Guide to communicating radiation risk in support of

action before, during and after a radiation emergency

A guide produced by The Society for Radiological Protection via a

collaborative workshop with attendees from EDF Energy, the Office for
Nuclear Regulation, Sellafield, AWE, The Environment Agency, Public
Health England, and The Department for Business Energy & Industrial
Strategy.
SRP President’s Foreword

Effective communication of radiation risk is a key part of radiation

protection, particularly in protecting people from the effects of a
radiation emergency. It is important to present the facts, enable people
to make informed decisions, build trust with the public and key
stakeholders, and dispel myths.

Achieving effective risk communication is a challenging task. The public

generally has a negative perception of radiation, and with conflicting
views being presented in the media and social media, the radiation
protection professional needs to be well prepared before they interact
with the public.

In a world where everyone can communicate and share information

online to millions of people, what is fact? What is opinion? Who is an
expert?

Recognising this challenge, in November 2019, SRP launched a new

workstream aimed at developing a series of short practitioners’ guides to
communicating radiation risk.

Radiation emergencies are an area of concern for the public, especially

following the accident at Fukushima Daiichi in 2011. Additionally, recent
changes in emergency planning legislation re-affirms the requirements
for effective communication and engagement.

The first of these practitioners’ guides therefore focuses on

communicating radiation risk before, during and after a radiation
emergency.

The content of the guide was developed via a collaborative workshop

pulling together experiences of attendees from UK Government, UK
Regulators, Nuclear Operators, Hospitals and Media/Communication
Specialists.

It is hoped it will provide a useful framework for those communicating

radiation risk in support of emergency preparedness, or in the unlikely
event it is needed during or after a radiation emergency.

Pete Bryant
President of the Society for Radiological Protection

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Contents
Scope of the guide ...................................................................................................................................4
Framework for communicating radiation risk in a radiation emergency .................................................4
Developing the Communication Strategy – how to communicate effectively .........................................7
A Checklist for Developing your Strategy: ............................................................................................7
Refining your message – what messages to choose ................................................................................9
Do’s and Don’ts of Communicating Radiation Risk ..............................................................................9
Measuring Effective Communication .....................................................................................................10
Closing Statement ..................................................................................................................................11
Appendix A - List of authors and stakeholders involved in the production of this guide .......................12
Appendix B - Further reading .................................................................................................................14
Appendix C - List of example stakeholders that should be considered in preparing your
communication strategy ........................................................................................................................15
Appendix D - Example case study...........................................................................................................16

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Scope of the guide
The following guide covers communication of radiation risk throughout the complete lifecycle of a
radiation emergency that may arise as a result of working with ionising radiation, including:
• prior to,
• during, and
• after the emergency.
This guide, developed via a collaborative workshop with the attendees listed in Appendix A, is
designed as a practitioners’ guide for communicating radiation risk. It provides useful guidance to all
radiation protection practitioners, and associated communication specialists. In particular, it will assist
radiation protection and emergency preparedness specialists involved in supporting an operator or
local authority with communication responsibilities under relevant legislation, including the Radiation
(Emergency Preparedness and Public Information) Regulations (REPPIR 2019).
Suggestions for further reading on communication with the public, with a focus on communication of
radiation risk are given in Appendix B.

