Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident (2004)

The Table C.1 indicates whether a particular state distributes KI.

Information used in developing this appendix was culled from responses to a request for information sent to states by the committee; information posted on the Internet by state, federal, and public-health institutions; and a few published articles.

States that do not have commercial NPPs within their borders or within 10 miles of their borders do not distribute KI. Maine discontinued its distribution program after the decommissioning of the Maine Yankee power plant (Maine Bureau of Health, 2003).

Several states with commercial NPPs have thus far decided not to distribute KI. These are listed in Table C.2 with information regarding KI distribution provided by the state to the committee or otherwise available. In addition, an entry is given for Idaho, a state with a test rather than a commercial NPP; it cannot envision an accident of a magnitude that would require distribution of KI to those in the sparsely populated area near the facility.

Chapter 6 discusses the four states with only postincident distribution programs.

The discussion below provides some information on the several states with predistribution programs except Connecticut, Maryland, and Tennessee, which are discussed in detail in Chapter 6.

California instituted a three-pronged program of predistribution, public education, and stockpiling and emergency distribution. Predistribution involved a mass-mailing of information on the availability of KI, which included a postcard order form to return to the state to obtain KI for the household or business. KI was then returned, two tablets per person, for the number of people indicated on the order form as residing or working at the household or business (California Office of Emergency Services, 2002). Businesses and residents received a “Potassium Iodide Fact Sheet” with an information sheet regarding dosage, how to address side effects, dosages for children and infants (FDA 2001a guidance), and where to purchase additional KI. Materials were available in Spanish and English. The education program involved releases to newspapers, television, and radio; placing information in telephone directories serving the area; and establishing a public-information telephone line. Non-English media serving the area were also used in the public-education program. As of July 29, 2003, mailers had been sent to 154,000 addresses, and orders were received from 26,000 addresses; 275,000 dosages have been distributed.

City and country governments have the responsibility of maintaining KI for emergency workers in the emergency planning zone (EPZ). California provided KI on request to state agencies and public schools within the EPZ. The schools were given guidance on how to develop their own distribution plan for the inventory. The state coordinated with military institutions to ensure that KI was offered to military personnel and their families within the EPZ.

Stockpiled KI would be distributed to evacuation reception centers in an incident. When the emergency classification level is at the “Alert” stage, the state Office of Emergency Services plans to deliver KI to the evacuation centers if the situation appears to worsen or on request of a county operational area.

All costs of the California KI distribution program are covered by the owners of the state’s two commercial NPPs with other costs of emergency planning, training, and exercises. The state noted that with more federal funding the state would be better placed to maintain the stockpile when shelf-life is reached and to offset costs of the public-information line and the Web site.

Delaware requested KI from the Nuclear Regulatory Commission in March 2002 to distribute to permanent and transient populations within 10 miles of the Salem/Hope Creek Generating Stations in New Jersey (Delaware Emergency Management Agency, 2002). The predistribution occurred from August to October 2002 (Delaware Emergency Management Agency, 2002, Delaware Health and Social Services, 2002a,b). The predistribution consisted of providing KI at specified locations on specific days to residents showing proof of residence, such as a driver’s license or utility bill; child-care center operators; and those employed in the area who provided verification of employment on business letterhead from their employer (Delaware Health and Social Services, 2002b). Two tablets per person affected were provided. The KI that remains after the predistribution will be available at emergency registration facilities as a supplement to evacuation during an emergency (Delaware Health and Social Services, 2002a). A fact sheet (Delaware Health and Social Services, 2002c) provides information on KI, when it is to be taken, contraindications (dermatitis herpetiformis and hypocomplementemic vasculitis are named), side effects, how it should be stored, and recommended dosages. Precautions regarding high-risk groups over 40 years old and overdosing of neonates are not provided in the fact sheet. The recommended dosage was that given in the Food and Drug Administration (FDA, 2001a) guidelines.

Illinois. Before the Nuclear Regulatory Commission offering of KI, the state made KI available for designated emergency workers and immobile populations. After the offering, the state acquired 360,000 tablets to cover 180,000 people within the EPZ for six sites. The state indicated in its response to the committee’s request for information that the cost of the initial acquisition of KI was $78,000 and that it acquired an additional 750,000 dosages at a cost of $150,000. The inventory is in storage as part of the state’s emergency preparedness stockpile. Recipients of KI were required to sign a disclaimer indicating they would read and follow the instructions for proper use of the drug and would consume it only when advised by state or local authorities. Distribution was to persons “claiming to live or work within 10-miles of the nuclear plants, not by household”. Some 12,000 tablets were dispensed in the predistribution; the state

noted that this was about 6% of the eligible population requesting the drug.

The state attempted to recruit local public-health agencies as outlets for KI distribution, but most declined because of liability concerns. Individual businesses in or near the EPZs requested KI for employees, but schools, day-care centers, and other facilities have not, citing liability issues. Jails, nursing homes, and hospitals are given KI because they are considered to be housing immobile populations.

