Multiple Objective Decision Analysis for Potassium Iodide Distribution in Nuclear Incidents

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Multiple Objective Decision Analysis for
Potassium Iodide Distribution in Nuclear Incidents

• L. Robin Keller
• Tianjun Mike Feng and Qiang David Zeng
• UC Irvine

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Multiple Objective Decision Analysis for
Potassium Iodide Distribution in Nuclear
Incidents

• A National Academy of Sciences book advises
  states and local jurisdictions to use a multiple
  objective decision analysis process to evaluate
  plans for distribution of potassium iodide (to
  protect against thyroid cancer) when there will
  be radioactive iodine exposure due to an accident
  or terrorism at a US nuclear power plant.
• The decision process features were proposed
  following public hearings involving multiple
  stakeholders with divergent political
  perspectives and varying assumptions about
  scientific evidence

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(No Transcript)
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Health Risk

• If a nuclear incident (from an accident or
  terrorism) occurs and radioactive iodine is
  released
• People exposed to the plume could have an
  increased risk of thyroid cancer due to
  inhalation
• Young children fetuses most at risk
• Thyroid cancer is very rare for children, this
  could increase that risk, but it would still be
  quite rare
• (Thyroid gland is located beneath the voice box
  (larynx), produces thyroid hormone helps
  regulate growth and metabolism)

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Disaster at Chornobyl Nuclear Power Plant in
Ukraine in 1986
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Chornobyl

• People were not told of plant disaster for days,
  so exposed to plume and inhalation risks
• Children and pregnant/nursing mothers ate leafy
  vegetables and drank milk from exposed cows over
  weeks, so received high doses of radioactive
  iodine from ingestion
• All who later got thyroid cancer were 4 years
  old (including fetuses) at exposure
• 3 thyroid patients died- 2 from bad anesthesia in
  surgery and 1 from parents not giving child
  thyroid pills (thyroid cancer highly treatable)

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Protective Measures

• Primary Evacuate
• Secondary Shelter in place
• Supplemental
• Take potassium iodide (KI) right before exposure
  to radioactive iodine to
• -fill up thyroid with stable iodine
• -block out radioactive iodine from
  getting into the thyroid

to protect against all nuclear incident risks,
not just radioactive iodine
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United States Nuclear Power

• US Nuclear Power Plants are a different, safer
  design (compared to Chornobyl)
• Assume ingestion pathway would be controlled in
  the US

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Process Background

• Massachusetts Congressman Edward J. Markeys law1
  passed directing National Academy of Sciences to
  conduct a study on best way to distribute KI
• National Research Council of National Academies
  received funding via Centers
  for Disease Control
• 1. Law 107-188 sect. 127

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Process Background, continued

• Keller joined as decision analyst on committee of
  experts
• thyroid cancer physicians
• radioactive safety experts
• nuclear power plant safety
• emergency management
• Committee received oral or written public
  testimony from experts at agencies and
  organizations

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• Timeline
• May-Sept. 2003
• Committee met monthly in DC (and once at UCI
  and Woodshole, MA offices of National Academy of
  Sciences)
• Oct. 03 Book sent to external reviewers
• Dec. 03 Prepublication briefings to agencies
  NRC, EPA, National Stockpile, FEMA) and to staff
  of Congressman Markey/Senate majority leader
  Bill Frisk, MD.
• Dec. 03 Released to public
  http//www.nap.edu

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Characteristics of Decision Problem

• Political process calls for scientific
  perspective
• Committee membership primarily experts on
  radiation, thyroid cancer, nuclear power plants
  not policy experts
• Discussion of KI separated from other ways to
  improve public health and safety
• KI seen as the anti-nuke pill as if it will
  protect everyone from all radiation for sure
  framed as a sure-thing
• One side refuses to allow cost to be considered
• Not-so-hidden agenda get rid of nuclear power
  plants
• Agency experts often said there is no
  one-size-fits-all solution

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Types of Alternative Actions

• Predistribute to households, schools, hospitals,
  etc.
• Via mail
• Via voluntary pick up
• Stockpile at evacuation reception centers
• Do not pre-distribute

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Objectives Hierarchy
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• Note minimizing cost is not an objective

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See Excel spreadsheet

• Use of sliders for weights on objectives
• Gives wiggle room to see how different
  alternatives for KI distribution can be best in
  different situations

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Sample Display of Overall Value of Plans-
Results Depend on Weights on Objectives and
Planning Region
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Insights

• Instead of choosing a specific location (like San
  Onofre, CA), we created 3 hypothetical regions
  (rural, suburban, urban) and showed how they
  might vary on their performance on the objectives

