intervention for chronic and emergency exposure situations the medical management of radiation...

Intervention for Chronic and Emergency Exposure SituationsIntervention for Chronic and Emergency Exposure Situations

The Medical Management of Radiation InjuriesThe Medical Management of Radiation Injuries

Psychological EffectsPsychological EffectsLectureLecture

IAEA Post Graduate Educational Course in Radiation Protection and Safety of Radiation Sources

Module X.8 - The Medical Management of Radiation Injuries

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IntroductionIntroduction

Importance of psychological impact of Importance of psychological impact of radiation accidents has been in the past radiation accidents has been in the past underestimatedunderestimated

This lecture willThis lecture will explain explain the the nature and nature and causescauses of of

psychological effects psychological effects in radiation emergencin radiation emergencyy describe the symptoms of psychological describe the symptoms of psychological

stress caused by the accidentstress caused by the accident present elements for management of present elements for management of

psychological consequences of the accidentpsychological consequences of the accident


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ContentContent

Medical consequences of the radiation Medical consequences of the radiation accidents accidents

Psychological consequences of radiation Psychological consequences of radiation accidents accidents

What is psychological stress caused by What is psychological stress caused by the accidentthe accident

What can we do about stressWhat can we do about stress Management of psychological effectsManagement of psychological effects SummarySummary


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Psycho-social Effects and Radiation Psycho-social Effects and Radiation AccidentsAccidents Psycho-social effects of an radiation Psycho-social effects of an radiation

accident can far outnumber any direct accident can far outnumber any direct effectseffects

The wide spread public anxiety and The wide spread public anxiety and pessimism in Chernobyl accident pessimism in Chernobyl accident appeared to be out of all proportions to th appeared to be out of all proportions to th eradiation induced health effectseradiation induced health effects

In accident management it is therefore In accident management it is therefore necessary to take these effects into necessary to take these effects into accountaccount


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Medical Consequences of Radiation Medical Consequences of Radiation AccidentsAccidents

Health effects directly related to radiation Health effects directly related to radiation exposureexposure Deterministic Deterministic StochasticStochastic

Health effects indirectly related to Health effects indirectly related to radiation exposureradiation exposure Caused by the accident per seCaused by the accident per se Caused by the interventionCaused by the intervention


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Health Effects Directly Related to Health Effects Directly Related to Radiation ExposureRadiation Exposure

Not related to awareness of exposure Not related to awareness of exposure or to subjective perception of riskor to subjective perception of risk

CCan be prevented or reduced by an be prevented or reduced by protective actionsprotective actions which minimise which minimise public exposurepublic exposure


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Health Effects Indirectly Related to Health Effects Indirectly Related to Radiation ExposureRadiation Exposure

CCan faran far o outnumber any direct effectsutnumber any direct effects CCan affect hundredsan affect hundreds o of thousandsf thousands Can last for many yearsCan last for many years Do not correlate well with Do not correlate well with actualactual exposure exposure

bbut with subjective perception of riskut with subjective perception of risk Protective actionsProtective actions to reduce exposure to reduce exposure

may be counterproductive with respect to may be counterproductive with respect to such effectssuch effects


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Why Do People Fear Ionising Why Do People Fear Ionising Radiation?Radiation?

Unknown threatUnknown threat Can not be seen or feltCan not be seen or felt Conflicting information in mass mediaConflicting information in mass media Contradictory data from different “scientists”Contradictory data from different “scientists” Use of “radiation theme” in economical and Use of “radiation theme” in economical and

political discussionspolitical discussions Long term consequences of radiation exposureLong term consequences of radiation exposure Lack of education among general public, Lack of education among general public,

physicians and other professionalsphysicians and other professionals Social understanding of any situation involving the Social understanding of any situation involving the

term “radiation” is negativeterm “radiation” is negative


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Psychological EffectsPsychological Effects

Psychological effects includePsychological effects include Psychic sufferingPsychic suffering Changes in risk perceptionChanges in risk perception Modification in individual and social Modification in individual and social

behaviorbehavior


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Psychological Effects (Cont’d)Psychological Effects (Cont’d)

Major accidents showed that affected Major accidents showed that affected peoplepeople Believe in the threat to their healthBelieve in the threat to their health Doubt what has been reported about Doubt what has been reported about

accident and resulted dosesaccident and resulted doses Got modification in the life styleGot modification in the life style Have somatic complainsHave somatic complains Got substance abuse (alcohol, Got substance abuse (alcohol,

tranquilizers, sleeping pills)tranquilizers, sleeping pills)


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The Severity of Psychological The Severity of Psychological ReactionsReactions

The severity depends on:The severity depends on: Factors related to the accident:Factors related to the accident:

suddenness, intensity, duration, available social support etc.

