Protective Action Questions and Answers for Radiological and Nuclear Emergencies:A companion document to the U.S. Environmental Protection Agency Protective Action Guide (PAG) Manual


vvEPA

United States
Environmental Protection
Agency

EPA-402-F-23-001 | September 2023
www.epa.gov/radiation/pag-public-communication-resources

Protective Action
Questions & Answers for
Radiological and Nuclear Emergencies

A companion document to the

U.S. Environmental Protection Agency	||

Protective Action Guide (PAG) Manual	j #

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Protective Action
Questions & Answers for
Radiological and Nuclear Emergencies:

A companion document to the
U.S. Environmental Protection Agency
Protective Action Guide (PAG) Manual

This the second update to the September 2017 publication. The 2022
update replaces non-specific language about the health effects of
radiation with messages on the risks of cancer and Acute Radiation
Syndrome that can be used when dose estimates become available.
This 2023 update reflects advances in radiation protection science
and communication.

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Foreword

One of the most critical factors in the success of a radiological response is the effectiveness of
public communication. "The timely and effective flow of information between agencies and the
public is vital for facilitating and encouraging appropriate protective actions, reducing rumors
and fear, maintaining public trust and confidence, and reducing morbidity and mortality,"1

Pre-scripted radiation emergency public safety messages will both improve timeliness and
increase consistency of the information communicated, which will enhance emergency plan-
ners' ability to effectively communicate with the largest number of people. Social media and the
24-hour news cycle have created an expectation for answers and information on an accelerat-
ed schedule; both the media and the public want access to updated information on crises on
various information platforms throughout the day. These answers will help your department or
organization to meet and exceed that expectation.

This document is intended to help emergency planners prepare public communications prior
to and during a radiological emergency; it is designed to be worked into emergency response
plans and standard operating procedures. Each radiological emergency is unique; the messag-
es contained in this book need to be adapted for the specific emergency at hand.

Based on the safety measures in the U.S. Environmental Protection Agency (ERA) Protective
Action Guide (PAG) Manual, this document is applicable to all types of radiological emergencies
that may necessitate the implementation of a protective action. It complements the planning
considerations presented in the PAG Manual and Federal Emergency Management Agency's
incident-specific messaging documents Improvised Nuclear Device Response and Recovery:
Communicating in the Immediate Aftermath and Communicating During and After a Nuclear
Power Plant Incident.

The questions and answers in this document represent the best of the work produced through
other government emergency radiological communications efforts. This document includes
new messages addressing potassium iodide administration and populations that require spe-
cial consideration, including pregnant and breastfeeding women, children, and individuals with
disabilities.

Ideally, these messages never will be needed; nevertheless, we have a responsibility to be pre-
pared to empower the public by effectively communicating how people can protect themselves
and their families in the event of a radiological or nuclear emergency.

1 Becker, S. 2004. ''Emergency communication and information issues in terrorist events involving radioactive materials." Biosecurity and
Bioterrorism: Biodefense Strategy, Practices, and Science 2 (3); 195-207.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Contents

Protective Action Guidance	1

1.	What is a protective action?	1

2.	How do people know which steps to take?	1

3.	What are the PAGs?	1

4.	Who uses the PAGs?	1

5.	What kinds of steps are included in the PAG Manual?	2

6.	What is evacuation? What is sheltering? What is the difference?	2

7.	What other steps might officials ask people to take?	2

8.	How do officials know when to carry out protective actions?	3

9.	Wouldn't it make more sense to carry out all of the protective actions right

away as soon as a radiation emergency occurs?	3

10.	Why don't officials just automatically advise everyone to evacuate

when a radiation emergency occurs?	3

11.	Are there controls on food?	.4

12.	Are there controls on drinking water?	4

13.	When should I take potassium iodide?	4

14.	Do the PAGs continue to play a role in protecting people after the immediate
emergency is over?	5

15.	What is the basis for the PAGs?	5

16.	Where can I find out more about protective actions?	5

Affected Community: Immediate Actions	6

17.	If I am outside, what steps should I take to protect myself and my

loved ones?	6

18.	If I am inside a building, what steps should I take to protect myself and

my loved ones?	7

19.	If I am in a car or truck, what steps should I take to protect myself and

my loved ones?	7

20.	If I am in a potentially affected community, what steps should I take to

protect myself and my loved ones?	8

21.	What should people do if they are on a boat near the affected area?	8

22.	What should people do if they're told to evacuate?	9

23.	Are care shelters available for people who are evacuating?	9

24.	There is a protective action on the next street but not on mine. How do

I know I am safe?	9

25.	A radiological release occurred. Why haven't I been issued safety

precautions?	10

26.	Why are the recommended actions changing, and which one should

I follow?	10

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Potassium Iodide (Kl): Important Information	11

27.	What is potassium iodide? How does it work?	11

28.	Should my family take potassium iodide?	11

29.	What types of incidents release radioactive iodine?	11

30.	Will potassium iodide protect me from radiation?	11

31.	Are over-the-counter medicines that contain iodine, such as disinfectants

or throat sprays, a good suPstitute for potassium iodide?	12

32.	What about taking household disinfectants or antiseptics that contain

iodine? Are these a good substitute for potassium iodide?	12

33.	Is taking large amounts of iodized salt a good substitute for potassium

iodide?	12

34.	Are herbs or herbal products a good substitute for potassium iodide?	13

35.	Are there other medications or supplements I can take to minimize

my risk?	13

36.	Do people need a prescription to obtain potassium iodide?	13

Additional Information: Situation Specifics	14

37.	Where should II go for information about the situation?	14

38.	I am seeing a lot of information and instructions on Internet blogs about

what to do. Should I follow that advice?	14

39.	I received a text message giving me instructions on what to do. How do

I tell if it is an official message or a fake?	14

40.	How many people have been injured or killed?	15

41.	Where is the radioactive material located?	15

42.	Where is the radioactive dust and smoke going?	15

43.	What is a plume?	15

44.	What should I do if I come across an object that might be radioactive?	15

45.	What are emergency responders doing now?	16

46.	How can people learn about the safety of their family members?	16

47.	What will happen to people in the affected neighborhoods?	16

48.	How can the public help?		16

49.	When will it be safe for people to return to their homes and businesses?	17

50.	Will this affect air travel?	17

51.	Will this affect travel on waterways, both at home and abroad?	17

Radiation Health Effects	18

52.	What is radiation?	18

53.	What is radioactive material?	18

54.	Is there any way for me to tell if radioactive materials are present or if

I am being exposed to radiation?		18

55.	What are millirem (mrern) and millisieverts (mSv)?	18

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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56.	What is a curie (Ci) or a bequerei (Bq)?	19

57.	Will people who have been exposed to the radiation get cancer?	19

58.	Is radiation contagious?	20

59.	Are people at risk for radiation poisoning or sickness?	21

Food, Water and Air Safety	22

60.	Is the food safe to eat?	22

61.	Can people eat food from their gardens or locally caught fish and game?	22

62.	Is the water safe to use?	22

63.	What should farmers do with their crops?	23

64.	What should farmers and ranch owners do with livestock?	23

65.	Is the air safe to breathe?	23

Decontamination	25

66.	If people are told by health and emergency management officials to
self-decontaminate, what does this mean?	25

67.	How quickiy does an exposed person have to remove contamination

from their body?	26

68.	I am injured, and I think my wound is contaminated. What should I do?	26

69.	Is it safe for me to let someone who might have been affected by the

radiological incident into my home?	26

70.	How should people decontaminate their homes and their possessions?	27

Exposure Versus Contamination	28

71.	How do I know if I've been exposed to radiation or contaminated by

radioactive materials?	28

72.	What is the difference between radiation exposure and radioactive

contamination?	28

Special Issues and Concerns: Pregnancy and Breastfeeding	29

73.	I am pregnant. Is my baby in danger?	29

74.	Is it safe to breastfeed?	29

75.	Can pregnant women take potassium iodide pills?	31

76.	Can breastfeeding women take potassium iodide?	31

77.	I am trying to get pregnant. Should I worry that my future children will

be affected?	31

Special Issues and Concerns: Children	32

78.	What should I do about my children and family? Should I leave to

find my children?	32

79.	What is being done to protect children in school?	32

Protective Action Questions & Answers for Radiological and Nuclear Emergencies	iv