Framework for communicating radiation risk in a

radiation emergency
This framework emphasises the importance of planning, and namely developing a “Communication
Strategy” which includes building trust and effective relationships, as well as pre-prepared key
messages, and tools for communicating these messages, prior to an emergency occurring. This will
help ensure that a consistent message is communicated, throughout all stages of an emergency. It is
now, as part of normal business, that the greatest opportunities are found to build trust with
stakeholders. This could include communication with the public at visitor centres to provide
information, generate interest and build trust. This will ultimately reduce the risks associated with
misunderstanding and conflicting messages.
Due to the diversity of radiation emergencies, and in the relevant stakeholders that may need to be
consulted, it is not possible for this guide to provide the exact communication strategy, nor exact
messages that need to be communicated. However, it can provide a framework that can be applied
by the practitioner to support the development of a communication strategy and refinement of the
messages for their specific situation.
Key to successful communication is the need to have a clear aim of what you want to achieve. So, the
first questions we need to ask ourselves are:
• Why do we want to communicate about radiation risk at the various stages of a radiation
emergency?
• Who do we want to communicate with?
• How are we going to communicate, which channels shall we use?
Ultimately, we want to:
• Build trust with stakeholders
• Enable people to make their own informed decisions, as ultimately individuals will decide for
themselves if they feel safe, and
• Ensure people feel informed to decide on the actions they wish to take, such as adopting
appropriate countermeasures, when required.

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 • Meet people’s needs of being given clear communication and instruction written with plain
language, while feeling informed and engaged rather than being passive victims.
To ensure the aims are met the output of this framework must:
• Reach the target audience
• Develop the messages and tools for communicating at all stages of the radiation emergency
• Ensure a consistent message is communicated by all involved in the dissemination of
information on radiation risk at the various stages of a radiation emergency.
Figure 1 provides a framework for approaching the communication of radiation risk. Further details
on what should be considered within the communication strategy, and useful pointers to refine the
messages to be communicated, are provided in the latter sections of this guide.

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 Prior to Emergency
•
Timeline

Develop a Communication Strategy (covering the whole life cycle of the

emergency)
• Test the Communication Strategy and update as necessary
• Implement relevant parts of the Communication Strategy (including preparation
of any tools and messages to be used at the later stages of the emergency)
• Measure effectiveness of the Communication Strategy
• Periodically review, learn and improve Communication Strategy (based on
metrics)
• Monitor external communications (eg social media)
• Plan to respond to alarmist/misleading messages

During Emergency
• Implement relevant parts of the Communication Strategy
• Reinforce prior information
• Coordinate response to emergency with other stakeholders to ensure a
consistent message
• Ensure there are live updates to all stakeholders
• Measure effectiveness of the Communication Strategy
• Periodically review, learn and improve the Communication Strategy (based on
metrics)
• Monitor external communications (eg social media)
• Respond to alarmist/misleading messages

After Emergency (Recovery Phase)

• Implement relevant parts of the Communication Strategy
• Coordinate response to the emergency with other stakeholders to ensure a
consistent message, noting the stakeholders may have changed. For instance,
how are the customer service staff for a nuclear energy operator going to
communicate about the radiation risk to customers?
• Measure effectiveness of the Communication Strategy (based on metrics)
• Periodically review, learn and improve the Communication Strategy (where
applicable based on metrics such website traffic, social media trends, surveys
etc.)
• Monitor external communications (eg social media)
• Respond to alarmist/misleading messages

Figure 1 Framework for Communicating Radiation Risk in a Radiation Emergency

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Developing the Communication Strategy – how to
communicate effectively
We can often forget that communication and sociology are well established fields. So, when preparing
your Communication Strategy, the first thing you should ask is “Am I the correct person to lead the
development of this?”

Most operators, large corporations and local authorities have Communication Departments and they
should be the people to approach to either lead or support the development of your Communication
Strategy. If you don’t have one within your organisation consider if you can gain access to this
expertise elsewhere.

Remember - “If you fail to plan, you are planning to fail!”

A Checklist for Developing your Strategy:

To achieve the aims mentioned earlier, development of your communication strategy should:

Consider all stages of the radiation emergency e.g. prior to, during, and after the
emergency.

Identify all your stakeholders, both in support of developing the Communication Strategy
and who you may need to communicate to prior to, during or after the emergency (e.g.
Public, Blue Light Services, Local Authority, Regulators, Hospitals, the Media etc.).
To help with this step an example list of stakeholders is provided in Appendix C of this guide.

