Connecticut Department of Public Health
Potassium Iodide (KI) and Nuclear Emergency Readiness
http://www.dph.state.ct.us/brs/eoha/ki/ki_home.htm

Delaware Health and Social Services – Division of Public Health (PDF File)
Facts about “KI”
http://dema.delaware.gov/Docs/Ki_QandA.pdf

Florida Department of Health – Bureau of Radiation Control (PDF File)
Potassium Iodide (KI) Fact Sheet
http://www.doh.state.fl.us/environment/radiation/KI-Fact-Sheet.pdf

Illinois Department of Nuclear Safety
Important Information on the Use of Potassium Iodide (KI) Tablets
http://www.state.il.us/idns/html/emergencyinfo/kibrochure.asp

Michigan Department of Environmental Quality
The Potassium Iodide (KI) Issue
http://www.michigan.gov/deq/0,1607,7-135-3312_4120_4243-10401–,00.html

New Jersey Department of Health and Senior Services
EMERGENCY PREPAREDNESS
Public Health Component
http://www.state.nj.us/health/er/piodide.htm

New York State Department of Health
Use of Potassium Iodide During Radiological Emergencies: Information for the Public
http://www.health.state.ny.us/nysdoh/ki/ki_high.htm

Pennsylvania Department of Health
Potassium Iodide (KI) Frequently Asked Questions
http://www.dsf.health.state.pa.us/health/cwp/view.asp?a=171&q=233572

Texas Department of Health
Potassium Iodide Information
http://www.dshs.state.tx.us/radiation/dirty.shtm

Vermont Department of Health
A Fact Sheet on Potassium Iodide & the Vermont Distribution Program
http://healthvermont.gov/enviro/rad/KI_fact.aspx

Potassium Iodide (KI) Information on the ATA Site

Questions and answers about potassium iodide (KI)

American Thyroid Association endorses potassium iodide for radiation emergencies

Editorial: “Say yes to potassium iodide,” by Peter G. Crane, reprinted from the Seattle Post-Intelligencer, February 14, 2002

Web links for important documents about potassium iodide

Potassium Iodide Frequently Asked Questions
http://www.nrc.gov/about-nrc/emerg-preparedness/about-emerg-preparedness/potassium-iodide.html

Final Text of NRC Ruling NRC 10 CFR Part 50 (RIN 3150-AG11)
Consideration of Potassium Iodide in Emergency Plans
Federal Register, January 19, 2001 (Volume 66, Number 13)
Rules and Regulations, pages 5427-5440 [DOCID:fr19ja01-1]
http://www.nrc.gov/reading-rm/doc-collections/cfr/fr/2001/20010109part2.html

U.S. Food and Drug Administration (FDA) Center for Drug Evaluation and Research:

Radiation Emergencies
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm063807.htm

Frequently Asked Questions on Potassium Iodide (KI)
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072265.htm

Home Preparation Procedure for Emergency Administration of Potassium Iodide Tablets to Infants and Small Children
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/UCM072248

Guidance for Industry: KI in Radiation Emergencies–Questions and Answers
(explaining flexibility in KI dosing guidelines)
http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM080546.pdf

Guidance: Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies
http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM080542.pdf

U.S. Congress:

Section 127 (Potassium Iodide) of H.R. 3448,
the Public Health Security and Bioterrorism Preparedness and Response Act of 2002
(Enrolled as Agreed to or Passed by Both House and Senate), enacted June 12, 2002

Go to http://thomas.loc.gov/. Search for Bill Number “HR 3448″ in the 107th Congress. Choose Version 3 (“H.R.3448.ENR”). Once in the bill, choose “Sec. 127, Potassium Iodide.”

