. According to further investigation, the sound of water leakage was detected
and it was discovered in CCD camera image at 16:05 (see Attachment V-18 to 20) that water was
flowing out from the side of the pit into the screen area.
TEPCO considered that the outflow water came from the T/B in high concentration ofradioactive materials similar to the outflow that had been found in the vicinity of the water intake
of Unit 2 on April 2, and then started from 17:30 the same day removing the cables within the
power supply cable conduit connected to the pit, filling waste cloths in the power supply cableconduit and injecting concrete into the pit. TEPCO finished these tasks at 18:40 (see AttachmentV-20) and confirmed at 18:45 the outflow had stopped.
On May 11, with regards to this accident of highly contaminated water outflow in the vicinityof the water intake of Unit 3, NISA instructed TEPCO to check and report on the impact on theocean and the routes of the inflow and outflow. TEPCO compiled the results of the examination
on aspects such as the impact on the ocean and the route of the inflow and outflow, as well as theprevention measures for recurrence and dispersal of the contaminated water in the "Report
Concerning the Outflow of Water Containing Radioactive Materials from the Vicinity of theWater Intake of Unit 3 of the Fukushima Dai-ichi NPS" and submitted it to NISA on May 20.
[Governmental Interim Report] Chapter V 6 (1)Implementation of seawater monitoring
To assess the state of radioactive material emissions, MEXT conducted ocean monitoring. At
points approximately 30 kilometers offshore—a distance that allows air radiation levels to bemeasured while avoiding health risks to human personnel—seawater samples were collectedfrom eight sites approximately 10 kilometers apart. For example, at Site 1, off the coast of the
Fukushima Daiichi Nuclear Power Plant, maximum detected levels on March 23 were 76.8 Bq/L
for iodine 131 and 24.1 Bq/L for cesium. Air radiation levels at sea, and the radioactivity
concentration of ocean dust, were also monitored. In addition, sea-floors were monitored in
Miyagi, Fukushima, and Ibaraki prefectures and iodine 131, cesium 134, and cesium 137—allthought to be a result from Fukushima were detected.
Since April 2011, numerical oceanic prediction systems (JCOPE2 and JCOPET) have beenused to conduct simulations of the dispersion of radioactivity concentrations on the ocean surface
and other quantities[Nongovernmental Report] Part 1 Chapter 2 Section 1

7. Insufficient seawater monitoring
Seawater monitoring was important in addition to aircraft monitoring in the present accident.
Since the Fukushima Daiichi NPS faces the sea, most of the radioactivity released into the air fell
into the sea. Moreover, owing to overflow of the coolant water poured using concrete pumps,
high-level contaminated radioactive water was discharged through cracks in the concrete, andapproximately ten thousand tons of low-level contaminated radioactive water was intentionallydischarged into the sea to free up storage space for high-level contaminated water. This led toconcern regarding radioactive contamination of the sea, difficulty of fishery operations in thesurrounding sea area, and damage caused by harmful rumours or misinformation, that is, whole
all Japanese sea products are contaminated by radioactivity.
However, the MEXT in charge of emergency monitoring started seawater monitoring using aship on 22 March, since there is an insufficient number of permanent monitoring posts unlike
land areas. At the beginning, the MEXT requested the Japan Agency for Marine-Earth Science29

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and Technology (JAMSTEC) to conduct the sampling of seawater and the measurement of thesamples. This monitoring was carried out at eight points already used in the "Comprehensive
evaluation program of radioactivity in the marine environment" conducted by MEXT and an
additional eight points.
However, all these sampling points were only set in a sea area within 30km offshore. These
monitoring schemes were unsuitable for issues such as the dispersion of radioactive materials
owing to ocean currents and marine sediment.
For this reason, in April, five new monitoring points were added by using five observation
buoys for measuring seawater temperature, salinity concentration, tidal current direction and thedrift of the current. However, various issues can be pointed out about the way that sea water
monitoring ought to be performed. At first, the NISA suggested their view such as “radioactive
material will be diffused with a tidal current, and will become diluted when the radioactive
material is actually intaken by fishes and seaweed” and did not recognize the need for monitoringin the sea. For that reason, sea water monitoring conducted by the MEXT was limited to thepoints more than 30km apart from the Fukushima Daiichi NPS. As a result, the dynamics of theradioactive materials released from the source could not be clarified.
Secondly, there was no monitoring system fully considering a regional specific tidal current.
As shown in a TV documentary “Seeking hotspots in the sea” broadcast by NHK in November
2011, since sea water off Fukushima Prefecture travels down to the southern region along thecoast after the “Oyashio” current meets the “Kuroshio” current, radioactive materials in sea water
traveled down to off Ibaraki Prefecture in the southern area of Fukushima Dai-ichi NPS, which
led to the situation where radioactive materials temporarily accumulated in sand eels and forced
fishermen in Ibaraki Prefecture to refrain from fishing. However, since monitoring points
conducted by the MEXT were simply set up in the area 30 km from the site without considering
the property of the tidal current, the situation was not sufficiently clarified.
[Nongovernmental Report] Part 2 Chapter 5 Section 3

Descriptions about monitoring for subsoils[Nongovernmental Report] in the following way.

of

ocean

are

given

in

Implementation of seawater monitoring
To assess the state of radioactive material emissions, MEXT conducted ocean monitoring. At
points approximately 30 kilometers offshore—a distance that allows air radiation levels to bemeasured while avoiding health risks to human personnel—seawater samples were collectedfrom eight sites approximately 10 kilometers apart. For example, at Site 1, off the coast of the
Fukushima Daiichi Nuclear Power Plant, maximum detected levels on March 23 were 76.8 Bq/L
for iodine 131 and 24.1 Bq/L for cesium. Air radiation levels at sea, and the radioactivity
concentration of ocean dust, were also monitored. In addition, sea-floors were monitored in
Miyagi, Fukushima, and Ibaraki prefectures and iodine 131, cesium 134, and cesium 137—allthought to be a result from Fukushima were detected.
Since April 2011, numerical oceanic prediction systems (JCOPE2 and JCOPET) have beenused to conduct simulations of the dispersion of radioactivity concentrations on the ocean surface
and other quantities[Nongovernmental Report] Part 1 Chapter 2 Section 1

Thirdly, there was little understanding of radioactive materials in subsoils of the ocean. The
monitoring target set by the MEXT was not subsoils of the ocean but sea water. Consequently,
radioactive materials also accumulated in bottom-dwelling coastal fishes (e.g., flat fish andflounder etc.), and accumulation in medium-sized fish due to the food chain started to occur.
Fourthly, responses for the long-term necessity of seawater monitoring have not been
sufficient yet. While the accident is not resolved, the possibility of water contaminated with ahigh concentration of radioactive material seeping out from the underground cannot be denied in
30

Japan Health Physics Societyspite of construction to stop the contaminated water flowing out. The monitoring of the highconcentration contaminated water should be also continued. There is a necessity for morecomprehensive monitoring besides that around the NPS taking into consideration that radioactive
materials falling to the ground are released to the sea through a river by rain or decontamination
works. At this time, reserchers are mainly conducting the measurement activities in the region
except for Fukushima prefecture, but this issue should be addressed by the MEXT that is incharge of monitoring.
[Nongovernmental Report] Part 2 Chapter 5 Section 3

Descriptions about monitoring for sea products are given in [Governmental Final
Report] and [Nongovernmental Report] in the following way.
(c) Seawater fish
A total of 5,051 specimens of saltwater fish were tested by the end of February 2012, andradioactive materials in excess of the provisional regulation value were detected in 162
specimens. Soon after the nuclear accident, radioactive materials in excess of the provisional
regulation value were detected in species of surface fish in coastal waters, such as sand eels andwhitebaits. However, since radioactive materials beyond the provisional regulation value weredetected in whitebaits caught off Fukushima Prefecture on June 6, 2011, no species of surface
fish with that much of contamination have been found. Later, radioactive materials in excess ofthe provisional regulation value have come to be detected in species of bottom fish in coastal
waters, and they are still being detected in such fish species as of the end of February 2012. In
most cases, contaminated fish has been found in sea areas to the south of the Fukushima Dai-ichi
NPS.
These contamination trends are believed to reflect the phenomena that radioactive materials
discharged from the Fukushima Dai-ichi NPS into the sea have been carried to the south by theocean current (the Oyashio current) and that radioactive materials have moved from the sea
surface to the bottom of the sea in the course of time.
[Governmental Final Report] Chapter V 5 (1)Thirdly, there was little understanding of radioactive materials in subsoils of the ocean. The
monitoring target set by the MEXT was not subsoils of the ocean but sea water. Consequently,
radioactive materials also accumulated in bottom-dwelling coastal fishes (e.g., flat fish andflounder etc.), and accumulation in medium-sized fish due to the food chain started to occur.
Fourthly, responses for the long-term necessity of seawater monitoring have not been
sufficient yet. While the accident is not resolved, the possibility of water contaminated with ahigh concentration of radioactive material seeping out from the underground cannot be denied inspite of construction to stop the contaminated water flowing out. The monitoring of the highconcentration contaminated water should be also continued. There is a necessity for morecomprehensive monitoring besides that around the NPS taking into consideration that radioactive
materials falling to the ground are released to the sea through a river by rain or decontamination
works. At this time, reserchers are mainly conducting the measurement activities in the region
except for Fukushima prefecture, but this issue should be addressed by the MEXT that is incharge of monitoring.
[Nongovernmental Report] Part 2 Chapter 5 Section 3

The following isssues can be raised in association with monitoring of seawater,
subsoils of ocean, and sea products.

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Monitoring of seawater, subsoils of ocean, and sea products – lack ofunderstanding of the necessity
 Since the necessity of sea area monitoring was not fully understood, themonitoring area was limited to the region within 30km from Fukushima
Dai-ichi NPS at the early stage after the accident. Ocean currents formed
around this local area were not considered in the monitoring design, which
led to missing knowledge on the dynamics of the transition of radioactive
materials from the source.
Monitoring of seawater, subsoils of ocean, and sea products – lack ofprediction tools Since the seawater off Fukushima Prefecture travels down to the southern
region of the Fukushima Dai-ichi NPS along the coast after the “Oyashio”
current meets the “Kuroshio” current, radioactive materials in seawater
traveled down to off the coast of Ibaraki Prefecture in the area south of the
Fukushima Dai-ichi NPS, which led to the situation that radioactive
materials temporarily accumulated in sand eels, forcing fishermen in
Ibaraki Prefecture to refrain from fishing. In addition, radioactive materials
also accumulated in bottom-dwelling coastal fishes (e.g., flat fish, flounder,etc.). The timing of the accumulation of radioactive materials in
medium-sized fish owing to the food chain could not be predicted since themonitoring target at the early stage postaccident was not ocean subsoils but
seawater.

(2) Prediction of diffusion of radioactive materials(a) System for Prediction of Environmental Emergency Dose Information (SPEEDI)
To minimize radiation exposure of residents in an emergency and get information
on diffusion of radioactive materials, the System for Prediction of Environmental
Emergency Dose Information (SPEEDI) has been established. The predictions is to be
utilized as a foundamental information to select areas where protection measures suchas evacuations are carried out by government or municipality or to choose radiation
monitoring points. Descriptions about SPEEDI are given in [Governmental Interim
Report], [Governmental Final Report], [National Diet Report] and[Nongovernmental Report] in the following way.
(1)Overview of the SPEEDI system
The System for Prediction of Environmental Emergency Dose Information (SPEEDI) quickly
predicts the atmospheric concentration of radioactive materials and radiation dose in thesurrounding area of an emergency situation, including nuclear power stations, based on releasesources, meteorological conditions and topographical data. Predicted results are shown withsymbols and isolines on a map.
Release sources data for the calculations of the SPEEDI are to be provided by the Emergency
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Response Support System (ERSS). The ERSS predicts and analyzes the outcome and subsequentdevelopment of the accident based on information concerning the behavior of the reactor, which
is provided by nuclear power station operators, and its predicted amounts of discharged
radioactive materials are provided to SPEEDI.
The Basic Disaster Prevention Plans stipulates that MEXT should adequately prepare andmaintain the SPEEDI system even during normal times and improve necessary functions,
including connections to the Off-site center. The Plan also stipulates that MEXT should shift
SPEEDI to emergency mode immediately after the Ministry is notified of the occurrence of a
specified event (stipulated in Article 10 (1) of the Act on Special Measures Concerning Nuclear
Emergency Preparedness (Specific Event)), and make proper predictions on the impacts ofradiation and share the results of those predictions with all relevant ministries and agencies.
The Government's NE Response Manual stipulates that if an accident occurs in a commercial
reactor, NISA should activate ERSS to grasp release source information, which is transferred to
the MEXT. MEXT should predict based on this release source information the impacts ofradiation using the SPEEDI computer, which is installed at the Nuclear Safety Technology Center(hereinafter referred to as the "Nuclear Safety Technology Center") and provide the results to the
NISA, NSC, all relevant prefectural governments and the Off-site center.
This NE Response Manual stipulates that the results of the SPEEDI calculations should be
used at a nuclear incident as the basis of discussions on how to take measures to protect residents
in the vicinity of the NPS. Actually, when the national government conducted a comprehensive
nuclear emergency response drill in Fukushima Prefecture in 2008, drills on shifting SPEEDI toemergency mode, taking adequate protective actions and verifying the results using SPEEDI
were included.
In this Accident the release source information from ERSS on which SPEEDI calculations are
based was not obtained. To be more precise, due to the loss of external power supply caused by
the earthquake on March 11, TEPCO's Safety Parameter Display System (SPDS), which was
installed within the premises of the Fukushima Dai-ichi NPS to provide the reactor data to ERSS,
ended up being unable to transfer data to ERSS. Moreover, as described in Section III5(1)b, after
16:43 on March 11, the Government's dedicated line, which sends data from the Fukushima
Dai-ichi NPS to the main computer of ERSS through the Off-site Center, became unavailable.
Thus in the implementation of response measures for the nuclear accident, SPEEDI which isbased on release source information from ERSS, was not able to perform calculation predictions
on the dispersion of radioactive materials since plant data could not be transferred to ERSS as aresult of at least two transfer line failures. Against the expectation of aforementioned training
drills, it was impossible to utilize the SPEEDI for setting the evacuation zones because SPEEDI
could not predict the atmospheric concentration of radioactivity and radiation dose.
[Governmental Interim Report] Chapter V 2

4.3.4 Prediction systems for emergencies
The government developed and deployed ERSS and SPEEDI in order to support theconsideration of protective action for residents when a nuclear emergency occurs. Because theprogression of events during this accident was so swift and the information from ERSS on sourcesof release was not available for so long, the calculation results from SPEEDI were not useful tothose making decisions on evacuation orders in the earliest stages.
There were some people involved in nuclear emergency preparedness who recognized, before
the accident, the limitations of the prediction systems. However, a review of the existing
framework in which evacuation orders would rely on the calculation results of the prediction
systems was not held. Moreover, no systematic study was done of measures that could compensate
for the limitations of SPEEDI or of ways to utilize the calculations’ predictions.

1. Outline of the emergency prediction systems
The government had been developing the ERSS and SPEEDI prediction systems in order to33

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implement nuclear emergency response measures in a swift and appropriate manner. The plan wasthat, when an accident occurred, ERSS would calculate the amount of radioactive material thatwas being released from the nuclear facility into the atmosphere by nuclide and time (releasesource information); based on this release source information, SPEEDI would conduct a
predictive calculation of the impact on the environment concomitant with the progression of theaccident; and evacuation and other emergency measures would be taken based on the calculation
results.

Fig. 4.3.4-1 Outline of the coordination between ERSS and SPEEDI
a. ERSS (emergency response support system)
ERSS is a system that (i) monitors the condition of the reactors at a nuclear power plant and (ii)
predicts the progression of an accident and the external release of radioactive material, based on
information transmitted from the nuclear power plant.
The Nuclear Power Engineering Test Center (note: this entity conducted a business transfer
relating to nuclear safety regulation to JNES on 2003 and dissolved) began developing ERSS in
1987, in the wake of the 1986 accident at the Chernobyl Nuclear Power Plant. ERSS was put into
operation in 1996. Its deployment, maintenance, and management, as well as the expansion of its
functions, are under the jurisdiction of METI; meanwhile JNES is responsible for the actual
operation and management of ERSS, including analyses and predictive calculations.
ERSS works as follows: (i) it automatically collects data from a nuclear power plant on theoperation status of electrical power supplies, the coolant condition of the reactors, etc., thepressure and water levels in the reactors, the measured values of radiation, etc., and uses thesedata to determine the condition of the reactors, reactor containments, etc., using a specificcalculation model; (ii) it inputs the results of these determinations into a specific calculation
model, and predicts the progression of core meltdown, damage to reactor vessels, loss ofcontainment integrity, etc., as well as making predictive calculations on the release source
information.
When plant information is unavailable, it is possible to predict the progression of an accident
from typical accident postulates that have already been incorporated in the database and from theanalysis data thereof.
The prediction results of the ERSS calculations are sent to NISA-ERC (the Emergency
Response Center at METI), NSC, Off-site Centers, etc. to be considered when taking protective
action for residents. The ERSS calculation results from release source information are also used
for SPEEDI calculations and predictions.

b. SPEEDI (System for Prediction of Environmental Emergency Dose Information)
When an accident occurs that releases radioactive material from a nuclear facility into theoutside environment, the SPEEDI system conducts predictive calculations on the radioactive
diffusion and the exposure doses of residents, etc. in the surrounding environment, based onrelease source information and weather forecasts, etc., and displays the results mainly as diagramson maps.
SPEEDI was developed by the Japan Atomic Energy Research Institute (which merged withJapan Nuclear Cycle Development Institute [JNC] on October 1st, 2005; its current name is Japan
Atomic Energy Agency), in the wake of the Three Mile Island accident in 1979 and commenced
operation in 1985. At the beginning of its development, SPEEDI was intended to be used to
predict such matters as the distribution of radioactive material and exposure doses in the34

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environment surrounding nuclear facilities, but it later came to be utilized in nuclear emergency
preparedness as well. The deployment, maintenance, management, and expansion of SPEEDI
functions were placed under MEXT jurisdiction, while the Nuclear Safety Technology Center(NUSTEC) conducts the actual operation, including the use of its calculated predictions.
The function of SPEEDI is to use a specific calculation model to calculate predictions of theairborne concentration, the amount of surface ground deposition and air absorbed dose rates ofradioactive material that is released externally, and the exposure dose of residents in thesurrounding areas, etc.; this is based on release source information such as (i) the results ofpredictive calculations with ERSS (ii) unit release rate assumption (1Bq/h) and (iii) other assumed
values, as well as topological and other data, weather forecast information, etc. The reach of thecalculations is a maximum of a square of 100km on a side (25km at high resolution) and amaximum of approximately 72 hours after release. The results of the calculations are displayed as
diagrams on maps and may be viewed at terminals installed at MEXT, NISA-ERC, the NSC, theprefectural office where the site is located, off-site centers, etc.

2. The expected role of the prediction systems before the accident
ERSS and SPEEDI were positioned in the Regulatory Guide: Emergency Preparedness for
Nuclear Facilities (NSC RG T-EP-II.01) and Guidelines for Environmental Radiation Monitoring(NSC RG T-EN-II.02) (Monitoring Guideline) as important tools in deciding the evacuation
orders and other protective actions for residents. Consideration of protective actions for residents
using ERSS and SPEEDI was repeatedly emphasized during disaster prevention drills, according
to the Monitoring Guideline. Some people involved in nuclear emergency preparedness hadrecognized, even prior to the accident, the limitations of the prediction systems. However, areview of the existing framework, in which evacuation orders would be issued relying on thecalculations of the prediction systems, was not held before the accident.
a. Position in the Monitoring Guideline
According to the Monitoring Guideline, the actual method of operation for ERSS and SPEEDI
is as follows.
(i) During the initial stage after an accident, calculations are made with SPEEDI, inputtingsome assumed values such as 1Bq/h (which is the so-called “unit release rate assumption”)
since it is generally difficult to acquire release source information. The results are used toelaborate the emergency monitoring plan to measure radiation dose rates in the atmosphere,etc.
(ii) In the case where release source information has been obtained from ERSS calculations,this is used to conduct calculations with SPEEDI, to create and distribute diagrams ofeffective doses from external exposure, etc.; it’s desirable to obtain such diagrams quickly
for the considering protective action.
(iii) In the case where the results of emergency monitoring have been obtained, a whole rangeof diagrams shall be prepared, based on those results and the results of the predictive
calculations with SPEEDI, to be used for considering and implementing protective action.
As we have shown, the Monitoring Guideline stipulates that predictive calculations with
SPEEDI shall be conducted using unit release rate assumption and other assumed values until
release source information is obtained from ERSS, and that once release source information is
obtained, such information shall be input into SPEEDI to conduct predictive calculations.
However, there is no explicit mention of how to respond in case release information from ERSS is
not available for long periods of time.
b. Treatment in the Comprehensive Nuclear Emergency Preparedness drills
During the annual Comprehensive Nuclear Emergency Preparedness drills, exercises had been
actually conducted, as per the Monitoring Guideline, to do predictive calculations with SPEEDI(using the release source information derived from ERSScalculated predictions) and decide thescope of evacuation on the basis of the results. No exercises were conducted based on the35

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possibility that release source information might not be obtained from ERSS for long periods oftime.
c. The understanding of the role of the prediction systems on the part of the people involvedin nuclear emergency preparedness
Given the positioning of ERSS and SPEEDI in the Monitoring Guideline and their treatment inemergency preparedness drills, bureaucrats gradually came to the understanding that ERSS andSPEEDI were important tools in providing information to assist the decision-making regarding
evacuation orders.
Some people engaged in nuclear emergency preparedness at NISA, the NSC, JNES and JAEA
began to have doubts about the emergency response drills, and the very idea of relying on the
ERSS and SPEEDI calculations when establishing evacuation zones, etc. Some of the main
suspicions were:(i) Whether the ERSS was reliable in predicting the release of radioactive material from thecontainment vessel in advance, given the difficulty of predicting the timing and magnitudeof the damage to the containment vessels with the ERSS analysis code.
(ii) Whether there was a possibility that the accident progression prediction would not function if
the progression of an accident at the plant was affected due to some reasons including
malfunctions of equipment which does not provide input data to ERSS.
(iii) Whether it was difficult for SPEEDI to predict diffusion of radioactive materials whichreflected specific weather conditions such as localized rain, localized snow or other else.
However, as was explained in detail in 4.3.1, there was no progress in holding a review of theEmergency Preparedness Guide to create evacuation orders that did not rely on the calculation
results of ERSS and SPEEDI.
[National Diet Report] Chapter 4, 4.3.4

・Utilization and dissemination of information yielded by SPEEDI up to March 15
a. Utilization and dissemination of the results of an hourly basis calculation, assuming a unit
radioactivity release rate
As described in Section (1) above, MEXT directed the Nuclear Safety Technology Center,
which manages and operates SPEEDI, to switch the SPEEDI system to emergency mode at 16:40
on March 11.
In response to this directive, the Center switched SPEEDI to emergency mode at 16:49 that day.
At the same time, the Center started calculations to predict the atmospheric dispersion ofradioactive materials on hourly basis using the meteorological data from 16:00 that day andassuming a unit radioactivity release rate of a 1Bq/h from the Fukushima Dai-ichi NPS based on
the Environmental Radiation Monitoring Guidelines prepared by NSC. It should be noted,
however, that the results of the calculations above was not a prediction based on an actual releaserate, but simply a prediction of the direction of dispersion and the relative concentration ofradioactive materials in the air based on a unit release rate.
In response to the directive from MEXT, the Nuclear Safety Technology Center provided thepredicted results of their unit release rate calculation, to MEXT, the ERC, the NSC, the Off-site
Center, the Fukushima Prefectural Office, and JAEA. The Nuclear Center requested that the
Nuclear Safety Technology Center adjacent to the Off-site Center provide the results of their unit
release rate calculation. In response to the request, at approximately 23:00 on March 11, theNuclear Safety Technology Center provided the results of their unit release rate calculations only
once to the Fukushima prefectural Monitoring Center via email, which had been intermittently
available during that time.
Among the organizations that received the unit release rate calculations, the Monitoring Center
used the results as a reference to formulate their monitoring program from March 12. Other
organizations did not use these results to discuss practical and concrete measures since they
thought that the calculations based on an assumed unit release rate did not show any actual36

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radiation dose levels. They also had no idea of making the results public. As described earlier, theresults of the unit release rate calculation, however, had predict the direction of dispersion ofradioactive materials and the distribution of relative amounts of radioactive materials, they could
have been useful in determining the direction of evacuation of residents (refer to Section 3 (3) cand f).
b. Utilization and dissemination of the results of calculations conducted by organizations
based on various assumptions
Besides the unit release rate calculations, between March 11 and 15, MEXT, NISA and NSC
conducted calculations to predict the impact of radioactive materials released from the Fukushima
Dai-ichi NPS by entering various assumed values into SPEEDI as release source information.
Between March 12 and 16, the MEXT, conducted 38 SPEEDI calculations with various releasesource information and shared the results within the MEXT emergency operation Center (EOC),
and provided some of the calculation results to both the ERC and the NSC.
Aside from this, on the night of March 12, NSC made one request for a SPEEDI calculation to
the Nuclear Safety Technology Center. The NSC received the calculation results and shared themwith its members, members of its technical advisory body at an emergency, and some staff
members of the NSC Secretariat. The NSC, however, believed that the calculation results should
only be utilized for internal discussion. As a result, the calculation results were not shared withany other organizations.
Meanwhile between March 11 and 15, NISA conducted 45 SPEEDI calculations by enteringvarious assumptions of release source information in order to grasp the dispersion feature ofradioactive materials. The obtained predicted results were shared with various functional teams
within the MEXT-ERC. The first set of results were provided to the Prime Minister's Office andthe Off-site center.
NISA had requested that the Nuclear Safety Technology Center to conduct the SPEEDI
calculation to predict the impacts of radioactive materials released from Unit 1 of the Fukushima
Dai-ichi NPS and provided the SPEEDI predictions to the Agency staff at just past 1:30 on March
12. The officials gave the predictions to the staff of the Cabinet Secretariat who attempted to share
the predictions with the staff of various ministries who were stationed in the basement of thePrime Minister's Office.
NISA sent the Prime Minister's Office the SPEEDI predictions with an accompanying message
that NISA believed that the SPEEDI predictions were of low reliability because of calculations
based on assumed release source information. Cabinet Secretariat staff, who received thepredictions from NISA staff before dawn on the morning of March 12, treated them as reference
information and did not report to Prime Minister Naoto Kan (hereinafter referred to as "Prime
Minister Kan"). Also NISA itself did not report the predictions to Prime Minister Kan either.
[Governmental Interim Report] Chapter V 2

3. The response by the relevant organizations with regard to the prediction systems when theaccident occurredSPEEDI calculation results were not used to establish the evacuation zones during the initial
response to the accident for several reasons: the release source information was unavailable from
ERSS for a long period of time; the event progressed rapidly; and it was difficult to predict when
the radioactive material would be widely released.
a. The operation status of ERSS
During the accident, the transmission of plant data from the Fukushima Daiichi Nuclear Power
Plant stopped because the external power supply was lost and the server installed at the
Fukushima Daiichi plant to transmit information on the inside of the reactors, etc. to ERSS had
shut down. Moreover, the government’s dedicated line for data transmission also broke down.
Around the same time, the electric power supply for the reactors’ computers was also lost, so
ERSS lost the ability to grasp the state of the plants at the Fukushima Daiichi Nuclear Power37

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Plant.
It was known before the accident that the loss of electric power supplies could become aproblem in obtaining release source information for ERSS. Nevertheless, the emergency power
supply was left unconnected, and the data did not have multiple transmission routes.
Because of this situation, JNES used ERSS to calculate some predictions on the progression of
the accident, etc. based on the analysis results of the plant information (activation and shutdownof equipment, opening and shutting of valves, etc.) obtained from TEPCO by fax and phone, andfrom analogous events extracted from the database. Part of this was sent to the prime minister’s
office. Release source information predicted by the results of the analysis of similar events wasprovided to NISA as well, but this was not based on actual plant parameters and therefore lacked
accuracy.
b. The operation status of SPEEDI
Because release source information was not available from ERSS at the time of the accident,
prediction calculations, etc. were initially conducted with SPEEDI using release information for
unit release rate assumption and release source information predicted on the basis of the results of
the analysis of similar events by ERSS.
Under instructions from MEXT, NUSTEC began calculating predictions at 16:40 on March 11
using unit release rate assumptions, and the results were distributed to NISA and other relevantorganizations. Figure 4.3.4-2 is the first predictive calculation diagram that was calculated, using
unit release rate assumption.
The people in charge at NISA, MEXT, and the Secretariat of the Nuclear Safety Commission
also conducted predictive calculations after the accident, in which they used assumed values otherthan unit release rate assumptions.

Fig. 4.3.4-2 Diagram of predictive calculations with SPEEDI using unit release rate assumption(predictions for air absorbed dose rates, March 11 16:00-17:00)[National Diet Report] Chapter 4, 4.3.4
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・Utilization and dissemination of information produced by SPEEDI from March 16
onwardb. Performing a retrospective estimation of release source information by SPEEDI andpublicizing the predictions
In response to the change of operation body of SPEEDI from MEXT to NSC, as described in
Section a above, from March 16, NSC began discussions on how to utilize SPEEDI in a situation
where release source information from ERSS was not available.
As part of the discussion, on the following day, March 17, in response to the direction of theVice Chairman of NSC, Mr. Yutaka Kukita (hereinafter referred to as "NSC Vice Chairman
Kukita") and under the cooperation of JAEA and the Japan Chemical Analysis Center, the NSC,
led by a member of the Emergency Response Technical Advisory Body, started discussions on
how to estimate release source information using SPEEDI and how to estimate the radiation dose
based on the estimated release source information.
What is specifically meant by estimating release source information using SPEEDI in asituation where release source information is not available, is to estimate the actual amount ofradioactivity released by multiplying the unit amount of radioactivity released by a ratio ofobserved radiation dose rate at a specific point to a calculated radiation dose rate of the unit
release rate at the same point. In the calculation above, the NSC used radiation dose rates in the air
obtained by the monitoring and the atmospheric concentration of radioactive materials obtained by
dust sampling. To be more precise, the NSC selected data for calculation by analyzing themonitoring data collected before March 15 and newly obtained data from MEXT.
As a result, at around 09:00 on March 23, NSC obtained the results of calculation concerning
the cumulative radiation dose in the surrounding areas of the Fukushima Dai-ichi NPS between
March 11 and 24. It was found that an equivalent dose of the thyroid gland of infants, which werepart of the calculation results, exceeded 100mSv of the criteria for stable iodine distribution (refer
to Section 4 (1) c below) indicated in the "the Guideline for Measures for Nuclear Installations"(hereinafter referred to as "Guideline for Measures"), which was prepared by the NSC. Thus NSC
Chairman Haruki Madarame (hereinafter referred to as "NSC Chairman Madarame") and NSC
member Ms. Shizuyo Kusumi reported these results to the Prime Minister's Office (for the resultsof this report, refer to Section 3(2)a below).
According to the direction of the Prime Minister's Office, the NSC held a press conference ataround 21 p.m. on March 23 and publicize the calculation results.
[Governmental Interim Report] Chapter V 2

c. Reverse estimate calculation of released source term information using SPEEDI conductedby NSCOn March 16, NSC began making reverse estimate calculations of released source term
information and simulations of the diffusion of radioactive material based upon those results; it
was allowed to directly request the SPEEDI calculation from NUSTEC, although MEXT had theoriginal responsibility for making requests to NUSTEC for SPEEDI calculations.
The reverse estimate calculation of release source information is a method that compares themeasured value of the radiation dose rate at a certain geographical point during a certain period oftime (obtained from environmental radiation monitoring) and the predicted value for the samegeographical point and period of time (derived from SPEEDI predictions using unit release rate
assumption), and uses this ratio to retroactively estimate past release source information. It is
possible to reproduce the state of diffusion of radioactive material up to that point in time using
past release source information derived by this reverse estimate calculation in recalculations with
SPEEDI. The results of this numerical simulation are useful for understanding the total picture of
the state of environmental pollution and serve as reference material for protective action.
This kind of reverse estimate calculation of release source information was only conducted
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during the Chernobyl nuclear accident and the JCO Accident, and no procedure manuals had been
prepared. It was difficult for people who had not experienced conducting the calculation during
either of those accidents to do these calculations.
In order to conduct reverse estimate calculations, it takes some time after the diffusion of theradioactive material actually begins for a meaningful amount of measured values for comparison
purposes to be accumulated from environmental radiation monitoring. Therefore, after theaccident’s onset, it took some time before it became possible to implement reverse estimate
calculations.
The NSC went forward with the reverse estimate calculations and the numerical simulation of
the state of diffusion of radioactive material with the help of experts who had past experience withreverse estimate calculations in parallel with the accumulation of measured values fromenvironmental radiation monitoring. It took some time after March 16 to gather the atmosphericconcentration data of radioactive nuclides necessary for the reverse estimate calculation, but thereverse estimate was completed on the morning of the 23rd.
[National Diet Report] Chapter 4, 4.3.4

・Relationship between SPEEDI calculation results and evacuation measures
As described in Chapter V 2. (2) a. of the Interim Report, under the MEXT’s instructions since
the accident occurred on March 11, the Nuclear Safety Technology Center, which manages andoperates SPEEDI, calculated the likely atmospheric dispersion of radioactive materials on hourly
basis assuming a unit radioactivity release rate of a 1Bq/h from the Fukushima Dai-ichi NPS andreported the results of the calculations to relevant organizations.
The calculation results were useful in making judgment on which direction people should be
evacuated as they predict the directions of dispersion of radioactive materials. But none of theseorganizations used these results to discuss practical evacuation measures nor considered making
them public, since the organizations thought that the calculations based on an assumed unit release
rate did not show any actual radiation dose levels.
[Governmental Final Report] Chapter IV 2

c. SPEEDI utilization policy(a) Problems with the systems and the entities that make use of themSPEEDI is a system that can predict radiation dose rates in the surrounding environment when anuclear accident occurs, based on the emissions source information that is transmitted from theEmergency Response Support System (ERSS). However, the ERSS may fail to function incollecting and transmitting the reactor information when a nuclear accident occurs, and in such asituation SPEEDI itself, too, might fail to function. Therefore, the policies of utilizing SPEEDI
when the ERSS cannot function should have been reviewed beforehand, and the results of thereview should have been shared among the personnel concerned to respond to the accident.
Nevertheless, many of the individuals who were responsible for taking response measures in theevent of an accident had a belief that there would be no room to allow for the utilization ofSPEEDI in evacuation activities once the ERSS failed to function. The Guideline forEnvironmental Radiation Monitoring (NSCRG T-EN-II.01) has a clause on the methods ofutilizing SPEEDI in the event that emissions source information cannot be obtained (i.e., when the
ERSS does not function). However, no consensus had been reached on whether this could beapplied to evacuation activities. Furthermore, no clarification had been made as to the entities thatwould make use of SPEEDI (operation and public announcement) in the event that an off-site
center failed to function.
(b) SPEEDI and evacuation orders
One of the major reasons as to why SPEEDI was not effectively utilized, as described in (a)above, is considered to lie in the fact that any of the relevant organizations did not have an idea of40

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its potential role in the implementation of evacuation activities, being in preconception about theimpossibility of utilizing SPEEDI in evacuation activities when emissions source information
could not be obtained from the ERSS. However, prediction was possible through SPEEDI byassuming the unit emissions, even when the emission sources information could not be obtained,
and actually the prediction results had been obtained; it may be concluded that, if the prediction
results by assuming the unit emissions had been distributed, there was room of allowance for therespective local governments and residents to be able to select a more appropriate timing or
direction to evacuate.
The relationship between the actually released evacuation orders (those for the Fukushima
Dai-ichi NPS were released since March 12) and the SPEEDI information (predictions assuming
unit release) is discussed earlier in Chapter IV. 2. (3) above. Table VI-1 below sorts out therelationship between the specific orders and SPEEDI data, and possible specific evacuation
procedures etc. (timing of evacuation, direction of evacuation, etc.) provided the SPEEDI
information had been used.
For a simple practical discussion, the third order from among the three evacuation orders since
March 12 is examined here: the case of stay-indoor order within 20-30 km from the accident site
at 11:00 a.m. on March 15. In this case, a little before the order (at 08:30 a.m. to 10:15), a highradiation dose rate of around 10,000 μSv/h had been measured, at a point near the main gate of the
Fukushima Dai-ichi NPS, and late at night on the same day (23:15 to 23:55), about 7,000 to 8,000
μSv/h high level dose rate had been still recorded (see Fig. IV-6 in Chapter IV. 2. (3) d. above),indicating a larger amount of release of radioactive materials than before.
Specifically, SPEEDI predicted dispersion mostly towards the land (to south-west tonorth-west) from March 15 to March 16. Therefore, even if implementing evacuation, it appears
that it was possible to minimize the out-door exposure to radiation by keeping the initial order tostay indoors first for the meantime and waiting the time periods, while staying alert to SPEEDI
information, when the SPEEDI’s prediction of dispersion constantly avoids overlapping with theevacuation route (for example, after 07:00 on March 16, when the prediction of dispersion was
coast bound and did not overlap with whichever evacuation route was taken). Actually, as
reviewed in detail earlier in Chapter IV 2 (3) d, there is a possibility that the evacuees from the
Minamisoma City and Namie Town who had begun evacuation on March 15, particularly in theevening or later (after around 15:00), might have taken their evacuation route overlapping with thepredicted direction of dispersion of radioactive materials. A detailed release of advice on theevacuation route and timing based on the SPEEDI information could have avoided these situations
to happen.
As seen above, even in cases that the information of the source of emissions was not available
from ERSS, there seems to have been room for effective use of SPEEDI.
Table VI-1
Evacuation
Orders05:44 on March
12・
Evacuation
from
10km
zone from theaccident site
18:25 on March
12・
Evacuation
from
20km

The predictions by SPEEDI and possible evacuation policy based on it○ Constantly coast bound (towards southeast) from 05:00 am to noon
○ Southbound from 13:00 to 15:00○ Westbound from 15:00 to 16:00, northwest to north from 16:00 to
18:00[Possible evacuation policies]
The predicted dispersion was constantly coast bound in the morning
after the evacuation order. Even if radioactive materials were being
released, evacuation was possible well in order. As dispersion waspredicted south bound into the afternoon, the residents from the southof power station had to be careful in evacuation.
○North bound from 18:00 to 19:00○Almost constantly coast bound (towards northeast) from 20:00 to
10:00 on the next day, March 13.
[Possible evacuation policies]
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zone from theaccident site

11:00 on March
15
・Stay-indoors in
the 20 to 30km
zone from theaccident site

The predicted dispersion was true north bound from the time ofevacuation order until 20:00. Later on until about noon on the next day,March 13, predicted dispersion was mostly coast bound. Therefore,
even if radioactive materials were being released, evacuation well inorder was possible later in the evening.
○South west bound from 11:00 to noon
○North west bound from 13:00 to 02;00 on the next day, March 16○South to south east bound after 03:00 on the next day, March 16[Possible evacuation policies]
Many residents actually evacuated despite the stay-indoor order. The
predicted dispersion after the order, however, was constantly landbound: west to north west bound after the order and only changed towest to south bound over the night until early morning of the next day,March16. Incidentally, a large amount of radioactive materials werereleased from March 15 to March 16. The dispersion was being
predicted to change to coast bound for the first time after 06:00 on
March 16. Therefore, there appears to be a possibility of limiting
exposure risks to radiation, by an advice on the evacuation timing
based on this prediction.
[Governmental Final Report] Chapter VI 1

ERSS and SPEEDI are systems to forecast future events based on a certain calculation model.
In particular, if release source information cannot be retrieved from ERSS, SPEEDI data alone
lacks the accuracy to serve as a basis for establishing evacuation zones. In this accident, events
unfolded very rapidly and the results of the projection could not be utilized for the initial
evacuation orders. Although some nuclear emergency preparedness practitioners were aware of
the limitations of the projection systems, no reviews of the framework for issuing evacuation
orders based on the calculations of the projection systems hade been completed prior to theaccident. Nor was the network of environmental radiation monitoring improved to offset thelimitations of the projection systems.
After the accident, release source information could not be retrieved from ERSS for many hours.
Related organizations, including NISA and MEXT, concluded that SPEEDI’s calculated results
could not be utilized, and so the system’s results did not contribute to the initial evacuation orders.
The results of the calculations from reverse estimate culclations that were disclosed by NSC at alater date were misunderstood, and believed to have been projections from the time the accident
occurred. This gave rise to further misunderstanding and the belief that the government could
have prevented residents’ exposure to radiation had the results been disclosed promptly andSPEEDI been effectively utilized in making decisions about the initial evacuation orders.
[National Diet Report] Chapter 4, 4.3

d. Treatment of the predictive calculation results from SPEEDI by the government andFukushima Prefecture
As we saw in 3, a., a situation such as this accident, in which release source information could
not be obtained from ERSS for some time after the accident, and only predictive calculations with
SPEEDI using unit release rate assumptions and assumed values were possible, was not
anticipated by the Monitoring Guideline and was not postulated by the relevant organizations,
including NISA and MEXT.
The senior officials and the officials in charge at these relevant organizations decided that “theaccident is not a situation where SPEEDI can be used” and reached the essential conclusion thatSPEEDI would not be utilized. As a result, methods of using SPEEDI calculations were notsystematically considered during the initial response, not only between these relevantorganizations but also within the organizations themselves. The predictive calculations were partly
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used merely as reference material for deciding the measuring points of the emergency monitoringand determining orders of priority for screening. During the initial response to the acident, theresults of SPEEDI calculations were not transmitted to the politicians at the Prime Minister’s
office who were in effect considering protective action for the residents.
The SPEEDI results had been sent by email to the Fukushima Prefecture Headquarters for
Disaster Control from March 12 on, but there was little will to systematically utilize the results,
and 65 of the 86 emails received were deleted without sharing the information within theorganization.
(Omisssion)c. The possibility of utilizing the SPEEDI calculation results
Even in cases, such as in this accident, where SPEEDI cannot be utilized to establish evacuation
zones for the initial response, there are situations where it can be actively used in considering
protective action for residents, beginning with the reverse estimate calculations that the NSC
conducted on this occasion.
As the Monitoring Guideline stipulates, for example, when establishing an emergency
monitoring plan it can be utilized as reference information when determining the directions andplaces for reinforcing surveillance, even if there are uncertainties.
Also, in cases such as venting, where the timing for releasing radioactive material is determinedby the people in charge, it may be possible to obtain information for considering protective action
for residents by conducting predictive calculations with SPEEDI—even if the calculations are
based on assumed values–by assuming that a release will occur at the time of the venting.
We believe that there was a possibility to utilize SPEEDI as a tool for betterinformed
decision-making regarding life-saving and other related activities at and near the accident site, as
an alternative to evacuation. In this accident, the evacuation areas were established as concentric
circles for the entire range of the people within the area, without exceptions, which meant that thefiremen and other people conducting rescue operations for the victims of the earthquake and thetsunami had to regretfully suspend activities. In order to continue, to the extent possible,
life-saving and other activities whose suspension would cause extremely large losses, we believethat it would be useful to predict areas where the impact of the diffusion of radioactive material is
expected to be relatively small, and then to transmit that information in a timely manner to theplaces where the activities are taking place by combining the information with monitoring
information.
(Omission)
5. The announcement of the SPEEDI calculation results, which led to misunderstanding andconfusion
On March 23, NSC announced the results of its numerical simulation of the diffusion ofradioactive material based on reverse estimate calculations. Because the information made public
was misinterpreted, and was believed to be the results of prior predictions, residents mistakenly
believed they would have been able to avoid radiation exposure if the SPEEDI calculation results
had been made public at an earlier time, and that the results could have been used for decisions
made regarding evacuation and sheltering.
a. The sequence of events for the announcement of the SPEEDI calculations results
As explained in 3, d., at the time of the accident, MEXT, NISA and the other relevantorganizations concluded that SPEEDI essentially could not be utilized. Moreover, the results of
the SPEEDI calculations consisted of information that was to be utilized by the persons in charge
in the relevant organizations, and were not assumed to be of direct use by residents. This is why, atthe beginning, the SPEEDI calculation results were not made public and demands from the media
for their disclosure were not met.
Later, on March 23, under instructions from Chief Cabinet Secretary Edano, NSC announced
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the results of the numerical simulation of the diffusion of radioactive material based on theirreverse estimate calculation.
From April 26 on, also under orders from Edano, each of the relevant ministries and agencies
disclosed SPEEDI results. However, the disclosures of the results were conducted separately by
NSC, NISA and MEXT, and some confusion resulted, such as in the case where Special Advisor
to the Prime Minister Goshi Hosono announced in a press conference that all the calculation
results had been made public, only to find that some ministry and/or agency had failed to disclose
them.
Table 4.3.4-1 shows the sequence of events for the announcement of the SPEEDI results.
The government did not sufficiently explain the functions, etc. of these calculation results from
SPEEDI before their announcement, resulting in misunderstanding and confusion among theresidents, who naturally wondered whether SPEEDI could have been utilized effectively indetermining evacuation orders during the initial response to the accident.
Table 4.3.4-1 Sequence of events of the announcement of SPEEDI calculation results
Date
Substance
March 15
Media requests during MEXT press conference that SPEEDI calculation
results be made public.
March 23
NSC announces calculated values from reverse estimate calculations forrelease source information.
((a) below: calculated values for radiation doses from internal exposure of
thyroid in children.)April 10
NSC announces calculated values from reverse estimate calculations forrelease source information.
((a) below: calculated values for radiation doses from external exposure of
thyroid in children.)April 25
Chief Cabinet Secretary Edano orders disclosure of all SPEEDI calculation
results.
April 26Disclosure by MEXT, NSC((b) below: calculations in (b) below are currently disclosed together on the
MEXT website.)
April 30
Special Advisor to the Prime Minister Hosono (Executive Director, Integrated
Headquarters) announces in press conference that all SPEEDI calculation
results have been disclosed.
May 2
Hosono announces in press conference that there were some undisclosed
SPEEDI calculation results.
May 3Announcement by MEXT, NISA ((c) below).
(a) Results of reverse estimate calculations of release source information based on values
from emergency monitoring, etc.
(b) Results of predictive calculations based on unit release rate assumption at the stage where
release source information from ERSS is not known.
(c) Results of predictive calculations using postulated amount released in case where releasesource information from ERSS is not available.

b. Insufficient explanation by the government at the time of the announcement of the resultsof reverse estimate calculations
The results of the numerical simulations of the diffusion status of radioactive material based onreverse estimate calculations that NSC announced on March 23:

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Fig. 4.3.4-6 Results of the reverse estimate calculations of release source information using
SPEEDI made public by NSC on March 23(Calculation results of radiation dose from internal exposure of thyroids in children)
The results of the numerical simulations of the diffusion status of radioactive material based onreverse estimate calculations that NSC announced on March 23:
The calculation results that NSC announced on March 23 were a numerical simulation of thepast diffusion of radioactive material based on the reverse estimation of release source
information from the measured values of radioactive nuclide concentration from the emergency
monitoring. Since the results of the numerical simulation were calculated to ensure that they
coincided with the actual measured results of the emergency monitoring, it was a foregone
conclusion that there would be no contradiction between the numerical simulation calculated as
the state of past diffusion of radioactive material and the actual results of the emergency
monitoring.
In making the March 23 announcement, the government did not sufficiently explain the natureof the numerical simulation or the difference between it and ordinary SPEEDI prediction results;
instead, it merely announced the data as calculation results using SPEEDI. Because of this, themisunderstanding spread among residents that the government had obtained the results of accurate
predictive calculations and then hidden them, and that radioactive exposure could have been
avoided.
c. How the SPEEDI calculation results should be handled
When information subject to a degree of uncertainty, such as the SPEEDI calculation results, ismade public without distinguishing it from accurate information, it may result in unnecessary
anxiety among residents and create confusion. It is necessary to explain such information in a
detailed and careful manner, so that the residents have an accurate understanding of its substanceand significance.
The explanations by the government in its answers in the Diet, press conferences, etc. so far
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have not been consistent. For example, highly contradictory statements have been maderepeatedly by government officials, with some stating that the scope of SPEEDI utilization was
narrow in the first place and others explaining that better responses would have been possible had
SPEEDI been utilized in this accident.
The response of the government with regard to the announcement of the SPEEDI results was
problematic. (In 3.6 we take up in detail how government information disclosure should be
conducted during emergencies.)[National Diet Report] Chapter 4, 4.3.4

There is an argument in the discussion on the use of the SPEEDI, that is, what level of accuracy
is necessary for scientific endorsement of the evidence or what level of “uncertainty” can beallowed. Of course, prediction is usually accompanied by a certain level of uncertainty, but in the
Fukushima nuclear accident, the uncertainty was increased because the accuracy of the source
information used in the prediction of the release of radioactive materials was unknown. It must be
difficult in reality to use prediction data calculated with increased uncertainty of the source
material used to make a judgement.
However, information and tools could not be obtained as their availabllity was limited in the
Fukushima nuclear accident. Therefore, efforts should have been made to maximumly utilize themwith more consciousness of safety, in other words, to reduce the possibility of receiving radiation
exposure as much as possible even if a constant “uncertainty” was remaining. Since the NISA and
MEXT ought to have considered that the leaders in the Prime Minister’s office were strongly
aware of wind direction, wind speed and perspective of wind direction, utilization of theprediction data of the SPEEDI would have been possible for use as one of the materials forjudgement if the data was informed to the leader of the Prime Minister’s office.
[Nongovernmental Report] Part 2 Chapter 5 Section 3

The following isssues can be raised in association with the System for Prediction ofEnvironmental Emergency Dose Information (SPEEDI).
System for Prediction of Environmental Emergency Dose Information(SPEEDI) – underutilization of prediction results Since the external power supply was lost following the earthquake and theGovernment's dedicated line for sending data became unavailable, therelease of source information from the Emergency Response Support
System (ERSS) on which SPEEDI calculations are based was not carriedout. For this reason, the Nuclear Safety Technology Center provided thepredicted results of their unit release rate calculation based on “theEnvironmental Radiation Monitoring Guidelines”, to the Ministry of
Education, Culture, Sports, Science and Technology (MEXT), theEmergency Response Center (ERC), the Nuclear Safety Commission(NSC), the Off-site Center, the Fukushima Prefectural Office, and the Japan
Atomic Energy Agency (JAEA) in response to the directive from MEXT on
11 March 2011. However, these predicted results were neither utilized to
discuss practical evacuation measures nor disclosed to the public, since thecalculations based on an assumed unit release rate did not show any actual
radiation dose levels.
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Japan Health Physics Society On the night of 12 March, NSC made one request for a SPEEDI calculation
to the Nuclear Safety Technology Center. The NSC received the calculation
results and shared them with its members, members of its technicaladvisory body in an emergency, and some staff members of the NSC
Secretariat. The NSC, however, believed that the calculation results should
only be utilized for internal discussion. As a result, the calculation results
were not shared with any other organizations.
 Meanwhile between 11 and 15 March, the Nuclear and Industrial Safety
Agency (NISA) conducted SPEEDI calculations by entering various
assumptions of release source information in order to grasp the dispersion
trend of radioactive materials. The obtained predicted results were sharedwith various functional teams within the MEXT-ERC. A few results were
provided to the Prime Minister's Office and the Off-site Center. However,NISA sent the Prime Minister's Office the SPEEDI predictions with anaccompanying message that NISA believed the SPEEDI predictions to beof low reliability because the calculations were based on assumed releasesource information. Cabinet Secretariat staff treated them as reference
information and did not report them to the Prime Minister.

(b) Simulation system on the diffusion of radioactive materials in the ocean
Descriptions about the simulation system in the ocean are only given in[Nongovernmental Report] in the following way.
Since April 2011, numerical oceanic prediction systems (JCOPE2 and JCOPET) have beenused to conduct simulations of the dispersion of radioactivity concentrations on the ocean surface
and other quantities.
[Nongovernmental Report] Part 1 Chapter 2 Section 1

The following isssue can be raised in association with the simulation system in theocean.
Simulation system on the diffusion of radioactive materials in the ocean –lack of prediction tools in the emergency preparedness system
 No simulation system for the diffusion of radioactive materials in the ocean
has been established in the nuclear emergency preparedness system, sincepeople do not live on sea area, unlike on land.

(3) Evacuation of residents
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Overview of evacuation instruction are given in [Nongovernmental Report] in thefollowing way.
Sequence of evacuation instructions
The Tokyo Electric Power Company sent an Article 15 Notification to notify the occurrence ofan emergency situation in the Fukushima Daiichi NPS based on the Act on Special Measures
Concerning Nuclear Emergency Preparedness. Two hours and 15 minutes after receiving thisnotification, the government declared a nuclear emergency situation at 19:03. After that,
evacuation instructions issued by the government can be divided into three steps. The first step isthe series of evacuation instructions issued at the early stage after the accident. At 20:50 on 11
March, the Fukushima prefecture government issued the first evacuation instruction for residents
living within a 2km radius of the Fukushima Daiichi NPS. About 30 minutes later, at 21:23, thegovernment issued an evacuation instruction for residents within a 3km radius and a stay-indoors
instruction for residents within 3-10km of the Fukushima Daiichi NPS. Moreover, at 5:44 on 12
March, the government issued an evacuation instruction for residents living within a 10km radiusconsidering the increase in pressure of Unit 1. In addition, at 18:25 on the same day, thegovernment expanded evacuation zone to the area within a 20km radius considering the hydrogen
explosion at Unit 1. This sequence indicates that four different evacuation instructions were issued
within 24 hours after the first evacuation instruction. The second step is the two instructions
issued in the middle of March. Four days after the occurrence of the earthquake, at 11:01 on 15
March, the government issued a stay-indoors instruction for residents within a 20-30km radius.
Ten days later, on 25 March, the government requested the residents of the same area tovoluntarily evacuate. The third step is the revision of the evacuation instructions issued in middle
and late April. On 11 April, one month after the occurrence of the accident, Chief Cabinet
Secretary Mr. Edano referred to two items, the establishments of a deliberate evacuation area andemergency evacuation prepared area as a revision of the evacuation zone. Ten days after that, on
21 April, the establishment of restricted area with a penalty for entering the area within a 20km
radius and the reduction of the evacuation area for the Fukushima Daini NPS from 10km to 8km
were announced. Moreover, the next day, 22 April, Mr. Edano annoounced three items, thecancellation of the stay-indoors instruction for the residents within 20-30km, and theestablishments of a deliberate evacuation area and an emergency evacuation prepared area.

Table 1 Sequence of evacuation instructions

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Japan Health Physics Society[Nongovernmental Report] Part 2 Chapter 5 Section 4

Descriptions about criteria and zones, communication, and implementation andcancelation of measures of evacuation and stay in house are given in [Governmental
Interim Report], [Governmental Final Report], [National Diet Report] and[Nongovernmental Report] in the following way.
(a) Criteria and zones of evacuation and stay in housea. Implementation of evacuation programs regarding the Fukushima Dai-ichi NPS accident
In response to the fact that all AC power supplies were lost and the Emergency Core Cooling
System was unable to provide water to Fukushima Dai-ichi NPS, Prime Minister Kan declared anuclear emergency situation at 19:03 on March 11 and established the Nuclear Emergency
Response Headquarters (NERHQ) in the Prime Minister's Office (refer to Section III 2 (1)).
In response to the declaration of the nuclear emergency state at the Fukushima Dai-ichi NPS,
the Prefectural Nuclear Emergency Response Center discussed an instruction of evacuation for
citizens within a 2km radius of the nuclear power plant, where regular nuclear emergency drills
and exercises were conducted. At 20:50 that day, Prefectural Governor Yuhei Sato instructed
citizens an evacuation within a 2km radius of the Fukushima Dai-ichi NPS.
This evacuation instruction was not issued on the basis of a specific act but de facto measure toprevent a disastrous scenario. In response to this order, officials from the towns of Okuma andFutaba took all possible measures by alerting citizens in the area, using a municipal disastermanagement radio communication network, sound trucks and having fire fighters makedoor-to-door visits.
Later, after a press conference by Chief Cabinet Secretary Edano concerning the declaration of
the nuclear emergency state, NSC Chairman Madarame, Vice Chairman of the Nuclear andIndustrial Safety Agency, Eiji Hiraoka (hereinafter referred to as "Vice Director-General of NISA
Hiraoka"), and TEPCO executives convened on the fifth floor of the Prime Minister's Office (not49

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at the Crisis Control Center on the basement floor), where concerned ministers asked for theiropinions on the conditions of the nuclear reactors, the range of the evacuation area and othermatters.
In that discussion, various opinions were offered including "reactor cores might be damaged in
the worst case scenario" and "a vent operation is required to avoid that." In terms of the range ofthe evacuation area, the Nuclear Emergency Guideline, which was created by the NSC, states thatthe range of the emergency preparedness zone (EPZ) where emergency countermeasures are
sufficiently taken should be within a 10km radius but the preventive action zone (PAZ) that is
described in a document of the International Atomic Energy Agency (IAEA) is the area within a
3km radius. So "within a 3km radius" is sufficient, even if it assumed that a vent operation isrequired. In addition, Vice Director-General of NISA Hiraoka explained that a regular evacuation
drill is conducted within a 3km radius under a supposed vent operation. Based on these opinions
and explanations, the evacuation was instructed for the zone within a 3km radius, and astay-indoors was instructed for the zone within a 3 to 10km radius from the Fukushima Dai-ichi
NPS.
In response to this decision reached in a meeting held on the fifth floor of the Prime Minister's
Office at 21:23 that day, the NERHQ instructed the Fukushima Prefectural Governor and all
relevant local governments to issue an evacuation order to citizens within a 3km radius of the
Fukushima Dai-ichi NPS and to issue a stay-indoors order to citizens within a 10km radius of thepower station. At 21:52 the same day, Chief Cabinet Secretary Edano held a press conference
concerning the evacuation orders.
Subsequently, no vent operation was conducted despite an abnormal increase in the pressure
inside the primary containment vessel at Unit 1 and despite the fact that the implementation of avent operation at Units 1 and 2 was instructed by the Prime Minister. Before dawn on the morningof March 12, concerned ministers discussed the range of the evacuation zone again on the fifth
floor of the Prime Minister's Office in the presence of Vice Director-General of NISA Hiraoka and
NSC Chairman Madarame. During this discussion, an opinion was expressed that it would not benecessary to extend the evacuation zone if a vent operation were conducted under well-controlled
conditions but, if taking a conservative stance on this matter, even a relatively significant hazard
could be handled if an EPZ were expanded to within a 10km radius. Based on this opinion, it was
decided that the evacuation zone would be expanded to within a 10km radius. At 05:44 on March
12, the NERHQ instructed the Fukushima Prefectural Governor and all relevant local
governments to issue an evacuation order to citizens within a 10km radius of the Fukushima
Dai-ichi NPS. At 09:35 the same day, Chief Cabinet Secretary Edano held a press conference
about the evacuation order. A 06:15 the same day, after the decision was made to expansion theevacuation zone, Prime Minister Kan flew to Fukushima Dai-ichi NPS by helicopter.
During a vent operation had still been tried at 15:36 on March 12, there was an explosion in theReactor Building of Unit 1. A discussion was held on the fifth floor of the Prime Minister's Officeabout how to grasp the plant situation and how to take protective measures. It was decided that anevacuation order would be issued to citizens within a 20km radius. At 18:25 on March 12, theNERHQ instructed the Fukushima Prefectural Governor and relevant local governments to issue
an evacuation order to citizens within a 20km radius of the Fukushima Dai-ichi NPS.
At 20:32 the same day, Prime Minister Kan addressed the Japanese people to explain the
expansion of the evacuation zone range. Following Prime Minister Kan, at 20:50 the same day,
Chief Cabinet Secretary Edano talked about the explosion at the Reactor Building of Unit 1,
explaining that it was not the explosion of the primary containment vessel so a large volume ofradioactive material would not leak out. He also explained the expansion of the evacuation zone
range.
Subsequently, the following incidents occurred in succession: at 11:01 on March 14, Unit 3
exploded; at around 06:00 on March 15, a big boom was heard from Unit 4; at around 08:11 thesame day, some damage to the fifth floor of the Reactor Building of Unit 4 was confirmed; and at
09:38 on the same day, a fire broke out in the northwest section of the third floor of the Reactor
Building of Unit 4. In response to these incidents, at 11:00 on the same day, the NERHQ issued anorder to the Fukushima Prefectural Governor and all relevant local governments to issue a50Japan Health Physics Society
stay-indoors order to citizens within a 20 to 30km radius of the Fukushima Dai-ichi NPS.
Immediately after this, a press conference by the Prime Minister and the Chief Cabinet Secretary
was held to explain the order in greater detail.
(Omission)(2) Decision, instruction, communication and implementation of long-term evacuation
programsa. How high-level radiation points were found outside the evacuation zone and how theGovernment handled them
From March 16, the NSC evaluated the radiation monitoring data that was collected by MEXT
(refer to Section 1(2)a) above. As a result, high radiation doses (values greater than 10mSv of thestay-indoors evacuation criteria prescribed in the Nuclear Emergency Guideline) were located atpoints outside the 30km radius. On March 18, the NSC asked NISA to investigate the presence ofprivate houses around these points. The NSC then asked MEXT to install fixed cumulative
radiation dose meters at these points to conduct environmental monitoring.
However, on March 20, the NSC judged that high radiation doses had occurred at this time ofyear due to the influence of both radioactive clouds (plumes) that passed from midnight to theearly morning of March 15 and the rainfall that deposited radioactive materials on the groundsurface and that because radiation doses would decrease due to both physical decay of radioactive
materials and rainfall, it was not necessary to immediately change the stay-indoors evacuation
zone in this situation.
In the meantime, the NSC, as described in Section 2 (3) b above, performed the SPEEDI
retrospective estimation of the release source information. On March 23, the NSC performed aSPEEDI infant thyroid gland equivalent dose calculation based on a limited number of monitoring
results. As a result, the NSC estimated that there were areas with high equivalent doses beyond thedesignated evacuation zone to the northwest and south of the Fukushima Dai-ichi NPS. The NSC
took this fact serious and reported the following to the Prime Minister's Office: (i) the SPEEDI
retrospective estimation of release source information, which was conducted for an outdoor stayfor 24 hours, should be considered to be overestimation of the radiation dose, (ii) the estimation,
which was based only on data obtained from two locations in Fukushima prefecture and one
location (Tokai-mura) in Ibaraki prefecture, were lacking in accuracy, and (iii) it might require agreat deal of time to make prior arrangements to facilitate the implementation of evacuation
programs. Based on this report, it was decided that the evacuation zone should not be expanded
immediately and that further discussion should be devoted to this issue by conducting research on
the exposure of infant thyroid glands to radiation to confirm the data values based on actual
measurement. In addition, the retrospective estimation results were publicized on the same day.
In response to the results of the SPEEDI retrospective estimation, on March 24, Cabinet
Secretariat advisor, Mr. Toshiso Kosako (hereinafter referred to as "Advisor Kosako"), provided
an advisory report of “Advice for Evacuation Zone and Intake of Iodine Tablets” to the Prime
Minister's Office stating that it would not be immediately necessary to implement the intake ofiodine tablets and that, as a temporary countermeasure against the current situation, it might bepreferable to begin a voluntary evacuation of residents in stay-indoors evacuation zones within a
20 to 30km radius. The NSC received an order from the Prime Minister's Office to summarize
what the NSC would suggest doing based on the advice of Advisor Kosako. On March 25, the
NSC provided NERHQ with "Advice for emergency monitoring and protective countermeasures,"stating that, at this time, it might not be necessary to change the current evacuation andstay-indoors evacuation zones; it might be necessary to strongly advise residents in areas whereradiation doses were likely to be relatively high to begin voluntary evacuation, even if they werein a stay-indoors evacuation zone within a 20 to 30km radius; and it might be better, from aprotective point of view, to advise residents in areas where radiation doses were not very high tobegin voluntary evacuation.
In addition, on March 29, in response to a request for further consideration from the Prime
Minister's Office, the NSC submitted its summary report of recommendations on high radiation
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dose locations (Namie-town, Iitate-village) beyond a 30km radius of the Fukushima Dai-ichi NPS
to the Prime Minister's Office stating that, concerning areas of high radiation doses, cumulative
radiation doses might be approximately 28mSv if a person regularly spent time outdoors fromMarch 15 to March 28; cumulative radiation doses might be approximately 21mSv, even taking
into consideration the shield effect of wooden houses; and the cumulative radiation doses werealready considered to be beyond the 10mSv of the stay-indoors evacuation dose level and that
residents in these areas should stay indoors for as long as possible.
Subsequently, in response to instructions from the Prime Minister's Office, NISA instructed
officials from Namie-town and Iitate-village to tell residents to stay-indoors for as long as
possible in order to avoid radiation exposure, even if they lived outside the 30km radius.
(Omission)c. Halt of daily services
From March 15, when the stay-indoors evacuation order was issued, more and more residents
began to stay indoors. Supermarkets, banks and other stores, which were necessary for daily life,
were rapidly disappearing. Under these conditions, it was hard not only for residents who lived
within the stay-indoors evacuation zones, but also for those who lived outside the zones to live
their lives.
For example, in Iwaki-city, from March 15, a stay-indoors evacuation order was issued toresidents in one area in the north of the city. However, since misinformation had spread that thestay-indoors evacuation order had been issued to the whole city, convenience stores andsupermarkets, whose employees had been evacuated, successively closed down. In addition, there
were fewer and fewer trucks available in the city. Under these circumstances, for example, afirefighter with a heavy-vehicle license had to go to Koriyama-city to drive a tank truck filled withbasic necessities back to Iwaki-city.
In Minami-soma-city, residents who lived within the stay-indoors evacuation zone voluntarily
evacuated and stores in the city began to close down. In addition, fewer and fewer trucks wereavailable within a 30km radius of the stay-indoors evacuation zone. Such a situation caused the
distribution of essential items to be interrupted making it hard for residents to live their daily lives.
Thus, between March 18 and 20, and on March 25, chartered buses were made available toevacuate groups of residents.
In response to this situation, on March 25, Chief Cabinet Secretary Edano held a press
conference stating that the distribution of essential items had been interrupted making it hard forresidents to maintain their daily social lives and that, depending on how things developed, there
was no denying that the levels of radiation could increase and another evacuation order might beissued. He concluded by instructing residents in the evacuation zone to stay indoors.
In addition, at the Local NERHQ on the same day, Chief Cabinet Secretary Edano instructed
Local NERHQ that there be adequate communication with cities, towns and villages locatedwithin the stay-indoors evacuation zone and that, depending on their needs, propercountermeasures should be taken either by providing residents with support for their daily lives orby helping them with their evacuation. In response to the instructions, it was decided that the headof the Local Headquarters should visit cities, towns and villages in the stay-indoors evacuation
zone. On March 25, he visited the mayors of Minami-soma-city and Namie-town. Subsequently,
he visited the heads of the each city, town and village located in the stay-indoors evacuation zone
and explained the evacuation plans and exchanged opinions with them.
In addition, between March 26 and 27, NERHQ first-hand observations both in
Minami-soma-city and Soma-city allowed the Local NERHQ to conduct a comprehensive studyof the halt of daily commodities. On March 26, the Local NERHQ dispatched staff to
Minami-soma-city to be stationed as government liaison officers.
[Governmental Final Report] Chapter V 3

d. Relationship between a stay-indoors order in a 20-30km radius (at 11:00 on March 15) and52

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SPEEDIAt 11:00 on March 15, the government issued a stay-indoors order to residents within a
20-30km radius of the Fukushima Dai-ichi NPS. According to the SPEEDI calculation results
assuming unit release rates since 11:00 that day (see Figure IV-5), radioactive materials emitted
from the Fukushima Dai-ichi NPS were predicted to disperse to the southwest from 11:00 to 12:00
of the same day, but from the west to the northwest from 13:00 March 15 to 2:00 March 16. From
3:00 March 16 onward, they were predicted to disperse from the south to the southeast.
At 9:00 on March 15, prior to the stay-indoors order above, the high radiation dose rate of
11,930μSv/h was measured near the main gate of the Fukushima Dai-ichi NPS (see Figure IV-6).
According the SPEEDI calculation results assumed unit release rates around the time when thisdose rate was measured, radioactive materials emitted from the Fukushima Dai-ichi NPS werepredicted to disperse to the southwest from 9:00 to 10:00 the same day. At around 23:00 on March
15, the high radiation dose rates of about 7,000μSv/h to 8,000μSv/h were measured again near themain gate of the Fukushima Dai-ichi NPS. According to the SPEEDI calculation results assuming
unit release rates since 23:00 the same day (see Figure IV-5), radioactive materials emitted fromthe Fukushima Dai-ichi NPS were predicted to disperse to the northwest from 23:00 March 15 to
2:00 March 16.
While the government issued the stay-indoors order on March 15, Minami Soma City provided
guidance to evacuate out of the city to those who wanted to move out on the same day onward,
and many residents evacuated to Iitate Village and Kawamata Town. In the morning of March 15,
Namie Town, at the mayor’s judgment, already decided to evacuate residents to Nihonmatsu City,and implemented the evacuation after communicating the decision to residents (for the evacuation
situation in Minami Soma City and Namie Town, see Chapter V 3. (3) f. and c. of the Interim
Report, respectively). Of residents of these municipalities, those who began evacuating early inthe evening of March 15 (around 15:00) were likely to have followed the evacuation routes in thesame direction as the dispersion of radioactive materials.
[Governmental Final Report] Chapter IV 2

Evacuation within a 3km radius and stay-indoors instruction within a 3-10km radius
Evacuation within a 3km radius and stay-indoors instruction within a 3-10km radius were
issued from the Prime Minister’s office at 21:23 on 11 March as an “instruction for making
assurance” although radioactive materials had not leaked at that time. In this section, three items,
whether or not the timing of the evacuation instructions was appropriate, whether the distance of
3km radius was appropriate and the procedure for the decision of the evacuation instructions, arediscussed below.
As for the first item the timing of the evacuation instruction, the lateness can be highlighted as aproblem. At first, it took two hours and fifteen minutes from the sending (at 16:45) of the Article
15 Notification of the occurrence (at 16:36) of an emergency situation in the Fukushima Daiichi
NPS to the declaration (at 19:03) of an emergency situation issued by Prime Minister’s office.
This lateness was due to about a one hour delay in obtaining the approval of Banri Kaieda, theMinister of Economy, Trade and Industry (METI) (at 17:35), and an additional delay of a little lessthan one hour because of a report that need the approval of Prime Minister Naoto Kan, and he had
to quit attending a meeting once (at 18:12) between majority and minority party heads.
Moreover, the Prime Minister’s office announced the following message simultaneously withthe emergency situation declaration (at 19:03) and did not immediately issue the evacuation
instruction.
“As of now, no effects of radioactive materials on the outside of the facility have been
confirmed. Therefore, for residents and visitors, there is no need to immediately take any special
actions at this time. Please stand by in your home or present place without starting to evacuate in ahurry and get the latest information through disaster prevention radio communications set by local
government, television and radio and so on. Again, there is currently no leakage of radioactivity
outside the facility. Please remain calm.”
The timing of the evacuation instruction for residents living within a 3km radius was two hours
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after (at 21:23) this declaration and thirty minutes after this evacuation instruction for residents
within 2km was announced to Ookuma and Futaba cities by Fukushima prefecture.
This evacuation instruction was not retroactive and not announced after radioactive materials
had leaked outside the facility. It can be highly evaluated that the instruction was previously
issued as a precautional measure assuming a possible situation. However, generally, it is difficult
to judge the situation on the basis of information released just after an accident. The evacuation
instruction for residents around the nuclear power plant in the present accident should also havebeen issued as early as possible.
The International Atomic Energy Agency (IAEA) recommended the establishment of aprecautionary action zone (PAZ) where evacuation should be carried out before or shortly after amajor release owing to an accident at the nuclear facility. However, no PAZ was established, inspite of the fact that the leader of the nuclear safety measures division in Fukushima prefectureand some citizens requested the Nuclear Safety Commission to adopt this concept during theperiod of the revision of the Emergency Preparedness Guideline in 2007 in Japan. If this PAZ wasestablished in the guideline before the major release in the accident, it may have been possibe toannounce an evacuation instruction just after the accident at an earlier timing.
It took less than 5 hours from the report of the occurrence of an abnormal event from TEPCO tothe announcement of the evacuation instruction. It can be highlighted that there was a possibility
that residents might be exposed to radiation when the event rapidly progressed and evacuation of
the residents whose risk is the highest was delayed and carried out in the evening when theevacuation zone was expanded.
Considering the above-mentioned findings, it cannot be overlooked that two hours and fifteen
minutes was needed from the Article 15 Notification to the declaration of an emergency situation,and the evacuation instruction was not announced at the time of the declaration of an emergency
situation because radioactivity was not yet released and finally the evacuation instruction was
delayed until two hours later. When the safety of the residents is the first priority, it is necessary to
make a system enabling the immediate announcement of an evacuation instruction just after the
Article 15 Notification and enableing rapid evacuation after the actual instruction.
There are many serious issues in the validity of the region of the second item “3km radius”. The
region of the 3km radius was determined taking into consideration that 1) it was sufficient to makean area within a 3km radius evacuation zone even if venting of the reactor is assumed to benecessary to avoid the worst case scenario, 2) the PAZ concept in the emergency preparedness
guideline and IAEA was firstly considered and 3) a 3km radius was set for the vent of the reactor
in the exercise of the evacuation. In addition, this was determined through an agreement with
Haruki Madarame, Chair of the Nuclear Safety Commission, in accordance with the manual of thenuclear disaster measures. The region within a 3km radius which was determined as aprecautional measure on the basis of advice from the experts, is regared as valid.
As for the third item, procedure for decision of the evacuation instructions, it can be pointed outthat confusion occurred qwing to the shutdown of the operation of the Off-site Center. Originally,
the decision to implement the evacuation instruction was to be carried out in the Off-site Centerset near the nuclear power plant. However, measures such as evacuation instructions were
examined separately at the fifth floor and crisis control center in the basement first floor because
the Off-site Center failed and information communication was imcomplete.
It must be a problem to spend much time to announce the evacuation instruction around
Fukushima Daiichi NPS. In the future, it is necessary to clarify the decision body for evacuation
instruction and the way the Off-site Center ought to be run. Moreover, it is also important to solve
the communication problem in the crisis at the Prime Minister’s office since it is necessary to
clarify the accurate information for the purpose of the safe evacuation of residents.
Evacuation instruction for residents within a 10km radius
The decision to change the stay-indoors instruction within a 3-10km radius to an evacuation
was announced at 5:44 on 12 March taking into consideration the risk of hydrogen explosion
owing to the increase in pressure in Unit 1. In parallel with the instruction to evacuate within a
10km radius, venting of the reactor in Unit 1 was prepared and carried out. However, the Prime
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Minister’s office did not issue the instruction of the evacuation within a 10km radius consideringthat venting was underway.
The determination of the distance of a 10km radius was relatively easy because it was assumed
in the the emergency preparedness guideline and was within the range (8-10km radius) of theemergency preparedness zone (EPZ) where emergency countermeasures should be sufficiently
taken. The timing of the instruction was also adequate from the viewpoint of the protection ofresidents because it was announced considering that the evacuation area was not expanded in
preparation for something that had already occurred, but for the possibility of the occurrence ofsomething. On the other hand, the instructions to evacuate or stay indoors outside a 10km radius
after this should be verified.
Evacuation instruction for residents within a 20km radius
The instruction to evacuate within a 20km radius was decided at 18:25 on 12 March taking into
consideration the hydrogen explosion (explosion of reactor building) that occurred at 15:36 on thesame day, the possibility that a similar explosion may occur in Units 2 and 3, and the insufficiencyof the 10km radius if recriticality happens. The points for verification are the following twoquestions; why was the distance set at 20km and why was it set concentrically?
The issue of the distance of 20km in the first point is the obscure evidence, unlike for the
distance of 10km assumed in the emergency preparedness guideline. There is conflicting
information in the evidence for the 20km radius. According to the news, a member of staff in the
MEXT involved in the decision to instruct evacuation within a 20km radius on 12 March said that
there was no evidence used in determining the 20km radius, the number was intuitively decided.
However, Special Advisor to the Prime Minister, Mr. Goshi Hosono contradicted, that at least
there was no MEXT staff involved in the decision table. This sounds to me outrageous because it
may be said by guessing that someone has a part in leaking information. After this serious
situation suddenly happned, I asked where the region was where the health of the public would bedamaged. As a result, the answer of an area with a radius 20km was provided by experts. I do notthink the judgment was inappropriate.
Next, can we say that the evacuation region within a 20km radius was sufficient? According to
Deputy Chief Cabinet Secretary, Mr. Tetsuro Fukuyama, there was a possibility that both theresidents and the staffs supporting the evacuation would be exposed to radiation if a new
explosion occured during the three days that were predicted for the completion of the evacuation
within a 20km radius. Moreover, there was no preassumption of the location for the evacuation in
the case of the evacuation area beyond the 10km radius as it was not assumed in the emergency
preparedness guideline. As the United States instructed their citizens, if the evacuation area within
an 80km radius is decided, a radius of 50km or 80km would not be practical and the evacuation
would become extremely difficult, because Fukushima city (about 300,000 people) andNihonmatsu city (about 60,000 people) would be in the evacuation area in addition to Futaba town
(about 70,000 people) overlapping with the 20km-radius area.
In other words, if the evacuation area is thoughtlessly expanded, traffic jams would occur in theroutes for evacuation, which would lead to the possibility that residents around the nuclear power
plants who have a higher risk could not rapidly evacuate. In addition, it would become difficult to
support the residents who could not evacuate by themselves, such as the elderly and inpatients.
Moreover, taking into consideration the limited places that can accept the evacuated residents, thedistance of a 20km radius could have been adequate. However, it should be noted that there weresome problems in specifying the area within the 20km radius because there was no map to cover
the area in the Off-site Center and evacuation within a 20km radius was beyond the assumption in
the emergency preparedness guideline.
The second point that the evacuation area was set concentrically to avoid the issurance of aseries of different instructions for evacuation that may lead to patchwork-like evacuation areas,
may not be a mistake considering the possibility of rapid changes in wind direction. For example,
it is assumed in the evacuation drill in nuclear power plants to basically set the emergency
preparedness zone concentrically. In some cases, a fan-shaped evacuation zone that is formed as apart of a circle is set considring the wind speed and direction. In the reports by the IAEA or the55

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NRC, the evacuation instruction is basically set by dividing the area concentrically, although there
are different points set among the nuclear power plants.
However, four different evacuation instructions were announced within 24 hours after theoccurrence of the accident if counting the evacuation instruction within a 2km radius announced
by Fukushima prefecture. It should also be noted that there were many reasons why people wholive in safe area finally evacuated or some of the residents were severely burdened such as manytransfers to different shelter sites due to anxiety and confusion arising from numerous conflicting
evacuation instructions.
In addition, the role of the municipality during an emergency situation has been clarified
because a series of evacuation instructions were made by a top leader in the Prime Minister’s
office. Originally, the evacuation instructions were made at the Off-site Center where themunicipality staff work. However, in this accident, Okuma city was the only city that sent staff to
the Off-site Center among six cities or towns. Other municipalities could not send their staff
owing to their involvement in responding to the earthquake and tsunami, and implementation of
the evacuation of residents within a 3km radius. This accident indicates an overwhelming lack ofability of the municipality to respond to a complex disaster including a nuclear accident. These
could be significant points for discussion on the role of the municipality in an emergency
including the implementation of the evacuation.
Stay-indoors instruction for residents in a 20-30km radius
After the series of events that occurred after the evacuation instruction for residents in a 20km
radius on 12 March (hydrogen explosion in the reactor building in Unit 3 on 14 March, hydrogen
explosion in the reactor building in Unit 4 on 15 March and the related fires), the Prime Minister’s
office instructed the residents in a 20-30km radius to stay indoors on 15 March. The decision ofthis instruction to stay indoors was made following advice from Mr. Haruki Madarame, Chair of
the Nuclear Safety Commission (NSC), that is, there is no need for evacuation beyond a 20km
radius. However, the problem is just extending the time to stay indoors.
Originally, the stay-indoors instruction was carried out for the reason that radiation exposure
during staying indoors while the radioactive plume is passing is lower than that during evacuating
outdoors. For this reason, some countries have set a number of days for the stay-indoors
instruction. However, there was no regulation in Japan, which accordingly led to a forced
stay-indoors instruction for a long time. The stay-indoors instruction area of 20-30km radiuscaused in a difficult situation for those living there, because commodities necessary for life could
not be gained and fundamental medical services such as hospitals could not be utilized.
The negative influence from the extension of the stay-indoors instruction affected the area
beyond 30km radius. As an example, we can use Iwaki city located in a 30-50km radius from thenuclear power plant. Although there were few areas within the 30km radius in Iwaki city, themayor of Iwaki city requested all of its citizens to refrain from doing outdoor activities. As a result,many citizens who lived outside of the 30km radius (50,000 people out of 340,000 people)
evacuated out of the city. Moreover, the number of people who thought they should also evacuate
increased upon seeing many people evacuating from the area within a 20km radius through Iwaki
city. The outflow of residents gave a strong impression of dangerous, which made delivery
workers afraid of radiation exposure. This resulted in a shortage of commodities in the area
beyond the 30km radius. Such a vicious circle produced difficulties in the economical activities
and lives of the residents in the region of a 20-30km radius and the surrounding area.
Evacuation instruction not announced
On 12 March, Chief Cabinet Secretary Mr. Edano said in a press conference “It was not as if the
explosion such as a large volume of radioactive material would lead to the leaking…. The present
countermeasure does not indicate the occurrence of a specific danger for the residents who live in
the area within a 10-20km radius…. To make sure of it, we expanded the evacuation area to a
20km radius from the viewpoint of making absolutely sure”. Under this announcement, themayor of Tsushima in Namie town located within the 30km radius knew of explosion at Unit 3 on
14 March, and decided to recommend voluntary evacuation from 15 March. However, the56

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SPEEDI calculation on 15 March predicted a broad diffusion of radioactive materials in thenorthwestern region on 15 March when the residents in the Tsushima area were evacuating.
Almost all of the released radiactive materials following the accident of Fukushima Daiichi NPS
are considered to be due to the destruction of nuclear facilities of Units 1 to 3 on 12-15 March,which flowed to the northwestern area, including Iidate village, according to the wind direction
and caused an accumulation of the radioactive materials.
In the emergency preparedness guideline, an index to decide on evacuation or stay-indoors
instructions was “predicted dose of radiation to be exposed if no measures are taken or radioactive
concentration in foods as an actually measured value”. The “SPEEDI” was used to calculate thepredicted dose, but this information could not be used in the decision to implement the evacuation
instruction.
Request for voluntary evacuation
On 25 March, the government received the following advice from the nuclear safetycommission (NSC) “It is desirable to facilitate active voluntary evacuation for people living in thearea where the ambient dose is relatively higher among the stay-indoors area of 20-30km radius”“It is also desirable to let the other people voluntarily evacuate from the viewpoint of precaution”.
The government announced “We will actively facilitate voluntary evacuation in the area of
20-30km radius”.
The concept of “voluntary evacuation” is not in the guideline of emergency preparedness.
According to an interview with Deputy Chief Cabinet Secretary Mr. Tetsuro Fukuyama, it wassaid that the terminology of “voluntary evacuation” was firstly produced during a discussion on
evacuation among Chief Cabinet Secretary Edano, Special Advisor to the Prime Minister Terada,
Deputy Chief Cabinet Secretary Fukuyama, Prime Minister Kan, METI Minister Kaieda andSpecial Advisor to the Prime Minister Hosono. They decided a judgment that people who had themeans for evacuation and could move by themselves and ensure a location to evacuate to shouldbe immediately evacuated, and people who could not move by themselves in the area of the
20-30km radius should stay indoors under the risk of the next explosion, because there was a
possibility to cause panic when deciding the order for getting on the buses provided by thegovernment.
The government described for the reason why they kept “voluntary evacuation” instead of anevacuation instruction, “It was for the purpose of avoiding misrecognization as increased danger”.
However, “voluntary evacuation” was ambiguous and caused the residents much anxiety because
there was no detailed explanation. This issue was particularly observed in municipalities (e.g.,
Tamura city) where evacuation, stay-indoors, and the other areas were mixed. There were many
residents who felt that this request of voluntary evacuation was irresponsible.
Voluntary evacuation is not addressed in the guideline of emergency preparedness, whichcaused anxiety for the residents who did not have sufficient information and was seriously
criticized because it was a shift of responsibility to leave the judgment of evacuation to theresidents themselves. Henceforward, such an evacuation instruction should not be announced as aprotective measure in an emergency.
[Nongovernmental Report] Part 2 Chapter 5 Section 4(b) Communication of measures of evacuation and stay in housec. How evacuation orders were communicated
The NE Response Manual prescribes that the head of Local Headquarters shall communicate anevacuation order to each municipality including cities, towns and villages.
In fact, however, immediately after the earthquake, communication by telephone proved to bedifficult. Moreover, the relevant personnel were unable to reach the Nuclear Emergency Response
Local Headquarters (Local NERHQ). Thus it was decided that a new communication route
through the Fukushima Prefectural Office and another one through the Secretariat of the NERHQ
be added to the Local NERHQ communication route.
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However, most of the municipalities actually learned of the evacuation orders through the mass
media including TV since it took a long time for a telephone call to get through. Some learned
through the verbal announcements by police vehicles, including police patrol cars.
The cities, towns and villages communicated with citizens in the area by using a municipal
disaster management radio communication network, sound trucks, police cars, and by fire fighters
making door-to-door visits.
In addition, when an evacuation order went out to residents in the area within a 3km radius of
the Fukushima Dai-ichi NPS on March 11, nearly all of the residents had already evacuatedoutside a 3km radius. At 00:30 the next day, March 12, the Emergency Operators Team confirmedthat all the residents within a 3km radius had been evacuated (the team confirmed that again at
01:45).
[Governmental Interim Report] Chapter V 3

4.2.2 Problems with the actual evacuations from the residents’ perspective
1. Timing of when residents became aware of evacuation orders
The national government expanded the evacuation zone in incremental phases after the accident,
after which each evacuation order was promptly communicated to residents by the local
governments.
For instance, in Futaba Town, Okuma Town, and Tomioka Town—where many of themunicipalities within the 10km radius zone of the Fukushima Daiichi Nuclear Power Plant werelocated—approximately 80 percent of the residents became aware of the issuance of theevacuation order by about 09:00 on March 12, which was approximately three hours after theevacuation order was issued (just before 06:00). Moreover, in terms of Namie Town, anevacuation order was also communicated in a timely manner to residents living within the 10km
radius zone.
In Naraha Town, where the Fukushima Daini Nuclear Power Plant is located, a decision wasmade to evacuate all residents at 08:00 on March 12, even before the issuance of the evacuation
order by the national government: 80 percent of the residents had become aware of the evacuation
order at around 10:00 Similarly, while the village office for Katsurao Village had issued its own
evacuation order to all residents of the village at 21:00 on March 14, prior to the issuance of theevacuation order by the national government, 90 percent of the residents came to know about theevacuation order immediately after that. In this case, the communication of evacuation orders was
also extremely prompt.