Consult with your stakeholders during the development of the strategy. This is an
opportunity to start building “trust” but also to make sure the strategy is informed by “their
needs”. Ask yourself:
• What do they want to know?

• What do they need to do / know?

Setting up an engagement forum is a useful way of ensuring ongoing communication whilst

building trust, both during the development of the strategy and beyond.

Identify the most effective communication methods to reach your stakeholders at the
various stages. Remember that you may need to use different methods/channels for
different stakeholders and at different times.
When determining the method(s) of communication consider:
• Am I disseminating information or am I wishing to engage? Do I want to spread
information, often to the largest audience possible, or open opportunities for two-way
engagement, or both? If I open engagement with a large audience, am I able to
effectively engage with them and fully consider their views? Or could it be more
efficient to engage with smaller targeted groups of stakeholders? Are there
stakeholder groups with specific needs or wants?

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 • What communication methods am I going to use – for example, social media, written
or visual information, mainstream media (journalists, radio, TV), online forums, public
outreach, or invite people for site visits?

• Is my method of communication inclusive? What if people do not read, have sight or

hearing issues, or if English is not their first language? Consider if messages can be
given with pictures/infographics/videos/other channels instead of, or as well as, words.

Communication / Media Specialists will able to advise about selecting the correct method.
But remember it takes investment to make a message visible and available to a wide
audience. So consider the budget requirements, noting there is no point in picking a
method if you cannot afford it.
Where mainstream media is identified as an appropriate communication method
remember although it provides an opportunity to reach a large audience rapidly, what
starts as a clear message from an organisation may become clouded by the journalists’ take
on the story.
It is therefore important to build trusted relationships with key media outlets. Engaging
with the journalists and the media as part of the development of the strategy will start to
build that trusted relationship.
Always remember due diligence is an important step in mitigating against the propagation
of incorrect/distorted messages. Such messages may be intentional or unintentional, but
once a rumour has started it can be very hard to stop. Consideration of pre-recorded
interviews or the opportunity to see an article prior to publication are useful ways of
ensuring messages remain on point. If an incorrect/distorted message does appear in the
media, a quick, authoritative, response can help squash it, but a lack of clear
communication will increase its spread.

Where you have identified direct engagement with stakeholders as a preferred method of
communication, consider who is the best person to speak. Although technical advice
should come from a specialist, they may not be the correct person for public
communication. Does the Communication Strategy need to include training of potential
speakers? If you want to reach a wide audience have you considered advocates that might
be able to help share your messages? Are there community leaders that the public would
listen to if the emergency overturned their trust in the experts?

Develop and agree a joint strategy for co-ordinating communication with all other
stakeholders involved in the communication of radiation risk at the various stage of a
radiation emergency. This will ensure a consistent message is communicated from all
organisations, minimising the risk of confusion or misunderstanding.

Where appropriate, develop metrics for measuring the effectiveness of the communication
methods and messages and be prepared to adapt communications if necessary.
Further guidance on developing metrics is provided later in this guide.

Consider what is needed to implement the communication strategy, and re-engage with
your stakeholders via an engagement forum1 or similar to test the strategy and gain
support for its implementation.

1 An engagement forum is one means of including people that could be directly or indirectly affected,
to facilitate open and accountable dialogue and build greater mutual trust.

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Remember that once the strategy is implemented it is important at appropriate intervals, to
undertake a review, learn and improve exercise. This can be before or after any emergency occurring.
People’s fears, concerns, questions and beliefs can change with time. Additionally, technology is
evolving, and new forms of communication can develop at great speed. Messages and channels for
delivery may therefore need to change with time to ensure the strategy remains current and to
improve its effectiveness. This is applicable at all stages of the radiation emergency, e.g. prior to,
during, and after the emergency.

Refining your message – what messages to choose

In parallel to the development of the strategy you need to refine the messages you wish to
communicate, taking account of the chosen method of communication and the wants and needs of
the stakeholders.