National Council on Radiation Protection and Measurements (NCRP):

These and other reports are available for purchase at http://www.ncrppublications.org:

“Management of Terrorist Events Involving Radioactive Material”
(Report #138, published 2001; abstract and press release may be read on the NCRP site)

“Induction of Thyroid Cancer by Ionizing Radiation”
(Report #80, published 1985; abstract may be read on the NCRP site)

“Protection of the Thyroid Gland in the Event of Releases of Radioiodine”
(Report #55, published 1977)

United Nations:
United Nations Press Release GA/9718
UNSCEAR Focuses On Chernobyl Accident in General Assembly Report
http://www.un.org/News/Press/docs/2000/20000606.ga9718.doc.html

World Health Organization:
Guidelines for Iodine Prophylaxis following Nuclear Accidents (PDF File)
http://www.who.int/ionizing_radiation/pub_meet/Iodine_Prophylaxis_guide.pdf

British National Radiation Protection Board:
Stable Iodine Prophylaxis: Recommendations of the 2nd UK Working Group
on Stable Iodine Prophylaxis
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1254510581689

Potassium Iodide (KI) Information on the ATA Site

Questions and answers about potassium iodide (KI)

American Thyroid Association endorses potassium iodide for radiation emergencies

Editorial: “Say yes to potassium iodide,” by Peter G. Crane, reprinted from the Seattle Post-Intelligencer,
February 14, 2002

Web links for state information about potassium iodide

What is KI?
Potassium iodide (KI) is the same form of iodine used to iodize table salt. KI floods the thyroid with iodine, thus preventing radioactive iodine from being absorbed. If taken at the proper time, KI protects the thyroid from radioactive iodine from all sources – air, food, milk, and water. KI is a non-prescription drug that can be bought over the internet and at some pharmacies. KI is made in pill and liquid forms. The two FDA-approved brands of full adult dose 130-mg KI pills are IOSAT® (Anbex, Inc.) and Thyro-Block® (Medpointe, Inc.). The FDA-approved brand of 65-mg KI pills is ThyroSafe® (Recip US). Properly packaged, KI’s shelf life is at least 5 years and possibly as long as 11 years. If you accidentally take a very old pill, it may not work fully but it won’t hurt you.

What is the proof that KI works?
After the 1986 Chornobyl (formerly called “Chernobyl”) nuclear accident, shifting winds blew a radioactive cloud all over Europe. As many as 3,000 people exposed to that radiation have already developed thyroid cancer. Most victims had been babies or young children living in Ukraine, Belarus, or Russia at the time of the accident. According to a UN report released in February 2002, another 8,000 to 10,000 exposed people may develop thyroid cancer within the next 10 years. Poland, immediately adjacent to Belarus and Ukraine, distributed KI to its people and does not appear to have had an increase in thyroid cancer.

When should KI be taken?
Taken 6-12 hours before exposure to radioactive iodine, KI fills the thyroid cells and prevents the gland from absorbing radioactive iodine. KI is also protective if taken within the first few hours after exposure to radioactive iodine. People should take one dose a day, only while they are being exposed to radioactive iodine and one day afterward. KI should be used only under instruction from local health authorities. Not every radioactive release includes the radioactive iodine that can cause thyroid cancer. For example, a “dirty bomb” is not likely to contain radioactive iodine because it has a short half-life. (A “dirty bomb” is a conventional bomb mixed with radioactive material, and designed to explode spewing out the radioactive isotopes and contaminating a wide area.) Only health authorities can determine which radioactive isotopes are released during a nuclear event, and, if radioactive iodine is released, when to take KI and how long to keep taking it.

What are the recommended KI doses?
The U.S. Food and Drug Administration (FDA) has published general recommendations for minimum KI doses: a full 130-mg pill for adults, 65 mg for children 3 to 18 years old, 32 mg for babies 1 month to 3 years old, and 16 mg for newborns up to 1 month old. In the U.S., KI pills are now sold in both 130-mg and 65-mg doses. The pills are scored to make it easier to cut them up for children’s doses. An April 2002 FDA statement says that “absolute precision in dosing is generally not critical to safety or efficacy” and “the overall benefits of KI far exceed the risks of overdosing, especially in children.” According to the FDA, children over 1 month old can safely be given a full-dose 130-mg pill on each of 2 consecutive days. However, newborns should be given only a 16-mg dose. The easiest way to prepare a 16-mg dose is to dissolve a 130-mg pill in 8 oz of a clear liquid and feed the newborn 1 oz of the liquid. Another alternative is to give the newborn 16 mg of the liquid form of KI (saturated solution of potassium iodide [SSKI]), which requires a doctor’s prescription. For FDA suggestions on preparing KI doses for children, see http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072254

Who should not take KI?
Millions of people have taken KI but few serious side-effects have been reported. The only people who should not take KI are those who have had a major allergic reaction to iodine. In the amounts that the FDA recommends, and for the few days that public health officials expect people to need KI, patients with thyroid disease can safely take the pills in the regularly recommended doses. During a nuclear emergency, KI’s benefit far outweighs any potential risk. Adults over age 40 do not need KI at all unless they are exposed to extremely high levels of radioactive iodine.