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Urban Site Example
Minimize Radiation Health Risks to Public Minimize Radiation Health Risks to Public Minimize Radiation Health Risks to Public Relevant Characteristics of Urban Site Example
A. Minimize Radioactive Iodine Risk to Thyroid A. Minimize Radioactive Iodine Risk to Thyroid A. Minimize Radioactive Iodine Risk to Thyroid  
  a.1. Maximize KI Availability a.1. Maximize KI Availability  
    a.1.1. Max. Availability for Children and Pregnant Women Residents 100,000 -student school system
    a.1.2. Max. Availability for Other Residents Large resident population
    a.1.3. Max. Availability for Mobile Population Population increases by 25 from mobile workers
  a.2. Optimize Ability to Take KI on Time a.2. Optimize Ability to Take KI on Time  
    a.2.1. Max. Number of People who Know Where Pill is Possible new residents won't be covered by earlier predistribution
    a.2.2. KI Taken at Optimal Time if No Evacuation Possible hurricane or ice storms might impede evacuation
    a.2.3. KI Taken at Optimal Time if Evacuation Delays possible if evacuation impeded by traffic or weather
    a.2.4. Ensure KI is Stored to ensure Stability KI might be stored in cars/wallets
  a.3. Minimize Harm from Inappropriate KI Administration a.3. Minimize Harm from Inappropriate KI Administration  
    a.3.1. Correct KI Dose Given (and Taken) for Age Large population of children
    a.3.2. First KI Dose Not Taken Too Late Weather or traffic might impede evacuation to KI stockpile site
    a.3.3. Adverse KI Side Effects (nonthyroid cancer) Minimized Some pre-existing thyroid cases in large population of older adults or mobile workers
B. Minimize Harm from Other Aspects of Incident B. Minimize Harm from Other Aspects of Incident B. Minimize Harm from Other Aspects of Incident  
  b.1. KI Procedures Dont Impede Evacuation b.1. KI Procedures Dont Impede Evacuation Transport network barely able to handle routine peak loads
  b.2. Avert Mortality and Morbidity from Radiation or Accidents b.2. Avert Mortality and Morbidity from Radiation or Accidents Transport network barely able to handle routine peak loads
  b.3. Minimize Panic/Anxiety due to KI Procedures b.3. Minimize Panic/Anxiety due to KI Procedures Large crowds possible
  b.4. KI Procedures Resource Use Not Excessive b.4. KI Procedures Resource Use Not Excessive Large population to cover for KI/predistribution and communication costs
  b.5. Simple KI Procedures before and during Incident b.5. Simple KI Procedures before and during Incident Multiple nearby jurisdictions
b.6. Educate Public to Respond to Nuclear Incident b.6. Educate Public to Respond to Nuclear Incident Emergency planning zone in one political jurisdiction
Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ) Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ) Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ) Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ)
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Suburban Site Example
Minimize Radiation Health Risks to Public Minimize Radiation Health Risks to Public Minimize Radiation Health Risks to Public Minimize Radiation Health Risks to Public Relevant Characteristics of Suburban Site Example
A. Minimize Radioactive Iodine Risk to Thyroid A. Minimize Radioactive Iodine Risk to Thyroid A. Minimize Radioactive Iodine Risk to Thyroid A. Minimize Radioactive Iodine Risk to Thyroid  
  a.1. Maximize KI Availability a.1. Maximize KI Availability a.1. Maximize KI Availability  
      a.1.1. Max. Availability for Children and Pregnant Women Residents Young families, expanding schools and day care, extensive busing
      a.1.2. Max. Availability for Other Residents Many working-age residents employed outside EPZ
      a.1.3. Max. Availability for Mobile Population Rapidly developing population, near major metro. area
  a.2. Optimize Ability to Take KI on Time a.2. Optimize Ability to Take KI on Time a.2. Optimize Ability to Take KI on Time  
      a.2.1. Max. Number of People who Know Where Pill is Possible new residents won't be covered by earlier predistribution
      a.2.2. KI Taken at Optimal Time if No Evacuation Occasional major snowstorms might impede evacuation
      a.2.3. KI Taken at Optimal Time if Evacuation Occasional major snowstorms might impede evacuation
      a.2.4. Ensure KI is Stored to ensure Stability KI might be stored in cars or wallets
  a.3. Minimize Harm from Inappropriate KI Administration a.3. Minimize Harm from Inappropriate KI Administration a.3. Minimize Harm from Inappropriate KI Administration  
      a.3.1. Correct KI Dose Given (and Taken) for Age Large population of children