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Fig. 4.2.2-1 Percentage of residents who had knowledge of the respective evacuation orders(100 percent: Residents who were evacuated)
2. Sources of information about the evacuation orders
The main source of residents’ information about the evacuation orders were communications
from the local governments. This fact indicates the local governments’ highlevel ability totransmit information to residents.
In Naraha Town and Katsurao Village, where the local governments had decided to evacuate
residents even prior to receiving evacuation orders from the national government, 70 percent of
the residents learned about the evacuation orders through communications from the local
governments. Even in many other municipalities that fell within a 20km radius of the Fukushima
Daiichi Nuclear Power Plant, 40 percent to 60 percent of the residents also came to know about
the issuance of respective evacuation orders through local governments or other local sources(such as the emergency municipal radio communication system and the police). The proportion ofresidents who learned about the issuance of respective evacuation orders through the mass media,
such as from television broadcasts, stayed within the range of 10 percent to 20 percent.
On the other hand, in those municipalities that included areas designated as Deliberate
Evacuation Areas since April, including Minamisoma City, Iitate Village and Kawamata Town,
approximately 40 percent of the residents learned about the evacuation orders through the mass
media, such as from television broadcasts.
In contrast, there were serious problems in the communication of evacuation orders from thenational government to local governments. The only municipalities that were able to receive theevacuation order communications from the national government were Futaba Town, Okuma Town,
and Tamura City; in contrast, Tomioka Town, Naraha Town, Namie Town, Hirono Town,
Minamisoma City, Kawauchi Village, and Katsurao Village were either unable to receive theevacuation orders from the national government, or had issued evacuation orders to residents attheir own discretion based upon their assessment of the situation through news reports and othersources prior to the national government’s issuance of evacuation orders. On one hand, thecommunication of evacuation orders from local governments to residents could be evaluated as
extremely prompt, but on the other hand it could also be said that the emergency communications
from the national government to the respective local governments had mostly failed to function.
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Figure 4.2.2-2: Sources of information for evacuation orders[National Diet Report] Chapter 4, 4.2.2(c) Implementation and cancellation of measures of evacuation and stay in house
3. Time of evacuation
After the local governments issued evacuation orders to the residents, the evacuation operation
was carried out promptly.
Of the residents in Futaba Town, Okuma Town, and Tomioka Town, where many areas fellwithin the 10km radius zone from the Fukushima Daiichi Power Plant, 80 percent to 90 percent
began to evacuate several hours after the local governments issued the evacuation order. In Namie
Town, similar trends were observed in the areas that fell within the 10km radius zone. In Naraha
Town, the local government decided to evacuate all residents at 08:30 on March 12, and 80
percent of the residents began to evacuate within several hours of the decision’s announcement.
Similarly, in Katsurao Village, owing to the issuance of an evacuation order at the village’s own
discretion at 21:15 on March 14, 90 percent of the residents had evacuated by midnight of thesame day.
In the towns of Tamura City and Hirono Town, close to 80 percent of the residents began toevacuate several hours after the issuance of evacuation orders by the local governments. In
Kawauchi Village and Minamisoma City, where both municipalities fell within the 20km radiuszone and many residents were ultimately forced to evacuate, approximately 20 percent to 30
percent of the residents had been evacuated as of March 12, when evacuation orders were issued
for the 20km radius zone; the proportion of residents who were evacuated on a voluntary basis
increased gradually thereafter.
In Iitate Village and Kawamata Town, which were designated as a Deliberate Evacuation Areain April, a large number of residents were not evacuated as of March 15. As to the 30km radiuszone, a shelter-in-place instruction was issued at 11:00 on March 15, and residents were requested
to evacuate on a voluntary basis on March 25. In fact, the residents had successively elected toevacuate on a voluntary basis without waiting for the evacuation order from the national
government.
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Figure 4.2.2-3: Percentage of evacuated residents(Omission)
In every press conference, then Chief Cabinet Secretary Edano described all evacuation andshelter-in-place orders to residents as “precautionary measures” and “measures taken to provide
utmost assurance.” He did not explain how far the accident situation had actually progressed or
speak about the future outlook of the situation at the time.
Our view is that there was a need for the government to provide, at the very least, some
explanation of the situation to residents, addressing the sense of anxiety among the residents
rather than relying on bland generalizations in phrases like “precautionary measures” or“measures taken to provide utmost assurance.” It was necessary in particular to explain the future
outlook of the nuclear reactors, even if the forecasts were preliminary, and to inform residents
about the approximate duration of their evacuation. It was also necessary to explain how to
prepare for evacuation—after informing them about what was known and as yet unknown
regarding the conditions at the nuclear power plant—in order to contribute to a better
understanding and assessment of the situation among residents.
As evidenced in the quotes above, residents expressed a strong sense of dissatisfaction with thecontents of the evacuation orders. The clear reality is that the government and the Nuclear
Emergency Response Headquarters (NERHQ), failed to respond to residents’ needs for useful
information about their evacuation in issuing the evacuation orders at the onset of this accident.
5. Expansion of the evacuation zone and phased evacuation
a. A number of evacuees relocated more than six times
According to the survey conducted by the Commission, more than 20 percent of the evacuees
from Futaba Town, Okuma Town, Tomioka Town, Naraha Town, Hirono Town and Namie Town,
all of which are municipalities close to the Fukushima Daiichi Nuclear Power Plant, relocatedmore than six times. This was mainly because the government expanded the evacuation zone, inphases, from a 3km radius zone, to a 10km radius zone, and then to a 20km radius zone, putting aheavy burden on the residents.
This point was also brought up in a large number of opinions in the free-answer section of thesurvey received from residents, notably from those of Okuma Town, Tomioka Town, and61

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Minamisoma City. These opinions pointed out that residents relocated from shelter to shelter, andwere evacuated to new locations several times.

Fig. 4.2.2-4 Number of times that evacuees from each municipality
relocated during March 2012
(Omission)b. Would it have been better to issue evacuation orders for a wide area in advance?
With regard to the phased evacuation, two main questions were raised.
(i) Would it have been possible to prevent the large number of relocations if the government
had designated a wider evacuation zone of 20km radius from the Fukushima Daiichi
plant at the outset, rather than issuing evacuation orders in phases?
Haruki Madarame, Chair of the Nuclear Safety Commission (NSC), has pointed out that it isnecessary to consider the problem of shadow evacuation when the government designates
evacuation zones. Shadow evacuation is a problem that occurs when residents in areas that do not
require evacuation overreact to evacuation orders. This may give rise to road congestion, which
may in turn cause delays in the evacuation of residents from areas that actually require it. With
regard to the phased evacuation that was carried out, Madarame asserts that, although theevacuation areas had been designated in phases after only considering the situation of the nuclear
power plants, in hindsight, the decision had been “correct” with respect to preventing the shadow
evacuation, however inadvertently.
Hypothetically, given the limited number of evacuation routes, if evacuation orders had been
initially issued for areas within a 20km radius of the power plants, delays would have been
expected in the evacuation of residents from areas closer to the nuclear power plants, where theneed for immediate evacuation was most urgent. In that sense, we cannot necessarily assert that it
would have been better to issue evacuation orders at the onset of the accident for areas within a
20km radius of the power plants.
In fact, among the opinions in the free-answer section of the survey received from residents ofFutaba Town and Tomioka Town, located near the nuclear power plants and where residents had
begun to evacuate at the very onset of the evacuation phase, are the complaints of many residents
that because the road congestion and road conditions were so serious, it had taken a very long time62

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to reach their evacuation shelters.
(ii) Would it have been possible to prevent the phased evacuations if the first evacuation
order had designated the evacuation shelters in the areas outside of the 20km radius zone
from Fukushima Daiichi plant?
According to the Fukushima Prefecture Regional Disaster Prevention Plan (Nuclear Emergency
Response Section) (Prefecture Regional Disaster Prevention Plan), each of the municipalities
located within a 10km radius (equivalent to the Emergency Planning Zone, or EPZ.) of a power
plant is expected to possess regional disaster prevention plans and evacuation plans. According to
the Prefecture Regional Disaster Prevention Plan, in relation to its responsibility for formulating
the regional disaster prevention plans and evacuation plans, each municipality is, as a rule,primarily responsible for formulating evacuation plans and implementing these plans, but in theevent of evacuation over a wider area (across municipalities), Fukushima Prefecture bears the
responsibility of formulating an evacuation plan.
However, in reality, Fukushima Prefecture did not anticipate the need to fulfill this
responsibility, so in its response to this accident, the prefecture rarely played a leading role in the
preparation for wider-area evacuations. The only evacuation cases in which Fukushima Prefecture
took the lead in coordinating shelters across municipalities were for Futaba Town and Okuma
Town, when an evacuation order was issued for areas lying within a 10km radius from the
Fukushima Daiichi Nuclear Power Plant (Fukushima Prefecture designated evacuation shelters in
Kawamata Town for the residents of Futaba Town, and in Tamura City for the residents of Okuma
Town).
As a result, the initial designation of evacuation shelters, even across municipalities, wasrelegated primarily to the towns and villages. Therefore, in some cases, the first evacuation
destinations were shelters within the same town or village, where evacuations were carried out ina context in which details of the circumstances at the nuclear power plants were not being
communicated to the residents. If it had been possible for Fukushima Prefecture to take the lead in
responding to the evacuation of residents with foresight, such as by designating evacuation
shelters and guiding evacuees to areas outside the 20km radius zone at the initial phase ofevacuation, it might have been possible to ease some of the burdens on residents that experienced
the phased evacuation. Inadequate foresight and preparation for wider-area evacuation in the
Prefecture Regional Disaster Prevention Plan was one cause of the confusion during the residents’evacuation.
6. Destruction of the livelihoods of residents caused by the long-term shelter-inplace orders
a. Impact of shelter-in-place orders on residents
After the issuance at 11:00 on March 15 of the shelter-in-place order to residents living within a
20-to-30km radius from the Fukushima Daiichi plant, residents, other than those who evacuatedvoluntarily, stayed indoors continuously over a ten-day period until a new request to voluntarily
evacuate themselves (unofficial governmental instruction) was released on March 25. Thus, theresidents who did not evacuate voluntarily, even after March 25, were forced to remain indoors formore than a month until the shelterin-place orders were lifted on April 22. The areas subject tosuch shelter-in-place orders included parts of Minamisoma City, Iitate Village, Namie Town,
Katsurao Village, Tamura City, Kawauchi Village, Naraha Town, Hirono Town, and Iwaki City.
Staying indoors for a long period of time destroyed the livelihoods of residents through the
stoppage of logistics and commerce, particularly in Minamisoma City, Iwaki City, Tamura City,and Iitate Village.
(Omission)b. Shelter-in-place was originally intended to be a short-term measure
Originally, having residents shelter-in-place was assumed to be a short-term measure. The
longer residents were forced to shelter-in-place, the more difficult their lives would become.
The shelter-in-place orders were only aimed at keeping residents indoors during the period of63

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time when a radioactive plume (cloud) is passing. We can conclude, by interpreting the“Emergency Preparedness for Nuclear Facilities” (Emergency Preparedness Guide) drawn up by
the NSC, that the effective duration of this measure is not expected to span as long as ten days.
The appropriate number of days for residents to stay indoors under a shelter-in-place order isassumed to be a maximum of two days, in accordance with the international consensus fromwhich the Emergency Preparedness Guide takes reference, although it is not clearly stipulated in
the Emergency Preparedness Guide. Since the Emergency Preparedness Guide was formulatedwith reference to the international consensus, the Emergency Preparedness Guide is in principle
considered to be based upon a similar stance. As the need for shelter-in-place orders was assumed
to last only for a short period, little thought had been given in the Emergency Preparedness Guide
to a situation in which commerce and logistics come to a standstill. From the perspective of theresidents, it is necessary for the government either to implement measures aimed at securing thedaily livelihoods of residents when shelter-in-place orders are extended over a longer duration, orto provide an estimate of the forecasted duration of shelterin-place orders when such orders areissued.
In this case, no indications were given to the residents regarding the expected duration of the
shelter-in-place orders when they were issued on March 15 for residents living within the 20km to
30km radius zone. Consequently, residents lost access to necessary lifelines when logistics andcommerce halted. Although the secretariat of NERHQ/NISA’s support to residents subject toshelter-in-place orders commenced, at the latest, on March 21, only insufficient relief supplies
were provided. The attention and care given by the national government toward supporting theresidents’ lives was completely inadequate.
[National Diet Report] Chapter 4, 4.2.2

4.2.3 Evacuation of all hospital patients
Immediately after the accident, people who had difficulty evacuating—such as hospitalized
patients—were left behind in the area within a radius of 20 kilometers from the nuclear plant,
which had been designated an evacuation zone or Restricted Area. In the chaos immediately
following the earthquake, sufficient government assistance was not provided to these hospitals, so
medical professionals had to single-handedly search for a means of evacuation and to secure
hospitals that would accept the transfer of hospitalized patients. In a situation where
communication was limited and sufficient information could not be obtained, the evacuation of
hospitalized patients was extremely difficult, resulting in many cases of aggravated medical
conditions or death. All the hospitalized patients and medical professionals in these hospitals wereforced to bear an enormous burden in the process of evacuation. The worst situations were faced
by seriously-ill patients in hospitals that could not secure transportation methods that would not be
injurious to patients or evacuation shelters with medical equipment at an early stage. We must
conclude that the reasons these situations arose were flaws in the disaster prevention plans of local
governments and medical institutions, both of which had not anticipated a large-scale nuclear
disaster that would require the establishment of a wide range of evacuation zones.
The Prefecture Regional Disaster Prevention Plan was formulated only in anticipation of an
accident of a similar scale to that of the JCO accident; as a result, hospitals were supposed tocreate their own evacuation plans and implement the evacuation single-handedly. Since the scaleof the accident at the Fukushima Daiichi Nuclear Power Plant vastly exceeded what had been
anticipated, hospitals were unable to secure both evacuation shelters and means of evacuation
single-handedly; however, Fukushima Prefecture and the local municipalities were only passively
involved in the evacuations of hospitalized patients. The reason why the evacuation orders in this
accident imposed an excessive burden on the hospitalized patients is that Fukushima Prefecture
and municipalities were unprepared for this scale of nuclear disaster.
[National Diet Report] Chapter 4, 4.2.3

4. Verification – why the evacuation of patients was extremely difficult64

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In the Regional Disaster Prevention Plan for Nuclear Emergency Preparedness, the evacuationof the residents living within a 3 km radius was preassumed and the evacuation of a broad area
within a 10 or 20 km radius was not previously assumed. The reasons for the difficulty of theevacuation of the patients in hospitals around the NPS are arranged below from five viewpoints,
communication of the evacuation information from the government or relevant organizations,communication tools, contact system of the police and Self-Defense Forces, reservation of theconveyance means and reservation of accommodation destinations for patients after evacuation,
which were necessary to respond to this situation on the basis of preassumption.
(4.1) Communication of evacuation information from the government and its relevantorganization
It is necessary for the judgment of “evacuation of all inpatients” to obtain the information fromreliable sources rapidly and surely because of risks during their transportation.
As mentioned above, in Fukushima Prefecture’s Regional Disaster Prevention Plan for Nuclear
Emergency Preparedness, it is stated that regional medical organizations should receive
information on evacuation from the city, town or village. However, in reality, although someresidents heard the evacuation instruction through the emergency municipal radio communication
system, none of the hospitals received information directly and individually from the city, town orvillage. Hospitals relied on the TV news, visited the local government and the Off-site Center, anddirectly got information from policemen who came to the hospital to clarify the situation.
The reason why the communication of information was confused is considered to be a failure incommunicating information from the sources, that is, TEPCO, the government and the prefecture,to the local government.
In the case of the Fukushima Dai-ichi NPS, the Off-site Center was located in Okuma city andthe alternative facility was the Fukushima Prefectural Government Minamisoma Office. However,as both facilities were damaged by the earthquake, after that, the function of the Off-site Center
was transferred to the prefectural office.
The rescue team was established in the Prefecture Nuclear Emergency Response Center justafter the accident. The team consisted of twenty and a few staff and responded night and day. The
leader of the team in the center, who is the successor of the leader just after the accident, said
“There is no fact that evacuation instruction was individually issued by the prefecture for sevenhospitals which was located within 20km radius. It is natural to recognize that the evacuation
instruction for hospitals was included in the governmental instruction of evacuation for the
residents. The hospitals were seeking the place by themselves to allow the transportation after
evacuation. We, the rescue team, continued various works including radiological tasks such as
preparedness for screening survey in an emergency and distribution of stable iodine, ensuring theevacuation places, setting up temporary toilets and first-aid stations, preparedness for distributionof medicines to medical organizations and the first-aid stations, and responses to the DMAT
(Disaster Medical Assistance Team). Information collection was carried out using various routes,
such as from the police and the hospitals. On 13 March, we clarified how many patients remainedin the hospitals and which hospitals they were in, but there were no records about the evacuation
instruction. Although we knew the number of the patients, we did not know whether they could
walk by themselves or not. We responded to them instantly.”
The municipality also experienced much difficulty in collecting informations. According to the
Okuma town Nuclear Emergency Response Center, there was a system to gather emergency staff,
which enables relevant staff in the Off-site Center and to communicate with local governmental
staff via a mobile phone conference call system. However, in the present accident, this systemfailed because the Off-site Center was seriously damaged and suffered from a power failure as
mentioned above. For this reason, it is said that Okuma town immediately sent their staff to theOff-site Center after the disaster on 11 March.
In Okuma town, the subsequent evacuation instructions for the residents within a 2-3km radius
on 11 March were announced by the TEPCO staff who came to the town office. As the first
information on the evacuation instruction for the residents within a 10km radius, which was, outof assumption was obtained from a policeman in a local police substation, the Okuma town
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requested confirmation from the Futaba police station, and directly confirmed it with theprefecture.
(4.2) Communication tools
After the earthquake, mobile and fixed phones in almost all the affected areas failed, which led
to the situation that one call was successful after 20-30 of attempts. In the case of the Futaba
Public Welfare Hospital, a professor, who was an expert in the field of emergency medical carefrom the Fukushima Medical University, in the Prefecture Nuclear Emergency Response Center
decided the evacuation of the serious cases by phone attempting to the hospital thirty to forty
times. According to the professor, at that time, there were probably three satellite phones in the
Prefecture Nuclear Emergency Response Center, but there was no opportunity to use them as they
were in use by the relevant staff.
Originally, for example, in the case of Okuma town, there was no system to communicate bysatellite phone as a backup function in the Regional Disaster Prevention Plan.
(4.3) Communication system between the police and the Self-Defense Forces
Many hospital staff that faced emergency evacuation testified as follows: “It seems that there
was no collaboration between the police and the Self-Defense Forces and they acted
independently”. Even though there were wireless tools available to both the police and the
Self-Defense Forces, they communicated through the Prefecture Nuclear Emergency Response
Center and not directly communicated each other. This is due to a rule that a prefectural governor
orders to the Self-Defense Forces in an emergency.
The rescue team in the Prefecture Nuclear Emergency Response Center explained “It is known
that the police and the Self-Defense Forces communicated through the Prefecture Nuclear
Emergency Response Center, but it is unknown whether or not they also directly communicatedeach other. This may be an inference. We cannot guess whether each party communicated witheach other taking into consideration chain of command of each party”. The lack of directcommunication between the police and the Self-Defense Forces led to confusion of theinformation and the responses. The most typical example is the case of the transportation of thepatients in Futaba Hospital.
(4.4) Ensuring tools for transportation
In spite of the decision to evacuate upon receiving the evacuation instruction, there weredifficulties in ensuring transportation tools for patients in many hospitals. The tools were motor
coaches, vehicles and a helicopter belonging to the Self-Defense Forces, and ambulances andhospital staff’s cars. Ambulances were necessary for the transportation of the serious cases, but
motor coaches were the main tool for the transportation because the number of ambulances waslimited. “We informed the Self-Defense Forces of the number of hospitals and patients that
required resque, but this information was provided by area and we did not provide details of
specific hospitals. The evacuation was also necessary for not only patients in hospitals but also
members in facilities for seniors and handicapped people, and general public” (said by a memberof the rescue team in the Prefecture Nuclear Emergency Response Center).
The hospitals repeatedly requested the prefecture, the town and the local police to ensure thetools for transportation of the patients. However, as seen from the failure of the communication of
the evacuation instruction, the requests from hospitals were not immediately informed and not
responded to at once. For example, in the case of Futaba hospital, a director of the hospital drove a
car by himself and repeatedly made requests for rescue to the policemen and the members of the
Self-Defense Forces that he met on the road, since all the staff in Okuma town evacuated just after
the explosion of Unit 3 at 15:36 after the first evacuation started at 14:00 on 12 March. However,the next rescue vehicle came there at about 9:00 on 14 March, which was a serious delay.
Moreover, at Imamura hospital, the director of the hospital made requests for rescue through theprefectual police because they refused to prepare an ambulance. In Kodaka Akasaka hospital, theyfirstly heard that buses for evacuation would be supplied by the Self-Defense Forces, but the buses
never arrived there, and they finally evacuated using buses provided by the Niigata prefectual66

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police.
(4.5) Ensuring accommodation for the patients after evacuation
Minamisoma Municipal City Odaka Hospital is the only hospital that had already decidedorganized a place for evacuation before the patients left the hospital, although no method oftransportation of the patients could be found. “As the reasons why the transportation was rapidly
possible without deaths, the following three points are raised; 1) an Odaka ward office was nearby,2) there were many staff in Odaka hospital, which was not damaged by the earthquake and 3)
Minamisoma Municipal City General Hospital was nearby” (manager of Minamisoma Municipal
City Odaka Hospital). A second evacuation was needed because Minamisoma Municipal City
General Hospital was located 23km from Fukushima Dai-ichi NPS. In the other hospitals, there
was no information about the destination of the transportation when the patients were taken fromthe hospital. In addition, the destination of the first evacuation was the same place as that for thegeneral residents. It was a bad environment, that is, it was difficult to provide medical care. For
this reason, the hospital staff searched for a new hospital using their personal connections. There
were few cases in which the government was involved in the search.
[Nongovernmental Report] Part 2 Chapter 5 Special contribution(d) Designation of deliberate evacuation zone and specific spots recommended forevacuationd. Establishment of deliberate evacuation zones and emergency evacuation preparationzones
In the NE Guideline, it is not assumed that a stay-indoors evacuation is carried out for a long
period of time. As per the description above, the results of radiation monitoring and SPEEDI
retrospective estimation showed there were areas with high levels of radiation dose even in areas
more than 20km from the Fukushima Dai-ichi NPS. The distribution of essential items wasinterrupted in stay-indoors evacuation zones and it was hard for residents to conduct their daily
lives. In response, from March 31, the NERHQ started further discussions on additional
evacuation zones based on estimation results of the annual cumulative dose that had been createdby MEXT.
In this discussion, it was decided that actual measurement data should be used for the
cumulative dose between the start date and the latest date of measurements, values corrected by
SPEEDI simulation results should be used for the cumulative dose before measurement started,the latest actual measured values should be used for the cumulative dose after the latest
measurement date for the conservative purpose, and then the cumulative dose over a year from thenuclear accident was decided to be estimated, and all these results were decided to be mapped.
In addition, the guidelines in the NE Guideline stating that "stay-indoors evacuation orders shallbe issued if the cumulative dose is 10mSv or more, and evacuation orders if 50mSv or more"might be appropriate for incidents where radioactive material is released for a relatively shortperiod of time. But these indices might not be appropriate for the current nuclear accident where
there has been an extended period of exposure to radioactive materials accumulated on the ground.
Hence, it was decided to take the lowest limit of 20mSv out of the range from 20mSv to 100mSv
which ICRP defined as indices for the evacuation under the nuclear emergency situation. It was
decided that residents in an area higher than 20mSv/year should be evacuated according to theevacuation program, and residents in an area lower than 20mSv/year should be prepared to begin
evacuating or follow a stay-indoors evacuation order at a nuclear emergency, assuming a worst
case scenario for the conservative purpose, even if a hydrogen explosion is less likely due to thefilling of nitrogen.
On April 10, the NERHQ officially asked the NSC for their advice on the evacuation strategy
for residents living in (i) areas beyond a 20km radius of the Fukushima Dai-ichi NPS that hadhigh levels of radiation dose, and (ii) areas beyond a 20km radius of the Fukushima Dai-ichi NPS
with a probability of high levels of radiation dose at the emergency.
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On the same day, in response to the request of NERHQ, the NSC proposed the following
advice: with regards to (i), areas beyond a 20km radius of the Fukushima Dai-ichi NPS (including
areas beyond a 30km radius) where cumulative dose may reach 20mSv within the period of one
year from the date of the nuclear accident shall be designated "deliberate evacuation zones"; areasthat are in stay-indoors evacuation zones within a 20 to 30km radius but outside deliberate
evacuation zones shall be designated "emergency evacuation preparation zones"; and residents
should always be ready and able to follow a stay-indoors evacuation order or evacuation order atthe emergency. In addition, even residents in emergency evacuation preparation zones are advised
to begin voluntary evacuation. Because it is anticipated that it may be difficult to complete
evacuations swiftly in an emergency situation, it is strongly recommended that children, pregnant
women, those who require nursing care and hospitalized patients should not enter these areas.
On April 11, based on the advice of the NSC, Chief Cabinet Secretary Edano announced afundamental concept of how deliberate evacuation zones and emergency evacuation preparation
zones should be established.
Subsequently, the government issued early advice to the affected municipalities and then, on
April 22, based on "Estimated Values of Cumulative Dose Based on Actual Measurements"
concerning zones beyond a 20km radius of the Fukushima Dai-ichi NPS, which was prepared by
MEXT on April 10, the NERHQ established deliberate evacuation zones and emergency
evacuation preparation zones pursuant to the provisions of Article 20, Paragraph 3 of the Act on
Special Measures Concerning Nuclear Emergency Preparedness. In addition, the NERHQ
provided those municipalities with a directive to tell residents in the former zones to be preparedto leave their homes in an evacuation after a period of approximately one month, and those in thelatter zones to always be prepared to either evacuate from their homes at the emergency or to beprepared to begin a stay-indoors evacuation. Further, the stay-indoors evacuation order toresidents in areas within a 20 to 30km radius of the Fukushima Dai-ichi NPS was lifted.
(Omission)
f. Establishment of specific spots recommended for evacuation
By April 22 when deliberate evacuation areas and emergency evacuation preparation zones had
been established, spots where annual cumulative radiation dose might exceed 20mSv assumingthat the radiation dose levels continued afterwards had been found in parts of Date-city andMinami-soma-city. However, the distribution of these spots was not understood for an extendedarea, but for a limited area. Hence, the Government Emergency Response Center did not designate
those entire areas including these points as deliberate evacuation zones. Instead, they decided totake a wait-and-see approach to observe how radiation dose might decrease with time bymonitoring them over time.
Subsequently, however, on June 3, MEXT estimated cumulative radiation dose and found that
there were spots where the estimated annual cumulative radiation dose for one year after the
nuclear accident might exceed 20mSv of a criteria for deliberate evacuation zones, in parts ofDate-city and Minami-soma-city, which are located outside the deliberate evacuation zone.
In response to this fact, the NERHQ discussed the adoption of concrete measures for locations
where spots with high radiation dose were found in some areas and created a guideline referred toas "Response to specific spots estimated to exceed an integral level of exposure of 20mSv over a
one-year period after the accident." The guideline stated that spots where the estimated annual
cumulative radiation dose over a one-year period after the nuclear accident might exceed 20mSv
should be designated as "specific spots recommended for evacuation," and that the NERHQ
should notify all residents living in these spots and assist and support their evacuation. On June 16,
the NERHQ asked the NSC for its advice on this guideline. That same day, the NSC responded tothis request replying to the effect that it had no objection to the NERHQ’s ideas, although it might
be necessary to consider possible ways to solve this problem without conducting an evacuation,
including finding ways to decontaminate the areas that were only partially contaminated with highconcentration of radioactive materials.
Based on this advice, the NERHQ decided that the spots where the estimated annual cumulative
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radiation dose over a one-year period might exceed 20mSv should be designated as specific spots
recommended for evacuation. That same day, Chief Cabinet Secretary Edano released a statement
to that effect.
It was decided that the Local NERHQ should specify spots, per house, where decontamination
is not easy and are estimated to exceed 20mSv/year, through mutual consultation between the
Fukushima prefectural government and the cities, towns or villages where those spots are located.
Through mutual consultation with the respective municipal governments, the Local NERHQ
designated parts of Date-city on June 30 and November 25, parts of Minami-soma-city on July 21
and August 3, and parts of Kawauchi-village as specific spots recommended for evacuation.
Additionally, specific spots recommended for evacuation have not been issued with evacuation
orders pursuant to the provisions of Article 20, Paragraph 3 of the Act on Special Measures
Concerning Nuclear Emergency Preparedness. This policy is based on the idea that specific spots
recommended for evacuation are not dangerous enough to instruct all residents to begin
evacuation since radiation levels will be minimal if residents leave the area, and that the
government will provide information to alert them to the possibility of radiation exposure andsupport residents if they need to be evacuated.
[Governmental Interim Report] Chapter V 3

9. Establishment of the Deliberate Evacuation Area
The following is an overview of the course of events behind the establishment of the Deliberate
Evacuation Area.
On March 15, the NERHQ issued shelter-in-place orders to residents within a 20-to-30km
radius from Fukushima Daiichi Nuclear Power Plant. In the aftermath, the prolonged period ofshelter-in-place orders posed numerous problems for the livelihood of residents, and the truth ofthe degree of contamination over the area gradually became clearer. Nevertheless, the NERHQ
neither established a new evacuation zone nor lifted the shelter-in-place order, but rather only
urged residents on March 25, 2011 to voluntarily evacuate. On April 22, they finally establishedthe Deliberate Evacuation Area over the area.
The Deliberate Evacuation Area is an area outside the 20km radius from the Fukushima Daiichi
Nuclear Power Plant, where there was concern that the cumulative air dose might reach 20 mSv
within a one-year period after the accident. Residents were encouraged to evacuate to anotherlocation within roughly one month’s time. The Deliberate Evacuation Area specifically referred toareas northwest of the nuclear power plant with high contamination levels, including some partsof Katsurao Village and Namie Town, all area of Iitate Village, and some parts of Kawamata Town
(Yamakiya district) and Minamisoma City.
(Omission)
10. Specific spots recommended for evacuation
The NERHQ established “specific spots recommended for evacuation,” with regard to thoselimited areas facing difficulties in decontamination, outside both the Restricted Area and the
Deliberate Evacuation Area, where integral doses were predicted to exceed 20 mSv over one year
after the accident. The NERHQ indicated the necessity of cautioning residents in these areas andalso assisting and encouraging their evacuation. As a result, the spots designated as “specific spots
recommended for evacuation” were 117 points (128 households) in Date City, 142 points (153
households) in Minamisoma City, and 1 point (1 household) in Kawauchi Village as of May 2012.
[National Diet Report] Chapter 4, 4.2.2

Revision of the evacuation area
The government made a revision of the evacuation area on 11 April and implemented therevision on 21 and 22 April. This revision consisted of (1) setting of a restricted area where theviolator was fined by law, (2) reduction of the evacuation area from within a 10km to an 8km
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radius from the Fukushima Dai-ni NPS, (3) cancellation of the stay-indoors area from a 20 to a
30km radius, (4) setting of the deliberate evacuation area outside of the 20km radius where theresidents were required to deliberately evacuate within approximately one month and (5) settingof emergency evacuation preparation zones where residents should always be ready and able tofollow a stay-indoors evacuation order or evacuation order in an emergency and are advised to
begin voluntary evacuation.
The most important point in this revision was the setting of a deliberate evacuation area in thenorthwestern region where a high radiation level was observed despite being beyond the 30km
radius. However, forty days had already passed since the occurrence of the accident by the time
the revision of the evacuation area was implemented. The evacuation area should have beenrevised as soon as possible. Earlier revision was possible because the diffusion of the radioactive
materials into Iidate village was predicted by the SPEEDI after 12 March and there were radiation
monitoring data available for the northwestern region.
Moreover, a point to be raised as an issue is that the government did not actively clarify therevision of the evacuation area and stay-indoor area implemented from just after the accident to
the end of March. The revision in April was for long-term relocation to avoid the accumulated
dose by living for a long time, which was different from the temporary evacuation in theemergency in March. However, this distinction was not clearly shown according to the instructionof the residence office. It may be inevitable to facilitate the evacuation of the residenst aftersufficiently preparing and obviously informing the relevant residents of the type of the evacuationthat is not temporary but long-term one.
[Nongovernmental Report] Part 2 Chapter 5 Section 4

The following isssues can be raised in association with the evacuation of residents.
Evacuation of residents and its criterion – extension of order to stay indoors
 The results of radiation monitoring and SPEEDI retrospective estimation
showed there were areas with high radiation doses even more than 20km
from the Fukushima Dai-ichi NPS. The distribution of essential items was
disrupted in stay-indoors evacuation zones and it was difficult forresidents to conduct their daily lives. In the Nuclear Emergency
Guidelines, the enforcement of a stay-indoors evacuation for a long periodof time was not assumed.
Evacuation of residents and its criterion – instruction of deliberate
evacuation
 On 11 April 2013, Chief Cabinet Secretary Edano announced afundamental concept of how deliberate evacuation zones should beestablished. Subsequently, the government issued early advice to theaffected municipalities and then, on 22 April, the Nuclear Emergency
Response Headquarters (NERHQ) established deliberate evacuation zones
and provided those municipalities with a directive to inform residents inthe zones to be prepared to evacuate after a period of approximately one
month.
Evacuation of residents and its criterion – communication of evacuation
instruction70

Japan Health Physics Society The Emergency Preparedness Guide prescribes that the head of the local
headquarters shall communicate an evacuation order to each municipality,
including cities, towns, and villages. Most of the municipalities actuallylearned of the evacuation instructions through the mass media including
TV. Some of them learned through verbal announcements from police
vehicles, including police patrol cars.
Evacuation of residents and its criterion – evacuation beyond a designatedzone for emergency preparedness
 Each of the municipalities located within a 10km radius (equivalent to theEmergency Planning Zone, or EPZ) of a power plant is expected topossess regional disaster prevention plans and evacuation plans. Eachmunicipality is, as a rule, primarily responsible for formulating evacuationplans and implementing these plans, but in the event of evacuation over a
wider area (across municipalities), Fukushima Prefecture bears the
responsibility of formulating an evacuation plan. However, in reality, theonly evacuation cases in which Fukushima Prefecture took the lead incoordinating shelters across municipalities were for Futaba Town andOkuma Town, when an evacuation instruction was issued for areas lying
within a 10km radius.
Evacuation of residents and its criterion – evacuation of socially vulnerable
individuals
 People who had difficulty evacuating, such as hospitalized patients, wereleft behind in the area within a radius of 20km from the nuclear plant,
which had been designated as an evacuation zone. In the situation where
communication was limited and sufficient information could not be
obtained, the evacuation of hospitalized patients was extremely difficult,resulting in many cases of aggravated medical conditions or death.

(4) Radiation exposure(a) Radiological protection criteria
Overbiew of radiological protection criteria in the Emergency Preparedness Guide
are given in [Governmental Interim Report] in the following way.
c. Standards in Japan
In Japan, the following standards have been established based on the ICRP recommendations(Pub. 60) issued in 1990.
Firstly, the NSC has set up the NE Guideline (refer to Section 2 (3) b above) as emergency
countermeasures against accidents in nuclear facilities.
This NE Guideline formulated the "indices of stay-indoors evacuation and evacuation". A
stay-indoors evacuation should be conducted if a predicted effective dose from external exposure71Japan Health Physics Society(predicted exposure to radioactive material or radiation while being outdoors during a period of arelease of radioactive materials) is 10 to 50mSv, and evacuation (or a stay-indoors evacuation into
concrete buildings) should be carried out if the external radiation dose is more than 50mSv.
Secondly, the NE Guideline formulated the "indices of protective measures concerning theintake of stable iodine tablets" as a guideline for taking stable iodine tablets to protect the thyroid
gland from radiation exposure. The stable iodine tablets should be applied when a predictedequivalent dose of infant thyroid gland exposure to radioactive iodine is more than 100mSv ( inprinciple for people under 40 years old).
In addition, with regards to food, the NERHQ formulated the "Index for restrictions on theintake of food and beverages" in the table below as a guideline for discussions on whether or not it
is necessary to take measures to restrict food and beverages.
Table V-1 Index for restrictions on the intake of food and beverages, unit Bq/kg
TargetRadioactive iodine
Radioactive cesium
Drinking water
300
200
Milk and other dairy products
300
200
Vegetables (excluding root
2,000
vegetables and tubers)
Vegetables
500
Cereals
500
Meat, eggs, fish, others
500
Prepared based on the guidelines of "Emergency Preparedness for Nuclear Facilities" (firstpublished in June 1980 and last revised on August 23, 2011)
Next, concerning workers engaged in radiation work in radiation controlled areas (hereinafterreferred to as "radiation workers"), Japan has formulated "Ionization Radiation Injury Prevention
Rules" (hereinafter referred to as "Ionization Rules"), "Rules for Commercial Nuclear Power
Reactors concerning Installation, Operation, etc." (hereinafter referred to as "Commercial Reactor
Rules"), "Notice on Exposure Limits Based on Provisions of Commercial Power Reactor Rules"(hereinafter referred to as "Commercial Reactor Notice"), and "National Personnel Authority
Rules 10-5 (Prevention of Radiation Injuries in Staff)", which states that the radiation exposure
dose (hereinafter referred to as "Dose Limit") of radiation workers should be less than or equal to
100mSv/5 years and less than or equal to 50mSv/year based on ICRP recommendations. In thisregard, however, it is stipulated that, in emergency situations, the exposure limit shall be 100mSv,
in Article 7, Paragraph 2 of Ionization Rules; Article 9, Paragraph 2 ofCommercial Reactor Rules; Article 8 of Commercial Reactor Notice; and Article 4, Paragraph 3of National Personnel Authority Rules 10-5.
[Governmental Interim Report] Chapter V 4

 Criteria for administration of stable iodide
Descriptions about criteria for administration of stable iodide are given in[Governmental Interim Report], [Governmental Final Report] and [National Diet
Report] in the following way.
e. Distribution of stable iodine
Stable iodine is a chemical that mainly consists of non-radioactive iodine. Taking iodine forradiation exposure can help prevent radioactive iodine from being incorporated into the thyroid
gland even after radioactive iodine has entered the body. Thus stable iodine is used to prevent
thyroid gland cancer from occurring.
The "guidelines concerning the preventive intake of stable iodine tablets" prepared by the NSC
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in April 2002, describes how to determine whether or not stable iodine tablets should be taken
stating that "various protective measures can be implemented, including shelter, evacuation andpreventive intake of stable iodine tablets, in accordance with the NERHQ' judgment." Additionally,
while addressing concerns regarding the side effects of stable iodine, these guidelines also
stipulate that great care should be taken to ensure residents take stable iodine tablets as safely andas soon as possible in an emergency situation where it is predicted that the infantile thyroid gland
equivalent dose due to radioactive iodine will reach 100mSv, and if the NERHQ instructs
residents to take stable iodine as a preventive measure.
The NE Response Manual prescribes that the "Technical Advisory Organization in an
Emergency" staff shall provide a technical advice in the "Joint Council for Nuclear Emergency
Response" established in the Off-site Center and that a draft of protective intake policy
implemented by the Urgent Emergency Measures Policy-making Committee should be reported to
the NERHQ, that the NERHQ' decision on the intake of stable iodine tablets should then becommunicated by the head of the NERHQ to the head of the Local NERHQ, who should convey
this information to the governors of local governments, and finally that the governors of local
governments should then provide this information to their residents.
At 13:15 on March 12, the Local NERHQ issued a written order to the leaders of the prefectural
government and respective municipalities (Okuma-town, Futaba-town, Tomioka-town,
Namie-town) to the effect that "if instructions are issued for residents to take stable iodine tablets,
it should be decided by all possible means that stable iodine tablets be distributed to evacuation
facilities and that a sufficient number of pharmacists and doctors should be stationed at theseevacuation facilities.
Moreover, as described in b above, the Local NERHQ asked the ERC for advice and its
comments on a draft that the screening level should be changed to 40Bq/cm2, or 6,000cpm. In
response to this request, the NSC told the ERC that instructions should be given at their screening
services to the effect that stable iodine tablets should be provided to those who had radiation doseof more than 10,000cpm. However, this information was not communicated to the Local NERHQ.
On the night of March 14, the ERC medical treatment team was informed that the evacuation of
hospitalized patients within a 20km radius had not yet been completed and they provided thisinformation to the NSC. In response, a few hours later at 3:10 on March 15, the NSC provided the
ERC advice to the effect that the hospitalized patients should have taken stable iodine tablets
when they were evacuated according to a provision concerning "Rules on the intake of stableiodine tablets in the evacuation of hospitalized patients from an evacuation zone (within a 20km
radius)." The ERC sent this advice to the Local NERHQ by fax. However, that same day, theLocal NERHQ was busy relocating to the Fukushima Prefectural Office building. It was not until
later that evening, after they had completed their move, that they discovered the fax conveying
this advice. The Local NERHQ, which considered it highly likely that in addition to hospitalized
patients many elderly citizens living in local communities and hospital staff still remained, createdan instruction draft to the effect that subjects who should take stable iodine should include
residents other than hospitalized patients. That night, the Local NERHQ provided the ERC with
its instruction draft stating that residents who should take stable iodine tablets should include all
citizens that still remained within a 20km radius. In response to this, the ERC asked the NSC foradvice on this instruction draft. At 01:25 on March 16, the NSC distributed advice to the ERC tothe effect that all of those who remained within a 20km radius should take stable iodine tablets
while being evacuated according to the "Rules on having those who remain in evacuation zones(within a 20km radius) take stable iodine tablets when being evacuated." The Local NERHQ,
which confirmed this advice via the ERC, issued a written order at 10:35 the same day to theleaders of the Fukushima prefectural government and 12 affected municipalities to "have those
who are evacuated from evacuation zones (within a 20km radius) take stable iodine tablets."
However, the Fukushima prefectural government did not follow this instruction on the intake ofstable iodine tablets because the government had already confirmed that there were no subjects
who remained within a 20km radius.
Additionally, the Basic Disaster Prevention Plan stipulates that the "National Government(MEXT and MHLW), Japan Red Cross, local governments and nuclear operators shall cooperate73

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with each other in storing and maintaining radiation measuring materials and equipment,
decontamination materials and equipment, stable iodine tablets, medicinal chemicals andequipment for emergency relief activities, as well as materials and equipment for medical
services." Six regional municipalities surrounding the Fukushima Dai-ichi NPS and Fukushima
Dai-ni NPS (Hirono-town, Naraha-town, Tomioka-town, Okuma-town, Futaba-town andNamie-town), as per the advice in the "Manual for radiation emergency medical care activities inFukushima Prefecture," already had 136,000 stable iodine tablets on hand, which corresponded tothree doses for the estimated population of intake subjects (below 40 years old) in an EPZ(Emergency Planning Zone), which is a regional zone within a 10km radius requiring enhanced
comprehensive disaster prevention planning. Additionally, Iwaki-city and Koriyama-city, whichwere not designated as EPZ, also stored and maintained stable iodine tablets.
Moreover, the Fukushima prefectural government stored and maintained 68,000 stable iodine
tablets in the Environmental Medical Research Institute located in Okuma-town for tourists andother visitors to the prefecture. The local Government also asked the ERC and other organizations
to help secure stable iodine tablets and was able to obtain approximately 1,360,000 stable iodine
tablets from a major stable iodine manufacturer and from the Ibaraki prefectural government.
On March 14, the Fukushima prefectural government discussed whether or not stable iodine
tablets should be distributed to all municipalities within an approximate radius of 50km of thenuclear power station and reached the decision to distribute two tablets to each resident ofyounger than 40 years old within these zones in each municipality. By March 20, the Fukushima
prefectural government had distributed approximately 1,000,000 stable iodine tablets to residents
living in municipalities in the Hama-dori and Naka-dori districts.
Additionally, around and after March 15, some regional municipality offices surrounding the
Fukushima Dai-ichi NPS distributed stable iodine tablets to their residents of their own accord.
For example, on March 15, the Miharu-town town office not only distributed stable iodine tablets
to its residents, but also instructed them to take the tablets. In the middle of the night of March 13,
Miharu-town town officials learned that the radiation level had increased at the Onagawa Nuclear
Power Station. Weather forecasts predicted rain with an easterly wind for the following day,March 15. Miharu-town town officials were afraid that its residents might be exposed to radiationand decided to distribute stable iodine tablets to its residents and instructed them to take the tablets.
At 13:00 that day, Miharu-town town officials, using a municipal disaster management radio
communication network, made sure that each and every resident was informed of this decision.
They distributed stable iodine tablets to approximately 95% of object residents under supervisionof the local pharmacists. Later, health and welfare service section staff of the regional medical
division of the Fukushima prefectural government learned that the Miharu-town town office had
distributed stable iodine tables and instructed intake subjects to take them without directives fromeither the national or local governments. In the evening of the same day, the section staff
instructed Miharu-town officials to stop distributing stable iodine tablets and to recover all ofthem as there had been no instructions from the national government. Miharu-town town officials
did not obey this demand.
[Governmental Interim Report] Chapter V 4(b) Orders from the government concerning the intake of iodine tablets
On March 13, 2011, the Medical Squad of the Local NERHQ commenced preparations in themorning to issue an order from the Director-General of the Local NERHQ, as mentioned in
Chapter IV. 4. (5) b. above, concerning the screening level corresponding to the anticipatedradiation exposure limit. During that process, the NSC delivered a FAX transmission at
approximately 10:40 of the same day to the ERC with the comment that stable iodine tablets
should be administered to those whose radiation contamination exceeded the screening level. A
liaison officer dispatched from the NSC to the ERC received this transmission. However, thiscomment was not shared within the ERC Medical Treatment Squad, and nor was it reviewed in the
ERC, and therefore it was not transmitted to the Local-NERHQ, either. This is considered to be theresult of a lack of awareness, on the part of the NSC liaison officer, of the importance and74

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necessity of incorporating the NSC comments into the orders to be issued by the Director-Generalof the NERHQ. It can be so understood from the grounds that the said liaison responded to the
NSC Secretariat over the phone soon after he had received the above fax message from the NSC as“it is too late to alter the existing plan because it is already moving on with the original level,”suggesting a difficulty in incorporating the comment in the order, and that the comment was nevershared or reviewed in the ERC thereafter.
On the other hand, the staff of the NSC Secretariat who learned from the liaison “it is too late toalter the existing plan because it is already moving on with the original level,” conveyed themessage to each NSC committee member. The NSC, however, did not give any further advice forthe reason, “The NSC is by nature an advisory body. What should be advised is already advised.”
The NSC indeed is an advisory body but it cannot be denied that the fact that they took no further
action but merely stating “what should be advised is already advised” about their own comments
which seriously concerned the people’s safety reflects the lack of responsibility as anadministrative body concerning people’s safety.

(c) Orders from the local governments concerning the intake of iodine tablets
As reported in detail in Chapter V. 4. (5) e. of the Interim Report, the Miharu Town
administration decided at midnight on March 14, 2011, to distribute and issue orders for the intake
of stable iodine tablets, based on an anticipation of residents’ exposure to radiation. At
approximately 13:00 on March 15, this was announced to the residents of the town over thecommunity radio system or other means, and under the supervision of pharmacists, stable iodine
tablets were distributed to 95% of the residents. A staff of the Local Medical Care Division, Health& Hygiene Promotion Office of Fukushima Prefecture who came to know of this fact issued anorder in the evening of the day to suspend the distribution and recall the tablets, based on thereason that no instructions had been received from the national government. However, the Miharu
Town administration did not comply. Considering the fact that the NSC’s opinion about theadministration of stable iodine tablets was dismissed as outlined in (b) above, it cannot be
concluded that the decision by the Miharu Town administration was inappropriate simply because
it had not been backed by an instruction from the national government. In the existing emergency
preparedness, administration of stable iodine tablets is, in principle, subject to the judgment of thegovernment nuclear emergency response headquarters (according to the Nuclear Emergency of
Response Manual). However, in view of the aforementioned incident, a system which allows local
municipalities to independently administer the tablets should be reconsidered, and so is theappropriateness to distribute them in advance to the residents as a precaution.
[Governmental Final Report] Chapter VI 1

4.4.2 Stable iodine that did not work as a protection measure
Radioactive iodine, once it is incorporated in the human body, is accumulated in the thyroid
gland, which can cause thyroid cancer. It is thought that stable iodine in the form of iodine tablets
can effectively prevent radioactive iodine from accumulating in the thyroid gland. The Guidelines
for the Taking of Stable Iodine Tablets as a Preventive Treatment in Times of Nuclear Emergency,
released by the Safety Commission, specify general views concerning the taking of iodine tablets
as a preventive treatment in times of nuclear emergency. The prefecture’s regional disasterprevention plan stipulates that the Prefecture Headquaters for Disaster Control shall give
instructions to the people in the prefecture, among others, about the distribution and taking of
iodine tablets based on the instructions from the Nuclear Emergency Response Headquarters(NERHQ) or on the decision of the governor of the prefecture.
In the aftermath of this accident, however, neither the NERHQ nor the governor of Fukushima
Prefecture gave instructions to take iodine tablets within the period of time in which they would
be effective. The NSC’s advice about the administration of iodine tablets was ambiguous andwhether the NSC’s advice reached Fukushima Prefecture and the cities, towns, and villages
concerned, has not been confirmed. There were two types of cities, towns, and villages, local
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governments that responded to the needs of their respective people: those in which iodine tablets
were distributed so the people could take them, and those that did not distribute them but waitedfor instructions. As a result, many of the people in Fukushima Prefecture were unable to takeiodine tablets despite the fact that the cities, towns, and villages in the prefecture had stock.
(Omission)
2. Miscommunication between the central and prefectural governments regarding iodine
tablet instructions
The Fukushima prefectural government started the deployment of iodine tablets immediately
after the occurrence of the accident so that they could be distributed to its people and instructions
could be given to them to take those tablets. They had a stock of iodine tablets for the towns
neighboring the nuclear power plants, as well as for the cities, towns, and villages located outside
the 50km radius around the Fukushima Daiichi Nuclear Power Plant. From the very beginning,
the Fukushima prefectural government moved to fill the gap between the number of iodine tablets
needed for these people and the number of iodine tablets they actually had in stock.
The NSC, although they had no information from SPEEDI nor any emergency monitoring data,
issued advice on March 13, based on a screening inspection result, that iodine tablets should betaken.
This advice, however, did not reach Fukushima Prefecture and the cities, towns, and villages
concerned. The governor of the prefecture, despite having the authority to do so, did not give
instructions to each city, town, and village concerned to take iodine tablets.
a. Failure to confirm instructions to take iodine tablets
According to NSC, the medical group of the Prime Minister’s Nuclear Emergency Response
Headquaters (ERC) and NRC started a meeting at midnight on March 12 to discuss a screening
level and confirmed the step to administer iodine tablets to those people with at least 10,000 cpm
of radiation.
After 10:00 on March 13, NSC was asked by the Local Nuclear Emergency Response
Headquarters (Local NERHQ) for advice on screening instructions to be given to the governor of
the prefecture and the mayors of Okuma Town, Futaba Town, Tomioka Town, and Namie Town.
NSC sent a fax to ERC. The faxed document shows a handwritten, additional instruction to “set10,000 cpm of radiation as the criterion for the commencement of decontamination and taking of
iodine tablets” when conducting screening. According to a hearing with NSC, a staff member of
the NSC Secretariat, who was there working handed this document to a member of ERC, but that
document did not arrive at the Local NERHQ Accordingly, the Local NERHQ distributed the
instructions, without incorporating NSC’s advice, to the prefecture and the cities, towns, andvillages concerned.
The instructions, which did not reflect advice of NSC, arrived at NSC the same day. They
should have understood at that point that their advice had not adequately reached the affected sites.
NSC, however, did not confirm the situation nor did it again give advice.
On March 14, the Fukushima prefectural government raised the screening criterion fordecontamination from 13,000 cpm to 100,000 cpm and used that criterion accordingly. NSC
judged that if a measured figure showed 13,000 cpm, that would be “equivalent to the thyroid
dose of approximately 100 mSv,” which would, assuming that all internal exposure is caused byiodine, become “a criterion for commencing the administration of stable iodine.” NSC therefore
advised against loosening the criterion. The people on the ground, however, were not aware thatthe screening criterion was in fact the criterion for administering iodine tablets. Again, NSC’s
advice did not lead to the taking of iodine tablets.
In a hearing, a member of NSC said, “We advised that affected people should take iodine
tablets once a measured figure reached 10,000 cpm, so I thought the iodine tablets were being
taken accordingly.” According to a hearing with NISA, they were unable to “find anyone who hadreceived such a document” in the secretariat of the NERHQ, which in theory should have received
written advice about the administration of iodine tablets.
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The NSC has explained that the role they are expected to play is “to give advice” and that they
“will not be involved in the act of giving instructions or in decisionmaking.” In their mind,
confirming that the information was received or proposing their opinion is outside the scope of
their responsibilities, even if their advice is not reflected in countermeasures.
In the end, the secretariat of the NERHQ and NSC, both of which were in charge of measuresagainst initial exposure through the use of iodine tablets–which was thought to be the mostimportant measure in times of nuclear emergency–did not share recognition with each other nor
did they confirm the status of instructions.
b. The governor of the prefecture, who did not give instructions
Meanwhile, the Fukushima prefectural government kept waiting for instructions from thecentral government. It was through the document dated March 16, in which it was specified thatiodine tablets should be administered to the people in the evacuation zone (any place locatedwithin a 20km radius) when they evacuate, that the prefectural government first became aware of
the receipt of instructions to distribute and take iodine tablets. But the prefectural government was
not aware of the existence of the document until March 18. At that point, the evacuation of people
living within the 20km radius had already been completed; the Fukushima prefectural government
had failed to give instructions to distribute and take iodine tablets.
It was possible for the governor of the prefecture to give instructions to take iodine tablets at his
own discretion without waiting for the instructions from the central government. Nevertheless, theFukushima prefectural government did not deliberate at all about the extent to which it was
authorized to make its own judgment concerning the issuance of instructions to distribute and takeiodine tablets.
It wasn’t that the Fukushima prefectural government lacked the basic information necessary formaking an independent judgment to give instructions for distributing and taking the iodine tablets.
It was true that, as far as the areas near the nuclear power plants are concerned, only one
monitoring post, out of the 24 posts in the prefecture, kept functioning immediately after theoccurrence of the earthquake. But the Fukushima prefectural government had received
information from SPEEDI and also possessed, albeit not sufficiently, information from the central
government and TEPCO concerning the status of the nuclear power plants. Having obtained theresult of emergency monitoring of environmental radioactivity, the prefectural government wasaware that some regions had a high level of spatial dose rates of radiation. They also had
confirmed that levels of radioactive iodine as high as over 1,000,000 Bp/kg were detected in grasscollected on March 15 in places 35-45 km away from the nuclear power plant. When comparedwith the cities, towns, and villages that gave instructions on their own to distribute and take iodine
tablets, it can be said that the Fukushima prefectural government possessed enough information onmatters such as the level of spatial dose rates of radiation and the status of the nuclear reactors, tohave decided whether iodine tablets should be taken or not.
The governor of Fukushima Prefecture, however, did not give instructions to take iodine tablets.
In our 17th hearing, the governor described the reason. He said, “We carried out our operations
after they had been confirmed by the central government” and “We as the prefectural government
did not distribute [iodine tablets].” Regrettably, the response by the Fukushima prefectural
government was indeed problematic.
[National Diet Report] Chapter 4, 4.4.2

The following isssues can be raised in association with the criteria foradministration of stable iodide.
Radiological protection criteria – criteria for administration of stable iodide –confusion regarding administration criteria
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Japan Health Physics Society Local governments were able to obtain a sufficient amount of stable iodine
tablets, but instructions to take the stable iodine tablets were not given
because there was no information on predicted radiation dose by SPEEDI. On
the other hand, new criteria for the administration of stable iodine were
provided by the NSC on the basis of a screening level. This advice, however,
did not reach Fukushima Prefecture and the cities, towns, and villages
concerned. There was no opportunity to take iodine tablets except for someresidents who were given instructions at a local government’s own discretion.
 On 13 March 2013, the NSC advised the ERC that stable iodine tablets should be
provided to those who had radiation dose exceeding 10,000cpm detected at attheir screening services. However, this information was not communicated to the
local NERHQ.
 At 01:25 on 16 March, the NSC distributed advice to the ERC to the effect that allof those remaining within a 20km radius should take stable iodine tablets while
being evacuated.
 The local NERHQ, which confirmed this advice via the ERC, issued a written
order at 10:35 the same day to the leaders of the Fukushima prefectural
government and 12 affected municipalities. However, the Fukushima prefectural
government did not follow this instruction on the intake of stable iodine tablets
because the government had already confirmed that there were no individuals
remaining within a 20km radius.
 The Fukushima prefectural government also asked the ERC and otherorganizations to help secure stable iodine tablets and was able to obtainapproximately 1,360,000 stable iodine tablets from a major stable iodine
manufacturer and from the Ibaraki prefectural government. On 14 March, theFukushima prefectural government reached the decision to distribute two stableiodine tablets to each resident under 40 years of age in all municipalities within
an approximate radius of 50km of the nuclear power station. However, theFukushima prefectural government did not give instructions to each city, town,
and village concerned to take iodine tablets, despite having the authority to do so.
 During the night of 14 March, Miharu town officials had fears that its residents
might be exposed to radiation and decided to distribute stable iodine tablets to its
residents and instructed them to take the tablets. At 13:00 on 15 March, Miharu
town officials, using a municipal disaster management radio communication
network, made sure that each and every resident was informed of this decision.
They distributed stable iodine tablets to approximately 95% of residents under thesupervision of local pharmacists. Later, staff of the Fukushima prefectural
government learned that the Miharu town office had distributed stable iodine
tables and instructed the residents to take them. In the evening of the same day,the staff instructed Miharu town officials to stop distributing stable iodine tablets
and to retrieve all of them as there had been no instructions from the national
government. Miharu town officials did not obey this order.

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Japan Health Physics Society Screening levels
Descriptions about screening levels are given in [Governmental Interim Report],[Governmental Final Report], [Nongovenmental Report] and [TEPCO Report] inthe following way.
c. Implementation of screening"What should be done in radiation emergency medical care and how" stipulates that relevant
local governments, under mutual cooperation with their partner organizations, are specifying
places where to conduct rescue and evacuation operations as well as planning to conduct
screening services , if necessary. In response to this situation, the "Manual for radiation
emergency medical care activities in Fukushima Prefecture" stipulates that a medical treatment
team shall be established, which will be led by the divisional councilor of the hygiene services
division of the department of health and welfare services in the Nuclear Emergency Response
Center and that a screening team shall be established and will consist of health and welfare service
staff, core-city healthcare center staff, doctors from the prefectural hospital and the medical
association, and radiology technicians from the Fukushima Regional Association of RadiologicalTechnologists, which will conduct body-surface contamination monitoring with survey meters todetermine if monitored individuals or subjects need decontamination.
In response to the declaration of a nuclear emergency state by the Japanese government on thenight of March 11, the Fukushima prefectural government decided to implement screening
services and started doing so the next day, on March 12. However, there were far more monitoring
subjects than expected so there were not enough staff members within the prefecture to allow
them to adequately handle all screening services. The Fukushima prefectural government asked
the national government, local governments, universities and the Federation of Electric Power
Companies for their cooperation in conducting screening services at evacuation facilities andpermanent facilities designed for community use. More than a total of 200,000 monitoring
subjects representing over 10% of the prefectural population received screening services. The
count rate of those monitoring subjects was between 13,000 and 100,000 cpm. The number ofsubjects who needed partial external cleansing was 901, and the number of subjects whose
measured count rates was higher than 100,000cpm and needed whole body cleansing was 102.
However, the count rates of those monitoring subjects whose measured exposure was higher than
100,000cpm was below the designated level when they removed their clothing.
[Governmental Interim Report] Chapter V 4

a. Screening level before the nuclear accident
The “Manual for radiation emergency medical care activities in Fukushima Prefecture,” which
was created in 2004 fiscal year under the authority of the Fukushima prefectural government, wasbased on a manual entitled "Recommendation on radiation emergency medical care" which was
prepared by the NSC in July 2001 and stipulated that the screening level for residents (a criterionof comprehensive outer body clean up) should be 40Bq/cm2.
Since the level of 40Bq/cm2 is equivalent to counting rates of about 13,000cpm (counts per
minute) when measured by survey meters owned by the Fukushima prefectural government, it set
the screening level at 13,000cpm when the accident occured.
b. Raising the screening level after the nuclear accident
The Local NERHQ at the Off-site Center, which started discussions on screening levels on
March 12, asked the ERC advice in the morning of March 13 on the Local NERHQ head’s draft
instruction for setting the criterion of 40Bq/cm2 or 6,000cpm.
At the ERC, the medical team was responsible for matters concerning the screening, but there
was hardly anyone in that team, who had expertise on screening levels. Meanwhile, at the ERC,
there were two liaison officials dispatched from the NSC. At around 10:13 on March 12, one of the79

Japan Health Physics Societyliaison officials faxed the draft instruction to the NSC to seek the NSC’s opinion on the draft
instruction. Upon receiving the fax, the NSC, at around 10:40 the same day, faxed a revised
version of the above-mentioned draft instruction by adding comments that the screening level of
6,000cpm should be revised to 10,000cpm and that those who experienced exposure in excess of
10,000cpm should take stable iodine tablets, and the aforementioned liaison official received thefax. The said liaison official who received the comments from the NSC mentioned above told astaff member of the NSC Secretariat who called immediately afterwards that “Since we are alreadymoving along this way, we can no longer change things about the screening level or the intake ofstable iodine tablets”. The Secretariat staff member told the NSC members of this conversation,
but the NSC refrained from making any further advice on the grounds that the NSC is an advisoryorganization and that it has already advised on matters on which it should give advice.
No member of the ERC medical team received the revised comments of the NSC from theaforementioned NSC liaison official. Thus, the NSC’s revised comments that recommended theintake of stable iodine tablets under certain conditions were not communicated to the ERC medical
team, which inevitably did not consider them, and therefore did not convey them to the Local
NERHQ.
As a result, at around 14:20 on March 13, the Local NERHQ, based on the provisions ofParagraph 3, Article 20 of the Nuclear Emergency Preparedness Act, handed to a prefectural
government staff member an instruction document to the effect that the screening level should
40Bq/cm2 or 6,000cpm, after making only some wording changes to the aforementioned draft
instruction and without incorporating the NSC’s comments on the intake of stable iodine tablets.
However, as the prefectural government staff member who received this instruction did not deliver
the instruction document to the rescue team that was responsible for matters related to thescreening at the Prefecture Nuclear Emergency Response Center, and thus the instruction was notcommunicated to the rescue team.
The Fukushima prefectural government, meanwhile, already began the screening of evacuees
from March 12, and was using the screening level of 40Bq/cm2 prescribed in the “Manual forradiation emergency medical care activities in Fukushima Prefecture”.
However, radiology experts in a radiation emergency medical care team dispatched to
Fukushima Prefecture on March 13 came up with an opinion that the screening level should beraised from 40Bq/cm2 (13,000cpm) to 100,000cpm, after considering that water (hot water) to be
used for whole-body decontamination (showering) appears to be in short supply and thatwhole-body decontamination under low-temperature conditions is believed to have big
disadvantages. Some of the aforementioned radiology experts disagreed to the raising of thescreening level, but a majority of the radiation emergency medical care team ultimately supported
the higher screening level. Based on the opinion of these experts, the Fukushima prefectural
government decided to raise the screening level to 100,000cpm for whole-body decontaminationfrom March 14 onward and also conduct wipe-off decontamination for those with the counting rateof 13,000cpm to less than 100,000cpm. At the time, as described, the instruction by the head of the
Local NERHQ to set the screening level at 40Bq/cm2 or 6,000cpm had not yet reached the rescue
team of the Prefecture Nuclear Emergency Response Center. So, in deciding the new screening
level, the Fukushima prefectural government did not discuss whether it would run counter to the
instruction.
Around early in the evening of March 13, an ERC medical team staff member learned that the
Fukushima prefectural government was going to raise the screening level to 100,000cpm by thecommunication from the prefectural government. But, since the staff member was not told by otherteam members that the aforementioned instruction by the head of the Local NERHQ had been
issued and was not aware of the existence of that instruction, the staff member did not point out tothe Fukushima prefectural government that its plan to raise the screening level to 100,000cpm
would go against the aforementioned instruction.
Before dawn on March 14, having learned via the “ERC medical team status report” preparedby the ERC medical team that the Fukushima prefectural government was raising the screening
level, the NSC held a discussion on the matter and concluded that if the entire 13,000cpm is fromiodine from internal exposure, it would be equivalent to the infant thyroid equivalent of 100mSv,
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which is the criterion of stable iodine administration90. Thus, at 4:30 the same day, the NSC
provided the ERC with advice to the effect that “it is desirable not to raise the screening criterion
to 100,000cpm and keep it at the current value of 13,000cpm.” The ERC medical team staff
member mentioned above received the NSC advice and relayed it to the Fukushima prefectural
government. However, the Fukushima prefectural government decided to continue with thescreening and decontamination with the new criterion, as it judged that the new screening leveland decontamination methods it decided to apply from the same day would not go against the NSC
advice because they involved partial wipe-off decontamination of those with the counting rate of
13,000cpm to less than 100,000cpm.
On March 18, four days after the NSC gave the advice that the screening level should be kept at
13,000cpm, the NSC received the request from the head of the Research Center for Radiation
Emergency Medicine of the National Institute of Radiological Sciences (NIRS) that “it would bedesirable to raise the screening level to 100,000cpm, as the air dose rate is high in the affectedareas and the screening is difficult to conduct.” Accepting the request, the NSC, at 14:40 on March
19, provided the ERC with the advice that the screening level should be raised to 100,000cpm(“Recommendation on screening criteria of radiation emergency medical care”). Acting on theadvice, at 23:00 on March 20, the Local NERHQ issued an instruction to raise the screening levelto 100,000cpm, based on the provisions of Paragraph 3, Article 20 of the Nuclear Emergency
Preparedness Act. This means that no decontamination is required for those with the counting rates
of less than 100,000cpm. However, the Fukushima prefectural government did not change its
practice of conducting partial wipe-off decontamination for those with the counting rates of
13,000cpm to less than 100,000cpm, in order to ensure the safety of those with the counting ratesof 13,000cpm to less than 100,000cpm and avoid confusing people at the screening sites byaltering the criteria again.
[Governmental Final Report] Chapter IV 4(d) Raising the screening level
To respond to the residents’ concern regarding the fears of contamination by radioactive
materials, appropriate screening and subsequent decontamination is absolutely necessary.
Fukushima Prefecture initially established the screening level at 40 Bq/cm2 (equivalent to 13,000cpm), when it had started the screening process and subsequent decontamination on March 12,
2011. However, it raised on March 13, 2011 the screening level for whole-body decontamination
to 100,000 cpm, effective from March 14, 2011, based on suggestions of radiological experts. But
at this moment Fukushima Prefecture was not aware that the raised screening level was against theorder from the Director-General of the Local NERHQ released in the afternoon of March 13, 2011
(the screening level to set at 40 Bq/cm2 etc.), because it had not been transmitted to thePrefectural Emergency Response Center.
One of the staff members of the ERC Medical Treatment Squad learned from a Fukushima
Prefecture’s report in the evening on March 13, 2011 that Fukushima Prefecture was intending toraise the screening level to 100,000 cpm. The staff member, however, did not know of theaforementioned order itself, and was not able to point out that raising the screening level to
100,000 cpm was against the said order. Knowing about the intentions of the Fukushima
Prefecture government to raise the screening level before dawn of March 14 from an ERC report,
the NSC reviewed the plan immediately and advised the ERC at 04:30 on the same day that thescreening level should be kept at 13,000 cpm. This advice was conveyed to Fukushima Prefecture,
but the prefecture kept its own policy and continued its own screening and decontamination
procedures, based on the understanding that the new screening level and decontamination
procedure did not necessarily contradict with the NSC’s suggestion, because they decontaminatedthe people by partial sampling, instead of doing nothing to the persons counting not less than
13,000 cpm but below 100,000cpm.
Later at 14:40 on March 19, the NSC renewed its advice to the ERC and endorsed raising thelevel to 100,000 cpm, and on March 20, the Director-General of the Local NERHQ issued theorder at 23:00 to set the screening level at 100,000 cpm. This new order, however, did not81Japan Health Physics Society
stipulate to implement decontamination of the people counting not less than 13,000 cpm but
below 100,000 cpm, leaving room to interpret as no requirement of decontamination of suchpeople, and thus the new order became less strict than that of Fukushima Prefecture back then.
[Governmental Final Report] Chapter VI 1
Raising the screening level
In the first meeting of the Urgent Radiation Exposure Medical Care Adjustment Meeting held at
18:00 on 13 March, the following four points were discussed; 1) if 13,000 cpm derived in anormal situation is used as a radiological criterion, water for decontamination of a great number of
evacuees could not be ensured because suspension of the water supply occurred in almost all areas,2) shortage of human resouces, 3) low temperature that falls below the freezing point in the night,
and 4) health risk when significant contamination remains by raising the screening level fordecontamination. Finally, it was proposed to Fukushima prefecture to raise the screening level forwhole-body decontamination to 100,000 cpm. On the next day, 14 March, the regional medical
division of the Fukushima prefectural government decided that the screening level for whole-bodydecontamination was 100,000 cpm and partial wipe-off decontamination was necessary when the
count rate was more than 13,000 cpm and also less than 100,000 cpm. Where is the legal
foundation to change the screening level? Originally, there was no description to enable us tochange the value of 13,000 cpm according to the emergency situation. However, this value wasregarded as ineffective for the present accident, because this value was derived assuming a small
amount of released radioactive iodine and was not an index considering the release of great deal ofradioactive materials, a great number of evacuees, and the implementation of screening for them.
According to the Act on Special Measures Concerning Nuclear Emergency Preparedness, thedescription on screening level is found in a section on emergency measures. In the nuclear
emergency response section of the Fukushima Prefecture Regional Disaster Prevention Plan, theemergency measures have been prescribed as follows: “the government decides rapid emergency
measures on the basis of technical suggestions of the Nucelar Safety Commission (NSC) andprepares to instruct them to prefectual or local governments”. On the other hand, one of the tasksof the Prefectural Headquarters for Disaster Control was “decision of the emergency measures”.
Fukushima prefecture decided to raise the screening level on 14 March as part of the emergency
measures. Receiving the decision, organizations associated with radiation survey implemented
screening using the new value. At 4:30 on 14 March, the NSC advised the METI Emergency
Response Center (NISA-ERC) regarding the screening level, and did not approve this change ofthe screening level at first. However, on 20 March, the NSC finally announced a notification tochange the screeing level to 100,000 cpm.
[Nongovernmental Report] Part 2 Chapter 5 Section 6(5) Exposure Dose Standards and Screening Guidelines in Times of Emergency
Meanwhile, after the accident at the Fukushima Daiichi NPS, when J Village and the Onahama
Coal Center were being set up as entry and exit points to the contamination area, whereas there are
guidelines for determining the need for decontamination, etc. (screening level), it was anticipatedat the time that decontamination to the level stipulated by law (4Bq/cm2) would be difficult.
Therefore, the ERC Health Physics Team at the Headquarters asked emergency exposure medical
experts, etc. visiting Fukushima Prefecture as an emergency medical team dispatched for the
emergency for advice via TEPCO employees, to which the reply was received that a screening
level of 40Bq/cm2 would be appropriate. In order to abide by this level for certain, the screening
level was initially set conservatively at 6,000cpm. Thereafter, from the standpoint of keeping thescreening levels consistent among related agencies, including Fukushima Prefecture, the screening
level was set to 100,000cpm on and after April 20. This level of 100,000cpm was offered asadvice on March 20 by the NSC in reference to an IAEA manual that stipulates screening levels
for general residents. Furthermore, when the Nuclear Disaster Onsite Countermeasures
Headquarters lowered the screening level from 100,000cpm to 13,000cpm, TEPCO was instructed
to lower its screening levels in the same manner on and after September 16 and screening levels
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were lowered to 13,000cpm.
[Tepco Report] Chapter 13 Section 2(5)The following isssues can be raised in association with screening levels.
Radiological protection criteria –screening level – validity of the level The screening level was raised in accordance with the present situation using
different levels from those that had been previously established.
 The "Manual for Radiation Emergency Medical Care Activities in Fukushima
Prefecture," which was created under the authority of the Fukushima prefectural
government, was based on a manual entitled "Recommendation on Radiation
Emergency Medical Care", which was prepared by the NSC, and stipulated thatthe screening level for residents (a criterion of comprehensive outer body cleanup) should be 40Bq/cm2. The Fukushima prefectural government set thescreening level at count rates of 13,000cpm (counts per minute), which isequivalent to about 40Bq/cm2 and started to implement screening services on 12
March 2011.
 The Local NERHQ asked the ERC for advice in the morning of 13 March
regarding setting the criterion of 40Bq/cm2 or 6,000cpm. The ERC requested
comments from the NSC on the criterion. The NSC responded that the screening
level of 6,000cpm should be revised to 10,000cpm and that those who
experienced exposure in excess of 10,000cpm should take stable iodine tablets;
however, these comments were not communicated to the Local NERHQ by the
ERC.
 Radiology experts in a radiation emergency medical care team dispatched to
Fukushima Prefecture on 13 March voiced the opinion that the screening levelshould be raised from 40Bq/cm2 (13,000cpm) to 100,000cpm, after consideringthat water (hot water) to be used for whole-body decontamination (showering)appeared to be in short supply and that whole-body decontamination under
low-temperature conditions is believed to have major disadvantages.
 The Fukushima prefectural government decided to raise the screening level to
100,000cpm for whole-body decontamination from 14 March onward and also
conducted partial wipe-off decontamination for those with a count rate of
13,000cpm to less than 100,000cpm.
 Before dawn on March 14, having learned that the Fukushima prefectural
government was raising the screening level, the NSC provided the ERC withadvice to the effect that “it is desirable not to raise the screening criterion to100,000cpm and to keep it at the current value of 13,000cpm.” However, theFukushima prefectural government decided to continue with the screening anddecontamination with a screening criterion of 100,000cpm, as it judged that the
new screening level and decontamination methods would not go against the NSC
advice because they involved partial wipe-off decontamination of those with acount rate of 13,000cpm to less than 100,000cpm.
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 Subsequently, the NSC received the request that “it would be desirable to raise
the screening level to 100,000cpm, as the air dose rate is high in the affected areasand screening is difficult to conduct.” Accepting the request, the NSC, at 14:40 on
19 March, provided the ERC with the advice that the screening level should beraised to 100,000cpm (“Recommendation on Screening Criteria of Radiation
Emergency Medical Care”).