If taken for long enough, KI can cause temporary hypothyroidism (underactive thyroid gland). “Long enough” is different for every person. Prolonged treatment can become a serious problem for very young children. Such children should be seen afterward by a health professional. Patients with Graves’ hyperthyroidism or with autonomous functioning thyroid nodules should also be seen.

Why worry so much about thyroid cancer if most people survive it?
In general, 90% of patients survive thyroid cancer. The post-Chornobyl cancers have been aggressive and have been unusual in affecting children younger than 10 years of age. Thyroid cancer survivors always remain at risk for recurrence and require lifelong medical care. Likewise, the people who were exposed to radioactive iodine from the Chornobyl accident but have not developed thyroid cancer remain at risk for life and must continue to be tested. The demands of regular testing and care for this large population are putting a heavy burden on both patients and health care systems.

How should KI be incorporated into an overall emergency plan?
KI is an adjunct to evacuation, sheltering (staying in an unventilated room with the doors and windows closed), and avoiding contaminated food, milk, and water. KI should not take the place of any other protective measure.

Won’t having KI pills lull people into a false sense of security?
Not likely. Local authorities recommend that people leave the vicinity of a nuclear emergency as quickly as possible. People are being taught that KI is just a supplement to evacuation.

Why waste time taking a pill if you’re being told to evacuate?
Because nuclear releases are unpredictable but traffic jams are likely to delay speedy evacuation, people should take their KI before they evacuate, following instructions from local health officials.

Why offer KI to people just within 10 or 20 miles of a plant? Can’t radiation be harmful farther away?
KI distribution should not be limited to 10 or 20 miles. No one can predict how far a radioactive iodine cloud might spread. After Chornobyl, higher than expected rates of thyroid cancer were found more than 200 miles away from the nuclear plant. Thus, no one can predict how far from a nuclear plant the U.S. should distribute KI if it is to protect every person who might be exposed to radioactive iodine. Because there is no right answer, the American Thyroid Association recommends three levels of coverage, determined by distance from the nuclear plant:

What do U.S. government agencies recommend?
KI is endorsed for radiation protection by the U.S. Food and Drug Administration. The Department of Health and Human Services has included KI in the National Pharmaceutical Stockpile for use in health emergencies. In December 2001, the Nuclear Regulatory Commission wrote to the 34 states that either have a functioning nuclear power plant or are within 10 miles of another state’s plant; the letter offered two free KI pills for each resident within the 10-mile “emergency zone” surrounding active plants, and an extra supply to be provided for transients. As of September 13, 2002, Alabama, Arizona, California, Connecticut, Delaware, Florida, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Vermont and Virginia had taken up the NRC on its offer. Instead of accepting the NRC offer, Illinois chose to distribute KI pills provided by the operator of most of the state’s nuclear plants. Tennessee has had its own KI program in place since 1981. Maine has discontinued its state program.

The Public Health Security and Bioterrorism Preparedness and Response Act of 2002, enacted by Congress in May 2002, creates a mechanism to extend the radius of KI distribution to communities within 20 miles of nuclear plants, and directs the President to decide which agency or agencies will oversee KI stockpiling and distribution. Distribution under the new law could begin as early as June 2003.

Won’t distribution and public education be expensive and time-consuming?
Possibly, although the potential benefit of KI far outweighs the cost. The Bioterrorism Act directs the National Academy of Sciences to study “the most effective and safe way to distribute and administer potassium iodide tablets on a mass scale.” The National Academy of Sciences panel should address many of the decisions still to be made, for example: Who should be responsible for distribution? Within 50 miles of a nuclear plant, how should pills best be predistributed to families to store at home, before the time of need? Within 50 miles of a plant, should pills also be kept at local schools, clinics, post offices, and police and fire stations for distribution during an emergency? How should children be treated at school? How should stockpiles be maintained? Provision must also be made to educate the public about why KI is important, what it can and cannot do, and how and when to use it. The states that want KI are working out individual distribution and education plans, as part of their overall emergency plans. Vermont’s draft plan is posted on its web site (http://healthvermont.gov). It is noteworthy that the offer of KI has led some states to reassess their overall emergency response plans.