Where possible you should pre-prepare any messages and the methods for communicating these
messages, prior to an emergency occurring. This will ensure there is appropriate time to consider the
messages and co-ordinate any communication with other stakeholders involved in the
communication of radiation risk at the various stages of a radiation emergency, reducing the risk of
misunderstandings or conflicting messages.

Do’s and Don’ts of Communicating Radiation Risk

Communications will be more effective if you achieve the following:

Keep the message simple and relevant to specific target audiences. Ask yourself do they
really need to know that? For instance, do they really need to understand the concepts of
radiation protection such as dose? Try to avoid technical language or jargon, including
avoiding the use of dose units that may not be understood by many of the public. If
needed, just use one unit rather than multiple variations e.g. mSv only.

Ensure the messages are open and honest. Be transparent. Do not mislead otherwise your
professionalism and integrity will be questioned and established trust and reputation may
be damaged.

Make sure the message is engaging and uses plain language. Given the amount of
information we come across on a day to day basis how do you capture people’s attention
and make sure they remember it? Consider the use of infographics and video messages to
improve engagement.

Make sure the message is readily accessible and inclusive. Do not make assumptions on
pre-assumed knowledge.

Where appropriate make sure you use different methods of communicating your message.
Do not assume all your stakeholders can read, see or hear.

Remember to put things into context and provide a balance of explaining both the
negatives and the benefits. For instance, when communicating prior information to the
public who are within an emergency planning zone, do not focus solely on the negatives of
radiation and nuclear power. Put it into context, of why it is needed. This will help with
managing the negative perception of radiation risk and allowing the public to make an
informed decision.

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A case study is provided in Appendix D as an example.

When directly engaging face-to-face with stakeholders be prepared but remember you cannot predict
all the questions or potential concerns that will be raised. If available, consider training for potential
speakers.

In addition to the above the following list of points are useful tips to remember:

Remember we do not do and know everything, no one does! Be prepared to admit and
communicate uncertainties. This is an important part of being credible. If unclear
information is given out as certain this can lead to lack of credibility and once lost, trust is
hard to regain If you do not know the answer to a question it is ok to say you will get back
to them with the answer.

Be honest, straightforward and make people feel comfortable talking to you. Listen to their
concerns to understand their fears rather than make assumptions. Empathy can help build
relationships and trust.

Remember no-one wins from an argument. Listen to and consider any criticism then
respond positively with empathy. Respond as appropriate, but do not get defensive.

Measuring Effective Communication

Measuring the effectiveness of the communication methods and messages is a useful tool to help
refine the communication strategy and to shape future messaging. However, developing a suitable
metric can be challenging.

In developing metrics to measure the effectiveness of your communication strategy:

Consider what information will give you confidence in your strategy at different stages of a
radiation emergency, or what will alert you to a problem? Is there a way of measuring it?
What is the best way of measuring it? Should it have a metric or is a qualitative measure
better? Is the mechanism for measuring effectiveness different at each stage of the
radiation emergency?

For example, if you want confidence that people are doing what you’ve asked them to do,
a good metric is to measure how many people have done it. For instance, if you have asked
people to buy or download a document, measure the number of purchases or downloads
and have a target number / percentage you want to achieve.

Or, if you wish to measure understanding or knowledge, consider the use of a survey. But
be careful with the wording of questions, for instance if you are testing if they know when
to shelter than asking “Do you know when to shelter?” will not necessarily give a true
representation. However, asking a multiple-choice question “In which of the following
events do you need to shelter?” will provide a much clearer picture. You will need to find a
way of targeting the stakeholders you are interested in and encourage them to respond.

Identify when you should measure the effectiveness of your strategy and at what
frequency

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 Decide if you need to undertake a baseline study first to determine any change as a result
of your communications.

