What Hospitals Need to Know About Small Modular Reactors

On July 21, Pennsylvania Governor Josh Shapiro signed Act 37, which rewrites the fee structure the state charges nuclear operators. It no longer penalizes small modular reactors (SMR) and micro-reactors for needing more sites than a traditional plant. It's the kind of law that can reshape where reactors might get built over the next decade. Indiana, Texas, Wisconsin, Maryland, and a lengthening list of other states have passed their own SMR incentives over the past two years. If your hospital or healthcare facility hasn't had a conversation yet about whether one of these could land in your service area, this may be a reasonable time to start one.

The reason SMRs are spreading is somewhat baked into their design. A conventional reactor site houses several large units and needs a big, well-established footprint. SMRs are smaller, factory-built, and can be trucked to locations that don't have the grid infrastructure a traditional plant would require, which means rural counties and smaller communities are now plausible hosts in a way they weren't before. That could appeal to many state legislators who are trying to solve energy and data-center demand problems.

It's also the reason emergency managers who've never thought about radiological preparedness might need to start.

The Basics

Traditional reactors come with a federally mandated Emergency Planning Zone (EPZ) that is 10 miles for evacuation and sheltering, and 50 miles for food and water contamination planning. Hospitals inside that zone typically receive dedicated funding, training, and exercises from the plant operator, because the rules require it. Many SMR designs qualify for something much smaller (a "fenceline" or site-boundary EPZ) that stops at the plant's property line because the developer can show an accident wouldn't push off-site radiation levels above EPA thresholds. NuScale's VOYGR reactor was the first design the U.S. Nuclear Regulatory Commission (NRC) approved on this basis.

That's a real safety improvement, and it's also a notable gap when you consider that a hospital two miles from a site-boundary reactor gets none of the formal funding or training obligations a legacy EPZ promises, even though it would still be the first call if something went wrong. New designs add hazards that don't appear in most existing emergency plans, either. Some of these can use liquid sodium coolant, which ignites on contact with air or water. Others use toxic liquid beryllium or lead. Fusion reactors, a separate technology worth tracking also, use tritium, which ordinary handheld radiation meters have trouble picking up.

The CDC's Radiation Hazard Scale, first published in 2014 and refined through years of testing with public information officers and health professionals, sorts radiation risk into five color-coded categories, from background-level green to potentially lethal red, without leaning on units of measurement that most people, including healthcare workers, don't use in their daily lives. CDC's own case modeling paired the scale with a "Get Inside. Stay Inside. Stay Tuned." message and found that sheltering in place for 48 to 72 hours could cut a simulated at-risk population from roughly 91,000 people down to about 12,000.

Category 5 (red) means that radiation doses are dangerously high and potentially lethal. High doses of radiation can cause massive damage to organs of the body and kill the person. The exposed person loses white blood cells and the ability to fight infections. Diarrhea and vomiting are likely. Medical treatment can help, but the condition may still be fatal despite treatment. At extremely high doses of radiation, the person may lose consciousness and die within hours.

More information about Acute Radiation Syndrome.

Category 4 (orange) means that radiation doses are dangerously high and can make people seriously ill. Radiation doses are not high enough to cause death, but one or more symptoms of radia­tion sickness may appear. Radiation sickness, also known as Acute Radiation Syndrome, is caused by a high dose of radiation. The severity of illness depends on the amount (or dose) of radiation. The earliest symptoms may include nausea, fatigue, vomiting, and diarrhea. Symptoms such as hair loss or skin burns may appear in weeks.

More information about the health effects of radiation.

More information about the medical treatment of radiation exposure.

Category 3 (yellow) means that radiation doses are becoming high enough where we may expect increased risk of cancer in the years ahead for people who are exposed. Leukemia and thy­roid cancers can appear in as few as five years after exposure. Other types of cancer can take decades to develop. Studies have shown that radiation exposure can increase the risk of people developing cancer. This increased risk of cancer is typically a fraction of one percent. The lifetime risk of cancer for the population due to natural causes is approximately 40 percent. The increase in risk of cancer from radiation depends on the amount (or dose) of radiation, and it becomes vanish­ingly small and near zero at low doses of radiation. Similarly, studies of cancer rates following short term exposures and doses have shown increases in cancer risks. These types of expo­sures and doses are typically expressed over time, such as dose per hour.

More information about the health effects of radiation.

Category 2 (green) means that radiation levels in the area are higher than the natural background radiation for that geographic area. However, these radiation levels are still too low to observe any health effects. When radiation levels are higher than what we normally have in our natural environment, it does not necessarily mean that it will cause us harm.

More information about the health effects of radiation.

Category 1 (white) means that radiation levels in the area are within the range of natural background radiation for that geographic area. The typical natural background radiation dose in the Unit­ed States is approximately 3.1 mS/year, including the contribution from radon.

Low amounts of radioactive materials exist naturally in our environment, food, air, water, and consequently in our bodies. We are also exposed to radiation from space that reaches the surface of the Earth. These conditions are natural, and this radiation is called the natural background radiation¹.

Learn more about radiation in your life and how it can vary by location.

Parting thought

Pennsylvania is just the most recent state to make this move, but it likely won't be the last. So, if there's no SMR proposal anywhere near you yet, there's a decent chance there could be within a few years, given how fast state incentives are moving. Two things are worth doing regardless of timeline: 1) find out whether your state has a radiation control program director or NRC liaison officer, and get to know them before you need them, and 2) pull the CDC Radiation Hazard Scale into your existing risk communication templates now, so it's a tool your team already knows rather than one they're learning live.

^1. National Council on Radiation Protection and Measurements (2009). Ionizing Radiation Exposure of the Population of the United States. NCRP Report 160. Bethesda: NCRP.

Author: Tom Kitchen, Jr., MECM, manager, emergency management