 Criteria for contamination of soil, etc.
Descriptions about criteria for contamination of soil (schoolyards and educational
facilities, and bathing areas, utilization of crushed stones, and disposal of disaster
waste and sewage sludge) are given in [Governmental Interim Report],[Governmental Final Report], [National Diet Report] and [Nongovenmental
Report] in the following way.
a. Schoolyards and the other educational facilities in Fukushima Prefecture
Fukushima Prefecture requested the Local NERHQ to indicate the criteria for reopening theschools and the other educational facilities in the prefecture. In response to the request, MEXT
began to consider the criteria. From April 6 to 7, MEXT requested the Nuclear Safety
Commission to deliberate on the criteria for reopening by presenting the results of the air radiationdose rate measurements that Fukushima Prefecture took in the schoolyards of elementary andjunior high schools, preschools and nursery schools within the prefecture (except those in theevacuation area within a 20km radius of the Fukushima Dai-ichi NPS). However, the Commission,as an advisory agent, replied to the Ministry that some planned criteria should be proposed first.
On April 8, MEXT was directed by the Prime Minister's Office to deliberate on the criteria for theuse of school facilities as a matter of the whole Government. Therefore MEXT began consulting
on the criteria of use with the Nuclear Safety Commission.
At the time, MEXT believed that it was necessary to consider the consistency of the criteria forthe establishment of the planned evacuation area, which was deliberated within the Government,
and the contribution of internal exposure. On April 11, the NERHQ specified the area where thecumulative radiation dose may exceed 20mSv as the planned evacuation area based on the criteriaof 20-100mSv that had been established by the ICPR in the event of an emergency whenevacuation is required (a reference level for public exposure in the event of an "radiation
emergency situation" in the recommendation issued in 2007). MEXT decided 20mSv/year, whichis the upper limit established by the ICPR for a situation after an accident has stabilized (areference level for public exposure in the event of an "exiting exposure situation" in therecommendation issued in 2007) as the criterion. Further, MEXT estimated that the contributionof the internal radiation dose to the whole radiation dose is 0 to 5.6% (2.2% on average). Because
this contribution was small, the Ministry decided not to take the effect of internal exposure into
consideration and to calculate the total exposure as external exposure. Assuming a student stays
indoors for 16 hours and outdoors (in schoolyard) for eight hours a day, an air radiation dose rateof 3.8μSv/h corresponds to 20mSv/year of exposure. Therefore MEXT decided to adopt this value
as a guide. Furthermore, the Ministry considered that "it is appropriate to decrease the dose ratethat students are exposed to as much as possible while adopting the criterion of 1 - 20mSv/year as
the reference level after an emergency situation has stabilized as a tentative guideline," and "evenif an air radiation dose rate exceeding 3.8μSv/hour is measured, the level that students are exposed
to can be limited to 20mSv/year by taking countermeasures to ensure activities are mainly doneindoors." Based on this consideration, MEXT established the "Provisional view regarding the
judgment of the use of schoolyards and educational facilities in Fukushima Prefecture" indicating
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that: (1) activities in the schoolyard should be restricted to approximately one hour a day when an
air radiation dose rate exceeding 3.8μSv/h is detected in the schoolyard, and (2) the schoolyard
can be used as usual when an air radiation dose rate below 3.8μSv/h is detected. MEXT submitted
this provisional view to the NSC via the NERHQ and asked for its advice on April 19. This view
meant that no upper limit was established on the air radiation dose rate for schoolyards that can beused as per (1) above, and the schoolyard can be used without any limitation when the airradiation dose rate is less than 3.8μSv/h as per (2).
Considering that it is required to reduce the radiation dose of students as much as possible, the
NSC Japan admitted in its response to the request from MEXT that the view of the NERHQ wasto minimize the radiation doses of students, on condition that: (1) the results of measurements
such as the consecutive monitoring should be reported to the Committee approximately once
every two weeks, and (2) approximately one pocket dosimeter should be distributed to eachschool and provided to a faculty staff member who represents the activity pattern of the students
to check the exposure condition.
On the same day, after receiving this response, MEXT notified Fukushima Prefecture of theabovementioned "Provisional view regarding the judgment of the use of schoolyards andeducational facilities in Fukushima Prefecture" with the condition indicated in the NSC 's advice.
On May 11, MEXT suggested two measures for the surface soil in the schoolyard, "tointensively gather and store underground" and the "upside-down replacement method," aseffective exposure reduction methods based on the result of the investigation conducted by JAEA.
On May 27, the Ministry decided to provide financial support to the owners of educational
facilities that implemented the exposure reduction method for the soil in their schoolyards inschools where air radiation dose rates exceeding 1μSv/h were detected.
On August 26, MEXT indicated the level that students would be exposed to should be
1mSv/year or less in schools after the summer vacation ended and the air radiation level rate of
1μSv/h or less as the guide to meeting the criterion. The Ministry also suggested that, although it
is not required to restrict outdoor activities even if the air radiation dose rate exceeded the guide, it
was preferable that measures such as decontamination were taken promptly, and it was important
to identify and decontaminate the area where high radiation doses were detected locally.
Additionally, after April 14, MEXT consecutively monitored the schoolyards of 52 schools
where relatively high air radiation dose rates (3.7μSv/h or higher) had been detected during themonitoring performed by Fukushima Prefecture from April 5 to 7. As a result, air radiation dose
rates of 3.8μSv/h or higher were detected in 13 facilities on April 14, however, an air radiationdose rates of 3.8μSv/h or higher was not detected in any school after May 12. The highest level on
August 25 was 0.8μSv/h.
b. Criteria for disaster waste disposal
An extremely large amount of disaster waste was produced by the earthquake and tsunami. The
Waste Management and Public Cleansing Act does not apply to waste that is contaminated withradioactive materials (Article 2 Clause 1 of the Act) and there is no other law that regulates thedisposal of disaster waste contaminated with radioactive materials. Therefore the Ministry of theEnvironment established the criteria for disposal in consultation with the Ministry of Health,Labour and Welfare and METI.
On May 2, the Ministry of the Environment decided in consultation with the related ministries
and agencies to conduct an investigation into the concentration of radioactive materials in thedisaster waste in the Hamadori and Nakadori regions of Fukushima Prefecture, then continued
further studies based on the results of this investigation and presented the "Disposal Guideline forDisaster Waste in Fukushima Prefecture" on June 23. In this guideline, the Ministry indicatedseveral criteria such as: the incinerated ash of the disaster waste may be disposed in landfill when
the concentration of radioactive cesium is 8,000Bq/kg or less; when the concentration is between
8,000Bq/kg and 100,000Bq/kg, preferably the ash should be stored temporarily until the safety ofdisposal is confirmed; and preferably the ash should be stored within a facility that is capable ofshielding radiation when the concentration exceeds 100,000Bq/kg.
Because radioactive materials of high concentration were detected in the incinerated ash of the85

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waste even in prefectures other than Fukushima, the Ministry of the Environment presented the"Present Guideline for Measurement and Handling of Incinerated Ash in General Waste
Incineration Facilities" as a standard for the handling of the incinerated ash according to thedisposal policy for the disaster waste in Fukushima Prefecture to 16 prefectures in the Tohoku,
Kanto and other districts on June 28.
On August 31, the Ministry of the Environment indicated a policy that permitted the disposal ofincinerated ash with a concentration of radioactive cesium in the range of 8,000Bq/kg to
100,000Bq/kg in landfill, which had been previously been considered preferable to be stored
temporarily until the safety of its disposal was confirmed, on condition that: (1) public water areas
and groundwater should be protected from contamination by radioactive cesium, and (2) the
landfill sites should be placed under long-term control including restrictions on the use of the site.
c. Sewage sludge
On April 30, a high concentration of radioactive cesium was detected in sewage sludge inFukushima Prefecture. After this was reported, inspections for radioactive materials in sewage
sludge were conducted in other prefectures and similarly high concentrations were detected.
There are two types of sewage treatment: (1) combined sewerage (which collects the sewage
and rainwater in the same sewage pipe for transfer to a sewage treatment plant), and (2) separate
sewerage (which collects the sewage and rainwater in separate pipes that transfer only the sewage
to a sewage treatment plant and let the rainwater flow into a river and/or the ocean). The highconcentrations were detected in the sludge in the sewage treatment plants of the combined
sewerage system. Therefore it is believed that the high concentrations of radioactive materials
were detected because of the dispersed radioactive materials which were carried by the rainwater
to the sewage treatment plants and concentrated there.
On May 12, the NERHQ presented "Concept of Provisional Handling of Sewage By-products
in Fukushima Prefecture" to indicate that the dehydrated sludge with a relatively highconcentration exceeding 100,000Bq/kg should be stored appropriately after volume reduction in
the prefecture whenever possible.
On June 16, at the request of other prefectures to indicate a criterion for the dehydrated sludge,
the NERHQ presented "Provisional View on By-products of Sewage Treatment and the like inwhich a High Concentration of Radioactive Materials is Detected" to indicate that: the sludge inwhich radioactive cesium over 100,000Bq/kg has been detected preferably should, where possible,
be stored in a facility that is capable of shielding radiation within the prefecture from where thesludge originated; sludge with radioactive cesium of 8,000Bq/kg or less may be disposed of in
landfill on certain conditions, such the landfill site not be used for residential purposes; and sludge
with radioactive cesium in the range of 8,000Bq/kg to 100,000Bq/kg may be disposed of in
landfill under certain control conditions.
d. Disposal site for sewage sludge and the like
The Nuclear Emergency Response Center and the Ministry of the Environment indicated thedisposal criteria for dehydrated sludge and incinerated ash containing radioactive materials.
However, their disposal and reuse have not progressed because of opposition from the inhabitants
around the disposal sites and rejection from the disposal operators, therefore some sewage
treatment plants and waste incineration facilities are still being forced to store the sewage sludge
and incinerated ash that has not been accepted.
(3) Contamination of seawater, pool water, etc.
a. Criteria for bathing areas
On June 7, the Ministry of the Environment began to deliberate on guideline regarding the useof bathing areas in response to the directive from Chief Cabinet Secretary Edano. On June 14, theMinistry held the Roundtable Conference for Radioactive Materials in Bathing Areas to hear fromexperts on radioactive materials. On June 24, on the basis of advice from the NSC Japan, theMinistry presented a guideline about radioactive materials in bathing areas that indicated: (1)radioactive cesium of 50Bq/liter or less and radioactive iodine of 30Bq/liter or less should be86

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considered as the provisional guideline for the summer of 2011; (2) managers of bathing areas
preferably should monitor the concentration of radioactive materials in the water and display the
result on a placard or some other means; (3) managers and users of bathing areas preferablyshould take measures to reduce the effective radiation dose; and (4) managers of bathing areas
preferably should monitor the air radiation dose rate at the beach and the like and caution users
displaying the result on a placard or some other means when an air radiation dose rate higher than
the surrounding area is detected.
b. Use of outdoor swimming pools in schools in Fukushima Prefecture
On June, MEXT decided not to indicate any guidelines for assessing the use of outdoor
swimming pools because radioactive iodine, cesium and other radioactive materials had not been
detected in the tap water of Fukushima Prefecture and it was thought students would only be
exposed to very low levels of radiation from the water in swimming pools. When using outdoor
swimming pools, the levels of radiation that students will be exposed to should be estimated bymonitoring the water in the pool.
[Governmental Interim Report] Chapter V 5

a. Schoolyards and the other educational facilities in Fukushima Prefecture
The circumstances that led the MEXT to present the “Provisional criteria regarding the
judgment of the use of schoolyards and educational facilities in Fukushima Prefecture”(hereinafter referred to as the “Provisional criteria”) on the use of school building and schoolyards
at schools in Fukushima Prefecture were as described in Chapter V 5. (2) a. of the Interim Report.
In the Provisional criteria presented on April 19, the concept was that if the air radiation dose
rate in schoolyards is 3.8 μSv/h or below, the radiation exposure would not exceed 20 mSv/year,
the upper limit of the reference level for public exposure in an “existing exposure situation”
established by the ICPR (see Chapter V 4. (1) b. of the Interim Report), assuming that if a student
stays outdoors (in the school yard with the air radiation dose rate of 3.8 μSv/h) for eight hours a
day and in wooden buildings (the air radiation dose rate of 3.8 μSv/h×0.4) for 16 hours a day, theannual exposure dose would be 20mSv. On May 12, the MEXT announced the results of thecalculations of the accumulated dose in a one-year period after the nuclear accident estimated on
the basis of life patterns of students. In the calculations, the behavioral patterns of students wereassumed by closer-to-reality values, and the air radiation dose rates used were those in concretebuildings where students actually spend school hours. All in all, the assumptions used in thecalculations were much closer to the reality than those that supported the Provisional criteria.
More specifically, the calculations were based on the following assumptions: (i) the
accumulated radiation dose between the nuclear accident and April 14 is 2.56 mSv, (ii) using theassumed air dose rate of 3.8 μSv/h in schoolyards as the reference level, the air dose rate in schoolbuildings is set at 0.1 times, the air dose rate outdoors outside school at 0.61 times, the air dose
rate in wooden houses at 0.244 times, (iii) in the life patterns of school days (200 days) between
April 15, 2011, and March 11, 2012, students spend one hour in commuting to school, two hours
in school yards, five hours in school buildings, three hours outdoors outside of school, and 13
hours in wooden houses, (iv) in the life patterns of holidays (131 days) between April 15, 2011,
and March 11, 2012, students spend eight hours outdoors and 16 hours in wooden houses, (v) the
average attenuation rate of the air dose rate between April 15, 2011, and March 11, 2012 is 0.705.
Based on the above assumptions, the cumulative radiation dose for students in a one-year period
after the nuclear accident was estimated at 9.99 mSv.
In the Provisional criteria, the MEXT explicitly stated that it adopted the criterion of 1-20mSv(the reference levels for public exposure established by the ICRP for an “existing exposure
situation” after an accident has stabilized in its 2007 recommendation (Pub.103)) as a “tentative
guideline.” However, MEXT Minister Yoshiaki Takagi (hereinafter referred to as “MEXT
Minister Takagi”) referred to matters not contained in the Provisional criteria several times in his
replies to interpellations in the Diet, saying that “with the severest value of 20mSv/year in thereference levels of 20-100mSv/year in the event of a radiation emergency situation as the starting87

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point and with the reference levels of 1-20mSv/year after an emergency has stabilized as atentative guideline, we have adopted the policy that is appropriate to decrease the exposure dose
as much as possible.” MEXT officials in charge of relevant matters prepared draft replies in lightof MEXT Minister Takagi’s way of thinking and intentions. The MEXT Minister and others
referred to “with the severest value of 20mSv/year in the reference levels of 20-100mSv/year as
the starting point” in an effort to mitigate anxieties among residents in Fukushima Prefecture as
much as possible.
(Omission)e. Handling of contaminated crushed stones
On December 28, the Fukushima Decontamination Team of Ministry of Environment(hereinafter referred to as the “Decontamination Team”) received a request from the Nihonmatsu
municipal government: “A junior high school student residing in Nihonmatsu City showed thecumulative radiation dose of 1.6mSv over a three-month period. When we looked into the matter,
the air dose rate in the condominium the student lives in was higher than the outdoor air dose rate.
We would like the Decontamination Team to investigate the cause of this.” Upon receiving therequest, the Decontamination Team, in cooperation with the Nihonmatsu municipal government,
checked on the condominium and also had interviews with officials of the constructor of thecondominium on January 5-6, 2012. As a result of its investigation, the Decontamination Teamconcluded that it is highly likely that the crushed stones shipped from a quarry in Namie Town
were contaminated and were used in constructing the condominium. On January 6, theDecontamination Team, through the Local NERHQ and others, communicated with the METI,
which has jurisdiction over civil engineering and building materials, to that effect.
Upon receiving the communication, the METI identified the quarry that shipped crushed stones
used in the building of the condominium (it is located in the deliberate evacuation area about
25km in a straight line distance from the Fukushima Dai-ichi NPS; hereinafter referred to as“Quarry A”), and found after the further investigations in cooperation with the Ministry of Land,
Infrastructure, Transport and Tourism (MLIT) and the relevant municipalities that: (i) Quarry A
was shipping out crushed stones between the nuclear accident and April 22, when the area inwhich it is located was designated as the deliberate evacuation area, (ii) the air dose rate within
Quarry A was high relative to the air dose rates in neighboring quarries; (iii) the air dose rate atanother construction site where crush stones shipped by Quarry A were used (an agricultural
waterway built by the constructor that constructed the condominium on the same day as the dateof commencement of construction work on the condominium) was higher than the air dose rate in
the surrounding areas, and (iv) no other construction sites that used crushed stones from quarries
other than Quarry A showed higher air dose rates than those in the surrounding areas.
Upon receiving the request for the establishment of criteria for radioactive materials in crushedstones, etc. around mid-January 2012, the METI considered the matter and, on March 22, 2012,
presented the “Shipment Criteria for Crushed Stones and Gravel” intended for the Coastal(Hama-dori) and Central (Naka-dori) regions in Fukushima Prefecture, which allows shipments ofthese products with the radioactive cesium concentration of no higher than 100Bq/kg (for crushedstones and gravel used in public works projects outdoors, the surface dose rate of no higher than
0.23 μSv/h).
In May 2011, before the distribution of contaminated crushed stones was discovered, theDirector-General of the Public Works Department of the Fukushima prefectural government asked
the Local NERHQ to present the criteria for radiation doses of materials used in public works
projects. The request was conveyed by the Local NERHQ to the Nuclear Sufferers Life Support
Team. The Team considered on how to reply to the request, but the official reply to the request is
yet to come. The shipment of contaminated crushed stones from Quarry A was made before thedesignation of the deliberate evacuation area on April 22, 2011, or before the request of the
Director-General of the Public Works Department came.
[Governmental Final Report] Chapter IV 5
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4.4.4 Resumption of schools
1. Debate shifts from whether schools should be resumed to whether use of school grounds
needs to be restricted
In late March 2011, spring vacation began for kindergartens, elementary schools, junior highschools, and special-needs schools, as well as for the nursery centers in Fukushima Prefecture.
Fukushima Prefecture deliberated whether or not the new term for schools and nursery centersshould commence in April as scheduled.
Following the accident, a decision was made at the Prime Minister’s Nuclear Emergency
Response Headquarters that MEXT would take charge of establishing the benchmark regarding
the school resumption issue. On April 6, 2011, MEXT submitted to NSC the air dose monitoring
results for the school grounds of elementary and other schools should be resumed. The same day,
MEXT again requested NSC’s advice on specifying the “areas where the air dose rate is not low.”
The next day, on April 7, NSC suggested that MEXT present its own benchmark for judgment,
and as reference, advised them that the exposure dose limit for the public was 1mSv/year. The
same day, despite the advice from NSC, MEXT again requested NSC for advice on whether
schools should be resumed. NSC’s response to MEXT was the same was as stated in its previous
response.
On April 9, MEXT shifted the topic of consideration from whether schools should be resumed
to the setting of a numerical benchmark for judging whether school buildings and grounds, etc.
could be used, assuming the schools would resumed. Based on the fact that the upper boundary
for the reference level on the dose that the general public would allow after the accident settles as
set forth in the 2007 recommendations of ICRP, MEXT proposed to NSC that the exposure dosebe set at 20mSv/year as an approximate benchmark. The same day, NSC responded that: (i) The
20mSv/ year benchmark, which is the upper boundary for the reference level in the ICRP 2007
recommendations, should be utilized on a limited basis; and (ii) Even if this value is adopted, thedoses for external and internal exposures combined should fall within the benchmark. NSC
advice was to the effect that, in order to set forth a maximum permissible limit for external
exposure only, the contribution of internal exposure should be estimated at around the same doseas external exposure, and therefore, a benchmark should be decided by roughly halving the upperboundary. Furthermore, at a press conference on April 13, NSC members stated that in view ofinternal exposure, an exposure dose of around 10mSv per year is acceptable.
Nevertheless, MEXT calculated that the contribution of internal exposure was negligible
enough to ignore. On this basis, through its exchanges with NSC, MEXT set on April 19 theprovisional exposure dose value for judging the use of school buildings and grounds, etc. at
1-20mSv/year, and by extension, stuck with the 20mSv/year value. In accordance with this,
MEXT decided to restrict the outdoor activities of children and students only at the schools whichhave school and kindergarten grounds with air dose measurements of more than 3.8μSv/h –equivalent to an exposure dose of 20mSv per year. Regarding schools with less than 3.8μSv/h,
MEXT and NSC concluded that it was acceptable to utilize school buildings and grounds, etc.
normally, and NERHQ made an announcement to this effect. MEXT issued a notification about
this to the Fukushima Prefectural Board of Education. As a result, limitations on the use of school
grounds and on outdoor activities were imposed on 13 schools with air doses exceeding 3.8μSv/h(as of April 19). These included restrictions of outdoor activities to less than one in Fukushima
Prefecture, and requested NSC’s advice on the safety of resuming schools and on whether the
resumption of such schools was advisable. On the same day, NSC responded: (i) Even if schools
in the Indoor Evacuation Area within the 20-30km radius zone of the Fukushima Daiichi Nuclear
Power Plant were to be resumed, it would be undesirable for children and students to play
outdoors; and (ii) For all other areas where the air dose rate was not low, due consideration
should be given to whether schools should be resumed. The same day, MEXT again requested
NSC’s advice on specifying
the “areas where the air dose rate is not low.” The next day, on April 7, NSC suggested that
MEXT present its own benchmark for judgment, and as reference, advised them that the exposure
dose limit for the public was 1mSv/year. The same day, despite the advice from NSC, MEXT
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again requested NSC for advice on whether schools should be resumed. NSC’s response to
MEXT was the same was as stated in its previous response.
On April 9, MEXT shifted the topic of consideration from whether schools should be resumed
to the setting of a numerical benchmark for judging whether school buildings and grounds, etc.
could be used, assuming the schools would resumed. Based on the fact that the upper boundary
for the reference level on the dose that the general public would allow after the accident settles as
set forth in the 2007 recommendations of ICRP, MEXT proposed to NSC that the exposure dosebe set at 20mSv/year as an approximate benchmark. The same day, NSC responded that: (i) The
20mSv/ year benchmark, which is the upper boundary for the reference level in the ICRP 2007
recommendations, should be utilized on a limited basis; and (ii) Even if this value is adopted, thedoses for external and internal exposures combined should fall within the benchmark. NSC
advice was to the effect that, in order to set forth a maximum permissible limit for external
exposure only, the contribution of internal exposure should be estimated at around the same doseas external exposure, and therefore, a benchmark should be decided by roughly halving the upperboundary. Furthermore, at a press conference on April 13, NSC members stated that in view ofinternal exposure, an exposure dose of around 10mSv per year is acceptable.
Nevertheless, MEXT calculated that the contribution of internal exposure was negligible
enough to ignore. On this basis, through its exchanges with NSC, MEXT set on April 19 theprovisional exposure dose value for judging the use of school buildings and grounds, etc. at
1-20mSv/year, and by extension, stuck with the 20mSv/year value. In accordance with this,
MEXT decided to restrict the outdoor activities of children and students only at the schools whichhave school and kindergarten grounds with air dose measurements of more than 3.8μSv/h –equivalent to an exposure dose of 20mSv per year. Regarding schools with less than 3.8μSv/h,
MEXT and NSC concluded that it was acceptable to utilize school buildings and grounds, etc.
normally, and NERHQ made an announcement to this effect. MEXT issued a notification about
this to the Fukushima Prefectural Board of Education. As a result, limitations on the use of school
grounds and on outdoor activities were imposed on 13 schools with air doses exceeding 3.8μSv/h(as of April 19). These included restrictions of outdoor activities to less than one hour per day,and also restrictions on the use of sand pits.
MEXT’s shift in the topic of consideration coincided with the beginning of the new term forthe schools and nursery centers in Fukushima Prefecture, generally April 6 and 7, 2011.
Furthermore, MEXT, in setting forth a benchmark for judging the use of school buildings andgrounds, confirmed, as of its exchanges with NSC on April 12, the number of schools and nursery
centers upon which the restrictions would be imposed. If an air dose of 3.8μSv per hour and half
this value of 1.9μSv/h were to be adopted as the benchmark for judgment, the number of schools
in Fukushima Prefecture to which the restrictions apply, was 43 and 414 schools, respectively (asof April 8).
MEXT shifted the topic of consideration and fixated on 20mSv per year to confirm the statusquo and to implement minimum restrictions on outdoor activities. Doubts remain about the extent
to which MEXT considered the health and safety of children.
2. Meaning of the benchmark
The 3.8μSv per hour air dose, which MEXT set forth as the benchmark on the basis of which
to impose restrictions on the use of school grounds, was calculated by taking the ICRP 2007
recommendations’ upper boundary of the reference level (1-20mSv per year) on the dose that thegeneral public should receive after an emergency settles. However, this value was equivalent to
the 20mSv per year dose assumed in the government’s establishment of the Deliberate
Evacuation Area at around the same time on April 22. Consequently, the Japanese public strongly
protested that 3.8μSv per hour was too high, on the grounds that the benchmark for ensuring thesafety of children was set at the same dose level as for areas requiring evacuation.
Incidentally, in Ukraine five years after the Chernobyl nuclear accident, residents wereforbidden to live in areas that had a projected dose of more than 5.0mSv per year. MEXT’s dosebenchmark for imposing school ground use restrictions was even higher than the dose benchmarkthat was applied in Ukraine.
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3. Exposure reduction measures
After MEXT notified Fukushima Prefecture of the benchmark for judging the use of schoolbuildings and grounds, etc., the Japan Federation of Bar Associations and the Japan Medical
Association issued statements urging that the restrictions on the use of school grounds be dealt
with carefully. In addition, MEXT Minister Yoshiaki Takaki received a request dated May 23
from 70 parents and guardians in Fukushima Prefecture asking the government to retract the
20mSv/year benchmark for the use of school grounds.
In response, on May 27, MEXT issued a notification to Fukushima Prefecture, entitled,“Near-Term Measures for Reducing the Dose Affecting Children and Students, Etc. Receive at
Schools and Other Facilities in Fukushima Prefecture.” While maintaining the aforementioned
benchmark of 1-20mSv per year, MEXT aimed to keep the dose that children and students, etc.
receive at schools in FY2011 to 1mSv/ year in the near term. Furthermore, MEXT decided to
distribute dosimeters to all schools and nursery centers in Fukushima Prefecture as well as offer
financial support for schools at which the air dose rate of the school grounds and other areas
measured more than 1μSv/h, in order to help cover the costs of decontamination.
Until then, MEXT’s only exposure reduction measure for Fukushima Prefecture was to haveschool personnel wear dosimeters to confirm the status of exposure. For schools with air dose
measurements under 3.8μSv/h, MEXT had no rational and viable exposure reduction measures inplace, such as restrictions on the use of school grounds and postponement of school start dates.
Assuming that radiation exposure should be kept as low as is rationally feasible in line with theviews of ICRP, we believe that MEXT’s position to not consider any exposure reduction
measures for schools with air doses not exceeding the benchmark was problematic.
[National Diet Report] Chapter 4, 4.4.4

Section 3 Environmental Restoration and Waste Management
Protection of children
Concern regarding the effects of radiation on children has become a particularly significant
issue. According to the ICRP, on 19 April, MEXT issued provisional criteria on the use of schoolbuildings and schoolyards at schools in Fukushima Prefecture to restrict the outdoor activities ofchildren and students to less than one hour per day only at the schools that have air dose
measurements of more than 3.8μSv/h. According to the measurement results obtained by MEXT
on 14 April, 52 kindergardens and 13 primary or junior high schools fell under this restriction.
In the notification on 26 August, MEXT indicated the level that students would be exposed toshould be 1mSv/year or less in schools and the ambient dose rate of 1μSv/h or less as the guide tomeeting the criterion, referring to the reference levels (1 to 20 mSv/y) after the emergency
situation given by the ICRP recommendation.
[Nongovernmental Report] Part 1 Chapter 2 Section 3

The following isssues can be raised in association with criteria for contamination ofsoils (schoolyards and educational facilities, and bathing areas, utilization of crushedstones, and disposal of disaster waste and sewage sludge).

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Japan Health Physics SocietyRadiological protection criteria – criteria for contamination of soil (schoolyards
and educational facilities, and bathing areas, utilization of crushed stones, anddisposal of disaster waste and sewage sludge) – consistency of concepts forderivation of criteria
 It has become difficult to explain the consistency among all the criteria sinceeach criterion was determined using a different concept.
 The value of 3.8μSv/h for ambient dose rate, which was announced by MEXT in"Provisional view regarding the judgment of the use of schoolyards andeducational facilities in Fukushima Prefecture" was derived using 20mSv/y,which is the upper limit in the band of reference level established by theInternational Commission on Radiological Protection (ICRP) for an existing
exposure situation. Subsequently, MEXT decided to aim to reduce the level ofcontamination to 1mSv/y.
 The provisional criterion for bathing areas announced by the Ministry of theEnvironment (MOE) was derived such that the individual dose due to external
and internal exposure would be within 10% of 1mSv/y.
 The concept of the reference level established by the ICRP for an existing
exposure situation was not applied to the criteria of utilization of crushed stones
and disposal of disaster waste and sewage sludge. These criteria were derived
from “Near-term policy to ensure the safety for treating and disposing ofcontaminated waste around the site of Fukushima Dai-ichi Nuclear Power Stationof Tokyo Electric Power Company” (control not to exceed 1mSv/y for residents
and workers and 10μSv/y for the public in the case of recycling exposure
scenario) announced by the NSC on 3 June 2011.

 Criteria for food and beverages
Descriptions about criteria for food and beverages are given in [Governmental
Interim Report], [Governmental Final Report], [National Diet Report] and[Nongovenmental Report] in the following way. Estimation results of dose due tointake of food and beverages are described in [MHLW HP (30 Oct. 2011)] and[MHLW HP (11 Mar. 2013)].
c. Provisional regulation value for food and beverages
The MHLW, which is in charge of the Food Sanitation Act, had never examined the adequacyof existing criteria for strategies on what to do with food and beverages distributed within Japan
if they were contaminated with radioactive materials.
On March 15, as described above, a high concentration of radioactive materials was detected
in weeds that had been collected in Fukushima Prefecture. The MHLW staff in charge of thismatter thought some action should be taken with regard to the radioactive contamination of food.
They determined, however, that any action should be consistent with the Act on Special Measures
Concerning Nuclear Emergency Preparedness. In other words, they did not imagine that any
action could be taken on the basis of the Food Sanitation Act. Meanwhile, MAFF was worried
that agricultural products might be seriously impacted by rumors. Hence, they determined that in
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Japan Health Physics Societyorder to prevent agricultural products from being negatively affected by rumors, it was necessary
to develop general criteria for deciding whether or not any food in question should be allowed tobe distributed within disaster-affected regions as well as to non-affected regions. On March 16,
MAFF strongly urged the MHLW to implement criteria for food exposed to radioactive materials
in accordance with the Food Sanitation Act. In addition to this urgent request from MAFF, the
MHLW itself determined that it was necessary to examine food distributed in a wide range ofareas on the basis of the Food Sanitation Act and decided to examine the adequacy of criteria forradioactive material as prescribed in the Act. Finally, the MHLW decided that the index for
restrictions on the intake of food and beverages, which the NSC had implemented based on thesimulation of a nuclear accident within Japan, should be adopted in order to take swift andappropriate action and solve the current emergency situation. The MHLW decided to adopt theIndex as the provisional regulation value for food and beverages in accordance with the Food
Sanitation Act. The MHLW naturally took into consideration the significant potential effects ofradioactive iodine on childhood thyroid cancer and adopted the Codex Index (100Bq/kg as thecriterion for all food and beverages in terms of radioactive iodine). The MHLW also decided thatmilk and dairy products exceeding the criterion of 100Bq/kg should not be used for modified drymilk for infant or for milk to be directly consumed. Additionally, on March 17, the MHLW issued
a notice to all prefectural governments to the effect that the index value indicated by the NSC
should be adopted as a temporary provisional regulation value (hereinafter referred to as"provisional regulation values") and that any food or beverages exceeding this criteria should not
be provided for human consumption pursuant to Paragraph 2 of Article 6 of the Food Sanitation
Act.
In terms of the Basic Food Safety Act, the MHLW did not have to ask the Food Safety
Commission for advice (hereinafter referred to as "Advice") on the effects of the implemented
provisional regulation values on food security and health. However, the MHLW decided that it
was proper to ask for arbitrary advice in accordance with Paragraph 3 of Article 24 of the same
Act. On the other hand, Article 11 of the Act stipulates that in a situation where the MHLW must
ask the Food Safety Commission for advice, the MHLW does not have to comply in the event ofan exceptionally urgent case. The MHLW implemented the provisional regulation values after
deciding that they had to take urgent action on food and beverages contaminated with radioactive
materials.
Additionally, on March 20, the MHLW minister asked the Food Safety Commission foradvice on the index value (provisional regulation value) for radioactive material in food andbeverages. On October 27 of the same year, the Food Safety Commission issued a noticeaddressed to the MHLW minister on the effects of the implemented provisional regulation value
on food security and health in which no evaluation results per radionuclide were provided.
d. Provisional regulation value for seafood
On April 4 of the same year, 4,080Bq/kg of iodine 131 was detected in young sand eels thatwere caught off the coast of Ibaraki Prefecture on April 1. Detailed data was sent to the MHLW.
As described above, the NSC Indices for restricting the intake of food and beverages containno criteria for the restriction of seafood contaminated with radioactive iodine nor do theprovisional regulation values based on the Indices for restricting the intake of food and beverages.
Hence, the MHLW decided that it was necessary to implement temporary regulation values forseafood in terms of radioactive iodine and thus began an urgent discussion with the NSC. As aresult of the discussion, the MHLW decided to adopt 2,000Bq/kg as a criterion value for seafoodin terms of radioactive iodine, with the understanding that a criterion value of 300Bq/kg for
drinking water, milk and dairy products, and a criterion value of 2,000Bq/kg for vegetables interms of radioactive iodine were already implemented as regulation values and could be used as
references, and because both seafood and vegetables were classified as solid food. On April 5, on
the basis of the advice of the NSC, the MHLW issued a notice to all local governments to theeffect that provisional regulation values for seafood in terms of radioactive iodine should be
2,000Bq/kg and that any seafood exceeding this criterion should not be provided for humanconsumption pursuant to Paragraph 2 of Article 6 of the Food Sanitation Act.
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Japan Health Physics Societye. Provisional regulation values for tea
Tea was classified as "other" in the Index for restricting the intake of food and beverages. The
provisional regulation value for tea was 500Bq/kg. On May 11 of the same year, radioactive
cesium exceeding the provisional regulation value of 500Bq/kg was detected in green tea leaves
produced in Kanagawa Prefecture. In response to this, the MHLW asked fourteen local
governments to perform more intensive monitoring of green tea leaves. Additionally, on May 13,
radioactive cesium exceeding the provisional regulation value was detected in unrefined (dried)
tea leaves produced in Kanagawa Prefecture. In response to this, on May 16, the MHLW asked
fourteen local governments to perform monitoring of unrefined tea leaves to restrict the
distribution of unrefined tea leaves that exceeded the provisional regulation value (500Bq/kg).
Because unrefined tea leaves were monitored with the same criteria as green leaves, there wasa consensus among the relevant local governments and within the national government thatmonitoring unrefined tea leaves according to the same criteria as green leaves did not fit reality
based on the following reasoning: unrefined tea leaves may have a concentration of radioactive
cesium five times greater than that of green leaves because they are dry-processed; and tea, which
is nearly always for drinking, is prepared by steeping tea leaves in hot water reducing
concentration levels. However, on June 2 of the same year, the MHLW issued a notice to theeffect that the same temporary regulation value should be applied to all types of tea leaves
including unrefined tea leaves on a regular basis. Relevant industry groups, worried that tea
products might be negatively affected by rumors, strongly recommended the monitoring of tea
leaves. Ultimately, all local governments decided to perform monitoring of unrefined tea leaves.
[Governmental Interim Report] Chapter V 5

j. New regulation values for foodAs described in Chapter V 5. (1) c. of the Interim Report, the MHLW set the provisional
regulation values for radioactive materials in food on March 17, after the occurrence of the nuclear
accident, and on March 20, asked the Food Safety Commission for recommendations on regulation
values (index values) of radioactive materials (request for the Assessment of the Effect of Food on
Health), receiving the notification of the results of the assessment on October 27. The MHLW
decided to consider new regulation values with the basic concept of lowering the maximum
permissible dose to 1mSv a year, while paying heed to the assessment of the effect of food on
health. On October 28, the MHLW asked the Pharmaceutical and Food Sanitation Council for its
recommendations on standards and criteria concerning radioactive materials in food, based on
Article 11, Paragraph 1 of the Food Sanitation Act.
On December 22, the Radioactive Material Measures Working Group of the Food Sanitation
Subcommittee of the Council judged that the lowering of the regulation value (the intervention
dose level) to 1 mSv per year is appropriate, and recommended that given that new standard limits
replacing the provisional regulation value are designed to the long-term situation going forward in
the wake of the accident at the Fukushima Dai-ichi NPS, only radionuclides for which thelong-term effects need to be considered (radionuclides with long half-lives) should be subjected to
the regulations. The Working Group then presented a draft for new standard limits, changing theclassification of foods from the five categories for the provisional regulation values to the four
categories of “drinking water,” “infant foods,” “milk” and “general foods” for the new standard
limits.
Subsequently, on January 17, 2012, the MHLW once again asked the Food Safety Commission
for its opinions about the establishment of standards and criteria for radioactive materials in food.
On January 19, the Food Safety Commission told the MHLW that another Assessment of theEffect of Food on Health is unnecessary, saying that “the Commission notified the results of theAssessment in the Cabinet Order No. 862 dated October 27, and since then, no new scientificknowledge has been confirmed. Therefore, the Commission recognizes that this is the case where
the substance and degree of adverse effects on human health are clear, as defined in Article 11,
Paragraph 1, Item 2 of the Food Safety Basic Act (Act No. 48, 2003)”.
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On December 27, 2011, the MHLW asked the Radiation Council for its opinions on the
proposals of revisions of the “Ministerial Ordinance on Milk and Milk Products concerning
Compositional Standards, etc.” (Ministry of Health and Welfare Ordinance No. 52, 1951) and“Specifications and Standards for Foods, Food Additives, etc.” (Ministry of Health and Welfare
Notification, No. 370, 1959), prepared on the basis of the aforementioned draft standard limits
presented by the Radioactive Material Countermeasures Working Group of the Food Sanitation
Subcommittee of the Pharmaceutical Affairs and Food Sanitation Council on December 22.
Following the Radiation Council’s recommendations, the MHLW revised the ministerial ordinanceand notification concerned on March 15, 2012, and the revised ministerial ordinance andnotification was put into force on April 1. Provisional regulation values in the past and new
standard limits are shown in Table IV-2.
Table IV-2 Comparison of standard limits on radioactive cesium in foods
Provisional regulation values
Food category
Regulation
value
Drinking water
Milk, dairy products
Vegetables
GrainsMeat, eggs, fish, etc.

200
200
500
500
500

New standard limits
Food category
Standard
limit
Drinking water
10
Infant foods
50
Milk
50
General foods
100
Drinking water
10
Unit：Bq/kg[Governmental Final Report] Chapter IV 5

e. New food product regulations based on 1 mSv per year
With regard to the provisional regulations, a health impact assessment by the Food Safety
Commission pointed out the need to individually respond to persons highly susceptible toradiation due to genetic predispositions.
On March 29, 2011, the Food Safety Commission released a report entitled, “Emergency
information regarding radioactive substances.” The report presented the basic stance thatradioactive substances in food products should be limited as much as possible, and that, inparticular, pregnant women, women who are potentially pregnant, infants, and children should
pay special attention to what they eat. The report paid further consideration to iodine and cesium
but indicated that not enough information was available at the time. And it pointed to the need tocontinue food impact assessments, and the need to gather information on strontium.
On October 27, the Food Safety Commission compiled and submitted to MHLW a foodhealth impact assessment which said that the radiation has an impact on health if the accumulated
dose over the span of an individual’s life is approximately 100 mSv or more, that children are
more susceptible to radiation than adults, and that it is difficult to comment on the health impact
of radiation when it amounts to 100 mSv or less. In response, MHLW worked to set new
standards based on the Food Sanitation Act and applied those new standards from April 1, 2012.
The new standard is set at 1 mSv/y and basically reflects the ICRP’s public upper dose limit
during normal times. However, the new standards are similar to the provisional regulations in thatthey were drafted only in consideration of the possibility of internal exposure through food.
[National Diet Report] Chapter 4, 4.4.3

Setting provisional regulations
Shipping restrictions for food and beverages were firstly judged on the basis of provisional
regulations (refered to as provisional standards by TV news). The background of setting the95

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provisional regulations is described below.
The legal foundation for setting measures such as shipping restrictions for food is the Food
Sanitation Act. Article 1 of this law is as follows: the objective of this law is to protect citizen
health by implementing regulations or other measures required from the viewpoint of publichealth for the purpose of ensuring the safety of food. However, before the present accident, thecriteria to implement measures, such as regulations, was not prepared for radioactive
contamination such as in this accident. For this reason, the indices for restricting the intake offood and beverages given by the Nuclear Safety Commission (NSC) were used as provisional
regulation values. The provisional regulation values of radioactive iodine and cesium are shown
below.

The NSC gives indices for restricting the intake of food and beverages in the emergency
preparedness guideline. These indices are an intervention level for use in an emergency and are
not concentration criteria that show whether radioactive materials in food and beverages affectpublic health or not. On the basis of concepts of the International Commission of RadiologicalProtection (ICRP) and IAEA, as a foundation for setting protective measures, these indices were
established using a 5 mSv/y effective dose (50 mSv/y in the case of a thyroid equivalent doseowing to radioactive iodine) as an avertable dose, taking into consideration the actual conditionsof Japanese dietary life.
Protective measures such as shipping restrictions were actually conducted on the basis ofthese indices, but such indices had not been incorporated in the Food Sanitation Act, which is thefoundation of the shipping restrictions. For this reason, the expression “provisional regulation
values in the Food Sanitation Act” was used. To incorporate these indices, it is necessary to revise
the Food Sanitation Act. However, as of the end of January 2012, the provisional regulation
values had still been used continuously.
[Nongovernmental Report] Part 1 Chapter 2 Section 2

Estimation of internal exposure due to intake of foodRadioactive Material Countermeasures Working Group Food Sanitation Subcommittee
Pharmaceutical Affairs and Food Sanitation Council (Dose assessment, etc.)[Objective]
To help examine the risk management concept for food in the near future after the accident at
Fukushima Daiichi NPS, the amounts of radioactive materials in Japanese daily diet and thecommitted effective dose (hereinafter “dose”) are estimated below.
[Method]
1. Group for estimation
In the case of deterministic dose assessment, “whole population”, “pregnant women”,“infants”, “embryos and fetuses”, and “nursing infants” were selected as groups for theestimation. In the case of probabilistic dose assessment, “below 6 years of age”, “7 to 12 years ofage”, “13 to 18 years of age”, and “whole population” were targets of the estimation.
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2. Radioactivity concentration in food used in estimation
Data (hereinafter “monitoring data”) consolidated and published by the MHLW in the period
between the occurrence of the accident and 31 August 2011 was used as the radioactivity
concentration in food. Monitoring data below the detection limit was treated as 10 Bq/kg for
Cs-134 and Cs-137. In the case of no monitoring data, 0 Bq/kg was assumed. The monitoringdata of (1) food beyond provisional regulation values and (2) sea products of Fukushima
prefecture were removed from the estimation because such foods had never been shipped.
3. Amount of food intake of Japanese people used in estimation
Amount of food intake was determined referring to the “Special Totaling Work Report oninvestigation of frequency and amount of food intake” published by the National Institute of
Health and Nutrition as an investigation result entrusted by the Standard Review Section,
Department of Food Safety, Pharmaceutical and Food Safety Bureau of the MHLW. Small
categories in this report were used as a categoraization of food for estimating the amount of
intake. Distribution of the amount of intake was determined refering to two results analyzed byMrs. Rieko Matsuda, Food Director (National Institute of Health Sciences), using the Results of
the National Health and Nutrition Survey and by Mr. Yoshitaka Godai, Researcher(Environmental Dynamics Study Division, the Institute for Environmental Sciences), using theamount of food intake of infants in Aomori prefecture.
4. Method of estimation of internal exposure owing to intake of radioactive materials in food
The following two methods were adopted for estimating internal exposure
4.1 Method of determistic dose assessment of internal exposure
A method to estimate the internal exposure per one month assuming that a person in a group
continues to eat an average amount of food with a specific radioactivity concentration wasapplied to a deterministic dose assessment. In this trial calculation, the median value of theradioactivity concentration in food was used for the dose assessment in every category. Also,
this may be with less possibility, the 90 percentile value of radioactivity concentration was usedin the estimation conservatively assuming that a person in the group continues to eat highly
contaminated food*.
* The median value, not the arithmetic mean value was used as the representative dose,
because the radioactivity concentration in food did not show a normal distribution. This
indicates that the dose of 50th person of 100 people sorted in dose order is the medianvalue. A 90th percentile value means that 10% of these people have higher doses. It would
be difficult to continue to eat food equivalent to the 90th percentile value in each category,
which means it is a fairly conservative estimation.
4.2 Method of probabilistic dose assessment of internal exposure*
A method to estimate the median and 90 percentile of dose distribution obtained by
calculating the virtual dose distribution for 1000 people and by multiplying a randomly selectedradioactivity concentration from actual measurement results with a randomly selected amount of
intake from the Japanese distribution was applied to a probabilistic dose assessment.
* Internal exposure is determined by multipying mass (amount of intake) of food intake byradioactivity concentration of the food. However, there is an individual difference in theamount of food intake and radioactivity also differs in each food. The probabilistic method
is a way to estimate dose considering individual differences.
In the case of the probabilistic method, individually different values are expressed by using
random numbers. (Dose distribution is estimated virtually determined as a variable using random
numbers, assuming distribution of the variable, and using a model to determine the individuallydifferent value.)
5. Preassumption used in the other estimation
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5.1 Dose conversion factor
Conversion factors to dose (mSv/month or mSv/year) shown in “Guideline for environmental
monitoring (March 2008)” given by the Nuclear Safety Commission were used in the estimation.
The conversion factor for I-131 was used for radioactive iodine and those for Cs-134 and Cs-137
were used for radioactive cesium. Dose conversion factors given in ICRP Pub.88 and Pub.95
were used for embryo and fetus, and nursing infant.
5.2 Estimation period
Internal exposure was estimated for two cases every month using monitoring data obtained in
March, April, May, June, July and August, for one year. Monitoring data after September wereassumed to be the same as data for August. The intakes for pregnant woman, and embryo andfetus were assumed for nine months.
5.3 Target radioactive nuclides
Intaken radioactive materials were calculated for I-131, Cs-134 and Cs-137, regarding I-131
as radioactive iodine and the summation of Cs-134 and Cs-137 as radioactive cesium.
Radioactive iodine in the food category was assumed to decay according to its physical half life.
Physical decay was not considered in the estimation for radioactive cesium.
5.4 Treatment for special foodProcessed food with available measurement data was used. It is assumed for tea in theprocessed foods that 10g of tea leaf is used to make 300ml of green tea and 60% of radioactive
cesium in tea leaf is transfered into green tea.
[Results]
1. Deterministic dose estimation (national average is used for amount of intake)(1) Dose estimation using actual measurement results in 6 months (March to August 2011)
A. Continuous intake of food with median value of radioactive concentration

B. Continuous intake of food with 90 percentile value of radioactive concentration*

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Japan Health Physics Society* The situation of a continuous intake of food with 90 percentile radioactivity concentration
leads to a conservative estimation, which is difficult to occur in normal life.
(Note for both A and B)* Infant: 1 to 6 years of age.
* The dose for pregnant woman is small because the amount of intake for pregnant woman
is smaller than that of the general population group.
* The annual dose estimation for pregnant woman, and embryo and fetus shows a total fora pregnancy period of 9 months.
2. Probabilistic dose estimation
Below 6 years of age

7-12 years of age

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13-18 years of age

Whole population[Discussion and issues]
1. Doses due to intake of food under the situation controlled by provisional regulation
values were estimated to be lower than the naturally received dose* owing to the intake ofan average amount of food.
* The annual committed effective dose (Japanese average) owing to the intake of naturalradioactive materials (radioactive potassium, etc.) is about 0.4 mSv. In addition, theannual committed effective dose owing to the intake of natural radioactive materials(polonium 210) has a variation of 0.2 mSv to 0.8 mSv. Taking into consideration sucha variation, the additional dose owing to the intake of food after the Fukushima
Daiichi accident would not be so high.
2. There may be a possibility that this result leads to an underestimation for individuals who
eat only food including a high level of radioactivity. To clarify the actual situation, a total
diet study* in response to the objectives must be effective.
* A method to estimate the intake amount of specific chemical materials in a normal
daily diet.
* Investigation of intake and radioactive contamination of food will be started after thethird revised budget is confirmed.
3. The validity and meaning of this result should be verified and analyzed in comparison
with other investigations of internal exposure and total diet studies.
4. The contribution of nuclides other than target radioactive nuclides should be estimated byusing a scaling factor of radioactive cesium (ratio of nuclides other than radioactive
cesium).
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Japan Health Physics Society[MHLW HP (30 Oct. 2011)]

Estimation of amount of intake of radioactive materials in food within one day
1 Objective
To estimate the amount of intake of radioactive materials in food in a normal diet, focusing onfood that is located in one of exposure pathways to radioactive materials.
2 Method
2.1 Estimation of market bascket sample (MB sample)(1) Overview
Food was purchased in 12 regions (Hokkaido, Iwate, Fukushima (Hamadori, Nakadori, andAizu regions), Tochigi, Ibaragi, Saitama, Kanagawa, Niigata, Osaka, and Kochi prefectures) in
February and March 2012. Fresh food was bought from local or neighborhood products whenpossible. On the basis of the intake average according to the food and the area in the national
health and nutrition examination survey, one days intake of radioactive materials (Bq/man/day) ina normal diet was calculated by measuring the mass of food, separated into 13 categories of foodas it is or after cooking, making MB samples by mixing and unified them, and analyzing
radioactive cesium (Cs-134 and Cs-137) and radioactive potassium (K-40: natural nuclide) as
MB samples including drinking water. Moreover, the committed effective dose (mSv/year) was
calculated when a person continued to consume average meals for one year.
(2) Measurement method
MB samples in 2 liter marinelli containers were measured for 22 hours using a Ge
semiconductor detector. The detection limit was dependent on the samples, but was about 0.1
Bq/kg for Cs-134 and Cs-137. When the concentration in the sample was lower than the detection
limit, the amount of intake was calculated by making the concentration half of the detection limit.
When a background count rate was observed, the background value was subtracted from thecount rate of the sample. The concentration was corrected as of the day of the collection of foodafter taking into consideration the decay of radioactive cesium.
2.2 Estimation using samples from meals prepared(1) Overview
Meal sets for an absent person were collected from families in 9 regions (Hokkaido, Iwate,
Fukushima, Tochigi, Ibaragi, Saitama, Niigata, Oosaka, and Kouchi prefecture) from March to
May 2012. The meals for one whole day for three males and females in the six age categories[baby (below 1 year of age), infant (1 to 6 years of age), child (7 to 12 years of age), youth (13 to
18 years of age), adult (19 to 60 years of age), and senior (retires over 60 years of age)] and threepregnant women, that is for 39 persons as a total, were collected as the samples in each region. In
the case of Fukushima prefecture, three samples each were collected from the meals for one
person in Hamadori, Nakadori and Aizu regions. Analyzing radioactive cesium (Cs-134 andCs-137) and K-40 in these samples, the amount of one day’s intake of radioactive materials(Bq/man/day) and the committed effective dose (mSv/year) calculated when a person continued
to have an average meal for one year were obtained.
(2) Measurement method
Since the water content of the meal sample for an absent person is generally high, it wasmeasured using a Ge semiconductor detector after evaporating the water on a hot plate, reducing
the volume, and homogenizing the mixture, as appropriate. As the meal size depended on the age
category, a U8 container, 200ml container and 1 liter marinelli container were used according to
the sample size. The measurement time was limited to 24 hours. For this reason, the detection
limit varied with the sample and was 0.04 to 1.8 Bq/kg for Cs-134 and Cs-137, and 0.53 to 14
Bq/kg for K-40. The maximum detection limit (24 hour measurement using a U8 container) was
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found in the case of a baby’s breast feeding (20g in a whole day). When the concentration in thesample was lower than the detection limit, the amount of intake was calculated by making theconcentration half of the detection limit. When a background count rate was observed, thisbackground value was subtracted from the count rate of the sample. The concentration wascorrected as of the day of the collection of food after taking into consideration the decay ofradioactive cesium.
3. Overview of the results
3.1 Results for MB samples
Among all 168 samples, Cs-134, Cs-137 and K-40 were detected in 75, 88 and 147 samples,
respectively.
The amounts of one day’s intake of radioactive materials in food were estimated to be 0.17 to
1.7 Bq/man/day for Cs-134 and Cs-137, and 69 to 89 Bq/man/day for K-40. The committed
effective doses were estimated to be 0.0009 to 0.0094 mSv/year for Cs-134 and Cs-137, and 0.16
to 0.20 mSv/year for K-40, as shown in Table 1 and Figure 1. The committed effective doses forradioactive cesium were just lower than 1% of 1 mSv. The amounts of one day’s intake ofradioactive material estimated from samples made in three regions (Miyagi and Fukushima(Nakadori) prefectures, and Tokyo metropolitan area) from September to November 2011 were0.42 to 3.4 Bq/man/day for Cs-134 and Cs-137, and 77 to 91 Bq/man/day for K-40. The
committed effective doses were 0.0024 to 0.019 mSv/year for Cs-134 and Cs-137, and 0.18 to
0.21 mSv/year for K-40. Comparing these results, it was made clear that the amount of intake ofradioactive cesium significantly reduced, but the amount of K-40 did not reduce.
Table 1 Committed effective doses for radioactive cesium and potassium in MB samples.

* Committed effective dose coefficients (Sv/Bq) for adults given in
ICRP Publication 72 were used in the conversion of Bq to Sv.

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Figure 1 Committed effective doses for radioactive cesium in MB samples.
3.2 Results of samples of meal set for absent person
The committed effective dose estimated from the measurement results of radioactivity
concentrations in each region are shown in Table 2 and Figure 2. The average committed
effective dose was estimated to be 0.0012 to 0.0039 mSv/year for Cs-134 and Cs-137, and 0.17 to
0.21 mSv/year for K-40. The maximum value of regional average (Ibaragi prefecture) owing toradioactive cesium was merely 0.0039 mSv/year and below 1% of 1 mSv. The averagecommitted effective dose of each age category is shown in Table 3. The committed effective
doses for babies and infants were lower than those for youths.
The maximum committed effective dose in all the samples was 0.027 mSv/year (Fukushima
prefecture). The maximum 90 percentile value calculated in each region was 0.0091 mSv/year(Ibaragi prefecture). In this manner, if meals with relatively high radioactivity concentration arecontinued for one year, committed effective dose in one year would be one order of magnitude
lower than 1 mSv, although doses due to meals showed a variation in the same region.
Table 2 Committed effective dose of radioactive cesium and potassium estimated fromsamples of meal set for absent person* Committed effective dose coefficients (Sv/Bq) for adults given in
ICRP Publication 72 were used in conversion of Bq to Sv.

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Figure 2 Committed effective doses for radioactive cesium in samples of meal set for absent
personTable 3 Average committed effective dose for each age category estimated from samples ofmeal set for absent person

3.3 Comparison of results between MB samples and samples of meal set for absent person
The committed effective doses in one year for K-40 estimated from MB samples and samples
of meal set for absent person were similar values. On the other hand, the committed effective
doses for Cs-134 and Cs-137 in the MB samples were found to be higher than those for the
samples of meal set for absent person. One of the reasons may be that foodstuffs in the MB
samples were purchased within local or neighbor products, but those in the samples of meal set
for absent person were collected normally without restrictions.
[MHLW HP (11 Mar. 2013)]

The following isssues can be raised in association with criteria for food andbeverages.
Radiological protection criteria – criteria for food and beverages –comprehensiveness of food categories
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Japan Health Physics Society Since in the provisional regulatory values (by 31 March 2012) for radioactive
materials contained in foods, the restriction values for radioactive iodine infish and foods not to consumed directly, e.g., tea leaves, were not specified,much confusion occurred.
Radiological protection criteria – criteria for food and beverages – universal use
for various types of accident
 Since the new regulatory value for food and beverages enforced on 1 April
2012 was derived for only radioactive cesium on the basis of 1mSy/y as aninternal exposure dose and can be applied to the current situation after thepresent accident, it cannot be universally used as a criterion for emergency
preparedness where various types of accident should be considerd.
Radiological protection criteria – criteria for food and beverages – approach todose criteria
 In the derivation of the new regulatory value for food and beverages enforcedon 1 April 2012, 1mSv was adopted as a dose criterion, strictly shifting from
5mSv; nevertheless, the estimated dose due to intake of contaminated foods
was sufficiently low and was determined without full discussion withstakeholders associated with the production, distribution, and consumption offoods.

 Protective criteria for temporary entry into restricted zones
Descriptions about protective criteria for temporary entry into restricted zones are
given in [Governmental Interim Report] in the following way.
g. Establishment of restricted areas and temporary access to the restricted areas
Following an evacuation order issued at 18:25 on March 12, residents in regions within a
20km radius were evacuated to areas outside the designated regions. During their ongoing andprolonged life as evacuees, some of the residents started to return home to the evacuation zones
to collect their belongings. The Nuclear Emergency Response Local Headquarters (Local
NERHQ) submitted a report on this situation the Government Emergency Response Headquarters(NERHQ). Around and after March 24, the NERHQ started discussions on how to deal with thissituation and enthusiastically work on this matter corresponding to, Chief Cabinet Secretary
Edano’s directive issued on March 28.
On March 28, as a measure to prohibit residents from entering the evacuation zones, theLocal NERHQ provided all the cities, towns and villages concerned with a notification of"Prohibition of access to evacuation zones within a 20km radius”. On March 30, the Prefectural
Headquarters also notified all evacuation centers and other facilities of this measure.
Based on discussions about temporary access to the restricted areas and mutual consultation
with the relevant heads of cities, towns and villages, the NERHQ had already asked the NSC for
its advice on the implementation of restricted areas within a 20km radius of the Fukushima
Dai-ichi NPS, and the NSC replied that it had no objection to the NERHQ' ideas. At 11:00 on
April 21, the NERHQ issued a directive to the heads of all the cities, towns and villages
concerned that restricted areas should be established within the specified radius.
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Additionally, temporary access to an established restricted area within a 20km radius of the
Fukushima Dai-ichi NPS was permitted only to those individuals who were exposed to airradiation dose rate lower than 200μSv/h and were planning to stay in the area for five hours. Thisvalue of 200μSv/h was obtained by assuming five hours consisting of a three-hour round trip
from the boundary of the 20km radius to the furthest access area and two hours spent at home orother access points, and by dividing 1mSv of annual permissible radiation dose, advised by the
NSC, by 5.
The steps for applying for temporary access to an established restricted area were as follows:
first, all applications for temporary access to an established restricted area were accepted at an
information booth established by the Fukushima prefectural government; lists of names were
sorted by cities, towns or villages and sent to the respective municipalities; those lists of names
were further sorted by regions and grouped into smaller districts; and then preferred dates werearranged. Additionally, it was decided that the staff of cities, towns or villages should attend to
those temporarily accessing the established restricted areas.
However, this work created a great burden for cities, towns and villages suffering from thenuclear accident and the tsunami. Thus a total of approximately 5,560 staff was dispatched fromMETI and other government offices to support the related work.
Initially, areas within a 3km radius of the Fukushima Dai-ichi NPS were excluded from thisinitiative to temporarily access restricted areas. The zones within a 3km radius of the Fukushima
Dai-ichi NPS were those to which were initially issued with evacuation orders. In a situation
where the impact of the nuclear accident had not been settled, it was necessary to take successive
measures against an unforeseen emergency.
Subsequently, the conditions of the nuclear reactors at the Fukushima Dai-ichi NPS stabilized.
In response to this, on August 9, NERHQ confirmed that it was safe to enter the areas within a
3km radius of the Fukushima Dai-ichi NPS and issued an announcement to that effect. Thus,
temporary access to those established restricted areas in Okuma-town and Futaba-town was
officially granted.
[Governmental Interim Report] Chapter V 3

The following isssues can be raised in association with protective criteria for
temporary entry into restricted zones.
Radiological protection criteria – protective criteria for temporary entry into
restricted zones – balance among other risks
 Irrespective of the ambient dose level in the residence, the maximum timespent at home during temporary entry was limited to 2 h, and the total time
taken for the round trip from the relay point to each home was limited to 5 h.

 Dose criteria for emergency work
Descriptions about dose criteria for emergency work are given in [Governmental
Interim Report], [Governmental Final Report], [National Diet Report] and[TEPCO Report] in the following way. Protective criteria for governmental officials
including the Self-Defense Forces and local government employee such as police
officer and fireman are described in [Governmental Interim Report].
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Japan Health Physics Society(2) Radiation dose limit for radiation workers in an emergency
a. Raising the exposure limit to 250mSv
TEPCO executives, who had been staying at the Prime Minister's Office since the accident at
the Fukushima Dai-ichi NPS, were informed by corporate headquarters that radiation levels at thesite were rising. The TEPCO executives recognized that it might be impossible to continue
operations to manage the nuclear accident if they insisted on the current legal exposure limit andasked the NSC and NISA for their advice. In response to this request, at the Prime Minister's
Office in the afternoon of March 14, it was decided that the exposure limit for emergency
operations should be increased from 100mSv to 250mSv. At that time, consideration was given to
the fact that ICRP Pub. 103 stipulates that the exposure limit for emergency workers should be
500mSv to 1,000mSv, 250mSv is half the lower limit, and the "Regulatory Guide for Reviewing
Nuclear Reactor Site Evaluation and Application Criteria" developed by the Japan Atomic Energy
Commission in 1964 describes that the exposure to be temporarily allowed based on therecommendations of the guide is 250mSv.
In response to this implementation, on the same day, the Ministry of Health, Labor andWelfare and METI worked together to prepare a ministry order and a notice to the effect thatfrom the date when a nuclear emergency is declared to the date when the nuclear emergency islifted in a zone where emergency countermeasures must be taken the exposure limit should, in
unavoidable circumstances, be 250mSv. Sometime after midnight the same day, they asked
MEXT Radiation Council for advice. The Council debate the proposed exposure limit by email
throughout the day until just before dawn the following day and replied that it was reasonable. In
response to this advice, the Ministry of Health, Labor and Welfare and METI formulated aministry order and a notice to that effect, dated April 14 and the ministry order and notice were
issued (published in an official gazette) on March 15.
b. Discussion on raising the exposure limit to 500mSv
On March 17, three days after raising the exposure limit for emergency workers from
100mSv to 250mSv, a discussion was held at the Prime Minister's Office to raise the exposure
limit even further to 500mSv. In response to this, the Ministry of Health, Labor and Welfare and
METI started to prepare a plan to that effect within the Ministries. However, there was ultimately
no instruction to that effect from the Prime Minister's Office.
c. Lowering the exposure limit to 100mSv
On August 30, the Ministry of Health, Labor and Welfare started discussing lowering theexposure limit for emergency operations back to 100mSv. The Ministry, under mutual
arrangement with TEPCO, METI, and other organizations, excluding staff who had already been
involved in this arrangement before the exposure limit was raised, started to implement a ministryorder63 where the phrase "in unavoidable circumstances" should be changed to “in unavoidable
circumstances and in circumstances the Minister of Health, Labor and Welfare deems
unavoidable" for the "ministry order on the special rules of Ordinance on the Prevention of
Ionizing Radiation Hazards to respond to the events resulted from the 2011 Tohoku District-off
the Coast of Pacific Ocean Earthquake", and asked the Council of Labor Policy for advice on
October 24. The Council replied that it was reasonable. The ministry order became effective as ofNovember 1.
(Omission)a. Radiation dose limit for government employees in emergency works
As per the description in Section (1) c above, Article 4, Paragraph 3 of the National Personnel
Authority Rules 10-5 prescribes that the dose limit for government employees in emergency
works shall be 100mSv, which is the same for general workers.
On the morning of March 16, a staff member of National Personnel Authority in charge of
National Personnel Authority Rules learned via a news report that both the MHLW and METI
had raised the radiation dose limit for workers engaged in emergency works. With regards to107

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national government employees employed in regular government service, it is likely that, forexample, Nuclear Safety Inspectors might be engaged in emergency works at a nuclear power
station. Hence, a staff member immediately asked MHLW to provide him with the relevant
documents. To discuss the matter, the staff member also phoned a Defense Ministry staff memberin charge of a "Ministry of Defense official directives concerning staff health care" that is quoted
from National Personnel Authority Rules 10-5. At approximately 18:00 on March 16, the same
staff member asked the MEXT Radiation Council advice on a ministry order revision that the
exposure limit should be 250mSv to respond to events resulting from the 2011 Tohoku
District-off the Pacific Ocean Earthquake from the date when the nuclear emergency is declared
to the date when the nuclear emergency is lifted, in a zone where emergency countermeasures
must be taken in unavoidable circumstances.. The Radiation Council had a debate on the
proposed dose limit by email from 18:30 to 19:30 that day. They reached a consensus and repliedthat it was reasonable. In response to this advice, the National Personnel Authority revised part of
the Nuclear Disaster Special Measures Law, Article 28 of the National Personnel Authority Rules
10-5, as follows: "In response to events resulting from the 2011 Tohoku District-off the Pacific
Ocean Earthquake from the date when the nuclear emergency is declared (pursuant to Paragraph
2 of Article 15 of the Nuclear Disaster Special Measures Law enacted in 1999, No. 156) to thedate when the nuclear emergency is lifted (pursuant to "Paragraph 4 of the Article, in a zone
where emergency countermeasures must be taken prescribed in Paragraph (8) of Article 17 of thesame Law), in unavoidable circumstances the exposure limit "100mSv" (prescribed in Item (3) of
the same Paragraph), concerning the application of the provision of Paragraph 3 of Article 4,should be replaced with the dose limit of 250mSv." This revision was published in a government
gazette the next day, March 17, and took effect that day.
Additionally, Nuclear Safety Inspectors who worked in the Fukushima Dai-ichi NPS safety
inspectors' office collecting information after the nuclear accident (refer to Section III2(7) above)were not directly engaged in emergency operations in reactor buildings.
Defense Ministry staff, including Self Defense Force personnel, is government employees for
special government service and they are not directly subject to National Personnel Authority
Rules. However, Paragraph 2 of Article 26 of "Ministry order on health care management of
Defense Ministry staff" stipulates that "the limit of effective dose equivalent for directees(workers under management) who are engaged in emergency works to prevent radiation hazards
shall comply with the rules of staff who are engaged in emergency works (Paragraph 3 of Article
4 of National Personnel Authority Rules 10-5. Hence, the limit for the effective dose equivalent
shall comply with the rules of National Personnel Authority Rules 10-5.
In response to the declaration of the nuclear emergency state on the night of March 11, at
19:30 on the same day the Self Defense Forces issued a "Self-Defense Force action commandconcerning the implementation of nuclear disaster dispatch service for nuclear emergency eventsat the TEPCO Fukushima Dai-ichi Nuclear Power Station and Fukushima Dai-ni Nuclear Power
Station." From March 17, Self-Defense Force personnel were engaged in flushing water out intoa spent fuel pool, but none of them received a radiation dose exceeding 100mSv, which was theprevious radiation dose limit prior to being changed.
b. Radiation dose limit for local government employees in emergency works
Provisions of the Industrial Safety and Health Act, rather than those of the National Personnel
Authority Rules, are applied to local government employees including police officers and firemen.
Hence, the radiation dose limit for local government employees in emergency operations wasraised to 250mSv on March 14.
A guideline on the radiation dose limit for police officers and firemen contained in the NE
Guideline prepared by the NSC in June, 1980, stipulates that "the upper limit of radiation dose,
especially for those who are engaged in emergency works in a nuclear accident site among thoseengaged in disaster prevention works (for example, staff other than radiation workers employedat the nuclear power station as well as experts dispatched from the national government, those
who are employed at police or fire stations. Self-Defense Force personnel, those who areemployed in urgent medical care service), shall be 100mSv in terms of effective dose for108

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emergency works in urgent and unavoidable circumstances to prevent a disaster from worsening
and to save lives. Additionally, the "Manual for firefighting activities at nuclear power facilities"
prepared by the Fire and Disaster Management Agency in March 2001 stipulates that the"radiation dose limit shall be 100mSv for emergency works to save lives. There were no changes
in them.
None of the mobile police officers and firemen engaged in flushing water out into a spent fuelpool was exposed to radiation doses exceeding 100mSv.
[Governmental Interim Report] Chapter V 4

b. Discussion on raising the exposure limit to 500mSv
On March 17, three days after raising the exposure limit for emergency workers from 100mSv
to 250mSv, Special Advisor Hosono, in light of the facts that the SDF was scheduled to begin
discharging water from its water cannon trucks into the spent nuclear fuel pool of Unit 3 of the
Fukushima Dai-ichi NPS from the same day and that on the previous day, on March 16, the SDF
gave up on the sprinkling of water from helicopters due to the high radiation dose level, thoughtthat it is necessary to raise the exposure dose limit further up to 500mSv in order to avoid
situations where the work at the nuclear power station cannot be done due to the exposure limit,
while paying heed to the recommendations of the International Commission on RadiologicalProtection (ICRP). Special Advisor Hosono first asked House of Representatives Member Akihisa
Nagashima (hereinafter referred to as “House of Representatives Member Nagashima”), former
Parliamentary Vice-Minister of Defense, to sound out the National Personnel Authority, theMinistry of Health, Labour and Welfare and the Ministry of Economy, Trade and Industry about apossible plan to raise the radiation exposure limit. When House of Representative Member
Nagashima approached National Personnel Authority President Takeshi Erikawa, Senior Vice
Minister of Health, Labour and Welfare Yoko Komiyama, and Senior Vice Minister of Economy,
Trade and Industry Motohisa Ikeda to sound them on a possible plan to raise the dose limit, they
did not express any particular opposition. So, Special Advisor Hosono proposed to Prime Minister
Kan that the dose limit should be raised again.
When Prime Minister Kan called relevant cabinet ministers, including Minister of Health,Labour and Welfare Ritsuo Hosokawa, METI Minister Banri Kaieda and Minister of Defense
Toshimi Kitazawa (hereinafter referred to as “Defense Minister Kitazawa”) and National Public
Safety Commission Chairman Kansei Nakano (hereinafter referred to as “National Public Safety
Commission Chairman Nakano”), to his office at around 18:30 on March 17 to hear their opinions
about the raising of the dose limit, Minister of Defense Kitazawa and National Public Safety
Commission Chairman Nakano voiced negative or cautious views about it. In the evening of thesame day, Minister of Defense Kitazawa again conveyed his opinion against it to Prime Minister
Kan. Under these circumstances, Prime Minister Kan decided against the raising of the exposure
dose limit.
[Governmental Final Report] Chapter V 3

1. The government increases the dose limit for nuclear power plant workers
In response to the accident, based on the opinions of the Radiation Council, MHLW set forth aministerial ordinance concerning special provisions in Article 7, paragraph 2 of the Rules forPrevention of Damage from Ionizing Radiation (hereafter, “Ionization Rules”) on March 14, 2011.
Similarly, METI, based on the opinions of the Radiation Council, released a notice on special
provisions pertaining to Article 9, paragraph 2 of the provisions of the Rules for Commercial
Nuclear Power Reactors concerning Installation, Operation, etc. (hereafter, “Commercial Reactor
Rules”). Consequently, the upper limit for the exposure dose received by workers performing
emergency operations at the Fukushima Daiichi Nuclear Power Plant was increased from 100mSv
to 250mSv. After March 16, the advisory team of the Cabinet Secretariat advised the Prime
Minister’s Office to further increase the upper limit to 500mSv for emergency operations.
Discussions on this only took place at the Prime Minister’s Office, however, and internal reviews
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On April 28, 2011, MHLW, in accordance with a request from METI, announced that should
radiation workers involved in emergency operations at Fukushima Daiichi Nuclear Power Plant
engage in radiation work other than emergency operations, their exposure dose would be in
violation of the Ionization Rules, only if it exceeds 50mSv per year—not in combination with theexposure dose from emergency operations at the nuclear power plant, but counting only the
exposure dose from non-emergency operations (Ki-Hatsu 0428 No.1). METI explained to MHLWthat due to a shortage of workers engaged in emergency operations at the Fukushima Daiichi plant,
workers from other nuclear power plants had offered their support. However, if the exposure dosefrom emergency operations is counted toward the upper limit of the dose that nuclear power plant
workers receive during normal operations (50mSv/year or 100mSv/5 years), then the support
workers would have been unable to work upon returning to their original nuclear power plants.
The above-stated notification, by decree, enabled the work carried out at Fukushima Nuclear
Power Plant to be separated from the ordinary operations of these volunteers. The cumulative
exposure dose received by the volunteer workers remained unchanged. Health effects would still
be considered in line with the LNT model.
[National Diet Report] Chapter 4, 4.4.5(5) Exposure Dose Standards and Screening Guidelines in Times of Emergency
In responding to the Fukushima Daiichi NPS accident, judging from the work environment, it
was clear that accumulated radiation exposure would increase, and there was a concern in theability to continue accident response work within the dose limits enforced at the time. Since thedose limit during times of emergency stipulated by law at the time was 100mSv, TEPCO, via
TEPCO employees working at the Official Residence, consulted with the NSC and NISA in
regard to reconsideration of dose limits stipulated by law. Thereafter when the ERC Health
Physics Team at the Headquarters was contacted by the Official Residence in regard to raisingdose limits, the response was given that it would help if dose limits were raised since it wasdifficult to continue working while abiding by those limits. In response to these activities, on theafternoon of March 14, at the Official Residence, it was decided that the dose limit in emergency
works would be raised from 100mSv to 250mSv. Although TEPCO is not in a position to know
the basis for setting the limit at 250mSv, according to the Interim Report by the Government's
Investigation and Verification Committee on the Accident at the Fukushima Nuclear Power
Station of Tokyo Electric Power Company (government’s accident investigation committee), it
appears that this value was decided in consideration for either half value of the lower dose limit
during emergencies stipulated by the International Commission on Radiological Protection(ICRP) or an indication value determined provisionally by the Japan Atomic Energy
Commission.
A debate in regards to the methods for applying these dose rates for doses received during
emergency work ensued. Namely, whereas the emergency dose limit would be applied whenengaging in emergency work at the Fukushima Daiichi NPS, the normal dose limit (100mSv/5
yrs or 50mSv/yr) would be applied when working at other nuclear facilities, etc. thereafter, so thequestion was whether to add the dose received during emergency work to the latter or to handle it
as a separate incident. An opinion was conveyed through METI that the Interim Report by the
Radiation Council General Assembly that summarized the results of debating the acceptance of
ICRP and ICRP 2007 recommendations indicates that emergency work doses will be treatedseparately from normal work doses, and in light of a resolution of the accident at the Fukushima
Daiichi NPS and a smooth handling of upcoming periodic inspection, etc. on nuclear power
facilities nationwide, doses received during emergency work should be treated separately fromthe standpoint of normal work dose limit management (emergency work doses will be kept
independent from normal work doses and separate dose limits will be applied to each). However,the Ministry of Health, Labor and Welfare issued an official notice that stated that whenmanaging dose limits during normal work if a worker has a history of engaging in emergency
work the doses received during that work shall be included and the limit of 100mSv/5 years shall110

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be observed.
The Ministry of Health, Labor and Welfare took the initiative in deliberating this issue of
emergency dose limits thereafter and on November 1, a ministerial ordinance was issued thatstated that the dose limit shall be returned to 100mSv, except when stipulated by the Minister of
Health, Labor and Welfare in cases of emergency where it cannot be especially avoided, andexcluding workers who are engaged in emergency work prior to issuance of the ministerial
ordinance.
[Tepco Report] Chapter 13 Section 2(5)The following isssues can be raised in association with dose criteria for emergency
work.
Radiological protection criteria – dose criteria for emergency work – dose limit
taking life-saving work into account In the second interim report on the incorporation of the 2007
Recommendations of the ICRP into domestic systems, the Basic Committeeof the Radiation Council proposed to match the dose limits to internationally
recommended values, taking into consideration that opportunities toparticipate in international activities were increasing for domestic workers,
because the current restriction criteria in Japan (dose limit, 100 mSv)
interfered with emergency medical care and other essential operations.
 On the other hand, in response to the present accident, 250mSv was adopted
as a dose limit for emergency workers. This value is lower than theinternationally approved principles and the recommended value of the 2007
Recommendations of ICRP (emergency medical care, no restriction; otheremergency rescue operations, 1,000 or 500 mSv; other rescue operations, 100
mSv).
Radiological protection criteria – dose criteria for emergency work – treatment
of individual doses received in an emergency situation
 In the second interim report on the incorporation of the 2007
Recommendations of the ICRP into domestic systems, it was indicated thatemergency work doses will be treated separately from normal work doses.
However, the Ministry of Health, Labor and Welfare (MHLW) issued an
official notice stating that when managing dose limits during normal work, if
a worker has a history of engaging in emergency work, the doses received
during such work should be included and the limit of 100mSv/5 years should
be applied.

