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Subtask

SHAMISEN comprises three research subtasks (STs 1, 2 and 3) focused on meeting a specific objective, a further subtask (ST4) on cross-cutting issues, and a project management subtask (ST5) as shown below. Each of the 3 research subtasks and ST4 are further divided into actions, as described below.


Constituent subtasks (ST), actions (A) and cross-cutting actions (CCA) of SHAMISEN

ST1 - Lessons learned from dosimetric and health screening, evacuation and health surveillance

Overall objective

To review guidelines and experiences from previous radiation emergencies regarding management of dosimetric screening, evacuation and health surveillance. This will be achieved through three complementary actions (the three strings of the shamisen) covering the entire spectrum from emergency response and evacuation to health surveillance and epidemiological studies.

    
Overall approach

A joint meeting of the A1.1 partners at month 38 (MS7) will be held to review, discuss and define the lessons learned on dose-assessment, evacuation and medical management in previous accidents.
A1.1 - Critical review of recommendations on and experiences in dose assessment, evacuation, medical assessment of potentially exposed people, and dose reconstruction for intermediate to long term studies
 
Aim: to draw lessons from previous experiences and to feed these into recommendations made in A3.1.
Approach: critical reviews of:
  1. Recommendations and experiences on dose assessment for internal contamination.
  2. Recommendations, capabilities and experiences on dose assessment for external exposures.
  3. Recommendations and experiences on post-accident medical assessment.
  4. Criteria for identifying persons requiring dose assessment.
  5. Guidelines and experiences on evacuation and their public health consequences.
  6. Experiences in communicating dose assessment results to different stakeholders (including local populations, medical community and decision makers).
    

A1.2 Critical review of long-term medical surveillance programmes

Aim: to provide a set of lessons learned from medical surveillance on physical and mental health of populations exposed to fallout from the Chernobyl and Fukushima accidents, as an input to ST3.
Approach:
  1. Review of recommendations, regulations, decrees and of long-term medical surveillance programmes, of exposed populations following the Chernobyl and Fukushima accidents to evaluate impacts of longterm medical surveillance programmes in these populations;
  2. Workshop (MS4), including participation of medical surveillance experts from countries affected by the Chernobyl and Fukushima accidents, on the impact of surveillance measures on public health, and their justification from clinical and scientific viewpoints ñ in conjunction with A1.3;
  3. Summary of lessons learned for improving long-term medical surveillance of different categories of affected populations.
The work will include a generic assessment of recognized ethical challenges in medical screening, drawing on experience from other cases such as cancer screening, as well as real challenges from the Chernobyl and Fukushima cases.

A1.3 Critical review of lessons learned from epidemiology on radiation risks from radiation accidents
 
Aim: to summarise lessons learned from epidemiological studies of radiation risk, as an input to recommendations on health surveillance and implementation of epidemiological studies of a potential radiation accident in Europe in A3.5.

Approach: critical review of the organization and logistics of epidemiological follow-up of past radiation accidents. Key points to be considered include 1) definition of the study populations (workers involved in the accident and its clean-up, and the general population, with particular attention to potentially vulnerable groups: children, pregnant women, elderly or ill); 2) their identification and follow-up (screening and collection of health data); 3) dose measurement and reconstruction (in collaboration with A1.1 and A1.2); and 4) acceptability to various stakeholders. Work will focus on four accidental situations with different scopes (magnitudes of doses and populations exposed): Chernobyl, Fukushima, Fleurus and Three-Mile Island. Lessons learned will be summarized into the comprehensive report on lessons learned from ST1 (D1.1) as input for recommendations in A3.5.


ST2 - Lessons learned from living conditions and health status of populations

Overall objective

To review the health and concerns of populations living in contaminated areas following radiation accidents. In particular, ST2 aims at identifying impacts on living and social conditions, and summarising the worries, needs and expectations of the affected populations with regards to their health and welfare. Sociopsychological consequences of the Chernobyl and Fukushima accidents will be also analysed and discussed.


Overall approach

The objectives will be achieved through a description and analysis of specific case studies in different situations observed after the Chernobyl accident (A2.1; A2.2). Activities carried out after the Fukushima accident will also be reviewed, incorporating an analysis of testimonies of medical experts and local stakeholders from contaminated territories in Japan (A2.3).


