The Fukushima Dai-ichi accident: additional lessons from a radiological emergency assistance mission.

In response to the March 2011 earthquake-tsunami disaster and the Fukushima Dai-ichi nuclear accident, a special nongovernmental Radiological Emergency Assistance Mission flew to Japan from the United States. Invited by one of Japan's largest hospital and healthcare groups and facilitated by a New York-based international disaster relief organization, the mission included an emergency physician, a health physicist, and a disaster management specialist. During the 10 d mission, team members conducted fieldwork in areas affected by the earthquake, tsunami, and nuclear accident; went to cities and towns in the 20-30 km Emergency Evacuation Preparation Zone around the damaged nuclear plant; visited other communities affected by the nuclear accident; went to evacuation shelters; met with mayors and other local officials; met with central government officials; exchanged observations, experiences, and information with Japanese medical, emergency response, and disaster management colleagues; and provided radiological information and training to more than 1,100 Japanese hospital and healthcare personnel and first responders. The mission produced many insights with potential relevance for radiological/nuclear emergency preparedness and response. The first "lessons learned" were published in December 2011. Since that time, additional broad insights from the mission and mission followup have been identified. Five of these new lessons, which focus primarily on community impacts and responses and public communication issues, are presented and discussed in this article.