(b) Radiation exposure of residents
Dose assessment for residents is not sufficient in the investigative reports. Work to111

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clarify the dose of actual residents is important issue.
 Estimation of thyroid equivalent dose of radioactive iodine by simple measurement
Descriptions about estimation of thyroid equivalent dose of radioactive iodine bysimple measurement are given in [Governmental Final Report] and [National Diet
Report] in the following way.
(b) The retrospective estimation of release source information by SPEEDI and
implementation of investigation on the exposure of infant thyroid glands to radiation
As described in Chapter V 2. (3) b. and Chapter V 3. (2) a. of the Interim Report, starting around
March 17, the NSC performed the SPEEDI retrospective estimation of the release source
information. On March 23, the NSC performed a SPEEDI infant thyroid gland equivalent dose
calculation based on a limited number of monitoring results. As a result, the NSC estimated that
there were areas with high equivalent doses beyond the designated evacuation zone to the northwest
and south of the Fukushima Dai-ichi NPS. The NSC took this fact seriously and reported it to thePrime Minister’s Office. After discussions at a meeting presided over by Prime Minister Naoto Kan(hereinafter referred to as “Prime Minister Kan”), joined by Cabinet Secretary Advisor Kosako andsuch experts as Kazuo Sakai, director of the Research Center for Radiation Protection, National
Institute of Radiological Sciences, it was concluded that since the high dose rates, that represent thevalues when one stays outdoors for 24 hours, are overestimated, the evacuation zones should not be
expanded immediately and investigation on the exposure of infant thyroid glands to radiation should
be conducted to confirm the data values based on actual measurement.
Therefore, on March 25, the NSC requested NERHQ to conduct investigation on the exposure of
infant thyroid glands to radiation covering those aged between one and 15 in the stay-indoors zones
and areas with high infant thyroid equivalent doses estimated by SPEEDI. The Local NERHQ
conducted investigation on the exposure of infant thyroid glands to radiation in Iwaki City March
26-27, in Kawamata Town March 28-30, and in Iitate Village March 30. The investigation found noone with the exposure beyond the screening level (0.2μSv/h) shown by the NSC.
[Governmental Final Report] Chapter IV 2

1. Insufficient initial exposure evaluation
During the accident, radioactive materials were emitted directly into the environment, resulting
in the evacuation of approximately 150,000 residents. Radioactive iodine, radioactive cesium andother radioactive materials emitted from the Fukushima Daiichi Nuclear Power Plant as radioactive
plumes behaved differently depending on the weather conditions, including precipitation of rain andsnow. As a result, radioactive materials were deposited in the soil northwest of the Fukushima plant.
In order to take measures to reduce the effect of these radioactive materials on the health of theresidents, it was important for the NERHQ and Fukushima Prefecture to ascertain not only thelong-term exposure of the residents but also the initial exposure situation.
The Fukushima Prefecture radiation emergency medical care manual required that theevacuation route and exposure dose be recorded at the time of screening. But in practice, the large
number of evacuees that were being handled hampered recordkeeping, and the investigation into theinitial exposure levels of the residents was not handled sufficiently.
The effective half-life of iodine 131 is about five to seven days in infants and children, so ifearly measurements are not taken it is impossible to grasp the actual situation. Based on experiencein the Chernobyl nuclear accident, it is known that an emergency exposure evaluation in the initialperiod is important with respect to gauging internal exposure to radioactive iodine.
There are two types of exposure—internal exposure and external exposure—but the external
exposure of the residents in the initial period depends on the behavior of the radioactive plume andthe actions of the people who are exposed. It is necessary to estimate the exposure levels of
individual residents by taking into account the records of their actions. Fukushima Prefecture was112

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responsible for estimating external exposure levels; as part of the Fukushima Prefecture HealthManagement Survey, the prefecture conducted an External Exposure Dose Estimates Study overfour months from March 11.
The Local Nuclear Emergency Response Headquarters (Local NERHQ) conducted someinvestigations into internal exposure by radioactive iodine. In response to a request from NSC, theLocal NERHQ performed screening tests for thyroid gland exposure levels on 1,080 infants andchildren (from 0 years old to 15 years old) in Iwaki City, Kawamata-machi, and Iitate-mura fromMarch 26 to March 30. From the results of these tests, the NSC of Japan reached the conclusion that
there were no infants or children with a thyroid gland equivalent dose in excess of 100mSv.
The NSC of Japan has recognized that these tests were simple monitoring to check whether or
not there were any infants or children whose internal exposure had been in excess of a screening
level classified as 100mSv, and were therefore low precision tests. Among the test subjects were
three children with internal exposure below the screening level, but with readings in excess of
30mSv. However, it appears that NERHQ did not wish to expand the investigation. With excusessuch as “conducting a follow-up investigation would cause enormous unease among the test
subjects, their families and the local communities,” etc., NERHQ asked NSC for “advice to theeffect that a follow-up investigation is not necessary” for these children. In the end, NSC issued
advice in a form that reflected the wishes of NERHQ; it stated: “we should judge whether or not a
final follow-up investigation should be implemented while continuing to monitor the situation at thenuclear plant.” These were the last tests; NERHQ did not perform any further tests of the thyroid
gland exposure levels of the children. Fukushima Prefecture also appealed to researchers who were
performing their own examinations of the thyroid gland exposure of the residents at that time tostop measuring internal exposure levels.
Neither the NERHQ nor Fukushima Prefecture performed sufficient tests of internal exposure toradioactive iodine, so the actual initial internal exposure of the residents to radioactive iodine isunclear. Although the Prefecture Health Survey will perform thyroid gland tests on the residents ofthe prefecture that were under 18 years old at the time of the accident for their entire lives, the factthat the initial exposure levels are unknown is a weakness in these evaluations.
[National Diet Report] Chapter 4, 4.3

The following isssues can be raised in association with estimation of thyroid
equivalent dose of radioactive iodine by simple measurement.
Radiation exposure of residents – estimation of thyroid equivalent dose ofradioactive iodine by simple measurement
 Screening tests for thyroid gland exposure levels on 1,080 infants andchildren were carried out in Iwaki City, Kawamata-machi, and Iitate-murafrom 26 March to 30 March 2011; however, this involved low-precision tests
and no further tests of the thyroid gland exposure levels of the children werecarried out.

 Internal dose assessment by whole body counter (WBC)
Descriptions about internal dose assessment by whole body counter (WBC) are
given in [National Diet Report] in the following way.
3. Prefectural People’s Health Management Survey does not include internal exposure113

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screening
The health impacts of radiation must be pursued and examined over the long term. On May 27,
2011, Fukushima Prefecture established the Fukushima Prefecture Health Management Survey
Committee. The purpose was to relieve prefectural residents’ concerns related to the nuclear power
plant accident and to ensure their safety and comfort in the long term through a health monitoring
scheme. The health management surveys comprise a basic survey of all prefectural residents, andalso a more detailed survey of children aged 18 or younger, pregnant women, and others for whom
additional surveying is deemed necessary. For the basic survey, questionnaires are sent to individual
residents and are used to estimate external radiation exposure during the period for which air doses
were highest. The detailed survey includes four distinct parts: 1) a thyroid examination for children
aged 18 and younger; 2) a health survey with an additional comprehensive blood test; 3) a survey
for pregnant women; and 4) a survey on mental health and living habits.
However, none of the surveys include a screening for internal exposure that takes into accountthe long-term impact of radioactive cesium. While there are surveys of residents conducted using
WBCs by the municipalities and hospitals, there is no national or prefectural-level plan to collectthat data and implement long-term impact surveys.
a. Prefectural health surveys and internal exposure surveys using WBCs
A WBC internal exposure screening was implemented as a preliminary survey prior to theprefecture health monitoring surveys; however, according to interviews with individuals related to
the Fukushima Prefecture Health Management Survey Committee, the decision was taken to nolonger include WBC screenings in the prefecture health management surveys because the level ofinternal exposure was very low and it was not likely that levels would rise as a result of foodconsumption. Ten months following the accident, approximately 40,000 of Fukushima’s 2,000,000
residents had received internal exposure examinations. One-third of those examinations wereconducted by hospitals independently of the prefectural survey.
(Omission)c. Inadequate internal exposure monitoring
If, as a result of internal exposure due to consumption of food products, an increase in theJapanese residents’ internal exposure levels did occur, it would be impossible to confirm the levels
and implement countermeasures because surveys for internal exposure levels are not being
conducted. At present, neither the national nor prefectural governments have plans to implement
internal exposure level screenings. While internal exposure surveying using WBCs is not includedin the prefectural health monitoring surveys, there is strong demand for this surveying by theresidents, as reflected by the fact that WBCs have been obtained and measurements are conducted atmunicipal offices, private hospitals, and private sector organizations. These data are not being
compiled in one database, but rather stored separately by individual municipal governments andhospitals.
The prefectural government has requested hospitals that conduct WBC screenings free of charge
for residents to provide the WBC measurement data that is collected. This request, however, hasbeen rejected. The hospitals cited the necessity for patient permission as a prerequisite for providing
the data.
There is thus no policy in place by the national or prefectural governments for monitoring andutilizing internal exposure data, and as there are no measures in place for implementing WBC
screenings, there is no collaboration or cooperation between hospitals and municipalities that
conduct WBC examinations on their own.
[National Diet Report] Chapter 4, 4.3

The following isssues can be raised in association with internal dose assessment bywhole body counter (WBC).
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Radiation exposure of residents – internal dose assessment using whole bodycounter (WBC) – investigation system
 As part of the Fukushima Prefecture Health Management Survey started inJune 2011, individual doses for external exposure were investigated as theExternal Dose Estimation based on the behavior records in the Basic Survey.
However, investigation of the dose for internal exposure using the WBC was
not carried out in the Basic Survey. For this reason, the WBC measurement
results are individually kept in each municipality or hospital since these data
are a form of personal information that is unavailable for use for otherobjectives without permission. The WBC measurement for internal exposure
was not addressed in the nuclear emergency preparedness plan, which was amain cause of the delay in conducting the WBC measurement.
Radiation exposure of residents – internal dose assessment using whole bodycounter (WBC) – measurement method Since individual dose assessment for internal exposure using the WBC highlycollected the needs of residents, the WBCs were individually set up bymunicipalities, hospitals, and nongovernmental organizations, in addition to
direct management by the Fukushima prefectural government. Therefore, thedose assessment was carried out by nonunified methods without
standardization.

 External dose assessment by personal dosimeters
Descriptions about external dose assessment using personal dosimeters are given in[Nuclear Regulation Authority (NRA) HP], [Fukushima Prefecture HP] and[Fukushima city HP] in the following way.
Dosimetry using personal dosimeter
Support project to urgently prepare personal dosimeters
Subsidized project carried out by Fukushima prefecture since 2011 fiscal year to let residents
confirm their individual dose due to external exposure and correlated with health control.
Support for the preparation of personal dosimeters and survey meters to be provided bycity, town or village for residents (below 15 years of age and pregnant women).

The percentage of support is 100%.
Number of supported cities, towns and villages* Preparation of personal dosimeters using this support project was carried out by 58
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cities, towns and villages in 59 cities, towns and villages in Fukushima prefecture in2011 fiscal year. (Remaining Kawamata town was out of the count because Kinki
University had cooperated with the town to prepare badge-type personal dosimeters)[Nuclear Reguration Authority HP (30 Nov. 2012)]
Radiation dose obtained at the present stage
2 Personal dosimeters(1) Refer to inquired data (22 cities, towns and villages) to advisory groupMedian: below 1 mSv/year
When the radiation dose is higher than the average value of the measured group, the backgroundreason was confirmed and measurement was continued.
(2) Fukushima city (from homepage and newspaper)Median: 0.8 mSv/year (0.2 mSv per 3 month measurements: Fukushima city)
There is a case higher than 10 mSv/year due to inappropriate use of the dosimeter.
Overview of measurement resultsobtained using personal dosimeters analyzed by advisory group(FY 2011)

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Note: This table was sorted by measurement period and number.
Median corresponds to measurement period, unless otherwise stated.
These data were obtained from the inquired data to advisory group by city, town andvillage and also there were indication by category.
When the measurement was performed twice and the first and the second data were
not linked, the data were described in every measurement case.
This table was separately described when the measurement tools were different even if
the measurement was done for the same period by the same city, town and village.
[Fukushima Prefecture HP (26 Apr. 2012)]

Measurement results of personal dose meters (glass badge)
Fukushima city provided personal dose meters (glass badge) to children and pregnant women andimplemented a measurement of accumulated dose for 3 months from September to November, andmeasurement results of the personal dose meters (glass badge) are notified.
Furthermore, these data were reviewed by the Fukushima city health care examination committeethat consists of doctors in Fukushima city medical association and Fukushima city radioactivity
advisers.
Target of the measurements(1) Infants and students below junior high school who live in Fukushima city
(2) Pregnant women who live in Fukushima city
* Both (1) and (2) includes evacuees in Fukushima city owing to the Great East Japan
Earthquake and subsequent tsunami.
Period of the measurements
Measuremnts were carried out for 3 months (from 1 September to 30 November 2011), andresults were analyzed for two separate periods.
1st measurement 1 to 30 September 2011
2nd measurement 1 October to 30 November 2011
Measurement results
1. Number of measurement targets, who were provided dosimeters and from whom data werecollected.
* The first collected number and ratio are as of 31 October 2011.
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Japan Health Physics Society* The second collected number and ratio are as of 26 December 2011.
* Measument number for three months are the data as of 26 December 2011.
2. Number and ratio of measurement for three months* The maximum dose is 2.7 mSv* The backgrounds of the glass badge used by people who received more than 2.0
mSv for three months
 Misplacement of the glass badge outdoor Misplacement of the glass badge on bicycle
 X-ray inspection of baggage in airport
3. Estimation of annual dose

4. Views from the Fukushima city health care examination committee
These data were reviewed at the Fukushima city health care examination committee
meeting held on 4 January 2012. The following views from the committee members were
provided; “From the present results, there is little possibility of radiation leading to anincrease in cancer incidence”.
[Fukushima City HP (17 Jan. 2012)]

The following isssues can be raised in association with external dose assessment
using personal dosimeters.
Radiation exposure of residents – external dose assessment using personal
dosimeters Since dose assessment was carried out by each municipality by lending
personal dosimeters in response to the needs of residents, individual dose data
for external exposure are kept in the respective municipality because thesedata are a form of personal information that is unavailable for use for otherobjectives without permission.
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Japan Health Physics Society External dose estimation on the basis of behavior survey
Descriptions about external dose estimation on the basis of behavior survey are
given in [Governmental Interim Report], [Governmental Final Report],[National Diet Report] and [Nongovernmental Report] in the following way.
d. Medical checks conducted for the citizens of Fukushima Prefecture
On May 19, the Fukushima prefectural government established the Fukushima Prefecture Health
Monitoring Survey Research Committee to discuss how to conduct medical checks for the citizensof Fukushima Prefecture. In response to those committee discussions, on June 30, the Fukushima
prefectural government began delivering sets of inquiry forms, which dealt mainly with dietary andbehavioral records from March 11, to individual evacuees from Namie-town, Iitate-village andYamakiya district of Kawamata-town, who were subjects participating in the survey. The same setof inquiry forms was delivered to all remaining citizens of the prefecture on and after August 26.
The survey included forms for entering basic survey details as well as medical checkup, Q&A
survey, and thyroid gland examination results. The results of the survey are to be managed andmaintained in a database on a long-term basis.
[Governmental Interim Report] Chapter V 4

d. Medical checks conducted for the citizens of Fukushima Prefecture
As described in Chapter V 4. (5) d. of the Interim Report, the Fukushima prefectural
government has been conducting health surveys on the residents in the prefecture.
The Fukushima prefectural government, based on the basic surveys in these health surveys,
estimated the external exposure doses of a total of 25,667 people (including 1,358 radiation
workers) for four months after the nuclear accident and announced the estimation results on June
12, 2012. Of those surveyed, people with the external exposure dose of 10mSv or higher numbered
147 (including 48 radiation workers). The maximum value of external exposure dose for people
other than those who had experiences in engaging in radiation-related work was 25.1mSv.
[Governmental Final Report] Chapter IV 4

As noted above, screening examinations only indicate the possibility of external or internal
exposure. From this data alone, it is impossible to know the exact number of people who sufferedfrom external or internal exposure or to get further details about the dose to which they were
exposed. Because it is impossible to specify an accurate exposure dose for individuals, the external
exposure dose was estimated in Fukushima Prefecture’s “Prefectural People’s Health Management
Survey” (Ken-min Kenko Kanri Chosa), on the basis of each individual’s activities.
This survey made estimates of the cumulative effective dose of external exposure based on
individual’s activities between March 11 and July 11, 2011, using an assessment system developedby the National Institute of Radiological Sciences (NIRS). The results for a number of regions havebeen announced.
Shown below are the estimated results for 14,412 persons, excluding nuclear plant related
workers, from the Yamakiya district of Kawamata Town, Namie Town and Iitate Village, where theair dose rate was relatively high, resulting in their designation as regions subject to precursory
examination (as of June 2012).
Table 4.1-3 Estimated cumulative effective dose of external exposure for 14,412 residents inthree areas from March 11 to July 11, 2011
Results of estimated cumulative effective dose of external exposure for 14,412 residents
excluding “Occupationally Exposed Persons”
119Japan Health Physics SocietyLess than 1mSv
1mSv to10mSv
More than 10mSv

8,221
6,092
99

57.0%
42.3%
0.7%

[National Diet Report] Chapter 4, 4.1

From now on, how should we control radiation effects on residents for long-term period? For
example, Fukushima prefecture decided to implement “Prefectural People’s Health Management
Survey” for the purpose of health control of residents in the future. According to a report on
December provided by the committee, accumulated radiation doses of 1589 residents are given as
follows: 998 (62.8%) for below 1 mSv, 1,547 (97.4%) for below 5 mSv, 1585 (99.7%) for below
10 mSv, and 4 for above 10mSv, and the maximum dose is 14.5 mSv (1 resident). However, thisresult is just an “estimation from behavior records using interview sheet”. Number of collection
was 370 thousands within about 2 millions of target residents. In the future, more accurate, rapid
and expertized long-term survey implemented by national government would be needed.
[Nongovernmental Report] Part 1 Chapter 2 Section 4

The following isssues can be raised in association with external dose estimation on
the basis of behavior survey.
Radiation exposure of residents – external dose estimation on the basis ofbehavior survey As part of the Fukushima Prefecture Health Management Survey started inJune 2011, the individual dose for external exposure was investigated as theExternal Dose Estimation, using the behavior records obtained via sets ofinquiry forms in the Basic Survey. However, the recovery ratio of inquiry
forms was only 18% in December 2011. (As of 31 January 2013, the recovery
ratio for the whole area of the prefecture was 23.2% and that for thepreceding investigation area, Yamakiya district of Kawamata Town, Namie
Town, and Iitate Village was 56.7%)(c) Radiation exposure of plant recovery workers
 Reservations of personal dosimeters, WBCs and protective tools, and administrationof stable iodine in emergency works
Descriptions about reservations of personal dosimeters, WBCs and protective
tools, and administration of stable iodine in emergency works are given in[Governmental Interim Report], [Governmental Final Report], [National Diet
Report] and [TEPCO Report] in the following way.
b. Organizational framework for radiation control after the nuclear accident(a) Establishment of radiation controlled zones
After the nuclear accident at the Fukushima Dai-ichi NPS, radiation levels increased throughout
the entire premises of the nuclear power station. However, TEPCO was not initially willing toredefine a controlled area as stipulated in its in-house safety regulations. On April 27, however, as
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described in Section c (b) below, based on the fact that a female radiation worker received radiationdose greater than the allowed dose limit, NISA instructed TEPCO to validate its organizationalframework for radiation control and implement measures to rectify this situation. In response to this,on May 2, TEPCO designated the entire premises of the Fukushima Dai-ichi NPS as a temporaryand emergency radiation controlled zone to be controlled in the same manner as a radiation
controlled zone. It was decided that the temporary and emergency controlled zone should be treatedas a controlled zone stating that it would be marked with a sign showing that access to thedesignated area is restricted to those individuals who do not require access in order to perform theirduties, other necessary signs would be installed, and that radiation workers must be equipped with arental APD and other protective equipment.
(b) Registration as a radiation worker
At the Fukushima Dai-ichi NPS, from the date of the nuclear accident through to May 10,
radiation workers were allowed to carry out their duties inside the temporary and emergency
radiation controlled zone after receiving a brief 30-minute explanation about how to protect
themselves from radiation and how to wear protective equipment. In addition, (although there is nolegal obligation to do this) there was a delay in radiation workers getting registered as professionalradiation workers with a radiation worker certificate provided by the Central Registration Center ofRadiation Workers and so some radiation workers performed their duties without a radiation worker
certificate.
(c) APD (alarm pocket dosimeter)
TEPCO had about 5,000 APDs installed at the entrance to the controlled zone of Units 1 to 6
and at the entrance to the centralized waste treatment facilities, but most of them were covered inwater and damaged by the tsunami. Hence, as a temporary arrangement, it was decided to perform
radiation control measures using about 320 APDs that had been kept in a Seismic Isolation Building.
Sometime between March 12 and 13, 500 APDs (200 of them from the Fukushima Dai-ni NPS)
were provided as aid supplies from Kashiwazaki-Kariwa Nuclear Power Station. Unfortunately,
however, there was a lack of communication between the pickup window personnel that received
the APDs and the health physics team that desperately needed them, and these APDs were simply
stored, unused until April 1. Many workers left the Fukushima Dai-ichi NPS after the earthquake
and initially very few remained to perform their duties. Gradually more and more joined them until
there were not enough APDs and by March 15 not every worker was able to wear an APD. In
response to this situation, Mr. Masao Yoshida, head of the Fukushima Dai-ichi NPS (hereinafterreferred to as "site superintendent Yoshida") decided to let only the leaders of an operational groupwear APDs on behalf of the entire group as long as the following conditions were met: (i) the
assumed total radiation dose per job is not great (less than about 10mSv), (ii) air radiation dose rates
at the work site are known, (iii) environmental dose rates gradient (difference between air radiationlevel rates in the same space) is not great, and (iv) all members of an operational group always
together at a work site. This decision was made based on the following assessment: the provisory
clause, which states that "however, if it is considerably difficult to perform the said measurementwith the said radiation measuring instrument, the said dose from external exposure may becomputed using the measured dose equivalent rate, and if it is also considerably difficult to computeit, then the said value may be obtained through calculations," of Article 8, Paragraph 3 of Ionization
Rules stipulating that "the measurement of radiation dose from external exposure according to
Article 1 shall be performed by wearing radiation measuring instrument on parts of the bodyspecified in the following items", was applicable to this case. As described above, a sufficientnumber of APDs was finally obtained on April 1. TEPCO decided to have all of its workers wear
APDs from the same day and to not allow them to work if there were not enough APDs.
(d) Managing access to and from a controlled area
After the nuclear accident, access to and from the controlled area of the management system
was initially rendered inoperative for calculating the radiation dose of individual radiation workers.
TEPCO decided to manually calculate the radiation dose of individual radiation workers using
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APDs. On April 14, TEPCO had five simplified instruments installed in the Seismic Isolation
Building for gaining access to and from the controlled area management system. At the same time,they introduced a radiation work permit with bar code patterns so that the names and radiation doseof individual workers could be automatically recorded.
[Governmental Interim Report] Chapter V 4(c) APD (alarm pocket dosimeter)
TEPCO had about 5,000 APDs installed at the entrance of the controlled zone of Units 1 to 6 at
the Fukushima Dai-ichi NPS and in the centralized waste treatment facilities, but most of them werecovered with water and damaged by the tsunami. Hence, as a temporary arrangement, it was
decided to perform radiation control measures for workers using about 320 APDs that had been kept
in the Seismic Isolation Building.
The TEPCO Kashiwazaki-Kariwa Nuclear Power Station (hereinafter referred to as the“Kashiwazaki-Kariwa NPS”), which was aware of the status of the accident through informationfrom TEPCO’s television conference system and the communication with the Emergency
Response Center health physics team at the Fukushima Dai-ichi NPS (hereinafter referred to as the“Fukushima Dai-ichi NPS health physics team”), sent 530 APDs, eight units of battery chargers
for APDs (three units for 10 APDs and five units for 100 APDs) and an APD alarm setter as relief
supplies to the Fukushima Dai-ichi NPS from March 11 to March 12. Of these suppliers, 30 APDs,
three units of battery chargers (for 10 APDs) and an APD alarm setter arrived at the Fukushima
Dai-ichi NPS on March 12 and were used from the same day. However, of the 500 APDs sent
separately on March 12, though 300 APDs arrived at the Fukushima Dai-ichi NPS on the same day
and 200 APDs on March 13, they were not used, as described later, as battery chargers compatible
with these APDs had yet not arrived. Furthermore, as a member of the Fukushima Dai-ichi NPS
health physics team, who knew that these APDs were kept unused, left the Fukushima Dai-ichi
NPS by March 14, the 500 APDs remained unused and were kept at the Seismic Isolation Buildingof the Fukushima Dai-ichi NPS until the end of March. The five units of battery chargers (for 100
APDs), together with the 200 APDs mentioned above, were loaded on a truck heading for the
Fukushima Dai-ni NPS on March 12. However, after they arrived at the Fukushima Dai-ni NPS on
March 13, only the 200 APDs that could be transshipped immediately were delivered to the
Fukushima Dai-ichi NPS, while the five units of battery chargers (for 100 APDs) mentioned above
were kept in a warehouse of the Fukushima Dai-ni NPS.
The Fukushima Dai-ichi NPS health physics team initially thought some 350 APDs secured byMarch 12 would be sufficient as the number of workers outside the Seismic Isolation Building was
not so large. However, as the number of workers increased later, the number of APDs ran shortfrom around March 15.
In response to this situation, Mr. Masao Yoshida, head of the Fukushima Dai-ichi NPS(hereinafter referred to as “Site Superintendent Yoshida”) decided to let only the leaders of an
operational group wear APDs on behalf of the entire group as long as the following conditions
were met: (i) the assumed total radiation dose per job is not great (less than about 10mSv), (ii) air
radiation dose rates at the work site are known, (iii) environmental dose rates gradient (difference
between air radiation dose rates in the same space) is not great, and (iv) all members of an
operational group are always together at a work site. This decision was made based on thefollowing assessment: the provisory clause, which states that “however, if it is considerably
difficult to perform the said measurement with the said radiation measuring instrument, the saiddose from external exposure may be computed using the measured dose equivalent, and if it is also
considerably difficult to compute it, then the said value may be obtained through calculations,” ofArticle 8, Paragraph 3 of Ionization Rules stipulating that “the measurement of radiation dose fromexternal exposure according to Article 1 shall be performed by wearing radiation measuring
instrument on parts of the body specified in the following items” was applicable to this case.
In parallel with the above, the Fukushima Dai-ichi NPS health physics team told the TEPCOHead Office that APDs were in short supply. Of APDs that were ordered in early 2010 and being
delivered gradually, the TEPCO Head Office, around March 16, asked the supplier to frontload the122Japan Health Physics Societydelivery of 400 APDs that were to be delivered in April 2011, and 100 of them were delivered to
the Fukushima Dai-ichi NPS on March 17. The delivery brought the total number of APDs
available at the Fukushima Dai-ichi NPS to 450, but the Fukushima Dai-ichi NPS continued withthe practice of letting only the leaders of an operational group wear APDs on behalf of the entire
group. The remaining 300 APDs were delivered on April 3.
On March 17, the TEPCO Head Office, through Chubu Electric Power Company, which was the
managing company of the Federation of Electric Power Companies (FEPC) at the time, asked
Shikoku Electric Power Company (hereinafter referred to as “Shikoku Electric Power”) to provide
APDs. In response to the request, Shikoku Electric Power sent out 450 APDs as well as five unitsof battery chargers (four for 100 APDs and one for 50 APDs) and two alarm setters. They weredelivered to the J-Village stadium by around March 21. However, when TEPCO employees taking
charge of management of equipment and materials at the J-Village stadium checked the equipment
and materials delivered, they could not find the alarm setters and sent only the APDs and battery
chargers to the Fukushima Dai-ichi NPS. Informed of the delivery, the head of the Fukushima
Dai-ichi health physics team became aware of the absence of the alarm setters and the fact alarm
setters at the Fukushima Dai-ichi NPS cannot be used for the APDs delivered by Shikoku ElectricPower. However, the health physics team head sent back the ADPs and battery chargers to the
J-Village stadium without asking the TEPCO Head Office to secure other alarm setters or giving
thought to using the APDs without altering the alarm setup value, as the team head was of the viewthat there would be no problem in continuing with the practice of letting only the leaders of an
operational group wear APDS on behalf of the entire group as done at the Fukushima Dai-ichi
NPS at the time and was not aware of the need to secure more APDs as soon as possible. Thus, theAPDs and other supplies delivered by Shikoku Electric Power were kept at the J-Village stadium
without being used.
Subsequently, on March 31, the NISA, which became aware of the TEPCO practice of letting
only the leaders of an operational group wear APDs, told TEPCO that the practice was notdesirable and urged TEPCO to take all necessary steps for radiation control for its workers.
Following this, on the same day, TEPCO decided to do away with the practice of letting only theleaders of an operational group wear APDs. Furthermore, informed by the Kashiwazaki-Kariwa
NPS that became aware of this, TEPCO searched the Fukushima Dai-ichi NPS and the Fukushima
Dai-ni NPS, and found the aforementioned 500 APDs at the Fukushima Dai-ichi NPS on March 31,
and the aforementioned five units of battery chargers (for 100 APDs) at the Fukushima Dai-ni NPS
on April 1. In addition, with the additional deliveries of 190 APDs and two units of battery
chargers (one for 100 APDs and one for 50 APDs) form the Kashiwazaki-Kariwa NPS, a sufficientnumber of APDs and other equipment was secured on April 1 and the normal practice of having all
workers wear APDs resumed the same day.
[Governmental Final Report] Chapter IV 4

4. Working conditions of the nuclear power plant workers
a. Management of external exposure doseAt the time of the accident, TEPCO had approximately 5,000 alarm pocket dosimeters (APD) at
the premises of the Fukushima Daiichi plant. Before the accident, TEPCO distributed them toeach worker in order to manage the external exposure dose received during their shifts. However,many were washed away in the tsunami, reducing the number of usable APDs to approximately
320. For work conducted around March 15, TEPCO could not provide enough APDs for all theplant workers, who went to either controlled areas or areas where an air dose equivalent to that ina controlled area was measured.
At times, TEPCO could not gauge the dose received by every worker, and in some cases, one
APD would be loaned to a group. In principle, when loaning the APD to workers, the radiation
manager on site would conduct interviews about the work each group would be performing, inorder to determine whether to loan one APD to the group or to loan APDs to individuals.
One APD per group was used for the most part when outdoor work was conducted in places
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One APD per group was used in a similar way when air doses at the main control rooms ofUnits 1 and 2 and Units 3 and 4 increased due to the blasts resulting from, among other reasons,the hydrogen explosion at each of the units, which caused doors to break.
Our questionnaire showed that for 47 to 54 percent of the workers, APDs were distributed tothem as a group. Up to the end of March, a similar percentage of workers reported having theirown APD. A small percentage of workers, however, reported that no dosimeters had been
distributed to them.

Fig. 4.4.5-2 Management of the dose received by nuclear power plant workers (multiple
answers allowed)
Using APDs to manage the dose received by workers as a group does not necessarily constitutea violation of the law. But there was no system in place to ensure that radiation managers on site
appropriately determined their distribution to individuals or groups. After the accident, radiation
managers on site managed APD data by hand or with spreadsheets that show the inadequacies in
the ways in which the exposure dose received by individual nuclear power plant workers weremanaged.
According to our questionnaire, around 30 percent of the nuclear power plant workers were
never informed of their cumulative exposure dose.

Fig. 4.4.5-3 Cumulative Exposure Doseb. Management of the internal exposure dose(i) Delay in the internal exposure measurements
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Delays in WBC measurements caused delays in the identification of plant workers with highinternal exposure doses. As a consequence of the accident, workers who received an exposure
dose in excess of the legal limit included a TEPCO worker who received an internal exposure
dose as high as 590mSv, highlighting the importance of internal exposure measurements.
The delays in the WBC internal exposure tests are thought to have been caused by two factors:
a shortage of working WBCs at the time of the accident; and the timeconsuming nature of the test.
Before the accident, four WBCs were installed at the Fukushima Daiichi Nuclear Power Plant, andwere used to measure the internal exposure of plant workers every three months. However, theaccident released a large quantity of radioactive particles, causing the concentration of radioactive
material in the environment to increase, including the concentration in the air dose in the WBC
room. The contaminated background level meant that the four WBCs could not be used. From
March 22nd, TEPCO borrowed JAEA’s vehicle-mounted WBCs, which were were installed at the
Onahama Call Center, and internal exposure tests of the workers commenced. Thereafter, TEPCO
borrowed WBCs from JAEA and other institutions as needed in an effort to increase the numberof tested workers.
It also took time to assess the data. After a worker was measured using a WBC, if a highcontamination was observed, personal decontamination was carried out to remove external
exposure. The worker then needed to wait approximately two weeks to receive a test purely for
only internal exposure. Workers had to receive tests every few weeks.
The root cause of the test delays is thought to be the inability to utilize the WBCs kept on thepremises, due to the background air dose from the accident. The fact that TEPCO had not
anticipated the release of radioactive material in an accident is, we believe, very problematic.
(ii) Background to the increases in internal exposure dose
One of the factors that contributed to increases in internal exposure doses was the lack ofprotective tools available to prevent the absorption of radioactive material. The full-face mask isthe simplest and most essential equipment to prevent the internal exposure of workers to radiation.
Full-face masks come as dust masks or charcoal masks. The two types differ in whether the mask
filters radioactive iodine or not. Immediately following the accident, workers needed to wear the
charcoal mask, which can absorb iodine, in order to prevent exposure to radioactive iodine.
Since the main control room was outside the controlled areas, it was not equipped with asufficient number of full-face masks. Workers who worked at the main control room carried out
emergency operations using the charcoal masks and dust masks that were available at the service
building. However, the number of charcoal masks was limited. Furthermore, while a minimum
number of masks were available, a sufficient number was not available for all plant workers. The
short supply of charcoal masks attributable to TEPCO’s insufficient preparations for a possible
accident is another problem to tackle.
[National Diet Report] Chapter 4, 4.5

13.2 Post-Earthquake Radiation Control(1) Radiation Control Overview
As a result of the tsunami, core damage, and reactor building explosions that occurred after theearthquake, it became pointless to try to differentiate between conventional controlled areas andother areas. Furthermore, APD and borrowed equipment (rechargers) located at the entry
management points for controlled areas were inundated with water from the tsunami and rendereduseless, and with the subsequent power loss, management systems used for managing entry and exit
into controlled areas as usual, and aggregating exposure doses, etc., lost function.
Furthermore, with the loss of power stack radiation monitors and monitoring posts (MP) failed
to function, so monitoring cars were deployed to start to measure (air dose rate, weather data, etc.)
the environment, such as near the boundaries of the power station site. Two monitoring cars
including a monitoring car provided by Kashiwazaki-Kariwa started to take measurements on
March 12.
Furthermore, it was decided that all radiation control matters related to the power station would
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be handled unilaterally by the ERC at the power station located in the seismic isolated building.
In the early morning hours of March 12, since radiation levels within the site had risen, it was
decided that APD and protective clothing/protective equipment worn in accordance with the level ofcontamination that prior to the earthquake had only been worn in control areas, would be worn
when leaving the seismic isolated building to engage in work.
The large-scale release of radioactive materials and the reactor building explosions led to not
only contamination by radioactive materials of the entire site, but also contamination inside theseismic isolated building. Contamination of the entire site led to an increase in background radiationlevels, making it difficult to evaluate internal exposure using the WBC located within the facility.
In dealing with the accident a base of operations separate from the seismic isolated building
became necessary, so the J Village soccer practice facility located approximately 20km to the southof the Fukushima Daiichi NPS was selected for this purpose. On March 17, J Village became thebase of operations for training workers engaged in emergency work, donning protective equipment
and lending out dosimeters when engaging in work within the Fukushima Daiichi NPS without
going through the seismic isolated building. As recovery work went into full force, and J Village
became home to many workers and functioned effectively as a base of operations for filling out therequired paperwork for receiving new workers to work inside the power station facility amidst thelimited space within the seismic isolated building. Furthermore, a mobile WBC used to evaluate theinternal exposure of workers engaged in emergency work was lent by the Japan Atomic Energy
Agency (JAEA), so measurements could be taken at the Onahama Coal Center, etc.
(Omission)(3) Condition of the Seismic Isolated Building and Radiation Level Reduction
Countermeasures
Many people gathered in the seismic isolated building, which was the base of operations forhandling the Fukushima Daiichi NPS accident, but the seismic isolated building environment
worsened along with the surrounding environment. The efforts that were made to improve these
conditions and the environment are discussed below.
There is only one entry/exit to the seismic isolated building and it is used by people as well as
for loading and unloading. It has double-entry doors with one door closing before the other opens,
so that outside air is not blown directly inside. This space between doors is where workers remove
protective equipment and workers and items being brought inside are checked for contaminationand decontaminated right inside the seismic isolated building. The double-door entry to the seismic
isolated building is managed in this way 24 hours a day as strictly as possible through suchmeasures as decontaminating and curing anything that exceeds background radiation levels even if
4Bq/cm2 of normal contamination cannot be detected. However, as a result of the release ofradioactive materials and the entry (double-door entry) being bent by the explosive blast, outside air
found its way inside and radioactive concentration levels inside the seismic isolated building
increased. As a result, a female TEPCO employee was exposed to a dose that exceeds legal limits.
Furthermore, during work conducted in the early morning of March 12 approximately 30
workers that had returned to the seismic isolated building were confirmed to be contaminated. The
workers were temporarily isolated in a conference room since no policy had been predetermined inregard to screening levels during a nuclear disaster and also to prevent the spread of contamination,
after which they were moved to Kawauchi Village, a place where background levels were lower, inorder to take more accurate readings, however, background levels at Kawauchi Village had alreadyrisen so measurements were abandoned and the workers returned to the seismic isolation building.
Since there were many workers engaged in recovery work who were sleeping in the seismic
isolated building in order to handle the expansive amount of work required following the accident,
it became necessary to reduce exposure doses during their stay. Therefore, in addition to theexisting charcoal filter ventilation equipment, countermeasures were gradually implemented, suchas setting up localized exhaust fans with charcoal filters, erecting a temporary house at the entrance
to prevent carrying in contamination, replacing OA floor mats (easily adhering radioactive material
and hard to decontaminate) with tile that is easy to decontaminate, using sheets for curing, and126

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shielding windows with lead in order to reduce dose rates. As a result of these countermeasures, theair dose rate inside the seismic isolation building gradually decreased.
Furthermore, as with the seismic isolated building, charcoal filter exhaust fans were set up (Unit
1 to 6 MCRs: from April 4, 2011), survey areas for preventing the carrying in of contamination
when entering and exiting, and monitoring (Unit 5 and 6 MCR where personnel were stationed at all
times: from March 30, 2011) was performed in the MCRs where workers resided for long periods
following the accident in order to monitor reactor instruments.
In addition, efforts were made to procure radiation control materials from the field and anew,
since these materials were lacking due to the large number of workers that had assembled to engage
in emergency work in an effort to contain the accident as quickly as possible.
[Tepco Report] Chapter 13 Section 2(3) Iodine Tablet Dosing Status
Based on the advice of the Headquarters’ industrial physicians on March 13 the General
Manager at the ERC at the power station (Site Superintendent) ordered the medical team leader tomake an internal announcement for the dosing of iodine tablets. Notices about iodine tablets
distribution were put up within the complex without exception.
For the first few days after the commencement of iodine tablet distribution, the medical teamgave instructions about dosing during the morning and evening power station ERC meetings, andthereafter, information about dosing methods was disseminated within the seismic isolated buildingin the same manner as changes were made. (On March 20, dosing was changed to one tablet after
the second day of dosing. On April 10, it was decided that continuous dosing would continue until
the 14. In the case of intermittent dosing the change was made that two tablets should be taken on
the first day of dosing.)
Guidelines for dosing stated that all workers under 40, and those workers over 40 who desiredso, should be dosed if engaging in disaster work where the predicted thyroid gland equivalent doseradiation level from radioactive iodine was 100mSv.
Iodine tablets were provided for approximately 7 months from March 13 through October 12,
and the scope of provision was shrunk down on August 2 to some workers in designated buildings
and then completely halted on November 21. Approximately 2000 workers, including contractors
and TEPCO employees, were dosed, and approximately 17,500 tablets were provided with about
75% receiving less than 10 tablets per person, and at most 87.
Workers that took more than 20 iodine tablets or that continually dosed for more than 14 days
were given medical examinations (approximately 230 exams given), and no abnormalities wereseen. There were 178 workers that showed thyroid gland deposited equivalent doses of over
100mSv, and 25 workers under the age of 40 did not take iodine tablets. During the accident it was
extremely difficult to take suitable protective action in regard to radiation control, and the fact that,even though information about iodine tablet dosing was disseminated, ultimately there were
workers that did not take the tablets, which is a point that requires examination.
Thoroughly disseminating information in advance in the form of manuals and deciding on
dissemination methods to be employed during accidents in addition to providing regular educationin regard to precautions and usage guidelines regarding iodine tablet dosing and the need for it
would be effective for increasing awareness about iodine tablet dosing in the event that iodine tablet
dosing becomes necessary.
[Tepco Report] Chapter 13 Section 3

 Measuments and assessments of personal dose in emergency work
Descriptions about reservations of personal dosimeters, WBCs and protective
tools, and administration of stable iodine in emergency works are given in[Governmental Interim Report], [National Diet Report] and [TEPCO Report] in127

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the following way.
(2) Overview of people affected by radiation exposurea. Exposure of radiation workers
Table II-2 Exposure of radiation workers
Exposure dose (mSv)
Number of persons
Proportion (%)
Above 250
60.04
200 (excl.) to 250 (incl.)
30.02
150 (excl.) to 200 (incl.)
20
0.12
100 (excl.) to 150 (incl.)
133
0.79
50 (excl.) to 100 (incl.)
588
3.48
20 (excl.) to 50 (incl.)
2,193
12.96
10 (excl.) to 20 (incl.)
2,633
15.57
10 or less
11,34067.04
Total
16,916(The information about the number of persons is as reportedby TEPCO. The information is as of
September 30.)
In the period between March 11 (beginning of the accident) and the end of September, morethan 16,900 persons were engaged in emergency work activities.
The legal limit on the maximum dose that is incurred on a worker while being engaged inemergency work activities had been 100 mSv. However, on March 14, a decision was made topermit 250 mSv as the maximum dose for a worker during engagement in particularly demanding
work activities conducted in response to the Fukushima nuclear accidents.
Six workers have exceeded this dose limit of 250 mSv during engagement in work activities
conducted in response to the Fukushima nuclear accidents.
[Governmental Interim Report] Chapter II 4

c. Occurrence of exposed subjects and their countermeasures(a) Subjects exposed to contaminated water from the Unit 3 turbine building
On March 24, three workers from a TEPCO partner company (male staff member A in his 30s,
male staff member B in his 20s, and male staff member C in his 30s), who were installing electric
cables under the surface of the basement floor of the Unit 3 turbine building, were exposed to highradiation dose while working immersed in contaminated water. In terms of radiation dose (external
exposure), staff member A received 180.1mSv, staff member B received 179.34mSv and staff
member C received 173mSv before they had finished working.
On March 24, these three staff members were informed that the air radiation dose rate at theworksite in the basement of the Unit 3 turbine building was about 2mSv/h on the previous day,March 23, before they walked down to their work site. They put on Tyvek protective suits andcharcoal filter masks and also carried an APD with them. Additionally, staff members A and B put
on low quarter shoes and staff member C wore high boots. Then they headed for the work site.
Their APD was set to sound an alarm once each time the external radiation dose reached 4mSv andto sound a continuous alarm for three minutes to alert them that the external dose had reached
20mSv.
The three staff members found that there was a pool of water about 15cm deep covering theentire floor. They thought that it was probably only seawater and decided to start working. Their
APD sounded before they started working. However, they thought that either their APD had
sounded to tell them that its battery was flat or that their APD had malfunctioned due to thefollowing reasons: they had been informed in advance that the air radiation dose rate at the worksite was about 2mSv/h, and they had heard alarms before indicating an APD malfunction or as an
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alert to charge a flat APD battery. Thus they proceeded with installing the electric cables. Later staff
member A heard the APD sound continuously and wondered if the air radiation dose at the work site
could be higher than expected. However, he thought it was important for them to complete their job
to restore the power supply so they continued working.
After completing their job, it was discovered that these three staff members were all likely tohave received high radiation dose. Staff members A and B in particular were at a high risk ofradiation heat burns from their feet being soaked in radioactive water because they were wearing
low quarter shoes thus subjecting them to continuous localized exposure. They visited Fukushima
Medical University Hospital and the National Institute of Radiological Sciences to get cleaned up
and have a checkup and get tested to measure their internal radiation doses. The localized radiationdose both staff members A and B received on their feet was 466mSv. Neither staff member A nor B
suffered radiation heat burns on their feet.
In response to this incident, on March 25, TEPCO and its partner companies decided that if
workers find something at their work sites contrary to what they are told in advance, they shouldreport to the Station ERC to seek directions and that workers should leave their work sites
immediately if they hear an APD sound its alarm. They gave their workers instructions to this effect.
(b) Subjects exposed to radiation exceeding the dose limit for female staff (5mSv for threemonths)Four whole body counters (WBCs) that had been installed at the Fukushima Dai-ichi NPS wererendered inoperative due to a power blackout and an increase in air radiation dose rate. On March
22, TEPCO borrowed vehicle-mounted WBCs from JAEA and had them installed at Onahama.
TEPCO started measuring the internal radiation dose of individual workers who were engaged inemergency work at the Fukushima Dai-ichi NPS using these WBCs. As a result, on April 27 andMay 1, it was discovered that two female staff had received radiation dose exceeding the dose limit
for women that is 5mSv for three months.
Female worker D, in her 50s, who was exposed to 17.55mSv of radiation, had mainly been
engaged in firefighting related jobs at the fire station gatehouse near the Seismic Isolation Building
excluding the period from March 11 to 23 when she had been temporarily evacuated to the
Fukushima Dai-ni NPS. While she was working there, she refueled fire engines more than once
outside the Seismic Isolation Building. Female worker D had been working at the gatehouse until
she received the instruction of evacuation issued from the Fukushima Dai-ichi NPS on March 23.
Female staff member E, in her 40s, was exposed to 7.49mSv of radiation while she had been
engaged in healthcare-related work as a crisis team member in the Seismic Isolation Building
during the period from March 11 to 15. In the Seismic Isolation Building, she usually stayed in theemergency response control room on the second floor. Whenever someone was injured or sick, shewent to the sick bay located near the entrance on the first floor to take care of him or her. She also
worked near the entrance of the Seismic Isolation Building whenever emergency personnel arrived
from outside. The doors of the entrance to the Seismic Isolation Building, which were bent andtwisted at the time, were only temporarily sealed up. Hence, the air radiation dose rate on the firstfloor was higher than that on the second floor. In addition, female staff member E has not returnedto the Fukushima Dai-ichi NPS since leaving there on March 15.
A common factor in both female staff members D and E, who were exposed to radiation, wasthat both of them had spent a long period of time near the entrance of the first floor of the Seismic
Isolation Building, where the air radiation dose rate had been relatively high since the day of thenuclear accident. One factor specific to female staff member D was that she was engaged inrefueling operations several times outside the Seismic Isolation Building.
On May 2, TEPCO summarized the causes of these radiation exposure incidents in which its
staff received radiation dose beyond allowable dose limits and established measures to prevent
similar incidents in the future and reported their findings to NISA.
This report describes the causes of these incidents as follows: after the nuclear accident, accessto and from the Seismic Isolation Building was not properly controlled initially, the double-entry
doors to the Seismic Isolation Building were not airtight and the doors to the Seismic Isolation
Building were bent and twisted by the hydrogen explosions in Units 1 and 3. TEPCO concluded that129

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these factors resulted in female staff members D and E inhaling radioactive materials. Based on thisconclusion, TEPCO implemented measures to prevent similar incidents in the future as follows: (i)on and after March 23, the Fukushima Dai-ichi NPS shall be managed and controlled without
female workers, and (ii) the concentration of radioactive materials in the air shall be reduced in the
Seismic Isolation Building by installing a local ventilation machine. In addition, TEPCO decided to
implement the following additional measures for the future: (i) the entire premises of the Fukushima
Dai-ichi NPS shall be treated as a controlled zone, (ii) radiation workers shall wear proper
protective equipment to match their working environments, (iii) a system shall be implemented tocontrol exposure, (iv) internal exposure doses for individual workers shall be measured more often(once a month when incidents have occurred and once every three months during normal times), (v)individual radiation workers shall be tested to measure internal radiation dose if the externalradiation dose they have received exceeds 100mSv, and (vi) they shall not be allowed to work at the
Fukushima Dai-ichi NPS if the external radiation dose they have received exceeds 200mSv. TEPCO
reported these findings to NISA.
(c) Subjects exposed to radiation exceeding the dose limit for urgent emergency work (250mSv)
Subsequently, it was discovered that, on June 10 two workers (male staff member F in his 30s
and male staff member G in his 40s), on June 20 1 worker (male staff member H in his 50s), and on
July 7 three workers (male staff members I, J, and K in their 20s) had been exposed to radiation
over 250mSv of the radiation dose limit, which was newly mandated by law.
Male staff members F, G, and H kept watch in the main control room of Units 3 and 4 during theperiod from March 11 to the evening of March 13 and subsequently they were engaged in theirwork several times. The exposure dose that these three staff members received were as follows:
staff member F received 678.08mSv (88.08mSv of external dose and 590mSv of internal dose), G
received 643.07mSv (103.07mSv of external dose and 540mSv of internal dose) and H received
352.08mSv (110.27mSv of external dose and 241.81mSv of internal dose).
Staff members F and G were engaged in collecting plant data in the main control room. Staff
member H was the leader of additional staff in the same room. After the earthquake, the airradiation dose rate increased in the main control room of Units 3 and 4. Staff member H instructed
the other staff in the room to wear masks. Unfortunately, there were not enough charcoal filter
masks, which can screen out volatile iodine, for each staff member in the room. Some staff in themain control room wore charcoal filter masks and others wore dust filter masks, which cannot
screen out volatile iodine, until charcoal filter masks were delivered from the Seismic Isolation
Building in the evening of March 12. Staff members F, G, and H wore dust filter masks until the
charcoal filter masks were delivered from the Seismic Isolation Building in the evening of March 12.
In the control room, individual staff members were in charge of specific panels and were engaged inchecking their respective panels on a continual basis. Staff members F and G spent most of theirtime checking the meters nearest the emergency doors, which were bent and twisted by the blast of
the explosion. On the evening of March 13, these three staff members were replaced with backup
members and then moved to the Seismic Isolation Building. At dawn on March 15, they were
instructed to evacuate to the Fukushima Dai-ni NPS. Subsequently when they moved to the Seismic
Isolation Building of the Fukushima Dai-ni NPS, they were grouped into teams to collect data in thesame rooms in regular shifts for intervals of several hours. Additionally, staff member F was
engaged in vent operations with two other staff members on March 13. Staff member G was
engaged in refueling operations with two other staff members near Unit 1 on March 12. Staff
member H had not been engaged in any outdoor operations until he moved to the Seismic Isolation
Building. From March 14, he was engaged in refueling operations or checking fire extinguishingpumps at his work site. In addition, these three staff members had not taken stable iodine tablets
until they moved to the Seismic Isolation Building on the evening of March 13. Additionally, staff
member F had occasionally smoked cigarettes before the explosion in Unit 1 on March 12.
Additionally, staff members F and H wore glasses.
Further, three staff members, I, J, and K, had been engaged in both restoring meters to theirformer state in the main control rooms of Units 1 and 2, and securing electric power supply
outdoors, staying mainly in the Seismic Isolation Building since the earthquake. The radiation dose130

Japan Health Physics Societythat these three staff members received was as follows: staff member I received 308.93mSv(49.23mSv of external dose and 259.70mSv of internal dose), staff member J received 475.50mSv(42.40mSv of external dose and 433.10mSv of internal dose) and staff member K received
359.29mSv (31.39mSv of external dose and 327.90mSv of internal dose).
Early in the morning of March 12, the main control room shift supervisors of Units 1 and 2
instructed the staff in the rooms to wear masks. Staff member K wore a charcoal filter mask. Staff
member J, most likely wore a dust filter mask, at least in the beginning. Staff member I joined theoperations in the control room from that same day and from the very beginning wore a charcoal
filter mask.
Subsequently, staff members I, J, and K were engaged in restoring meters to their former state in
the main control rooms of Units 1 and 2 and in carrying meters to the control rooms wearing Tyvek
protective suits and charcoal filter masks.
The emergency doors to and from the main control rooms of Units 1 and 2, which had been bent
and twisted by the blast from the explosion in Unit 1, were only temporarily sealed up with vinyl
sheets. Meters on the side of Unit 1 were located in a stream of air flowing from the emergency
doors. Staff members I, J, and K were also engaged in restoring these meters to their previous state.
Additionally, there were sweets and drinks on the tables in the main control rooms of Units 1
and 2. These three staff members sometimes ate and drank at the table without wearing masks.
Moreover, staff members J and K sometimes took their masks off and spent short periods of time
without them or they loosened their masks because their breath fogged up their masks or theirmasks were too tight giving them a headache. Additionally, staff members I and J wore glasses.
A common factor in both staff members F and K receiving radiation exposure was that both ofthem were engaged in their duties near the emergency doors. Moreover, a common factor in staff
members F, G, H, and J receiving radiation exposure was that they wore dust filter masks instead ofcharcoal filter masks while they were working.
TEPCO summarized the causes of radiation exposure for staff members F and G on June 17 andthose of staff members H, I, J, and K on August 12, and reported these findings to NISA. The report
describes the suspected causes of radiation exposure as: (i) it was difficult to wear masks properly
and implement protective measures to control radiation even more effectively, (ii) its staff had nochoice but to eat and drink in the main control room, (iii) the arms of glasses created a gap between
the face and the mask, and (iv) its workers were engaged in their duties near the emergency doors,
where the concentration of radioactive material was estimated to be extremely high. Based on theseestimations, TEPCO decided to implement the following measures to prevent similar radiation
exposure in the future: (i) information shall be shared more efficiently and equipment and material
including masks shall be placed in their proper location, (ii) staff shall eat and/or drink only indesignated areas, (iii) staff shall learn how to use and manage protective equipment for personal
protection, and (iv) staff shall complete a pre-work survey.
(d) Health care provided for staff engaged in emergency works
TEPCO conducted further evaluations on the internal exposure its staff received. Subsequently,
it was discovered that some employees who had been working on the premises of the Fukushima
Dai-ichi NPS quit immediately after the nuclear accident and their whereabouts remained unknown.
TEPCO collected and compiled this data and reported their findings to NISA. On July 7, NISA
performed an on-site inspection to confirm that identification was not conducted properly, not evenwith public/official identification; that upon issuing a work permit the license was not delivered byhand; and that access to and from the nuclear power station was not managed exactly according to
specific rules and regulations prescribed by nuclear power station authorities. On August 1, basedon this on-site inspection, NISA reprimanded TEPCO and instructed TEPCO to provide a reportsummarizing how it would improve its system.
Prior to June 8, access to the Fukushima Dai-ichi NPS was possible even without a work permit.
From June 8, access to the station required a work permit. However, a work permit was only issued
if a partner company had confirmed the original public/official document with a photo attached.
TEPCO issued copies of the work permit. Thus, TEPCO's work permit were handed out on a per
partner company basis, not on a per person basis. TEPCO decided that from July 19 work permits
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should be handed out directly to individual workers on a per person basis.
In addition, TEPCO asked its partner companies to perform aggregate data research. As a result,it was discovered that a total of 150 workers (11 workers in March, 66 workers in April and 73
workers in May), who previously belonged to TEPCO's partner companies and worked on thepremises of the nuclear power station, were unable to be contacted. On August 8, TEPCO
announced this. Subsequently, TEPCO and its partner companies fully examined all lists of theiremployees and established their contact details. As a result, as of October 31, only 16 of the 150
workers were unable to be contacted. In addition, as of this date, employees who had worked on thepremises of the station after July were all contacted.
On May 17, the NERHQ developed a "Policy for Immediate Actions for the Assistance of
Nuclear Sufferers" implementing long-term health management and a database capable of tracking
the exposure radiation dose over the long-term for all workers engaged in emergency operations to
help control the current situation. In response to this situation, on June 27, the MHLW establishedan "investigative commission for long-term health management of workers at TEPCO's Fukushima
Dai-ichi NPS" lead by Mr. Yoshiharu Aizawa, vice-president of Kitasato University School of
Medicine. The commission discussed how to conduct long-term health management of employees
engaged in emergency work even after they left their current jobs including acquiring necessary
information and conducting health checks. On September 26, the commission developed a reportand issued an announcement to that effect.
[Governmental Interim Report] Chapter V 4

b. Workers at the nuclear power plant who had a cumulative internal and external exposure
dose greater than 250mSv
The figures for the estimated cumulative effective dose of external exposure for residents in theadvance survey described above are generally low. The workers at the nuclear power plant, however,were exposed to higher doses than the residents due to this accident.
During the period from March 2011 to April 2012, the number of workers engaged in efforts tobring the accident under control included 3,417 from TEPCO and 18,217 from other cooperatingcompanies. Six TEPCO workers were exposed to a radiation dose in excess of 250mSv (cumulative
dose of external and internal exposure), which is the upper dose limit for emergency responders
stipulated in the Ordinance of the Ministry of Health, Labour and Welfare on special provisions to
the Ordinance on Prevention of Ionizing Radiation Hazards. The number of workers who were
exposed to a radiation dose in excess of 100mSv (cumulative dose of external and internal
exposure), which is the figure considered to be the reference dose for incurring health damage,amounted to 146 persons among TEPCO workers and 21 persons among workers from othercompanies. The average exposure dose for workers from TEPCO and from other companies is,respectively, 24.77mSv (TEPCO) and 9.53mSv (other companies).
[National Diet Report] Chapter 4, 4.1

4.4.5 Exposure of nuclear power plant workers
On March 11, 2011, with the Fukushima Daiichi Nuclear Power Plant’s Unit 4 undergoingdisassembly for inspection and Units 5 and 6 undergoing routine inspections, over 5,000 workers
from partner companies were working at the nuclear power plant. Including TEPCO employees, a
total of approximately 6,400 people were working at the site. Due to the emergency operations in
the wake of the disaster, 167 of the nuclear power plant workers were exposed to radiation over
100mSv (total for internal and external exposures)—a dose that is thought to mean a significant
cancer risk, assuming the LNT model. Among these, 6 workers were exposed to over 250mSv—theupper limit of the dose for workers in emergency operations, as set by the law—and 2 female
workers were exposed to doses above the exposure limit for women. Between March 2011 andApril 2012, the average exposure dose received by the workers of TEPCO and of partner companies
was 24.77mSv and 9.53mSv, respectively.
The Commission conducted hearings and a questionnaire to gauge the radiological protection
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TEPCO offered to nuclear power plant workers immediately after the accident at the Fukushima
Daiichi Nuclear Power Plant. The questionnaire targeted approximately 5,500 nuclear power plant
workers who were working on-site at the time of the accident. The purpose was to collect theopinions of the workers regarding the radiological protection measures taken by TEPCO
immediately after the accident, including the management of dose levels. The hearings wereconducted with a total of ten people, including TEPCO’s radiological management personnel (headoffice and on-site), who manage the exposure of nuclear power plant workers, as well as the nuclear
power plant workers, including five of the six people exposed to over 250mSv. The measures thatTEPCO had taken for severe accidents were insufficient. As for the radiation protection measures
TEPCO took for the nuclear power plant workers dealing with the accident, the fact that multiple
workers were exposed to radiation in excess of the dose limit for the worker in emergency
operations is a problem that should be noted. The delays in measuring the exposure doses of theworkers which came about as a result of delays in taking internal exposure measurements, as well as
TEPCO’s insufficient management of the cumulative exposure doses of workers, are also problems
that should be noted. Meanwhile, it is worth pointing out that at the Fukushima Daiichi plant,
TEPCO workers and others took protective actions to reduce the exposure of the plant workers attheir own discretion, including measuring the contamination level within the premises and creatinga dose map.
In order to ensure the safety of residents, measures to counter the exposure of nuclear power
plant workers are crucial; it is vital that the safety of the workers is ensured in dealing with anaccident.
(Omission)
2. Situation of high exposure risk
TEPCO’s legal responsibilities as an operator toward workers are provided for in the Ionization
Rules. According to these rules, among other obligations, the operator is obligated to measure theexternal and internal exposure doses of radiation workers and to inform them of these results
without delay. However, during the emergency immediately after the accident, there was a lack ofradiological protection equipment, as, for example, dosimeters were washed away by the tsunami.
TEPCO was unable to sufficiently manage the exposure dose received by the nuclear power plant
workers and take protective action for them against radiation.
TEPCO explained that from before the accident, efforts were being made to reduce the dose
received by nuclear power plant workers. However, according to hearings with TEPCO’s radiation
management personnel, dose management after the accident had been, in large part, left up to the
judgment of the workers on site. In our survey of the workers who were at the site, many
expressed dissatisfaction with this.
The following paragraphs describe specific cases of high exposure and violations of laws andordinances.
a. Exposure due to contaminated water in the turbine building of Unit 3
On March 24, 2011, the feet of three workers from an affiliated company who were laying
cables on floors 1 and B1 (basement) of the turbine building of Unit 3 of the Fukushima Daiichi
plant came into contact with contaminated water, and received an external exposure dose of morethan 170mSv. Two of the workers were wearing low shoes. As a consequence, radioactive
material adhered to their feet, and the workers were at risk for beta burns. These workers were
examined at the Fukushima Medical University Hospital and were hospitalized the following day
at the Research Center Hospital for Heavy-Ion Radiotherapy at the National Institute ofRadiological Sciences. The remaining worker was taken to the Fukushima Medical University
Hospital and was hospitalized the following day at the Research Center Hospital. Theirexaminations revealed that the dose to their feet and their internal exposure did not reach a levelthat required treatment.
b. Female workers
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Between March 11 and 23, 2011, a female worker in her fifties received a cumulative radiationdose of 19.38mSv due to work conducted on site, including the fueling of fire trucks and othervehicles. Another female worker in her forties, over a period of four days from March 11, 2011,
received a cumulative radiation dose of 9.09mSv due to medical work conducted within theseismic isolation building. These doses significantly exceed the 5mSv three-month upper limit for
female radiation workers, as set forth in Article 4, paragraph 2 of the Ionization Rules. Afterphysicians examined the two female workers, the diagnosis was that their exposure had no effecton their health.
c. Workers exposed to radiation exceeding the 250mSv emergency dose limit
Between March 11 and May 23, 2011, a TEPCO employee in his thirties who worked at themain control room of Units 3 and 4 of Fukushima Daiichi Nuclear Power Plant collected data at
the main control room, operated equipment of the power plant, and engaged in tasks outdoors, inthe turbine building, and in the reactor building; in these processes, he received a cumulative
radiation dose of 670.36mSv. Between March 11 and May 30, 2011, a TEPCO employee in his
forties who worked at the main control room of Units 3 and 4 of the Fukushima plant conductedsimilar work and received a cumulative radiation dose of 639.73mSv.
During a one-month period from March 11, 2011, a TEPCO employee in his fifties who worked
as a shift supervisor at the main control room of Units 3 and 4 giving instructions to operators at
the main control room. While he did not enter the reactor building or the turbine building, hereceived a cumulative exposure dose of 346.27mSv. What the above three people share incommon is that, during the three-day period from the disaster’s occurrence on March 11 to March
13, they all worked at the main control room of Units 3 and 4, managing equipment within the
power plant, for example, by making round trips as a team between the main control room and theturbine building/reactor building.
In addition, between March 11 and around early May 2011, three TEPCO workers, as membersof the recovery team at the site, traveled to and from the seismic isolation building and the main
control room of Units 1 and 2, taking instrument measurements and conducting recovery efforts.
At the main control room, workers sometimes went to the reactor building and turbine building toconnect the cables and transport batteries, among other tasks. In less than two months, the threeworkers received cumulative radiation doses in the range of 289.41 to 458.72mSv.
The exposure levels of these six workers significantly exceed the 250mSv upper limit for
exposure for emergency operations, as set forth in the ministerial ordinance concerning the special
provisions of Article 7, paragraph 2 of the Ionization Rules.
[National Diet Report] Chapter 4, 4.4.5

13.3 Handling and Circumstances Surrounding Worker Exposure(1) Worker Exposure Radiation Level Distribution
Measurement and evaluation of exposure radiation levels with workers engaged in emergency
work at the Fukushima Daiichi NPS has been implemented continuously since the
Tohoku-Chihou-Taiheiyo-Oki Earthquake. The monthly external exposure for workers engaged inradiation work at the Fukushima Daiichi NPS from the accident in March 2011 until February 2012,
as well as an accumulated radiation level (accumulation of external exposure and internal exposureradiation level totals) distribution is indicated in [Attachment 13-3].
The average worker external exposure value for 3,765 people during March 2011 was high at
13.81mSv; however, the average value for 5,128 people in April of 2012 was 1.07mSv/month due
to decreasing trends in field work environment dose rates. This is approximately 10 times thenormal annual average exposure radiation level of 1.4mSv/yr (FY2009) for workers at the
Fukushima Daiichi NPS, and approximately 10 times higher than normal outage environments evenfor work environments during March 2012.
The employee and nonemployee exposure radiation level distribution for March 2011 is shown
below. According to this, it is clear that the exposure by TEPCO employees is pushing up the
average.
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Six workers suffered an exposure that exceeds the emergency worker radiation level limit of
250mSv; however, all of these workers were TEPCO employees who were operators orelectrical/instrument engineers that were in the MCR following the accident to monitor instruments.
As soon as it was discovered that these workers suffered a dose that exceeded 250mSv they wereimmediately removed from the Fukushima Daiichi NPS and have undergone health examinations
and have been examined periodically by physicians. No impact to their health has been seen.
Long-term health management shall be implemented in accordance with radiation levels for
emergency workers in the future, including those workers that suffered a dose that exceeded
250mSv. A government policy has been stipulated1 in regard to the long-term health management
emergency workers and the policy calls for the implementation of periodic tests and examinationsin accordance with radiation months; however, in addition to this, all efforts will be made to manage
the help of emergency workers, including increasing the range of workers to be screened for cancer.
(2) Worker Exposure that Exceeded Radiation Level Limits
In regard to exceeding radiation level limits, the occurrence of events ① and ② below havebeen confirmed. The report regarding determination of the causes and formulation of the recurrence
prevention countermeasures has been submitted to NISA, and currently exposure radiation level
management is being enhanced and recurrence prevention countermeasures are being thoroughly
implemented upon the instruction of NISA and the Ministry of Health, Labor and Welfare.
Furthermore, no abnormalities have been found in the results of medical exams performed on
the following employees to date.
① Two female TEPCO employees exceed radiation level limit stipulated by law (5mSv/3
months) law (5mSv/3 months)1
Two female TEPCO employees (in their 40s and 50s) were engaged in fire engine refueling,
desk work in the seismic isolated building, and caring for people who felt ill in the seismic isolatedbuilding, etc. Although they took appropriate radiological protection measures, such as wearing fullface masks with charcoal filters, in working in the field, it is estimated that their effective dose
exceeded the legal radiation level limit as a result of that they inhaled radioactive materials that had
leaked from the outside into the seismic isolated building where it was difficult to prevent the influxof reactive materials due to the reactor building explosions.
Furthermore, on and after May 23, because women were not allowed to work within the
Fukushima Daiichi NPS, there is no possibility that the above two female employees sufferedexposure within the Fukushima Daiichi NPS after this day.
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Japan Health Physics Society② Six male TEPCO employees exceeded the emergency radiation level limit stipulated bylaw (250mSv)
The six male TEPCO employees are MCR operators and electrical/instrument related
maintenance workers that engaged in operation and monitoring work and also work to restore
monitoring instruments, etc. in the MCR, etc. for several days following the day of the earthquake.
As a result of (1) the influx of contaminated air into the MCR through the MCR's emergency
door that was damaged by the reactor building hydrogen explosions (through which gasoline
generator power cables were passed at the night of March 11 in order to supply power to the MCR),(2) the fact that it was difficult to accurately take protective action, such as appropriately selecting,wearing, and obtaining the mask, in conjunction with the quick escalation of the event and (3) otherfactors, these workers ingested radioactive materials.
When the emergency worker radiation level limit of 250mSv was adopted, the Radiation
Council issued a statement regarding the determination that the limit is appropriate. The statement
conveyed that the limit was determined to be appropriate in light of consistency with internationallyallowed recommended values (500mSv), 500mSv is the threshold of tissue damage and thedefinitive effect of the value is internationally determined not to lead to acute disorders or causedelayed serious disorders. The radiation level limit of 250mSv is positioned in this way from theperspective of the effects of radiation and protection; however, whereas emergency workers weremanaged in accordance with the aforementioned radiation level limits, and as mentioned previously,some emergency workers during the initial stages of the accident ingested radioactive materials andas a result suffered a dose that exceeds radiation level limits, steps have been taken for stricter
control to ensure that radiation level limits are not exceeded since the above event.
Under the management background as stated above, as of the present, no radiation damage had
occurred among all emergency workers, including workers that suffered a dose that exceededradiation limits. Whereas workers responded amidst extremely harsh conditions during the initialstages of the accident, it is considered that substantial safety management had been implemented
from the perspective of preventing radiation damage.
[Tepco Report] Chapter 13 Section 3

The following isssues can be raised in association with radiation exposure of plant
recovery workers.

