The Committee was formed by the EBMT Board after 9/11, in 2002, to address terrorist radiation incidents. The committee was created because at that time there was no worldwide network in place to address the immediate medical consequences of a major accidental or terrorist radiation incident that might involve hundreds or thousands of victims. The EBMT led the way on it and has been followed by the US RITN, and similar national initiatives, for example in Korea.
Nuclear Accident Committee Team
To use the EBMT’s unique resource of 500 centres in 27 European Sovereign States (networking into potentially 2500 satellite hospitals) with skilled haemato-oncology specialists (2500+) and nurses throughout Europe, the central part of an infrastructure to deliver care to potentially thousands of patients.
We know from previous radiation incidents that radiation victims will only rarely need a Stem Cell Transplant (see the Pocket Guide), but the skill of haemato-oncologists looking after patients with bone marrow failure is the key to potentially saving lives.
Although these units/beds will be used only under the direction of the health services of the countries involved, we know from past experience of radiation incidents that victims will, anyway, end up in large haemato-oncology centres, all of which are members of the EBMT network, and this could be usefully coordinated. Crucially, we can coordinate and optimize care and collect data, and the President of the SCT society of the country(s) involved will be the pivot for communication.
- Input into ongoing international consensus meetings to optimise triage and treatment for victims, define bed configurations, and train care workers. We give invited lectures internationally, produce reports and write papers, and help other countries with infrastructure advice. If a developing country has an incident, we offer technical and infrastructure advice.
- We have been outside observers for Radiation Response Exercises in the UK, India and Korea
- We formally meet once a year at the Annual EBMT Conference. We give formal invited lectures worldwide, including recently China, Russia and Iran. We also meet, when required, to address specific topical issues on an ad-hoc basis.
- In 2005, we held a European/US consensus meeting at Vauix de Cernay, Paris, to obtain agreement on triage and treatment of Mass Radiation Victims and produced a ‘Pocket Guide’ that was in paper form and available on the EBMT website.
- In 2010, the EBMT NAC received a grant from the UK Home Office to put in place by 2012 a plan for possible use of clinical recourses in the event of a major radiation incident at the London Olympics. We had numerous meetings and identified 55 transplant centres in 5 regions with 132 satellite hospitals that could take patients, and then undertook a training programme for these clinicians and other healthcare workers. The mechanism of this template can be extrapolated to other European Countries where EBMT training has taken place.
- On the 11th March, 2011, the Fukushima disaster occurred. We were alerted by WHO and the EBMT mobilized 120 centres in 48 hrs (a further 72 centres agreed to store autologous SC). At the invitation of the Japanese BMT society, we went to Japan on the 26th March, 2011, within two weeks of the disaster, meeting most of the key players, including the Deputy Prime Minister. We then convened an emergency EBMT NAC meeting one week later with 45 attendees from Japan, US, and Europe at the EBMT Annual Meeting, and further meetings in June 2011 and at COSTEM, July 2011. We concluded that Autologous Stem Cell Transplants would only be of use under extremely exceptional circumstances. But a bonus to this work was we were able to use Fukushima as a live, real-time exercise to test the robustness of our responses to a Radiation emergency.
- In April 2016, at the fourth Nuclear Security Summit that took place in Washington, D.C, it was stated that a likely scenario for a terrorist attack is a Radiation Dispersal Device (RDD), also known as a “dirty bomb” – The EBMT Nuclear Accident Committee (NAC) convened a meeting in Paris on the 3rd of June 2016 involving a small selected panel of experts from the French Institut de Recherche Biomédicale des Armées (IRBA) and the Institut de Radioprotection et de Sûreté Nucléaire (IRSN), the German Military Bundeswehr Institute of Radiobiology, the Swedish Radiation Emergency Medicine Center (KcRN) and the National Board of Health and Welfare, the UK Public Health England (PHEng), in addition to clinical experts from the EBMT. The conclusion (Report below) was that if the correct precautions are taken there will not be a clinical radiation health issue.
- In October 2017, we convened a meeting in Paris to update this Pocket Guide which is to be launched in March 2018, and it is planned to have Japanese, French and Spanish versions available soon.
The overall strategy is broadly twofold; 1/ maintaining standards for optimizing care for radiation victims by having dedicated meetings when required, and 2/ for cost reasons, we run as a virtual organization, other than meeting formally once a year at the EBMT Annual Meeting.
The procedure for becoming operational would be as follows. Following the alert of a major radiation incident through WHO or social media, we would, as with the Fukushima incident, still initially run predominately as a virtual organization (through the existing secretariat email database). We would immediately send out an alert simply asking centres if they wished to be contacted further as information becomes available. We would then link through our network with the National Emergency agency involved to say we are available for advice if required. Even if we are not officially involved, we know probably all victims requiring hospital admission, will inevitably be admitted to EBMT Centres. We will alert all centres to fill in MED-A forms on admission of victims. This will be the driver to offering advice and the prospective inclusion of anonymous clinical data into our dedicated Parkside database. A representative will go to the site if indicated.
We will continue to have the Committee involved in networking with the International Radiation Preparedness community by giving lectures, attending meetings and writing papers, so as to maintain the very high level of expertise we have in the central core of the NAC. To this end, we will intermittently, when indicated, continue to have Scientific Sessions at EBMT.
What the EBMT NAC can offer
- Network between WHO IAEA EU, Japan, India, China? Korea? and US RITN UK HPA
- Rapid education from website (www.ebmt.com)
- Advise on dose estimation
- Protocols for treatment
- Advice for ongoing panoramic real-time treatment issues.
- Advice on Stem Cell collection and storage
- Advice on allogeneic transplantation decisions. Troubleshooting of political questions (particularly EU countries)
- Parachute in an infrastructure for expertise and guidance
- Collection of ongoing clinical datasets
- EBMT, under the direction of local National Health Services, networking across national borders for potential patient beds
Publication guidelines for all studies of the EBMT, Go-CART Coalition and Joint Studies with the WBMT
EBMT NAC Membership and Collaborations
The Committee consists of individual national members (usually a senior haemato-oncologist) from all the high-population European countries, and includes additionally members from the Emergency Resilience Response agencies from France, the UK, and Germany.
- Representative members of selected 27 European Counties
- World Health Organisation (Collaborating Centre)
- International Atomic Energy Authority IAEA
- United States Radiation Injury Treatment Network (RITN) Memorandum of Understanding (MUO)
- Bundeswehr Institute Radiobiology University - Ulm, Germany
- Institut de Radioprotection et de Sûreté Nucléaire - Paris, France
- Swedish Radiation Emergency Medicine Centre
- UK Public Health
In addition, we have associate members from India, Pakistan, Saudi Arabia, Iran, Israel, China, Taiwan, Japan, Korea, and Russia, and have given presentations in most of these countries.