Factors related to individual:Factors related to individual: past experience, personal loss, perception

of threat, personal coping abilities etc.


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What Is Psychological Stress What Is Psychological Stress Caused by the Accident?Caused by the Accident?

A normal reaction to abnormal eventA normal reaction to abnormal event Unusually strong psychical and emotional Unusually strong psychical and emotional

reactions experienced in the face of an reactions experienced in the face of an accident could interfere with one’s ability accident could interfere with one’s ability to function during or after the eventto function during or after the event

In some cases these reactions can turn In some cases these reactions can turn into post traumatic stress disorderinto post traumatic stress disorder

New diagnostic entity “chronic New diagnostic entity “chronic environmental stress disorder” has been environmental stress disorder” has been proposedproposed


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Stress Reactions – Stress Reactions – PhysicalPhysical

Early Early NauseaNausea Muscle tremorsMuscle tremors SweatingSweating DizzinessDizziness ChillsChills Increased heart rateIncreased heart rate Increased blood Increased blood

pressurepressure HyperventilationHyperventilation

LateLate FatigueFatigue Increased use of Increased use of

alcohol and drugsalcohol and drugs Exaggerated startle Exaggerated startle

responseresponse Sleep - related Sleep - related

difficultiesdifficulties

Physical


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Stress Reactions – Stress Reactions – CognitiveCognitive

EarlyEarly ConfusionConfusion Difficulty making Difficulty making

decisionsdecisions Impaired thinkingImpaired thinking Difficulty problem Difficulty problem

solvingsolving Memory lossMemory loss Calculation difficultiesCalculation difficulties Difficulty to remember Difficulty to remember

namesnames

LateLate Decreased attention Decreased attention

spanspan Poor concentrationPoor concentration Memory problemsMemory problems FlashbacksFlashbacks

Cognitive


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Stress Reactions – Stress Reactions – EmotionalEmotional

EarlyEarly AnxietyAnxiety AngerAnger FearFear IrritabilityIrritability GuiltGuilt OverwhelmedOverwhelmed GriefGrief HopelessnessHopelessness

LateLate Feeling abandonedFeeling abandoned ResentmentResentment Feeling alienationFeeling alienation WithdrawalWithdrawal NumbnessNumbness DepressionDepression

Emotional


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Psychological ProblemsPsychological ProblemsLate Late

Continuation of some early problemsContinuation of some early problems Concerns about the consequences of the Concerns about the consequences of the

exposure exposure Discrimination from the other peopleDiscrimination from the other people Establishment of illness behaviorEstablishment of illness behavior


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Changes in Health Behavior of Changes in Health Behavior of Affected PeopleAffected People

Extensive medical examinations have Extensive medical examinations have further enhanced worries about current further enhanced worries about current aand future effectsnd future effects

Change in illness behaviour and Change in illness behaviour and diagnosticdiagnostic behaviour together with vast behaviour together with vast screeningscreening programprogrammemes have lead to s have lead to increase in number of diagnosed diseases increase in number of diagnosed diseases in most organ systemsin most organ systems


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Psychological Stress of Injured Psychological Stress of Injured IndividualsIndividuals

Patient needsPatient needs Comfort, relief of Comfort, relief of

symptomssymptoms Stability and Stability and

authoritative supportauthoritative support InformationInformation ConcernConcern HopeHope ControlControl StimulationStimulation

Patient problemsPatient problems Overly scientific Overly scientific

approachapproach Repeated tests, Repeated tests,

examinationsexaminations PhotographsPhotographs Reactions of othersReactions of others Too many ‘experts’Too many ‘experts’ Too much media Too much media

attentionattention


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Medical / Nursing Staff ProblemsMedical / Nursing Staff Problems

Fear / anxietyFear / anxiety Isolation by othersIsolation by others Lack of knowledge (medical treatment, Lack of knowledge (medical treatment,

long term effects, etc.)long term effects, etc.) New experiences:New experiences:

Interactions with “experts,” public Interactions with “experts,” public officials, reporters, etc.officials, reporters, etc.

Loss of autonomy (activities may be Loss of autonomy (activities may be monitored / managed by authorities)monitored / managed by authorities)


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What Can We Do About Stress?What Can We Do About Stress?