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Radiation exposure of plant recovery workers – network for urgently borrowing
alarm pocket dosimeters (APDs)
 Although many APDs were provided as aid supplies from other NPSs, these
APDs were simply stored and remained unused owing to a lack ofcommunication. There were not enough APDs and by 15 March, not every
worker was able to wear an APD, which led to the decision that only theleaders of each operational group would wear APDs on behalf of the entire
group.
Radiation exposure of plant recovery workers – control of internal exposure inan emergency
 The individual doses of 6 workes exceeded 250mSv, which was the dose limit
for emergency workers temporarily prescribed after the accident.
 The main control room outside the controlled areas was not equipped with asufficient number of full-face masks. In addition, since the number of charcoal
filter masks was not sufficient for all of the workers, some staff members justwore dust filter masks until charcoal filter masks were delivered from the Seismic
Isolation Building in the evening of 12 March.
 There were actual cases in which staff members sometimes ate and drank in themain control room without wearing masks, sometimes took their masks off andspent short periods of time without them, and sometimes loosened their masks
because their breath fogged up their masks or their masks were too tight, causing
headaches. Moreover, there was a possibility that the arms of glasses created a
gap between the face and the mask.
 The emergency doors to and from the main control rooms of Units 1 and 2, which
had been bent and twisted by the blast from the hydrogen explosion in Unit 1,
were only temporarily sealed with vinyl sheets. Meters on the side of Unit 1 werelocated in a stream of air flowing from the emergency doors. In the main control
room of Units 3 and 4, some staff members also spent most of their time checking
the meters nearest the emergency doors, which were bent and twisted by the blastof the explosion.
 Some staff members in the main control room of Units 3 and 4 did not take stableiodine tablets until they moved to the Seismic Isolation Building on the eveningof 13 March.
 Since the ambient dose in the whole body counter (WBC) room became higher
following the accident, those WBCs could not be used. From 22 March, TEPCO
borrowed vehicle-mounted WBCs, which were installed at the Onahama Call
Center, and internal exposure tests of the workers were commenced.
 When a high contamination was observed, personal decontamination was carriedout to remove external contamination. Since the worker then needed to wait for
approximately two weeks to receive a test purely for internal exposure, it tooktime to assess the high-level internal exposure.
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Japan Health Physics Society The doses of two female employees significantly exceeded the 5mSv
three-month upper limit for female radiation workers, although they tookappropriate radiological protection measures such as wearing full-face maskswith charcoal filters whilst working in the field, since the double-entry doors
to the Seismic Isolation Building were not airtight and the doors to the
Seismic Isolation Building were bent and twisted by the hydrogen explosions
in Units 1 and 3.
 178 workers showed thyroid gland equivalent doses of over 100mSv, and 25
workers under the age of 40 did not take iodine tablets.
Radiation exposure of plant recovery workers – control of localized exposure inan emergency
 On 24 March, two of three workers who were installing electric cables under
the surface of the basement floor of the Unit 3 turbine building were exposed
to high radiation doses while working immersed in contaminated water,
because they were wearing low quarter shoes. Although it was made clear,after getting cleaned up and having a checkup and getting tested to measureinternal radiation doses, that neither worker suffered radiation heat burns on
their feet, there had been a possibility of suffering from radiation heat burns
due to continuous localized exposure.
Radiation exposure of plant recovery workers – managing access to and from acontrolled area in an emergency
 After the nuclear accident, access to and from the controlled area of the
management system was initially impossible for calculating the radiation doseof individual radiation workers. It was then decided to manually calculate theradiation dose of individual radiation workers using APDs. (On 14 April, five
simplified instruments were installed in the Seismic Isolation Building for
gaining access to and from the controlled area management system. At thesame time, a radiation work permit with bar code patterns was introduced sothat the names and radiation doses of individual workers could be
automatically recorded).
 From the date of the nuclear accident to 10 May, radiation workers wereallowed to carry out their duties after receiving a brief 30-minute explanation
about how to protect themselves from radiation and how to wear protective
equipment.

(5) Communication to the public
Descriptions about communication to the public are given in [Governmental
Interim Report], [Governmental Final Report] and [Nongovenmental Report] in138

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the following way.
8. Details of events in areas where there may be problems with the provision of information to
the public(1) Institutional arrangements for the dissemination of information concerning the Fukushima
nuclear accident
The dissemination of information about the Fukushima Dai-ichi nuclear accident was started firstindependently by (1) the Chief Cabinet Secretary, (2) NISA, which is the administration agency for
TEPCO, (3) the Local Nuclear Emergency Response Headquarters (only after it was transferred to
the Fukushima Prefectural Office on March 15), (4) Fukushima Prefecture, and (5) TEPCO.
However, from March 12 the dissemination was conducted after getting the approval of the Prime
Minister's Office in advance as described below, and then since April 25 the press release has been
carried out under one umbrella by integrating the publicity of the Government and TEPCO as
described in III 4 (2) b above.
From March 12 to 15, the Local Nuclear Emergency Response Headquarters did not deal with thepress because the Off-Site Center, in which the Headquarters was established, was located within
the evacuation area (Okuma-town).
(Omission)(6) Announcement concerning the detection of tellurium, etc.
a. Publication of the results of the radionuclide analysis by NISAAs described earlier in 1(1) b, Fukushima prefecture conducted radiation monitoring around the
Fukushima NPS during the period from March 11 to 15. As a result, radioactive materials such as
iodine 131 and 132, cesium 137 and tellurium 132 were detected in samples of: (1) atmosphericsuspended dust collected in Namie-town during the period from 08:39 to 08:49 on March 12, and(2) atmospheric suspended dust collected in Minamisoma-city during the period from 13:20 to
13:25 the same day.
However, the secretariat of the Nuclear Emergency Response Headquarters did not publish
immediately most of the results of the monitoring conducted during the period from March 11 to 15,
and disclosed most of it for the first time on June 3.
b. Process until publication on June 3
When publishing the "Results of the Emergency Monitoring in the Vicinity of the Fukushima
Dai-ichi and Dai-ni NPS (conducted from March 11 to 15)" on June 3, the Local Nuclear
Emergency Response Headquarters explained the process until the publication as in the following:"the Local Nuclear Emergency Response Headquarters evacuated from the Off-site Center in
Okuma-town on March 15. As it was necessary to check the data left at the Off-site Center, the staffof the Off-site Center visited the building of the Center in Okuma-town again to retrieve the related
files and integrated the results of the monitoring on May 28. Now we can publish the results today
on June 3."
However, the results of the monitoring conducted in the vicinity of the Fukushima NPS in the
period from March 11 to 15 had been transmitted from the Local Headquarters to the secretariat of
the Nuclear Emergency Response Headquarters. The staff of the secretariat of the Nuclear
Emergency Response Headquarters who received the transmitted results published only the resultsof the monitoring that had been integrated in the form of tables by the Local Headquarters, and did
not integrate by himself the other results into the form of tables or any other form and left them as
was without publishing. Early in May, the secretariat of the Nuclear Emergency Response
Headquarters started to integrate the monitoring data that had not been published and prepared themfor publication as well as arranging the unpublished results of independent calculations using
SPEEDI for publication. The secretariat instructed the Local Headquarters to arrange theunpublished monitoring data for publication. According to the instruction, the Local Headquarters
integrated the monitoring data and retrieved the materials left in the Off-site Center in Okuma-town.
At that time the aforementioned unpublished data were retrieved and integrated, and then published139

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on June 3.
(7) Ambiguous expression of no “ immediate” effects on health
The Government often explained, "It does not have immediate effects on health" about the
influence of radiation on the human body. For example, in the Chief Cabinet Secretary's press
conference at approximately 18:00 on March 16, the Government explained that "It is not values
that will have immediate effects on the human body" about the monitoring results on the same day(the values over 30μSv/h had been obtained in Iitate, Minamisoma and Namie); the Government
also explained in the Chief Cabinet Secretary's press conference at approximately 16:00 on March
19 that "Please understand that the radiation dose does not have immediate effects on the health ofcitizens (even if you temporarily ingest food from which radioactive materials exceeding theprovisional limit are detected), so please act calmly" concerning the detection of radioactive
materials exceeding the provisional limit prescribed in the Food Sanitation Act from the milk
extracted within Fukushima Prefecture and the spinach harvested within Ibaraki Prefecture. In
addition, the Consumer Affairs Agency explained on the Agency’s web on March 20 that "It is notbelieved to have an immediate effect on your health even if you occasionally ingest food in whichradioactive materials exceeding the provisional limit prescribed in the Food Sanitation Act weredetected" in the message "About Delivery Restriction on Food Because of Detection ofRadioactivity" from the Minister of Consumer Affairs, Mr. Renho. Similar explanations wererepeated in the later messages of March 21 and 23. Furthermore, NSC also explained to the publicthat "Even if you continue to ingest food in which radioactive materials exceeding the prescribed
limit are detected, it will not have immediate effects on your health" in the notice "To the People
Living Outside the Areas where Evacuation or Sheltering Indoors is Conducted" on March 21,
2011.
It seems that the expression "immediate" effects was used on the basis of the following scientificknowledge: the causalities between radiation exposure and the occurrence of diseases such as
cancer is not clear for low-level radiation exposure; and it will take a considerably long time forcancer to occur if it ever does. In fact, the expression "It does not have immediate effects on thehuman health" may be interpreted by some people as "it is unnecessary to be anxious about the
impact on the human health," while it may be interpreted by other people as "It does not
immediately affect human health, however, some effects will be brought about on the human healthin the longer term." However, it was not necessarily clear which one the intended meaning was ofthe expression and there was no detailed explanation about it.
The Consumer Affairs Agency deleted the word "immediately" from the aforementioned message
on April 1. With regards to the intention to have used the expression "It cannot be considered to
immediately affect..." in the "Q&A for Food and Radioactivity" page on the Agency's website, theAgency explained that acute symptoms would not develop in the human body even if food in whichradioactive materials exceeding the provisional limit were detected were occasionally ingested
because the radiation dose from the ingested food is very small, but that the influence in case when
the ingested radioactive materials accumulate in the human body cannot be completely denied
because they are radioactive.
[Governmental Interim Report] Chapter V 8(5) Problems of provision of information to the nation and the international society
As mentioned in Chapter V 8 above, viewed from the perspective of residents near the disastersite who were forced to evacuate, and from the perspective of the Japanese people as a whole, inmany ways the manner in which the Government provided information to the Japanese people after
the accident created the impression, indeed the suspicion, that it was not telling the facts rapidly andaccurately. When explaining the reactor core situation (especially the core meltdown issue) and thecrisis situation at Unit 3, and when conveying information on the effect of radiation on the human
body, the Government frequently repeated difficult-to-understand explanations such as, “Thesituation is not something that would have an immediate effect on the human body.”
In the event of a nuclear emergency, which can gravely affect large areas and where the situation
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can change from moment to moment, the way the competent authorities provide information within
the country and abroad is an extremely important issue. In the case under investigation, the evident
tendency was to be slow in communicating and disclosing urgent information, holding back onpress releases, and giving vague explanations, and this type of risk communication during an
emergency cannot be regarded as acceptable, regardless of the situation. This Investigation
Committee intends to continue investigating and inquiring into this issue further, and shall present
necessary proposals regarding it in its final report.
There is something to be noted, too, with regard to providing information to other countries.
Immediately after the decision was made to discharge contaminated water into the sea, the decision
was executed without prior explanation to neighboring countries. This event included elements that
led other countries to distrust Japan’s nuclear emergency response, even if the action did not flout
treaty obligations (for example, the Convention on Early Notification of a Nuclear Accident). Thisshould serve as an important lesson for the future.
[Governmental Interim Report] Chapter VII 5

f. Analysis concerning the provision of information to the public(Omission)(c) Publicity about the impact of radiation
When conducting publicity activities concerning radiation exposure or concerns for radiation
exposure to residents during the accident at the Fukushima Dai-ichi NPS, the government often
used the expression “immediate (no immediate effect on the human body”). Chief Cabinet Secretary
Edano, taking a responsible role of government announcements, used often this kind of wording. He
mentioned at the beginning as, regarding low level radiation dose exposure of residents, forexample, “it does not harm human health much” (at around 08:30 on March 13), “the situation will
not develop to harm health in our view” (at around 15:30 on the same day), or “ a quantity not toworry about” (at around 21:00 on March 14). At the subsequent press conferences he began to use
the expression as “immediate (no immediate effect on the human body);” for example: “in broad
strokes, no immediate effect on human body,” at around 18:00 on March 16, regarding monitoring
figures of the same day at around 20 km from the Fukushima Dai-ichi NPS; or ”Your thoroughunderstanding and response with coolness are cordially requested, since the figures are not at a levelthat immediately affects your health (even if you take tentatively the food which contained
radioactive materials exceeding the provisional regulation values)” at the press conference at around16:00 on March 19, regarding radioactive materials detected from milk etc. exceeding provisionallyregulated values. Later in the hearing by the Investigation Committee, Chief Cabinet Secretary
Edano explained as “(We) Used (the expression) for implying that the effect of accumulated low
level radiation exposure was not obvious, but at least the value was in a level not to cause acute
symptoms,” referring to the expression “immediate…”
Besides, the expression “immediate (no immediate effect on health)” was also used on theConsumer Affairs Agency’s home page and in the NSC bulletin as mentioned previously in Chapter
IV. 8. (8).
In the background of such expression of “immediate,” there is scientific knowledge regarding
low level radiation exposure that correlation between radiation exposure and development of cancer
etc. is not obvious, and it will take considerably long time to become cancerous even if correlation
exists. Chief Cabinet Secretary Edano’s explanations mentioned above are likely to be based on thisscientific knowledge. However, this expression “no immediate effect on the human body” could
refer to “there is no need to worry about the effect on the human body” or conversely, “while there
is no immediate effect on the human body, there are long-term effects to the human body.” It was
not necessarily clear which meaning the expression had been used in reference to. Expressions suchas this, which could be comprehended in more than one way, should be avoided in the use of
publicity in times of emergency, and is an important issue to be reviewed in the future from theperspective of risk communication.
[Governmental Final Report] Chapter VI 1
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Japan Health Physics Society(7) Issues of the provision of information and risk communication
When a nuclear disaster that has a serious impact on a wide area occurs and additionally where
the circumstances change from one moment to the next, the approach taken to disclosing
information domestically and internationally by the institutions concerned is extremely important.
There are many means of conveying information, including press conferences and websites, but
unilaterally conveying a decision by the government or an expert is known as a risk message.
However, when conveying information in the case of a nuclear disaster, unilateral risk messages
will conversely pose a danger of fueling confusion and mistrust among the people, because it will
involve communicating information on sophisticated scientific and technical matters andinformation on radiation and radioactivity that bears little connection to the everyday lives of thegeneral public. It is desirable to communicate disaster-related information while getting feedback on
things such as what kinds of information citizens need, particularly citizens in the vicinity of theaccident site, and how these citizens are perceiving (interpreting) the information that has beencommunicated.
As already stated, the ways in which information was provided from the government to the publicin the aftermath of this accident raised many questions and doubts as to whether the information had
been communicated in a prompt and accurate manner, from the perspective of the residents in thesurrounding areas who had had to evacuate, and the people at large. Examples are: the way ofproviding information on the situation and predictions of dispersion of radioactive substances,which is important in the evacuation of residents in the vicinity; way of providing information on
the core conditions (in particular, core meltdown) and the critical conditions at Unit 3 of the
Fukushima Dai-ichi NPS; and repeated explanations of “there is no immediate effect on the human
body,” that were difficult to understand, when providing information on the impact of radiation on
the human body.
In this way, irrespective of the circumstances, as a result of cumulative problems such as delaysin the transmission and release of urgent information, the holding back of press releases and the lackof easy-to-understand explanations, citizens in the vicinity were prevented from making appropriate
autonomous decisions. Additionally, these problems fueled doubts and mistrusts among citizens,
including that “the government and TEPCO are probably covering something up.” As a risk
communication approach at a time of an emergency disaster, it was inappropriate.
A fundamental principle of public relations is to convey facts promptly, accurately and in aneasy-to-understand manner. Even in an emergency disaster, adhering to this principle is crucial
because it serves eventually to help people in the vicinity to make appropriate autonomous
decisions and prevents unnecessary uncertainty and confusion taking hold among citizens. At thesame time “promptness” and “accuracy” are sometimes in conflict with one another. In thatsituation it should be kept in mind that if sacrificing “promptness” in order to ensure “accuracy,”
there is conversely a danger of inviting citizen’s mistrusts and concerns. When a situation develops
in which information cannot be obtained and accurate public relations are not possible, it is bothnecessary and important to communicate that situation as it stands.
Additionally, looked at from the standpoint of being “easy to understand,” the communication on
evaluative facts requires particular consideration. As facts to be included in publicity, in addition toalready-released and already-known simple facts (for example, an explosion occurred at the reactor
building or contaminated water flowed into the sea, etc.), there are also evaluative facts that can beinferred from various already-known facts (for example, a core meltdown, or the impact of radiationon the human body, etc.). Unless these types of evaluative facts are explained with a great deal ofcare, more than occasionally it will be difficult to gain citizens’ understanding. Where evaluative
facts are concerned, it may be believed that in some cases it is probably not possible to say anything
conclusive due to insufficient information or the uncertainty of the situation, but even in thosecircumstances it would be desirable to provide an explanation to that effect and then disclose
information as promptly as possible.
The following can be said for all emergency situations, not just for nuclear disasters, but it isnecessary to build mutual trust between the public and the government and to provide relevant
information in an emergency while avoiding societal confusion and mistrust. To this end, a risk
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communication approach on risks and opinion exchanges thereupon should be adopted for aconsensus building among all stakeholders based on mutual trust. This time, amid the state of
confusion arising from the outbreak of a complex disaster, as previously noted a large number ofproblem areas could be detected in the government’s public relations activities, including those of
NISA, from a risk communication perspective. The government should examine, byinstitutionalizing an appropriate body, how to provide relevant information in an emergency to the
public, promptly, accurately, and in an easily understandable as well as clear-cut (not misleading)manner. Inappropriate provision of information can lead to unnecessary fear among the nation.
Therefore, an expert on crisis communication may be assigned for providing appropriate
suggestions to the cabinet secretary responsible for information provision to the public in an
emergency.
[Governmental Final Report] Chapter VI 2
Chapter 4 Risk communication[Outline] In this chapter, the appropriate method of risk communication in the Fukushima Daiichi
nuclear disaster implemented by the Kan Administration, and the effects on public concern andefforts to bring the accident under control are discussed. From a public opinion poll, it has become
clear that the public had a strong anxiety regarding information provision on the nuclear emergency
by the government. Communication with the public on the status of nuclear reactors and the risks of
low-dose radiation effects was a field in which the government had no experience. There werevarious trials and errors in finding an appropriate way for rapid and accurate disclosure of
information. In addition, the Prime Minister’s office had originally shown weakness in foreign
public relations. A system of risk communication was gradually completed after the accident.
Moreover, an appropriate way of risk communication in the era of social media is also discussed.
Social media, e.g., Twitter, Facebook and blogs, was utilized as a communication tool following the
Fukushima Daiichi nuclear accident. Here, information on the internet provided by member of the
public and experts, and official announcement from the government and TEPCO is compared, and it
is examined whether or not the government provided information required by people.
Section 1 Public anxiety regarding effects of nuclear emergency
There is a significant gap in risk perception between the general public and experts, regarding
nuclear technology and health risks owing to radioactivity. Owing to large differences in knowledge
and information amount, there is originally a problem that it is difficult for the general public andexperts to communicate with each other. It becomes particularly important to provide accurate
information in an easy-to-understand manner to the public in the case of a nuclear disaster. The
Japanese people would be highly sensitive to issues regarding radiation owing to their experience ofradiation in Hiroshima and Nagasaki.
However, after the Fukushima Daiichi nuclear accident, serious anxiety regarding the healtheffects of radioactive materials spread among Japanese citizens. According to a public opinion poll
implemented by newspapers with national circulations on April 2010, approximately 70% of the
respondents responded that the information provision and explanation by the government was
inappropriate. This quantitively endorses the fact that strong anxiety regarding the unknown disasterand frustration against the explanation by the government was broadly shared. In addition,according to the public opinion poll implemented by NHK, 60 to 70% of the respondents reported alow estimation of the government’s response to the Fukushima Daiichi nuclear accident, which had
been continuously serious since the government announced. After TEPCO’s announcement of theoccurrence of a meltdown at the early stage after the earthquake and the increase in criticism of thegovernment’s initial responses, this estimation became lower. Moreover, as mentined in Section 4,
such an elevated anxiety regarding radioactivity contamination can be seen from the trend in thesocial networks. After the accident, searches for terms related to the nuclear disaster such as“cesium” and “reactor meltdown” on the internet rapidly increased. Websites and Twitter accountsof experts who did not have a governmental role attracted much attention from citizens seeking asecond opinion against the governmental information. Special Advisor to the Cabinet, Hiroshi
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continued to suggest the importance of social and mental risk in the information provision of thenuclear disaster, pointed out that loss of trust from citizens occurred in reality looking back a seriesof responses to the accident. Also, he sugggeted that we should learn from the failures ofgovernmental risk communication, “At first, the government has to deeply recognize that it has lostthe confidence of its citizens regarding nuclear administration.”[Nongovernmental Report] Part 2 Chapter 4 Section 1(a) Understanding of low dose radiation exposure
Descriptions about understanding of low dose radiation exposure are given in[Governmental Final Report], [National Diet Report] and [Nongovenmental
Report] in the following way.
(g) Public understanding of radiation effects
Radiation effect to human body was reviewed in the Interim Report Chapter V. 4. (1), but cannot
be regarded easy to understand since it requires knowledge to understand the concept of such as
stochastic effect. Furthermore, it is also hard to accept that the general public had sufficient
opportunities to learn about scientific characteristics of radiation or its effect to human body at
schools or in a community19. It is reported that a considerable number of the public get fears
against radiation effect regarding the accident at the Fukushima Dai-ichi NPS, and there are victims
of fraudulent businesses taking advantage of such people’s fears. The facts stated above are likely
the cause of these happenings.
This accident has served as a reminder of the need not only to take all possible precautions inorder to protect ourselves against radiation, but also to “fear radiation properly.” Knowledge such as
the following will be useful in order to “fear radiation properly”:(i) Radioactive materials are not contagious like a virus;(ii) The average annual radiation exposure from natural radiation (including internal radiation
exposure from foods etc.) without accidents at nuclear power stations etc. is about 2.1 mSv a
year in the county (international average is about 2.4 mSv a year);(iii) Iodine-131 absorbed in human body accumulates in thyroid gland, but since its half-life isshort, only about eight days, the residual iodine-131 originating from the accident at the
Fukushima Dai-ichi NPS remains only little;(iv) The physical half-life of cesium-134 is two years and that of cesium-137 is 30 years. A large
amount of them still remain in the environment, but unlike the iodine, they do not accumulate
in particular parts of human body upon absorption. They are distributed uniformly to muscular
tissues of the whole human body, and half of them will be removed from the adult’s body in
90 days;(v) Human bodies originally contain about 120 Bq/kg of radiation materials including
potassium-40 and carbon-14;(vi) There are foods in our daily life consumption that contain 100 Bq/kg or more of radioactive
potassium; and(vii) Correlation between exposure dose and cancer initiation is not apparent in an environment ofless than 100 mSv, but the radiation protection principle assumes a direct proportion between
them.
There is, of course, a need to put utmost effort into preventing unnecessary exposure in the future,
and at the same time, as many opportunities as possible should be institutionalized for the public to
get knowledge and deepen their understanding of radiation. By doing so, the individuals would be
able to judge the radiation risks based on correct information; in other words, they would be freed
from unnecessary fears about or from underestimating, the radiation risks because of the lack of
information.
[Governmental Final Report] Chapter VI 2

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b. Communicating risk from radiation during the accident
How was the risk concerning radiation communicated during the accident?
Radiation cannot be felt. If the dose is low, its effects do not immediately appear. However, thepossibility that it can cause leukemia or cancer years, or even decades, later, is generally agreed
upon.
The residents who had to live in an environment contaminated by radioactive material after theaccident sought information about the level of radioactivity that would serve as a basis for making
decisions. Mothers, in particular, sought accurate information about the extent of thecontamination in the food and drink they were giving their children, and about the radiation dosefrom the environment and its effect on their health. The information that was made available to theresidents was not satisfactory. MEXT not only failed to communicate the results of theirenvironmental monitoring, for example, but later admitted that it had no intention of letting theresidents know the results directly after the accident. Public dissatisfaction became obvious whenmany of the mothers in Fukushima Prefecture and society at large levied criticism at theannouncement of twenty mSv per year as the standard for reopening schools.
The government has yet to respond to the residents’ urgent question: “What is the level of theenvironmental radiation where we live and how will it affect our health?” The content of theinformation the various government agencies is supplying to the residents more one year after theaccident has not changed from prior to the accident, and their attitude towards children andstudents remains the same.
Many of the residents do not know that the risks to their health increase with an increase in theradiation dose, and that there is no safe level. If they understood what the risks meant in terms of
the effect on their lives and how those risks could be measured and mitigated, then that would
help them to decide how to go on with their daily lives.
The understanding of the effect of radiation is different for each of the residents, so it isnecessary to understand the differences between those exposed. For example, explanations for
infants, the young, pregnant women or people with especially high radiation sensitivity should be
different from explanations to other groups. Only after residents have a deep understanding ofwhat is appropriate for them can they decide and act. When accidents occur and all they hear is amessage of safety and reassurance, such as that following the Fukushima accident, residents willreact with either trust or disbelief as the information presented is insufficient for them to make aproper analysis.
[National Diet Report] Chapter 4, 4.4.1

3. Explanations to the public concerning low-dose radiation exposure
There is no doubt that anxiety regarding low-dose exposure risk among people spread after theaccident, taking into consideration people’s highly elevated frustration with governmental
information provision as mentioned in Section 1. The reason for the increase in the nation’s anxiety
is based on multiple backgrounds as discussed in Chapter 2, Sections 2 and 4, but the issues raised
from the viewpoint of governmental communication are many. Statements of Chief Cabinet
Secretary Mr. Edano who became practically the highest ranking person for the purpose of
explaining the nuclear disaster to people in place of the Prime Minister are reviewed below.
The government—and in particular Chief Cabinet Secretary Edano—repeatedly stated that theradioactive elements released into the environment after the accident had “no immediate effect onhuman health.” The ambiguity of this statement fostered continuing public debate concerning thepossibility of adverse effects on health due to long-term exposure to radiation.
Edano provided the following explanation at the Budget Committee meeting of the House ofRepresentatives in November 2011:“During the first two weeks following March 11, I held 39 press conferences. At seven, I statedthat ‘there is no immediate effect of radiation on the human body or human health.’ At five of theseseven, my statement was made in the context of questions concerning food and drink. I nevermade any general statement that there would be no adverse effect to health. Rather, I repeatedly
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stated that there is a specified standard value for the level of radioactivity detection in milk which
would adversely affect the health if its ingestion were to continue for one year, and that even if such
milk were ingested once or twice, there would be no immediate problem.” Regarding this point, theexpression “immediate” is used in 10 of Chief Cabinet Secretary Edano’s statements on radiation
effects on health in the first two weeks.
Chief Cabinet Secretary Edano also stated at the Diet that the health assurances provided underthese statements were limited to one or two ingestions. A review of actual records of his statements,
however, casts some doubt on whether this description was entirely reasonable. The record shows,for example, that at his March 20 press conference, he said: “… even if a person continues to ingest
spinach containing radioactive materials at the recently detected concentration level, it isinconceivable that it would immediately affect health.” Likewise, at a press conference the day
before, when responding to a question on the risks related to milk, he said: “If, hypothetically, aperson were to continue to ingest milk containing radioactive materials at the recently detectedconcentration level for one year at the average rate of ingestion in Japan, the radioactive dose
exposure would be about the same as one CT scan.” The phrase “about the same as one CT scan”
may naturally be taken to imply that the dose was not large; it is difficult to hold that this statement
did not represent a public assurance of safety.
Days later, he told reporters that “even if something having this value or higher were ingested
several times or for several days, it could not possibly have any immediate effect nor would it haveany future effect”; the implication is quite clear that it is based on the assumption of a certain
numerical limit. However, this statement is made in conjunction with an explanation that aprovisional standard value—that is, the level of radioactive material the government declares
acceptable to ingest —pertains to the absence of adverse effects after ingestion for one year. Such astatement and other explanations easily led to public misunderstanding. If we assume that his
response given at the Diet was true to his intent, then it can only be concluded that statements weremade which, in their overall effect, were misleading.
Moreover, Chief Cabinet Secretary Edano compared with exposures received during international
air travel and CT scans and annual natural background exposure. Isuues such as the possibility ofconfusion due to the variations of such comparisons and whether or not voluntarily received
exposure could be a standard for comparison with passively received exposure should be verified.
First of all, regarding the health risks of radioactivity, it was difficult for the general public tofully understand the relationship among many technical terms and the degree of health effects,
because technical terms that are difficult to understand such as “Sv”, “Bq”, “radioactive iodine” and“radioactive cesium” were used in TV news, etc. In addition, many staff members who attended thebriefing by Edano told us that there was no time to prepare appropriate expected questions andanswers. There were cases in which Edano had to explain the situation of the accident at theinterview meeting just after a secretary or NISA’s staff simply explained an overview of the latest
situation regarding nuclear power stations and radiation monitoring.
With the benefit of hindsight, Edano has reflected on those press conferences, saying, “If I spokein terms of the reports themselves as they were brought to me, it is quite certain that very few would
be able to understand the content. … For me, the most mentally wrenching problem was the degree
to which I could speak on the matter at hand in a way that would be at least barely intelligible.” In
this way, under severe time constraints in a situation of urgency, the process of translating thedifficult specialized terminology to readily understandable Japanese unavoidably proceeded inhurried consultations with the agency’s Deputy Director-General Yasui, Sakai of the National
Institute of Radiological Sciences, and a few other advisors, or on a largely ad lib basis by Edano. In
this light, we recommend that the government—in conjunction with the media and guided by thelessons that have emerged concerning the inherent difficulty of communicating low-dose radiation
risk to health—develop methods to communicate such information to the public and formulate andadopt a unified risk scale, which would provide a more objective and comprehensible measure of
the level of low-dose radiation risk to health.
[Nongovernmental Report] Part 2 Chapter 4 Section 2

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Descriptions about mental health care are given in [National Diet Report] and[Nongovenmental Report] in the following way.
4.4.6 Mental health impact of long-term evacuation
1. Importance of mental health support measures
Those involved in the Chernobyl nuclear accident have pointed to the importance of mental
health support measures for residents living in the vicinity of a nuclear disaster. In the report issued
to mark the 25th anniversary of the Chernobyl nuclear accident in Ukraine, it was noted that various
psychological states had been observed in residents following the accident in 1986. These include
the “syndrome of victimhood,” in which a large number of the affected individuals refer tothemselves as a community of victims over their entire lives, and the “syndrome of social
exclusion,” where an absence of initiative and a dependence on the government for support
dominate the collective consciousness of affected individuals.
In addition, at the seventh meeting of this Commission, a representative of the Ministry of
Emergency Situations of Ukraine noted that “with regard to the issue of how stress affects humanhealth . . . we came to understand that stress has an adverse impact on health and can cause physicalailments and illness.” In this way the impact on the mental health of residents and workers at thenuclear power plant affected by the accident was pointed out.
The importance of mental health support measures in a nuclear disaster was noted in a domestic
context too, following the JCO Criticality Accident. NSC pointed to the importance of introducing
mental health support measures and bringing in experts directly following the occurrence of adisaster, including the appointment of a mental health expert at the emergency nuclear response
headquarters established by a local government directly after a nuclear disaster, and the necessity ofensuring that mental health support bases are established in prefectural and municipal healthcare
centers.
2. Impact of the accident on the mental health of the residents and support measures
Following the accident, there were many residents who endured mental stress as a result of living
as evacuees in evacuation centers. In the free comment space provided in the survey distributed toevacuated residents by this Commission, there were many accounts of mental pressure following
the shock of the accident, with some people revealing they were taking tranquilizers. From thedoctors who visited the evacuation centers, we were also told of the need for mental health care formany of the patients who they had examined.
Since around the end of March 2011, MHLW has been engaged in efforts to dispatch “mental
healthcare teams,” composed of psychiatrists and mental health nurses from around the country, tothe affected areas. These “mental healthcare teams” have been dispatched to evacuation centers andother locations to attend to the mental health needs of residents affected by the earthquake andtsunami, as well as residents who evacuated due to the nuclear accident.
In cooperation with Fukushima Prefecture, MHLW established a mental healthcare center in
February 2012 to provide consultation support for psychiatric disorders such as post-traumaticstress disorder (PTSD), and to implement home-visit consultations for people living in temporary
accommodation.
As mental healthcare is not an issue that can be resolved in the short-term, it will be necessary tomaintain a continuous response in the future.
[National Diet Report] Chapter 4, 4.4.6(c) Communication through mass media and internet
Descriptions about communication through mass media and internet are given in[Nongovenmental Report] in the following way.
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Information transmission by government
The Cabinet’s Twitter account, @Kantei_Saigai, went live on March 13 and gave relevant
information from ministries and agencies with tweets on press conferences.
Operated around the clock by three young members of the Cabinet Public Relations Officeworking in rotation, the Tweets were typed, confirmed by a Public Relations Officer, and thenposted; in some cases, the Public Relations Officer wrote the posts himself. By the end of the month,
the account had 300,000 followers. Regular information provision from @Kantei_Saigai wasstarted from March 14 (midnight on March 13) For example, on March 13, the Cabinet published
48 Tweets, mostly consisting of plain text transcripts of Prime Minister Kan’s press statement, but
nothing on radiation doses, aside from a link to Deputy Chief Cabinet Secretary Fukuyama’s
definition of “microsievert” and a message noting that no abnormalities were found in monitoring
results near the main gate of the nuclear power plant. Two days later, the Cabinet posted 62 tweets,
largely quoting from press conferences and announcements by Prime Minister Kan and Chief
Cabinet Secretary Edano. Despite heightened concern regarding radioactivity in mid-March, theCabinet’s number of Tweets was only 23 on March 23, and 19 the following day. Such Tweets wererelated to the detection of radioactive iodine in the water at the Kanamachi Purification Plant. While
the Cabinet instructed parents to avoid giving tap water to infants in and around Tokyo, it also
tweeted comments like, ”It is safe to drink tap water ” (March 23) , and “For anyone other than
infants, there would be no physiological effect (from drinking such tap water)” (March 24) . Despite
the confusing messages, the government still did not interact with its Twitter followers. In somecases, the off-target Tweets were quite extreme: One hospital’s deputy director Tweeted that patientswere on the verge of starvation. Member of the Self Defense Forces were flagged not to disclose
information in the process of the response. There are phenomena in support of Edano such as“#Sleep Edano” and “#Bear-up Edano” as a response to governmental information provision. This
spread after an internet user attached the hashtag “#edano_nero” on Twitter. However, Edano had noknowledge of what happened on the internet, he did not read newspapers for two weeks after thedisaster and just heard it from the secretary in charge of public relations.
The fact that the Prime Minister’s office utilized Twitter motivated other ministries and local
governments to also use Twitter. The issue here is “masquerade”, a situation in which someone orsome organization different from the Twitter’s owner uses the account. If the ministry’s account was
hacked, the reliability of information would be lost. Therefore, METI and MIC built a system tosmoothly obtain an “authenticated account” for the purpose of confirming whether or not a user isauthentic on April 5, in collaboration with Twitter. The guideline was also announced. This system
was unified and published on the “Public Institution Social Media Portal” website.
By building this system, the public institutions became to be able to apply for an authenticatedaccount and authentication of the twitter provided by official website for twitter, “Twinavi”, if they
applied from account registration page for public institution in Twinavi. Moreover, “J-government
on Twinavi” in which accounts in the public institutions was consolidated, was simultaneously
published at “Public Institution Social Media Potal” which was released from the METI. This led toease in locating the official Twitters accounts of public instituions.
On March 30, METI and the Local Authorities Systems Development Center (LASDECL) jointly
called on public agencies to make public information related to earthquakes and electric power
available in HTML, CSV, or other small-volume data format. This request was made for several
reasons. One was that files in large-volume PDF and Excel data formats tended to impede access attimes of heavy usage. Another was the difficulty of information sharing with such files because of
the limited viewing capabilities of cellphones. These formats were also difficult to use in terms ofsearch facilitation and adoption of automated map display systems.
One of METI’s objectives was to determine electric power usage and implementat power saving
measures, mainly in the regions served by TEPCO. After receiving the data, MEXT called on the
online community to utilize the data, through the Twitter account, @openmeti, which was thehandle of its IT Project Office. Through these movements, the Yahoo Japan portal site and othersites processed the TEPCO data and displayed the state of electric power usage on their top pages orother prominent locations in real time.
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Information transmission by TEPCOTEPCO issued close to 10 daily press releases immediately following the onset of the Fukushima
accident: The releases were only in PDF format. During the planned power outages on March 14 inparticular, the PDF format made it especially difficult for users to search for the affected areas; thiswas only exacerbated by the fact that the company did not offer a complete list of the areas.
TEPCO launched its Twitter page (@OfficialTEPCO) on March 17. The first information was
related to the planned power outages.
Users also criticized the company for not apologizing for the disaster itself. Within 24 hours, thecompany had 160,000 followers, which grew to 280,000 by the end of the month. TEPCO
continued to tweet about planned power outages but, using the same approach as the Cabinet, did
not interact with its followers.
Credibility of media after the disaster
According to an internet investigation entitled “Investigation on contact with media regarding thenuclear disaster following the Great East Japan Earthquake” carried out by Nomura ResearchInstitute from 19 to 20 March just after the nuclear disaster, the answer of “credibility has become
lower” after hearing information on the nuclear disaster was 28.9% for that announced fromgovernment and local govenments, which is significant compared with that of 9.0% for social media
in which there might be a false rumor. Even in the case of the answer “credibility has become
higher”, estimation of the information from government and local governments was 7.8%, which islower than 13.4% for the information from social media. On the other hand, in the case of theanswer of “important media and information sources in relation to the nuclear disaster”, informationof the government and local governments in the internet occupied 23.1%, which is higher than
18.6%, that of newspaper companies (the first rank is TV (NHK), 80.5%; 36.3% for information of
published newspapers; 43.2% for information of potal site).
It should be noted that the target of the internet investigation was people aged 20 to 59 living in
the Kanto area, there was no estimation by users in the affected area (mainly Tohoku area) and thetiming of the investigation was early. However, this investigation could be a reference for
estimation of internet information at the early stage of the accident. The Twitter followers of@Kantei_Saigai numbered about 260,000 on 21 March, which was picked up by various news
outlets. Most internet users would have known it. From this investigation, it was clarified that thereliability of the government drastically decreased although the information from the government
and local governments regarding the nuclear disaster was provided via the internet.
It could be seen that in the responses to the nuclear accident, the government promptly started
sharing information via the homepage and @Kantei_Saigai. The Twitter account was followed bymore than 300,000 users in two weeks and played a role as an information provision tool for a large
number of people. However, this did not lead to the improvement of the reliability of thegovernment.
Comparing the interests of internet users with information provision from the government, on 15
and 23 March when there were a lot of internet searches and uploads on the topics of radiation orradioactivity, there were few topics regarding radiation provided by the government. The topics
were just limited to an announcement of safe for the meantime and requests for a cool response to
the event.
It can be seen from the high interest in radiation and radioactivity and the transient situation thatcitizen’s activities to measure radiation were broadend to nationwide by using internet that many
people considered this event as their own and their region’s problem but not Fukushima’s issue.
While no information on high radiation hot spots was provided by the government and media,
interested people started to measure radiation by themselves, disclosed measurement results on theinternet and made their own network.
This is because information in connection with the public interests were not available because thegovernment did not have bidirectional information exchange using characteristics of the social
media.
From this background, there is a vulnerable system for information provision in the government.
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At first, staff did not have a good understanding of social media. Although there was recruitment ofstaff understanding portal site and volunteer work by advertising companies, the advertisement andthe portal site have characteristics of one-way information provision as seen in mass media, which
is different from the bidirectional and real-time characteristics of the portal site. It was in September
when bloggers were invited to the “Cabinet Public Relations Office, advisor of IT public relations”.
Comments and responses on Twitter have been raised as a topic in the Cabinet Public Relations
Office, but did not reach the leader in the center of the responses to the accident.
On the other hand, Professor Hayano, who provided real-time information since the early stage
after the accident, had few followers before the accident. At the early stage after the accident, he did
not have many sources of information and wrote Tweets on the basis of information from TV. He
collected much data by exchanging information through social media. Also, he connected withmany expert researchers and became a hub of information exchange. He promptly responded to
mistakes suggested by his followers and finally gained trust. By assigning him in the interactive
exchanges, he could appropriately obtain information that people wanted and provide the relevant
data. This indicates that it is important for social media to exchange information rather than only
provide it.
In an emergency situation such as a nuclear accident, a large amount of information is exchanged,
but in many cases, its reliability is uncertain. In particular, it is essential to gather experts who can
explain what were said about highly expert knowledge such as nuclear power plants and radiation inan easy-to-understand manner. Professor Hayano understood people interests through social media
and provided easy-to-understand information in real time as an expert.
Moreover, it is requied to provide accurate information in a timely manner like that commotion
was stopped by calling an attension by an expert of the National Institute of Radiological Sciences(NIRS) to prevent a rumor’s broadening. To let them have an interest on the information, it is also
necessary to timely provide accuarate information. Mass media type communication such as
one-way information provision from the government, cannot gain trust, but is simply a source of
information.
In contrast with the insufficient information provision from the government, people who canprovide information by themselves highlighted local radiation monitoring data, measured radiationby using their own surveymeters and expanded their information by developing a network using
measurement results. Mr. Ishikawa, who works for the Natural Laboratory, received e-mail such as“It is great to be able to confirm the numerical value, whereas governmental information is
uncertain. Only these data is available because governmental information cannot be relied on. I’mreally appreciative.” “Citizens are not idiots. We are cool, so there would be no panic after such data
are disclosed. We become so anxious when the data are not disclosed.”Thus, a voluntary network for measuring data grew for people who have distrust of governmental
information provision. On the other hand, elementary confusion occurred, such as mistakes in themeasurement method of the survey meter. There were some people who continued to disclose theirmeasurement data without understanding how to properly use the survey meter, which led to asituation where uncertain information continued to be spread.
The government, however, deserves credit for an initiative led by the Ministry of Economy, Tradeand Industry (METI) that asked public agencies to provide their data. Thus, simple values weretransformed to graphs that could be observed on portal sites, thus facilitating their readyunderstanding.
As social media flourished, mass media waned. As such, the public offered harsh criticisms
online—a survey by the Nomura Research Institute found that, after the earthquake, the public did
not trust mass media outlet any more, other than NHK. NHK actively used Twitter and blogs. Its
Science and Culture Department blog @nhk_kabun had just 3,000 followers before the earthquake,but by March 21 the community had grown to 223,903. On many days, the number of Tweets
exceeded 100, and the staff members later related that they had strongly felt the concerns andfeelings of those people and relayed them as feedback to the broadcast commentators. This clearly
demonstrated the need for mass media to receive as well as transmit information, in two-way
communication.
One problem that clearly existed for social media is its inability to reach all generations and150

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levels in society. We fear that the “digital divide,” and the resulting disparity in information accessbetween those who use social media and those who do not, may further widen.
<Summary>
As a result of the above discussion, it can be said that the government could not implement the
information provision that people required. There is no evidence that the government had an interestin people on the internet, at least during March after the nuclear disaster.
One cause of the problems information provision is the lack of understanding of thecharacteristics of communication via social media. The government had used social media from the
beginning of the post-accident period, but did not respond in a bidirectional manner after receiving
the information and only informed it in a one-way manner similar to conventional mass media.
It has been clarified that it is important to receive and analyze information via social media toimplement a two-way communication rather than information provision.
Receiving information is possible by reading message in Twitter without depending on an
expensive system and by utilizing a web service used in this verification, but the government did
not implement it, too. It can be said that understanding of not only characteristics but also
technology of the communication was insufficient.
Social media will become a more important communication tool in the future because the numberof users continues increasing. However, whereas social media is a convenient tool, it has adangerous aspect. To utilize it efficiently, we have to have sufficient knowledge regarding its
characteristics, and the technology and dangers of social media.
On the basis of such reviews, it would be valuable for government to make a system forinvestigation and analysis of writing in the social media in relation to receipt of necessary
information. A system that enables real time display of what internet users are interested in andawareness of the users’ response to a keyword is now technically possible to make. If it is made, thesystem would have a role for information provision and responses. However, if the system fails tofunction in an emergency due to an error of computer or mechanical system, information provision
would be impossible. It should also be noted that investigation of the writings on Twitter showed avery slight difference from monitoring.
Also, the role of the government in information provision should be fully discussed. To expand
collaboration formed after this accident, such as collaborating with technical staff that can construct
figures and tables in an easy-to-understand manner on the basis of existing data and explanation of
relevant experts, in preparation with emergency situation, it is necessary to make a system thatenables us to obtain available data in times of emergency, share it, and minimized unreliable dataarising from problems associated with an emergency.
[Nongovernmental Report] Part 2 Chapter 4 Section 4(d) Information delivery to oversea countries
Descriptions about information delivery to oversea countries are given in[Governmental Interim Report] and [Govenmental Final Report] in thefollowing way.
(c) Prior notification of water discharge into the ocean
After the paperwork was completed, TEPCO and the Local Nuclear Emergency Response
Headquarters notified the parties concerned such as the municipalities and the fishery cooperatives
associations of the water discharge into the ocean. On the other hand, since TEPCO, NISA andothers started the paperwork for the discharge on the morning of April 4 until they obtained theconsent of Prime Minister Kan at 15:00, they did not notify the authorities concerned (such as the
Ministry of Foreign Affairs, the Ministry of Agriculture, Forestry and Fisheries, the municipalities
concerned and the fishery cooperatives associations), the IAEA or other countries of the plan todischarge the contaminated water into the ocean.
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At 16:00 the same day, TEPCO held a press conference to announce that it planned to dischargesome of the contaminated water into the ocean as soon as the preparation got ready. At 18:30 thesame day, TEPCO held another press conference to announce the planned time of the discharge into
the ocean. In addition, Chief Cabinet Secretary Edano announced the plan for the water discharge
into the ocean in a regular press conference held at 16:03 the same day. Furthermore, NISA alsoannounced the plan for the water discharge into the ocean in an unscheduled press conference held
at 16:25 the same day.
[Governmental Interim Report] Chapter V 6

9. Details of events in areas where there may be problems concerning the provision of
information to the international community(1) Provision of information concerning the discharge of contaminated water into the sea
a. Notification of the discharge of contaminated water into the sea to other countries andinternational organizations
As described above in 6 (1) e, TEPCO decided to discharge relatively less contaminatedaccumulated water into the sea with the consent of NISA on April 4. However, no staff at NISA who
had been involved in the paperwork for the procedure required for the discharge recognized orpointed out the necessity of notifying related foreign countries. After it was decided that thedischarge would be conducted, a staff member of NISA who was watching the Chief Cabinet
Secretary's press conference that started at 16:03 on April 4 and recognized the need for notification,then visited the ERC to obtain the materials related to the discharge into the sea, and then notified
the IAEA of the discharge via email at 17:46 the same day.
In addition, after 15:30 on April 4, a staff member of the Ministry of Foreign Affairs, who was at
the Integrated Emergency Response Office, learned that TEPCO was planning to discharge thecontaminated water into the sea and notified the related divisions within the Ministry about it. The
news was communicated via email from a mobile phone to the staff member of the Ministry who
was in charge of publication during the regular briefing that started at 16:00 the same day. The staff
member notified the diplomats of the foreign countries of the news in the briefing. The discharge ofthe less contaminated water within the centralized waste disposal facilities actually started at 19:03
the same day. The Ministry of Foreign Affairs was notified of the planned discharge into the sea by
the Ministry staff member who had been stationed at the Integrated Emergency Response Office,then informed all the diplomatic corps via email and fax that the discharge would begin that day.
However, the notification stating that the discharge would begin that day was sent at 19:05 the same
day after the discharge had already started at that time.
On April 5, the Ministry of Foreign Affairs and NISA again explained the details of the dischargeof the contaminated water into the sea and its impact in the regular briefing that started at 16:00 (47countries and two international organizations attended). Furthermore, on April 6, the Ministry ofForeign Affairs explained the details of the discharge and its impact to the embassies of South
Korea, China and Russia located in Tokyo.
b. Question from the view point of the fulfillment of international commitment
As mentioned earlier in 6 (1) e (b), NISA concluded that the discharge of the less contaminatedwater into the sea conducted on April 4 did not have a significant impact on human health because
the total effective dose rate had been evaluated to be 0.6mSv/year which was below the 1mSv/year
value stipulated as the dose limit in the rules and notification about commercial reactors (see 4 (1) cabove). The next day, on April 5, NISA enquired the Ministry of Foreign Affairs whether thedischarge into the sea complied with the treaty, and received a response that said the discharge did
not fall within the scope which requires notification prescribed in Article 2 of the Convention on
Early Notification of a Nuclear Accident.
With regards to the obligation to notify prescribed in Article 198 of the United Nations
Convention on the Law of the Sea, the Ministry of Foreign Affairs said, "the discharge does notcorrespond to the event 'in which the marine environment is in imminent danger of being damaged
or has been damaged by pollution' prescribed in Article 198 of the United Nations Convention on
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the Law of the Sea" and concluded that the discharge does not fall within the scope which requires
Japan to notify other countries as stipulated in the Article. However, the Ministry of Foreign Affairs
does not believe that there is no need for notification. Foreign Minister, Takeaki Matsumoto, said to
the Committee of Foreign Affairs of the House of Representatives on April 13, "We should sincerely
consider the problem presentation (from foreign countries) that requests detailed explanation inadvance and also will make an effort to resolve the problem". Even if no notification obligation is
stipulated in treaties, it is reasonable to consider that it is necessary to notify the related countries
around Japan of the discharge in advance.
Furthermore, there are remarks that say it is not acceptable to discharge without any notificationor consultation and Japan should get the agreement of neighboring countries on the discharge even
if the concentration is rather low.
(2) Supply of information to other countries in the initial period after the accident
a. Framework of information provision to other countries
The Government held regular briefings regarding the Fukushima NPS accident in principle oncea day during the period from March 13 to May 18 and three times a week after May 19 for the
diplomatic corps residing in Tokyo. In the briefings, the explanation about the status andcountermeasures regarding the accident was given by the staff who were in charge of the respective
area and were mainly from the Foreign Ministry, but also from NSC, MEXT, the Ministry of Health,Labour and Welfare, the Ministry of Agriculture, Forestry and Fisheries, the Fishery Agency and
NISA.
b. Information Provision to the USA after the accident occurred
The United States was greatly concerned about the status of the plant at the Fukushima NPS fromthe moment the accident had occurred. Although experts from the United States Nuclear Regulatory
Commission (USNRC) and DOE contacted the agencies concerned to gather information, theUnited States could not get sufficient information. However, regular consultation between Japan andthe US was initiated by the Prime Minister's Office on March 22, then the information and views
regarding the plant were exchanged and the acceptance of relief supplies was coordinated during
subsequent consultations. The consultation between Japan and the US significantly improved theflow of information regarding the plant for the US.
[Governmental Interim Report] Chapter V 9

10. Coordination with other countries and the IAEA
(1) Coordination with USA
As described above in 9 (2) b, the regular consultations initiated by the Prime Minister's Officeon March 22 between Japan and the USA were attended by the DOE and the NRC of the US, theagencies concerned in Japan and TEPCO who shared and exchanged information and views
regarding the plant and coordinated the acceptance of relief supplies.
During the consultations, there were many offers of cooperation such as the provision of barges
that contained freshwater, stationing of US experts at the Integrated Emergency Response Office,integration of the results of monitoring analysis by the DOE and the SPEEDI analysis in Japan, andconsultation about the use of remote controlled robots for monitoring and removing rubbles/debris.
(2) Support from other countries and Japan’s response to their support
With regards to the offers of support from foreign countries regarding to the Tohoku District - off
the Pacific Ocean Earthquake, the Ministry of Foreign Affairs mainly coordinated the recipients
since the day the disaster had occurred.
With regards to the Fukushima NPS accident, various equipment was offered by foreign countries
such as water pumps to use for the cooling of reactors, fire engines, barges containing freshwater,
remote controlled robots, gamma cameras, protective clothing, protective masks, monitoringvehicles, aerial monitoring equipment, germanium semiconductor detectors and personal
dosimeters.
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Furthermore, protective clothing, rubber gloves and boots came soon after the middle of March,and several countries supplied those materials at the request of Japan.
On the other hand, the Government declined offers of equipment that required training on theiroperation before acceptance or equipment that was plentiful in Japan. For example, the offer tosupply stable iodine was declined because there were large stocks of it in Japan and the storage andtransportation of the stable iodine offered was expensive because it was in the form of liquid.
Further, the offer of remote controlled unmanned robots was declined because it was necessary to
be trained in their operation in the country supplying the robots. In addition, one country offered tosupply monitoring vehicles; however the acceptance was delayed because it took a long time tosecure drivers who could operate them.
The equipment offered by the USA was readily accepted because it was coordinated during theconsultations between Japan and the USA in which the agencies concerned attended. Furthermore,since early April, the use of a "US-Japan Nuclear-Related Assistance Tracker" was proposed, which
was an integrated at-a-glance format that represents information such as an explanation about theequipment that could be supplied, the destination of the equipment and the party who would accept
them. This system lead to the acceptance of the relief supplies being more coordinated.
(3) Evacuation advice of foreign governments to their nationals in JapanOn March 16, the USA recommended USA citizens residing in Japan to evacuate from the area
within a 50-mile (80km) radius of the Fukushima Dai-ichi NPS. The recommended evacuation
distance of 50 miles was specified by the NRC on the basis of radiation dose for the worst-casescenario. In addition, that same day, the USA recommended the families of USA government staff
to evacuate voluntarily from Japan.
On April 15, the USA withdrew their evacuation advice on March 16 for the families of USA
government staff. Furthermore, on October 7, the evacuation area was decreased to a 20km radiusfrom the 50-mile radius that had been specified on March 16.
Some countries other than the USA also published evacuation advice similar to that of the USA.
(4) Coordination with the IAEA
Article 2 Section 4 of the Convention on Assistance in the Case of a Nuclear Accident orRadiological Emergency stipulates that signatory countries shall notify IAEA of experts, equipment
and materials that could be made available to other signatories to assist them in the event of a
nuclear accident or radiological emergency within the limits of their capabilities. On March 16,
Japan asked the IAEA to provide information regarding items in the possession of other signatories
such as remote controlled monitoring robots, aerial survey systems, unmanned trucks andunmanned helicopters. In response to this request, IAEA asked several countries to provide
information about their respective equipment. The countries responded after March 17 and Japan
accepted the equipment that those countries could supply such as the remote controlled robots.
[Governmental Interim Report] Chapter V 10

9. Details of Events in Areas where there may be Problems Concerning the Provision ofInformation to the International Community(1) Provision of information to various countries
a. Press conferences by the Chief Cabinet Secretary and joint briefings
Since the nuclear accident, as part of the provision of information to other countries, thegovernment took the measures such as: (i) simultaneous interpretation at the press conferences by
the Chief Cabinet Secretary, (ii) briefings on the diplomatic corps in Tokyo by the Ministry ofForeign Affairs, and (iii) briefings to the foreign press by the Cabinet Public Relations Office of the
Cabinet Secretariat (hereinafter referred to as the “Cabinet Public Relations Office”).
Firstly, since the evening of March 13, the government uploaded the English translation of theminutes of the press conferences by the Chief Cabinet Secretary on the website of the Prime
Minister’s Office, and additionally, beginning with the press conference by the Chief Cabinet
Secretary held at around 18:00 on March 16, the government introduced the simultaneous154

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interpretation of press conferences by the Chief Cabinet Secretary.
Next, the Ministry of Foreign Affairs, together with other relevant government ministries andagencies, including the NISA, held regular briefings on the diplomatic corps in Tokyo, in principle,
once a day during the period from March 13 to May 18, and three times a week on May 19 onward.
Furthermore, the Cabinet Public Relations Office, together with other relevant government
ministries and agencies, including the NISA, held briefings on the foreign press from March 21
through the end of 2011.
b. Responses to individual inquiries
In addition, the NISA and other relevant government ministries and agencies responded toindividual inquiries from overseas.
After the declaration of a nuclear emergency at 19:03 on March 11, the Secretariat of the NERHQ
was established at the ERC on the third floor of the METI’s annex building, and the staff of theInternational Affairs Office of the Policy Planning and Coordination Division of the NISA,
including the head of the Office who is in charge of the NISA’s international public relations affairs,
joined the ERC public relations squad, taking charge of the provision of information to othercountries as well as responses to individual inquiries from foreign governments, etc.
The Cabinet Public Relations Office also responded to individual inquiries from the foreign press,
etc.
c. Information Provision to the U.S. immediately after the accident occurred(a) Provision of information from immediately after the accident until the start of Japan-U.S.
consultations
The U.S. took strong interest in the situation of the accident at the Fukushima Dai-ichi NPS since
immediately after the occurrence of the accident, and since March 12, U.S. government officials(including government officials in Japan, such as those at the U.S. embassy in Japan; hereinafterreferred to just as the “U.S. side” without specifying their official titles or their individual names)
repeatedly called Chief Cabinet Secretary Edano and other cabinet ministers stationed at the Prime
Minister’s Office or the staff of the Prime Minister’s Office to offer U.S. support and seek theprovision of information on the nuclear accident. In addition to the direct provision of information
over the phone, the Japanese government explained the conditions of the reactors in the Ministry ofForeign Affairs on March 13, by phone calls from NISA Deputy Director-General Nishiyama before
dawn on March 14, and within the METI during daytime the same day. However, in the evening ofMarch 14, the U.S. side asked Chief Cabinet Secretary Edano for the further provision of
information and the stationing of U.S. nuclear experts at the Prime Minister’s Office. The U.S. sidemade the request apparently because they found the information provided by the Japanese
government and Japan’s system for disseminating information as still not sufficient. Chief Cabinet
Secretary Edano withheld any immediate reply to the U.S. request at that stage because the U.S.
intentions behind the request were not necessary clear.
Around that time, the U.S. Nuclear Regulatory Commission (NRC), while staying in close
contact with NRC experts dispatched to the U.S. embassy in Japan, was considering the scope of anevacuation advisory it was planning to issue on its own to U.S. citizens in Japan, one of the reasonsthe U.S. was seeking detailed information from the Japanese government. However, the Japanese
government was incapable of providing information to the U.S. in a manner satisfactory to the U.S.
side, partly because the Japanese government was not made aware of such circumstances on the partof the U.S. and also because the information on the nuclear plant itself grasped by the Japanese
government was not sufficient and officials of the NISA and other government staff familiar with
the information on the nuclear plant were preoccupied with their work to deal with the plant’s
situation. This appears to be one of the reasons why the U.S. side was dissatisfied with the provisionof information by the Japanese government.
Around March 15, the U.S. side again pressed Chief Cabinet Secretary Edano to accept thestationing of U.S. nuclear experts at the Prime Minister’s Office, and after obtaining Prime Minister
Kan’s approval, Chief Cabinet Secretary Edano gave the go-ahead for NRC experts to be stationed
at the Prime Minister’s Office to gather information from March 16. Following this, METI staff and155

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NISA staff provided NRC experts with the information on the accident on the second floor of thePrime Minister’s Office for several days from March 16.
Subsequently, for example, the U.S. side participated in a conference on the accident at the
Fukushima Dai-ichi NPS that started at the Ministry of Defense on March 16 (from the Japaneseside, officials of the Ministry of Foreign Affairs, the NISA, the Ministry of Defense and TEPCO
participated), and before dawn on March 17, the U.S. side made another phone call to Chief Cabinet
Secretary Edano, and came to the Integrated Headquarters on March 18 in their continued efforts togather information.
(b) 50-mile evacuation advisory
As described in (a), the NRC was making attempts to collect information through various routes
in order to consider the scope of the evacuation advisory it was planning to issue on its own to U.S.
citizens in Japan. As the NRC failed to obtain sufficient information, it decided to issue theevacuation advisory from the safer side, and on March 17 (Japan time) advised U.S. citizens inJapan to evacuate outside of a 50-mile (about 80km) radius of the Fukushima Dai-ichi NPS. Amid
the lack of sufficient information on the conditions of the nuclear power plants at the Fukushima
Dai-ichi NPS, the evacuation advisory is understood to have been issued on the basis of theconsideration that the radiation dose at a point 50 miles from the Fukushima Dai-ichi NPS wasforecast to rise to around 1rem (10mSv).
(c) Commencement of Japan-U.S. Consultations
Around March 18, Special Advisor Hosono and House of Representatives Member Nagashima
contacted the U.S. side at the Integrated Headquarters, etc. and the exchange of views with the U.S.
side made them keenly aware of the need to unify the multiple channels for the provision of
information to the U.S. side in order to provide accurate information to the U.S. side. Therefore,
Special Advisor Hosono and other officials prepared a draft plan for the establishment of amechanism of consultations between the Japanese and U.S. governments where relevant officials of
the two governments get together to share information and coordinate the request for andacceptance of relief supplies (hereinafter referred to as the “Japan-U.S. Consultations”). Afterobtaining the approval of Prime Minister Kan, they started preparations for the first session of theJapan-U.S. Consultations. Around that time, Prime Minister Kan instructed Deputy Chief Cabinet
Secretary Fukuyama to coordinate the views of the ministries and agencies concerned toward thelaunch of the Japan-U.S. Consultations and Special Advisor Hosono to administer the Japan-U.S.
Consultations.
Subsequently, following a preparatory meeting between the U.S. side and the relevant Japaneseministries and agencies held on March 21, Deputy Chief Cabinet Secretary Fukuyama and Special
Advisor Hosono convened the Japan-U.S. Consultations, starting on March 22. From the Japaneseside, the consultations were joined by Deputy Chief Cabinet Secretary Fukuyama, Special Advisor
Hosono and House of Representatives Member Nagashima, from the government side, and an
official attached to the Assistant Chief Cabinet Secretary (for security and crisis management),
officials from the relevant ministries and agencies, including the NSC, the Ministry of Foreign
Affairs, the Ministry of Defense, the NISA, the MEXT, and TEPCO officials in charge. Thereafter,
the sharing of information on the nuclear plants, exchanges of views and the coordination for theacceptance of relief supplies with the U.S. side were conducted at the Japan-U.S. Consultations. The
status of information sharing between the Japanese and U.S. governments improved markedly
through the Japan-U.S. Consultations, and the exchange of information among the relevant Japaneseministries and agencies came to be carried out more efficiently at meetings among the relevant
ministries and agencies that preceded the Japan-U.S. Consultations.
(2) Provision of information concerning the discharge of contaminated water into the sea
a. Notification system based on the Convention on Early Notification of a Nuclear Accident
Under the METI’s Nuclear Disaster Management Operation Manual, in the event of a nuclear
accident that discharges radioactive materials, the Head of the International Affairs Office of the
Policy Planning and Coordination Division of NISA is to make judgment on whether the accident
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falls under the Convention on Early Notification of a Nuclear Accident and, if it does, notify the
IAEA of the accident.
In response to the latest nuclear accident, the staff of the International Affairs Office of the Policy
Planning and Coordination Division of the NISA (hereinafter referred to as the “NISA Staff
Responsible for International Public Relations Activities”), including the Head of the International
Affairs Office of the Policy Planning and Coordination Division of NISA, who is responsible for the
notification under the Convention, as with the case at the time of the Integrated Nuclear Emergency
Response Drill, did not have their desks within the ERC and provided information to other countries
working out of the International Affairs Office of the Policy Planning and Coordination Division.
Thus, the NISA Staff Responsible for International Public Relations Activities and the ERC
shared information on documents shared within the ERC by having the ERC send them to theInternational Affairs Office of the Policy Planning and Coordination Division. However, as the
NISA Staff Responsible for International Public Relations Activities were not stationed at the ERC
on a full-time basis, it was difficult for them to immediately take hold of information that is not
documented.
b. Notification of the discharge of contaminated water into the sea to other countries andinternational organizations
As described in Chapter V 6. (1) e. of the Interim Report, TEPCO decided to discharge relatively
less contaminated accumulated water in the centralized waste treatment facility into the sea with theconsent of the NISA on April 4. However, no one among the NISA Staff Responsible forInternational Public Relations Activities was involved in the paperwork for the procedure required
for the discharge and no NISA staff involved in the paperwork recognized or pointed out thenecessity of notifying related foreign countries. One of the NISA Staff Responsible for International
Public Relations Activities watching the Chief Cabinet Secretary’s press conference that started at
16:03 on April 4 on TV learned of the planned implementation of the above-mentioned discharge
for the first time and realized the need for notification, visited the ERC immediately to obtain thematerials related to the discharge into the sea, and then notified the IAEA of the planned
implementation of the discharge via email.
In addition, after 15:30 on the same day, a staff member of the Ministry of Foreign Affairs, who
was at the Integrated Emergency Response Office, learned the plan to discharge the contaminatedwater into the sea and notified the related divisions within the Ministry about it. The news wascommunicated via email from a mobile phone to the staff member of the Ministry who was incharge of publication during the regular briefing that started at 16:00 the same day. The staff
member notified the diplomats of the foreign countries of the news in the briefing.
The discharge actually started at 19:03 the same day. The Ministry of Foreign Affairs was
notified of the planned discharge into the sea by the Ministry staff member who had been stationed
at the Integrated Headquarters, and then informed all the diplomatic corps via email and fax that thedischarge would begin that day. However, the notification was sent at 19:05 the same day after thedischarge had already started.
On April 5, the Ministry of Foreign Affairs and the NISA again explained the details of thedischarge of the contaminated water into the sea and its impact in the regular briefing that started at
16:00 (47 countries and two international organizations attended). Furthermore, on April 6, theMinistry of Foreign Affairs explained the details of the discharge and its impact to the embassies ofPeople’s Republic of China, the Republic of Korea (hereinafter referred to as South Korea) andRussia, located in Tokyo.
[Governmental Final Report] Chapter IV 9

The following isssues can be raised in association with communication to the
public.

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Communication to the public – spreading understanding of radiation effects
 The Government often explained, "It does not have immediate effects on
health", concerning the influence of radiation on the human body. This
expression may be interpreted by some people as "it is unnecessary to be
anxious about the impact of radiation on human health," while it may beinterpreted by other people as "it does not immediately affect human health,however, some effects on human health will appear in the longer term."
However, it was not necessarily clear what the intended meaning of theexpression was, and there was no detailed explanation. Moreover, anxiety
regarding unknown nuclear disasters and dissatisfaction about the explanationfrom the government were broadly shared.
Communication to the public – comprehensibility of radiological protection
system Residents who had to live in an environment contaminated by radioactive
material after the accident sought information about the level of radioactivity
that would serve as a basis for making decisions. Mothers, in particular,sought accurate information about the extent of contamination in the food andbeverages they were giving their children, and about the radiation dose fromthe environment and its potential effects on their health. However, theinformation that was made available to the residents was not satisfactory.
Communication to the public – utilization of mass media
 The government rapidly responded to online communication by consolidating
the relevant information onto its homepage and opening an official twitter
account of the Cabinet. However, it used only one way communication suchas mass media and could not provide appropriate timely information or gain
the public’s confidence, since the information was not obtained throughbidirectional exchanges utilizing the characteristics of social media.
Communication to the public – response to foreign residents and overseas
countries Although the discharge of the less contaminated water into the sea conducted
on 4 April 2011 did not fall within the scope requiring notification prescribedin the United Nations Convention on the Law of the Sea, the notification
stating that the discharge would begin was sent the day of discharge after it
had already started and countries around Japan were not informed of thedischarge in advance.
 The U.S. Nuclear Regulatory Commission (NRC) had been seeking detailed
information regarding the status of the Fukushima Dai-ichi NPS from theJapanese government since 12 March 2011. However, the Japanese
government was incapable of providing such information to the U.S. in a
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manner satisfactory to the U.S. side, because Japanese government had notbeen able to acquire sufficient information on the nuclear power plant itself
and officials of NISA and other government staff familiar with the situation at
the nuclear plant were preoccupied with their work of dealing with the plant’s
situation. For this reason, the NRC decided to issue evacuation advice as asafety measure, and on 17 March (Japan time) advised U.S. citizens in Japanto evacuate to outside of a 50-mile (about 80km) radius of the Fukushima
Dai-ichi NPS. This led to confusion because this radius for evacuation was
significantly larger than the 20km radius of the Japanese evacuation area.

(6) Nuclear emergency preparedness(a) Nuclear emergency preparedness system and responses of relevant organization after
accident
Nuclear emergency preparedness and the response of the relevant organization
have been pointed out in the all investigative reports from various viewpoints.
However the responses of the relevant organization have been already described in
the above issues selected. For this reason, to avoid overlapping of the descriptions,[National Diet Report] that describes the overview of the nuclear emergency
preparedness, was referred in the following way.
3.2.1 The government’s organizational framework at the time of the nuclear disasterThe government’s nuclear emergency preparedness system assumes that after a declaration of a
nuclear emergency situation (Nuclear Emergency Declaration) is issued, the NERHQ and the Local
NERHQ, which is established at the Off-site Center, serves as the core, and, with other relevantorganizations, works together and cooperates in their response to a nuclear accident.
1. Organizational framework in the event of nuclear disasterThe government’s preparedness system in the event of a nuclear disaster is prescribed in detailunder the Nuclear Emergency Preparedness Act, the Basic Plan for Emergency Preparedness andthe Nuclear Emergency Response Manual (NER Manual), etc.
According to the NER Manual, etc., the NERHQ and the Local NERHQ are the coreorganizations that respond to a nuclear disaster. When the prime minister issues a Nuclear
Emergency Declaration, the NERHQ (for which the prime minister serves as the director-general)
should be established at the Kantei and the Local NERHQ at the Off-site Center. The
director-general of the Local NERHQ, to whom the director-general of the NERHQ delegates partof his/her authority, undertakes the response to the accident, including the issuance of evacuation
orders, in accordance with the actual local conditions and with the support of the NERHQ and the
support and cooperation of the other relevant organizations such as municipal governments (seeFigure 3.2.1-1).
In order to facilitate coordination among these organizations, the Integrated Nuclear Emergency
Preparedness Network was formed among the Kantei, the METI Emergency Response Center(NISA-ERC), where the secretariat of the NERHQ is established, the Off-site Center, and the
Cabinet Office’s Nuclear Safety Commission (NSC), an organization that advises on responses tonuclear accidents. Information and communication equipment, including the videoconference
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Figure 3.2.1-1 Outline of the organizational framework concerning the nuclear emergency
preparedness (in the case of this accident)
2. Impact of earthquake disasters, etc. on the nuclear emergency preparedness system
The abovementioned nuclear emergency preparedness system had been built on the assumptionthat the infrastructure, including communication and transportation networks, would function andoperate as in ordinary times; the loss of the functions of this infrastructure was not amply
anticipated and countermeasures for such a situation had not been adequately taken in advance. The
earthquake and its aftermath disasters that preceded this accident impacted or damaged the facilities
and equipment, significantly hampering the emergency response by the government and otherorganizations from the time immediately after the earthquake.
a. Disruption/confusion of communication networks
The earthquake and its aftermath disrupted a large part of the ground communication circuits inFukushima Prefecture. This made communications between the government, the Disaster Provision
Main Office of Fukushima Prefecture (the Prefectural Headquarters for Disaster Control) and otherrelevant organizations in Fukushima Prefecture, including the Off-site Center, extremely difficult. It
also became almost impossible to retrieve data on environmental radiation dose measurements frommonitoring posts set up by the Fukushima prefectural government.
In Fukushima Prefecture, a large proportion of the municipal disaster management radio
communication lines for use by the Prefectural Headquarters for Disaster Control were renderedunusable, resulting in a significant loss of communication capacity with municipal governments andother relevant organizations.
The general public circuits (including cell phones) experienced communication failures due to ahuge increase in communications traffic in the metropolitan Tokyo region immediately following
the earthquake. Preference circuits for use in the event of a disaster also reached their capacity,
disrupting communications for relevant organizations that depended on these means ofcommunication.
b. Disruption/confusion of transportation networks
The disruption and confusion faced by transportation networks following the earthquake and its
aftermath created significant obstacles to transportation from Tokyo to Fukushima Prefecture aswell as to transportation within Fukushima Prefecture. This resulted in a major delay in assemblingnecessary personnel at the Off-site Center.
c. Impact on other facilities
The earthquake also damaged the emergency generator at the Off-site Center, causing a delay in
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starting up the Off-site Center.
[National Diet Report] Chapter 3, 3.2.1

3.2.2 The status of the core organizations for responses to the accident
The cornerstones of the government’s emergency response system are the NERHQ, thesecretariat of the NERHQ, and the Local NERHQ. The NERHQ and its secretariat were responsible
for the monitoring of the nuclear facilities conditions, and as liaison for coordinating emergency
response measures, such as the evacuation of residents. They were unable to perform thoseanticipated roles, largely because the secretariat of the NERHQ failed in the function of collecting
and sharing information concerning the progression of the accident and the progress of the response,and partly because the Kantei stepped in to lead the government’s response to this accident. In
addition, the Local NERHQ could not take the initiative in the on-site response to the accident, suchas issuing evacuation orders, because it was not prepared, either for the simultaneous occurrences ofan earthquake, tsunami and nuclear accident, or for such a prolonged and serious accident.
1. NERHQ
a. RoleAccording to the Nuclear Emergency Preparedness Act, the NERHQ is an organization that is
temporarily established in the cabinet office after the prime minister issues a Nuclear Emergency
Declaration, for the promotion of emergency response measures and the comprehensive
coordination among relevant organizations. In the event of a nuclear power plant accident, the prime
minister serves as the director-general of the NERHQ and the Minister of Economy, Trade andIndustry (METI Minister) serves as the deputy directorgeneral. According to the NER Manual, thesecretariat of the NERHQ is to be established at the safety regulatory ministry/agency for nuclear
facilities where an accident occurs. In the case of this accident, the secretariat of the NERHQ wasestablished at NISA-ERC.
b. Confusion caused by a decision-making process different from that in drills
In the annual comprehensive nuclear emergency preparedness drills, the secretariat of theNERHQ collects and sorts out information from nuclear power plants, etc. Based on that, theNERHQ and/or the Local NERHQ decide on protective measures, and the secretariat of theNERHQ and/or the Local NERHQ give instructions for countermeasures to the relevant parties.
During this accident, the NERHQ held a total of eight meetings in the early phase of the accident
between March 11 and March 15. However, the core organization for the emergency response was
not the NERHQ, but the prime minister and other concerned parties who assembled in the prime
minister’s office and reception rooms on the fifth floor of the Kantei (the fifth floor of the Kantei).
As the situation of the events evolved so fast, as described in detail in 3.4.1, there was no time fordiscussion at these meetings of the NERHQ, and thus the fifth floor of the Kantei directly collected
opinions and views from TEPCO, NISA, the members of NSC and other parties concerned, andmade decisions based on them.
2. Secretariat of the NERHQ (NISA-ERC)
a. RoleThe secretariat of the NERHQ for this accident was established at NISA-ERC and was expected
to perform the functions of planning and coordinating responses to the accident being undertaken by
the NERHQ, the Local NERHQ, and other relevant organizations. More specifically, the secretariat
was responsible for the collection of information on nuclear plants, the forecasts, monitoring results
and other information of the dispersion of radioactive materials, and for the planning of protective
measures for residents (including evacuation orders) and the coordination, etc. of emergency
transportation of supplies, on the basis of such information. In particular, in the early stage before
the establishment of the Local NERHQ, the secretariat of the NERHQ, instead of the Local NERHQ,
was expected to perform the key role in the government’s response to the accident. (For example,
when the NERHQ issues evacuation orders to relevant municipalities, the secretariat is to promptly
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prepare draft orders and propose them to the director-general of the NERHQ.)
In order to perform these roles, NISA-ERC had, among its facilities necessary for emergency
response measures, a videoconference system connected to the conference room of the Kantei(where NERHQ meetings were held), NSC, the Off-site Center and other relevant organizations, aswell as multiple data display terminals of the Emergency Response Support System (ERSS) and the
System for Prediction of Environmental Emergency Dose Information (SPEEDI). In terms of staff,
necessary personnel was dispatched from relevant ministries and agencies, including the Cabinet
Secretariat, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) and theMinistry of Health, Labour and Welfare (MHLW), who were to facilitate the coordination of
emergency response measures with the organizations from which they were dispatched, including
evacuation guidance.