What are other countries doing?
The World Health Organization endorses KI. France, Ireland, Sweden, and Switzerland not only stockpile KI but predistribute it to their populations.

What does the American Thyroid Association recommend?
The American Thyroid Association (ATA) has been urging KI stockpiling since 1984. ATA members have been studying the Chornobyl nuclear accident and caring for its victims. The Association’s recommendations are outlined in the public health statement American Thyroid Association endorses potassium iodide for radiation emergencies. This plan is endorsed by the American Association of Clinical Endocrinologists, the Lawson Wilkins Pediatric Endocrine Society, and the Thyroid Foundation of America.

Potassium Iodide (KI) Information on the ATA Site

American Thyroid Association endorses potassium iodide for radiation emergencies

Editorial: “Say yes to potassium iodide,” by Peter G. Crane, reprinted from the Seattle Post-Intelligencer,
February 14, 2002

Web links for important documents about potassium iodide

Web links for state information about potassium iodide

Download Statement (PDF File, 197 KB)

March 18, 2011

The recent nuclear reactor accident in Japan due to the earthquake and tsunami has raised fears of radiation exposure to populations in North America from the potential plume of radioactivity crossing the Pacific Ocean. The principal radiation source of concern is radioactive iodine including iodine-131, a radioactive isotope that presents a special risk to health because iodine is concentrated in the thyroid gland and exposure of the thyroid to high levels of radioactive iodine may lead to development of thyroid nodules and thyroid cancer years later. During the Chernobyl nuclear plant accident in 1986, people in the surrounding region were exposed to radioactive iodine principally from intake of food and milk from contaminated farmlands. As demonstrated by the Chernobyl experience, pregnant women, fetuses, infants and children are at the highest risk for developing thyroid cancer whereas adults over age 20 are at negligible risk.

Radioiodine uptake by the thyroid can be blocked by taking potassium iodide (KI) pills or solution, most importantly in these sensitive populations. However, KI should not be taken in the absence of a clear risk of exposure to a potentially dangerous level of radioactive iodine because potassium iodide can cause allergic reactions, skin rashes, salivary gland inflammation, hyperthyroidism or hypothyroidism in a small percentage of people. Since radioactive iodine decays rapidly, current estimates indicate there will not be a hazardous level of radiation reaching the United States from this accident. When an exposure does warrant KI to be taken, it should be taken as directed by physicians or public health authorities until the risk for significant exposure to radioactive iodine dissipates, but probably for no more than 1-2 weeks. With radiation accidents, the greatest risk is to populations close to the radiation source.  While some radiation may be detected in the United States and its territories in the Pacific as a result of this accident, current estimates indicate that radiation amounts will be little above baseline atmospheric levels and will not be harmful to the thyroid gland or general health. 

We discourage individuals needlessly purchasing or hoarding of KI in the United States. Moreover, since there is not a radiation emergency in the United States or its territories, we do not support the ingestion of KI prophylaxis at this time. Our professional societies will continue to monitor potential risks to health from this accident and will issue amended advisories as warranted.

Contact: Bobbi Smith (703) 998-8890
BSmith@thyroid.org

2006-2007

President
David S. Cooper, M.D.
Baltimore, Maryland

Secretary
Gregory A. Brent, M.D.
Los Angeles, California

Treasurer
Charles H. Emerson, M.D.
Worcester, Massachusetts

President-Elect
Rebecca S. Bahn, M.D.
Rochester, Minnesota

Secretary-Elect
Richard T. Kloos, M.D.
Columbus, Ohio

Treasurer-Elect
David H. Sarne, M.D.
Chicago, Illinois

Directors
Ernest L. Mazzaferri, M.D. (2007)
Gainesville, Florida

Bryan R. Haugen, M.D. (2007)
Denver, Colorado

Sandra M. McLachlan, Ph.D. (2007)
Los Angeles, California

Gilbert H. Daniels, M.D. (2008)
Boston, Massachusetts

Steven I. Sherman, M.D. (2008)
Houston, Texas

Matthew D. Ringel, M.D. (2009)
Columbus, Ohio

Mary H. Samuels, M.D. (2009)
Portland, Oregon

Antonio C. Bianco, M.D., Ph.D. (2010)
Boston, Massachusetts

Alan L. Farwell, M.D. (2010)
Worcester, Massachusetts

Michael T. McDermott, M.D. (2010)
Aurora, Colorado

Executive Director
Barbara R. Smith, CAE

Headquarters Office
American Thyroid Association
6066 Leesburg Pike, Suite 550
Falls Church, Virginia 22041