Accidents can not be predictedAccidents can not be predicted

BUTBUT Psychological reaction to the radiological Psychological reaction to the radiological

accident could be accident could be prevented / decreased / relaxedprevented / decreased / relaxed

using different methods applied using different methods applied

before / during / after the accidentbefore / during / after the accident


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Management of Psychological Management of Psychological ConsequencesConsequences

To reduce the psychological To reduce the psychological consequences several measures are consequences several measures are availableavailable Medical responseMedical response Public health follow-upPublic health follow-up Social assistanceSocial assistance Government actions guidelinesGovernment actions guidelines Community accountability Community accountability


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How to Reduce Psychological EffectsHow to Reduce Psychological Effects

Have an ongoing information programme Have an ongoing information programme Give clear, simple and timely adviceGive clear, simple and timely advice Give consistent advice (one official point)Give consistent advice (one official point) Use international guidance Use international guidance Ensure protective actions are justifiedEnsure protective actions are justified Correct false informationCorrect false information Consider education and counsellingConsider education and counselling


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Warning of the PopulationWarning of the Population

Timely warning is one of the most Timely warning is one of the most important psychological aspects of important psychological aspects of dealing with the accidentsdealing with the accidents

Provide to the person a sense of control Provide to the person a sense of control over the situationover the situation

Call for the active attitude to the situation:Call for the active attitude to the situation: Searching processSearching process Preparation for protective actionsPreparation for protective actions


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Requirements for Warning MessageRequirements for Warning Message

Consistency Consistency Accurate, timely and completeAccurate, timely and complete Clear Clear SimpleSimple Sufficient Sufficient ConcreteConcrete Provided through multiply channelsProvided through multiply channels Frequently repeatedFrequently repeated


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Implications for Health Care Implications for Health Care ManagementManagement

Education is needed Education is needed beforebefore, , duringduring and and afterafter an incident an incident

Debriefing sessions aid in relieving stress Debriefing sessions aid in relieving stress and anxiety of staffand anxiety of staff

EEducation about radiation healthducation about radiation health effects is urgently needed for effects is urgently needed for

health health professionals to limit the public professionals to limit the public health health problem of socio-psychological problem of socio-psychological

effectseffects


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Mitigation of Public Non-radiological Mitigation of Public Non-radiological ConsequencesConsequences

One of the functional elements in IAEA-One of the functional elements in IAEA-TECDOC-953TECDOC-953

Applicable for all planning categoriesApplicable for all planning categories Should be performed by facility, local or Should be performed by facility, local or

national level national level Depending on the particular planning Depending on the particular planning

categorycategory


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Non-radiological ImpactsNon-radiological ImpactsLong Term Protective ActionsLong Term Protective Actions

Effects onEffects on Mental healthMental health Economic conditionsEconomic conditions EmploymentEmployment Long term needs for social welfareLong term needs for social welfare

and other non-radiological impacts and other non-radiological impacts caused by taking caused by taking longer term protective longer term protective actionsactions should be considered should be considered


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Non-radiological ImpactsNon-radiological ImpactsCapabilitiesCapabilities

Establish capability for addressing the Establish capability for addressing the public’s concerns and reactions during an public’s concerns and reactions during an actual or perceived nuclear or radiological actual or perceived nuclear or radiological emergencyemergency

Assure that affected people will perceive, Assure that affected people will perceive, understand, believe, personalize, and understand, believe, personalize, and respond to the warning respond to the warning


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Non-radiological ImpactsNon-radiological ImpactsLong Term MonitoringLong Term Monitoring

Before long-term monitoring or other Before long-term monitoring or other activities are conducted in areas designed activities are conducted in areas designed for unrestricted use after an accident, for unrestricted use after an accident, ensure the public understands the ensure the public understands the reasons for these continuing activities reasons for these continuing activities (e.g., scientific investigations of behavior (e.g., scientific investigations of behavior of radioisotopes in the environment)of radioisotopes in the environment)


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Non-radiological ImpactsNon-radiological ImpactsCompensationsCompensations

The process used to develop the system The process used to develop the system of compensation for emergency workers of compensation for emergency workers and the public following an emergency and the public following an emergency (radiation, chemical or other) should be (radiation, chemical or other) should be established following careful established following careful consideration of the benefits and long-consideration of the benefits and long-term social, psychological and economic term social, psychological and economic effectseffects


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SummarySummary

The The nature and nature and causescauses of psychological of psychological effects effects in radiation in radiation emergencies were emergencies were explainedexplained

The symptoms of psychological stress The symptoms of psychological stress caused by the accident were describedcaused by the accident were described

Elements for management of Elements for management of psychological consequences were psychological consequences were presentedpresented


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Where to Get More InformationWhere to Get More Information

See referencesSee references

on cover page of this lectureon cover page of this lecture

intervention for chronic and emergency exposure situations the medical management of radiation...

Documents

term radiation

radiation protection

ionising radiation

radiation exposurecaused

radiation exposurenot

awareness of exposure

actual exposure

chernobyl accident