Closing Statement
The content of this guide was developed via a collaborative workshop focusing on providing advice on
the communication of radiation risk before, during and after a radiation emergency. A list of the
attendees is provided in Appendix A.

As a practitioners guide its content is pitched at providing a concise summary of the key points that
should be considered by radiation protection practitioners, and associated communication specialists
supporting an operator or local authority with communication responsibilities under relevant
legislation, including the Radiation (Emergency Preparedness and Public Information) Regulations
(REPPIR 2019).
Suggestions for further reading on communication with the public, with a focus on communication of
radiation risk, are given in Appendix B.
This guidance is of first of a series of practitioners’ guides focusing on the communication of radiation
risk under various scenarios. Future guides will focus on topics such as medical exposures, non-
ionising radiation and public outreach.

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Appendix A - List of authors and stakeholders
involved in the production of this guide
Authors of the Guide

Name Role

Pete Bryant President of the Society for Radiological Protection (SRP)

Amber Bannon SRP Immediate Past President

Samantha Watson Secretary for the SRP Workshop used to develop this guide

Jim Thurston SRP Trustee & President Elect

John Croft SRP Member

Contributors to the SRP Workshop used to develop this guide

Name Role / Organisation

Pete Bryant Workshop Chair and SRP President / EDF Nuclear New Build (Hinkley Point C)

Amber Bannon Workshop Co-Chair and SRP Immediate Past President / Environment Agency

Samantha Watson Workshop secretary / Public Health England

Daniel West SRP Invitee / Atomic Weapons Establishment

Sarah Darwin SRP Invitee / Sellafield

Jim Thurston SRP Invitee

Jacob Fear Policy Manager on Civil Nuclear Resilience / BEIS

Carol Attwood Radiation Incident Management Team leader / Environment Agency

Caroline Richards Stakeholder Engagement & Communications Adviser / Environment Agency

John Spittlehouse Communications Manager / Office for Nuclear Regulation

Sandra Little Principal Nuclear Safety Inspector / Office for Nuclear Regulation

Matthew Pardo External Communications Manager / EDF Energy - Nuclear Generation

Ross Edwards Community Relations Manager / EDF Nuclear New Build (Hinkley Point C)

John Skegg Chair of Nuclear Emergency Arrangements Forum

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Page | 13
Appendix B - Further reading
International Atomic Energy Agency

• Communication and Consultation with Interested Parties by the Regulatory Body, IAEA Safety
Standards Series No, GSG-6. IAEA, Vienna (2017)
• Considerations in the Development of a Protection Strategy for a Nuclear or Radiological
Emergency, EPR-Protection Strategy 2020. IAEA, Vienna (2021)
• Preparedness and Response for a Nuclear or Radiological Emergency, IAEA Safety Standards
Series No. GSR Part 7. IAEA, Vienna (2015)
• Arrangements for Public Communication in Preparedness and Response for a Nuclear or
Radiological Emergency, IAEA Safety Standards Series No. GSG-14, IAEA, Vienna (2020).
• Nuclear Communicator’s Toolbox. IAEA, Vienna (2019)
https://www.iaea.org/resources/nuclear-communicators-toolbox
International Radiation Protection Association

• Practical Guidance for Engagement With the Public on Radiation and Risk
Nuclear Energy Agency/Organisation for Economic Co-operation and Development

• Towards a Shared Understanding of Radiological Risks, Summary Report of the NEA

Stakeholder Involvement Workshop on Risk Communication. OECD (2021)
• Commendable Practices on Transparency in Nuclear Regulatory Communication with the
Public, NEA/CNRA/R(2011)3. OECD (2011)
UK Government communications service

• Emergency planning framework (2018)

https://gcs.civilservice.gov.uk/publications/emergency-planning-framework/
• COVID-19 Communications Advisory Panel Report Advisory Panel Report COVID-19
Communications Advisory Panel Report (2020)
https://gcs.civilservice.gov.uk/publications/covid-19-communications-advisory-panel-report/
• RESIST Counter Disinformation Toolkit (2021)
https://gcs.civilservice.gov.uk/publications/resist-counter-disinformation-toolkit/