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80.	If some of the radioactive dust got on my clothes or skin, will I contaminate

my child? Is it safe for me to be around my child?	32

81.	Is it okay for me to give my child a bath?	32

82.	If people need to be decontaminated at a reception center or other location,

will I be able to stay with my children while they are decontaminated?	33

83.	Does my child need to have his/her thyroid scanned?	33

84.	What kind of emotional impact can a radiological incident have on

children? What should I look out for?	33

85.	Are children exposed to radiation at higher risk of harm?	34

86.	Should my children take potassium iodide?	34

Special Issues and Concerns: People With Disabilities

or Special Medical Needs	35

87.	If I go through decontamination at a reception center or other facility,

will my eyeglasses or contact lenses be taken away?	35

88.	I have a prosthetic limb. If I have to be decontaminated to remove

radioactive dust, will my prosthetic limb have to be taken away?	35

89.	Is there a general list of the kinds of devices, adaptive equipment,

prostheses and mobility aids that can be decontaminated?	35

90.	What if my service animal is found to be contaminated?	36

91.	How are service animals decontaminated?	36

92.	What should people do if they don't have access to their life-sustaining

medications?	36

93.	I receive radiation treatments for medical reasons. Should I stop my
treatments because I might have been exposed to radiation from

the emergency?	36

Special Issues and Concerns: Pets	37

94.	If people have been told to stay inside and self-decontaminate during
a radiation emergency, what should they do with their pets? How do I
decontaminate my pet?	37

95.	Is the water safe for my pet to drink?	37

96.	Is pet food safe for my pet?	37

97.	What should I do if my pet needs to go outside to use the bathroom?	38

Appendix—Radiation Communication Resources From
Emergency Support Function 15: Annex N	39

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Protective Action Guidance

1.	What is a protective action?

A protective action is an urgent step that people can take to protect their health and the
health of their loved ones from radiation in a nuclear or radiation emergency.

The main protective actions that the public might be asked to take are evacuation or
sheltering (staying inside).

2.	How do people know which steps to take?

Health and emergency management officials will tell the public if protective actions are
needed and which steps, whether evacuation or staying inside, will be most effective for
avoiding radiation.

Officials make these decisions about how to protect public health by using information
about local conditions and by following the recommendations in the Protective Action
Guide (PAG) Manual.

Be aware that as conditions change, the guidance also may change. Stay tuned for
updates.

3.	What are the PAGs?

PAGs, or Protective Action Guides, are radiation dose guidelines that would trigger
public safety measures, such as evacuation or staying inside, to safeguard public health
during a radiation emergency. The U.S. Environmental Protection Agency developed the
PAGs to help responders plan for and respond to radiation emergencies.

Every emergency is different, and the best action or set of actions in one situation may
not be appropriate at another time or in another situation.

Officials use the PAGs, combined with their existing local knowledge, to help them
make the very important decisions about which emergency steps are warranted and
when those steps should be enacted.

4.	Who uses the PAGs?

State, local and tribal governments have the main responsibility for taking measures to
protect life and health.

In a radiation emergency, state, local and tribal emergency response agencies use the
Protective Action Guides to decide when special actions are needed to avoid radiation
exposure and protect people's health.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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5- What kinds of steps are included in the PAG
Manual?

The Protective Action Guide (PAG) Manual includes actions that both government agencies
and members of the public can take to protect people's health in a radiation emergency.

In the beginning of a radiation emergency, the public might be asked to take one of
two main protective actions to avoid exposure to radiation: evacuation or sheltering
(staying inside). The PAGs also provide guidance on food safety and administration of
potassium iodide.

6.	What is evacuation? What is sheltering? What is
the difference?

Evacuation involves urgently moving people away from a specific area to avoid or mini-
mize health and safety risk.

Sheltering, on the other hand, involves having people stay inside their homes, offices,
schools or other buildings to reduce exposure to an outdoor hazard.

7.	What other steps might officials ask people to
take?

Depending on the situation, evacuation or sheltering may be supplemented by other
measures.

Limited Access—One possible step is to keep people out of the affected area by limit-
ing access to it.

Decontamination—Another step involves decontamination, which means remov-
ing radioactive particles that may have fallen onto a person's clothes, skin or hair.
Decontamination is done by having people wash or shower and change clothes.

Food—Sometimes officials may take steps to stop people and animals from consuming
certain foods if those foods may be contaminated. Authorities also may act to prevent
livestock from grazing in potentially contaminated areas and instead have the animals
drink water and eat feed that has been previously stored.

Water— If alternative drinking water is needed, officials can provide bottled water,
change the water source (such as switching to ground water), reroute water from an
unaffected water system or choose a combination of these actions.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Potassium Iodide— Potassium iodide (Kl) is a nonradioactive form of iodine. Ki can be
useful in situations where radioactive iodine has been released into the environment. Kl
works by filling a person's thyroid gland with stable iodine so that harmful radioactive
iodine is not absorbed, reducing the risk of thyroid cancer in the future. Kl is not an
"anti-radiation" drug. Never take Kl or give it to others unless you have been specific-
ally advised to do so by public health officials, emergency management officials or
your doctor,

8.	How do officials know when to carry out
protective actions?

When a radiation emergency occurs, officials will use available information and comput-
er models to quickly predict how much radiation people could potentially receive from
the incident.

Officials then use the Protective Action Guides to determine what actions to take to
avoid or minimize that potential exposure.

Expect recommended actions to be updated as the response evolves. Stay tuned to
television, radio and government emergency management websites for updates.

9.	Wouldn't it make more sense to carry out all of
the protective actions right away, as soon as a
radiation emergency occurs?

No. Different safety measures are used for different situations.

Taking all of the safety measures at once is not possible: For example, people should
not be told to stay inside and evacuate at the same time. Also, evacuating people when
it is unnecessary increases the chance of accidents and injuries.

Officials need to identify the threat the emergency poses to people so they can provide
the best advice on how to protect health. Actions will be determined based on available
information, with the immediate and most severe safety threats being addressed first.

10.	Why don't officials just automatically advise
everyone to evacuate when a radiation emergency
occurs?

In some situations, sheltering may be a better choice for preventing or reducing radi-
ation exposure. For example, if a cloud containing radioactive particles is expected to
pass over an area soon and then leave quickly, evacuation could actually expose peo-
ple to more radiation than staying inside.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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This is because evacuation takes time, and many people might be caught outside or in
their cars when the cloud passed over. People staying inside while the cloud passes by
would be more protected than those caught outside trying to evacuate.

Also, in some situations, evacuation may not be practical. For example, blocked high-
ways, power outages or severe weather could make evacuation difficult.

Officials using the Protective Action Guides and information about local conditions will
tell the public what steps are needed in a radiation emergency Follow the instructions
so that you do what is needed to protect yourself and your loved ones.

11. Are there controls on food?

Officials might advise against eating vegetables from home gardens.

In some situations, officials also might determine that it is necessary to take actions to
prevent radioactive material from entering the food supply

Steps might involve preventing livestock from grazing in potentially contaminated pas-
tures or fields and ensuring that animals eat and drink only feed and water that had
been previously stored.

When necessary, officials also might act to stop certain foods from coming to market or
limit consumption of certain foods that might be contaminated.

12. Are there controls on drinking water?

If alternative drinking water is needed, officials can provide bottled water, change the
water source (such as switching to ground water), reroute water from an unaffected
water system or choose a combination of these actions.

13. When should I take potassium iodide?

Never take potassium iodide (Kl) or give it to others unless you have been specifically
advised to do so by public health officials, emergency management officials or your doctor.

Kl is a nonradioactive form of iodine that can be useful in situations where radioactive
iodine has been released into the environment. It works by filling a person's thyroid
gland with stable iodine so that harmful radioactive iodine is not absorbed, reducing the
risk of thyroid cancer in the future.

Kl is not an "anti-radiation" drug. Kl is issued only in situations involving radioactive
iodine, and it protects only the thyroid gland; it does not help in situations involving
other types of radioactive releases, nor does it help protect other parts of the body.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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14.	Do the PAGs continue to play a role in protecting
people after the immediate emergency is over?

Yes, it is possible that protective actions, including food safety measures, will stay in
place to protect people until the area has been cleaned up.

