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Week of 27 February 1998

Vol. I, No. 22

Feature Article

Occupational hazards

MED develops nuclear accident response training program

by Eric McHenry

Only the medical profession asks its members to handle both radioactive materials and the victims of radiation accidents. And in the countries of Central and Eastern Europe and the former Soviet Union -- many of which have busy and understaffed hospitals, antiquated nuclear power facilities they can't afford to retrofit or even maintain, and stores of abandoned weapons -- the threat radiation poses is particularly acute.

That's why the BU School of Medicine, in cooperation with the University of Massachusetts Medical School and the U.S. Department of Energy, has implemented an extensive nuclear accident training program primarily for physicians and first-responders from that region. It provides instruction in preparation and response measures to doctors, public health professionals, radiation protection officers, and nuclear physicists representing 15 countries. More important, it teaches them to train others in the same strategies.

Medical accidents are by far the largest source of radiation-related sickness and death, according to Erwin Hirsch, MED professor of surgery and director of trauma at the Boston Medical Center.

Erwin Hirsch

Erwin Hirsch Photo by David Keough

"The medical side of the house," says Hirsch, who directs the preparation and response program, "the medical-industrial complex, is single-handedly responsible for more radiation incidents than any other portion of society.

"We're not doing this primarily because of terrorism or because we believe that industrial plants are going to blow up," he says. "We're doing it because we recognize that accidents happen in hospitals, in research laboratories, and in industry and that radioactive materials can be misused by people who are not properly trained."

The program's "train the trainer" approach is unique and was undertaken for the first time last October at the Radiation Emergency Assistance Center/ Training Site (REAC/TS) in Oak Ridge, Tennessee.

"They are a subcontractor of BU on this project, and they carry out this kind of specialized training on their premises all year round," says project manager Kirsten Levy, administrative manager at MED. "What they haven't done in the past, what we've added, is the 'train the trainers' idea. You get a core group of faculty educated, and then they can go off after suitable preparation and teach others in their home countries.

"We train them in a standardized program, and then inter-regional protocols can be developed and they can collaborate amongst themselves," she says.

The project grew out of an existing partnership between MED and Emergency Hospital in the Republic of Armenia and has been underwritten by a $1 million grant from the International Atomic Energy Agency (IAEA), a United Nations subsidiary. Aram Chobanian, dean of MED and provost of the Medical Campus, says that an emergency medical care program upon which BU and the Armenian hospital were collaborating, with a 'train the trainer' component, served as a working model for the nuclear project.

Emergency Hospital is located approximately 40 kilometers from a nuclear power station that supplies nearly half of Armenia's energy. Although a devastating 1988 earthquake did not damage the station's reactor, officials chose to shut it down. The intensified need for power brought about by a regional war and an energy blockade, however, made resuming operation necessary.

"When they put it back on," Levy says, "our partner Ara Minassyan, chairman of Emergency Hospital, suggested that a nuclear accident training component be built into the hospital's emergency medicine and trauma preparedness programs. I came home and broached the subject to Dr. Hirsch, who happens to have credentials in the area."

Hirsch conceived of a more expansive program involving trainees from many nations and the collaboration with REAC/TS. Levy secured the IAEA sponsorship. Their contract began on June 10, 1997, and the first seminar was held in Oak Ridge on October 12. Over a period of two weeks participants learned how to prevent, prepare for, and manage nuclear accidents. They also received pedagogical training that will enable them to provide the same instruction to others. Recently Hirsch oversaw the program's first two "echo courses," one in Armenia and one in Moscow. Each of the original 29 participants attended one of these follow-up sessions, which were meant to facilitate implementation of training courses in their home countries by allowing them to begin teaching the material.

Creating this initial cohort of trainers, Levy says, is strategically smart for several reasons. Most of them represent financially beleaguered nations, and sending wave after wave of trainees to the United States would be prohibitively expensive. Moreover, there are obvious advantages to teaching accident prevention and response on the sites where the accidents might theoretically occur.

"They're going to be facing such incidents, if they face them, in their countries," says Levy, "and so they should be training in the environment that's most familiar to them, using the materials that are going to be available to them."

Chobanian says that the IAEA has recognized and commended the program's success through its first two phases.

"There's tremendous enthusiasm for it," he says. "Each of the courses thus far has succeeded in its goals, almost beyond expectation. The sponsoring group is exceedingly happy and is asking, in a preliminary way, whether we'd be willing to think of expanding to other countries."