A2.1 Experiences with the Sámi population relating to Chernobyl fallout in Norway

Aim: to learn from the experiences, needs and expectations of the S·mi reindeer herders affected by Chernobyl fallout with respect to their health surveillance, including information and communication strategies, and economic implications of both fallout and restrictions.

Approach: review of scientific reports and feedback from local stakeholders, both reindeer herders and local medical professionals. A questionnaire will be developed and sent to local stakeholders. A seminar (MS5) will be organised in Norway, marking the 30th anniversary of the Chernobyl accident. A final action report will be issued (D2.1).


A2.2 Review of socio-psychological consequences of the Chernobyl accident in Belarus, Russia and Ukraine

Aim: to review the socio-psychological consequences of the Chernobyl accident on the populations living in (and evacuated from) contaminated areas of Belarus, Russia and Ukraine and to evaluate the success of programmes implemented for improving living conditions.

Approach: together with experts from these countries, partners will review:
Studies on the sociological and psychological impacts of the Chernobyl accident; and
Results of the ETHOS (17) and CORE (18) projects in Belarus, evaluating their effectiveness at improving health and welfare of affected populations.
A final action report will be issued on the basis of this review (D2.2).


A2.3 Review of current activities carried out after the Fukushima accident in Japan

Aim: to learn from the experiences and needs of populations affected by the Fukushima accident and from the interventions aimed at addressing these.

Approach: review of the innovative approaches implemented to help local Japanese populations address issues relating to their health and living conditions. An analysis of case studies presented during the ICRP Dialogue initiative (21) will be performed. A workshop (MS6) of medical professionals, radiation protection experts and local stakeholders will review the design and implementation of interventions addressing the health issues of the population. A final action report will be prepared (D2.3) and combined with D2.1 and D2.2 to form the report on lessons learned from ST2 (D2.4).


ST3 - Preparedness and improvement of post-accident response and health follow-up

Overall objective

To develop recommendations and procedures for preparedness, screening, surveillance and medical follow-up of populations affected by a future radiation accident.


Overall approach

The work will build upon the reviews of guidelines and recommendations carried out in ST1 and the case studies and lessons learned in ST2. Recommendations will cover: emergency response, evacuation, improvement of living conditions, training of medical personnel and epidemiological studies. The scope and content of the recommendations will be outlined (MS3) at the kickñoff meeting and revised and consolidated at the consortium meeting at month 9 (MS8). Recommendations will be disseminated to decision makers and radiation protection authorities for translation into policy, as well as to scientific, medical and non-expert audiences.


A3.1 Recommendations for collection and communication of data on dose in early, intermediate, and late post-accidental phases, and on medical assessment in the early emergency phase

Aim: to produce recommendations on procedures needed for dose and medical assessments after a potential radiation accident in Europe, specifically for:
  • Assessment of doses from internal contamination;
  • Assessment of doses from external exposure;
  • Initial clinical symptoms assessment and health investigation;
  • Selection criteria to identify persons requiring dose assessment;
  • Rational communication of dosimetry assessment results to different stakeholders (with CCA1).
Approach: the action will draw on lessons learned from ST1, particularly A1.1 and will be carried out in close collaboration with A3.4 and A3.5. In addition, a workshop will be organized (MS13), with health professionals (emergency doctors, medical physicists and nuclear medicine physicians) involved in radiological emergencies, to discuss the conclusions made in A1.1 and the best means of integrating procedures recommended in SHAMISEN with existing emergency management plans for radiation accidents.


A3.2 Recommendations for evacuation decisions

Aim: to design recommendations for evacuation criteria that take into account not only dose levels but also the health condition of populations (particularly sensitive subgroups such as children, pregnant women, elderly and hospitalised persons) and the availability of adequate means to evacuate them and facilities to receive them.
Approach: This action will build on the work carried out in A1.1.


A3.3 Designing health surveillance programmes that respond to the concerns of the local population and improve their living conditions

Aim: to adapt or design, as appropriate, health surveillance strategies that address the concerns, needs and expectations of affected populations.

Approach:
Based on input from A1.2 and lessons learned from case studies carried out in ST2, strategies will be identified that go beyond simple health monitoring and meet the broader objectives of improving living conditions of affected populations. Proposals will include engagement of populations in the design of surveillance strategies and in identification of their own information needs.