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Appendix C - List of example stakeholders that should
be considered in preparing your communication
strategy
The following is a list of potential stakeholders that should be considered in preparing your
communication strategy:

• Communication Specialists in the Operator / Local Authority

• Workers on the Operators Sites and any neighboring sites
• Members of the Public within the Emergency Planning Zones (Detailed and Outline)
• Neighboring areas
• Local Authority for Emergency Planning Zones (Immediate and Neighboring)
• Emergency Responders & Blue Light Services
• Senior Management with the Operator and Neighboring Operators
• Members of Parliament / Assembly Members for areas inside the Emergency Planning Zones
• Care Homes inside the Emergency Planning Zones
• Non-Government Organisations (Pro and Against Nuclear Energy)
• Front End Hospitals serving the areas inside the Emergency Planning Zones
• Professional Societies
• Regulators
• Schools inside the Emergency Planning Zones
• Schools outside the Emergency Planning Zones (post-recovery ONLY)
• UK Government and / or Devolved Government for those areas inside the Emergency Planning
Zones
• Religious Leaders inside the Emergency Planning Zones
• Community Groups / Parish Councils / Youth Centres inside the Emergency Planning Zones
• Local Businesses inside the Emergency Planning Zones
• Insurance Companies
• Farming Communities (e.g. National Farmers Unions) for those areas inside the Emergency
Planning Zones
• Mainstream and Local Media / Journalist
• Social Media Influencers
• Universities

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Appendix D - Example case study
It should be noted that at the time of this event (2006) social media was not as developed as it is now
and therefore this element is absent from the details of communications given in the case study. The
approach and issues highlighted, together with the lessons learned are still valid, but in a modern-day
event social media considerations would need to be included.

Incident name Polonium-210 Poisoning of Alexander Litvinenko in London, 2006

Description On 23/11/2006, Alexander Litvinenko died in London as a result of poisoning

by Po-210, an alpha particle emitter. The spread of radioactive contamination,
arising from the poisoning and the events leading up to it, involved many
locations in London including hospitals, hotels, offices, restaurants, bars and
transportation The potential for intakes of Po-210 arising from the
contamination posed a public health risk and generated considerable public
concern.
The scale of the event required a multi-agency response, including top level
Government emergency response management arrangements (COBR), the
Police led Strategic Co-ordinating Group, and the Health Protection Agency
(HPA), precursor of Public Health England) (PHE), who led co-ordination and
management of the public health response.
The public health response had to manage the concerns of thousands of
concerned individuals, together with staff and visitors at affected locations.
This included many overseas visitors.
The acute phase of the response lasted some 6 weeks into January 2007, with
the recovery phase lasting into the summer.
Prior to the event:

Details of The poisoning of an individual with radioactivity was not something that had
communication(s) been envisaged and therefore no communication plans specific to this
incident were made in advance.
However, HPA had a mature and well-rehearsed Nuclear and Radiological
Emergency Response Plan, including communication elements, that could be
adapted for this response. HPA also had an Incident and Emergency Response
Plan that provided overarching arrangements for all types of incidents.
Additionally, a bank of existing Q&As and other material developed for
emergencies had been tested in emergency exercises.
How was Exercising of emergency response plans had identified the need for a strong
communication communications element that provided appropriate information to a wide
received? spectrum of audiences.