One such cleanup measure is decontamination of land and property, which involves
cleaning radioactive contamination from an area so that people can return to their
homes and businesses. When this is not possible, another measure—relocation—may
be required. Relocation involves moving people out of an area permanently. An addi-
tional protective action may involve continuing to place controls on food and water.

15.	What is the basis for the PAGs?

The Protective Action Guides (PAGs) are radiation dose guidelines, or "trigger levels,"
designed to prevent immediate harmful health effects from radiation while balancing
the risks of developing cancer against the risks of protective actions, such as accidents
from evacuation.

Balancing the risks between radiation exposure and protective actions is important. For
example, evacuations present additional health and safety risks from traffic accidents
and stress-related illnesses. The PAG Manual provides updated planning considerations
based on the lessons learned from the 2011 evacuations related to the nuclear power
plant release in Fukushima, Japan.

16.	Where can I find out more about protective
actions?

We are strongly committed to keeping the public informed and to answering peo-
ple's questions. If you want to learn more about the Protective Action Guides (PAGs),
please go to www.epa.aov/radiation/Drotective-action-auides-Daas.

For information about [INSERT NAME OF RESPONSE HERE] protective actions, please
contact us on the web at [INSERT AGENCY WEBSITE HERE] or by telephone at

[INSERT AGENCY CONTACT NUMBER HERE],

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Affected Community: Immediate Actions

17. If I am outside, what steps should I take to protect
myself and my loved ones?

Doctors, scientists and health experts recommend a few simple steps that will help pro-
tect you and your loved ones.

If you are outside—

Cover your nose and mouth Covering your nose and mouth with a cloth can reduce
the risk of breathing in or swallowing radioactive material. You also may use a dispos-
able mask, such as a dust mask, if one is immediately available.

Don't touch objects or debris related to the release—they could be contaminated with
radioactive material.

Go inside and stay inside. Quickly go into a building where the walls and windows
have not been broken. Close all doors and windows. Go to the basement or middle of
the building. This will help shield you from any radiation that might be outside.

Remove your outer clothes. Once you are inside, carefully take off your outer layer
of clothing. Do this in case any radioactive material fell onto your clothes while you
were outside.

Put the clothing in a plastic bag and tie it shut, if possible. Be sure to keep the plastic
bag away from people and animals.

Shower or wash off. If possible, take a warm shower with lots of soap. Don't scald or
scratch your skin. Wash your hair. When washing, try to keep the suds and water from
entering your mouth, and don't swallow the water. Parents or other adult caregivers
should give children a shower or wash them following these directions.

If you cannot shower, use a wet wipe or clean wet cloth to wipe any skin that was not
covered by clothing (such as your hands and face).

Gently blow your nose and gently wipe your eyelids, eyelashes and ears with a clean
wet cloth.

Put on clean clothes. Clothing stored in a closet or away from radioactive material is
clean. If you do not have clean clothes, carefully brush off your outer layer of clothing
and get dressed again, Rewash your hands, face and exposed skin at a sink or faucet.

Tune in. Stay tuned to television, radio and government emergency management web-
sites for updates.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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18. If I am inside a building, what steps should I take
to protect myself and my loved ones?

Doctors, scientists and health experts recommend a few simple steps that will help pro-
tect you and your loved ones.

If you are in a building—

Stay inside. If the walls and windows of the Puilding are not broken, stay in the building
and don't leave.

If the walls and windows of the building are broken, go to an inside room and don't
leave. If the building has been heavily damaged, quickly go into another building where
the walls and windows have not been broken.

Close doors and windows. To keep radioactive material from getting inside, shut all
windows, outside doors and fireplace dampers. It is not necessary to put duct tape or
plastic sheets around doors or windows.

If weather conditions permit, close the windows and turn off the fan, air conditioner or
heater. Otherwise, set the fan, air conditioner or heater on recirculate. In-room fans (for
example, ceiling fans) that only recirculate indoor air are okay to use. Air-conditioning
systems in large buildings can be used if they are set on recirculate.

If you must go outside, follow the "if you are outside" instructions in question 17.

19. If I am in a car or truck, what steps should I take
to protect myself and my loved ones?

Cars and trucks provide little protection from radiation.

If you are in a car or truck—

Shut the windows and vents. Close the windows and turn off the fan, air conditioner
or heater if weather conditions permit. Otherwise, set the fan, air conditioner or heater
on recirculate.

Go inside and stay inside. If you are near your home, office or a public building where
the walls and windows have not been broken, go there immediately and go inside
quickly. Close all doors and windows. Go to the basement or middle of the building.

This will help shield you from any radiation that might be outside.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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If you cannot get to your home or another building safely pull over to the side of the
road and stop in the safest place possible. Turn off the engine and stay in the car until
you are told it is safe to get back on the road. Cars offer more protection than being
outside.

If it is a hot or sunny day try to stop under a bridge or in a shady spot so you and your
passengers don't overheat.

Tune in. Listen to the car radio or check government emergency management web-
sites for more instructions.

20. If 1 am in a potentially affected community, what
steps should I take to protect myself and my loved
ones?

If you are in a potentially affected community-

This will help shield you from any radiation that might be outside.

The wind can sometimes carry radioactive material from the site of the release. As a
precaution, people should stay inside for their personal safety until authorities say it is
okay to leave.

Tune in. Stay tuned to television, radio and government emergency management web-
sites for updates.

21. What should people do if they are on a boat near
the affected area?

Like cars, boats do not provide adequate protection from radioactive material. Tune in
to the radio for more information about the location of the radioactive material.

If you are in a boat, you have two choices:

• Return to a marina or boat landing, find a building and immediately go inside, OR

• Get information about the location of the radioactive material and navigate to a
distance far enough away from the incident.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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22.	What should people do if they're told to evacuate?

If you are told to evacuate, leave the area immediately.

When the public evacuates, they are moved to safer areas depending on levels of radia-
tion and radioactive material to keep exposures as low as possible.

If you are told to evacuate—

•	Pay close attention to what officials are telling you.

•	Take the designated routes to the location where you will be registered and
checked for contamination. A list of these locations can be found at [INSERT
AGENCY WEBSITE HERE],

•	If easily accessible, bring identification cards and medications with you.

•	Follow the instructions from law enforcement personnel.

Transportation will be provided to those who need it, including accessible transportation
for people with disabilities.

Limit phone calls to emergencies only, so those who need immediate help can be
answered quickly. Text messaging may work better during high-volume periods be-
cause it does not require as much bandwidth as a phone call.

23.	Are care shelters available for people who are
evacuating?

Yes, designated shelters have been opened.

You should first go to a designated location to be checked for contamination. Then you
can go to a shelter, or you can stay at a hotel or with family or friends.

24.	There is a protective action on the next street but
not on mine. How do 1 know 1 am safe?

Protective actions include buffer areas for safety. If you have not been issued a safety
precaution, it is because you are outside the affected and buffer areas. Safety precau-
tions may be updated as more information becomes available. Stay tuned to television,
radio and government emergency management websites for updates.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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25.	A radiological release occurred. Why haven't I
been issued safety precautions?

Safety precautions are not needed. The release was [TOO SMALL, TOO FAR AWAY,

CONTAINED PARTICLES THAT WERE TOO HEAVY TO TRAVEL VERY FAR, ETC.] to
necessitate safety precautions.

Even if radiation from the event is detected at your location, the levels will be so low that
taking a safety precaution may do more harm than good. Balancing the risks between
radiation exposure and protective actions is important. For example, evacuations pres-
ent additional health and safety risks from traffic accidents and stress-related illnesses.

26.	Why are the recommended actions changing, and
which one should I follow?

The recommended actions are being updated because the authorities have access
to better, more recent information about the event. The recommended actions are
designed to minimize risk to the affected population. You always should follow the
most recent recommended actions for your group/area.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Potassium Iodide (Kl): Important
Information

27. What is potassium iodide? How does it work?

Potassium iodide (Kl) is a nonradioactive form of iodine.

Kl is issued only in situations where radioactive iodine has been released into the envi-
ronment, and it protects only the thyroid gland.

Kl works by filling a person's thyroid gland with stable iodine so that the harmful radio-
active iodine from the release is not absorbed, reducing the risk of thyroid cancer in the
future.