January 25, 2007

President George W. Bush
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

Dear President Bush:

We are writing on behalf of the American Thyroid Association (ATA) to request that you rectify a very significant deficit in a particular aspect of antiterrorism preparation: namely, the lack of availability of potassium iodide (KI) for protection of young people against developing thyroid cancer in the event of a release of radioactive iodine. The ATA is a professional society of over 900 endocrinologists, surgeons and nuclear medicine physicians and researchers specializing in diseases of the thyroid gland. The ATA promotes excellence and innovation in clinical care, research, education, and public advocacy.

Section 127 of the 2002 Bioterrorism and Response Act directed you to establish a program that would increase the availability of KI to State and local governments for persons within 20 miles of a nuclear power plant. In response, a 2004 study by the National Academy of Sciences (NAS) recommended that “KI should be made available to everyone at risk of significant health consequences from accumulation of radioiodine in the thyroid in the event of a radiological accident”. Draft guidelines were then prepared by the DHHS, published in the Federal Register in August 2005, and revised after considering comments from the public. We understand that these revised guidelines have long been pending in the White House Office of Management and Budget as a result of objections raised by the Nuclear Regulatory Commission. Dr. William Kane from the Nuclear Regulatory Commission writes in his November 1, 2005 letter to Dr. Claypool of DHSS that removal and isolation of contaminated products is equal to or superior to KI protection of the thyroid gland after radioactive iodine release. Although this statement is supported by reference to the NAS report, our Public Health Committee, including several members of the NAS panel, believe that these statements are taken out of context. KI ingestion is the only tested and proven approach to protect against thyroid cancer.

The nuclear power station accident at Chernobyl in 1986 has made it perfectly clear that an accident or terrorist act at a power station in the USA could result in literally thousands of cases of thyroid cancer in children exposed to released radioiodines. The safety and effectiveness of KI in preventing these cancers is well established, especially the successful Polish experience with KI distribution after the Chernobyl accident. KI is not a panacea for all radiation effects, but it is an essential addition to other protective measures, namely sheltering, evacuation, and restriction of contaminated foods, to protect the thyroid against inhaled or ingested radioiodines.

The NAS report also states that it must be remembered that the plume phase and ingestion phase protection zones are established to provide a planning basis, and that a specific incident might call for protective actions to be implemented beyond the planning zone. Increasing the number and distribution of KI stockpiles is key to improved protection because KI must be given very quickly to be effective. Individually sealed KI tablets protected from light are long lasting. Although we have fortunately not yet had an accident that has required KI, it is irresponsible that this simple and inexpensive remedy has yet to be put in place to protect our young people.

We urge you to put an end to this unnecessary delay as soon as possible and institute the DHSS guidelines. We look forward to your response, and are prepared to offer our expertise in the evaluation and implementation of this policy.

Respectfully submitted,

David C. Cooper, MD	Gregory A Brent, MD
President, ATA	Secretary, ATA

Some time has passed since the report of the NAS committee was published (Distribution and Administration of Potassium Iodide in the Event of a Nuclear Accident, Board of Radiation Effects Research, National Research Council, The National Academies Press, 2004), and it is time to assess whether its conclusions and recommendations have had an effect on the availability of KI to the American public. The report reviewed background information on the benefits and risks of KI administration, and on the populations likely to benefit from KI. It then presented an extensive catalogue of existing distribution plans in the 17 states using pre-distribution and in 4 with post-distribution only. Information about programs in 14 countries was also given. In Appendix D a detailed process was described by which communities could design and evaluate potential KI distribution plans. Finally, three sets of conclusions and recommendations were presented, each related to what the committee considered to be the main issues it was charged to evaluate. They are succinctly presented in the Executive Summary of the report. For this critique they are abbreviated, paraphrased and commented upon here.