Outcomes Existing material, already tested in emergency exercises, meant that

communication teams were not starting from a blank sheet of paper.
During the event:

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Incident name Polonium-210 Poisoning of Alexander Litvinenko in London, 2006

Details of As soon as the presence of high levels of Po-210 were identified

communication(s) implementation of the communications strategy was put in place as an urgent
action. A team worked overnight on Q&As plus other supporting material.
A press conference was arranged, hosted by the HPA CEO and the director of
its Radiation Protection Division. HPA outlined the radiation monitoring that
was being carried out and based on the monitoring results received at that
stage, reassured the public that the risk to the general public was likely to be
very low. A simple demonstration with a glass of water was used to illustrate
how alpha radiation from Po-210 was unable to pass through skin or other
surfaces, providing an essential message to the public that Po-210 was not a
threat to health when it was in a suitable container. It had to be ingested,
inhaled or absorbed through a wound to be a threat to health.
The first few weeks were very intense in terms of media interest. Throughout
the incident the need to respect the sensitivities of the police investigation
was a key issue, while trying to ensure that the public were both protected
and provided with sufficient information. Clear boundaries needed to be set
on the media questions HPA could respond to directly and the questions that
needed to be directed to police communication colleagues.
HPA took an early decision on 27/11/2006 to provide the media with daily
press statements. HPA continued issuing daily updates until just before
Christmas, then moved to issuing weekly press statements until March 2007.
HPA’s Communications Division always tried to give its partners (such as
government departments, the police, the NHS, NHS Direct and local
authorities) advance sight and warning of information HPA published for the
media and the public. This allowed the Agency to work closely with partners
and ensure any issues could be flagged up quickly in what was a very fast-
moving news story.
It was agreed early that it would be useful to have HPA staff embedded in the
police investigation team’s office. Whilst this was primarily driven by
operational benefits there were also communication benefits with the police
and other stakeholders.
At each affected location, an HPA Consultant in Communicable Disease
Control (CCDC) was assigned as lead of a team. The CCDCs were well versed in
talking with the public and understanding and explaining risks. This public
health expertise was combined with Radiation Protection expertise for
communicating with management and staff.
Site specific questionnaires were developed for triage and risk assessments.
Those most at risk of having an intake of Po-210 were offered analysis of a
urine sample. Clear information was provided on what was involved, with a
significant amount of explanatory material placed on the website and
complemented by media interviews and filming in the dosimetry laboratories.
It was important to manage expectations by clearly explaining that the
technique took 4 to 5 days to produce a result.

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Incident name Polonium-210 Poisoning of Alexander Litvinenko in London, 2006

Monitoring results were given to the individuals, with information to explain

the significance of the results and put the risks into perspective. HPA felt it
important to inform the public of the unfolding investigation, especially as the
urine results were reassuring and confirmed that the risk to the general public
was low. Therefore, it was decided to release anonymised details of the results
to the public via the media, once the individual concerned had been informed.
This was a very difficult communications issue. It was found that grouping
results in broad ranges of dose assessments, and hence risk, was effective.
Appropriate scripts with advice and triage questionnaires were rapidly
developed for use by NHS Direct (a phone based 24-hour service providing
health advice and information to the public, now NHS111). The Chief Medical
Officer for England made a commitment for HPA to contact all NHS Direct
callers who wanted reassurance or follow up.
HPA formed an Overseas Advice Team (OAT) to follow up contact with around
650 international visitors who were in London at the time of the poisoning and
may have been exposed, but who had returned home by the time it was
discovered. The Government’s Foreign and Commonwealth Office (FCO) took
the lead in formally contacting relevant Embassies and organisations.
A formal clearance letter from the HPA CEO to Westminster City Council
(WCC), supported by a detailed monitoring and assessment report was
required to support “clearance” of a location in order to maintain public,
business and regulatory confidence.
It was recognised that actions taken by personnel involved would also
contribute to risk communication. For example, staff carrying out routine
“clearance” monitoring in facilities such as hotels used only gloves rather than
full PPE (unless monitoring indicated otherwise) so as not to contradict the
message to the public that risks were limited in most areas.
How was The first press conference was timed to allow for follow-up broadcast
communication interviews for the evening news programmes and for the print media to file
received? their news stories ahead of newspaper deadlines. Throughout the whole of
the subsequent response, significant effort was put into ensuring the
scheduling and content of press releases, briefings etc. was sympathetic to the
deadlines and needs of the media.
Issue of scheduled press statements helped ensure that the media had up to
date information, but also provided HPA with the time it needed to brief all its
many partners and stakeholders beforehand.
The use of CCDCs at affected locations helped communications, and as
doctors they immediately commanded respect.
In the very early response to the poisoning the emphasis was on carrying out
the measurements to provide a broad-brush view of the situation. However, it
became clear that to maintain public, business and regulatory confidence it
would be necessary to have detailed documentation to support “clearance” of
a location.