You should take Kl only if you have been specifically advised to do so by local public
health officials, emergency management officials or your doctor. It is not an "anti-
radiation" drug.

28. Should my family take potassium iodide?

Never take potassium iodide (Kl) or give it to others unless you have been specifically
advised to do so by the health department, emergency management officials or
your doctor.

Kl reduces risk from radioactive iodine only if taken very close to the time of exposure. It
is not an "anti-radiation" drug.

29. What types of incidents release radioactive iodine?

Radioactive iodine might be released during a nuclear power plant incident or a nuclear
detonation. In the case of a nuclear power plant release, the plant operators will know if
radioactive iodine has been released into the environment and will inform local officials
so that decisions on distributing potassium iodide can be made quickly.

30. Will potassium iodide protect me from radiation?

Potassium iodide (Kl) protects only the thyroid gland from radioactive iodine. It does not
provide protection from any other kind of radiation exposure.

Kl pills are not "radiation antidotes." Kl should be taken only if there is a specific public
health recommendation to do so.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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31. Are over-the-counter medicines that contain
iodine, such as disinfectants or throat sprays, a
good substitute for potassium iodide?

No. Over-the-counter medicines will not protect your thyroid, and some could be dan-
gerous to your health. It is true that many over-the-counter medicines contain some
form of iodine, such as iodine liquid for cuts and sores, disinfectants, and throat sprays.
These should never be taken as a substitute for potassium iodide (Kl). The amount of
iodine contained in most of these products is small and would have no protective effect
against radioactive iodine.

Over-the-counter medicines always should be used as directed. Some topical medi-
cines might contain ingredients that can be harmful if ingested.

Never take Kl or give it to others unless you have been specifically advised to do so by
the health department, emergency management officials or your doctor.

32. What about taking household disinfectants or
antiseptics that contain iodine? Are these a good
substitute for potassium iodide?

No. Household cleaners will not protect your thyroid. Drinking or consuming them could
poison you.

33. Is taking large amounts of iodized salt a good
substitute for potassium iodide?

No. Iodized salt will not protect your thyroid. It is true that iodized salt contains small
quantities of iodine, but the amount is too low to prevent radioactive iodine from being
absorbed by the thyroid.

Furthermore, although most people don't realize this, it could even be dangerous. The
main ingredient in salt—sodium chloride—can make people very ill if taken in large
amounts. Even tablespoons of salt taken repeatedly over a short period of time can
cause poisoning. Eating large amounts of salt also can cause high blood pressure and
other medical problems.

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34.	Are herbs or herbal products a good substitute for
potassium iodide?

No. Herbs will not protect your thyroid and could even be dangerous to your health. It is
true that some herbs and herbal products may contain iodine. But the amount of iodine
is not regulated, so it is not possible to know how much iodine you will be getting.

Taking large amounts of herbs or herbal products could endanger your health.

35.	Are there other medications or supplements 1 can
take to minimize my risk?

Other medications and radiation countermeasures can be used in rare cases, but take
those medications only when directed by the authorities or your doctor.

36.	Do people need a prescription to obtain potassium
iodide?

No. If public health and emergency management officials determine that taking
potassium iodide is appropriate, the pills will be provided to people at no cost.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Additional Information: Situation Specifics

37.	Where should I go for information about the
situation?

Stay tuned to television, radio and government emergency management websites for
updates.

Public health and emergency management officials will provide regular updates. You
also can go to the following website or toll-free hotline for information:

•	[INSERT AGENCY WEBSITE HERE]

•	[INSERT AGENCY PHONE NUMBER HERE]

38.	! am seeing a lot of information and instructions
on Internet blogs about what to do. Should I follow
that advice?

Check official sources first. You can find the latest information at [INSERT WEBSITE
HERE],

Blogs, social media and the Internet in general can provide useful information, but only if
the source is known and trustworthy.

Unfortunately, we know from past disasters and emergencies that small numbers of
individuals may take the opportunity to distribute false information. Even well
intentioned individuals can sometimes pass on incorrect information or rumors.

Therefore, double-check what you are reading with the information and instructions
being provided by the official website listed above, the official toll-free hotline, or local
radio and television broadcasts.

In an emergency, get information from reliable sources so that you can protect your
health and the health of loved ones.

39.	I received a text message giving me instructions
on what to do. How do I tell if it is an official

message or a fake?

If the government has issued an emergency text message, it will be clearly identi-
fied as coming from [INSERT INFORMATION. That is, the sender will read [INSERT
INFORMATION],

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Unfortunately, we know from past disasters and emergencies that small numbers of
individuals may use the situation to send out official-looking false information. Even
well-intentioned individuals can pass on incorrect information or rumors.

If you are unsure about a message, cross-check what you are reading with the informa-
tion and instructions being provided by the official website or the official toll-free hotline.

•	[INSERT AGENCY WEBSITE HERE]

•	[INSERT AGENCY PHONE NUMBER HERE]

40.	How many people have been injured or killed?

At this time, we do not yet know the specific number of casualties. An update will be
provided as soon as reliable information becomes available.

Right now, we are focused on getting help to people in the affected area as quickly and
safely as possible.

41.	Where is the radioactive material located?

Radiation and environmental health experts are checking air, water and ground condi-
tions in and around the release site to locate the areas with radioactive contamination.
Stay tuned to radio or television, or visit [INSERT AGENCY WEBSITE HERE] for the
latest information.

42.	What is a plume?

A plume is the cloud of radioactive material moving away from the incident site. A ra-
dioactive plume is not likely to be visible, but can be detected with radiation detection
instruments.

43.	Where is the radioactive plume going?

According to current weather predictions, the areas [DIRECTION] of [CITY] could be in
the path of the radioactive plume.

Until advised otherwise, people in neighborhoods and communities that could be in this
path should stay inside.

44.	What should I do if I come across an object that
might be radioactive?

Don't approach, pick up or touch debris or other objects that may be contaminated
with radioactive material. These objects could be dangerous, especially in the immedi-
ate vicinity of the incident.

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45. What are emergency responders doing now?

Emergency responders, radiation experts, scientists and representatives from all levels
of government are working together to protect the public and save lives.

If terrorism is suspected: Law enforcement is working to identify and apprehend those
responsible.

46. How can people learn about the safety of their
family members?

Use text messages instead of phone calls to try to reach your family and loved ones.

If phone lines or other types of communication infrastructure are damaged, or if the
lines are clogged, you may not be able to complete a phone call.

If you have access to a computer or a Web-enabled device, use e-mail, social media
websites like Facebook and Twitter, or online registries such as the Red Cross Safe and
Well website.

Emergency responders are gathering and organizing all vital information available. If you
are separated from your family or loved ones, search online for registries where people
can identify themselves and their location.

Bear in mind that it may take time for registries to put in the latest information. You can
seek additional information and counseling services at [LIST ORGANIZATIONS OR
LOCATIONS],

47. What will happen to people in the affected
neighborhoods?

/As appropriate: Lives have been lost, people have been injured, and homes and busi-
nesses have been destroyed.

All levels of government are coordinating their efforts to do everything possible to help
the people affected by this emergency.

As lifesaving activities continue, follow the instructions from emergency responders.
These instructions are for your safety and the well-being of your loved ones. The in-
structions are based on the best information we have right now; the instructions will be
updated as more information becomes available.

48. How can the public help?

Your help is vital in this situation.

Here are six important steps you can take to help:

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1. Don't abandon your car on the road. Instead, park your car where it won't
block traffic. This will allow responders to reach people who need help.

2. Don't go near the release site. It could put you in danger and prevent emer-
gency responders from doing their jobs.

3. Use text messaging. Phone lines might overload; use text messaging to communi-
cate with your friends and family. Text messages might be more likely to go through.

4. Don't go to the hospital, police stations or fire stations unless you have
a medical emergency. These facilities will be busy responding to the incident
and need to be available to those who are seriously injured or have another
medical emergency requiring immediate treatment.

5. Stay alert. If you see anything suspicious, contact your local police or the FBI
right away.

6. Stay tuned. We will continue to update you through television, radio and emer-
gency management websites.

49. When will it be safe for people to return to their
homes and businesses?

Federal, state and local partners are collecting information about the hazards in the af-
fected areas. Until this is done, we cannot predict when people can begin returning to
the area.