      a.3.2. First KI Dose Not Taken Too Late Weather or traffic might impede evacuation to KI stockpile site
      a.3.3. Adverse KI Side Effects (nonthyroid cancer) Minimized Some pre-existing thyroid cases in older or retired residents
B. Minimize Harm from Other Aspects of Incident B. Minimize Harm from Other Aspects of Incident B. Minimize Harm from Other Aspects of Incident B. Minimize Harm from Other Aspects of Incident  
    b.1. KI Procedures Dont Impede Evacuation b.1. KI Procedures Dont Impede Evacuation Transport network might not be able to handle peak loads
    b.2. Avert Mortality and Morbidity from Radiation or Accidents b.2. Avert Mortality and Morbidity from Radiation or Accidents Buses available for children, two interstates rural two-lane roads
    b.3. Minimize Panic/Anxiety due to KI Procedures b.3. Minimize Panic/Anxiety due to KI Procedures Many day-care facilities, power plant second largest employer
    b.4. KI Procedures Resource Use Not Excessive b.4. KI Procedures Resource Use Not Excessive Moderate-size population to cover for KI predistribution and communication costs
    b.5. Simple KI Procedures before and during Incident b.5. Simple KI Procedures before and during Incident Two counties
b.6. Educate Public to Respond to Nuclear Incident b.6. Educate Public to Respond to Nuclear Incident Emergency planning zone in two counties
Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ) Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ) Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ) Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ) Assume all plans will stockpile KI at schools, hospitals, and jails in KI Planning Zone (KIPZ)
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Rural Site Example
Overall Objectives Overall Objectives Overall Objectives Relevant Characteristics of Rural Site Example
A. Minimize Radioactive Iodine Risk to Thyroid A. Minimize Radioactive Iodine Risk to Thyroid A. Minimize Radioactive Iodine Risk to Thyroid  
  a.1. Maximize KI Availability a.1. Maximize KI Availability  
    a.1.1. Max. Availability for Children and Pregnant Women Residents Small schools, extensive busing, few children
    a.1.2. Max. Availability for Other Residents Very small resident population of 15,000 in agricultural area
    a.1.3. Max. Availability for Mobile Population Power plant largest employer in county
  a.2. Optimize Ability to Take KI on Time a.2. Optimize Ability to Take KI on Time  
    a.2.1. Max. Number of People who Know Where Pill is Few residents
    a.2.2. KI Taken at Optimal Time if No Evacuation Unlikely winter snows or spring river flooding could block main roads
  a.2.3. KI Taken at Optimal time if Evacuation Unlikely winter snows or spring river flooding could block main roads
    a.2.4. Ensure KI is Stored to ensure Stability KI might be stored in leaky barns
  a.3. Minimize Harm from Inappropriate KI Administration a.3. Minimize Harm from Inappropriate KI Administration  
    a.3.1. Correct KI Dose Given (and Taken) for Age/Body size Small population of children
    a.3.2. KI Taken at Optimal Time Weather or traffic might impede evacuation to KI stockpile site
    a.3.3. Adverse KI Side Effects Minimized Small Chance of pre-existing thyroid cases in middle-aged residents
B. Minimize Harm from Other Aspects of Incident B. Minimize Harm from Other Aspects of Incident B. Minimize Harm from Other Aspects of Incident  
  b.1. KI Procedures Dont Impede Evacuation b.1. KI Procedures Dont Impede Evacuation Entire KIPZ can normally evacuate in lt 3 hours
  b.2. Avert Mortality and Morbidity from Radiation or Accidents b.2. Avert Mortality and Morbidity from Radiation or Accidents Two-lane and farm roads
  b.3. Minimize Panic/Anxiety due to KI Procedures b.3. Minimize Panic/Anxiety due to KI Procedures School buses available for children Power plant largest employer
  b.4. KI Procedures Resource Use Not Excessive b.4. KI Procedures Resource Use Not Excessive Small population to cover for KI predistribution and communication costs
  b.5. Simple KI Procedures before and during Incident b.5. Simple KI Procedures before and during Incident One county jurisdiction
  b.6. Educate Public to Respond Appropriately to Nuclear Plant Incident b.6. Educate Public to Respond Appropriately to Nuclear Plant Incident Emergency planning zone in one county
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Conclusions

• Dont aggregate to too high a level
• Give decision makers wiggle room
• Software with sliders allows real-time decision
  aiding and sensitivity analysis
• Decision analysts can play a significant role in
  structuring consideration of major political
  issues by serving on National Academy committees