A3.4 Recommendations for improving professional support of affected populations

Aim: to develop a holistic strategy for improving the medical, psychological, and social support of affected populations. Proposals will include training and education of medical professionals (doctors, nurses, public health workers), particularly in primary care settings, on radiation effects, post-traumatic stress syndromes, and risk communication.

Approach:
A3.4 will draw on the reviews and lessons learned from ST1 and ST2. Identification and engagement of appropriate stakeholders (medical professionals, local and national decision makers, radiation protection experts, members of the general public) will be key to designing a successful strategy.


A3.5 Recommendations for preparedness and post-accidental epidemiology

Aim: to develop recommendations for health surveillance and implementation of epidemiological studies after a potential radiation accident in Europe. Key points to be considered are preparedness for postaccidental medical follow-up/epidemiology, collection of health data, definition of study populations, and ensuring long-term sustainability of health surveillance processes.

Approach:
A review of existing means for health surveillance, and their usefulness in post-accidental situations, will be conducted in different European countries (routine monitoring systems and systematic registration of pathologies such as cancers, thyroid diseases or birth defects). An evaluation will be carried out of the feasibility and pertinence of employing various epidemiological approaches after a radiation accident in Europe, including an assessment of the usefulness of active screening. Recommendations will take into account dose level, type of population (remediation workers, general population), age and health status of the population. This action will draw on lessons learned from ST1 and ST2, and aspects relating to dose will be conducted in close collaboration with A3.1.
A comprehensive report on the recommendations from ST3 will be produced (D3.1).


ST4 - Cross-cutting issues

CCA1 - Stakeholder engagement

Aim: to foster engagement of stakeholders in designing a relevant and meaningful health surveillance programme in the aftermath of an accident. Stakeholders include affected individuals, health professionals, health authorities at the local, regional, national and, where relevant, international level, as well as scientists and medical researchers.

Approach: This objective will be met through answering the following questions:
  • How to engage stakeholders in health surveillance and follow-up?
  • How to develop a practical radiological protection culture with these stakeholders?
  • How far to set up a common assessment of the radiological and health situation?
  • How to integrate heath surveillance into radiation protection programmes to improve living conditions?
  • Extensive consultations will be carried out through stakeholder roundtables and workshops with sociologists, psychologists and ethicists, radiation protection professionals, networks involved in emergency preparedness and in remediation, European Radiation Protection Platforms (MELODI, NERIS, EURADOS)

CCA2 ñ Economic implications of responses to a radiation accident

Aim: to provide estimates of costs/resources/benefits (based on anticipated health effects of both exposure and interventions, and resource implications of surveillance actions) associated with a response of a similar scale to that at Fukushima in the event of an accident in Europe.

Approach: A review will first be carried out of the resource and cost implications of previous accidents, in particular Fukushima. Scenarios of health surveillance and scales and types of accident will then be defined according on responses to previous accidents. Results will be presented in terms of resource use, costs and (dis)benefits which will be used as a baseline against which different types of response to a given accident are compared. These comparisons will be presented as a set of balance sheets (D4.1), a format ideally suited to public health decision-making.

    
CCA3 ñ Ethical Issues

Aim: to actively evaluate ethical challenges in the work of SHAMISEN. It is widely recognized that medical screening raises a number of ethical issues and challenges, many of which are of direct relevance to screening and health surveillance after radiation accidents.

Approach: ST1 will include a review of ethical issues and recommendations in heath surveillance and screening, including a generic assessment of recognized ethical challenges in medical screening, drawing on experiences from previous cancer screening and public health surveillance cases. Specific ethical challenges relating to Chernobyl and Fukushima will be assessed in the work of ST1 and ST2. The development of recommendations in ST3 will include identification of ethical challenges and procedures to address these challenges for all the areas considered.


ST5 - Project management and coordination

Aim: to ensure efficient operational management including administrative, financial and legal issues, liaison with the OPERRA Coordinator.

Approach: ST5 will develop procedures and tools to ensure results are delivered on time with adequate quality control and within cost; and to support appropriate work dynamics to help drive the whole Consortium as a team towards successful completion. In particular, ST5 will ensure coordination with the ST leaders so as to allow efficient circulation of information and cohesion of the work.