If you have been evacuated, do not return until you are told it is safe to do so by
authorities. Please don't put yourself or your family in danger by attempting to return
early. Returning early could interfere with responders' efforts to help those who need
immediate assistance.

50. Will this affect air travel?

Until we have more information, expect air travel in and near the affected area to be restricted.

Limiting air travel keeps airline crews and passengers safe and keeps the airspace free
for response and recovery efforts.

51. Will this affect travel on waterways, both at home
and abroad?

Until we have more information, expect the use of navigable waterways in the affected
area to be restricted.

Limiting waterway traffic keeps boaters, ship crews and passengers safe and keeps the
waterways free for response and recovery efforts.

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Radiation Health Effects

52. What is radiation?

Radiation is energy. It travels in the form of energy waves or energized particles.

Radiation can pose a health risk Py damaging the tissues and cells of your body, but
these risks can be limited by your distance from the source, the time exposed to the
source, and the barriers between you and the source.

During a radiological emergency, we try to keep exposure to radiation as low as possible.

53. What is radioactive material?

Radioactive material is a substance that gives off radiation in the form of energy waves
or energized particles. Radioactive materials released by a radiological incident could
include dust, powder, debris, liquids, and gasses. The types of radioactive materials re-
leased depends on the specific nature of the incident.

54. Is there any way for me to tell if radioactive
materials are present or if I am being exposed to
radiation?

Your natural senses are unable to detect radiation or radioactive material. The only way
to determine presence of, or exposure to, radiation or radioactive materials is with spe-
cial instruments or tests designed for that purpose. Emergency response authorities are
using these instruments to find radiation in the affected areas and will notify the public.

55. What are millirem (mrem) and millisieverts (mSv)?

These units measure radiation dose. Dose is defined as the amount of radiation or ener-
gy absorbed by a person's body. In the United States, dose is measured in units called
millirem (mrem). The international unit is millisievert (mSv).

The risk of health effects from radiation depends on the dose received. Safety recom-
mendations are designed to keep your dose as low as possible. The lower the dose,
the lower the risk.

[PUT IN CONTEXT OF RADIATION INCIDENT RADIOACTIVITY FINDINGS]

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56. What is a curie (Ci) or a bequerel (Bq)?

These units measure the amount of radioactive material in a sample, such as in a sam-
ple of water, soil or air. This is sometimes referred to as the sample's radioactivity (or
simply its activity). In the United States, we measure this amount of radioactive material
in curies (Ci), and the international community uses becquerels (Bq). Typically, results
will be in picocuries (pCi), which is one trillionth of a curie.

[PUT IN CONTEXT OF RADIATION INCIDENT RADIOACTIVITY FINDINGS]

57. Will people who have been exposed to the
radiation get cancer?

Use this statement if projected/actual dose is known —

The risk of cancer from radiation depends on the dose received.

The dose from the incident {was/is} estimated to be [INSERT DOSE . To put this in
perspective, about 99 percent of a population would not get cancer if their whole body
got a dose of 100 millisieverts (10,000 millirem).

• Follow all safety instructions. They are intended to keep your radiation dose as low
as possible.

• The lower the dose, the lower the risk.

Use this statement if projected/actual dose is not known —

The risk of cancer from radiation depends on the dose received.

Scientists and health experts are working now to gather information on the radiation
risks posed by this incident.

• Official updates will be provided via radio, television, and the Internet.

Follow all safety instructions provided by responders and local government. They are
intended to keep your dose as low as possible.

• The lower the dose, the lower the risk.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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58. Is radiation contagious?

No. Radiation is not like a cold. You cannot catch it from someone.

It is true, however, that people who have radioactive material on their clothes or their
bodies can leave some of that contamination on objects or people they come into
contact with.

But there is a simple solution: They should clean up or decontaminate themselves.
People who might have radioactive material on them can take the following steps:

Remove your outer clothes. Once you are inside, carefully take off your outer layer of
clothing. Do this in case any radioactive material fell onto your clothes while you were
outside.

Put the clothing in a plastic bag, and tie it shut, if possible. Be sure to keep the plastic
bag away from people and animals.

If you cannot shower, use a wet wipe or clean wet cloth to wipe any skin that was not
covered by clothing (such as your hands and face).

Gently blow your nose and gently wipe your eyelids, eyelashes and ears with a clean
wet cloth.

Change clothes. Change into clothes stored inside an intact building. If you cannot
change clothes, carefully brush off your outer layer of clothing. After brushing off, wash
your hands, face and exposed skin at a sink or faucet.

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59. Are people at risk for radiation poisoning or
sickness?

SELECT MESSAGE DEPENDING ON WHETHER ANSWER IS YES OR NO FOR THE
SPECIFIC LOCATION.

If yes, radiation experts say the release may have been large enough to cause immedi-
ate health effects for some people —

For people in [SPECIFY LOCATIONS]:

•	If you have skin burns, nausea, or if you began vomiting shortly after radiation
exposure, seek medical attention as soon as it is safe to leave your building or
place of shelter. These may be symptoms of acute radiation syndrome (ARS) or
radiation sickness, which is caused by exposure to large amounts of radiation over
a short period of time. Symptoms can appear within minutes to several days after
you were exposed to large amounts of radiation.

•	If you are not experiencing these symptoms or do not have another life-threatening
condition, stay away from hospitals. Hospitals need to care for those most
critically injured.

•	Follow all safety instructions to keep your radiation dose as low as possible.

If no, the dose from the release is too lovz to cause Acute Radiation Syndrome in the
specific location —

•	The release of radiation in [SPECIFY LOCATIONS] was not large enough to cause
radiation sickness. Radiation sickness is an illness from short-term exposure to a
large amount of radiation.

•	The highest amount of radiation we expect from this incident is far below the
amount that could cause radiation sickness.

If possible, get a comparison from radiation experts —

o The amount of radiation is [INSERT COMPARISON: HUNDREDS, THOUSANDS,
TEN THOUSAND, ETC times lower than the amount that could cause
radiation sickness.

•	We still want to keep radiation dose as low as possible, so please follow all
safety instructions.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Food, Water and Air Safety

60. Is the food safe to eat?

You may consume food and drinks that were inside a building. Check food in a refriger-
ator or freezer to make sure it hasn't spoiled.

You may eat food in sealed containers that were outside or in a damaged building as
long as you wipe off the container with a damp towel or cloth. Put these towels or
cleaning cloths in a plastic bag and tie it shut, if possible. Be sure to keep the bag away
from people and pets.

Unsealed foods that were outside may be contaminated with radioactive material. Do
not consume food from your garden, or food or liquids that were outdoors and uncov-
ered, until authorities tell you it is safe.

61. Can people eat food from their gardens or locally
caught fish and game?

People in [AREA] are instructed not to eat [FOOD FROM THEIR GARDENS, LOCAL
FISH, LOCAL WILDLIFE].

Responders will be monitoring the area around the release and will notify you when it is
safe to eat local fish, game and food from your garden.

If you are concerned and suspect that radioactive material has settled on your garden,
make sure to wash, or simply don't eat, the food.

Listen for instructions from state and local officials and responders regarding food safety.

62. is the water safe to use?

Bottled water and sealed juice or soda containers will be free of radioactive contami-
nation. If the containers were outside or in a damaged building, wipe off the container
with a damp towel or cloth. Put these towels or cleaning cloths in a plastic bag and tie it
shut, if possible. Be sure to keep the bag away from people and pets.

Water from the tap is probably safe. But until we have drinking water test results, only
bottled water is certain to be free of contamination.

Tap or well water can be used for cleaning yourself and your food.

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If alternative drinking water is needed, officials can provide bottled water, change the
water source (such as switching to ground water), reroute water from an unaffected
water system or choose a combination of these actions.

Boiling tap water does not get rid of radioactive material.

63.	What should farmers do with their crops?

If you are being asked to stay inside (shelter-in-place) or evacuate, follow the instruc-
tions of state and local officials. These instructions are for your safety.

We are asking farmers in [AREA] not to tend, harvest, eat or distribute their crops until
radiation monitoring and sampling results are analyzed, unless otherwise directed.

We recognize that your crops are your livelihood. State and local officials will keep you
informed as radiation monitoring and sampling results come in.

64.	What should farmers and ranch owners do with
livestock?

If you are being asked to stay inside (shelter-in-place) or evacuate, follow the instruc-
tions of state and local officials. These instructions are for your safety.