Fig. 3.2.2-1 Composition of the secretariat of the NERHQ in this accident
b. Inadequate information collection
The loss of all the AC power supply at the Fukushima Daiichi Nuclear Power Plant stopped the
ERSS data transmission server, disabling the predictive calculations by ERSS of the amounts andthe timing of the release of radioactive materials to the atmosphere outside the plant and theprediction calculations by SPEEDI of the dispersal of radioactive materials based on the ERSS
calculations.
In addition, sufficient information about the accident site of the Fukushima Daiichi Nuclear
Power Plant could not be obtained as expected. The plant’s nuclear safety inspectors from the officeof nuclear safety inspectors, who were to perform the role of information gathering, were visiting
the plant for safety inspections when the earthquake occurred. These safety inspectors, except for
those necessary to set up the Off-site Center, stayed at the accident site. However, they could notcollect enough information as TEPCO employees were involved with the emergency response. As
the means of communication with the outside was quite limited, all the safety inspectors left for the162

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Off-site Center around 4:00 on March 12. Thus, the secretariat of the NERHQ lost the means to
directly collect information from the accident site, including how TEPCO was responding to thesituation.
On March 13, at the instruction of the METI Minister, safety inspectors again visited the
Fukushima Daiichi plant, checked the plant’s preparedness system, etc. for the water injection work,and reported the inspection results to the Local NERHQ. However, they collected information only
from within the Seismic Isolation Building. All the safety inspectors, who feared for their physicalsafety due to the deterioration of the situation—including the explosion at the Unit 3 building andthe rising pressure in the pressure vessel and other facilities of Unit 2—evacuated to the Off-site
Center by the evening of March 14, with the approval of the head of the office of nuclear safety
inspectors. This again resulted in the loss of any means to directly collect information from theaccident site.
At the Off-site Center, TEPCO brought its in-house videoconference system into the company’sbooth soon after the recovery of the power supply and established the conditions for real-timecommunication with the TEPCO Emergency Response Center at TEPCO’s head office and the
TEPCO Emergency Response Center at the Fukushima Daiichi Plant, etc. However, partly because
the Off-site Center’s communication facilities had been substantially damaged, the Local NERHQ
never reported the detailed content of the communications of TEPCO’s videoconference system tothe secretariat of the NERHQ.
The secretariat of the NERHQ collected information on the accident site only through faxes sentfrom TEPCO and inquiries made to the TEPCO Emergency Response Center at TEPCO’s head
office by TEPCO staff dispatched to the secretariat. The secretariat of the NERHQ received a large
number of faxes from TEPCO, but was aware that this method of information collection wastime-consuming, and lacking in necessary information. However, bound by the notion formed inordinary times that there should be a clear line drawn between the safety regulatory agency andnuclear operators, the secretariat never took more proactive steps to improve its
information-gathering system, such as dispatching its staff to the TEPCO Emergency Response
Center at TEPCO’s head office to collect information.
c. Inadequate provision of information to other relevant organizations
In accordance with the NER Manual, relevant ministries and agencies were to send necessary
personnel to the secretariat of the NERHQ. In the initial response immediately after this accident,
however, some ministries and agencies failed to dispatch personnel to the secretariat, stating their
response to the earthquake and tsunami disasters as the reason. While the secretariat of the NERHQ
provided information to relevant organizations, mainly by fax, in many cases informationtransmitted by fax was not written in jargon-free style for officials without special or technicalknowledge about nuclear power. Officials at the relevant organizations who received faxed
information often could not understand the gravity of the situation, or were at a loss about how tohandle the received information, and thus there were some cases where the officials failed to share it
within the relevant organizations.
d. Responses to this accident that fell behind the curve
As NISA was tied up with the emergency response, the Cabinet Secretariat took over the generaland clerical affairs of the NERHQ via a cabinet decision. The Cabinet Secretariat and NISA thenreached an understanding that substantive work should be undertaken by NISA.
However, confronted with the unexpected dysfunction of the Local NERHQ as well as theinadequate collection and sharing of information as mentioned above, the secretariat of the NERHQ
had no choice but to fall behind the curve in considering and implementing response measures tothe nuclear accident. Regarding the evacuation of residents, for example, though the secretariat of
the NERHQ was considering possible areas for the evacuation, the fifth floor of the Kantei decided,
before the secretariat of the NERHQ had reached any specific conclusion, on an order for theevacuation of residents within a 3km radius of the Fukushima Daiichi plant. The same thing
happened with an order for the evacuation of residents within a 10km radius of the plant. The
members of the secretariat of the NERHQ, after learning that the evacuation areas had already been
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decided upon without their involvement, and despite their intent to provide necessary information inadvance of such a decision, gradually came to assume the passive attitude of acting on instructions
from the Kantei. In its response to the accident other than the designation of evacuation areas, there
is no evidence that the secretariat of the NERHQ ever made any effective proposals to the Kantei.
Thus, the secretariat of the NERHQ became an organization that took only ex-post facto or
passive action, such as relaying information on decisions by the fifth floor of the Kantei regarding
evacuation orders to the municipal governments concerned, and sending information obtained fromTEPCO to the Kantei.
3. Local NERHQ (Off-site Center)a. RoleThe Local NERHQ is designed as an organization to take the initiative in the government’s
emergency response measures and activities locally in the event of the issuance of the Nuclear
Emergency Declaration. The Local NERHQ is established at the Off-site Center (the center for
emergency response measures) and organizes the Joint Council for Nuclear Emergency Response(Joint Council) with the prefectural/municipal headquarters for disaster control of the nuclear
facility location, for purposes of information exchange and mutual cooperation.
An Off-site Center is designated for each nuclear facility as a base for responding to a nuclear
disaster. They were positioned to act as the base of the nuclear emergency preparedness system by
the Emergency Nuclear Preparedness Act, enacted in December 1999 in response to problems thatcame to the fore in the wake of the accident at JCO Co., Ltd.
Relevant ministries and agencies, as well as governments of prefectures and municipalities where
nuclear facilities are located, send personnel to Off-site Centers as staff to engage in disaster
response operations. Off-site Centers are also equipped with communication lines necessary for
their operations, videoconference systems connected to NISA-ERC and other relevant organizations,and terminals of ERSS and SPEEDI. In order to smoothly carry out the disaster response, thedirector-general of the NERHQ delegates, as necessary, part of his/her authority concerning orders
to evacuate residents, restrict the intake of beverages and food and the intake of stable iodine tablets,
etc. to the director-general of the Local NERHQ (or, in the case of a nuclear power plant accident,
the METI Senior Vice Minister).
For the Fukushima Daiichi plant and the Fukushima Daini plant, the Fukushima Prefectural
Nuclear Emergency Response Center, located adjacent to the Environmental Radioactivity
Monitoring Center of Fukushima Prefecture in Okuma Town, was designated as the Off-site Center.

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Fig. 3.2.2-2 Composition of organizations of the Off-site Center in this accident
b. Problems with the establishment of the Off-site Center
The establishment of the organizations that needed to be set up at the Off-site Center for this
accident required a lot of time due to the delays and cancellations of the arrivals of necessary
personnel (including the director-general of the Local NERHQ), as well as the earthquake’s impact
on facilities and equipment.
The towns that host the nuclear facility did not dispatch personnel, as they were tied up with their
response to the earthquake and tsunami disasters. The one exception was Okuma Town, where theOff-site Center was located.
METI Senior Vice Minister Ikeda (who was to serve as the director-general of the NERHQ) andother METI and NISA officials who were to be dispatched, left METI for the Off-site Center by car
around 16:00 on March 11, immediately after the earthquake, but were stranded on their way,caught in traffic jams caused by the earthquake. They decided to go to the Off-site Center using an
Self-Defence Force helicopter, but due to the limit on the number of people who could board, only afew people, including Ikeda and the NISA Deputy Director-General (who was to serve as the deputy
directorgeneral of the Local NERHQ), could actually head for the Off-site Center. People
dispatched by the Fukushima prefectural government also required a lot of time to arrive at theOff-site Center because of road damage caused by the earthquake. These people arrived at theOff-site Center at around midnight on March 12, more than five hours after the issuance of the
Nuclear Emergency Declaration.
When they arrived at the Off-site Center, however, it was totally without power, as the earthquake
had damaged its emergency generator. Therefore, the dispatched personnel temporarily went to theEnvironmental Radioactivity Monitoring Center of Fukushima Prefecture, but could not do much interms of their expected activities. The effective establishment of the Local NERHQ was delayed
until around 3:00 on March 12, when the emergency generator at the Off-site Center resumed
normal operations.
As described above, the Off-site Center could not perform any of its functions during the period
immediately after the occurrence of this accident, and therefore made no contributions whatsoever
to the emergency response at that time.
c. Problems with the operation of the Off-site Center
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At the Off-site Center, even after the restoration of the power supply, ground communicationlines such as for the videoconference system, telephones and fax machines remained disconnected.
The Off-site Center’s communication with the outside relied entirely upon a few satellite phones,
causing serious problems with the sharing of information, liaison and coordination with relevantorganizations. In particular, because the nuclear facility-hosting towns except for Okuma Town
failed to dispatch personnel to the Off-site Center as described above, little information was sharedwith those towns.
Due to the disruption of communication lines, it became impossible to obtain information onplants, ERSS or SPEEDI, making it extremely difficult for the Off-site Center to devise measures toprotect residents.
Though the information collected by the Local NERHQ was meant to be regularly announced orreleased at press conferences at the Off-site Center, such opportunities never came, as no media
visited the Off-site Center after this accident. The directorgeneral of the Local NERHQ and otherdispatched personnel made efforts to perform their respective roles. The director-general of the
Local NERHQ was engaged in operations such as issuing instructions to prepare for the intake ofstable iodine tablets, for example, though it was then not necessarily clear whether the
director-general of the NERHQ had actually delegated part of his authority to the director-general of
the Local NERHQ. However, as the situation at the Off-site Center was quite different from what
had been planned, the organizations at the Off-site Center were unable to adequately perform theirrespective roles designated legislation including the Nuclear Emergency Preparedness Act.
d. The prolongation and increasing seriousness of the situation and the relocation of the
Off-site Center
Following the expansion of the evacuation zone beyond a 10km radius of the Fukushima Daiichi
plant, the Off-site Center, located within a 5km radius of the plant, became isolated in theevacuation zone. It became difficult to procure fuel, food and other necessary supplies.
As the Off-site Center was not equipped with air filters to block the penetration of radioactive
materials, radiation doses within the building increased in tandem with the rises in radiation doses
in surrounding areas, raising concerns about the impact on the health of personnel there. Under
these circumstances, the Local NERHQ, after consultations with the secretariat of the NERHQ,
decided to relocate the functions of the Off-site Center to a location outside the evacuation zone.
However, the Fukushima Prefectural Government Minamisoma Office (located in Minamisoma
City), the alternate site, was occupied by the Soso District Development Bureau of the Fukushima
prefectural government as a headquarters mainly for response measures for the earthquake andtsunami disasters, which left no space for the Off-site Center. Eventually, on March 15, it was
decided to relocate the Off-site Center to the Fukushima prefectural government building.
The director-general of the Local NERHQ and its staff made efforts to perform their respectiveroles, and recorded their daily activities even amid the heights of confusion in which they foundthemselves. This deserves the Commission’s recognition and acclaim. However, as the situation of
the Off-site Center was completely different from what had been anticipated, the Off-site Center
could not take sufficient measures to protect the local residents.
After its relocation to the Fukushima prefectural government building, the Local NERHQ
gradually restored its expected functions and energetically undertook operations for local residents.
It also solicited requests for measures from people affected by the nuclear accident and conveyed
them to the government.
e. Inadequate assumptions about the complex disaster and the prolongation and seriousness ofthe nuclear accident
As described above, the Off-site Center was forced to relocate after failing to adequately perform
its expected functions. This largely resulted from the fact that the Offsite Center did not havelogistical support and personnel in place on the basis of full assumptions about the possibilities ofcomplex disasters, the simultaneous occurrences of earthquake/tsunami disasters and a nuclear
disaster, and a situation of prolonged and grave seriousness, as witnessed in this accident. However,it had at least been pointed out as a result of the administrative evaluation/monitoring by the166Japan Health Physics Society
Ministry of Internal Affairs and Communications (MIC) in February 2009 that measures would beneeded to reduce exposure to doses of radiation within the Off-site Center in the event of a nuclear
accident. Nonetheless, NISA failed to take adequate measures, concluding that no further measures
were needed as long as the measure was secured of the Off site Center building to be well sealed to
get less air circulation (air-tightness), and that the installation of air filters was not necessary.
[National Diet Report] Chapter 3, 3.2.2

3.2.3 Status of organizations supporting the emergency response
This section examines whether the planned assistance was provided to the core organizations incharge of emergency response noted in the previous section. Examined in this section are theEmergency Response Office in the Prime Minister’s Office, which was responsible for the initial
response following a nuclear accident, NSC, which was to provide technical and expert advice, andMEXT, which was in charge of measuring the effects of radiation and developing forecasting
systems in order to examine protective measures for local residents.
To summarize, confusion was seen within the Emergency Operations Team of the Emergency
Response Office in the Prime Minister’s Office during its simultaneous response to the disasters,
which included the earthquake and tsunami as well as the nuclear accident, but the team quickly
proceeded with general coordination and decision-making of the relevant organizations. However,many problems were observed at NSC, which was unable to provide collective advice as anorganization, and at MEXT, which failed to fully utilize the systems and tools it had developed toascertain the status of the diffusion of radioactive material.
1. Emergency Response Office in the Prime Minister’s Office (Crisis Management Center)a. RoleThe Crisis Management Center has been established and developed as part of the Cabinet’s
initiatives to strengthen its crisis management functions. The center was set up in 1995 in the wakeof the Hanshin-Awaji Earthquake and the sarin gas attack on Tokyo’s subway; it developed further
in response to incidents such as the 1996 Japanese embassy hostage crisis in Peru and the 1997
grounding and oil spill of a Russian oil tanker. Located in the basement of the Kantei, the center
includes a conference room for executive officials and an operations room to cope with a variety ofsituations.
The center also has visual-image, communication and information processing system forgathering and analyzing information, as well as a network linked to relevant government ministries
and agencies. The center ensures security through measures that prevent the leakage of radio waves
and a strict access screening system.
The November 21, 2003 Cabinet Decision “Regarding the Government’s Initial Response
Framework for Emergencies” stipulates that the Deputy Chief Cabinet Secretary for Crisis
Management is to establish an Emergency Response Office in the Prime Minister’s Office,wheneveran emergency occurs and quickly convene an Emergency Operations Team consisting of
director-general-level members from each government ministry and agency at the Crisis
Management Center to gather information relating to the government’s initial response.
The Emergency Response Office in the Prime Minister’s Office was meant to engage in theinitial response following the outset of a nuclear disaster up to the point when the NERHQ begins
full-fledged operations. Once the activities of NERHQ and its secretariat begin in earnest, it isassumed that operations will be handed over to the secretariat of the NERHQ. However, therelationship between the Emergency Response Office in the Prime Minister’s Office and thesecretariat of the NERHQ was not clearly defined in the NER Manual.
b. The response by the Emergency Response Office in the Prime Minister’s Office to this
accident
The Emergency Response Office in the Prime Minister’s Office was established at 14:50, four
minutes after the earthquake struck at 14:46 on March 11, 2011. Initially, the Emergency Response
Office in the Prime Minister’s Office was charged with responding to the earthquake and tsunami
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disaster.
Following the notice from TEPCO about the occurrence of an event coming under Article 15 of
the Nuclear Emergency Preparedness Act, METI Minister Kaieda reported to Prime Minister Kan,requesting that a Nuclear Emergency Declaration be issued; when doing so, however, thediscussions between the Director-General of NISA and the Deputy Chief Cabinet Secretary for
Crisis Management and other officials that were stipulated in the NER Manual were not undertaken.
The Deputy Chief Cabinet Secretary for Crisis Management and other officials did not even attend
the petition procedure for Prime Minister Kan. This is believed to have been caused by the unclear
nature of the NER Manual, and a lack of understanding on the part of executive officials and staff incharge at NISA regarding the details of the procedure whereby the Emergency Response Office in
the Prime Minister’s Office, among others, was to be involved, since related persons from theEmergency Response Office in the Prime Minister’s Office and the Emergency Operations Team
had not participated in annual comprehensive nuclear emergency preparedness drills.
After NERHQ was set up, the operation room within the Crisis Management Center began its
full-fledged emergency response by separating activities into two booths: one predominantly
focused on the response to the earthquake and tsunami disaster; the other predominantly focused on
the response to the nuclear disaster. The politicians in the Kantei, including Prime Minister Kan,
moved to a small room on the mezzanine floor and then to the area surrounding the Office of thePrime Minister on the fifth floor of the Kantei, because the operation room was in an uproar andthey were not comfortable making decisions in such a place. This caused a disruption in the flow of
information with the Crisis Management Center.
c. Relationship with the Emergency Response Office in the Prime Minister’s Office and thesecretariat of the NERHQ (NISA-ERC)
The Emergency Operations Team gathered at the Emergency Response Office in the Prime
Minister’s Office consisted of director-general level members from related government ministries
and agencies who had a certain degree of decision-making authority. The Team had been convened
on several past occasions in the wake of natural disasters and was accustomed to responding toemergencies. As a result, the coordination between related government ministries and agencies forthe response to this accident was, in general, performed promptly.
However, there were problems concerning information sharing with NERHQ. Originally, nuclear
plant information was to be gathered at the secretariat of the NERHQ in the ERC and conveyed to
NISA personnel dispatched to the Emergency Response Office in the Prime Minister’s Office. Plans
also called for this information to be shared with the Kantei as well. In this accident, however, as
has been mentioned above, the secretariat of the NERHQ was unable to sufficiently collectinformation (including plant information) about the site. In addition, NISA executive officials were
responding to the secretariat of the NERHQ and the fifth floor of the Kantei, making it impossible
for NISA, unlike the other government ministries and agencies, to permanently place executive
officials in the Emergency Operations Team. Therefore, the Emergency Response Office in thePrime Minister’s Office was unable to smoothly collect nuclear plant information, so it requested
TEPCO head office to dispatch TEPCO employees, and it started collecting information on the
nuclear plant. Incidentally, the first and second reports related to the explosion at Unit 1 of the
Fukushima plant, made by a police officer of the Fukushima Prefectural Police, were conveyed to
the Kantei via the National Police Agency. Given this, a sense of distrust of and malcontent withNISA gradually began to take hold in the members of the Emergency Operations Team gathered at
the Emergency Response Office in the Prime Minister’s Office.
2. The Nuclear Safety Commission (NSC)
a. RoleAs an expert body on nuclear power in the nuclear emergency preparedness activities, NSC is toprovide appropriate advice based on requests made by the director-general of NERHQ, or the prime
minister. According to the Basic Plan for Emergency Preparedness, when NSC receives a
notification pursuant to the provision of Article 10 from the operator, NSC is to set up aheadquarters organization called an emergency technical advisory body within its secretariat, as
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well as a local body of the emergency technical advisory body at the Off-site Center to which it will
dispatch, among others, the NSC commissioners and the advisors for emergency responses. In turn,
NSC is to collect information and perform investigations and analyses, as well as prepare technicaladvice.
b. Delay in establishing an emergency technical advisory body
NSC used the group e-mail system for mobile phones to summon the advisors for emergency
responses and attempted to establish an emergency technical advisory body. However, the groupe-mail was not delivered to some advisors for emergency responses, and disruptions in public
transportation and telecommunications meant that nearly all of the advisors for emergency
responses that were summoned failed to convene on March 11. During the initial response,
members of NSC and advisors for emergency responses were not dispatched to the site, nor wereany local body established at the Off-site Center.
NSC participated in the comprehensive nuclear emergency preparedness drills organized by thegovernment and practiced procedures for establishing an emergency technical advisory body byimplementing its own nuclear emergency preparedness drills. However, NSC had not anticipatedthe disruptions in public transportation or telecommunications that occurred as a result of thisearthquake and tsunami, which caused the delay in establishing the emergency technical advisorybody.
c. Unpostulated work demanded by the Kantei
According to the NER Manual, NSC is supposed to provide advice regarding technical matterson the implementation of emergency response measures when requested to do so by the prime
minister, who also serves as the director-general of NERHQ.
NSC Chairman Madarame and NSC Secretary General Akihiko Iwahashi attended the firstmeeting of NERHQ from19:03 on March 11, 2011, following a request made by the Kantei. Afterthe meeting ended, Madarame returned once to NSC Secretariat, but he returned again to the Kantei
at its request. From then on, he was almost continuously stationed at the Kantei until around March
15, involved in discussions held on the fifth floor. NSC Deputy Chairman Yutaka Kukita also
headed to the Kantei to sit in on the second meeting of NERHQ, and at the request of Madarame, heremained almost continuously assigned to the Kantei until around March 15 in order to aid the
Chairman.
On the fifth floor of the Kantei, Madarame and Kukita offered advice grounded in technicalexpertise, based on the plant information that had been collected. However, this advice was notoffered as advice from NSC as an organization, but merely represented personal views in theircapacity as members of NSC. NSC is an advisory body that uses the collective knowledge of its fiveexpert members to provide advice. As a result, this type of immediate on-the-spot response torequests for advice had not been assumed. With the prolonged absence of two of its five members aswell as its secretary general, NSC was significantly impaired from functioning as an organization.
d. Broad range of advisory requests and consultations
NSC is required to provide technical advice in response to requests received from thedirector-general of NERHQ and relevant organizations, but rules had not been clearly stipulated on
the target themes and methods for delivering this advice.
As a result, after this accident, the Secretariat for NSC was overwhelmed by a wide range ofadvisory requests, consultations and questions from numerous public offices, primarily including
the Ministry of Agriculture, Forestry, and Fisheries (MAFF), the Ministry of Health, Labour, andWelfare (MHLW), the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
and the Ministry of the Environment (MOE). Included among these were questions that went
beyond the expertise of NSC, such as “What will happen if migratory birds fly from Fukushima toTokyo?” and “We’ve had local residents evacuate, but what do we do about livestock?” Many otherquestions did not necessarily regard technical matters, such as “How should we handle the bodies oftsunami victims that have been exposed to radiation?” Members and staff remaining at the
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advisory requests or questions, and the workload exceeded NSC’s capacity.
3. The Ministry of Education, Culture, Sports, Science and Technology (MEXT)
a. RoleAccording to the MEXT Emergency Action Plan, MEXT must establish a Nuclear Emergency
Response Support Headquarters within the ministry when an event occurs at an METI-administeredfacility as designated in Article 10 or 15 of the Nuclear Emergency Preparedness Act.
According to MEXT’s Nuclear Emergency and Disaster Response Manual, the Nuclear
Emergency Response Support Headquarters exists mainly to provide advice for monitoring
conducted by the Off-site Center radiation squad, to analyze monitoring data, and to dispatch
disaster medical assistance teams to the site.
b. Insufficient monitoring support
According to the Basic Plan for Emergency Preparedness, MEXT and other relevantorganizations are to dispatch personnel and equipment to local governments to support emergency
monitoring activities undertaken by the local governments.
In this accident, most of the monitoring posts set up by Fukushima Prefecture were damaged in
the earthquake or tsunami and were unusable. On March 12, MEXT decided to dispatch monitoringvehicles and personnel to the Off-site Center. Three monitoring vehicles, one general vehicle used
for monitoring and monitoring personnel arrived on site on March 13, and MEXT’s support teambegan monitoring activities on March 15. Support provided by MEXT did not take into account theextended duration of the situation, which resulted in a shortage of fuel and other supplies for themonitoring vehicles. When the Local NERHQ moved to the Fukushima Prefectural Government
Building on March 15, the team was forced to leave the monitoring vehicles that had run out of fuelat the Off-site Center.
The emergency monitoring assumed prior to the accident was not carried out, so on the morningof March 16 at the Kantei, duties were assigned, mainly by Chief Cabinet Secretary Edano. MEXT
was placed in charge of compiling, and NSC was charged with assessing, the data from emergency
monitoring conducted outside a 20km radius of the Fukushima Daiichi plant.
MEXT had planned to begin airborne monitoring from the predawn hours of March 12, but theseplans were not implemented until much later. After coordinating with the Ministry of Defence(MOD), an MOD helicopter was placed on standby to conduct airborne monitoring on March 12,
but a miscommunication prevented MEXT personnel from boarding and the monitoring opportunity
was lost. In the end, airborne monitoring was conducted on March 25 with the cooperation of theJapan Aerospace Exploration Agency (JAXA).
c. Failure to utilize airborne monitoring data provided from overseas
After March 18, 2011, airborne monitoring data gathered by the United States Department ofEnergy using US military aircraft was conveyed to MEXT and NISA via the Ministry of Foreign
Affairs of Japan (MOFA). MEXT failed to share this data with NSC or the Kantei because it
considered the data to be the results of monitoring performed by the United States, and thus it was
not responsible for compiling such data. If it had been conveyed to the fifth floor of the Kantei, thisdata could have been used as a reference when protective measures were devised for local residents.
[National Diet Report] Chapter 3, 3.2.3

3.5.1 Initial response by Fukushima Prefecture
Fukushima Prefecture’s nuclear emergency preparedness system was set forth in the nuclear
emergency response section of the Fukushima Prefecture regional disaster prevention plan. The plan,
however, did not assume a nuclear emergency resulting from an earthquake or other natural disaster.
1. Fukushima Prefecture’s organizational structure for nuclear emergencies
Fukushima Prefecture’s organizational structure for times of nuclear emergency was laid out inthe nuclear emergency response section of the Fukushima Prefecture regional disaster prevention
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plan.
The nuclear emergency response section stipulates that, if a notification is received in accordancewith Article 10 of the Nuclear Emergency Preparedness Act, a Prefectural Headquarters for Disaster
Control is to be established at the Fukushima Prefectural Government offices (Main office) and thePrefectural Nuclear Emergency Response Headquarters is to be formed at the Off-site Center. It
further indicates that nine squads (general affairs, information gathering, communications, public
relations, external affairs, activity support, aid, supplies, and resident evacuation and safety) are tobe established under the Prefectural Headquarters for Disaster Control, and information gathering is
to be conducted and assistance is to be provided to municipal governments for resident evacuation.
In addition to the nuclear emergency response section, the Fukushima Prefecture regional disasterprevention plan also has an earthquake response section. This section notes that the national
government has confirmed the seismic safety of the nuclear power plants (the Fukushima Daiichi
Nuclear Power Plant and the Fukushima Daini Nuclear Power Plant), and that an earthquake is notassumed to cause a nuclear emergency. In other words, the regional disaster prevention plan was notformulated on the presumption that a natural disaster such as an earthquake would spawn a nuclear
emergency. The earthquake response section does set forth the organizational structure forearthquakes; however, this structure assumes a plan based on the same nine functional squads as set
forth in the nuclear emergency response section.

Figure 3.5.1-1 Initial organizational structure of the Fukushima Prefecture Headquarters for
Disaster Control
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2. Initial response
a. Structure of the earthquake- and tsunami-focused Headquarters for Disaster Control
When the nuclear accident happened, a large number of personnel at the Fukushima Prefectural
Office were working on the various functional squads at the aforementioned Fukushima Prefecture
Headquarters for Disaster Control, in accordance with the earthquake response section of the
Fukushima Prefecture regional disaster prevention plan, in order to implement earthquake andtsunami countermeasures. For this reason, the number of personnel available to respond to the
nuclear disaster was significantly limited, making it impossible to implement the structure laid out
in the nuclear response section of the regional disaster prevention plan.
Fukushima Prefecture therefore hastily established a new squad, which was devoted to the
nuclear disaster response, placed under the organizational structure set forth in the earthquake
response section. However, the squad’s staffing was limited and the squad was forced to respond to
nuclear power and radiation issues single-handedly without any clearly defined scope of operations.
Officials in the nuclear squad were, though, under the impression that the response to the nuclear
disaster was mainly to be carried out at the Off-site Center, and the ineffectiveness of the Off-site
Center thus pushed the prefecture’s response to the disaster into a state of confusion. The
Fukushima Prefecture Headquarters for Disaster Control had to oversee operations that it had notforeseen, including, for instance, securing truck-mounted generators requested by TEPCO andscreening evacuated residents.
b. Disabled prefectural government buildings and loss of communications
The Fukushima Prefecture regional disaster prevention plan stipulates that the Fukushima
Prefecture Headquarters for Disaster Control is to be established on the fifth floor of the main officeof the prefectural government building. However, the main office of the prefectural governmentbuilding was constructed in 1954 and its seismic resistance was low. The prefecture was aware of
the office’s unpreparedness for an earthquake and had planned anti-seismic reinforcement
construction, but at the time of the disaster, improvements had yet to be made. So the main office ofthe prefectural government building was completely disabled by the earthquake, making it
impossible to establish the Fukushima Prefecture Headquarters for Disaster Control. The division in
charge of nuclear emergency preparedness-related matters, which was to bear the central role inresponding to this accident, was based at West wing of the prefectural government building, which
was also difficult to use due to anti-seismic issues.
Fukushima Prefecture then transferred the necessary equipment to the third floor of the
Fukushima Prefecture Public Hall, a building designated in the regional disaster prevention plan as
an alternate facility in the event that the main office of the prefectural government building could
not be used. It was there that the Fukushima Prefectural Government set up the Fukushima
Prefecture Headquarters for Disaster Control. This building, however, only had two municipal
disaster management radio communication lines—a vital communication network during times of
emergency—whereas the main office of the prefectural government building was equipped with 47.
Communication networks between the prefectural and municipal governments and other agencies
were fragile, a major obstacle in responding to damage caused by the earthquake and tsunami as
well as the nuclear disaster. The municipal disaster management radio communications areimportant during times of any disaster, not only nuclear emergencies. Fukushima Prefecture’s risk
awareness can be considered lacking—budgetary restrictions aside—as anti-seismic reinforcements
were not prioritized for the building planned for the Headquarters for Disaster Control and an
adequate number of the municipal disaster management radio communication lines were notallocated to the substitute facility.
The Fukushima Prefectural Police Headquarters had also designated the main office of theprefectural government building as the location for establishing a disaster security center during
times of disaster, with the Fukushima Prefectural Police Office as a substitute facility. The
Fukushima Prefectural Police Office, however, had already installed communications facilities on
par with facilities at the main office of the prefectural government building. There was therefore no
significant inconvenience with communications during the initial stages following the accident.
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Japan Health Physics Societyc. Ineffectiveness of the Prefectural Nuclear Emergency Response Headquarters
Following the disaster, Fukushima Prefecture dispatched personnel to an Off-site Center andestablished the Prefectural Nuclear Emergency Response Headquarters but the officials were unable
to fulfill their assumed role.
In past comprehensive nuclear emergency preparedness drills, a scheme was assumed where at
the Off-site Center, discussions would take place at the Prefectural Nuclear Emergency Response
Headquarters to compile the intentions of the prefectural government, which were to be coordinatedwith the municipal and national governments in the Joint Council for Nuclear Emergency Response.
However, as events unfolded quickly in this accident, no substantial discussions took place in the
Prefectural Nuclear Emergency Response Headquarters and the Joint Council for Nuclear
Emergency Response.
Moreover, the Prefectural Nuclear Emergency Response Headquarters personnel were limited at
all times to three or four people, and, particularly after March 14, as the personnel were tied up in
preparation to transfer the Off-site Center to the Fukushima Prefectural Government office, it wasdifficult to implement emergency response measures, taking into account the actual situation ofprefectural residents.
[National Diet Report] Chapter 3, 3.5.1

3.5.2 Fukushima Prefecture’s response to resident evacuations
The Fukushima Prefectural Government and the national government were not aware of eachother’s respective situations following the nuclear power plant accident. Feeling a sense of crisis,
Fukushima Prefecture took its own initiative to issue an evacuation order for a radius of 2km fromthe Fukushima Daiichi Nuclear Power Plant. Thirty minutes later, however, the national
Government issued an evacuation order for residents within a 3km radius of the plant. It was
extremely difficult to disseminate information to the residents due to the shortage of the municipal
disaster management radio communication lines and the damage to communications equipment
resulting from the earthquake and tsunami.
1. Evacuation order given at the discretion of Fukushima Prefecture
Fukushima Prefecture, acting on its own accord, issued an evacuation order for residents within
2km of the nuclear power plant at 20:50 on March 11, approximately 30 minutes before the national
government’s decision to set the evacuation area to a 3km radius around the Fukushima Daiichi
Nuclear Power Plant.
The Fukushima Prefecture Headquarters for Disaster Control had acquired information fromTEPCO and was aware that the situation at the Fukushima Daiichi Nuclear Power Plant was quickly
deteriorating. However, it took approximately two hours after TEPCO notified the national
government before the declaration of a nuclear emergency situation was issued, pursuant to Article
15 of the Emergency Preparedness Act. Fukushima Prefecture was not notified of the declaration ofa nuclear emergency situation for nearly one and a half hours following the declaration. Although
the prefecture was aware that it did not have clear legal grounds for issuing an evacuation order,
they sensed danger in the national government’s failure to issue evacuation orders and decided toissue a resident evacuation order on their own for a 2km radius around the Fukushima plant. The
2km radius was determined by the prefecture as the bare minimum distance considering the 2km
evacuation radius used for residents in past comprehensive nuclear emergency preparedness drills.
When issuing its 2km evacuation zone radius, the prefecture was unaware that the national
government was also considering evacuation zones. The prefecture did not notify the national
government that it had issued the evacuation orders, and only 30 minutes later, at 21:23, the national
government issued evacuation orders for a 3km radius around the nuclear power plant without
knowing prefecture’s evacuation orders.
2. Difficulty disseminating information about the evacuation orders
After issuing the 2km radius evacuation order, Fukushima Prefecture held a press conference for173

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reporters at the Fukushima Prefecture Headquarters for Disaster Control, and then communicatedthe evacuation orders to municipal governments and residents using the Fukushima Police radio andregional fire department radio.
The municipal disaster management radio communications that were ordinarily supposed to serveas an important means of communicating information to municipalities did not work due to ashortage in the number of available lines, and communications equipment at some of the municipal
offices was damaged by the earthquake and tsunami. These factors made it tremendously difficult
for the prefecture to communicate the evacuation orders to the municipal governments.
[National Diet Report] Chapter 3, 3.5.2

The following isssues can be raised in association with nuclear emergency
preparedness system and responses of relevant organization after accident.
Nuclear emergency preparedness system – preparedness for complex disasters
 Serious confusion occurred in the relevant organization owing to insufficient
preparedness for an accident scenario where events unfold quickly and forfacing a complex disaster involving earthquakes and tsunamis occurring
simultaneously with a nuclear disaster.
 The central organization of the government's emergency response system is theNERHQ (the Prime Minister and the Minister of Economy, Trade and Industry(METI) serve as the director-general and the deputy director-general,
respectively). The secretariat of the NERHQ was established at NISA-ERC andwas expected to monitor the nuclear facilities' conditions and coordinate
emergency response measures, such as the evacuation of residents. They wereunable to perform those anticipated roles, largely because the secretariat of theNERHQ failed to collect and share information concerning the progression of
the accident and the progress of the response, and partly because the Kantei (thePrime Minister and other concerned parties who assemble in the prime minister's
office and reception rooms on the fifth floor of the Kantei) stepped in to lead thegovernment's response to this accident as the situation of the accidental events
evolved extremely rapidly.
 The Local NERHQ (the deputy minister of METI serves as the director-general),to which the NERHQ delegates part of its authority, is responsible for the
response to the accident, including the issuance of evacuation orders, inaccordance with the actual local conditions and with the support of the NERHQ
and the support and cooperation of the other relevant organizations such as
municipal governments. The establishment of the organizations that needed to
be set up at the Off-site Center (the center for emergency response measures) for
this accident required much time owing to the delays and cancellations of thearrivals of necessary personnel (including the director-general of the Local
NERHQ), as well as the earthquake's impact on facilities and equipment. The
effective establishment of the Local NERHQ was delayed until around 3:00 on
12 March, when the emergency generator at the Off-site Center resumed normal
operations. Feeling a sense of crisis, Fukushima Prefecture took its own
initiative to issue an evacuation order for a radius of 2km from the Fukushima
Dai-ichi NPS. Thirty minutes later, the national government issued an
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evacuation order for residents within a 3km radius of the plant. In thisemergency situation, the Off-site Center failed to adequately perform its
expected functions.
 Following the expansion of the evacuation zone beyond a 10km radius of the
Fukushima Dai-ichi NPS, the Off-site Center (located within a 5km radius of theplant) became isolated in the evacuation zone, making it difficult to procure fuel,food and other necessary supplies. As the Off-site Center was not equipped with
air filters to block the penetration of radioactive materials, radiation doses within
the building increased in tandem with the rises in radiation doses in surrounding
areas, and on 15 March, it was decided to relocate the Off-site Center to the
Fukushima prefectural government building.
 The Emergency Response Office in the Prime Minister's Office (Crisis
Management Center) was meant to engage in the initial response following theoutset of a nuclear disaster up to the point when the NERHQ begins full-fledged
operations. Once the activities of NERHQ and its secretariat began in earnest, it
was assumed that operations would be handed over to the secretariat of theNERHQ. However, the politicians in the Kantei, including Prime Minister Kan,
moved to a small room on the mezzanine floor and then to the area surrounding
the Office of the Prime Minister on the fifth floor of the Kantei, because theoperation room was in uproar and they were not comfortable making decisions
in such a place. This caused disruption in the flow of information with the Crisis
Management Center.
 As an expert body on nuclear power in the nuclear emergency preparedness
activities, NSC is meant to provide appropriate advice based on requests madeby the director-general of the NERHQ, or the prime minister. According to the
Basic Plan for Emergency Preparedness, NSC is to set up a headquartersorganization, called an emergency technical advisory body, within its secretariat,
as well as a local body of the emergency technical advisory body at the Off-site
Center to which it will dispatch the NSC commissioners and the advisors for
emergency responses. In turn, NSC is to collect information and perform
investigations and analyses, as well as prepare technical advice. However, owing
to disruptions in public transportation and telecommunications, nearly all of theadvisors for emergency responses that were summoned failed to convene on 11
March. During the initial response, members of NSC and advisors for
emergency responses were not dispatched to the site, nor were any local bodies
established at the Off-site Center.
 After the NSC Chairman attended the first meeting of NERHQ on 11 March
2011, following a request made by the Kantei, he remained almost continuously
assigned to the Kantei until around 15 March, together with the NSC Deputy
Chairman, and offered advice grounded in technical expertise, on the basis of theplant information that had been collected. However, this advice was not offered
as advice from NSC as an organization. With the prolonged absence of two of its
five members as well as its secretary general, NSC was significantly impaired in
its function as an organization.
 According to the MEXT Emergency Action Plan, MEXT must establish a
Nuclear Emergency Response Support Headquarters within the ministry, mainly
to provide advice for monitoring conducted by the Off-site Center radiation
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Japan Health Physics Societysquad, to analyze monitoring data, and to dispatch disaster medical assistanceteams to the site. MEXT and other relevant organizations are to dispatch
personnel and equipment to local governments to support emergency monitoring
activities undertaken by the local governments. On 12 March 2011, MEXT
decided to dispatch monitoring vehicles and personnel to the Off-site Center, but
the MEXT's support team did not begin monitoring activities until 15 March.
Owing to a shortage of fuel and other supplies for monitoring vehicles, when the
Local NERHQ moved to the Fukushima Prefectural Government Building on 15
March, the team was forced to leave the monitoring vehicles that had run out offuel at the Off-site Center.
 A Prefectural Headquarters for Disaster Control was to be established at the
Fukushima Prefectural Government offices (Main office fifth floor) and thePrefectural Nuclear Emergency Response Headquarters was to be formed at theOff-site Center. Nine squads were to be established under the Prefectural
Headquarters for Disaster Control to gather information and provide assistanceto municipal governments for resident evacuation. However, a large number of
personnel at the Fukushima Prefectural Office were working on the various
functional squads at the Fukushima Prefecture Headquarters for Disaster
Control, in order to implement earthquake and tsunami countermeasures.
Fukushima Prefecture therefore hastily established a new nuclear squad, which
was devoted to the nuclear disaster response. However, responses of the nuclear
squad fell into a state of confusion owing to the ineffectiveness of the Off-site
Center. The Fukushima Prefecture Headquarters for Disaster Control had tooversee operations that it had not foreseen, including, for instance, securingtruck-mounted generators requested by TEPCO and screening evacuatedresidents.
 The main office of the Fukushima prefectural government building, establishedas the Fukushima Prefecture Headquarters for Disaster Control, was due toundergo anti-seismic reinforcement construction because its seismic resistance
was low, but at the time of the disaster, improvements had yet to be made.
Fukushima Prefecture then transferred the necessary equipment to the third floorof the Fukushima Prefecture Public Hall, a building designated as an alternate
facility. This building, however, only had two municipal disaster management
radio communication lines-a vital communication network during times of
emergency-whereas the main office of the prefectural government building was
equipped with 47. Communication networks between the prefectural andmunicipal governments and other agencies were fragile, which created major
obstacles in responding to damage caused by the earthquake and tsunami as wellas the nuclear disaster.
 Following the disaster, Fukushima Prefecture dispatched personnel to an Off-site
Center and established the Prefectural Nuclear Emergency Response
Headquarters, but the officials were unable to fulfill their assumed role. This was
because no substantial discussions took place in the Prefectural Nuclear
Emergency Response Headquarters and the Joint Council for Nuclear
Emergency Response, particularly after 14 March, since the personnel were
occupied with preparations to transfer the Off-site Center to the Fukushima
Prefectural Government office as events unfolded quickly in this accident.

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Japan Health Physics Society(b) Opportunity of revision of nuclear emergency preparedness for complex disasters(earthquake, tsunami, and nuclear accident)
Descriptions about opportunity of revision of nuclear emergency preparedness forcomplex disaster are given in [Governmental Interim Report], [National Diet
Report] and [Nongevernmental Report] in the following way.
6. Response to nuclear emergency in the midst of complex disaster(1) History of the initiatives of the Japanese government and local governmental organizations
to address the risk of nuclear accident happening in the context of a complex disaster
The question of how one should respond to a nuclear emergency initiated by an earthquake cameinto focus following the occurrence of fire at the Kashiwazaki-Kariwa NPS when it was struck by
the Niigata-ken Chuetsu-oki Earthquake in 2007. The government of Niigata Prefecture, where thegiven NPS exists, pursued a unique approach to disaster prevention. For example, the prefectural
government added a chapter on a complex disaster to its Regional Disaster Prevention Plan for
Nuclear Emergency Preparedness.
Upon requests from the Niigata prefectural government, the national government requested theinvestigation committee on the above-mentioned accident at the Kashiwazaki-Kariwa NPS to
examine and report on the issue of preparedness against a nuclear emergency coupled with acomplex disaster. The report produced by the investigation committee stated the government’s
intention to sort out by the end of fiscal 2008, under the leadership of NISA, the issues that require
attention when responding to a nuclear emergency in a complex disaster. In April 2009, NISA
submitted “A Draft on the Issues Requiring Attention When Preparing an Emergency Response
Manual for Nuclear Emergency Coupled with Complex Disaster” at the sixteenth meeting of the
Nuclear Emergency Preparedness Subcommittee of the Nuclear and Industrial Safety Subcommittee
under the Advisory Committee on Natural Resources and Energy.
However, the draft document stated that the probability of a nuclear emergency being coupledwith a complex disaster was extremely small, based on the view that nuclear power facilities
employ a seismic structural design and are technologically well protected against earthquakes on adesign basis level, and also based on the view that the incident that had taken place at the
Kashiwazaki-Kariwa NPS as a result of the Niigata-ken Chuetsu-oki Earthquake fell short of being
a nuclear emergency. Therefore, the draft document concluded that it was reasonable to develop
countermeasures on the basis of ongoing organizational arrangements for disaster prevention andnegated the need to make new organizational arrangements for disaster prevention assuming thepossible occurrence of a nuclear emergency coupled with a complex disaster.
Moreover, the draft document received criticisms such as the following, which argued against thevery act of developing countermeasures against a nuclear accident coupled with a complex disaster,from concerned agencies of the national government and local governmental organizations:(i) The development of countermeasures against a nuclear emergency in a complex disaster may
become a cause of the mistaken view that major natural disasters are likely to initiate anuclear emergency;(ii) The implementation of countermeasures against a nuclear emergency in a complex disasterwill require major modifications to regional disaster prevention plans, etc.; or(iii) For affairs to be handled by an organization other than NISA, there has not been sufficientnegotiation with concerned organizations.
In response to such criticisms, NISA in October 2010 affirmed the view that the probability of a
nuclear emergency being initiated by a natural disaster is virtually zero, and finalized the policy thatcountermeasures against a complex disaster should be pursued within the ongoing scheme fordisaster prevention. From then on, up to the occurrence of the Fukushima nuclear accident, NISA
did not discuss countermeasures against a nuclear emergency coupled with a complex disaster.
In October 2008, in Fukushima Prefecture, a comprehensive drill for preparedness against a
nuclear emergency, which had been conducted annually in pursuant to the Act on Special Measures
Concerning Nuclear Emergency Preparedness, the Basic Disaster Prevention Plan, etc., was177

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conducted in conjunction with an emergency preparedness drill organized by the prefectural
government. The scenario used in the drill assumed a failure in the emergency cooling system, etc.,
at Unit 3 of the Fukushima Dai-ichi NPS causing the loss of cooling capability and core damage. It
was assumed that basic infrastructures, such as roads and telecommunication links, remained
available.
Besides the above, the Fukushima prefectural government was independently conducting drills
for preparedness against a nuclear emergency on an annual basis, and also was conducting
independently drills on specific subjects such as the evacuation of residents and the conducting ofmonitoring activities. The Fukushima prefectural government tried in many ways to improve thepractical significance of these drills by inviting citizens to participate in evacuation drills and bychoosing not to let the participants know about the scenario in advance. However, none of thesedrills assumed the combination of a nuclear accident and an earthquake, which eventually became a
reality.
In contrast, learning lessons from the accident that had happened at the Kashiwazaki-Kariwa NPS
as a result of the Niigata-ken Chuetsu-oki Earthquake, the Niigata prefectural government wasconsidering since May 2010 beginning evacuation drills assuming the simultaneous occurrence ofan earthquake and a nuclear emergency. In the same month, NISA told the Niigata prefectural
government that conducting a drill assuming the coupling of a nuclear emergency with anearthquake of seismic intensity of Level 5 weak (JMA scale) might spread anxiety andmisunderstanding among local citizens. After having internally discussed this opinion of NISA, theNiigata prefectural government decided not to assume an earthquake.
However, in a drill for preparedness against a nuclear emergency that the Niigata prefecture
government organized in November of the same year, the combination of heavy snowfall and anuclear disaster was assumed in a complex disaster scenario.
(2) Difficulty encountered in responding to the accident because it happened in the context of acomplex disasterIn the case of the Fukushima nuclear accident, damage caused by the earthquake was not limited
to destructive damage to the plant itself such as the failure of reactor cooling systems that resulted
from the impact of the tsunami. Activities conducted in response to the accident had to deal withgreat difficulties that ensued from the earthquake and tsunami, such as a shortage of manpower andthe impairment of telecommunication and transportation infrastructures.
As to the manpower shortage, the national government was not fully able to ensure sufficientavailability of manpower because it had to deal simultaneously with very widespread earthquake
damage and a nuclear emergency. The local governments of affected areas also faced the problemof limited manpower because they had to take care of residents who suffered damage from theearthquake and tsunami while administering nuclear emergency response measures such as
evacuation and body decontamination.
As to the impairment of communication infrastructure, telephone, facsimile and other means were
not readily available for use due to the earthquake. In conducting emergency response activities,
there arose difficulty in the sharing of information and communication among concernedorganizations. It should be noted that the off-site center (Local Emergency Response Center), which
had been expected to play a key role in the emergency by centrally managing information andleading emergency response activities, was hardly able to fulfill its purpose because theheadquarters, before being relocated to the Fukushima Prefectural Office on May 15, 2011, had noother means of telecommunication than satellite phones.
As to the impairment of transport infrastructure, heavy traffic congestion ensued from theearthquake in metropolitan areas, which prevented the smooth delivery of fire engines, water lorries,
battery carrying trucks, power supply vehicles, etc., on their way to the Fukushima Dai-ichi NPS
and caused delays in the delivery of necessary equipment. This is one of the major causes thatprevented the prompt execution of emergency response activities. The traffic problem delayed theassembling of members at the off-site center (Local Nuclear Emergency Response Headquarters)
and then continued to interfere with the activities of the Local Nuclear Emergency Response
Headquarters by causing a shortage of fuel and food. The poor condition of road traffic caused
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difficulty also to monitoring and evacuation activities.
Since the simultaneous occurrence of a nuclear emergency and a natural disaster was not
anticipated, we assume that these problems had not been given attention and therefore had entirely
been left without being addressed by corresponding measures. We believe that these problems could
have been avoided or at least alleviated if corresponding measures had been prepared and drills had
been conducted on the basis of sound assumptions on various events that might ensue from anearthquake or accident.
[Governmental Interim Report] Chapter VI 6

4.3.2 Insufficient disaster preparedness against complex disasters
The expansion of damage caused by this accident is attributed to the insufficient preparedness on
the part of the central government and municipal governments in facing a complex disasterinvolving earthquakes and tsunamis occurring simultaneously with a nuclear disaster.
The Niigata-ken Chuetsu-oki Earthquake, which occurred on July 16, 2007, triggered multiple
troubles and failures, including a transformer fire and a leakage of water containing radioactive
substances at the Kashiwazaki-Kariwa Nuclear Power Plant. In response to these outcomes, many
pundits requested nuclear power plants to put emergency preparedness measures in place to addresscomplex disasters. However, no integrated efforts had been made by the central government andmunicipal governments to establish disaster preparedness against complex disasters prior to theaccident at the Fukushima Daiichi plant.
Please note that “complex disaster” is used in this section to refer to an event whereby a nuclear
disaster occurs simultaneously or in line with a natural disaster, including an earthquake. The term
will subsequently be used according to this definition unless otherwise defined.
1. Initiatives to rework disaster preparedness structures based on the Regional Disaster
Prevention Plana. Roles of the Regional Disaster Prevention Plan
The Regional Disaster Prevention Plan defines how prefectural and municipal governments
should deal with nuclear disasters. It is created by each local government in line with the Basic Planfor Emergency Preparedness defined by the Central Disaster Prevention Council established in the
Cabinet Office.
NISA once worked on a policy allowing municipal governments hosting nuclear power plants tomodify their Regional Disaster Prevention Plans to make them ready for complex disasters. This
move, however, had not come up with any effective results, partly because of objections voiced byrelated agencies of the central government and some local governments hosting nuclear power
plants, prior to the time of this accident.
b. Planning based on the assumption that complex disasters are not likely to occur
The occurrence of the Niigata-ken Chuetsu-oki Earthquake in 2007 prompted a number of local
governments hosting nuclear power plants, including Niigata Prefecture, to request various agenciesof the national government, such as NISA, to implement measures in preparation for complex
disasters (including situations where a nuclear power plant is, or could be, affected by a large-scale
natural disaster).
Niigata Prefecture made an issue of the fact that the national government and the electricity
companies had no mechanism in place to provide information to municipal governments and local
residents in case an earthquake disaster and a nuclear accident occurred at the same time. The
prefecture requested that mechanisms be set up to promptly instruct local residents to evacuate andto publish the status of reactors after an earthquake in case a nuclear power plant was affected.
In response to this request, NISA outsourced research on complex disasters to a private company
to create a viable nuclear emergency response manual applicable for complex disasters. Based on
the research results, NISA drafted “Issues Requiring Attention When Preparing an Emergency
Response Manual for Nuclear Emergency in Preparation for an Event Whereby a Large-Scale
Natural Disaster Occurs Simultaneously or in line with Nuclear and Other Disasters (draft)” as of179

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April 27, 2009, submitting it to the Nuclear Emergency Preparedness Subcommittee of the Nuclear
and Industrial Safety Subcommittee under the Advisory Committee on Natural Resources andEnergy.
The draft incorporated some recommendations based on the outsourced research, but its
disinclination to drastically change the existing disaster preparedness structure can be observed inthis comment: “It is reasonable for us to implement effective and efficient measures againstcomplex disasters in line with the current nuclear emergency preparedness structure, since complex
disasters are highly unlikely to occur.”Specifically, the draft designated the Joint Council for Nuclear Emergency Response to discussevacuation orders, which would not make the decision in a timely enough fashion. It also limited
information disclosure activities to press releases provided by an Off-site Center, and did not design
any special mechanisms for them. As such, the request from Niigata Prefecture was not reflected in
the draft.
As the title of the draft, “Event Whereby a Large-Scale Natural Disaster Occurs Simultaneously
or in line with Nuclear and Other Disasters,” shows, NISA anticipated only the chance of a nuclear
disaster occurring at the same time as a natural disaster, and did not focus on the possibility of a
nuclear disaster that was triggered by a largescale natural disaster. This stance was based on NISA’s
past explanation to local governments hosting nuclear power plants that nuclear power plants were
designed with extremely stringent safety examinations in mind. Assuming that a large-scale natural
disaster could trigger a nuclear disaster would go against that explanation.
c. Objections posed by agencies of the national government and by some local governments
hosting nuclear power plants
Between 2009 and 2010, NISA presented the draft to agencies of the national government andlocal governments hosting nuclear power plants, requesting their comments. Some national
government agencies and local governments harshly objected to the content, with the result that
there was no discussion of any measures for use in response to complex disasters.
The draft assumed a situation in which a nuclear disaster and a natural disaster might occur
simultaneously. The organizations offering their comments claimed that this assumption would
drastically impact their Regional Disaster Prevention Plans and incur large costs, and that themodified assumption itself was too onesided.
Some organizations also claimed that they were confused, since there was no clear image of thedamage that was assumed in relation to complex disasters; they did not know the extent to which
they needed to enhance their existing nuclear disaster prevention structure.
In particular, some local governments voiced visceral objections, with one organization claiming,“Simply assuming that a natural disaster and a nuclear disaster can simultaneously occur, publicly
announcing measures in relation to this scenario, and instructing local governments in line with thisassumption, would simply ruin all the efforts made by local governments.” Some local governments
also mentioned that the Central Disaster Prevention Council managed by the Cabinet Office shouldhave convened to announce the content of the draft before it was reflected in their Regional Disaster
Prevention Plan. This was based on the awareness among people involved in disaster prevention
that the Central Disaster Prevention Council defining the Basic Plan for Emergency Preparedness as
the basis for their Regional Disaster Prevention Plan had strong influence over the nuclear
emergency preparedness structure of local governments. It became clear that the Act on Special
Measures Concerning Nuclear Emergency Preparedness, stipulated shortly after the JCO Accident,
did not necessarily define Japan’s nuclear disaster prevention framework in a systematic mannerand NISA, overseeing the Nuclear Emergency Preparedness Act, did not have enough power tosingle-handedly persuade the governments of localities hosting nuclear power plants.
d. No solutions provided by NISANISA did not offer any persuasive response to these opinions, and the discussion of this issue
totally stagnated. Since no solutions were provided by NISA, no progress was made in
implementing measures against complex disasters.
NISA revised the draft from scratch in the Nuclear Emergency Preparedness Subcommittee
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Meeting held on October 14, 2010, more than one year after it had published the draft, specifyingthat (i) NISA would consult with the Cabinet Office to discuss a future implementation plan with
the Central Disaster Prevention Council and that (ii) further assistance should be provided to local
governments to compensate for their insufficient resources in dealing with complex disasters.
However, it was more than four months after the above Nuclear Emergency Preparedness
Subcommittee, on February 28, 2011, before a specific discussion was held on (ii) assisting local
governments. Also, it wasn’t until March 8, 2011 that NISA consulted with the Cabinet Officeconcerning (i) the future implementation plan. In response to the approach from NISA, themanagers of the Cabinet Office answered that the matter should be handled by NISA, sincecomplex disasters were related to nuclear issues and could not be worked on by the Central Disaster
Prevention Council.
The national government and municipal governments, by sticking to the existing nuclear disasterprevention framework and their traditional means of planning for disaster preparedness, hampered
quick revision of the draft, leaving insufficient measures in place to provide for the safety of local
residents.
e. The impact on this accident
No specific planning was done concerning complex disasters, so that only a few municipal
governments explicitly described measures against complex disasters in their Regional Disaster
Prevention Plan.
The Nuclear Emergency Response section in the Fukushima Prefecture Disaster Prevention Plan
did not specify measures against complex disasters. As a result, the national government and the
local government lacked consistency and coherence when implementing measures such as theevacuation of local residents, triggering multiple problems and confusion over many issues. Thissituation has already been described in 3.5.
2. Insufficient anticipation of complex disasters in nuclear emergency preparedness drills
a. Overview of nuclear emergency preparedness drills
Nuclear emergency preparedness drills in Japan include the comprehensive nuclear emergency
preparedness drills conducted by the national government, and also the nuclear emergency
preparedness drills periodically conducted by the municipal governments hosting nuclear power
plants and other neighboring local governments based on their Regional Disaster Prevention Plan.
Many prefectural governments conduct nuclear emergency preparedness drills on an annual basis.
The national government has never provided programs targeting complex disasters in its
comprehensive nuclear emergency preparedness drills. Some local governments, however, started
initiatives against complex disasters.
b. Negative comments provided by NISA on nuclear emergency preparedness drills
On May 13, 2010, a meeting involving nuclear emergency preparedness organizations within
Niigata Prefecture was held in order to plan nuclear emergency preparedness drills in the prefecture.
The prefectural government took this opportunity to propose a scenario for drills where it was
assumed an earthquake and a nuclear disaster occurred simultaneously, leading to some discussion.
On May 19, 2010, Niigata Prefecture consulted with NISA about planning nuclear emergency
preparedness drills that included complex disasters. Niigata Prefecture suggested the following
scenario: “The Chuetsu region is hit by a strong earthquake. Some nuclear power plant facilities aredamaged by it, but no anomalies are observed at the nuclear reactors and no radioactive substances
are released from the nuclear facilities. No serious damage is inflicted to evacuation routes andshelters, which are only partially damaged. Thereafter, various protection measures, including theevacuation of local residents, are required, since the nuclear reactor facilities experience problems
unrelated to the earthquake and are expected to release large volumes of radioactive substances into
the peripheral environment.” This scenario assumed the simultaneous occurrence of a nuclear
disaster and an earthquake, with no direct cause-and-effect relationship between them. NISA
responded to the proposed scenario, commenting that the national government could not support thedrills, since the scenario suggested that even limited damage to evacuation routes and facilities by181

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an earthquake could result in problems at a nuclear reactor, and drills conducted based on thisambiguous scenario could worry local residents unnecessarily.
Niigata Prefecture believed that a nuclear emergency preparedness drill to prepare against thesimultaneous occurrence of earthquake and nuclear disasters would not mislead or concern theirlocal residents. With no compromise made with NISA and the possibility of the cancellation of its
emergency preparedness drill on the horizon, however, the prefecture thought it was best for them toconduct a drill regardless, as it was supposed to be conducted for the first time in five years. The
prefecture held discussions with Kashiwazaki City and Kariwa Village, both of which host nuclear
power plants, and explained at a nuclear emergency preparedness stakeholder meeting held on July13, 2010 that the prefecture had decided to assume a snow disaster, in consideration of a heavy
snowfall in the previous winter, as the scenario for the drill to be held that year; that would verify its
emergency preparedness against complex disasters and minimize the confusion and concerns oflocal residents. The related organizations agreed to this decision, and the 2010 nuclear emergency
preparedness drill for Niigata Prefecture was conducted on November 5, 2010.
NISA cited the following reasons why it was reluctant to conduct a nuclear emergency
preparedness drill based on the assumption that a large-scale natural disaster could trigger a nuclear
disaster: (i) severe nuclear accidents could never occur in principle, since extremely stringent safety
examinations were conducted during the design phase of nuclear power plant construction, (ii) a firethat occurred at the Kashiwazaki-Kariwa Nuclear Power Plant in the wake of the Niigata-ken
Chuetsu-oki Earthquake in 2007 was treated as something different from a nuclear disaster, and thesafety features of the plant were fully functional, and (iii) local residents should not be misled orconfused.
On the other hand, Ibaraki Prefecture based the implementation of nuclear emergency
preparedness drills participated in by local residents on its Regional Disaster Prevention Plan; it
conducted a comprehensive nuclear emergency preparedness drill with the participation of local
residents on September 30, 2008, based on the assumption that an earthquake and a nuclear disastermight occur at the same time. As exemplified by these drills, some municipal governments started
to implement nuclear emergency preparedness drills in anticipation of complex disasters. However,NISA never changed its stance that complex disasters were unlikely to occur at nuclear power plants,
and it neither led nor conducted any emergency preparedness drills that responded to complex
disasters.
3. Superficial implementation of the MIC recommendations against complex disasters
The Niigata-ken Chuetsu-oki Earthquake in 2007 made many recognize that important nuclear
facilities–and the equipment important for emergency response at times of nuclear disaster–were notresilient enough to fully withstand an earthquake. The Ministry of Internal Affairs andCommunications (MIC) published “Recommendations based on the administrative verification andmonitoring results of nuclear emergency preparedness operations (#1)” (MIC recommendations)
between 2007 and 2008, presenting various recommendations for addressing a complex disasterinvolving a largescale earthquake and a nuclear disaster.
Specifically, the “Earthquake-resistant measures implemented at important nuclear power plantfacilities required to offer emergency disaster response,” (“the recommendations onearthquake-resistant measures at important nuclear facilities”) included in the MIC
recommendations, prompted the Ministry of Economy, Trade and Industry (METI) to designate
what nuclear operators were required to work on in order to make their critical facilities andequipment earthquake-resistant, including the setup of an emergency response office andcommunication facilities to disseminate information externally in the event of an emergency. METI
was also asked to track and disclose the progress status of the efforts made by each nuclear operator.
NISA made each nuclear operator submit an “action plan concerning self-sufficient
fire-extinguishing and information delivery,” in line with the recommendations onearthquake-resistant measures at important nuclear facilities, on the earthquakeresistant measures
implemented at the operator’s central processing facility. The action plan submitted by each
operator to METI included an item entitled “Enhanced earthquake resistance by anchoring theprocessing equipment of monitoring post data.” As of September 30, 2008, NISA was notified that182

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all the nuclear power plants, including the Fukushima Daiichi Nuclear Power Plant, had completed
their action plan.
However, the outage of all alternating-current power sources triggered by the earthquake andtsunami on March 11, 2011 disabled all monitoring posts placed on the premises of the Fukushima
Daiichi Nuclear Power Plant.
This situation suggests that the operators had only been taking superficial measures againstcomplex disasters based on the recommendations on earthquake-resistant measures at importantnuclear facilities, and that NISA had not done enough to confirm their implementation. By notenhancing the necessary facilities through careful consideration of the possibility of complex
disasters, both the operators and NISA made it impossible to accurately monitor the leakage ofradiation from the Fukushima Daiichi plant, and this led to the inadequate protection of local
residents.
[National Diet Report] Chapter 4, 4.3.2

4.3.3 Superficial comprehensive nuclear emergency preparedness drills conducted by thenational government
The comprehensive nuclear emergency preparedness drill conducted annually by the national
government did not anticipate severe accidents or complex disasters at all. It was virtually useless asa measure to increase preparedness for nuclear accidents.
1. Overview of the comprehensive nuclear emergency preparedness drill conducted by thenational government
The nuclear emergency preparedness drills conducted in Japan include the comprehensive
nuclear emergency preparedness drill conducted by the national government, and also the nuclear
emergency preparedness drill conducted by municipal governments hosting nuclear power plants
and other neighboring local governments. The comprehensive nuclear emergency preparedness drill
conducted every year under the leadership of the national government, stipulated by Article 13 of
the Act on Special Measures Concerning Nuclear Emergency Preparedness, had virtually lost its
usefulness, because no substantial changes had been made over the years regarding accident
severity assumptions, prior preparations for the drill and the measures to be implemented.
2. Superficial implementation of the nuclear emergency preparedness drill by the national
governmenta. Insufficient assumptions of the probability of severe accidents
The comprehensive nuclear emergency preparedness drill assumed the events defined by Article
15 of the Act on Special Measures Concerning Nuclear Emergency Preparedness. However, it did
not anticipate critical events on the scale of this accident.
For example, the comprehensive nuclear emergency preparedness drill held in 2008 assumed anuclear core damaged by the failure in the cooling functions, which was triggered by multiple
equipment failures of the emergency nuclear core cooling system. It further assumed an event
defined by Article 10 of the Act on Special Measures Concerning Nuclear Emergency Preparedness
three hours after the occurrence of the accident, and another event defined by Article 15 of the Act
on Special Measures Concerning Nuclear Emergency Preparedness seven hours after that (i.e. 10hours after the occurrence of the accident). The scenario was based on a slow progression of thesesuccessive events.
We suppose that one of the reasons NISA did not consider the probability of severe accidents in
conducting drills was that it might have proven unacceptable to the local governments participatingin the drills.
b. Insufficient anticipation of complex disasters
When conducting the comprehensive nuclear emergency preparedness drill, NISA assumed thatcomplex disasters were highly unlikely to occur, and did not consider the possibility of anomalies
occurring simultaneously with a nuclear accident. The organization did not assume any of the183Japan Health Physics Society
numerous challenges that might occur at the time of a complex disaster, such as difficulties
dispatching personnel from Tokyo to the Off-site Center, or communication problems between the
Nuclear Emergency Response Headquarters (NERHQ) and the Local Nuclear Emergency Response
Headquarters (Local NERHQ). The comprehensive nuclear emergency preparedness drill conducted
in 2008, for example, assumed that the personnel dispatched to the Local NERHQ would start theirtravel after the occurrence of an event defined by Article 10 of the Act on Special Measures
Concerning Nuclear Emergency Preparedness and reach the local site within two hours. In reality,
the latest nuclear accident required more time to dispatch personnel, including the director-generalof the Local NERHQ, to the Off-site Center.
c. Superficial implementation of drills due to their expansion of scale
The comprehensive nuclear emergency preparedness drill is a large-scale drill involving many
stakeholders, including the prime minister and the minister of Economy, Trade and Industry, whooversee the entire government organization in the event of a disaster. A huge amount of work is
required in preparation for this drill, with many meetings that last several hours. The Nuclear
Emergency Preparedness Division of NISA, which is in charge of the annual comprehensive nuclear
emergency preparedness drill, spends about a year preparing for this drill, starting with the planningphase.
The preparations for the comprehensive nuclear emergency preparedness drill in 2008 tookapproximately nine months. These included: a total of six meetings to coordinate activities among
the central government, local governments, and nuclear operators: two meetings with aviation andother personnel; and five briefings conducted by Fukushima Prefecture for local organizations.
Participants in the comprehensive nuclear emergency preparedness drill change every year due topersonnel transfers and changes of administration in the central government. The variousorganizations in charge of the drill are required to brief participants from scratch every time the drill
is conducted. The time available to brief participants from the central government, including
bureaucrats and politicians, is very limited. With the huge amount of time required for preparation,in practice the drill was only conducted in line with a predetermined scenario. It was far from viable
or effective.
3. The impact on this accident
Emergency preparedness drills do not merely allow participants to actually experience evacuation
or obtain related knowledge. Repeating effective drills is critical in enabling participants to discover
new practical concerns, and improve their preparedness for unexpected events and emergency
situations.
However, the comprehensive nuclear emergency preparedness drill conducted by the national
government was aimed primarily at not worrying or confusing local residents, and also at respecting
the concerns of local governments that hosted nuclear power plants. In a sense, the drill was
conducted for the sake of having a drill. It was superficial in nature; just the fact that the drill was
actually held was considered important. Naturally, it lacked effectiveness in response to actual
accidents. This type of impractical drill did not enable participants to obtain a deeper understandingof the various systems in place for nuclear disasters, including SPEEDI. A NAIIC survey of local
residents (see Fig. 4.3.3-1) shows that the ratio of local residents who actually participated in
evacuation drills conducted by the national government or municipal governments was only around
10 to 15 percent, even in the local communities that host nuclear power plants. Virtually no local
government officials or local residents claimed that past emergency preparedness drills helped themweather this accident.

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Fig. 4.3.3-1: Ratio of local residents receiving evacuation drills before the accident(against all evacuated residents)[National Diet Report] Chapter 4, 4.3.3

Section 5 “Preparedness” for complex nuclear disaster and Fukushima Daiichi accident
In the “Guideline for Measures for Nuclear Installations" (that is "Nuclear Emergency
Guideline"), which was prepared by the NSC, there is no description about measures in the case of acomplex disaster (natural disaster, armed attack and nuclear accident). It is obvious that the
Fukushima Daiichi accident is a complex disaster (earthquake, tsunami and nuclear accident). The
situation in which the relevant organization cannot avoid blindly responding without “preparedness”
led to confusion in evacuation order. The Act on Special Measures Concerning Nuclear Emergency
Preparedness and the Nuclear Emergency Guideline, forming the current nuclear emergency system,
was made on the basis of experiences mainly in the JCO criticality accident (1999). Before thecriticality accident, it was prescribed that in the case of the occurrence of an accident, theEmergency Response Support System (ERSS) would be established in the Agency of Natural
Resources and Energy, which was a primary regulatory agency in those days and experts in the
Nuclear Safety Commission (NSC) would respond there. However, in the case of the JCO criticality
accident, Dr. Kenji Sumita, NSC Deputy Chairman conducted a study of controlling the accident at
the Tokai site, which led to good estimation. In the “Investigation Committee for Uranium
Processing Plant Criticality Accident Report” published by the NSC, there is a description that a
prototype “off-site center plan”, which was recommended by the technical committee of theneighboring disaster prevention measures such as nuclear power plants 5 months before the JCO
accident, has been put into practice, which has significant meaning.
On the basis of a kind of “experience in success” after the JCO accident, it was incorporated in
the Nuclear Emergency Guideline that an off-site center should be established around each nuclear
power plant. In other words, this is a concept of system design to set a central function for
emergency measures in field headquarters near the site collecting relevant staff. Such an emergency
preparedness system is considered to be effective to some degree in the case that the field
headquarters is capable of functioning sufficiently because progress of an event is not so rapid.
However, in the case of the occurrence of a nuclear disaster due to external events such as
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earthquake and tsunami, there is high possibility that the disaster due to each event simultaneously
occurs and responses to the disaster in the fieldheadquarters is expected to be difficult. Actually, inthe responses to the present accident in Fukushima Daiichi NPS, the system to conduct the
emergency activities under the field headquarters did not function, since relevant staff could not begatahered owing to the catastrophic damage to infrastructure caused by the earthquake and tsunami,
and continuous information exchange was difficult because of quite vulnerable means ofcommunication owing to a large-scale blackout and the ambient radiation level in the off-site center
increased according to the progress of the events of the accident.
It was not always the case that staff associated with safety regulation did not consider about thepossibility of complex disaster at all. For example, in the trusted research in FY 2008, JNES (anorganization supporting regulatory agency) investigated responses in complex disaster of nuclear
power plants in United States. In addition, NISA requested relevant organizations to consider the
possibilities of failings in the function of the off-site center and emergency radiation monitoring, inspite of the following statement, “There is a low probability to actually cause a complex disaster” ina document “Points to be considered in making a manual for nuclear emergency preparedness(draft)” in April 2009. However, from the current viewpoint after the experiences in the Fukushima
nuclear accident, criticism against too easy understanding of importance of measures could not be
avoided because measures had not been promptly implemented owing to too low estimatedpossiibility of the occurrence of a complex disaster.
[Nongovernmental Report] Part 3 Chapter 7 Section 5

The following isssues can be raised in association with opportunity of revision of
nuclear emergency preparedness for complex disaster.
Nuclear emergency preparedness system – opportunity of revision of nuclear
emergency preparedness for complex disasters (earthquake, tsunami, and nuclear
accident)
 Although problems of emergency preparedness assuming the possible
occurrence of a nuclear emergency coupled with a complex disaster werepointed out, no measures were taken against them.
 Upon requests from the Niigata prefectural government, following theoccurrence of a fire at the Kashiwazaki-Kariwa NPS when it was struck by the
Niigata-ken Chuetsu-oki Earthquake, the national government requested theinvestigation committee on the accident at the Kashiwazaki-Kariwa NPS to
examine and report on the issue of preparedness against a nuclear emergency
coupled with a complex disaster. The report produced by the investigationcommittee stated the government's intention to resolve the issues that require
attention when responding to a nuclear emergency in a complex disaster under
the leadership of NISA.
 However, the draft document entitled "A Draft on the Issues Requiring Attention
When Preparing an Emergency Response Manual for Nuclear Emergency
Coupled with Complex Disaster" submitted by NISA in April 2009, stated thatthe probability of a nuclear emergency being coupled with a complex disasterwas extremely small, on the basis of the view that nuclear power facilities
employ a seismic structural design and are technologically well protectedagainst earthquakes on a design basis level, as well as the view that the incident
that had taken place at the Kashiwazaki-Kariwa NPS as a result of the
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Niigata-ken Chuetsu-oki Earthquake fell short of being a nuclear emergency.
Therefore, the draft document concluded that it was reasonable to develop
countermeasures on the basis of ongoing organizational arrangements fordisaster prevention and negated the need to make new organizationalarrangements for disaster prevention assuming the possible occurrence of a
nuclear emergency coupled with a complex disaster.
 The draft document received the following criticisms, which argued against thevery act of developing countermeasures against a nuclear accident coupled witha complex disaster, from concerned agencies of the national government andlocal governmental organizations:(i) The development of countermeasures against a nuclear emergency in acomplex disaster may become a cause of the mistaken view that major
natural disasters are likely to initiate a nuclear emergency;(ii) The implementation of countermeasures against a nuclear emergency in acomplex disaster will require major modifications to regional disasterprevention plans, etc.; or(iii) There has not been sufficient negotiation with concerned organizations for
affairs to be handled by an organization other than NISA.
 In response to such criticisms, NISA revised the draft from scratch in October
2010, specifying that (i) NISA would consult with the Cabinet Office to discussa future implementation plan with the Central Disaster Prevention Council andthat (ii) further assistance should be provided to local governments tocompensate their insufficient resources in dealing with complex disasters. A
specific discussion on (ii) was held as late as 28 February 2011. Also, it was not
until 8 March 2011 that NISA consulted with the Cabinet Office concerning (i).
In response to this approach from NISA, the managers of the Cabinet Officeanswered that the matter should be handled by NISA, since complex disasters
were related to nuclear issues and could not be worked on by the Central
Disaster Prevention Council.
 The national government and municipal governments, by sticking to the existing
nuclear disaster prevention framework and their traditional means of planningfor disaster preparedness, hampered quick revision of the draft, leaving in placemeasures that were insufficient to provide for the safety of local residents.
 It had been pointed out, as a result of the administrative evaluation/monitoringby the Ministry of Internal Affairs and Communications (MIC) in February
2009, that measures would be needed to reduce exposure to doses of radiation
within the Off-site Center in the event of a nuclear accident. Nonetheless, NISA
failed to take adequate measures.

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2.2 Issues raised in the first JHPS recommendations
In the first JHPS recommendations entitled “Issues Associated with Radiation Protection
after Fukushima Daiichi Nuclear Power Plant Disaster - Responses of and Recommendations
from Japan Health Physics Society -” released on 17 April 2012, important issues associatedwith radiation protection were summarized into the following eleven items in accordance withthe exposure situation that changed over time after the accident, on the basis of discussions
during the symposia on Measures for Dealing with the Fukushima Nuclear Disaster and asession on the Fukushima Daiichi nuclear disaster at the 44th JHPS Annual Meeting in 2011.
1) Comprehensive issues related to all situations(Issue 1) Strategies for reducing anxiety and doubts of the general public regarding
radiation risk
(Issue 2) Methods of measuring ambient dose rate, surface contamination density, andconcentration of radioactive materials in foods
2) Issues related to emergency exposure situation(Issue 3) Criteria for evacuation and stay in house(Issue 4) Administration of stable iodide(Issue 5) Principles for regulation of ingestion of foods and drinks(Issue 6) Screening criteria for decontamination(Issue 7) Dose limit for emergency workers(Issue 8) Post disaster investigation of thyroid equivalent dose of radioactive iodine
3) Issues related to existing exposure situation(Issue 9) Provisional criteria for judging the safety of using school yards, forage,
cropping soil, fertilizers, bathing areas, etc.
(Issue 10) Systems for temporary entry into restricted zones(Issue 11) Management of radioactive wastes such as cesium-containing rubble, sludge,
and decontaminated soil
The points of discussion mentioned above are described below.
Issue 1: Strategies for reducing anxiety and doubts of the general public regarding radiation
risk[Points of discussion] Anxiety of the general public regarding foods and drinks
Foods and drinks are daily necessities. The general public is worried about theirradiation risks in the case of daily shopping and needs information on whether people
should purchase them. It is important to understand the correct meaning of regulatory
values of foods and drinks and to verify how the actual radiation measurements offoods and drinks are carried out and whether measurement results are disseminatedto consumers with accuracy.
 Anxiety of the general public regarding contamination hot spots
There are many cases wherein high-level radioactivity is found in sewage sludge andincinerated ash in the Kanto district, and radioactivity relatively higher than that inareas surrounding residential communities is observed, whereas the amount of
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Japan Health Physics Societyradiation exposure would be minimal if it is estimated in terms of the radiation effecton the human body. It is important to respond to the needs of local residents andproperly inform them of the results of dose assessments.
Anxiety of the general public regarding provisional criteria for judging the safety ofusing school yards, forage, cropping soil, fertilizers, bathing areas, etc.
Although parameters and exposure scenarios for deriving these criteria are assumed
conservatively, it is important to comprehensively and correctly disseminate themethods of deriving the criteria and their magnitude of conservativeness.
Anxiety of the general public regarding pregnant women, fetuses, and children
The radiation sensitivities and risks of pregnant women, fetuses and children are
higher than those of adults. This high sensitivity is not considered in the current
domestic radiation protection system that is based on international standards, except
for the regulation for the thyroid equivalent dose for infants in an emergency
exposure situation. A simple explanation on the triviality of radiation exposure leads
to the shortage of information. A well-balanced radiation protection system must bereconstructed, taking into consideration the relatively high sensitivity of younger
individuals and comprehensive accountability to the general public.