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Incident name Polonium-210 Poisoning of Alexander Litvinenko in London, 2006

Outcomes A learning point was that basic RP training needed to be included in the
internal training across HPA, especially for public facing professionals such as
CCDCs.
In addition to providing information via the press, other media and NHS Direct,
HPA also received many calls directly, which needed call centres to be
established.
It was a significant, but necessary, task to ensure that all external
communication information points gave coherent and up to date advice. A
consequential learning point from this, that was rectified, was that the
emphasis on meeting external communications needs had detracted from
keeping all HPA staff well briefed. The common element is the need to build
into plans the ability to ramp up the resources committed to communications
After the event:

Details of Daily press statements continued until just before Christmas 2006, with
communication(s) weekly update press statements issued until March 2007.
A joint WCC and HPA survey was commissioned to evaluate the effectiveness
of the HPA’s communications so that it, and others, could learn from the
incident and build on identified lessons for any future incidents. This was
particularly important due to the unprecedented nature of the incident. This
involved 500 interviews carried out between the 9 and 13 January 2007 with
London residents who had heard of the incident.
How was The WCC/HPA survey gave some indications of how key messages from HPA
communication throughout the incident were received:
received?
• Three quarters of the Londoners surveyed heard that the health risk to
the public was very low.
• 57% heard that if they were concerned, they should call NHS Direct for
more information and advice.
• The message heard was that Po-210 is only harmful when ingested or
inhaled.
• 41% of Londoners heard that low levels are not harmful to your health.
• 25% heard that Po-210 occurs naturally in the environment.
Outcomes Answers to WCC/HPA survey question ‘How worried were Londoners?’
indicated that the majority were either not worried at all or not very worried.
The amount of worry experienced was dependent on a number of factors:

• Women were significantly more worried than men.

• Ethnic minority groups were more worried than white groups.
• People living in outer London were more worried than those living in
inner London.
Lessons learned:

• Engagement with all stakeholders is a key element of a successful response.

• Being open and maintaining trust is essential.
• Having national response frameworks, and exercising them, provides important underpinning.

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Incident name Polonium-210 Poisoning of Alexander Litvinenko in London, 2006

• Successful communication and engagement are likely to be resource intensive.

Further reading

● Croft JR et al: Management of response to polonium-210 incident in London, IRPA 12;

http://www.irpa12.org.ar/fullpapers/FP0841.pdf
● Maguire H: Assessing public health risk in the London Polonium-210 incident, 2006; Public
Health 124 (2010) 313-318; Elsevier
● Shaw et al: The international follow-up of individuals potentially exposed to polonium-210 in
London 2006; Public Health 124 (2010) 319-325; Elsevier
● Bailey MR et al: Individual monitoring conducted by the Health Protection Agency in the
London Polonium-210 incident; HPA-RD-067
● Rubin G et al: Public information needs after the poisoning of Alexander Litvinenko with
polonium-210: cross sectional telephone survey and qualitative analysis; BMJ 2007; 335: 1143
● Westminster City Council, Framework strategy for dealing with radioactive contamination
arising from the circumstances surrounding the death of Alexander Litvinenko” Project report.
Westminster City Hall, UK, (2007).
http://www.londonprepared.gov.uk/downloads/litvenenko.pdf

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