We are asking farmers and ranchers in [AREA] not to transport their livestock and to not
consume or distribute milk from dairy animals until radiation monitoring and sampling
results are analyzed, unless otherwise directed. If you have milk-producing animals,
contact state and local officials for guidance.

Take these simple steps to protect your livestock from eating feed or drinking water
contaminated with radioactive material;

•	Move your livestock inside, away from more highly contaminated areas outside.

•	Use only stored feed and covered water. If possible, avoid using hay or alfalfa
kept outside.

65.	Is the air safe to breathe?

Federal, state and local partners are monitoring [AREA] to determine the location and
levels of radioactive material on the ground and in the air.

If radioactive particles are in the air, you can take these simple steps to reduce your
exposure:

•	Covering your mouth and nose with a cloth can reduce the risk of breathing-in
or swallowing radioactive materials. You may also use a disposable mask, such as
a dust mask, if one is immediately available.

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•	If you have been instructed to stay inside, remain inside. The roof and walls
provide protection from the radioactive material outside.

•	If weather conditions permit, close doors and windows. To keep radioactive
materials from getting inside, shut ail windows, outside doors and fireplace damp-
ers. It is not necessary to put duct tape or plastic sheets around doors or windows.

•	If weather conditions permit, turn off the fan, air conditioner or heater.

Otherwise, set the fan, air conditioner or heater on recirculate. In-room fans (for ex-
ample, ceiling fans) that only recirculate indoor air are okay to use. Air-conditioning
systems in large buildings can be used if they are set on recirculate.

We are tracking the radiation levels, and authorities will instruct you to leave the area if it
is in your best interest to do so.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

24

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Decontamination

66. If people are told by health and emergency

management officials to self-decontaminate, what
does this mean?

It means that people are being told to take several easy steps to remove any radioactive
material that might have fallen onto clothes, skin or hair.

Take the following steps to self-decontaminate:

Remove your outer clothes. Once you are inside, carefully take off your outer layer of
clothing. Do this in case any radioactive material fell onto your clothes while you were
outside.

Put the clothing in a plastic bag, if available. Store the plastic bag away from people
and animals.

Shower and wash off. If possible, take a warm shower with lots of soap. Don't scald
or scratch your skin. Wash your hair. When washing, try to keep the suds and water
from entering your mouth, and don't swallow the water. Parents or other adult caregiv-
ers should give children a shower or wash them following these directions.

If you cannot shower,; use a wet wipe or clean wet cloth to wipe any skin that was not
covered by clothing (such as your hands and face).

Gently blow your nose and gently wipe your eyelids, eyelashes and ears with a clean
wet cloth.

Tune in. Stay tuned to television, radio and government emergency management web-
sites for updates.

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67. How quickly does an exposed person have to
remove contamination from their body?

There is no set time. People should remove contamination as soon as possible to
reduce their radiation dose by following the steps listed above.

68. I am injured, and 1 think my wound s
contaminated. What should I do?

Flush the wound with lots of fresh water or saline, if possible. Otherwise, keep it
covered and seek medical attention.

69. Is it safe for me to let someone who might have
been affected by the radiological incident into my
home?

If someone has radioactive material on their clothes or body, a few simple steps can
clean up or decontaminate the person so that he or she can safely visit your home.

First, ask your visitors to remove their outer layer of clothing, put it in a plastic bag, and
tie it shut, if possible.

Second, have your visitors clean off using the following steps:

Remove their outer clothes. Once inside, your visitors should carefully take off their
outer layer of clothing in case any radioactive material fell onto their clothes while they
were outside.

Put the clothing in a plastic bag if available. Store the plastic bag away from people and
animals.

Shower or wash off. If possible, your visitors should take a warm shower with lots of
soap. They should wash their hair. They should not scald or scratch their skin. When
washing, they should try to keep the suds and water from entering their mouth, and
they shouldn't swallow the water. Parents or other adult caregivers should give children
a shower or wash them following these directions.

If your visitors cannot shower, they should use a wet wipe or clean wet cloth to wipe
any skin that was not covered by clothing (such as their hands and face).

They should gently blow their nose and gently wipe their eyelids, eyelashes and ears
with a clean wet cloth.

Have them change clothes. Have your visitors change into clothes stored inside an
intact building. If you do not have clothes for your visitors, they can carefully brush off
their outer layer of clothing. After brushing off, they should wash their hands, face and
exposed skin at a sink or faucet.

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70. How should people decontaminate their homes
and their possessions?

Don't decontaminate your home until you get information from emergency responders
or local officials.

You may not need to decontaminate your home, or there may be special instructions for
how to clean your home. For example, you may receive special instructions on wearing
protective clothing, cleaning methods, and washing the outside of your home. You can
find more information on steps you can take at [INSERT AGENCY WEBSITE HERE],

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Exposure Versus Contamination

71.	How do I know if I've been exposed to radiation or
contaminated by radioactive materials?

People cannot see, smell, feel or taste radiation, so you may not know whether you
have been exposed.

In addition, low levels of radiation exposure do not cause any symptoms.

People who were in areas of concern may be instructed to go to a screening center-
sometimes called a community reception center. At this location, responders will quickly
check for radiation by using special equipment to determine how much radiation is
present and whether it poses any danger.

If you think you have been contaminated, simply removing the outer layer of your cloth-
ing and washing exposed skin will significantly reduce any contamination you may have
on your body.

72.	What is the difference between radiation exposure
and radioactive contamination?

Exposure occurs when radiation interacts with the body. You can be exposed to radi-
ation without having radioactive material on your body (contamination). For example,
during a chest X-ray or computed tomography (CT) scan a person is exposed, but that
person is not contaminated and not radioactive.

Contamination happens when radioactive material is physically on or inside of a person
or object. If you are contaminated with radioactive material, you are being exposed to
radiation. Contamination can occur two ways:

1.	External contamination occurs when radioactive material settles outside, on the
surface of an object, or on a person's body or clothing,

2.	Internal contamination occurs when radioactive material enters the body. This
can happen when radioactive material is swallowed, inhaled, embedded or ab-
sorbed through the skin or wounds.

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Special Issues and Concerns:
Pregnancy and Breastfeeding

73. I am pregnant. Is my baby in danger?

After any radiation incident, expectant mothers who have concerns should seek advice
from their physicians, who should work in consultation with radiation professionals,

It is true that a fetus is extremely sensitive to radiation. According to the Centers for
Disease Control and Prevention (CDC), and as history has shown, most radiation re-
leases will not expose the fetus to levels high enough to cause harmful health effects or
Pirth defects.

After some radiation accidents in other countries, pregnant women terminated their
pregnancies because they feared that the radiation would harm the developing embryo
or fetus, but these terminations turned out to be totally unnecessary.

However, before any potential health risk to the embryo or fetus can be assessed,
health care professionals and radiation experts would determine what external or in-
ternal doses the expectant mother might have received because of being near the
incident.

Once dose levels to the expectant mother and fetus have been determined, your physi-
cian can consult with other medical and radiation professionals to identify potential risks
(if any) and provide appropriate counseling.

74. Is it safe to breastfeed?

In a radiation emergency it is important to keep your baby fed and hydrated, and
breastfeeding should continue when possible.

If you were indoors since the time of the radiation emergency, continue
breastfeeding.

If you were outside in the affected area during the incident, you may have
breathed-in or swallowed radioactive contamination that could be passed through
breast milk. Consider temporarily stopping breastfeeding and feed your baby with
breast milk that was pumped and stored before the emergency or with infant formula.
These options will reduce the potential risk of transmitting radioactive material to your
baby through breast milk.

• If you do NOT have previously expressed breast milk or infant formula,
continue breastfeeding. It is important to stay inside and make sure your baby
is hydrated and fed.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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o Do NOT leave your house or other indoor sheltering location to go get
infant formula. It is safer to stay inside and continue breastfeeding.

o Wash your hands, nipples, and breasts thoroughly with soap and warm
water before breastfeeding or expressing milk.

Using previously stored and pumped breast milk: When feeding your baby breast

milk that was pumped and stored before the emergency:

• Use previously expressed breast milk to feed your child as it will not be contami-
nated. Closed containers of milk that were stored inside the refrigerator or freezer
are safe to use.