Issue 2: Methods of measuring ambient dose rate, surface contamination density, andconcentration of radioactive materials in foods[Points of discussion]
 Methods of measuring ambient dose rate
Some ambient dose rate meters in local governments are set on the housetops
because the measurement target is radioactive plume in the air. It is necessary to take
into consideration the measurement height dependence in the case of radiation
monitoring on broadly contaminated soil. The method of measuring the ambient dose
rate according to the monitoring objective must be standardized, that is, to select a
short time constant in the case of an overall survey of contamination hot spots.
 Consideration of high background count rate
In many cases, Geiger-Müller (GM) survey meters for surface contamination areusually used in measurements of surface contamination density for beta emitters.
Since this type of survey meter has a low sensitivity for gamma rays that come fromoutside of the surface of a detection area, the net count rate should be estimated in
the case of measuring the surface contamination density by subtracting thebackground count rate that increases with the ambient dose rate from the measured
total count rate. Such a method must be standardized.
 Methods of measuring the concentration of radioactive materials in foods
A highly accurate Ge semiconductor detector is often used to confirm thatradioactivity concentration in foods is below the regulatory values, on the other hand,
the measurement system is too expensive. Outsourcing to measure them is also
expensive. For this reason, screening measurement using a NaI(Tl) scintillation
survey meter that is relatively cheaper to purchase may be feasible. In the case ofsuch a simple screening measurement, a gamma ray shield is necessary to reduce thebackground count rate accordingly. An appropriate measurement method must be
standardized, taking into consideration the relationship between the detection limit
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Japan Health Physics Societyand regulatory values in foods.
Methods of estimating internal dose using whole-body counters and the bioassay
methodEstimation of internal exposure using whole-body counters and the bioassay method
depends on how to calibrate the measurement system in accordance with radioactive
nuclides and how to provide a dose coefficient assuming a variety of timings ofintake, which is a significant issue that would clearly affect the effective dose
assessment. Considering such issues, the method of estimating the internal exposuremust be standardized.
Methods of measuring a screening level for the thyroid equivalent dose of radioactive
iodineA screening level for simplified thyroid measurement that is equivalent to 100 mSv
thyroid equivalent dose for one-year-old infants was established just after the
Fukushima accident. In the case of such a simplified measurement, it is necessary tomaintain a constant distance between the survey meter and thyroid of the target
person, and to subtract the background ambient dose rate from the measured dose
rate. Considering such issues, the method of measuring a screening level for the
thyroid equivalent dose of radioactive iodine must be standardized.

Issue 3: Criteria for evacuation and stay in house[Points of discussion]
 Balance among other emergency criteria (the same as Issues 4 and 5)
In the current system, the emergency criteria of evacuation and stay in house,
distribution of stable iodide, and regulation of the ingestion of foods and drinks are
independently determined. The emergency measures are closely connected, that is, it
is stated that stable iodide should be distributed at evacuation centers after theevacuation instruction. It is important to determine the emergency criteria by
overlooking beyond each emergency criterion.
 Assumption of long-term emergency situation and maintenance of infrastructure
including electricity, water, and communications (the same as Issue 5)
The current system assumes a short-term and temporary emergency situation.
Emergency measures applicable to a long-term emergency situation must be
examined by considering the balance with the maintenance of infrastructure
including electricity, water, and communications.
 Use of SPEEDI and simulations on the diffusion of radioactive materials in the ocean
The results of the System for Prediction of Environmental Emergency Dose
Information (SPEEDI) and simulations on the diffusion of radioactive materials in
the ocean must be disclosed at an early stage so that municipalities and evacuees canactively use the data.
 Communication with residents to designate the deliberate evacuation zones
Since residents in the deliberate evacuation zones have sufficient time to evacuate,
the designation of deliberate evacuation zones and the deadline for the completion ofevacuation must be determined after sufficient discussions with municipalities.
 Emergency planning zones (EPZs) (the same as Issue 4)Emergency planning zones (EPZs) that are designated for emergency preparedness
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within a radius of 8-10 km from nuclear power plants and related anti-disastermeasures through full discussions with municipalities must be reviewed byconsidering the post disaster spread of contamination to a large area.
Issue 4: Administration of stable iodide[Points of discussion]
 Balance among other emergency criteria (the same as Issues 3 and 5)
In the current system, the emergency criteria of evacuation and stay in house, thedistribution of stable iodide, and regulation of the ingestion of foods and drinks are
independently determined. The emergency measures are closely connected, that is, it
is stated that stable iodide should be distributed at evacuation centers after theevacuation instruction. It is important to determine the emergency criteria by
overlooking beyond each emergency criterion.
 Emergency planning zones (EPZs) (the same as Issue 3)
Emergency planning zones (EPZs) that are designated for emergency preparedness
within a radius of 8-10 km from nuclear power plants and related anti-disastermeasures through full discussions with municipalities must be reviewed byconsidering the post disaster spread of contamination to a large area.
Issue 5: Principles for regulation of ingestion of foods and drinks[Points of discussion]
 Balance among other emergency criteria (the same as Issues 3 and 4)
In the current system, the emergency criteria of evacuation and stay in house,
distribution of stable iodide, and regulation of the ingestion of foods and drinks are
independently determined. Since the emergency measures are closely connected, it isimportant to determine the dose criteria for the derivation of provisional regulatory
values for radioactive materials contained in foods by overlooking beyond each
emergency criterion.
 Assumption of emergency situation over a long-term and maintenance of infrastructure
including electricity, water, and communications (the same as Issue 3)
The current system assumes a short-term and temporary emergency situation.
Emergency measures applicable to a long-term emergency situation must be
examined by considering the balance with the maintenance of infrastructure
including electricity, water, and communications.
 Category of foods
In the provisional regulatory values (by 31 March 2012) for radioactive materials
contained in foods before the disaster, the restriction value for radioactive iodine infish, for example, was not specified. The categories of foods must be reviewed,
taking into consideration the annual amounts of ingestion and monitoring results ofactual foods.
 Scope of radioactive nuclides except for key nuclides
Provisional regulatory values (by 31 March 2012) for radioactive materials containedin foods were derived assuming the ratio, Cs-137:Sr-90 = 1:0.1. Since radioactive
strontium tends to concentrate in bone in the food chain, the provisional regulatory
values must be reviewed by considering the results of radiation monitoring in marine
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products.
Issue 6: Screening criteria for decontamination[Points of discussion] Validity of screening levels (100 and 13 kcpm) from the viewpoint of radiation
protection
The local nuclear emergency response headquarters increased the level of screening
contaminated surfaces for decontamination to 100 kcpm (100,000 counts per minute)on 20 March 2011 following the advice from the Nuclear Safety Commission ofJapan. The screening level was equal to the criterion for decontamination in theInternational Atomic Energy Agency (IAEA) publication entitled “Manual for First
Responders to a Radiological Emergency”, which is equivalent to 1 μSv/h at a
distance of 10cm. It was then lowered to 13 kcpm on 16 September 2011 following
the advice from the Commission that it is desirable to appropriately decrease thescreening level in a stepwise manner by considering the overall situation such asradiation monitoring results and number of people going in and out of the checkpoint.
The validity of the screening criteria for decontamination in an emergency must be
verified in terms of their effectiveness for radiation protection by considering therelationship between screening levels for radioactive nuclides and effective doses
owing to surface contamination remained without decontamination in accordancewith the principles of other emergency measures.
 Underestimation of count rate of GM survey meters
In many cases, Geiger-Müller (GM) survey meters have been used to measure theradioactive contamination of surfaces. GM counters underestimate the actual countby at least 20% in the measurement range with a count rate of as high as 100 kcpm
because of the occurrence of dead time due to a long resolving time. Such an issue inradiation measurement must be included in the verification of the validity of thecriteria from the viewpoint of radiation protection.
Issue 7: Dose limit for emergency workers[Points of discussion]
 Transition of dose limit for emergency workers to 250 mSv
In the second interim report on the incorporation of the 2007 Recommendations of
the International Commission on Radiological Protection (ICRP) into domestic
systems, the Basic Committee of the Radiation Council proposed to match the dose
limits to internationally recommended values because the current restriction criteria
in Japan (dose limit, 100 mSv) interfered with emergency medical care and otheressential operations. On the other hand, the Ministry of Economy, Trade and Industry
on 16 March 2011 consulted the Radiation Council to change the upper limit ofindividual dose for emergency workers from 100 to 250 mSv and obtained an
opinion that such a revision was appropriate on 26 March 2011. Taking into
consideration that the other various emergency measures are based on internationallyapproved principles and the recommended value of the 2007 Recommendations of
ICRP (emergency medical care, no restriction; other emergency rescue operations,
1,000 or 500 mSv; other rescue operations, 100 mSv), 500 mSv must be adopted as a
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Japan Health Physics Societydose limit for emergency workers.
Relationship between individual dose received in an emergency situation and dose
limit for radiation workers under normal conditions
When the individual dose received in emergency situation is applied to control the
exposure of radiation workers under normal conditions (50 mSv per year and 100
mSv over five years), radiation workers who have been exposed to radiation
exceeding 100 mSv during emergency work are prevented from engaging inradiation work for a given period. After this disaster, taking into consideration thatthe dose limit for emergency workers was set to 250 mSv, which is lower than theinternationally recommended value, and the current dose limit under normal
conditions for radiation workers was determined on the basis of a lifetime individual
dose of 1,000 mSv, the individual dose in an emergency should be controlled
independently of a compliance of the dose limits for radiation workers under normal
conditions (50 mSv per year and 100 mSv over five years) to control radiation
exposure.

Issue 8: Post disaster investigation of thyroid equivalent dose of radioactive iodine[Points of discussion]
 Simulating the atmospheric diffusion of the radioactive plume using SPEEDI andsurveys on residents’ behavior
Radiation monitoring was not satisfactorily carried out for approximately one week
after the nuclear disaster owing to its aftermath. Therefore, the results of simulationsof the atmospheric diffusion of the radioactive plume using SPEEDI and surveys on
resident’s behavior are essential for assessing the thyroid equivalent dose forradioactive iodine among residents after the disaster. The thyroid equivalent dose forradioactive iodine must be estimated and disclosed with its uncertainty on the basisof the results of simulating the atmospheric diffusion of radioactive plume using
SPEEDI and surveys on residents’ behavior.
Issue 9: Provisional criteria for judging the safety of using school yards, forage, cropping soil,
fertilizers, bathing areas, etc.
[Points of discussion]
 Balance among provisional criteria
As a temporary policy for judging the safety of using school yards and other outdoor
facilities, the Ministry of Education, Culture, Sports, Science and Technology(MEXT) initially announced a provisional criterion of 3.8 μSv/h, which was derived
from the reference level of 20 mSv/y, and decided to aim to reduce the level ofcontamination to 1 mSv/y. The provisional criteria for forage fed to cows, cropping
soil, and fertilizers announced by the Ministry of Agriculture, Forestry and Fisheries(MAFF) were derived on the basis of the provisional values for foods, which was
determined with consideration of the individual dose for radioactive cesium (5mSv/y). In addition, the provisional criterion for bathing areas announced by the
Ministry of the Environment (MOE) was derived so that the individual dose due toexternal and internal exposure was within 10% of 1 mSv/y. These provisional criteria
must be reconsidered on the basis of the overall policy by considering the radiation
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sensitivity of children and the balance among reference levels including and, if
necessary, adopting stepwise reference levels.
Issue 10: Systems for temporary entry into restricted zones[Points of discussion]
 Balance among radiation protection measures, inconvenience and heat stroke
During the temporary home visits allowed in summer 2011, the room temperaturereached 37 oC at some centers established as relay points through which residents
returned to their homes. Therefore, the requirement of wearing Tyvek clothing wasloosened to prevent heat stroke, i.e., people wearing long-sleeved clothes and long
trousers were allowed to enter the restricted zones, although they were required towear overshoes, gloves, a mask, and a hat. The maximum time spent at home waslimited to 2 h, and the total time taken for the round trip from the relay point to theirhomes was limited to 5 h. Since the elderly were included in the list of individuals
allowed temporary home visits, flexible systems must be proposed by considering
their own needs and ages, rather than uniformly imposing the wearing of a protective
suit and limiting the entry time.
Issue 11: Management of radioactive wastes such as cesium-containing rubble, sludge, anddecontaminated soil
[Points of discussion] Policy for managing radioactive wastes under the existing exposure situation
The radiation protection policies for the disposal of radioactive wastes in ICRP and
the Nuclear Safety Commission in Japan have been established assuming thesituation is under normal condition (planned exposure situation) where the dose limit
for the public of 1 mSv/y is complied. The application of these policies to the
management of radioactive wastes (e.g., temporary placement, treatment, storage,
and disposal) under the existing exposure situation, where decontamination (dose
reduction) in a large contaminated area is planned by setting reference levels chosenfrom between 1 and 20 mSv/y, may be unrealistic from the viewpoints ofjustification and optimization taking into consideration social and economical factors.
The radiation protection policy for the management of radioactive wastes under the
existing exposure situation must be established to make the environmental
restoration reasonably practical.
 Reference level for managing radioactive wastes
In the existing exposure situation, the management of radioactive wastes is justified
when the decrease in the ambient dose due to decontamination is judged to beappropriate despite the potential exposure to radiation due to the management of theradioactive wastes necessary for decontamination. Justification and optimization
should be fully discussed in the overall plan of environmental restoration.
Considering the reference level for the management of radioactive wastes is used toreduce the ambient dose in a large contaminated area, the reference level for the
management of radioactive wastes must be selected below the reference level for the
existing ambient dose in a stepwise manner. (When environmental restoration iscarried out by lowering the reference level for ambient dose due to a broadly
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contaminated land in a stepwise manner during the management of radioactive
wastes, lowering the reference level for the management of radioactive wastes can beachieved by restricting the entry of the public or imposing additional shielding
measures.)
How to determine the reference level for managing radioactive wastes
Stepwise approaches to decrease the individual dose should be taken by sharing theplan of environmental restoration, including the management of radioactive wastes,
with stakeholders including local residents under the existing exposure situation. The
optimized reference level for radioactive waste management in the existing exposure
situation must be selected from the dose band (1 to 20 mSv/y) with the relevant
stakeholder involvement.
Dose criteria for disposal of radioactive waste
When the temporary placement and storage are completed and the radioactive waste
management enter the disposal stage, radioactive wastes must be disposed of in aplanned manner so that the assessed individual dose becomes a target dose of 1
mSv/y or less, which corresponds to the individual dose under normal conditions, inline with the long-term goal of decreasing the individual dose due to environmental
radiation to less than the order of 1 mSv/y.

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2.3 Issues and recommendations raised at the JHPS symposia(1) Special Symposium on the second Fukushima project (25 May 2013)
In this section, comments made at the JHPS symposium held on 25 May 2013 are listed.
Voice records of speakers and audience members in the symposium are given in Appendix I.
Important issues and recommendations associated with radiological protection were selectedfrom recordings made at the symposium from the viewpoint of finding new points that had
not yet been raised in the draft report at that time, and are summarized in simple terms.
(Monitoring for internal exposure) When using a great number of whole body counters (WBCs) as a monitoring tool, it isimportant to manage their accuracy and to ensure traceability of calibration from theviewpoint of maintaining the reliability of the measurements. As there are no standards
for the WBCs, standardization should be carried out on the basis of recommendations of
the expert research group in JHPS.
 Standarizations of the standard phantom for calibration, detection limit, analyzing
method of the gamma spectrum, and the dose assessment are necessary. Also, a standard
manual for operators of the WBCs is needed.
 It is necessary to consider the maintenance of a great number of WBCs including thetraining of monitoring staff.
 To explain the monitoring results of the WBCs to the public, it is also necessary to makea Q&A booklet to enhance their understanding and assemble a manual taking into
consideration risk communication.
 Occupational exposure has been, so far, the target of WBC measurement. Moreover,internal exposure monitoring of the thyroid gland in terms of nuclear emergency
preparedness was carried out, which was a main cause of delay of the WBC
measurement.
 Priority of the order of the WBC measurement should be established a priori; forinstance, children sensitive to radiation and families with children should have firstpriority, because the number of WBCs is limited.
 Another issue is how accuracy should be maintained for the public, including children
with different body sizes.
(Environmental monitoring and its assessment) Following the Fukushima Dai-ichi nuclear power plant accident, it has become
necessary to revise the initial environmental monitoring method, in particular, toconstruct an environmental monitoring system considering post-accident investigationof thyroid equivalent dose.
 Equipment and a system to inform the public of monitoring results of measurement areneeded to utilize not only governmental but also nongovernmental powers.
 It is important to make a system incorporating the guidelines with better understandingof method and a framework to maintain the system for developing human resources inspite of a long time having passed, and to continue training staffs in the operation of theguidelines.
(Risk communication)
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 “Risk communication to the public – to ensure human resources” was pointed out as
issue 35 in this draft report, but a more important issue than ensuring the procurement of
human resources is that we have neglected efforts to improve people’s understanding ofradiation.
 “Risk communication to the public – comprehensibility of the radiological protection
system” was pointed out as issue 36 in this draft report, but it is necessary to makeemergency preparedness guidelines available even in situations without electricity orcommunication infrastructures.
 “Risk communication to the public – utilization of mass media” was pointed out as issue
37 in this draft report, but communication through the internet has limitations. It is
important to develop human resources for risk communication in the municipal
government and to ensure that radiation effects can be explained in a face-to-facemanner in an emergency.
 “Risk communication to the public – response to foreign residents and overseas
countries” was pointed out as issue 38 in this draft report, but if information is spread,anxiety would be reduced. Foreigners surrounded by Japanese people with sufficientknowledge and information of the accident will feel less anxiety. First, it is important toraise the knowledge level of Japanese people regarding radiation.
(General discussion)
 We should remember that simulation results by the System for Prediction ofEnvironmental Emergency Dose Information (SPEEDI) are merely predictions and notconsistent with the actual results. It may be a problem to use SPEEDI in a judgment
regarding the administration of stable iodine on the basis of information on whether or
not the predicted level meets the thyroid equivalent dose criterion. SPEEDI should be
utilized appropriately because it has an important role in emergency preparedness.
 Issues and recommendations should be selected considering the difference in risk
communication between normal and emergency situations, since there are various
considerations, for example, things to be done in a normal situation, things additionallyneeded in a transition from a normal to an emergency situation and things to be utilized
as they are.

(2) Special Symposium II on the second Fukushima project (22 February 2014)
In this section, comments made at the JHPS symposium held on 22 February 2014 arelisted. Voice records of speakers and audience members in the symposium are given in
Appendix II. Important issues and recommendations associated with radiological protection
were selected from recordings made at the symposium from the viewpoint of finding new
points that had not yet been raised in the draft report at that time, and are summarized insimple terms.
(Dose criterion for rehabilitation)
 As given in recommendation 19, it is desirable to decide the dose criterion with theactive cooperation and understanding of stakeholders. However, I’ve understood that
this is fairly difficult after hearing a presentation in the morning session today. In thesecond set of recommendations, it is better to recommend the manner in which experts
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should support society.
(Risk communication)
 I don’t have the confidence to clearly explain the meaning of the criterion, but there
must be examples of successful experiences in explaining the criterion to the public. It
is effective to share the successful experiences among experts because such successful
experiences were archived by the organization.
 In the morning session today, there was a report on the current status of contaminatedwater in the Fukushima Daiichi NPS. In the current draft of the recommendation,
contaminated water was not mentioned, but I would like to add this point as an item ofrisk communication.
(Decision-making process) The process to determine the dose limitation in an emergency of 250mSv was not
carried out in a transparent manner. I think that the process used to make various
decisions should be clearly disclosed to the public. There were some cases in which theprocess was not clear, and the decision-making process was like a black box. Regarding
this point, I would like to make a recommendation.
 In the release of water contaminated with low-level radioactive material to the ocean, I
would like you to include the importance of transparency in the decision-making
process and of public relations in this recommendation because the process was like a
black box.
(Education on radiation)
 It is necessary to improve education on radiation and risk not only in the affected area
but also in the entire country.
 Regarding education on radiation, risk communication in the current draft
recommendation seems to be for residents close to the site, but there is little mention of
education on radiation taking Japan as a whole into consideration. I would like you to
add this point to take account of the follow-up after the recommendation.
 In the recommendation, the action of providing comprehensive information andknowledge should be included.
 Regarding stakeholder involvement, I think that the discussion has continued without
any consideration of the benefits of radiation, despite there being both risks and benefits.
As the discussion on risks and benefits has only focused on safety and danger, thisshould be included in the recommendation.
 Not only radiation but other applications of science are not only evaluated in terms ofwhether they are safe or dangerous, which should be a fundamental part of education.
Otherwise, explanations by experts will not be understood by the public.
(Fundamental policy in the elaboration of recommendations) I was afraid that there is no subject in the recommendation, but I am delighted to hear
the speaker’s explanation of the reason including the speaker’s intention to consider thatpeople who read this recommendation will voluntarily act from their standpoint. I would
like you to add such a reason to the recommendation.

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2.4 Arrangement of issues
Including issues raised in the first JHPS recommendations and the JHPS symposium, theissues pointed out in the above sections are arranged in the following manner.
Radiation monitoring on land – unexpected effects on means of transportation andcommunication
Issue 1: Radiation monitoring on land could not proceed following the previously determined
emergency preparedness plan owing to unexpected effects due to road damage,widespread power failure, fuel shortages in monitoring cars, damage tocommunications networks, and delay in the preparation of helicopters.
Radiation monitoring on land – monitoring posts washed away and communication lines
severedIssue 2: Four of the 24 monitoring posts established by Fukushima Prefecture were washedaway by the tsunami and another 19 were unable to transmit data owing to severed
communication lines, which resulted in 23 monitoring posts being inoperable.
Tap water monitoring – communication method with public
Isuue 3: After notification on 23 March 2011 to refrain from providing tap water to infants inthe 23 wards of Tokyo and the Tama area, the radioactivity concentration in tap wateron 24 March decreased to below the regulation value. For this reason, it wasannounced that tap water may be used without any concern, including for infants.
However, since mineral water could not be obtained in many areas, there wereactually severe cases whereby people ultimately had to decide for themselves
whether to drink tap water including radioactive materials or to refrain from drinking
water and whether or not to continue breast feeding owing to concern of transferring
radioactive materials from mother to infant. [the first JHPS recommendations]Shipping restrictions and monitoring of agricultural and livestock products – expansionof contamination due to food chain
Issue 4: The Notice on Farming Management was not communicated to grain farmers, who
produce rice straw. Furthermore, the information and guidance provided to cattle
farmers were inadequate and it was discovered that cattle farmers had fed their cattle
rice straw that had been stored outdoors and was most likely contaminated withradioactive material. This led to the detection of radioactive cesium exceeding the
temporary regulation value in beef.
Shipping restrictions and monitoring of agricultural and livestock products –measurement method for livestock products
Issue 5: Beef fed by contaminated rice straw could not be identified by inspection afterslaughter.
Food monitoring – regional variations
Issue 6: Food monitoring was left to the test plans of the prefectures, so the level of themonitoring varied depending on the prefecture. The monitoring equipment and otherinfrastructure in the various prefectures were insufficient at the early stage after the199

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disaster. Moreover, there were also local governments that were unenthusiastic about
performing monitoring because of their concerns about the harm to their reputation,
so the level of monitoring varied depending on the local government.
Monitoring of forests and subsoils of rivers and lakes – lack of understanding of thenecessity
Issue 7: The necessity of monitoring forests and subsoils of rivers and lakes was not
sufficiently understood.
Monitoring of seawater, subsoils of ocean, and sea products – lack of understanding of thenecessity
Issue 8: Since the necessity of sea area monitoring was not fully understood, the monitoringarea was limited to the region within 30km from Fukushima Dai-ichi NPS at theearly stage after the accident. Ocean currents formed around this local area were notconsidered in the monitoring design, which led to missing knowledge on the
dynamics of the transition of radioactive materials from the source.
Monitoring of seawater, subsoils of ocean, and sea products – lack of prediction tools
Issue 9: Since the seawater off Fukushima Prefecture travels down to the southern region of
the Fukushima Dai-ichi NPS along the coast after the “Oyashio” current meets the“Kuroshio” current, radioactive materials in seawater traveled down to off the coastof Ibaraki Prefecture in the area south of the Fukushima Dai-ichi NPS, which led tothe situation that radioactive materials temporarily accumulated in sand eels, forcing
fishermen in Ibaraki Prefecture to refrain from fishing. In addition, radioactive
materials also accumulated in bottom-dwelling coastal fishes (e.g., flat fish, flounder,etc.). The timing of the accumulation of radioactive materials in medium-sized fishowing to the food chain could not be predicted since the monitoring target at theearly stage postaccident was not ocean subsoils but seawater.
System for Prediction of Environmental Emergency Dose Information (SPEEDI) –underutilization of prediction results
Issue 10-1: Since the external power supply was lost following the earthquake and theGovernment's dedicated line for sending data became unavailable, the release ofsource information from the Emergency Response Support System (ERSS) on which
SPEEDI calculations are based was not carried out. For this reason, the Nuclear
Safety Technology Center provided the predicted results of their unit release rate
calculation based on “the Environmental Radiation Monitoring Guidelines”, to the
Ministry of Education, Culture, Sports, Science and Technology (MEXT), theEmergency Response Center (ERC), the Nuclear Safety Commission (NSC), theOff-site Center, the Fukushima Prefectural Office, and the Japan Atomic Energy
Agency (JAEA) in response to the directive from MEXT on 11 March 2011.
However, these predicted results were neither utilized to discuss practical evacuation
measures nor disclosed to the public, since the calculations based on an assumed unit
release rate did not show any actual radiation dose levels. [the first JHPS
recommendations]Issue 10-2: On the night of 12 March, NSC made one request for a SPEEDI calculation to the
Nuclear Safety Technology Center. The NSC received the calculation results andshared them with its members, members of its technical advisory body in an
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emergency, and some staff members of the NSC Secretariat. The NSC, however,believed that the calculation results should only be utilized for internal discussion. As
a result, the calculation results were not shared with any other organizations.
Issue 10-3: Meanwhile between 11 and 15 March, the Nuclear and Industrial Safety Agency(NISA) conducted SPEEDI calculations by entering various assumptions of releasesource information in order to grasp the dispersion trend of radioactive materials.
The obtained predicted results were shared with various functional teams within the
MEXT-ERC. A few results were provided to the Prime Minister's Office and theOff-site Center. However, NISA sent the Prime Minister's Office the SPEEDI
predictions with an accompanying message that NISA believed the SPEEDI
predictions to be of low reliability because the calculations were based on assumed
release source information. Cabinet Secretariat staff treated them as reference
information and did not report them to the Prime Minister.
Simulation system on the diffusion of radioactive materials in the ocean – lack ofprediction tools in the emergency preparedness system
Issue 11: No simulation system for the diffusion of radioactive materials in the ocean has
been established in the nuclear emergency preparedness system, since people do notlive on sea area, unlike on land. [the first JHPS recommendations]
Evacuation of residents and its criterion – extension of order to stay indoors
Issue 12: The results of radiation monitoring and SPEEDI retrospective estimation showed
there were areas with high radiation doses even more than 20km from the Fukushima
Dai-ichi NPS. The distribution of essential items was disrupted in stay-indoors
evacuation zones and it was difficult for residents to conduct their daily lives. In the
Nuclear Emergency Guidelines, the enforcement of a stay-indoors evacuation for along period of time was not assumed. [the first JHPS recommendations]
Evacuation of residents and its criterion – instruction of deliberate evacuation
Issue 13: On 11 April 2013, Chief Cabinet Secretary Edano announced a fundamental
concept of how deliberate evacuation zones should be established. Subsequently, thegovernment issued early advice to the affected municipalities and then, on 22 April,
the Nuclear Emergency Response Headquarters (NERHQ) established deliberate
evacuation zones and provided those municipalities with a directive to inform
residents in the zones to be prepared to evacuate after a period of approximately one
month. [the first JHPS recommendations]
Evacuation of residents and its criterion – communication of evacuation instruction
Issue 14: The Emergency Preparedness Guide prescribes that the head of the local
headquarters shall communicate an evacuation order to each municipality, including
cities, towns, and villages. Most of the municipalities actually learned of theevacuation instructions through the mass media including TV. Some of them learned
through verbal announcements from police vehicles, including police patrol cars.
Evacuation of residents and its criterion – evacuation beyond a designated zone for
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Issue 15: Each of the municipalities located within a 10km radius (equivalent to theEmergency Planning Zone, or EPZ) of a power plant is expected to possess regional
disaster prevention plans and evacuation plans. Each municipality is, as a rule,primarily responsible for formulating evacuation plans and implementing these plans,
but in the event of evacuation over a wider area (across municipalities), Fukushima
Prefecture bears the responsibility of formulating an evacuation plan. However, in
reality, the only evacuation cases in which Fukushima Prefecture took the lead incoordinating shelters across municipalities were for Futaba Town and Okuma Town,
when an evacuation instruction was issued for areas lying within a 10km radius.
Evacuation of residents and its criterion – evacuation of socially vulnerable individuals
Issue 16: People who had difficulty evacuating, such as hospitalized patients, were left behindin the area within a radius of 20km from the nuclear plant, which had been
designated as an evacuation zone. In the situation where communication was limited
and sufficient information could not be obtained, the evacuation of hospitalized
patients was extremely difficult, resulting in many cases of aggravated medical
conditions or death.
Radiological protection criteria – criteria for administration of stable iodide – confusion
regarding administration criteria
Issue 17: Local governments were able to obtain a sufficient amount of stable iodine tablets,
but instructions to take the stable iodine tablets were not given because there was no
information on predicted radiation dose by SPEEDI. On the other hand, new criteria
for the administration of stable iodine were provided by the NSC on the basis of ascreening level. This advice, however, did not reach Fukushima Prefecture and thecities, towns, and villages concerned. There was no opportunity to take iodine tablets
except for some residents who were given instructions at a local government’s own
discretion. [the first JHPS recommendations] On 13 March 2013, the NSC advised the ERC that stable iodine tablets should be provided tothose who had radiation dose exceeding 10,000cpm detected at at their screening services.
However, this information was not communicated to the local NERHQ.
 At 01:25 on 16 March, the NSC distributed advice to the ERC to the effect that all of thoseremaining within a 20km radius should take stable iodine tablets while being evacuated.
 The local NERHQ, which confirmed this advice via the ERC, issued a written order at 10:35
the same day to the leaders of the Fukushima prefectural government and 12 affectedmunicipalities. However, the Fukushima prefectural government did not follow this
instruction on the intake of stable iodine tablets because the government had alreadyconfirmed that there were no individuals remaining within a 20km radius.
 The Fukushima prefectural government also asked the ERC and other organizations to help
secure stable iodine tablets and was able to obtain approximately 1,360,000 stable iodine
tablets from a major stable iodine manufacturer and from the Ibaraki prefectural government.
On 14 March, the Fukushima prefectural government reached the decision to distribute twostable iodine tablets to each resident under 40 years of age in all municipalities within an
approximate radius of 50km of the nuclear power station. However, the Fukushima
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take iodine tablets, despite having the authority to do so.
 During the night of 14 March, Miharu town officials had fears that its residents might be
exposed to radiation and decided to distribute stable iodine tablets to its residents andinstructed them to take the tablets. At 13:00 on 15 March, Miharu town officials, using amunicipal disaster management radio communication network, made sure that each and every
resident was informed of this decision. They distributed stable iodine tablets to approximately
95% of residents under the supervision of local pharmacists. Later, staff of the Fukushima
prefectural government learned that the Miharu town office had distributed stable iodine
tables and instructed the residents to take them. In the evening of the same day, the staff
instructed Miharu town officials to stop distributing stable iodine tablets and to retrieve all ofthem as there had been no instructions from the national government. Miharu town officials
did not obey this order.

Radiological protection criteria – screening level – validity of the level
Issue 18: The screening level was raised in accordance with the present situation using
different levels from those that had been previously established. [the first JHPS
recommendations] The “Manual for Radiation Emergency Medical Care Activities in Fukushima Prefecture,”
which was created under the authority of the Fukushima prefectural government, was basedon a manual entitled "Recommendation on Radiation Emergency Medical Care", which was
prepared by the NSC, and stipulated that the screening level for residents (a criterion ofcomprehensive outer body clean up) should be 40Bq/cm2. The Fukushima prefectural
government set the screening level at count rates of 13,000cpm (counts per minute), which isequivalent to about 40Bq/cm2 and started to implement screening services on 12 March 2011.
 The Local NERHQ asked the ERC for advice in the morning of 13 March regarding setting
the criterion of 40Bq/cm2 or 6,000cpm. The ERC requested comments from the NSC on thecriterion. The NSC responded that the screening level of 6,000cpm should be revised to
10,000cpm and that those who experienced exposure in excess of 10,000cpm should takestable iodine tablets; however, these comments were not communicated to the Local NERHQ
by the ERC.
 Radiology experts in a radiation emergency medical care team dispatched to Fukushima
Prefecture on 13 March voiced the opinion that the screening level should be raised from
40Bq/cm2 (13,000cpm) to 100,000cpm, after considering that water (hot water) to be used forwhole-body decontamination (showering) appeared to be in short supply and that whole-bodydecontamination under low-temperature conditions is believed to have major disadvantages.
 The Fukushima prefectural government decided to raise the screening level to 100,000cpm
for whole-body decontamination from 14 March onward and also conducted partial wipe-off
decontamination for those with a count rate of 13,000cpm to less than 100,000cpm.
 Before dawn on March 14, having learned that the Fukushima prefectural government was
raising the screening level, the NSC provided the ERC with advice to the effect that “it isdesirable not to raise the screening criterion to 100,000cpm and to keep it at the current valueof 13,000cpm.” However, the Fukushima prefectural government decided to continue withthe screening and decontamination with a screening criterion of 100,000cpm, as it judged thatthe new screening level and decontamination methods would not go against the NSC advice
because they involved partial wipe-off decontamination of those with a count rate of203

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13,000cpm to less than 100,000cpm.
 Subsequently, the NSC received the request that “it would be desirable to raise the screening
level to 100,000cpm, as the air dose rate is high in the affected areas and screening is difficult
to conduct.” Accepting the request, the NSC, at 14:40 on 19 March, provided the ERC withthe advice that the screening level should be raised to 100,000cpm (“Recommendation on
Screening Criteria of Radiation Emergency Medical Care”).

Radiological protection criteria – criteria for contamination of soil (schoolyards andeducational facilities, and bathing areas, utilization of crushed stones, and disposal of disaster
waste and sewage sludge) – consistency of concepts for derivation of criteria
Issue 19: It has become difficult to explain the consistency among all the criteria since eachcriterion was determined using a different concept. [the first JHPS
recommendations] The value of 3.8μSv/h for ambient dose rate, which was announced by MEXT in "Provisionalview regarding the judgment of the use of schoolyards and educational facilities inFukushima Prefecture" was derived using 20mSv/y, which is the upper limit in the band ofreference level established by the International Commission on Radiological Protection(ICRP) for an existing exposure situation. Subsequently, MEXT decided to aim to reduce thelevel of contamination to 1mSv/y.
 The provisional criterion for bathing areas announced by the Ministry of the Environment(MOE) was derived such that the individual dose due to external and internal exposure would
be within 10% of 1mSv/y.
 The concept of the reference level established by the ICRP for an existing exposure situation
was not applied to the criteria of utilization of crushed stones and disposal of disaster waste
and sewage sludge. These criteria were derived from “Near-term policy to ensure the safety
for treating and disposing of contaminated waste around the site of Fukushima Dai-ichi
Nuclear Power Station of Tokyo Electric Power Company” (control not to exceed 1mSv/y forresidents and workers and 10μSv/y for the public in the case of recycling exposure scenario)
announced by the NSC on 3 June 2011.

Radiological protection criteria – criteria for food and beverages – comprehensiveness offood categories
Issue 20: Since in the provisional regulatory values (by 31 March 2012) for radioactive
materials contained in foods, the restriction values for radioactive iodine in fish andfoods not to consumed directly, e.g., tea leaves, were not specified, much confusion
occurred. [the first JHPS recommendations]Radiological protection criteria – criteria for food and beverages – universal use for various
types of accident
Issue 21: Since the new regulatory value for food and beverages enforced on 1 April 2012
was derived for only radioactive cesium on the basis of 1mSy/y as an internal
exposure dose and can be applied to the current situation after the present accident, itcannot be universally used as a criterion for emergency preparedness where various
types of accident should be considerd.
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Japan Health Physics SocietyRadiological protection criteria – criteria for food and beverages – approach to dose criteria
Issue 22: In the derivation of the new regulatory value for food and beverages enforced on 1
April 2012, 1mSv was adopted as a dose criterion, strictly shifting from 5mSv;
nevertheless, the estimated dose due to intake of contaminated foods was sufficiently
low and was determined without full discussion with stakeholders associated with the
production, distribution, and consumption of foods. [the first JHPS
recommendations]Radiological protection criteria – protective criteria for temporary entry into restrictedzones – balance among other risks
Issue 23: Irrespective of the ambient dose level in the residence, the maximum time spent athome during temporary entry was limited to 2 h, and the total time taken for theround trip from the relay point to each home was limited to 5 h. [the first JHPS
recommendations]Radiological protection criteria – dose criteria for emergency work – dose limit taking
life-saving work into accountIssue 24: In the second interim report on the incorporation of the 2007 Recommendations of
the ICRP into domestic systems, the Basic Committee of the Radiation Council
proposed to match the dose limits to internationally recommended values, taking into
consideration that opportunities to participate in international activities wereincreasing for domestic workers, because the current restriction criteria in Japan(dose limit, 100 mSv) interfered with emergency medical care and other essential
operations. On the other hand, in response to the present accident, 250mSv wasadopted as a dose limit for emergency workers. This value is lower than theinternationally approved principles and the recommended value of the 2007
Recommendations of ICRP (emergency medical care, no restriction; otheremergency rescue operations, 1,000 or 500 mSv; other rescue operations, 100 mSv).
[the first JHPS recommendations]Radiological protection criteria – dose criteria for emergency work – treatment of individual
doses received in an emergency situation
Issue 25: In the second interim report on the incorporation of the 2007 Recommendations of
the ICRP into domestic systems, it was indicated that emergency work doses will betreated separately from normal work doses. However, the Ministry of Health, Laborand Welfare (MHLW) issued an official notice stating that when managing dose
limits during normal work, if a worker has a history of engaging in emergency work,
the doses received during such work should be included and the limit of 100mSv/5
years should be applied. [the first JHPS recommendations]Radiation exposure of residents – estimation of thyroid equivalent dose of radioactive
iodine by simple measurement
Issue 26: Screening tests for thyroid gland exposure levels on 1,080 infants and children werecarried out in Iwaki City, Kawamata-machi, and Iitate-mura from 26 March to 30
March 2011; however, this involved low-precision tests and no further tests of the
thyroid gland exposure levels of the children were carried out. [the first JHPS
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Radiation exposure of residents – internal dose assessment using whole body counter(WBC) – investigation system
Issue 27: As part of the Fukushima Prefecture Health Management Survey started in June
2011, individual doses for external exposure were investigated as the External Dose
Estimation based on the behavior records in the Basic Survey. However,investigation of the dose for internal exposure using the WBC was not carried out inthe Basic Survey. For this reason, the WBC measurement results are individually
kept in each municipality or hospital since these data are a form of personal
information that is unavailable for use for other objectives without permission. The
WBC measurement for internal exposure was not addressed in the nuclear
emergency preparedness plan, which was a main cause of the delay in conducting the
WBC measurement.
Radiation exposure of residents – internal dose assessment using whole body counter(WBC) – measurement method
Issue 28: Since individual dose assessment for internal exposure using the WBC highlycollected the needs of residents, the WBCs were individually set up by municipalities,
hospitals, and nongovernmental organizations, in addition to direct management by
the Fukushima prefectural government. Therefore, the dose assessment was carriedout by nonunified methods without standardization. [the first JHPS
recommendations] Although it is important, when using a great number of WBCs as
a monitoring tool, to ensure the traceability from the viewpoint of maintaining thereliability of the measurements, there are no standards for WBCs. Also, there are no
manuals to effectively explain the WBC monitoring results to the public.
Radiation exposure of residents – external dose assessment using personal dosimeters
Issue 29: Since dose assessment was carried out by each municipality by lending personal
dosimeters in response to the needs of residents, individual dose data for external
exposure are kept in the respective municipality because these data are a form of
personal information that is unavailable for use for other objectives without
permission.
Radiation exposure of residents – external dose estimation on the basis of behavior survey
Issue 30: As part of the Fukushima Prefecture Health Management Survey started in June
2011, the individual dose for external exposure was investigated as the External Dose
Estimation, using the behavior records obtained via sets of inquiry forms in the Basic
Survey. However, the recovery ratio of inquiry forms was only 18% in December
2011. (As of 31 January 2013, the recovery ratio for the whole area of the prefecture
was 23.2% and that for the preceding investigation area, Yamakiya district of
Kawamata Town, Namie Town, and Iitate Village was 56.7%)
Radiation exposure of plant recovery workers – network for urgently borrowing alarm
pocket dosimeters (APDs)
Issue 31: Although many APDs were provided as aid supplies from other NPSs, these APDs
were simply stored and remained unused owing to a lack of communication. There
were not enough APDs and by 15 March, not every worker was able to wear an APD,
which led to the decision that only the leaders of each operational group would wear
APDs on behalf of the entire group.
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Radiation exposure of plant recovery workers – control of internal exposure in an
emergency
Issue 32-1: The individual doses of 6 workes exceeded 250mSv, which was the dose limit for
emergency workers temporarily prescribed after the accident.
 The main control room outside the controlled areas was not equipped with a sufficientnumber of full-face masks. In addition, since the number of charcoal filter masks was not
sufficient for all of the workers, some staff members just wore dust filter masks until charcoal
filter masks were delivered from the Seismic Isolation Building in the evening of 12 March.
 There were actual cases in which staff members sometimes ate and drank in the main control
room without wearing masks, sometimes took their masks off and spent short periods of time
without them, and sometimes loosened their masks because their breath fogged up theirmasks or their masks were too tight, causing headaches. Moreover, there was a possibility thatthe arms of glasses created a gap between the face and the mask.
 The emergency doors to and from the main control rooms of Units 1 and 2, which had been
bent and twisted by the blast from the hydrogen explosion in Unit 1, were only temporarily
sealed with vinyl sheets. Meters on the side of Unit 1 were located in a stream of air flowing
from the emergency doors. In the main control room of Units 3 and 4, some staff members
also spent most of their time checking the meters nearest the emergency doors, which werebent and twisted by the blast of the explosion.
 Some staff members in the main control room of Units 3 and 4 did not take stable iodine
tablets until they moved to the Seismic Isolation Building on the evening of 13 March.
 Since the ambient dose in the whole body counter (WBC) room became higher following theaccident, those WBCs could not be used. From 22 March, TEPCO borrowed vehicle-mountedWBCs, which were installed at the Onahama Call Center, and internal exposure tests of theworkers were commenced.
 When a high contamination was observed, personal decontamination was carried out toremove external contamination. Since the worker then needed to wait for approximately two
weeks to receive a test purely for internal exposure, it took time to assess the high-levelinternal exposure.

Issue 32-2: The doses of two female employees significantly exceeded the 5mSv three-month
upper limit for female radiation workers, although they took appropriate radiologicalprotection measures such as wearing full-face masks with charcoal filters whilst
working in the field, since the double-entry doors to the Seismic Isolation Building
were not airtight and the doors to the Seismic Isolation Building were bent andtwisted by the hydrogen explosions in Units 1 and 3.
Issue 32-3: 178 workers showed thyroid gland equivalent doses of over 100mSv, and 25
workers under the age of 40 did not take iodine tablets.
Radiation exposure of plant recovery workers – control of localized exposure in an
emergency
Issue 33: On 24 March, two of three workers who were installing electric cables under thesurface of the basement floor of the Unit 3 turbine building were exposed to highradiation doses while working immersed in contaminated water, because they were207

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wearing low quarter shoes. Although it was made clear, after getting cleaned up andhaving a checkup and getting tested to measure internal radiation doses, that neither
worker suffered radiation heat burns on their feet, there had been a possibility of
suffering from radiation heat burns due to continuous localized exposure.
Radiation exposure of plant recovery workers – managing access to and from a controlledarea in an emergency
Issue 34-1: After the nuclear accident, access to and from the controlled area of the
management system was initially impossible for calculating the radiation dose ofindividual radiation workers. It was then decided to manually calculate the radiationdose of individual radiation workers using APDs. (On 14 April, five simplified
instruments were installed in the Seismic Isolation Building for gaining access to andfrom the controlled area management system. At the same time, a radiation work
permit with bar code patterns was introduced so that the names and radiation doses
of individual workers could be automatically recorded).
Issue 34-2: From the date of the nuclear accident to 10 May, radiation workers were allowed
to carry out their duties after receiving a brief 30-minute explanation about how toprotect themselves from radiation and how to wear protective equipment.
Communication to the public – spreading understanding of radiation effects
Issue 35: The Government often explained, "It does not have immediate effects on health",
concerning the influence of radiation on the human body. This expression may beinterpreted by some people as "it is unnecessary to be anxious about the impact ofradiation on human health," while it may be interpreted by other people as "it does
not immediately affect human health, however, some effects on human health willappear in the longer term." However, it was not necessarily clear what the intended
meaning of the expression was, and there was no detailed explanation. Moreover,anxiety regarding unknown nuclear disasters and dissatisfaction about the
explanation from the government were broadly shared. One of the reasons for this isthat we have neglected to endeavor to improve public understanding of radiation andhave never trained radiological protection experts for communication in themunicipal government in the nuclear emergency preparedness plan.
Communication to the public – comprehensibility of radiological protection system
Issue 36: Residents who had to live in an environment contaminated by radioactive material
after the accident sought information about the level of radioactivity that would serve
as a basis for making decisions. Mothers, in particular, sought accurate information
about the extent of contamination in the food and beverages they were giving theirchildren, and about the radiation dose from the environment and its potential effects
on their health. However, the information that was made available to the residents
was not satisfactory. [the first JHPS recommendations]
Communication to the public – utilization of mass media
Issue 37: The government rapidly responded to online communication by consolidating therelevant information onto its homepage and opening an official twitter account of the
Cabinet. However, it used only one way communication such as mass media andcould not provide appropriate timely information or gain the public’s confidence,since the information was not obtained through bidirectional exchanges utilizing the208

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characteristics of social media.
Communication to the public – response to foreign residents and overseas countries
Issue 38-1: Although the discharge of the less contaminated water into the sea conducted on 4
April 2011 did not fall within the scope requiring notification prescribed in the
United Nations Convention on the Law of the Sea, the notification stating that thedischarge would begin was sent the day of discharge after it had already started andcountries around Japan were not informed of the discharge in advance.
Issue 38-2: The U.S. Nuclear Regulatory Commission (NRC) had been seeking detailed
information regarding the status of the Fukushima Dai-ichi NPS from the Japanese
government since 12 March 2011. However, the Japanese government was incapableof providing such information to the U.S. in a manner satisfactory to the U.S. side,
because Japanese government had not been able to acquire sufficient information on
the nuclear power plant itself and officials of NISA and other government staff
familiar with the situation at the nuclear plant were preoccupied with their work of
dealing with the plant’s situation. For this reason, the NRC decided to issue
evacuation advice as a safety measure, and on 17 March (Japan time) advised U.S.
citizens in Japan to evacuate to outside of a 50-mile (about 80km) radius of the
Fukushima Dai-ichi NPS. This led to confusion because this radius for evacuation
was significantly larger than the 20km radius of the Japanese evacuation area.
Nuclear emergency preparedness system – preparedness for complex disasters
Issue 39: Serious confusion occurred in the relevant organization owing to insufficient
preparedness for an accident scenario where events unfold quickly and for facing acomplex disaster involving earthquakes and tsunamis occurring simultaneously witha nuclear disaster.
 The central organization of the government’s emergency response system is the NERHQ (thePrime Minister and the Minister of Economy, Trade and Industry (METI) serve as the
director-general and the deputy director-general, respectively). The secretariat of the NERHQ
was established at NISA-ERC and was expected to monitor the nuclear facilities’ conditions
and coordinate emergency response measures, such as the evacuation of residents. They wereunable to perform those anticipated roles, largely because the secretariat of the NERHQ failed
to collect and share information concerning the progression of the accident and the progressof the response, and partly because the Kantei (the Prime Minister and other concerned
parties who assemble in the prime minister’s office and reception rooms on the fifth floor of
the Kantei) stepped in to lead the government’s response to this accident as the situation of
the accidental events evolved extremely rapidly.
 The Local NERHQ (the deputy minister of METI serves as the director-general), to which theNERHQ delegates part of its authority, is responsible for the response to the accident,
including the issuance of evacuation orders, in accordance with the actual local conditions
and with the support of the NERHQ and the support and cooperation of the other relevantorganizations such as municipal governments. The establishment of the organizations thatneeded to be set up at the Off-site Center (the center for emergency response measures) for
this accident required much time owing to the delays and cancellations of the arrivals ofnecessary personnel (including the director-general of the Local NERHQ), as well as theearthquake’s impact on facilities and equipment. The effective establishment of the Local
NERHQ was delayed until around 3:00 on 12 March, when the emergency generator at theOff-site Center resumed normal operations. Feeling a sense of crisis, Fukushima Prefecture209

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took its own initiative to issue an evacuation order for a radius of 2km from the Fukushima
Dai-ichi NPS. Thirty minutes later, the national government issued an evacuation order forresidents within a 3km radius of the plant. In this emergency situation, the Off-site Center
failed to adequately perform its expected functions.
 Following the expansion of the evacuation zone beyond a 10km radius of the Fukushima
Dai-ichi NPS, the Off-site Center (located within a 5km radius of the plant) became isolated
in the evacuation zone, making it difficult to procure fuel, food and other necessary supplies.
As the Off-site Center was not equipped with air filters to block the penetration of radioactive
materials, radiation doses within the building increased in tandem with the rises in radiation
doses in surrounding areas, and on 15 March, it was decided to relocate the Off-site Center tothe Fukushima prefectural government building.
 The Emergency Response Office in the Prime Minister’s Office (Crisis Management Center)
was meant to engage in the initial response following the outset of a nuclear disaster up to thepoint when the NERHQ begins full-fledged operations. Once the activities of NERHQ and its
secretariat began in earnest, it was assumed that operations would be handed over to thesecretariat of the NERHQ. However, the politicians in the Kantei, including Prime Minister
Kan, moved to a small room on the mezzanine floor and then to the area surrounding the
Office of the Prime Minister on the fifth floor of the Kantei, because the operation room wasin uproar and they were not comfortable making decisions in such a place. This caused
disruption in the flow of information with the Crisis Management Center.
 As an expert body on nuclear power in the nuclear emergency preparedness activities, NSC ismeant to provide appropriate advice based on requests made by the director-general of theNERHQ, or the prime minister. According to the Basic Plan for Emergency Preparedness,
NSC is to set up a headquarters organization, called an emergency technical advisory body,within its secretariat, as well as a local body of the emergency technical advisory body at theOff-site Center to which it will dispatch the NSC commissioners and the advisors for
emergency responses. In turn, NSC is to collect information and perform investigations andanalyses, as well as prepare technical advice. However, owing to disruptions in public
transportation and telecommunications, nearly all of the advisors for emergency responses
that were summoned failed to convene on 11 March. During the initial response, members of
NSC and advisors for emergency responses were not dispatched to the site, nor were any local
bodies established at the Off-site Center.
 After the NSC Chairman attended the first meeting of NERHQ on 11 March 2011, following
a request made by the Kantei, he remained almost continuously assigned to the Kantei until
around 15 March, together with the NSC Deputy Chairman, and offered advice grounded intechnical expertise, on the basis of the plant information that had been collected. However,this advice was not offered as advice from NSC as an organization. With the prolonged
absence of two of its five members as well as its secretary general, NSC was significantly
impaired in its function as an organization.
 According to the MEXT Emergency Action Plan, MEXT must establish a Nuclear Emergency
Response Support Headquarters within the ministry, mainly to provide advice for monitoring
conducted by the Off-site Center radiation squad, to analyze monitoring data, and to dispatch
disaster medical assistance teams to the site. MEXT and other relevant organizations are todispatch personnel and equipment to local governments to support emergency monitoring
activities undertaken by the local governments. On 12 March 2011, MEXT decided todispatch monitoring vehicles and personnel to the Off-site Center, but the MEXT’s support
team did not begin monitoring activities until 15 March. Owing to a shortage of fuel and other210

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supplies for monitoring vehicles, when the Local NERHQ moved to the Fukushima
Prefectural Government Building on 15 March, the team was forced to leave the monitoringvehicles that had run out of fuel at the Off-site Center.
 A Prefectural Headquarters for Disaster Control was to be established at the Fukushima
Prefectural Government offices (Main office fifth floor) and the Prefectural Nuclear
Emergency Response Headquarters was to be formed at the Off-site Center. Nine squads were
to be established under the Prefectural Headquarters for Disaster Control to gather
information and provide assistance to municipal governments for resident evacuation.
However, a large number of personnel at the Fukushima Prefectural Office were working on
the various functional squads at the Fukushima Prefecture Headquarters for Disaster Control,
in order to implement earthquake and tsunami countermeasures. Fukushima Prefecture
therefore hastily established a new nuclear squad, which was devoted to the nuclear disaster
response. However, responses of the nuclear squad fell into a state of confusion owing to theineffectiveness of the Off-site Center. The Fukushima Prefecture Headquarters for Disaster
Control had to oversee operations that it had not foreseen, including, for instance, securingtruck-mounted generators requested by TEPCO and screening evacuated residents.
 The main office of the Fukushima prefectural government building, established as the
Fukushima Prefecture Headquarters for Disaster Control, was due to undergo anti-seismic
reinforcement construction because its seismic resistance was low, but at the time of thedisaster, improvements had yet to be made. Fukushima Prefecture then transferred thenecessary equipment to the third floor of the Fukushima Prefecture Public Hall, a building
designated as an alternate facility. This building, however, only had two municipal disastermanagement radio communication lines—a vital communication network during times of
emergency—whereas the main office of the prefectural government building was equippedwith 47. Communication networks between the prefectural and municipal governments andother agencies were fragile, which created major obstacles in responding to damage causedby the earthquake and tsunami as well as the nuclear disaster.
 Following the disaster, Fukushima Prefecture dispatched personnel to an Off-site Center andestablished the Prefectural Nuclear Emergency Response Headquarters, but the officials wereunable to fulfill their assumed role. This was because no substantial discussions took place in
the Prefectural Nuclear Emergency Response Headquarters and the Joint Council for Nuclear
Emergency Response, particularly after 14 March, since the personnel were occupied withpreparations to transfer the Off-site Center to the Fukushima Prefectural Government officeas events unfolded quickly in this accident.

Nuclear emergency preparedness system – opportunity of revision of nuclear emergency
preparedness for complex disasters (earthquake, tsunami, and nuclear accident)
Issue 40: Although problems of emergency preparedness assuming the possible occurrence ofa nuclear emergency coupled with a complex disaster were pointed out, no measures
were taken against them.
 Upon requests from the Niigata prefectural government, following the occurrence of a fire at
the Kashiwazaki-Kariwa NPS when it was struck by the Niigata-ken Chuetsu-oki Earthquake,the national government requested the investigation committee on the accident at the
Kashiwazaki-Kariwa NPS to examine and report on the issue of preparedness against a
nuclear emergency coupled with a complex disaster. The report produced by the investigationcommittee stated the government’s intention to resolve the issues that require attention when
responding to a nuclear emergency in a complex disaster under the leadership of NISA.
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Japan Health Physics Society However, the draft document entitled “A Draft on the Issues Requiring Attention When
Preparing an Emergency Response Manual for Nuclear Emergency Coupled with Complex
Disaster” submitted by NISA in April 2009, stated that the probability of a nuclear emergency
being coupled with a complex disaster was extremely small, on the basis of the view that
nuclear power facilities employ a seismic structural design and are technologically well
protected against earthquakes on a design basis level, as well as the view that the incident that
had taken place at the Kashiwazaki-Kariwa NPS as a result of the Niigata-ken Chuetsu-oki
Earthquake fell short of being a nuclear emergency. Therefore, the draft document concluded
that it was reasonable to develop countermeasures on the basis of ongoing organizationalarrangements for disaster prevention and negated the need to make new organizationalarrangements for disaster prevention assuming the possible occurrence of a nuclear
emergency coupled with a complex disaster.
 The draft document received the following criticisms, which argued against the very act ofdeveloping countermeasures against a nuclear accident coupled with a complex disaster, fromconcerned agencies of the national government and local governmental organizations:(i) The development of countermeasures against a nuclear emergency in a complex disastermay become a cause of the mistaken view that major natural disasters are likely toinitiate a nuclear emergency;(ii) The implementation of countermeasures against a nuclear emergency in a complex
disaster will require major modifications to regional disaster prevention plans, etc.; or(iii) There has not been sufficient negotiation with concerned organizations for affairs to behandled by an organization other than NISA.
 In response to such criticisms, NISA revised the draft from scratch in October 2010,
specifying that (i) NISA would consult with the Cabinet Office to discuss a future
implementation plan with the Central Disaster Prevention Council and that (ii) further
assistance should be provided to local governments to compensate their insufficient resourcesin dealing with complex disasters. A specific discussion on (ii) was held as late as 28
February 2011. Also, it was not until 8 March 2011 that NISA consulted with the Cabinet
Office concerning (i). In response to this approach from NISA, the managers of the Cabinet
Office answered that the matter should be handled by NISA, since complex disasters wererelated to nuclear issues and could not be worked on by the Central Disaster Prevention
Council.
 The national government and municipal governments, by sticking to the existing nuclear
disaster prevention framework and their traditional means of planning for disaster
preparedness, hampered quick revision of the draft, leaving in place measures that wereinsufficient to provide for the safety of local residents.
 It had been pointed out, as a result of the administrative evaluation/monitoring by the
Ministry of Internal Affairs and Communications (MIC) in February 2009, that measureswould be needed to reduce exposure to doses of radiation within the Off-site Center in theevent of a nuclear accident. Nonetheless, NISA failed to take adequate measures.

Radiological protection measures postaccident have different aspects depending onwhether the target is the public or workers. For the public, the residential area is the212Japan Health Physics Society
surrounding area or far from the accident site. Workers are plant recovery or
rescue/decontamination workers around the accident site, and the timing to implement theradiological protection measures is the early stage (up to 1 week postaccident), middle stage(up to 1 month postaccident), later stage (up to 1 year postaccident) or long-term stage (after 1
year postaccident). For this reason, the radiological protection measures were arranged in amatrix format including these categorizations. Also, where the above-mentioned 40 issues are
addressed in the matrix was clarified.
The locations of the issues in the matrix of the radiological protection measurespostaccident are shown in Table 2.4.1 for the public and Table 2.4.2 for workers. The relevant
issues are given within parentheses [].
Table 2.4.1 Locations of issues for the public in the matrix of the radiological protection
measures postaccident.
Stage post
accident

Early stage(up to 1 week
postaccident)

Middle stage(up to 1
monthpostaccident)

Protective measures postaccident for the public
Surrounding area
Radioactive plume Evacuation/stay in house [Issue 12,
14-16] Prediction of air diffusion [Issue 10]
 Administration of stable iodine [Issue
17]
Leak of contaminated water Prediction of diffusion in sea [Issue
11]
Environmental monitoring Monitoring on land [Issue 1-2, 7]
 Monitoring for sea [Issue 8-9]
Prevention of contamination expansion
 Screening level for decontamination[Issue 18]
Food and beverages
 Restriction of shipping and intake[Issue 20-22]
 Monitoring [Issue 3, 6]
Environmental monitoring Monitoring on land [Issue 1-2, 7]
 Monitoring for sea [Issue 8-9]

213

Remote area
Radioactive plume Prediction of air diffusion [Issue 10]

Leak of contaminated water Prediction of diffusion in sea [Issue
11]
Environmental monitoring Monitoring on land
 Monitoring for sea [Issue 8-9]

Food and beverages
 Restriction of shipping and intake[Issue 20-22]
 Monitoring [Issue 3, 6]
Environmental monitoring Monitoring on land [Issue 1-2, 7]
 Monitoring for sea [Issue 8-9]Japan Health Physics Society

Later stage(up to 1 year
postaccident)

Long-term
stage (after 1
year
postaccident)

Dose reduction
 Mapping contaminated soil
 Dose assessment [Issue 26-30]
 Modification of evacuation area [Issue
13] Temporary access to restricted area
[Issue 23]
 Measurement of thyroid equivalentdose [Issue 26]
 Decontamination (living space forchildren) Communication [Issue 35-38]
Prevention of contamination expansion
 Screening level for decontamination[Issue 18] Criteria for contamination of soil, etc.
[Issue 19]
Food and beverages
 Restriction of shipping and intake[Issue 20-22]
 Monitoring [Issue 3-6]
Environmental monitoring Monitoring on land
 Monitoring for sea [Issue 8-9]
Recovery in short-term range
 Dose assessment [Issue 27-30]
 Modification of evacuation area [Issue
13] Temporary access to restricted area
[Issue 23]
 Decontamination (living space) Communication [Issue 35-38]
Prevention of contamination expansion
 Screening level for decontamination[Issue 18] Criteria for contamination of soil, etc.
[Issue 19]
Food and beverages
 Restriction of shipping and cropping[Issue 20-22]
 Monitoring [Issue 3-6]
Environmental monitoring Monitoring on land
 Monitoring for sea [Issue 8-9]
Recovery in long-term range
 Dose assessment [Issue 27-30]
 Modification of evacuation area [Issue
13] Temporary access to restricted area
[Issue 23]
 Decontamination (living space, soil
and forests)
 Communication [Issue 35-38]
214

Dose reduction
 Mapping contaminated soil
 Dose assessment [Issue 27-30]

 Decontamination (living space forchildren) Communication [Issue 35-38]
Prevention of contamination expansion
 Criteria for contamination of soil, etc.
[Issue 19]
Food and beverages
 Restriction of shipping and intake[Issue 20-22]
 Monitoring [Issue 3-6]
Environmental monitoring Monitoring on land
 Monitoring for sea [Issue 8-9]
Recovery in short-term range

 Decontamination (living space) Communication [Issue 35-38]
Prevention of contamination expansion
 Criteria for contamination of soil, etc.
[Issue 19]
Food and beverages
 Restriction of shipping and cropping[Issue 20-22]
 Monitoring [Issue 3-6]
Environmental monitoring Monitoring on land
 Monitoring for sea [Issue 8-9]
Recovery in long-term range

 Decontamination (living space, soil
and forests)
 Communication [Issue 35-38]

Japan Health Physics Society
Prevention of contamination expansion
 Screening level for decontamination[Issue 18] Criteria for contamination of soil, etc.
[Issue 19]
Food and beverages
 Restriction of shipping and cropping[Issue 20-22]
 Monitoring [Issue 3-6]

Prevention of contamination expansion
 Criteria for contamination of soil, etc.
[Issue 19]
Food and beverages
 Restriction of shipping and cropping[Issue 20-22]
 Monitoring [Issue 3-6]

Table 2.4.2 Locations of the issues for workers in the matrix of the radiologicalprotection measures postaccident.
Stagepostaccident

Early stage(up to 1 week
postaccident)

Middle stage(up to 1
monthpostaccident)

Protective measures postaccident for workers
Plant recovery workers
External exposure
 Ensuring personal dosimeters [Issue
31, 33]
 Recording and storage of individual
dose data[Issue 34]
Internal exposure Administration of stable iodine [Issue
32]
 Ensuring mask and protective wear
[Issue 32]
 Ensuring WBC [Issue 31]
 Recording and storage of individual
dose data [Issue 34]
Prevention of contamination expansion
 Screening level for decontamination[Issue 18]
Dose reduction
 Dose limitation in emergency [Issue
24]
External exposure
 Ensuring personal dosimeters [Issue
31, 33]
 Recording and storage of individual
dose data [Issue 34]
Internal exposure
 Ensuring mask and protective wear
[Issue 32]
 Ensuring WBC [Issue 31]
 Recording and storage of individual
dose data [Issue 34]
Prevention of contamination expansion
 Screening level for decontamination[Issue 18]
Dose reduction
 Dose limitation in emergency [Issue
24]
215

Rescue/decontamination workers
External exposure
 Ensuring personal dosimeters Recording and storage of individual
dose data
Internal exposure Administration of stable iodine Ensuring mask and protective wear
 Ensuring WBC
 Recording and storage of individual
dose data
Prevention of contamination expansion
 Screening level for decontamination
Dose reduction
 Dose limitation in emergency
External exposure
 Ensuring personal dosimeters [Issue
31, 33]
 Recording and storage of individual
dose data [Issue 34]
Internal exposure
 Ensuring mask and protective wear
 Ensuring WBC
 Recording and storage of individual
dose data
Prevention of contamination expansion
 Screening level for decontamination
Dose reduction
 Dose limitation in emergency

Japan Health Physics Society

Later stage(up to 1 year
postaccident)

Long-term
stage (after 1
year
postaccident)

External exposure
 Ensuring personal dosimeters Recording and storage of individual
dose data
Internal exposure
 Ensuring mask and protective wear
 Ensuring WBC
 Recording and storage of individual
dose data
Prevention of contamination expansion
 Screening level for decontamination[Issue 18]

External exposure
 Ensuring personal dosimeters Recording and storage of individual
dose data
Internal exposure
 Ensuring mask and protective wear
 Ensuring WBC
 Recording and storage of individual
dose data
Prevention of contamination expansion
 Screening level for decontamination

Dose reduction
 Dose limitation in emergency [Issue
24]
External exposure
 Ensuring personal dosimeters Recording and storage of individual
dose data
Internal exposure
 Ensuring mask and protective wear
 Ensuring WBC
 Recording and storage of individual
dose data
Prevention of contamination expansion
 Screening level for decontamination[Issue 18]
Dose reduction
 Dose limit and ALARA projected dose
[Issue 25]

Dose reduction
 Dose limit and ALARA projected
dose
External exposure
 Ensuring personal dosimeters Recording and storage of individual
dose data
Internal exposure
 Ensuring mask and protective wear
 Ensuring WBC
 Recording and storage of individual
dose data
Prevention of contamination expansion
 Screening level for decontamination
Dose reduction
 Dose limit and ALARA projected
dose

The following results can be derived from the above arrangement of the issues inaccordance with radiological protection measures, as shown in Tables 2.4.1 and 2.4.2.







Two issues, Issue 39: Nuclear emergency preparedness system – preparedness forcomplex disasters and Issue 40: Nuclear emergency preparedness system – opportunityof revision of nuclear emergency preparedness for complex disasters (earthquake,tsunami, and nuclear accident), were developed regarding the whole of the emergency
preparedness plan; therefore, it was difficult to address any radiological protection
measures postaccident.
The other 38 issues could be obviously connected to radiological protection measurespostaccident.
In the issues from the viewpoint of radiological protection for the public, the issue
involving the characteristic that recommendations should differ between surrounding andremote areas was Issue 35: Communication to the public – spread of understanding ofradiation effects.
In the issues from the viewpoint of radiological protection for workers, the issue
involving the characteristic that recommendations should be prepared for both plant
recovery and rescue/decontamination workers was Issue 31-32: Radiation exposure of216

Japan Health Physics Societyplant recovery workers.
Issues involving the characteristic that recommendations should differ among stages
postaccident (early, middle, later and long-term) were Issue 18: Radiological protection
criteria –screening level – validity of the level and Issue 35: Communication to the public– spread of understanding of radiation effects.
Three radiological protection measures regarding monitoring on land, mapping
contaminated soil, and decontamination did not have any relevant issues associated withradiological protection.

On a basis of the above results, recommendations shall be developed in the next chapter asfollows.


Difference among stages postaccident (early, middle, later and long-term) should beconsidered in developing recommendations regarding Issue 18: Radiological protection
criteria –screening level – validity of the level.
Differences between surrounding and remote areas and among stages postaccident (early,
middle, later and long-term) should be considered in developing recommendations
regarding Issue 35: Communication to the public – spread of understanding of radiation
effects.
Recommendations for rescue/decontamination workers should be involved in thoseregarding Issue 31-32: Radiation exposure of plant recovery workers.

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Japan Health Physics Society
3. Recommendations from the viewpoint of radiological protection
3.1 Recommendations for protection of the public
In this section, recommendations are described in response to issues highlighted in theprevious chapter from the viewpoint of radiological protection of the public. In the drafting of
the recommendations, comments made at the JHPS symposia, as described in section 2.3,
were incorporated. On the basis of the results obtained in the previous chapter,
recommendations regarding Issue 18: Radiological protection criteria – screening level –validity of the level and Issue 35: Communication to the public – spread of understanding ofradiation effects were developed considering the difference among stages postaccident (early,
middle, later and long-term), and the differences between surrounding and remote areas andamong stages postaccident (early, middle, later and long-term), respectively.

Radiation monitoring on land – unexpected effects on means of transportation andcommunication
Recommendation 1: Alternative means or cooperative system for land monitoring should be
previously prepared assuming that the Off-site Center fails to function, the monitoring car isunable to be utilized or aircraft monitoring cannot be carried out as intended, and so forth.
Issue 1: Radiation monitoring on land could not proceed following the previously determined
emergency preparedness plan owing to unexpected effects due to road damage, widespread
power failure, fuel shortages in monitoring cars, damage to communications networks, anddelay in the preparation of helicopters.

Radiation monitoring on land – monitoring posts washed away and communication lines
severedRecommendation 2: Monitoring posts should be upgraded so as to ensure high tolerance toearthquakes and tsunami.
Issue 2: Four of the 24 monitoring posts established by Fukushima Prefecture were washed awayby the tsunami and another 19 were unable to transmit data owing to severed communicationlines, which resulted in 23 monitoring posts being inoperable.

Tap water monitoring – communication method with public
Recommendation 3: Communication methods should be prepared to inform the public of a
restriction period for the intake of drinking water (tap water, river water and well water, etc.)
indispensable to keep our lives and the meaning of the regulatory value.
Issue 3: After notification on 23 March 2011 to refrain from providing tap water to infants in the
23 wards of Tokyo and the Tama area, the radioactivity concentration in tap water on 24
March decreased to below the regulation value. For this reason, it was announced that tap
water may be used without any concern, including for infants. However, since mineral water
could not be obtained in many areas, there were actually severe cases whereby people
ultimately had to decide for themselves whether to drink tap water including radioactive
materials or to refrain from drinking water and whether or not to continue breast feeding
owing to concern of transferring radioactive materials from mother to infant. [the first JHPS
recommendations]Shipping restrictions and monitoring of agricultural and livestock products – expansionof contamination due to food chain
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Recommendation 4: Methods to predict and restrict the expansion of contamination due tothe food chain should be prepared for various agricultural and livestock products in responseto the characteristics of the accident.
Issue 4: The Notice on Farming Management was not communicated to grain farmers, who
produce rice straw. Furthermore, the information and guidance provided to cattle farmers
were inadequate and it was discovered that cattle farmers had fed their cattle rice straw that
had been stored outdoors and was most likely contaminated with radioactive material. This
led to the detection of radioactive cesium exceeding the temporary regulation value in beef.

Shipping restrictions and monitoring of agricultural and livestock products –measurement method for livestock products
Recommendation 5: Methods to measure radioactivity in livestock products in emergency
situations should be standardized in collaboration with expert committees and associatedsocieties while verifying their technological validity by comparison with previous findings
and conventional technologies. [the first JHPS recommendations]Issue 5: Beef fed by contaminated rice straw could not be identified by inspection after slaughter.

Food monitoring – regional variations
Recommendation 6-1: Methods to measure radioactivity in foods in emergency situations
should be standardized in collaboration with expert committees and associated societies while
verifying their technological validity by comparison with previous findings and conventional
technologies. [the first JHPS recommendations]
Recommendation 6-2: A cooperative system that will enable us to temporarily lend
equipment for measuring radioactivity in foods should be developed after nationwide
investigation of the availability of such equipment.
Issue 6: Food monitoring was left to the test plans of the prefectures, so the level of the monitoring
varied depending on the prefecture. The monitoring equipment and other infrastructure in thevarious prefectures were insufficient at the early stage after the disaster. Moreover, there
were also local governments that were unenthusiastic about performing monitoring becauseof their concerns about the harm to their reputation, so the level of monitoring varied
depending on the local government.

Monitoring of forests and subsoils of rivers and lakes – lack of understanding of thenecessity
Recommendation 7: Monitoring methods should be prepared taking into consideration the
behavior and transition of radioactivity in forests and subsoils of rivers and lakes.
Issue 7: The necessity of monitoring forests and subsoils of rivers and lakes was not sufficiently
understood.

Monitoring of seawater, subsoils of ocean, and sea products – lack of understanding of thenecessity
Recommendation 8: Coastal sea area monitoring methods should be prepared taking into
consideration the behavior and transition of radioactivity in sea water, subsoils of the oceanand sea products.
Issue 8: Since the necessity of sea area monitoring was not fully understood, the monitoring area
was limited to the region within 30km from Fukushima Dai-ichi NPS at the early stage after
the accident. Ocean currents formed around this local area were not considered in themonitoring design, which led to missing knowledge on the dynamics of the transition ofradioactive materials from the source.
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Monitoring of seawater, subsoils of ocean, and sea products – lack of prediction tools
Recommendation 9-1: Methods to predict and restrict the expansion of contamination due tothe food chain should be prepared for various sea products in response to the characteristicsof the accident.
Recommendation 9-2: A technique for simulating the transition of radioactivity in the ocean
should be prepared as a nuclear emergency preparedness measure.
Issue 9: Since the seawater off Fukushima Prefecture travels down to the southern region of the
Fukushima Dai-ichi NPS along the coast after the “Oyashio” current meets the “Kuroshio”
current, radioactive materials in seawater traveled down to off the coast of Ibaraki Prefecturein the area south of the Fukushima Dai-ichi NPS, which led to the situation that radioactive
materials temporarily accumulated in sand eels, forcing fishermen in Ibaraki Prefecture torefrain from fishing. In addition, radioactive materials also accumulated in bottom-dwelling
coastal fishes (e.g., flat fish, flounder, etc.). The timing of the accumulation of radioactive
materials in medium-sized fish owing to the food chain could not be predicted since themonitoring target at the early stage postaccident was not ocean subsoils but seawater.

System for Prediction of Environmental Emergency Dose Information (SPEEDI) –underutilization of prediction results
Recommendation 10-1: The calculation results obtained from SPEEDI should be promptly
disclosed together with their uncertainty in a clearly understandable form so thatmunicipalities and evacuees can actively use the data. [the first JHPS recommendations]
Recommendation 10-2: Usage of SPEEDI in the case that the Emergency Response Support
System (ERSS) is unable to be used and a detailed plan for the evacuation of residents in thecase that SPEEDI fails to be utilized should be clarified under the framework of nuclear
emergency preparedness.
Recommendation 10-3: When the entire range within concentric circles is established as anevacuation area owing to the fast unfolding of events in the present accident, methods topredict areas scarcely affected by the diffusion of radioactive materials and to speedily informthe relevant parties of the predicted information should be determined in combination with
monitoring information to continue disaster management, such as life saving activities in
evacuation areas, as long as possible.
Issue 10-1: Since the external power supply was lost following the earthquake and theGovernment's dedicated line for sending data became unavailable, the release of source
information from the Emergency Response Support System (ERSS) on which SPEEDI
calculations are based was not carried out. For this reason, the Nuclear Safety Technology
Center provided the predicted results of their unit release rate calculation based on “theEnvironmental Radiation Monitoring Guidelines”, to the Ministry of Education, Culture,
Sports, Science and Technology (MEXT), the Emergency Response Center (ERC), theNuclear Safety Commission (NSC), the Off-site Center, the Fukushima Prefectural Office,and the Japan Atomic Energy Agency (JAEA) in response to the directive from MEXT on 11
March 2011. However, these predicted results were neither utilized to discuss practicalevacuation measures nor disclosed to the public, since the calculations based on an assumed
unit release rate did not show any actual radiation dose levels. [the first JHPS
recommendations]Issue 10-2: On the night of 12 March, NSC made one request for a SPEEDI calculation to the
Nuclear Safety Technology Center. The NSC received the calculation results and sharedthem with its members, members of its technical advisory body in an emergency, and somestaff members of the NSC Secretariat. The NSC, however, believed that the calculation
results should only be utilized for internal discussion. As a result, the calculation results were
not shared with any other organizations.
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Issue 10-3: Meanwhile between 11 and 15 March, the Nuclear and Industrial Safety Agency(NISA) conducted SPEEDI calculations by entering various assumptions of release source
information in order to grasp the dispersion trend of radioactive materials. The obtained
predicted results were shared with various functional teams within the MEXT-ERC. A few
results were provided to the Prime Minister's Office and the Off-site Center. However, NISA
sent the Prime Minister's Office the SPEEDI predictions with an accompanying message thatNISA believed the SPEEDI predictions to be of low reliability because the calculations werebased on assumed release source information. Cabinet Secretariat staff treated them as
reference information and did not report them to the Prime Minister.

