University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Multiple Objective Decision

University of California, IrvinePresentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004

Multiple Objective Decision Analysis for Potassium Iodide Distribution in

Nuclear Incidents

L. Robin KellerTianjun “Mike” Feng and Qiang “David” Zeng

UC Irvine


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



Health RiskIf 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)


Disaster at Chornobyl Nuclear Power Plant in Ukraine in 1986


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)


Protective MeasuresPrimary: 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


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


Process Background• Massachusetts Congressman Edward J.

Markey’s 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


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


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


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


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


Objectives Hierarchy

a.1.1. Max. Availability for Children & Pregnant Women

a.1.2. Max. Availability for Other Residents

a.1.3. Max. Availability for Mobile Population

a.2.1. Max. Number of People who Know Where Pill is

a.2.2. KI Taken at Optimal time if No Evacuation

a.2.3. KI is Taken at Optimal Time if Evacuation

a.2.4. Ensure KI is Stored to Assure Stability

a.3.1. Correct KI Dose Given (and Taken) for Age

a.3.2. First KI Dose Not Taken Too Late

a.3.3. Adverse KI Side Effects (non-thyroid cancer) Minimized

a.1. Maximize KI Availability

a.2. Optimize Ability to Take KI on Time

a.3. Minimize Harm from Inappropriate KI Administration

b.1. KI Procedures Don’t Impede Evacuation

b.2. Avert Mortality and Morbidity from Radiation or Accidents

b.3. Minimize Panic/Anxiety due to KI Procedures

b.4. KI Procedures’ Resource Use Not Excessive

b.5. Simple KI Procedures before/during Incident

b.6. Educate Public to Respond to Nuclear Incident

A. Minimize Radioactive Iodine Risk to Thyroid

B. Minimize Harm from Other Aspects of Incident

MINIMIZE RADIATION HEALTH RISKS


• Note: minimizing cost is not an objective


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


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

Planning Region


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


Urban Site Example

Minimize Radiation Health Risks to Public Relevant Characteristics of Urban Site Example



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.2.1. 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.3.1. 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)

MinimizedSome pre-existing thyroid cases in large population of older adults or mobile

workers


b.1. KI Procedures Don’t Impede Evacuation Transport network barely able to handle routine peak loads

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 Large crowds possible

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 Multiple nearby jurisdictions

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)


Suburban Site Example

Minimize Radiation Health Risks to Public Relevant Characteristics of Suburban Site Example




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.2.1. 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.3.1. 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.1. KI Procedures Don’t Impede Evacuation Transport network might not be able to handle peak loads

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 Many day-care facilities, power plant second largest employer


Moderate-size population to cover for KI predistribution and communication costs

b.5. Simple KI Procedures before and during Incident Two counties

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)


Overall Objectives Relevant Characteristics of Rural Site Example




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.2.1. 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.3.1. 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.1. KI Procedures Don’t Impede Evacuation Entire KIPZ can normally evacuate in < 3 hours

b.2. Avert Mortality and Morbidity from Radiation or Accidents Two-lane and farm roads

b.3. Minimize Panic/Anxiety due to KI Procedures School buses available for children; Power plant largest employer


Small population to cover for KI predistribution and communication costs

b.5. Simple KI Procedures before and during Incident One county jurisdiction

b.6. Educate Public to Respond Appropriately to Nuclear Plant Incident Emergency planning zone in one county

Rural Site Example


Conclusions• Don’t 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

Documents

University of California, Irvine Presentation in Decision Analysis Society Cluster at INFORMS Conference, Denver, Oct. 2004 Multiple Objective Decision