• Wash your hands with soap and water before feeding.

• After each use, carefully clean all infant feeding supplies such as bottles and nip-
ples with soap and water and dry with a clean cloth or paper towel.

Using Infant formula: When feeding your baby infant formula —

• Use ready-to-feed infant formula, if available at your current location. Ready-to-feed
infant formula is a sterile liquid formula that does not need to be mixed with water,

• If you do not have ready-to-feed infant formula, use powdered infant formula.

• Prepare powdered infant formula with bottled water, if possible.

• Tap water may be used if local officials say it is safe. Water that has radioactive
material in it will not be made safe by boiling or disinfection. However, boiling or
disinfecting water can kill germs so it's important to follow all local water advisory'
instructions.

• Wash your hands with soap and water before feeding,

• After each use, carefully clean all infant feeding supplies, such as bottles and nip-
ples, with soap and water and dry with a clean cloth or paper towel.

If you temporarily stop breastfeeding:

• Hand express or pump your breast milk regularly and discard it to maintain your
milk supply and prevent a breast infection.

• Clean your pump kit parts after each use and dry them with a clean cloth or
paper towel.

• If needed, connect with a lactation support provider in your community who offers
phone consultations or telehealth appointments to help you manage your milk
supply and create a temporary feeding plan for your baby.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Breastfeeding can resume when advised by iocal health officials or after evacuation and
self-decontarnination. For additional questions or concerns, contact your baby's doctor.

75.	Can pregnant women take potassium iodide pills?

As with the rest of the population, pregnant women should take potassium iodide (Kl)
only when specifically advised to do so by public health officials.

Kl will cross the placenta and protect the thyroid of the growing fetus, as well as the ex-
pectant mother, from radioactive iodine.

76.	Can breastfeeding women take potassium iodide?

As with the rest of the population, breastfeeding women should take potassium iodide
(Kl) pills only when specifically advised by public health officials.

However, this will not be sufficient to fully protect the breastfed child. The child also
will need Kl in special doses adapted for newborns and infants. Don't administer extra
doses of Kl to newborns or infants unless directed by your doctor. If you are instructed
to give your child Kl, follow age-specific dosing instructions. All newborns and infants
should be evaluated by a doctor as soon as possible after administration of Kl.

Listen to your state or local public health officials for specific guidance on taking Kl pills.
For the latest information go to [INSERT AGENCY WEBSITE HERE],

77.	I am trying to get pregnant. Should I worry that my
future children will be affected?

There is no evidence that your future children will be at a greater risk for birth defects or
other problems.

Over many years, doctors and scientists have conducted extensive studies of children
born to atomic bomb survivors. They have found no indication of genetic effects in
these children.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Special Issues and Concerns: Children

78. What should I do about my children and family?
Should I leave to find my children?

If your children or family are with you, stay together.

If your children or family are in another home or building, they should stay there until you
are told it is safe to travel. You also should stay where you are. You risk exposure to
radiation if you go outside. You cannot help them if you are injured.

Schools have emergency plans and shelters. If your children are at school, they should
stay there until it is safe to leave. Don't go to the school until public officials say it is safe
to do so.

79. What is being done to protect children in school?

Schools have emergency plans in place to protect the children. These plans include
keeping everyone inside and providing assistance for those with special needs.

Children in schools will be cared for by teachers and staff until it is safe for them to
leave. Children will not be released to go outside until instructed to do so by health
officials and emergency responders.

80. if some of the radioactive material got on my
clothes or skin, will 1 contaminate my child? Is t
safe for me to be around my child?

Radioactive material can be removed by taking off and bagging your outer layer of
clothing, showering with soap and warm water, and putting on clean clothes.

People who have cleaned up pose no contamination risk to you, your property or the
members of your household.

81. Is it okay for me to give my child a bath?

Yes. If you think your children have radioactive material on their bodies, the most im-
portant thing to do is get them clean. A quick bath is one way to do that.

If there is concern that the water contains radioactive material from the incident, you
can still bathe your child. There is no additional risk from bathing your child; however,
make sure that your child doesn't drink the bath water.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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82. If people need to be decontaminated at a
reception center or other location, will I be
able to stay with my children while they are
decontaminated?

Parents should be able to stay with their children during decontamination and other
processes.

Children and their families (parents or caregivers) should not be separated unless critical
medical issues need to be addressed.

83. Does my child need to have his/her thyroid
scanned?

Thyroid scans are needed only when there is a possibility that radioactive iodine has
entered the body

Health experts are gathering information now and determining potential health threats.
You will be notified if thyroid scans are needed.

84. What kind of emotional impact can a radiological
ncident have on children? What should 1 look out
for?

Children are among the most vulnerable of those affected by a radiological emergency
because they lack the maturity, skills and experience to fully understand and process
what is going on.

Family members and caregivers should gently try to find out what the child thinks and
feels about the incident.

If children are scared because they have misunderstood what has happened, then
simple explanations should be provided while avoiding alarming details.

Children who exhibit signs of stress—such as difficulty sleeping, loss of appetite or bed-
wetting—should receive extra time and attention from family members and other care-
givers. If signs of stress continue, seek advice from a pediatrician or licensed therapist.

It is important to remember that children also need a chance to play and relax.
Encourage older children to be helpful and maintain regular routines.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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85.

Are children exposed to radiation at higher risk of
harm?

Children exposed to radiation may be at greater risk of harmfui health effects than adults.

Children have higher breathing rates, are growing and have closer physical proximity to
the ground, where radiation may be more concentrated; all of this makes children more
vulnerable.

Health experts are gathering information now to determine any potential health threats,
and they are specifically looking at potential effects on children. Instructions issued by
health officials are based on these findings.

86. Should my children take potassium iodide?

If public health officials say to take potassium iodide (Kl) in the affected area, children
should take potassium iodide unless they have known allergies to iodine.

However, the doses and procedures for giving Kl to children are not the same as for an
adult.

If Kl is needed, public health officials will provide specific guidance on doses and proce-
dures for giving Kl to children.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Special Issues and Concerns:
People With Disabilities or Special
Medical Needs

87.	If 1 go through decontamination at a reception
center or other facility, will my eyeglasses or
contact lenses he taken away?

Your glasses should not be taken away.

Eyeglasses may be washed in the shower.

You can continue to wear your contact lenses until you can safely get replacements.

88.	I have a prosthetic limb. If I have to be
decontaminated to remove radioactive dust, will
my prosthetic limb have to be taken away?

There is no reason for a prosthetic limb to be taken away.

Most prosthetic limbs can get wet, so they can be removed, thoroughly cleaned along
with the person, and put back on.

89.	Is there a general list of the kinds of devices,
adaptive equipment, prostheses and mobility aids
that can be decontaminated?

Unfortunately, no single guide currently available covers all situations.

However, a general list was published in 2006 by the New York Center for Terrorism
Planning and Preparedness in a document on hospital decontamination protocols.

The list identifies the following items that can be decontaminated: nonelectric wheel-
chairs, prosthetic limbs (without leather components), walkers, crutches (without foam
cushions/parts), canes (without foam cushions/parts), eyeglasses and prosthetic eyes.

Items that cannot be decontaminated, or that pose special challenges, include mech-
anical ventilators, electric wheelchairs, hearing aids, contact lenses and any leather
attachments/components of items.

For such items, discuss options with emergency responders and health officials.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

35

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90. What if my service animal is found to be
contaminated?

If your service animal is known or suspected to be contaminated, it will be
decontaminated.

In 2006, the Pets Evacuation and Transportation Standards (PETS) Act was created
to ensure that state and local emergency management partners address the specific
needs of individuals with service animals. The law includes provisions for decontaminat-
ing service animals.

91. How are service animals decontaminated?

Most animals can be decontaminated by simply using soap and water. For sensitive
areas where traditional washing methods may be more difficult—around the animal's
eyes, nose and mouth, and in its ears—damp towels or cleaning cloths may be used.

In some situations, emergency responders might place a muzzle on the animal to pre-
vent it from licking or drinking contaminated water.

92. What should people do if they don't have access
to their life-sustaining medications?

If you are in the affected area and your life is in danger because you are running out of
life-sustaining medication, such as insulin or heart medicine, take the following steps
to get medication:

• Call 911 if possible.

• Seek help from a neighbor.