Simulation system on the diffusion of radioactive materials in the ocean – lack ofprediction tools in the emergency preparedness system
Recommendation 11-1: Methods to utilize simulation results of the diffusion of radioactive
materials in the ocean should be determined under the framework of nuclear emergency
preparedness.
Recommendation 11-2: The calculation results obtained from the simulation system for
diffusion in the ocean should be promptly disclosed together with their uncertainty in aclearly understandable form so that municipalities and evacuees can actively use the data.
[the first JHPS recommendations]
Recommendation 11-3: A system to estimate the medium- to long-term effects of oceancontamination on sea products should be established.
Issue 11: No simulation system for the diffusion of radioactive materials in the ocean has been
established in the nuclear emergency preparedness system, since people do not live on sea
area, unlike on land. [the first JHPS recommendations]

Evacuation of residents and its criterion – extension of order to stay indoors
Recommendation 12: The adoption of both short-term and long-term criteria in a stepwisemanner should be examined by considering the balance between emergency measures that
may be effective both temporarily and over the long term, and the maintenance ofinfrastructure required to ensure the secure everyday life of the general public. [the first
JHPS recommendations]Issue 12: The results of radiation monitoring and SPEEDI retrospective estimation showed there
were areas with high radiation doses even more than 20km from the Fukushima Dai-ichi
NPS. The distribution of essential items was disrupted in stay-indoors evacuation zones andit was difficult for residents to conduct their daily lives. In the Nuclear Emergency
Guidelines, the enforcement of a stay-indoors evacuation for a long period of time was notassumed. [the first JHPS recommendations]

Evacuation of residents and its criterion – instruction of deliberate evacuation
Recommendation 13: Since the deliberate evacuation zones, which were proposed after thedisaster for the first time, were areas in which evacuation was recommended on the basis of
the annual individual dose rather than on the need for emergency evacuation, thoroughdiscussions should be held with municipalities to determine suitable evacuation zones and theperiod of evacuation. [the first JHPS recommendations]Issue 13: On 11 April 2013, Chief Cabinet Secretary Edano announced a fundamental concept of
how deliberate evacuation zones should be established. Subsequently, the government issued
early advice to the affected municipalities and then, on 22 April, the Nuclear Emergency
Response Headquarters (NERHQ) established deliberate evacuation zones and provided
those municipalities with a directive to inform residents in the zones to be prepared to221

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evacuate after a period of approximately one month. [the first JHPS recommendations]

Evacuation of residents and its criterion – communication of evacuation instruction
Recommendation 14: Measures, such as an order of evacuation, in the case that the Off-site
Center, where the Local Nuclear Emergency Response Headquarters (NERHQ) is located,fails to function should be previously established including, for instance, where the Local
Headquarters should be replaced to.
Issue 14: The Emergency Preparedness Guide prescribes that the head of the local headquarters
shall communicate an evacuation order to each municipality, including cities, towns, andvillages. Most of the municipalities actually learned of the evacuation instructions throughthe mass media including TV. Some of them learned through verbal announcements frompolice vehicles, including police patrol cars.

Evacuation of residents and its criterion – evacuation beyond a designated zone for
emergency preparedness
Recommendation 15-1: Emergency planning zones (EPZs) that are designated for
emergency preparedness within a radius of 8-10 km from nuclear power plants and related
disaster management measures should be reviewed through full discussions withmunicipalities with consideration of the post disaster spread of contamination to a large area,
as observed in this disaster. [the first JHPS recommendations]
Recommendation 15-2: The evacuation route and the destination should be previously
identified together with a method for the supply of food and drinks on the basis of the nuclear
accident size considered.
Issue 15: Each of the municipalities located within a 10km radius (equivalent to the Emergency
Planning Zone, or EPZ) of a power plant is expected to possess regional disaster prevention
plans and evacuation plans. Each municipality is, as a rule, primarily responsible forformulating evacuation plans and implementing these plans, but in the event of evacuation
over a wider area (across municipalities), Fukushima Prefecture bears the responsibility of
formulating an evacuation plan. However, in reality, the only evacuation cases in which
Fukushima Prefecture took the lead in coordinating shelters across municipalities were for
Futaba Town and Okuma Town, when an evacuation instruction was issued for areas lying
within a 10km radius.

Evacuation of residents and its criterion – evacuation of socially vulnerable individuals
Recommendation 16: For the evacuation of socially vulnerable individuals such as people inmedical institutions, homes for the aged and welfare facilities, and developmentally disabledindividuals, an emergency evacuation strategy including methods of communication bysatellite phone should be provided in the nuclear emergency preparedness plan that is
independent of the endeavor of the individuals or the facilities.
Issue 16: People who had difficulty evacuating, such as hospitalized patients, were left behind in
the area within a radius of 20km from the nuclear plant, which had been designated as anevacuation zone. In the situation where communication was limited and sufficient
information could not be obtained, the evacuation of hospitalized patients was extremely
difficult, resulting in many cases of aggravated medical conditions or death.

Radiological protection criteria – criteria for administration of stable iodide – confusion
regarding administration criteria
Recommendation 17-1: The emergency measures of evacuation and stay indoors,
distribution of stable iodide, and regulation of the ingestion of foods and drinks should be222

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comprehensively examined to ensure consistency in their principles. [the first JHPS
recommendations]
Recommendation 17-2: The concept of criteria for administration of stable iodine should beclarified, taking into consideration that there may only be insufficient radiation monitoringdata available in an emergency without SPEEDI information.
Issue 17: Local governments were able to obtain a sufficient amount of stable iodine tablets, but
instructions to take the stable iodine tablets were not given because there was no information
on predicted radiation dose by SPEEDI. On the other hand, new criteria for theadministration of stable iodine were provided by the NSC on the basis of a screening level.
This advice, however, did not reach Fukushima Prefecture and the cities, towns, and villages
concerned. There was no opportunity to take iodine tablets except for some residents who
were given instructions at a local government’s own discretion. [the first JHPS
recommendations]Radiological protection criteria – screening level – validity of the level
Recommendation 18-1: The validity of the screening criteria for decontamination in an
emergency in terms of their effectiveness for radiation protection should be verified inaccordance with the principles of other emergency measures by considering problems that
may arise in relation to the radiation measurement. [the first JHPS recommendations]
Recommendation 18-2: According to the stage postaccident (early, middle, later andlong-term), when the environmental contamination level reduces, a lower value of thescreening level for decontamination should be selected in a stepwise manner in accordancewith the reduction of the surrounding environmental contamination level. Also, the concrete
process for selecting the screening level should be previously determined.
Recommendation 18-3: Since there are many valuable items in broadly contaminated areas,
which could be recycled or reused in normal circumstances, the screening level for recycling
should be set in addition to that for decontamination. Moreover, in the case that objects forreuse or recycling are restricted, the process used for setting the screening level should be
previously determined because the screening level in the restricted areas can be relaxed inaccordance with environmental contamination level.
Issue 18: The screening level was raised in accordance with the present situation using different
levels from those that had been previously established. [the first JHPS recommendations]Radiological protection criteria – criteria for contamination of soil (schoolyards andeducational facilities, and bathing areas, utilization of crushed stones, and disposal of disaster
waste and sewage sludge) – consistency of concepts for derivation of criteria
Recommendation 19-1: Reference levels should be determined on the basis of the overall
policy by considering the radiation sensitivity of children and the balance among reference
levels, and, if necessary, stepwise reference levels should be adopted. Also, with thecooperation of experts who can support residents’ viewpoints, the active cooperation andunderstanding of stakeholders including residents should be obtained to determine thereference levels, which should not be described as permissible levels because they do notindicate a threshold between safe and hazardous levels. [the first JHPS recommendations]
Recommendation 19-2: The reference levels for radioactive waste should be set to below
those for broad contamination in the overall plan of environmental restoration with the active
cooperation and understanding of stakeholders including residents and the cooperation ofexperts who can support residents’ viewpoints. Also, radioactive waste should be managed sothat the assessed individual dose becomes lower than the determined reference levels and223

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disposed of in a planned manner so that the assessed individual dose satisfies a target dose of
1 mSv/y or lower. [the first JHPS recommendations]Issue 19: It has become difficult to explain the consistency among all the criteria since eachcriterion was determined using a different concept. [the first JHPS recommendations]Radiological protection criteria – criteria for food and beverages – comprehensiveness offood categories
Recommendation 20: Categories of foods and their restriction values should be reviewed byconsidering statistical results on their annual amount of ingestion and by monitoring ofradiation levels in foods and following an optimization principle in which social andeconomic factors are taken into account. [the first JHPS recommendations]Issue 20: Since in the provisional regulatory values (by 31 March 2012) for radioactive materials
contained in foods, the restriction values for radioactive iodine in fish and foods not to
consumed directly, e.g., tea leaves, were not specified, much confusion occurred. [the first
JHPS recommendations]Radiological protection criteria – criteria for food and beverages – universal use for various
types of accident
Recommendation 21-1: The emergency measures of evacuation and stay indoors,
distribution of stable iodide, and regulation of the ingestion of foods and drinks should becomprehensively examined to ensure consistency in their principles. [the first JHPS
recommendations]
Recommendation 21-2: The adoption of both short-term and long-term criteria in a stepwisemanner should be examined by considering the balance between emergency measures that
may be effective both temporarily and over the long term and the maintenance ofinfrastructure required to ensure the secure everyday life of the general public. [the first
JHPS recommendations]Issue 21: Since the new regulatory value for food and beverages enforced on 1 April 2012 wasderived for only radioactive cesium on the basis of 1mSy/y as an internal exposure dose andcan be applied to the current situation after the present accident, it cannot be universally used
as a criterion for emergency preparedness where various types of accident should beconsiderd. [the first JHPS recommendations]Radiological protection criteria – criteria for food and beverages – approach to dose criteria
Recommendation 22: The individual dose criteria used as references to derive the restriction
values of radioactive materials in foods should be determined after full discussion withstakeholders associated with the production, distribution, and consumption of foods. [the first
JHPS recommendations]Issue 22: In the derivation of the new regulatory value for food and beverages enforced on 1 April
2012, 1mSv was adopted as a dose criterion, strictly shifting from 5mSv; nevertheless, theestimated dose due to intake of contaminated foods was sufficiently low and was determined
without full discussion with stakeholders associated with the production, distribution, andconsumption of foods. [the first JHPS recommendations]Radiological protection criteria – protective criteria for temporary entry into restrictedzones – balance among other risks
Recommendation 23: Flexible systems that will allow people of different ages including theelderly to temporarily enter restricted zones for various purposes should be developed byconsidering the balance of radiation protection measures with other risks and inconvenience,224

Japan Health Physics Societyrather than uniformly imposing the wearing of a protective suit and limiting the entry time.
[the first JHPS recommendations]Issue 23: Irrespective of the ambient dose level in the residence, the maximum time spent at homeduring temporary entry was limited to 2 h, and the total time taken for the round trip from therelay point to each home was limited to 5 h. [the first JHPS recommendations]Radiation exposure of residents – estimation of thyroid equivalent dose of radioactive
iodine by simple measurement
Recommendation 26-1: The thyroid equivalent dose for the internal exposure to radioactive
iodine should be calculated on the basis of the results of simulating the atmospheric diffusionof the radioactive plume using SPEEDI, food inspections, and surveys on residents’ behavior.
Also, the calculation results along with their uncertainty should be disclosed. [the first JHPS
recommendations]
Recommendation 26-2: The standardization of methods of evaluating the thyroid equivalentdose of radioactive iodine by simple measurement should be examined in collaboration withexpert committees and associated societies while verifying their technological validity bycomparison with previous findings and conventional technologies. [the first JHPS
recommendations]
Recommendation 26-3: The thyroid equivalent dose assessment carried out by otherresearchers and methods to estimate the thyroid equivalent dose of 1,080 children using
simple measurements should be invetigated and the results should be reflected in thediscussion of the uncertainty of the thyroid equivalent dose of residents.
Recommendation 26-4: Emergency environmental monitoring guidelines should be verified
including dose assessment postaccident. A system that can be operated with goodunderstanding of the guidelines should be established developing human resources. Moreover,a mechanism to enable the system to be maintained over a long time should also beestablished.
Issue 26: Screening tests for thyroid gland exposure levels on 1,080 infants and children werecarried out in Iwaki City, Kawamata-machi, and Iitate-mura from 26 March to 30 March
2011; however, this involved low-precision tests and no further tests of the thyroid gland
exposure levels of the children were carried out. [the first JHPS recommendations]Radiation exposure of residents – internal dose assessment using whole body counter(WBC) – investigation system
Recommendation 27-1: A cooperative system that enables the temporary lending of WBCsand dispatch staff for measurements to the affected area should be developed after nationwide
investigation of the availability of such equipment and training of the staff. Also, a systemthat enables the investigation of internal exposure using WBCs should be established, led by
the national or prefectural government immediately after an accident.
Recommendation 27-2: It is necessary to consider methods of maintaining the large number
of WBCs after the accident and to make a Q&A booklet or manual instructions to enhance theunderstanding of how the monitoring results of WBCs should be explained to the public.
Issue 27: As part of the Fukushima Prefecture Health Management Survey started in June 2011,individual doses for external exposure were investigated as the External Dose Estimation
based on the behavior records in the Basic Survey. However, investigation of the dose forinternal exposure using the WBC was not carried out in the Basic Survey. For this reason, theWBC measurement results are individually kept in each municipality or hospital since thesedata are a form of personal information that is unavailable for use for other objectives
without permission. The WBC measurement for internal exposure was not addressed in the225Japan Health Physics Society
nuclear emergency preparedness plan, which was a main cause of the delay in conducting the
WBC measurement.

Radiation exposure of residents – internal dose assessment using whole body counter(WBC) – measurement method
Recommendation 28: The standardization of radiation-related emergency methods ofevaluating the internal dose using WBCs and the bioassay method should be examined incollaboration with expert committees and associated societies while verifying theirtechnological validity by comparison with previous findings and conventional technologies.
[the first JHPS recommendations]Issue 28: Since individual dose assessment for internal exposure using the WBC highly collected
the needs of residents, the WBCs were individually set up by municipalities, hospitals, andnongovernmental organizations, in addition to direct management by the Fukushima
prefectural government. Therefore, the dose assessment was carried out by nonunified
methods without standardization. [the first JHPS recommendations] Although it is important,when using a great number of WBCs as a monitoring tool, to ensure the traceability from theviewpoint of maintaining the reliability of the measurements, there are no standards forWBCs. Also, there are no manuals to effectively explain the WBC monitoring results to the
public.

Radiation exposure of residents – external dose assessment using personal dosimeters
Recommendation 29: A cooperative system that enables the temporary lending of personal
dosimeters to the affected area should be developed. Also, a system that enables theinvestigation of external exposure using personal dosimeters should be established, led by thenational or prefectural government immediately after an accident.
Issue 29: Since dose assessment was carried out by each municipality by lending personal
dosimeters in response to the needs of residents, individual dose data for external exposure
are kept in the respective municipality because these data are a form of personal informationthat is unavailable for use for other objectives without permission.

Radiation exposure of residents – external dose estimation on the basis of behavior survey
Recommendation 30: Knowledge and skill regarding the external dose assessment systemdeveloped in the implementation of the the Basic Survey of the Fukushima Prefecture HealthManagement Survey (the External Dose Estimation), the format of the inquiry form andrelevant activities for improving the recovery ratio should be shared. Also, a system thatenables us the survey to be started immediately after an accident should be established.
Issue 30: As part of the Fukushima Prefecture Health Management Survey started in June 2011, theindividual dose for external exposure was investigated as the External Dose Estimation,using the behavior records obtained via sets of inquiry forms in the Basic Survey. However,
the recovery ratio of inquiry forms was only 18% in December 2011. (As of 31 January 2013,
the recovery ratio for the whole area of the prefecture was 23.2% and that for the preceding
investigation area, Yamakiya district of Kawamata Town, Namie Town, and Iitate Village
was 56.7%)

Communication to the public – spreading understanding of radiation effects
Recommendation 35-1: Activities to improve nationwide knowledge of the long-term effectsof radiation should be started, taking into consideration not only areas relevant to the nuclear
emergency and education in schools but also all generations of Japanese people. Moreover, byconsidering the risks and benefits of not only radiation but also all other applications ofscience and technology, opportunities should be provided to discuss and understand concepts
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without taking alternative ways to whether they are safe or dangerous.
Recommendation 35-2: Human resources such as spokespersons for radiation protection
who can provide easy-to-understand explanations should be developed as part of a long-term
strategy. [the first JHPS recommendations] Also, the ability to explain radiation effects in aface-to-face manner in an emergency should be ensured by developing the communication
skills of people in municipal government to explain the risk posed by radiation to local
residents.
Recommendation 35-3: Effective methods for communication with the public, for instance,
small-size dialogue meetings in the surrounding area and large-size dialogue meetings inremote areas using large facilities in a major town, should be established taking into
consideration that there will be a large number of people to communicate with in remote areas
where the environmental contamination level is relatively low and the size of the area is large,
compared with the surrounding area near the accident site where the environmental
contamination level is relatively high.
Recommendation 35-4: Systems to dispatch risk commnunication experts who fully
understand the newest data and changes in the values of criteria with time should be preparedtaking into consideration that in the early stage postaccident, there were a lot of simple
questions regarding radiation and its effects, and the themes of the questions changed invarious ways with the passing of the stages postaccident (early, middle, later and long-term),such as suspicion about governmental announcements, the implications of various standards
or measurement results, greater understanding of measured results and suggestions forminimizing risk in daily life. In addition, systems to share both successful and unsuccessful
experiences should be prepared.
Recommendation 35-5: As an appropriate public relations measure, unclear expressions
such as those in which the intended meaning is unclear should be avoided. In particular, forthe explanations of radiation exposure, communication systems supported by experts shouldbe established together with consistent explanations of low-dose radiation effects in aneasy-to-understand manner.
Issue 35: The Government often explained, "It does not have immediate effects on health",
concerning the influence of radiation on the human body. This expression may be interpreted
by some people as "it is unnecessary to be anxious about the impact of radiation on humanhealth," while it may be interpreted by other people as "it does not immediately affect humanhealth, however, some effects on human health will appear in the longer term." However, it
was not necessarily clear what the intended meaning of the expression was, and there was no
detailed explanation. Moreover, anxiety regarding unknown nuclear disasters anddissatisfaction about the explanation from the government were broadly shared. One of thereasons for this is that we have neglected to endeavor to improve public understanding ofradiation and have never trained radiological protection experts for communication in themunicipal government in the nuclear emergency preparedness plan.

Communication to the public – comprehensibility of radiological protection system
Recommendation 36: Discussions should be started towards the reestablishment of simple
systems for protecting the public from radiation exposure, which will require highaccountability to the public, both under normal conditions and in emergencies (including
emergency and existing exposure situations), reconsidering the concept of radiation risk.. [thefirst JHPS recommendations]Issue 36: Residents who had to live in an environment contaminated by radioactive material after
the accident sought information about the level of radioactivity that would serve as a basis
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for making decisions. Mothers, in particular, sought accurate information about the extent ofcontamination in the food and beverages they were giving their children, and about theradiation dose from the environment and its potential effects on their health. However, theinformation that was made available to the residents was not satisfactory. [the first JHPS
recommendations]

Communication to the public – utilization of mass media
Recommendation 37: A system that enables the timely provision of information obtained byaccurately collecting information required by people through the bidirectional interactive
exchanges of information using social media in an emergency and utilizing both social media
and mass media should be established.
Issue 37: The government rapidly responded to online communication by consolidating therelevant information onto its homepage and opening an official twitter account of the
Cabinet. However, it used only one way communication such as mass media and could notprovide appropriate timely information or gain the public’s confidence, since the information
was not obtained through bidirectional exchanges utilizing the characteristics of social
media.

Communication to the public – response to foreign residents and overseas countries
Recommendation 38: Taking into consideration the effects on neighboring countries in an
emergency and ensuring the safety of foreign residents, a system that enables the timely
provision of information to foreign countries and residents should be developed whileclarifying the decision-making process for the order to evacuate and discharge to the ocean.
Moreover, the authorized discharge of water contaminated with low-level radioactive
materials to the ocean in a controlled situation should be decided with sufficient involvement
and understanding of stakeholders concerned with the fishing industry, with the cooperationof experts who can support the viewpoint of the industry.
Issue 38-1: Although the discharge of the less contaminated water into the sea conducted on 4
April 2011 did not fall within the scope requiring notification prescribed in the United
Nations Convention on the Law of the Sea, the notification stating that the discharge would
begin was sent the day of discharge after it had already started and countries around Japan
were not informed of the discharge in advance.
Issue 38-2: The U.S. Nuclear Regulatory Commission (NRC) had been seeking detailed
information regarding the status of the Fukushima Dai-ichi NPS from the Japanese
government since 12 March 2011. However, the Japanese government was incapable ofproviding such information to the U.S. in a manner satisfactory to the U.S. side, because
Japanese government had not been able to acquire sufficient information on the nuclear
power plant itself and officials of NISA and other government staff familiar with thesituation at the nuclear plant were preoccupied with their work of dealing with the plant’s
situation. For this reason, the NRC decided to issue evacuation advice as a safety measure,and on 17 March (Japan time) advised U.S. citizens in Japan to evacuate to outside of a
50-mile (about 80km) radius of the Fukushima Dai-ichi NPS. This led to confusion because
this radius for evacuation was significantly larger than the 20km radius of the Japanese
evacuation area.

Nuclear emergency preparedness system – preparedness for complex disasters
Recommendation 39-1: Nuclear emergency preparedness should be reconsidered
considering the voices of relevant municipalities including countermeasures prepared for an
accident scenario where events unfold quickly and a complex disaster involving earthquakes
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and tsunamis occurring simultaneously with a nuclear disaster.
Recommendation 39-2: Expert groups who can respond to unanticipated accidental eventsshould be developed by daily training incorporating up-to-date technical knowledge.
Issue 39: Serious confusion occurred in the relevant organization owing to insufficient
preparedness for an accident scenario where events unfold quickly and for facing a complex
disaster involving earthquakes and tsunamis occurring simultaneously with a nuclear
disaster.

Nuclear emergency preparedness system – opportunity of revision of nuclear emergency
preparedness for complex disasters (earthquake, tsunami, and nuclear accident)
Recommendation 40: Nuclear emergency preparedness should involve a system that isregularly and rapidly updated according to new knowledge, technology and suggestions andso on. Also, natural features should be established to prevent the inflexibility andobsolescence of countermeasures.
Issue 40: Although problems of emergency preparedness assuming the possible occurrence of a
nuclear emergency coupled with a complex disaster were pointed out, no measures weretaken against them.

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3.2 Recommendation on protection of workers
In this section, recommendations are described in response to issues highlighted in theprevious chapter from the viewpoint of radiological protection for workers. In the drafting therecommendations, comments listed at JHPS symposia as described in section 2.3 wereincorporated. On the basis of the results obtained in the previous chapter, recommendations
regarding Issue 18: Radiological protection criteria – screening level – validity of the level
were developed considering the difference among stages postaccident (early, middle, later andlong-term). In addition, recommendations regarding Issue 31-32: Radiation exposure of plant
recovery workers were developed considering those for rescue/decontamination workers.

Radiological protection criteria – screening level – validity of the level
Recommendation 18-1: The validity of the screening criteria for decontamination in an
emergency in terms of their effectiveness for radiation protection should be verified inaccordance with the principles of other emergency measures by considering problems that
may arise in relation to the radiation measurement. [the first JHPS recommendations]Issue 18: The screening level was raised in accordance with the present situation using different
levels from those that had been previously established. [the first JHPS recommendations]Radiological protection criteria – dose criteria for emergency work – dose limit taking lifesaving work into accountRecommendation 24: New dose limits for emergency workers to take into account the needfor emergency medical care should be examined while clarifying the decision-making process
and considering the fact that the adopted dose limit for emergency workers is 250 mSv, which
is lower than the internationally recommended value, and that the current dose limit forradiation workers under normal situations is determined on the basis of a lifetime individual
dose of 1,000 mSv. [the first JHPS recommendations]Issue 24: In the second interim report on the incorporation of the 2007 Recommendations of the
ICRP into domestic systems, the Basic Committee of the Radiation Council proposed tomatch the dose limits to internationally recommended values, taking into consideration that
opportunities to participate in international activities were increasing for domestic workers,
because the current restriction criteria in Japan (dose limit, 100 mSv) interfered withemergency medical care and other essential operations. On the other hand, in response to thepresent accident, 250mSv was adopted as a dose limit for emergency workers. This value islower than the internationally approved principles and the recommended value of the 2007
Recommendations of ICRP (emergency medical care, no restriction; other emergency rescue
operations, 1,000 or 500 mSv; other rescue operations, 100 mSv). [the first JHPS
recommendations]Radiological protection criteria – dose criteria for emergency work – treatment of individual
doses received in an emergency situation
Recommendation 25: The individual dose in an emergency should be controlled
independently of the compliance with the dose limits for radiation workers under normal
conditions (50 mSv per year and 100 mSv over five years) to control radiation exposure. [thefirst JHPS recommendations]Issue 25: In the second interim report on the incorporation of the 2007 Recommendations of the
ICRP into domestic systems, it was indicated that emergency work doses will be treated230Japan Health Physics Society
separately from normal work doses. However, the Ministry of Health, Labor and Welfare(MHLW) issued an official notice stating that when managing dose limits during normal
work, if a worker has a history of engaging in emergency work, the doses received during
such work should be included and the limit of 100mSv/5 years should be applied. [the first
JHPS recommendations]Radiation exposure of plant recovery workers – network for urgently borrowing alarm
pocket dosimeters (APDs)
Recommendation 31: An emergency procedure for borrowing APDs, whole body counters(WBCs) and protective tools for internal exposure from other nuclear power stations should
be developed for plant recovery workers. Also, systems to ensure the availability of sufficientnumbers of personal dosimeters and protective tools for internal exposure should beestablished for rescue or decontamination workers.
Issue 31: Although many APDs were provided as aid supplies from other NPSs, these APDs were
simply stored and remained unused owing to a lack of communication. There were notenough APDs and by 15 March, not every worker was able to wear an APD, which led to thedecision that only the leaders of each operational group would wear APDs on behalf of theentire group.

Radiation exposure of plant recovery workers – control of internal exposure in an
emergency
Recommendation 32: The performances and the methods of using protective tools forinternal exposure, appropriate methods for eating, drinking and excretion in the case of along-term emergency situation, protective measures to prevent the reduction of airtightness ofseismic isolation buildings used in an emergency and a method for the administration of
stable iodine should be trained and practiced in a practical manner for both the plant recovery
and rescue/decontamination workers.
Issue 32-1: The individual doses of 6 workes exceeded 250mSv, which was the dose limit for
emergency workers temporarily prescribed after the accident.
Issue 32-2: The doses of two female employees significantly exceeded the 5mSv three-month
upper limit for female radiation workers, although they took appropriate radiologicalprotection measures such as wearing full-face masks with charcoal filters whilst working in
the field, since the double-entry doors to the Seismic Isolation Building were not airtight andthe doors to the Seismic Isolation Building were bent and twisted by the hydrogen
explosions in Units 1 and 3.
Issue 32-3: 178 workers showed thyroid gland equivalent doses of over 100mSv, and 25 workers
under the age of 40 did not take iodine tablets.

Radiation exposure of plant recovery workers – control of localized exposure in an
emergency
Recommendation 33: Protective measures against the localized exposure of radiation should
be previously trained and practiced in a practical manner for plant recovery workers,
assuming a sudden change in the working environment such as an explosion and leakage ofcontaminated water in an emergency.
Issue 33: On 24 March, two of three workers who were installing electric cables under the surfaceof the basement floor of the Unit 3 turbine building were exposed to high radiation doses
while working immersed in contaminated water, because they were wearing low quartershoes. Although it was made clear, after getting cleaned up and having a checkup and getting
tested to measure internal radiation doses, that neither worker suffered radiation heat burnson their feet, there had been a possibility of suffering from radiation heat burns due to231

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continuous localized exposure.

Radiation exposure of plant recovery workers – managing access to and from a controlledarea in an emergency
Recommendation 34: Practical methods regarding the management of individual doses andeducation before registration as a radiation worker in the case of an emergency situation
postaccident, where it is difficult to precisely implement protective measures for radiation
control, should be established for the plant recovery workers.
Issue 34-1: After the nuclear accident, access to and from the controlled area of the management
system was initially impossible for calculating the radiation dose of individual radiation
workers. It was then decided to manually calculate the radiation dose of individual radiation
workers using APDs. (On 14 April, five simplified instruments were installed in the Seismic
Isolation Building for gaining access to and from the controlled area management system. At
the same time, a radiation work permit with bar code patterns was introduced so that thenames and radiation doses of individual workers could be automatically recorded).
Issue 34-2: From the date of the nuclear accident to 10 May, radiation workers were allowed tocarry out their duties after receiving a brief 30-minute explanation about how to protect
themselves from radiation and how to wear protective equipment.

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4. Final remarks
The accident at Fukushima Daiichi Nuclear Power Plant was extremely large-scaled
disaster comparable to Chernobyl Accident. After a criticality accident in JCO uranium
processing plant in Tokai village occurred in 1999, the Act on Special Measures Concerning
Nuclear Emergency Preparedness was legislated in the same year as an act on special
measures of the Disaster Countermeasures Basic Act and the Act on the Regulation of Nuclear
Source Material, Nuclear Fuel Material and Reactors. This act was established to protect lives,bodies and property of Japanese citizens and prescribed responsibilities of notification by
nuclear operator, collabolation between government and local public body, and establishmentof nuclear emergency response headquarters in an emergency, etc. As new measures in thosedays, placement of senior specialist for nuclear emergency preparedness, designation of the
Off-site Center and enforcement of the training for emergency preparedness were prescribed.
However, after the Fukushima Daiichi nuclear disaster following the Great East Japan
Earthquake, relevant laws including the Act on Special Measures Concerning Nuclear
Emergency Preparedness, guidances, plans and operational manuals could not responded tounanticipated situations, which disclosed their defectiveness. The Act on Special Measures
Concerning Nuclear Emergency Preparedness was revised on September in 2012.
To gain lessons learned from the Fukushima nuclear disaster, JHPS has reviewed issues
associated with radiological protection after Fukushima Daiichi Nuclear Power Plant Disasterthrough JHPS special symposia, Q&A communication and so on. After the accomplishment of
the first set of JHPS recommendations, five investigative reports (Governmental Interim
Report, Governmental Final Report, National Diet Report, Nongovernmental Report andTEPCO Report) were published, which clarified a lot of concrete facts in association withradiological protection. JHPS comprehensively reviewed these investigative reports,summarized voices collected in the JHPS symposia, verified how radiological protection
measures after an accident should be operated, and elaborated a comprehensive report on thesecond set of recommendations including the first set of recommendations.
In chapter VI “Wrap-up and Recommendations” in the Governmental Final Report, it isrecommended that “The government, nuclear operators, nuclear plant manufacturers, research
institutions, academies, and all such stakeholders (relevant organizations) involved in nuclear
power generation should take active roles in investigating the accident and in fact analyses,
and continue, in their respective capacities, their comprehensive and thorough investigationsof the remaining unresolved problems.” Moreover, in the JHPS special symposium, it waspointed out that follow-up after recommendations is important. JHPS considers that acommittee for the follow-up after recommendations should be established and such an activity
should be continued. In this sense, JHPS, including many radiological protection experts,
would have a responsibility to continue involvement associated with radiological protection
related to the Fukushima Daiichi nuclear disaster.
We hope that this second set of recommendations will be utilized by experts in the JHPS,
residents in affected areas and relevant staff in the government, and discussed by internationalradiation protection experts in cooperation with overseas associated societies such as the
Asian and Oceanic Association for Radiation Protection (AOARP), the International
Radiation Protection Association (IRPA) and the Health Physics Society in the US.
Through above-mentioned activities, we believe that these recommendations will be ofhelp in utilization as lessons learned from Fukushima Daiichi Nuclear Power Plant Disaster233

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and development of the scientific fields of health physics and radiological protection,

References
1) Investigation Committee on the Accident at the Fukushima Nuclear Power Stations ofTokyo Electric Power Company, Interim Report, 26 December 2011.
2) Investigation Committee on the Accident at the Fukushima Nuclear Power Stations ofTokyo Electric Power Company, Final Report, 23 July 2012.
3) National Diet of Japan Fukushima Nuclear Accident Independent Investigation
Commission, Report, 5 July 2012.
4) Independent Investigation Commission on the Fukushima Nuclear Accident, Report, 27
February 2012.
5) Tokyo Electric Power Company, Fukushima Nuclear Accident Analysis Report, 20 June
2012.
6) Estimation of radiation exposure due to intake of foods (in Japanese), 30 October 2011,
the Ministry of Health, Labour and Welfare (MHLW) HP(http://www.mhlw.go.jp/stf/shingi/2r9852000001tsmk-att/2r9852000001tt3v.pdf).
7) Measurement results of amount of intake of radioactive materials from foods (in Japanese),
11 March 2013, MHLW HP (http://www.mhlw.go.jp/stf/houdou/2r9852000002wyf2.html).
8) About Fukushima Health Management Survey (in Japanese), the 1st meeting of the study
team on health effects on the residents from the Fukushima Daiichi Nuclear Accident, 30
November 2012, Nuclear Regulation Authority (NRA) HP(http://www.nsr.go.jp/committee/yuushikisya/kenko_kanri/data/0001_03.pdf).
9) Exposure dose obtained in the present stage (in Japanese), 26 April 2012, Fukushima
Prefecture HP (http://www.pref.fukushima.jp/imu/kenkoukanri/240426shiryou.pdf).
10) About measurement results of personal dosimeters (glass badge) (in Japanese), 17 January
2012, Fukushima city HP(http://www.city.fukushima.fukushima.jp/soshiki/71/shinsai6.html).

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Appendix I Voice record at Special Symposium of the Japan Health Physics Society on thesecond Fukushima project (25 May 2013)

The JHPS Special Symposium on the second Fukushima project was held at Koshiba Hallin Tokyo University on 25 May 2013. Three reserved speakers previously invited from JHPS
members made their presentations regarding internal exposure monitoring, environmental
monitoring and assessment, and risk commnucation. In accordance with these presantations,members on the floor raised their questions and comments. The voice recod is as follows:
Internal exposure monitoring(Invited speaker)
 Internal exposures of 120,000 persons have been ever measured. The results indicatethat individual doses of almost all persons were lower than 1 mSv.
 The number of the Whole Body Counter (WBC) in operation is 150 to cope with thecurrent situation, which may not be precisely correct.
 Expert research group was established in the JHPS last year to discuss about
recommendations on internal exposure monitoring for the residents and standardizationof monitoring outside the body such as methods of measurements and estimation ofinternal exposure.
 The main issues in the discussions are domestic standardization of equipments formeasuring radioactivity in the body, recommendations on the maintenance of theequipments, approach of internal dose assessment for residents and archive andexplanation of the measurement results.
 The objective of the domestic standardization of equipments for measuring radioactivity
in the body is to ensure a quality of the WBC operated in Japan. The standardizationmeans to make a Japanese Industrial Standard (JIS) taking into considerationinternational standards. As for the WBC, IEC61582 will be refered.
 The main framework is to categorize the equipments in accordance with performancerequirements and objective of usage. Specifically to say, it is categoraized into fourtypes, such as WBCs with high performance in research institute and in-situ screening
measurement using detector and shield in the accident.
 Criteria of the inspection items will be set at according to type of the category.
 These criteria should basically follow the JIS, whreas ambigous part still remains. For
instance, it would be discussed what standard for phantom should be, because there isno description about the phantom in the IEC.
 It is planed that the standard will be established within two years, so it is in drafting so
as to be in time for the first JIS meeting.
 There are a lot of WBCs, particurally in Fukushima prefecture, there are 56 WBCs. It
should be noted to maintenance the accuracy of the WBCs. In National Institute ofRadiological Science (NIRS), the maintenance of the accuracy is carried out by acontract with the Ministry of Environment (MOE). The 18 WBCs were completed lastyear.
 Ambient dose in air surrounding the equipment, detection efficiency, resolution andquantification of the standard phantom have been evaluated with sufficient accuracy.
 As a future issue and recommendation, it is important to ensure the traceability from aviewpoint of assurance of the reliability of the measurement. Standarization on the basis
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of the activities in the JHPS expert research group is required since there is no relevant
standard in Japan.
There would be new issues during the discussion for the standardization. It is necessary
to unify understandings among interested members about preparation of standard
phantom for calibration, detection limit, spectrum analysis method and dose assessment
method, etc. Moreover, standard manual for operating staff of the WBC is needed.
As a problem of the resorce required for the monitoring of the internal exposure, it
should be discussed who maintains a lot of WBCs and how they do so, in addition todevelopment of the measurement staffs.
It is necessary to fully explain the measurement results to the public and make a Q&A
booklet including how they should do and manual assembly for WBC in cooperation
with experts of risk communication.

Question & comments
Q (attendee): How did you collect the WBC measurement staffs in Fukushima prefecture andfrom where?
A (speaker): At first, WBC measurements for residents were started in the NIRS as the
Fukushima Prefecture Health Management Survey. Subsequently, they were continued in
the JAEA. In addition, to respond the requirements for measurement in the Fukushima
prefecture, the WBCs were equipped in the municipal governments or hospitals and themeasurement staffs were placed there.
Q (chairperson): Is it necessary to previously prepare measurements for internal exposure in
the emergency preparedness? This is because main target of the WBC measurements was
occupational exposure. To say about internal exposure in the nuclear emergency
preparedness, it is only monitoring for thyroid. Were there any problems about it?
A (speaker): The most serious problem was delay of the WBC measurements due to various
factors. Start of the measurements was three months after the earthquake. There are a lotof issues, for example, who shoud have a priority among the public to be measured earlier
except for workers, children who are sensitive to radiation and family including children
should be measured earlier with high priority and how we could accurately measure themembers of the public who have various body sizes although workers had been main
target of the measurements.

Environmental monitoring and its evaluation(Invited speaker)
 I think it is necessary to review the initial environmental monitoring at early stage after
the accident. We should seek issues such as monitoring for ocean. There were manythings which could not be done well in the existing framework of the emergency
preparedness. It is necessary to review them after deeply reviewing the monitoing
results.
 We shoud consider whether the monitoring data were helpful, fully informed to the
public, could be given to the staffs who needs them and correct or not.
 To say about whether the monitoring data were helpful or not, the data was valuable asfundamental information for judgment of start of the evacuation of the public though
there were only data of ambient gamma dose rate in air just after the accident. However,236

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they were difficult to use for postaccident investigation of public exposure at earlystage.
The monitoring data were difficult to use except for gamma dose rate. We could not get
information about concentration in air and ground surface density of radioactive
nuclides just after the accident. These data can not estimate from the ambient dose rate
in air. The monitoring data of noble gas or gaseous substances could not see
immediately because sampling using charcoal filter is needed. Therefore, amount of
intake due to inhalation could not be estimated easily. As a result, these data weredifficult to be utilized for postaccident investigation of public exposure.
Necessary data is not only gamma dose rate that is available for estimation of external
exposure. The dose rate does not be used for estimation of the internal exposure. Thereis no data except for in the monitoring points. It would become necessary to investigate
the individual dose of the public after the accident even if the monitoring is densely
carried out. Especially concentration of radioactive nuclides in air could not be gained if
there is no monitoring at that time, though surface density of radioactive nuclides could
be measured later if they remain. As a result, it is difficult to estimate the external
exposure in the non-monitoring points and the internal exposure due to inhalation. As
for the internal exposure, postaccident investigation is possible by rapidly started WBC
measurements, thyroid monitoring and bioassay measuments and so on. The
concentration of radioactive nuclides in air could not be obtained if there is nomonitoring at that time.
Affected residents have their own lives after end of confusion postaccident. The life
without resolution of concerns of radiation effects leads to reduction of the QOL. Was
there necessity of environmental monitoring system including a scope of postaccident
investigation of the public exposure? Gamma spectrum measuments shoud be
previously prepared for the monitoring much more?
To say about whether the monitoring data were efficiently informed to peoples whoneed and use them after measumements, there were various types of data opened throgh
the internet. The data were copies of FAX, handwritten paper and PDF. The system andequipments for arranging the data so as to be easy to be utilized, for instance, to input
necessary data into EXCEL files. The staffs could realize what data is needed for the
analysis? The system and equipment for giving a significance of the analysis and thedata and making a material for judgments of countermeasure were sufficiently supplied?
The staff who decided final judgments understood what is needed for the judgment?
Were there any people who needed the data in the staffs or persons who would go for
rescue? The data was informed to “government” responsible for the systems,“non-govenment” requested or voluntarily activated, local community, medical andnursing staffs, and transport companies? Not only “government” and also“non-govenment” to utilize power of “non-govenment”. There is a need of not only
numerical data but also suggestions on appropriate countermeasures for radiologicalprotection and prevention of expansion of contamination. There is also a need of careafter the accident, for example, brave actions may produce a concern after emotionallyexcited situation during the disaster.
It is insufficient to only “accurately measure dose rate on the basis of count rate of
gamma ray using radiation monitor”. Measurements should be done according to theobjectives of the monitoring, what we want to know and what should be understood, forexample, what is shown by the ambient dose rate when there are stumpages or high237

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buildings surrounding the monitoring post. The system enables measurements according
to the objectives should be prepared.
It is necessary to review causes of whether environmental monitoring was useful for
actual responses to the accident and revise them. It is also necessary to reconfirm andreexamine the objective “what should be needed” and to reset the monitoring aim “howfar we should expect and respond the expectations”. The other means thanenvironmental monitoring should be established in the region where we cannot respondthe expectations. To realize this, it is necessary to closely discuss and verify between“monitoring staffs” and “usesers”.
Monitoring for relief is necessary towards recovery after grasping individual doses ofresidents exposed at an early stage after accident.

Question & comments
Q (attendee): Issues pointed out in the speaker’s presentation have been already described in
the guidance on environmental monitoring in emergency that was drawn up by the
Nuclear Safety Commission (NSC) a few ten years ago. As a member of a group drawing
up the guidance, I think the main issue is the best use of the guidance was not made inthis accident. It should be discussed after reading the guidance.
A (speaker): Since there is a long history, I think that various things must be considered well.
However, the fact we could not do is important. Before experts who drew up the guidance
retire, we should review the guidance again and not have the same experience in the next
accident though such accident should not occur again.
C (attendee): The fact that we cound not do in spite of the existence of the guidance meansthat the main issue is in the system for emergency beyond technical issues and how weshould operate it, which is problem in the government.
A (speaker): I’m now in the field of technology. I think the completion of the technology is toenable a practical use as a final goal and not just making an instrument.
C (attendee): There are NSC guidances, handbooks and manuals. At the extremely early stage
after accident, I suggested a responsible person in the MEXT to cope with according to
the manuals. However, the reply was that we don’t have to comply with the manuals
because we are now in emergency. There were few staffs who could act with correctknowledge about emergency guidance in the early stage after accident. Significant point
is to make a system enables operation well-understanding the guidances, to develop
human resources and to make a mechanism to be continuously handed down even if
governmental staffs change their position in the office every a few years. There would bea gap among the monitoring points even if the number of the points is increased. We
should consider what should be the objective and how far we should optimize. In such asituation, the SPEEDI would be helphul. Although a lot of rules are made in a complexedmanner, operator of the rules should continue the understanding and the training. The
repetition of making more complicated rule after forgetting previous considerations iswrong process. The most significant point is in management. To say about how thegovernment managed the emergency, the government should have requested a help ofexperts at early stage after accident because they don’t have one hundred percent inknowledge. It is important to continue a training how we should manage the existing
rules rather than make a new one.
C (attendee): Such a discussion should be pointed out as issues by JHPS and be connected to238

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recommendations from the JHPS. It is important to enable to use it efficiently.
Q (atendee): When the ambient dose rate is high, gamma specrum could not be utilized ifradioactive plum is coming. Filter is needed to measure concentrations of radioactive
nuclides in air. How the monitoring post should be in emergency? How we shouldmeasure them?
A (speaker): I think gamma specrum measurement should be prepared in the emergency
preparedness and such a tool shoud be reguraly examined.
C (chairperson): Things should be able to be done were not completed in this accident. Theseissues should be addressed in the recommendations from the JHPS.

Environmental monitoring and its evaluation(Invited speaker)
 Risk squad was set in the JAEA about ten years ago through the experiences of asphalt
and JCO accidents. It is fundamental for risk communication to hear voice from thepublic at first. To provide information is not significant. We are doing an activity to hearvoice from residents and to provide information necessary for the hearing.
 We started a seminar on radiation effect in Ibaragi prefecture. This activity is based on afundamental concept to make residents live with confidence because residents are
feeling a fear of radiation more than necessary. We think that we should start thisactivity in Ibaragi prefecture at first, since this activity would be necessary inFukushima prefecture. This seminar was in a lecture meeting style. Presentation waswithin 30 minutes (at longest 40 minutes). Afterwards, we heard voices of residents andreceive questions thoroughly without stopping and escaping. We responded tillattendance went home. Master of ceremony is selected from resident side. In principle,
time for question and reply was secured for more than 1 hour. After closing, we
continued respond to specific questions using a space to experience radiation
measurement. We refused to have a lecture’s fee. Instead, residents cooperated to aquestionnaire survey.
 The WBC measurements of Fukushima residents consist of not only measurements but
also polite explanation of the measurement results, which is similar to counseling. As aresult of the questionnaire, it has been clarified that most of all residents felt easy about
the radiation effects.
 In Fukushima prefecture, the seminar was held for elementary and junior high school.
The target of the seminar was mainly parents, particularly mothers. Five hundreds
members from JAEA were entried as staffs for the seminar. Four staffs were selected fora seminar from entried members. Exceptionally, there was a request from priest to holda seminar for a supporter of a temple. Such a special offer was coped with by staffs inrisk communication section in JAEA.
 Recently, there are a lot of questions about decontamination rather than radiation
exposure.
 Risk communication to the public ” to ensure human resources” was pointed out as an
issue 35 in this draft report, but more important issue than the ensuring the humanresources is that we have ever neglected endeavor to improve the people's literacy forradiation. The MEXT reduced education of science. There may have been a
consciousness they don’t want to educate radiation due to a memories of Hiroshima andNagasaki. This effect affected now. I would like JHPS to revise this.
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Risk communication to the public “comprehensibility of radiological protection system”
was pointed out as an issue 36 in this draft report. The radiation protection system that
we have established was considered in a normal situation. It is necessary to makeemergency preparedness available even in the situation without electricity andcommunication infrastructures.
Risk communication to the public “utilization of mass media” was pointed out as an
issue 37 in this draft report. Partner of the communication through the internet is wholeworld that includes different culture and society situations, for example, different
languages, cultures and religions. The communication through the internet needs hugeendeavor. Internet should be considered as a tool for information provision and risk
communication should be done in face to face manner. In such a sense, it is important todevelop human resources for risk communication in the municipal government and toensure at least two or three talents to explain about radiation effects in the face to facemanner in emergency.
Risk communication to the public- response to foreign residents and overseas countries
was pointed out as an issue 38 in this draft report, but it is important to educate Japanesepeople at first. There would be no time after an aacident occurs. If knowledge isspreaded, anxiety would be reduced and foreigners surrounded by Japanese people who
has sufficient knowledge and information, must not feel any concerns. Panic of elite
governmental staffs could be prevented by raising the knowledge level of Japanesepeople regarding radiation.
Although information provision to oversea countries is so important, the main causes ofthe present trouble are due to idleness of governmental staffs and bad cooperation in thegovernment. Staffs relevant to the government should utilize experts.
Now after two years have passed, the present issue is decontamination and ensuringstorage place for its waste. This issue has the same roots as problem of radioactive
waste that has been a significant issue for a long time in nuclear energy community.
This is the very important issue on risk communication.
Although communication activities are actively continued focusing a radiation issue, it
is not integrated at all. How the residents feel about the different responses amongscientific society, Ministry of Environment and JAEA?
The biggest issue that has never touched is education in school. The main players areteachers. It is necessary to establish education of radiation. How should we support it?
We are there for the purpose of information provision. Education is a job of teachers.
The injury in the affected areas has not been incurred, though two years have passed
since the accident occurred on 11 March 2011. I’d like to expect the JHPS todispassionately analyze various events occurred after the accident and take a step
forward as a radiological protection expert group.

General discussions
C (attendee): I think the JHPS recommendation is well-surmmarized, but there may be a part
missing. It is frequently said that big problem is SPEEDI informations were not disclosed,
but there may be a feeling that SPEEDI has an almighty power in the accident. It is
forgotten that there is an inconsistency between informations obtained by SPEEDI and inreality. I think that it must be dangerous to determine the emergency preparedness system240

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according to the only simulation results. On September 2012, the Nuclear Regulation
Authority (NRA) disclosed a map predicting diffusion of radioactive materials in air for
16 NPSs in our country when a severe accident occurs. There were some problems in themodeling and no consideration of geographical features. Mistake of input data wascorrected. Some municipalities start examining the storage of stable iodine in spite thatthey are placed in 100 km apart from the accident point, which would be an overresponse.
The cause of this is that the NRA disclosed an inappropriate prediction map. I’d like the
JHPS to suggest recommendations to correct such a thing. I’ll touch later a fact on disuseof simulation in the ocean.
C (attendee): The SPEEDI is a predicyion system, so the results may not be completely
consintent with that in reality. Since the use of the SPEEDI is an agreement in the world
after the Chernobyl accident and the accuracy of the prediction results was verified in theinternational comparison, it must be helphul to decide monitoring method and direction
for evacuation. Operational procedures to use the SPEEDI conflicted between the system
controlled under the NISA and that has been developed by the MEXT and the JAEA,
which leaded to a bad part of response of the accident. This occupies main reasons thatmade the situation more seirous. The simulation results of diffusuion in the ocean
calculated by the JAEA and the JAMSTEC were requested to disclose, but not completed.
The details on the SPEEDI have been described in the first JHPS recommendations.
C (attendee): The SPEEDI is a prediction system. It is a principle to design a countermeasureon the basis of measurement results of environmental monitoring, but the results cannot
be immediately obtained, so the prediction is needed. It is rather problem to let theprediction have an absolute role. The issue is haw to use the prediction results, forexample, it is judged that administration of stable iodine is necessary since the predictionlevel exceeds previously prescribed thyroid dose level. The simulation results is just a
prediction not show a reality.
To say about simulation in the ocean, there must be data for diffusion of heated water
discharge in the process of the licensing safety review since all NPSs in Japan are locatedalong the sea shore. It should be pointed out that we had not utilized in spite that there
were such simulation data in the ocean. Apart from this, it should be also pointed as an
issue that various available data obtained in the past had not been utilized efficiently.
C (attendee): The simulation model in the ocean was used in a committee in the Marine
Ecology Research Institute (MERI), but it did not go well due to a barrier between
ministries and agencies. The SPEEDI is a rapid prediction tool, and the results are
predictions and not show real situation. However, in the emergency preparedness, theSPEEDI occupies an important position, so it should be utilized in a better manner. It is
not a better way that the NRA suddenly adpoted what the NRC uses without sufficientknowledge. Revision is frequently needed because they do not have sufficientexperiences and knowledges of handling. In spite of recommendation to use the SPEEDI
consulting with the MEXT, it did not work. There are a barrier among the ministries andagencies.
C (attendee): Since there was no weather information though TEPCO independently has a
prediction system, we reported prediction results assuming a single wind direction andwind verocity at that time. We didn’t have an efficient way in prediction because there
was no source term data after explosion. After that, radiation exposure was calculatedusing predicted total released amout of radioactive materials. Nowadays, prediction forupcoming 24 hours is carried out when emergency situation starts preassuming drop of241

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power supply due to earthquake. For instance, we predicte a contamination map after
continuous release for 24 hours at a rate of one hundred million Bq/s and change of thewind direction for upcoming 24 hours. Using these informations, logistical support
organization is set up on the basis of the present experiences in the accident and it ispredicted when the wind direction will change to the location of the organization (whenthe plume will diffuse and when the wind direction is serious for the organization). The
countermeasure is examined so as not to be contaminated by restoring the windows when
the windowpane of the logistical support point has been broken. We can appropriately
suggest a direction of evacuation whenever the instruction of the evacuation is issued if
the wind direction is known. Without depending on the SPEEDI, we think the source
term can be predicted by precalculating simplified chart of the source term assuming aseries of event, for example, how high radioactivity it has in the case of ventilations of areactor without fuel failure, with a few tens percents of core meltdown or with various
wind direction and verocity.
C (attendee): Although the target of the JHPS recommendation is mainly people who are
directly affected by the accident, it should be also considered for people who are notdirectly affected. People who live in west areas of Nagoya city didn’t have a sense ofownership. The accident was a matter of other people’s affairs for them. The interest of
the accident is low. Big confusion happened when fireworks made in Fukushima area hadplanned because people didn’t study the accident at all. I would like the JHPS to also
consider about non-affected people.
C (attendee): In selecting issues, there are a lot of considerations, for example, things should
be done in normal situation and in transition period from normal to emergency situations,additionaly needed things and originally exisuting things should be utilized. I would likethe JHPS to select issues including whether or not there is a difference in risk
communication between normal and emergency situations.
C (attendee): There must be also difference in time series, for example, one week, one monthand one year after the accident. Method of risk commnunication would be varied
according to the distance from accidental site. Recommendation had better be examined
as a matrix of time and distance.
Concluded242

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Appendix II Voice record at session 2 in Special Symposium II of the Japan Health Physics
Society on the second Fukushima project (22 February 2014)
The JHPS Special Symposium II on the second Fukushima project was held at KoshibaHall in Tokyo University on 22 February 2014. After the first session in the morning to share
information on rehabilitation activities in Fukushima, a draft of the JHPS recommendations
for issues raised after reviewing the investigative reports was introduced. Members on thefloor discussed these recommendations with each other including previously gathered
comments. The voice recod is as follows:First half
Speaker’s reply to previously gathered comments
 There was a previous comment on the further enhancement of coastal sea area monitoring.
As the aim of this comment seems to be associated with radiation exposure owing to theintake of sea products, I think that recommendation 9-1 is related to the comment.
Recommendation 11-3 is also related to it.
 There was a previous comment on the utilization of shelter for evacuation, but this has
been addressed in the sentence “an emergency evacuation strategy including methods ofcommunication by satellite phone should be provided in the nuclear emergency
preparedness plan” in recommendation 16.
 There was a previous comment on the response to the understanding of radiation
measurement. This issue has already been included in recommendation 18-1.
Recommendation 35-1 is also related to it. I would like to touch on this comment again ina later session today.
 There was a previous comment on the revision of the radiation dose criterion that should
be selected from between 1 and 20mSv/y instead of 1mSv/y. This has also already been
touched on in recommendation 19-1, which gives a more comprehensive opinion.
Question & comments
C (chairperson): Regarding the comment on the difficulty of achieving 1mSv/y,decontamination is normally decided by considering the balance between the avoidable
dose and the required cost and labor. If anyone has a comment on this or the speaker hasan additional explanation, please go ahead.
C (speaker): I think that the ICRP and government simply adopted a value of 1mSv/y as along-term target for decontamination. There may be an opinion that 1mSv/y should be
immediately achieved in some areas. However, even in the same city, town or village,
there are various contamination levels. When 1 mSv/y is achieved in low-levelcontaminated areas, there will be an expectation to achieve 1 mSv/y even in thehigh-level contaminated areas. However, it would be difficult to achieve 1mSv/y in suchareas. If anyone who knows Fukushima residents well has an opinion on this, please let
us hear it.
C (chairperson): There is no other way except to adopt an option using the characteristics ofeach scene on a case-by-case basis in a situation between normal and emergency
exposure, that is, the existing exposure situation. On the other hand, deciding the dosecriterion on a case-by-case basis may be criticized when the criterion is freely changed. I
think that people have come to understand that some requests are impossible to achievewith the passing of time since the accident. Because of this, the best solution appears to243

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be to focus on high priority areas, e.g., public areas in relation to infrastructure to support
life. Regarding this point, I’d like to hear from attendees.
C (attendee): As given in recommendation 19, it is true that the dose criterion should be
decided with the active cooperation and understanding of stakeholders. However, after
hearing a presentation in the morning session today, I understand that this is fairly
difficult. It is very difficult to strike a balance between an ideal target and reality. In thesecond set of recommendations, it is better to recommend the manner in which experts
should always support society.
Q (chairperson): Such a criterion is ultimately decided by politics. On the other hand,politicians don’t like to take political risks. The national and local governments are in
charge of national and regional matters, respectively. Generally, it is possible to show thenumerical values in emergency and normal situations using science. In the stage oftransition from an emergency to a normal situation, difficult decisions are necessary
because the decision process requires the situation to be monitored and agreement to beobtained with people who will be affected by the decision. What political decisions arenecessary?
A (attendee): From the viewpoint of government, any decisions would be administrated in afair and impartial manner. I think the decision-making process is difficult, but local
government must follow the national standard if the national government provides a clear
direction. There is a possibility that residents will have a fear of radiation effect owing toexposure exceeding specific numerical values if they do not understand their meaning. It
is important to provide education on radiological protection in elementary school andjunior high school. Currently, we are struggling to achieve 1mSv/y but successfully
reducing the dose from 20mSv/y.
C (attendee): From the responses of residents at the Decontamination Information Plaza inFukushima city, there are some people who think that they will develop cancer if they are
exposed to radiation exceeding 1mSv/y. I found that the number 1mSv/y has a strong
impact on people. Some people become anxious if the government sets a standard thenthe contamination level exceeds the standard by a small amount. For instance, there arealso some people who want to make inspections by themselves by purchasing ameasurement tool even if there is a label on the food package saying “passed inspection”,
meaning that the food satisfies the standard for foods of 100Bq/kg. When a standard isdetermined, it should be shown as a band not a single value by considering how residents
think about it. Moreover, an explanation, for example, that radiation exposure exceeding
the standard does not have any immediate effect on health, should be added.
C (attendee): I found that it is easy to misunderstand a numerical value for the standard,
which leads to anxiety. I’m sure that there was a presentation about hazard maps using
red, blue and yellow colors at the IRPA international conference. I would like JHPS topropose such a method to reduce anxiety.
A (speaker): I also think that it is difficult to get residents to understand the meaning of thenumerical value. I don’t have an answer to the question about how we should explain it
so that it is understood. The insufficient explanation of the numerical value is clearly an
issue.
C (speaker): From my experiences of dialogue in meetings to directly communicate with
Fukushima residents held many times after the accident, the significant point for experts
is that they have to study a great deal of frequently changing things, such as various
standards produced after the accident, the ambient dose rate and evacuation areas, to244

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respond to Q&As as radiological protection experts. I found that the accumulation ofknowledge is necessary for experts in charge of the communication of risk to residents.
Also, it is difficult to correctly grasp the intention of some questions, whereas it isimportant to give explainations in an easy-to-understand manner.
C (chairperson): Although people tend to focus on the highest radiation dose, there is a large
gap between actual individual doses and doses estimated from ambient doses obtained bysurvey meters because people normally do not go to the high-dose places and do notalways eat highly contaminated food. In other words, experts should explain that
individual dose levels in an area are not always high even if there are a few high-doseplaces in the area. Also, experts should explain how we should respond in the case ofpartially high-dose area, whereas priority of the response to specially-high-dose area ishigh. Regarding this situation, it is necessary to provide explanations by experts in aneasy-to-understand manner. The understanding of residents cannot be obtained if suchinformation sharing by the government is impossible. In the case of internal exposure,radioactive materials move in the human body with time after their intake. It is very
difficult to simply estimate internal exposure only using data obtained by a whole bodycounter (WBC). There will be no answer if nobody analyzes the movement of radioactive
materials after their intake. This situation has not been understood by the public. Experts
can understand this situation, but cannot explain it to the public if the public no longer
trust experts. People or channels of communication to connect the public and experts areimportant. I think that high-quality information provision has not yet been achieved
because of the lack of connection between them.
C (attendee): I had the opportunity to talk to residents regarding the radiation riskcorresponding to 1mSv/y from the standpoint of a radiological protection expert, but insome cases, the aim of the communication was confused with the promotion of nuclear
power plants. There are people who cannot trust staff to objectively discuss nuclear
power plants because they always claim that they are safe. I found that we should
distance ourselves from the debate on nuclear power plants when discussing radiologicalprotection.
C (chairperson): People frequently tend to think in polar terms about nuclear power being
good or bad, but nuclear power has both good and bad points. It is necessary to constructa system to select various options.
C (attendee): I don’t have the confidence to clearly explain the meaning of the criterion, butthere must be examples of successful experiences in explaining the criterion to the public.
It is effective to share the successful experiences among experts because such successful
experiences were archived by the organization. According to recommendation 19,
radiological protection criteria should be determined by considering a balance amongreference levels. The fact is that the radiological protection criteria were determined day
by day when the criteria became necessary. However, to formulate the criteria, the same
fundamental concept was used in the same manner. There was consistency in the concept
used to derive practical amounts (e.g., Bq/kg) from the dose criteria, but the numericalvalues differed depending on the case in which practical amounts was used. As an
example, the clearance level was 100Bq/kg before the accident, but a similar standard fordisaster waste was changed to 8,000Bq/kg, which was difficult for the public tounderstand. I heard that it is also difficult for people with some knowledge of radiologicalprotection to explain the difference between 100 and 8,000Bq/kg. Except for the case ofstandards for foods, it may be difficult to decide in advance practical amounts in the case245

Japan Health Physics Societyof an accident, but I think it was necessary to prepare in advance for the possibility of an
accident by considering the distribution of goods.
Q (chairperson): In the United States, what process is in decision-making and politics?
A (attendee): Radiological protection criteria are determined by the NRC. There is staff
working under a few NRC members. The staff is similar to the members of the Nuclear
Regulatory Agency in Japan. The members of the NRC clearly decide the criteria. Afterhearing this decision, the staff elaborates the concepts. Moreover, the NRC members
always suggest that staff adopts the opinions from stakeholders. There is a system toensure that public hearings are frequently held for every issue, the results are disclosed on
the NRC homepage and opinions on the results can be sent to the homepage. I have theimpression that the NRC discuss standards carefully, taking a long time to determine eachstandard, whereas this leads to different opinions on whether the standards are good orbad.
C (chairperson): In my understanding, the NRC members communicate well, actively
participating in public hearings and symposia. The actions of members to actively hear
opinions at various opportunities seem to lead to effective decision making.
Latter half
Speaker’s reply to previously gathered comments
 There was a previous comment on the inadequacy of getting the public to wear personal
dosimeters. However, in the current draft of the recommendation, recommendation 29
suggests that a system to enable the investigation of external exposure using personal
dosimeters should be established. I would like to discuss this with attendees later.
 There was a previous comment on whether the control of occupational exposure isadequate or not. As I don’t know much about the radiation control at the site, I would liketo discuss this with attendees later. The relevant recommendation numbers are from 31 to34.
 There was a previous comment on responses to the lack of public understanding ofradiation measurement, but this point has already been raised in recommendation 35
under the title “spreading understanding of radiation effects. I would like you tounderstand that it includes radiation measurement, radiation protection and radiation
effects.
 There was a previous comment on discussion with stakeholders to examine international
standards for reference. In recommendation 35-5, we gave an example of an explanationof radiation exposure suggesting that risk communication systems supported by experts
should be established, but we did not touch on the examination of international standards
in terms of discussion with stakeholders.
 In the morning session today, there was a report on the current status of contaminatedwater in the Fukushima Daiichi NPS. In the current draft of the recommendation,
contaminated water was not mentioned, but I would like to add this point as an item ofrisk communication.
 From now on, the draft recommendations will be revised in accordance with thecomments made today. The second set of recommendations will be completed after
public consultation through the JHPS homepage.
 As the comment on new setting of registration for questions in the JHPS homepage is not
an opinion related to this recommendation but is a comment directed to JHPS itself, I will
not discuss this comment.
246Japan Health Physics SocietyThere was a previous comment on the lack of clarity from the viewpoint of 7W2H andthe necessity to give priorities in each recommendation. The target of thisrecommendation is not touched on in this draft recommendation. This is because thisdraft recommendation was written under the assumption that people who read it will act
from their own standopoint. In this sense, I would like you to understand that we drafted
the recommendations without giving a target by listing what needed to be done after theaccident and what actions are necessary.
There was a previous comment on the construction of a system to broaden importantinternational standards in an easy-to-understand manner by observing the activities of
ICRP and IAEA. As this comment is not an opinion related to this recommendation but
one directed to JHPS itself, I will not discuss this comment.

Question & comments
C (chairperson): A failure after the Chernobyl accident was to set a target level of 1mSv/y for
all areas immediately after the emergency. It is necessary to avoid such a situation. In theexisting exposure situation defined by ICRP, it is also necessary to avoid choosing avalue of 1mSv/y suddenly, and the reference level should be decreased in a stepwisemanner. This time, confusion occurred because 1mSv/y was suddenly chosen as thereference level. If a broad area is contaminated, it will be difficult to reach this level,
resulting in disappointment. For example, it took approximately 30 years to reach thislevel after a test on a nuclear weapon. Lessons from the Chernobyl accident have beenlearned. In the same manner, we have to learn lessons from the Fukushima accident, so
we at JHPS have elaborated a second set of recommendations. IAEA sets safety standards,
but there may be missing because not all information about the situation at the accidentsite may have been passed on. In this sense, this recommendation would be helpful, so I
would like you to adopt it.
C (attendee): As I heard that local government staff worked hard to revise the emergency
preparedness plan, I would like to discuss this topic. For nuclear emergency preparedness,
it is necessary to consider both optimization and justification. If the evacuation area
becomes larger, the number of evacuated residents will greatly increase. This may cause
problems if all residents start to evacuate simultaneously. Consideration of the protective
measures and the timing of evacuation while instructiong residents about other protectivemeans, e.g., staying indoors, is an issue in making an emergency preparedness plan by
local government. After the Fukushima accident, residents were instructed to take theprotective measures of staying indoors, evacuation and restricting their intake of food andbeverages. I would like you to investigate the effectiveness of these measures and review
them from a critical viewpoint. Restricting the intake of food and beverages could
prevent large internal exposure. This should be verified as soon as possible to help withthe formulation of regional emergency preparedness plans. After the Chernobyl accident,
as stated in the WHO report, there was a case of death from thyroid cancer caused by theintake of food and beverages, especially milk. As food and beverages were restrictedshortly after the Fukushima accident, internal exposure may have been markedly reduced.
Unfortunately, investigation of the radiation exposure of residents has not been completed
yet. I’m hoping that the government and JHPS will actively progress this investigation.
C (chairperson): I was appointed as a special advisor to the Cabinet. As pointed out before, afailure after the Chernobyl accident was not to impose restrictions on food and beverages.
If restrictions on food and beverages work well, the effect on reducing internal exposure247

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would be significant. In this sense, I think it is very important to verify the effect of therestriction after the Fukushima accident.
C (attendee): The process to determine the dose limitation in an emergency of 250mSv was
not carried out in a transparent manner. I think the process used to make various decisions
should be clearly disclosed to the public. In the discussion on raising the dose limitationin an emergency to 500mSv, although this idea was abandoned after consideration bymembers of the Cabinet, it should have been decided on the basis of scientific criteria.
There were some cases in which the process was not clear, and the decision-making
process was like a black box. Regarding this point, I would like to make a
recommendation. In the release of water contaminated with low-level radioactive material
to the ocean, the information was not communicated well. The most significant point is
the response to the question of which law should be used, the Act on Special Measures
Concerning Nuclear Emergency Preparedness or the Nuclear Reactor Regulation Law.
There was an idea that the release was the operator’s responsibility and that the
government didn’t have to publicize it actively. Or the government was not aware of theneeds of information provision on release of contaminated water. In this recommendation,
I would like you to include the importance of transparency in the decision-making
process and of public relations because the process was like a black box.
A (speaker): As I didn’t enter the discussion in the morning session, I would like to reply here.
There was a comment on enhancing education on radiation as a practical science. This
point has already been simply described in the draft recommendation. Regarding thecomment on the request to make a recommendation about compensation, we are
elaborating this recommendation from the standpoint of a radiological protection expert.
As compensation for the effects of the accident is a social science and out of our expert
field, it is difficult to get involved it in this recommendation.
C (attendee): Regarding the issue of compensation, we now have a nuclear reactor being
decommissioned. This reactor is now under regulations within the framewok of theoperation of nuclear reactors, which is an issue. I think that this issue is difficult to
discuss within JHPS, but it may be possible to respond to residents around the reactor. As
this reactor is now being decommissioned, the Act on Special Measures Concerning
Nuclear Emergency Preparedness no longer applies to this reactor. However, the residents
around the reactor understand that it is a nuclear facility, so I think that communication of
the radiation risk is an important issue. Regarding the issue of low-dose radiation
exposure, local residents and their children are currently deeply concerned about thisissue. I hope that policies on providing information on the effects of low-dose radiation,risk communication and emergency preparedness will be standardized by utilizing
lessons learned from this accident.
C (chairperson): As mentioned in the morning session, children in the Fukushima area have agood understanding of the effects of low doses of radiation because there is so muchinformation around them. On the other hand, the understanding of people who live in
distant areas is poor. I’m concerned that children moving to such areas when they growup might be isolated. An important discussion held by ICRP was about equity. For
example, there is a difference in equity between the location of nuclear power plants andconsumption area of electric power; people in the consumption are exposed to little risk.
From a nationwide viewpoint, there may be no problem in generating and consuming theelectric power in one country, but there is no balance in the distribution of risk among
these areas. ICRP has discussed how to explain this inbalance when they explain risk
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management. It is necessary to improve educations on radiation and risk not only in theaffected area but also in the entire country.
C (attendee): Regarding education on radiation, risk communication in the current draft
recommendation seems to be for residents close to the site, but there is little mention of
education on radiation taking Japan as a whole into consideration. I would like you to add
this point and take account of the follow-up after the recommendation.
C (attendee): I’m now examining how we should improve education on radiation, so I’m
expecting JHPS to provide an answer.
C (attendee): Regarding the inadequacy of getting the public to wear personal dosimeters, thespeaker mentioned the differences between the previous comment and the current draft
recommendation. The purpose of the recommendation from JHPS is to obtain the external
individual dose correctly. I think that the meaning of the previous comment is that theambient dose should be used in a complementary manner without assigning responsibility
for measuring the personal dose to the individuals. The fundamental considerations inboth opinions are the same, but I think that the unclear meaning of the distribution of
personal dosimeters produced these separate opinions.
C (attendee): There was a discussion last year about what protective measures are effective
when evacuated residents decide to return home. The protective measures to minimize thedose are environmental monitoring, external dose assessment using personal dosimeters
and internal dose assessment by WBCs to understand the radiation doses measured bythemselves. To underline the importance of protective measures such as personalmonitoring, we planned the morning session to include a speaker from the Cabinet Officeto outline governmental protective measures for safety and reliability. In the existing
exposure situation, I think that people should not be forced to wear the personal
dosimeters, which are just one effective tool among a range of protective measures.
However, as pointed out before, it is necessary to analyze the results obtained frompersonal dosimeters and WBCs without adopting the output as it is. I think that JHPS
should play a role in preventing misunderstanding of the results of the measurements. In
the recommendation, the action to provide comprehensive information and knowledge
should be included.
C (chairperson): I’d like to discuss a difficulty in dose assessment. Normally, the ambient
dose is measured at a height of 1m, but when the target of the dose assessment is a small
person such as child, it is necessary to convert the dose to one at a lower height, whichmeans changing the dose conversion factor. In other words, there are many cases where achange in the conversion factor depending on the age is needed. In addition, there may
also be cases where differences in the patterns of personal behavior prevent use of arepresentative value to assess each individual dose. In the case of internal exposure, thesituation becomes more complicated. The internal dose varies with not only the
representative radioactivity concentration in foods but also with what is ingested, when it
is eaten and the age because of differences in the tissue size and metabolism. It is difficult
to be convinced of the accuracy of a given radiation dose. Internal and external doses
simply indicate values for a representative person. Actual individual doses vary with the
body size and metabolism. In this sense, numerical values obtained by radiation
measurement or dose assessment should be understood as only indicating a level of risk.
The risk level shown by a risk band provides sufficient explanation in normal cases. On
the other hand, in cases where detailed numerical values are actually necessary,communication of the risk becomes difficult.
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C (attendee): In the morning session, there was a discussion of segmentation in the local
community, which was also found in a family. Education on radiation is necessary not
only for children but also for parents who raising children. I was afraid that this would
not be mentioned in the recommendation, but I’m delighted to hear the speaker’s
explanation of the reason including the speaker’s intention to consider that people whoread this recommendation will voluntarily act from their standpoint. I would like you to
add such a reason to the recommendation.
A (speaker): I acknowledge your comment. I would like to add it to the background section on
the fundamental policy in the elaboration of recommendations.
C (attendee): I think it is difficult to provide sufficient education on radiation in junior highschool because of the crowded curriculum. The budget for the Hakarukun (mobile simple
survey meter) business was discontinued, but in these times, it is necessary to continue it.
Regarding stakeholder involvement, I think that the discussion has continued without any
consideration of the benefits of radiation, despite there being both risks and benefits. As
the discussion on risks and benefits has only been on whether radiation is safe or
dangerous, this should be included in the recommendation.
C (attendee): I heard from a teacher in Fukushima prefecture that there is a shortage of time atschool to educate students on radiation and he also doesn’t know what he should teach.
Moreover, there is an opinion that students should not measure radiation because ofserious concerns about the effects of radiation of the parents. It is difficult to determine
what should be taught and how it should be taught without generating fear about radiation.
I would like JHPS to carry out activities to enable the public to understand that experts
are now discussing such points.
C (attendee): Numerical values and units of radiation are difficult to understand, and in manycases, people often understand in terms of goodness or badness and want experts to reply
in these terms. If too much information is provided by experts to explain radiation, thecommunication would become difficult to understand because of information overload of
the public. Not only radiation but also all other applications of science are not only
evaluated in terms of whether they are safe or dangerous, which should be a fundamental
part of education. Otherwise, explanations by experts will not be understood by the
public.
C (chairperson): I think that this was an issue in the era of the former Prime Minister Tony
Blair in U.K. He considered that the most significant problem in the country was
education, which he emphasized. At that time, SATIS (Science and Technology inSociety) was proposed. There are many aspects of sciences and technology that arecomplex and difficult to understand. However, if their understanding is not acquired
owing to a lack of education, a tendency to reject sciences and technology without
understanding them may occur. For this reason, education on scientfic activity has been
focused on in U.K. society.
Q (attendee): Today, I participated in a symposium about supporting public health after the
Fukushima nuclear accident. A misunderstanding was witnessed there, e.g., the figure of
1mSv/y was strongly defended. There is an impasse that returning home andrehabilitation cannot progress because of the insistence of reaching the target of 1mSv/y.
Some one has to announce that it is mistake to prevent people from returning home
without achieving the target of 1mSv/y. On the other hand, there are some issues
regarding what should be adopted as a numerical value for the annual individual dose andwho should announce it. If the Atomic Energy Society in Japan announces it, it would
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sound like a voice from nuclear community. I thought of JHPS and the Medical
Association as alternative candidates, but the Medical Association strongly defended thevalue of 1mSv/y in today’s symposium. To progress rehabilitation, I think that we shouldmake a statement on the importance of not insisting on 1mSv/y. What do JHPS members
think about this?
A (chairperson): Regarding the points you mentioned, there is a description of setting thetarget dose in the ICRP publication. Contamination over a large area or the situation afteran accident is addressed under an existing exposure situation. ICRP Publication 82 statesthat various doses below 10mSv/y should be selected. In addition, ICRP Publication 111,
which was prepared to ensure radiological protection after an accident, states that theexisting exposure situation should be controlled to the lower part of the dose range
between 1 and 20mSv/y. As an answer has already been given, we had better justunderstand this. The problem of who finally decides the annual individual dose should betackled by the government by considering the age distribution of the residents and thecharacteristics of the local area. I think that this issue of risk management is somewhat
beyond the scope of medical doctors, who normally make diagnoses. Considering thepast process used to determine 1mSv/y as the maximum dose for the public, the use of
1mSv/y as a standard during the rehabilitation or restoration period was a big mistake. In
the ICRP publication, it is stated that the target dose should be reduced from 20mSv/y to
1mSv/y in a stepwise manner. It is sufficient to respond to the issue of rehabilitation bysimply understanding such points. The objective of radiological protection is to optimize
protection. To prevent from the failure after the Chernobyl accident such as the target
value of 1mSv/y was announced in a dogmatic manner, various systems were completed
in approximately 20 years. However, there are few people who understand this failure.
C (attendee): Hearing the comments from floor, I’ve felt that there may be misunderstanding.
I think that the background on this matter is not well related to whether 1mSv/y is safe ornot. They cannot understand the issues involved, which is a problem. As the percentageof people suspected to have cancer upon thyroid inspection has increased since theaccident, the interest of people has changed from the topic of 1mSv/y to whether or not
children’s health can be protected. In Fukushima prefecture, we are investigating thereason for the increased incidence of suspected cancer upon thyroid inspection andchromosome investigation. In addition, when we talk to residents, we inform them that
we will make careful judgments after 3 to 5 years of continuous investigation because theinvestigation has only just started. Some residents want to trust people whose opinions
are similar to their own idea and also want to believe opinions opposite those of thegovernment because they have become tired of the confusion caused by 3 years ofpolitics. In such a situation, the announcement that a dose of more than 1mSv/y is
acceptable may arouse resident's antipathy.
C (chairperson): In Fukushima prefecture, the individual dose greatly varies depending on thelocation. The external exposure of residents due to radioactive plume probably exceeded
1mSv. When investigating the effects of radiation, dose assessments and surveys on theeffects on health based on epidemiological investigations are two essential aspects, andopinions based on one of the aspects are likely to be erroneous.
C (attendee): My impression is the unclearness of what should be explained. It is importantfor JHPS to explain to the public in an easy-to-understand manner, clarifying the situationfrom their viewpoints.
Q (speaker): I would like to reconfirm the consensus of the audience. I am now planning to251

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add a recommendation regarding contaminated water in the part in relation to risk
communication. What do you think about this? As there is no objection, I’ll add it in therecommendations.
C (chairperson): As I mentioned before, there are clear descriptions in ICRP publications 82
and 111. There are various ways to return to a normal situation from an emergency
situation. For this reason, in the ICRP publications, only range of the radiation dose isgiven to ensure an allowance and flexibility. A final value within the range of theradiation dose will be determined by the government. If the value is chosen after hearing
various opinions, a convincing consensus can be obtained to some degree. In this sense,
the process, that is, the procedure followed, is important.
C (speaker): We would like to complete the final draft recommendation including today’s
discussion. In addition, before finalizing this recommendation, we will again collectcomments from JHPS members through consultation via our homepage.
C (chairperson): As the draft recommendation is uploaded on the JHPS homepage, I hope wewill receive more frank comments. Thank you for your participation in this symposium.
Concluded252