Benefits and Risks Posed by KI Distribution

The report concluded that KI is an important agent for protection against thyroid-related effects of exposure to radioiodine if taken shortly before or after exposure, but that the Chernobyl accident is not necessarily a good model in planning for incidents in the United States because of differences in reactor design. It recommended that KI should be available to everyone at risk, including infants, children, pregnant women and adults younger than 40 years, and should be taken within a few hours of exposure to inhaled or ingested radioiodine. KI distribution should consider pre-distribution, local stockpiling outside the 10-mile emergency planning zone (EPZ) of nuclear power plants, national stockpiles and distribution capacity.

Comment

The report did not define the radius outside the EPZ that KI programs should address. A radius of 20 miles is required by the Bioterrorism Act of 2002 (P.L.107-188) but this is much too restricted in light of the Chernobyl experience. The winds after that accident carried the radioactive plume 150 miles to Bryansk, Russia, where thyroid cancer induced by 131-I was found (Davis S et al, Radiation Res 162:241-248, 2004) and 300 miles to eastern Poland where it was shown that a single dose of KI given 3 days after the accident, combined with restriction of milk intake, reduced the thyroid radiation dose by 70%, and that 40% of this reduction was from protection against inhaled 131-I (Nauman J and Wolff J, Am J Med 94: 524-532, 1993). Although an accident like Chernobyl may be less likely in the USA, the extent of spread of the plume containing 131-I could be similar.

Implementation Issues Related to KI Distribution and Stockpile Programs

The report concluded that a strategy is needed for local agencies to develop boundaries for KI distribution, and that conditions and states vary so much that no single best solution is possible. It recommended that state and local authorities should design and implement distribution plans based on their objectives, on features of their local regions and on risk estimates. It also recommended that the federal government should supplement the states’ programs by maintaining stockpiles and a distribution system that would ensure an adequate supply of KI tablets appropriate for the target populations. It recommended further that a better understanding of strengths, weaknesses, successes and failures, and resource requirements of existing KI distribution plans in the USA would be helpful for future programs.

Comment

The text of the report can assist states and localities without KI programs to design theirs by reviewing what others have done, and by following the suggestions given in Appendix D. No suggestions concerning how the recommended follow-up evaluations would be carried out were given. It is necessary to review what federal government agencies have done to provide and maintain the supply of KI needed for the states’ and localities’ programs. The draft of a guidance document from the Radiological Emergency Preparedness Section, Department of Homeland Security and the Department of Health and Human Services has been circulated for comment. The ATA found this draft to be inadequate in scope because it provides only for procurement of KI tablets by states and localities and gives no assistance with distribution or stockpiling.

• HHS KI Guidance Response Letter (December 15, 2004).

• Health and Human Services Guidelines Mislead and Misinform About Important Role of Potassium Iodide in Nuclear Incident, Say Thyroid Experts (Dec. 21, 2004)

Additional Research Needed

The report concluded that there is now sufficient knowledge to estimate thyroid cancer risks from radioiodine. Its recommendations for future research were keyed only to KI distribution plans. It recommended that the plans should include carefully developed and tested public education programs that are subject to continuing evaluation, that a national program for follow-up of persons given KI should be developed, and that the resource requirements of different KI plans should be evaluated by a federal agency. Other areas for research were also discussed in the text.

Comment

There is overlap between this section and the previous one emphasizing the need for continuing development and reevaluation of KI distribution plans. The committee, however, did not make recommendations for designing a mechanism that would actively assist the states and localities in creating and evaluating their individual programs. This would presumably require involving a federal or other agency with expertise to deal with the complex social and logistic requirements of such programs. The public’s interest in having the best possible protection against injury from a nuclear incident is fragmented by differing interpretations of need and methods to be employed. Since not all regions have, or will have, KI programs, the committee should have also given advice for individual members of the public concerning how they can provide for their own protection by informing them about KI tablets available for purchase.

The ATA Public Health Committee is awaiting release of a revised guidance document from DHS and DHHS, after which it will consider ways that might improve a still deficient program for protecting the public from thyroid injury resulting from a nuclear incident.