• As a last resort, go to the closest medical facility

• If you must go outside, remember to clean yourself thoroughly when you come
back inside. Remove your outer layer of clothes, shower and wash with soap and
warm water, and put on clean clothes.

93. I receive radiation treatments for medical reasons.
Should I stop my treatments because H might have
been exposed to radiation from the emergency?

As a general rule, a radiation incident should not cause people to stop or take a break
from potentially lifesaving medical treatments. However, tell your doctor if you think you
were exposed to radiation from the emergency The doctor will decide how to handle
your radiation treatments.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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Special Issues and Concerns: Pets

94.	If people have been told to stay inside and self-
decontaminate during a radiation emergency,
what should they do with their pets? How do I
decontaminate my pet?

If you are instructed to stay inside, your pets should be inside too.

If your pet was outside at the time of the incident, the pet can be brought inside and
decontaminated.

Start by putting on waterproof gloves and a dust mask (or other material to cover
your mouth).

Also, keep cuts and scrapes (both yours and your pet's) covered to keep radioactive
material out of any wounds.

Then wash your pet carefully in a shower or bath using shampoo or soap and
water. Rinse the pet completely

To make sure you have not picked up any contaminants, be sure to shower after
you have washed the pet, especially washing your hands and face.

95.	Is the water safe for my pet to drink?

Bottled water will be free of radioactive contamination. Wipe or rinse the outside of
bottles or cans before opening them. Clean the bowl prior to filling.

Water from the tap is probably safe. But until we have drinking water test results,
only bottled water is certain to be free of contamination.

96.	Is pet food safe for my pet?

As with other foods, sealed pet food is safe for animals to consume.

As with other foods, rinse or wipe off any debris from a sealed can or package with
tap water and put the cleaning cloth in a plastic bag away from people and animals.

Protective Action Questions & Answers for Radiological and Nuclear Emergencies	37

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97. What should I do if my pet needs to go outside to
use the bathroom?

If possible, remain indoors. If your pet must go outside, minimize the time spent outside
and repeat decontamination procedures upon reentering the building (see
question 94).

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

38

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Appendix—Radiation Communication
Resources From Emergency Support
Function 15: Annex N

Improvised Nuclear Device Response and
Recovery: Communicating in the Immediate
Aftermath

Incident Type: improvised Nuclear Device (many messages wiii be
applicable to other radiological emergencies)

Content:

•	Key messages for affected community and the nation

•	Pre-approved answers to anticipated public and media questions

•	Social media templates for immediate safety actions

URL: https://wwvv.fema.aov/sites/defaijlt/files/dQCuments/fema improvised-nuclear-de-
vice communicating-aftermath iune-2013.pdf

Communicating During and After a Nuclear
Power Plant Incident

Incident Type: Nuclear Power Plant Incident

Content:

•	Roles and responsibilities for communicating after a nuclear power
plant incident

•	Pre-approved answers to anticipated public and media questions

URL: https://www.fema.aov/sites/default/files/documents/fema nuclear-power-plant-in-
cident communicatina-during-after iune-2013.pdf

Communicating Radiation Risks: Crisis
Communications for Emergency Responders

Incident Type: Radiological Emergency (transportation or dirty bomb)

Content:

•	Guidelines for emergency message development

•	Example questions and answers for transportation and dirty bomb scenarios

URL: https://www.epa.gov/svstem/files/documents/2024-02/comm rad
riskssept2023 online.pdf

Improvised Nuclear
Device Response and
Recovery

Communicating in the Immediate
Aftermath

June 2013

*

SR''FEMA

Communicating During
and After a Nuclear
Power Plant Incident

June 2013

@®

® FEMA

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

39

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CDC Radiation Resources

Radiation Emergency Tool Kits for Public Health Professionals

•	Guidance, training and educational materials for professionals

•	Fact sheets and other content that can be used for public information

URL: https://www.cdc.aov/radiation-emeraencies/hcp/radioloaical-terrorism-toolkit/
https://www.cdc.aov/radiation-emeraencies/php/toolkit/

Radiation Basics Made Simple Videos

•	Eight brief educational videos on protective actions, countermeasures and health
effects, which can be used for public education or b-roll

URL: https://www.cdc.gov/radiation-emergencies/communication-resources/education-
al-videos.html

Radiation Communications Research Reports

•	Formative research reports on radiation-related message testing

URL: https://www.epa.gOv/radiation/paa-public-communication-resources#audience-research

CDC Radiation Infographics

Note: URLs provided after infographic listing.

Where to Go in a Radiation
Emergency

Decontamination

WHERETO GO IN A
RADIATION EMERGENCY

DEC0NTAM

NATION FOR YOURSELF
UND OTHERS

m

SfPSf



^=118!^

Gix



Aa

it

i"J

rrJ iss=-

Potassium Iodide: Kl

HOW POTASSIUM IODIDE (Kl) WORKS

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

40

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Prussian Blue

4

Improvised Nuclear
Device

7

Radiological Exposure
Device

RADIOLOGICAL EXPOSURE DEVICE

10

Contamination Versus
Exposure

RAC

HATION CONTAMINATION
VERSUS EXPOSURE

EXTERNAL CONTAMINATION





INTERNAL CONTAMINATION

	Mk

~emaie,iaie"'

A



5

Dirty Bomb

DIRTY BOMB OR RADIOLOGICAL
DISPERSAL DEVICE

ii.it.sia

8

Transportation Accidents

TRANSPORTATION ACCIDENTS

SSES^ 4s^hi

!f§ i

P

W/A

"fl)

• '£> ; ¦» ii* S3

ifSi « • A- ¦



UUil contaa 10 ur doctor

11

Radiation Emergencies
and Pregnancy

/v' RADIATION EMERGENCIES

AND PREGNANCY

A.4.;

SSSK£r* lisil





;iZrmirszrmv,rbbeTbi^ndi™.

¦ KM

T V" "s





MBk/C a, i





mg _

6

Nuclear Power Plant
Accidents

NUCLEAR POWER PLANT
ACCIDENTS

— 5s:i

A 1 M

9

Workplace Incidents

WORKPLACE RADIATION
INCIDENTS

iH

12

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

41

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1.	cdc.aov/radiation-emeraencies/infoaraphic/where-to-ao.html

2.	cdc.aov/radiation-emeraencies/infoaraDhic/decontamination.html

3.	cdc.gov/radiation-emergencies/infographic/potassium-iodide.html

4.	cdc.aov/radiation-emeraencies/infoaraphic/prussian-blue.html

5.	cdc.aov/radiation-emeraencies/infoaraDhic/contamination-versus-exDosure.html

6.	cdc.aov/radiation-emeraencies/infoaraphic/preanancv.html

7.	cdc.gov/radiation-emergencies/infographic/improvised-nuclear-device.html

8.	cdc.gov/radiation-emergencies/infograDhic/radiological-disDersal-device.html

9.	cdc.gov/radiation-emergencies/infographic/nuclear-power-plant-incident.html

10.	cdc.gov/radiation-emergencies/infographic/radiological-exposure-device.html

11.	cdc.gov/radiation-emergencies/infograDhic/transDortation-accidents.html

12.	cdc.gov/radiation-emergencies/infographic/workplace-radiation-incidents.html

Federal Agency Radiation Websites

Federal Emergency Management Agency: www.readv.gov

U.S. Department of Energy National Nuclear Security Administration:
energv.gov/nnsa/counterterrorism-and-counterDroliferation

U.S. Department of Health and Human Services (HHS), Centers for Disease Control and
Prevention: cdc.gov/radiation-emergencies/

HHS, Radiation Emergency Medical Management: remm.hhs.gov/

HHS, Substance Abuse and Mental Health Services Administration, Disaster Distress
Helpline: samhsa.gov/find-help/disaster-distress-helpline

U.S. Environmental Protection Agency: epa.gov/radiation

U.S. Nuclear Regulatory Commission: nrc.gov/about-nrc/emerg-Dreparedness.html

Additional Resources

Conference of Radiation Control Program Directors: crcpd.org
International Commission on Radiological Protection: icrp.org
National Alliance for Radiation Readiness: radiationreadv.org
National Council on Radiation Protection and Measurement: ncrponline.org

Protective Action Questions & Answers for Radiological and Nuclear Emergencies

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