Physicians specializing in radiology, nuclear medicine, and radio-oncology have been trained in the safe and effective use of radiation for medical diagnosis and treatment. They are most suitably equipped with knowledge and skills to address issues related to the consequences of radiation on human health – although they are not necessarily experts in radiation disaster medicine – and should therefore ideally constitute the team of emergency response medical experts in a radiation disaster. However, from a review of the literature in English, few of these specialists have been involved in the medical response to nuclear accidents in Chernobyl or Fukushima. Kereiakes et al. (1986) highlight the “very important role” of nuclear medicine specialists, but there is no indication of actual involvement of these specialists, just the likelihood and potential of their contribution to the Chernobyl medical response.

I recognize that, because of the language barrier, I have no access to Japanese publications about this important topic. From our literature search, only one article was published by a Japanese radiologist from Iwate Medical University for whom the response to the Fukushima accident was to act on patients who presented at his hospital (Ehara 2011). According to the information drawn from this limited number of publications, the role of “radiology professionals” in addressing nuclear accidents is recognized (American College of Radiology [ACR] 2006). The ACR document on disaster preparedness provides a clear body of theoretical knowledge on the medical response to a radiation accident and identifies those specialists as “sources of accurate information for patients, the public, and the medical community” (ACR 2006, p. 3). However, despite this declaration, the single most important issue of radiation, that is risk communication to the publics, is not addressed in the document. A review paper “Medical Response to a Major Radiologic Emergency” published by Radiology (Wolbarst et al. 2010) calls for the same contribution from “radiology specialists” to become advisors to policy makers or science communicators for the media. The review recognizes the need for an effective communication strategy. Yet again, radiologists are not taught on what and how to tell the publics when they have been asked whether it is safe or not to live in a certain area nearby the accident site.

In order for radiology specialists to be effective in medical responses to radiation disasters, training for public communication is necessary. At the standpoint of risk communication, radiology specialists are primarily taught to communicate with patients in the context of radiation in diagnostics and medical treatment on a one-to-one basis (Ohno 2010; Staudenherz and Sinzinger 2012). Currently, public communication within the context of scientific uncertainty and public mistrust is also increasingly emphasized in radiation disaster medicine that does not only teach radiology specialists to provide the publics with information about radiation exposure (Staudenherz and Sinzinger 2012).

Emergency medicine covers diverse areas from various diseases requiring emergency treatment in the emergency department (ED) to pre-hospital care. In Japan, emergency specialty has been developed as a discipline called “Acute Medicine,” which features continuity of trauma and critical care from pre-hospital, ED, and intensive care unit (Safar 1974; Japanese Association for Acute Medicine 2007). Although the scope of practice of emergency specialties may vary from country to country, physicians in the emergency arena are frequently involved with disaster preparedness and countermeasures.

In the Great East Japan earthquake, approximately 24,000 medical personnel were involved in medical activities in the Tohoku region during the first 2 months after the earthquake (see Chap.​ 3) (Ministry of Health, Labor, and Welfare 2011). However, only a small number of emergency physicians headed for Fukushima soon after the accident because concerns over radiation existed, and information on radiation was not properly shared. In addition, most of them had not been properly trained for radiation disasters.

Although only a few were available, emergency physicians who were trained in disaster medicine as well as radiation emergency were at the core of the subsequent medical responses dealing with the most difficult situation in the Fukushima accident (Tanigawa et al. 2011a, b).

The roles of emergency physicians in radiation disaster are clear: planning for pre-hospital and hospital responses, medical activities on the scene and at hospitals, and coordination in responses as medical advisors at the operation center, hospitals, and disaster headquarters. In order to achieve these tasks effectively, emergency physicians should understand the nature of radiation, and the impacts of radiation disaster on individuals and societies.

The current primary care system in Japan is not as developed as it should be as most patients accede to health care either through the hospitals or specialist consultation. As a result, hospital facilities were quickly overwhelmed in the wake of the disasters by an influx of patients who may not have needed urgent or specialized care in secondary or tertiary cares centers (Starkey and Maeda 2011

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