The state considered the KI distribution program as an element of bioterrorism preparedness and highlighted it in a “Security Update” (Illinois Homeland Security, 2002a): “New federal bioterrorism legislation passed by Congress last week directs the United States Department of Health and Human Services (HHS) to provide potassium iodide (KI) for stockpiling and distribution within a 20-mile radius of nuclear power plants in those states that elect to do so. The current Nuclear Regulatory Commission initiative on KI distribution within 10 miles of each plant site would affect about 180,000 residents, but expansion to 20 miles would boost that population base in Illinois to more than one million. The new legislation and its implications for Illinois are being reviewed.”

The state advises that the dosages provided in the FDA 2001a guidelines be given and further that “these guidelines are important to follow, particularly for children and infants whose thyroid glands are more active than adult thyroids and thus more sensitive to iodine levels” (Illinois Emergency Management Agency, 2002). The state also advises that “in instances where KI is given to a newborn, the infant should be monitored by a physician for symptoms of transient hypothyroidism following administration of the drug.” The state further cautions under the header “KI Is Not Safe For Everyone!” that those with known iodine allergies including those who are must avoid some sea foods and other foods with high natural iodine content. It also cautions that “those suffering certain thyroid disorders or taking thyroid medications, as well as pregnant women, nursing mothers, and individuals taken certain heart medications or antipsychotic drugs should consult their physicians before deciding to use KI.” “As with any medication, you should consult your physician to determine if KI is safe for you.” The state sought clarification regarding dosage

guidelines from FDA (Illinois Homeland Security, 2002b), indicating that two other states, Washington and New York, were also doing so. Illinois noted that “the FDA issued age-related guidelines for KI use last year warning that children should be limited to lower dosages not commercially available. With regards to the state’s liability if dosage guidelines could not be reasonably addressed, the FDA advised compliance with its guidance was voluntary.”

Noting that predistribution is the only practical means of ensuring that KI is available on a timely basis to those affected, the state emphasized that there was no effective means of ensuring that those who need it will actually possess it or use it appropriately. “Only through controlled application of KI is the effectiveness of the drug assured. At least some portion of the affected population will misconstrue the effectiveness of the drug and assume it provides a level of total exposure protection that could only be achieved by prompt evacuation, while others who consume the drug inappropriately will suffer adverse reactions.” The state also noted that the cost of the drug was inexpensive but that developing and maintaining a distribution system was time- and labor-intensive. It also said that “a key impediment to widespread availability of the drug through state-sponsored outlets is liability. The Nuclear Regulatory Commission’s 2001 offer of a free stockpile to any state that wanted to distribute KI contained an explicit disclaimer of any liability for the drug’s use or misuse. Any endorsement or promotion of KI use by the federal government should absolve state or local jurisdictions of liability.”

New Hampshire. Originally, New Hampshire’s Radiological Emergency Response Plan provided for issuing KI to emergency workers and institutionalized persons but not the general public. After the Nuclear Regulatory Commission’s offer, New Hampshire acquired 350,000 tablets for distribution in a voluntary program covering the public living, working, or attending school within the 10-mile EPZ. Schools and workplaces can obtain KI for their students and workers and are expected to develop their own plans to manage distribution in the event of an emergency. Interested members of the public can order KI by submitting an application that is available at town halls, at district offices of the Department of Health and Human

Services, and on the Internet. As of June 23, 2003, only 12,410 pills (3.5% of the total) had been distributed to the public within the 10-mile EPZ. The remainder of the allotment will be used for any needed emergency distribution.

The state notes that ingestion of KI as a supplementary protection is advisable if it will not interfere with evacuation. The planned approach to informing the public in an emergency is to advise the public in the evacuation area to take KI when an announcement advises emergency workers to take KI.

Massachusetts. The state requested 660,000 tablets from the Nuclear Regulatory Commission and engaged in a predistribution program of one tablet per person for each employee or resident within the 10-mile EPZ of the three nuclear facilities—two in Massachusetts and one in Vermont. Completion of a KI request form from the Massachusetts Department of Public Health was required (MDPH) (form available at www.state.ma.us/dph/rcp/rcpkifrm.htm). An employer could obtain KI for all employees at a facility. A notice was sent to employers within the EPZ outlining how to obtain KI for their employees and advising them about Web sites and phone numbers for employees to use to obtain information (MDHP, 2002a).

With regard to dosage, MDPH (2002b) posted a letter to interested parties on its Web site. The letter noted that the only formulation available was a 130-mg pill and gave the FDA 2001 advice on “lowest effective dosage”. MDPH noted that “until the 65 mg table is available, MDPH supports the administration of the 130 mg tablet for children in settings such as schools or child care centers in the event of emergencies. This is in agreement with FDA statements. The dosage is safe and well within the recommended therapeutic rage of KI for other indications. The blocking effect of iodide on the thyroid lasts only a few days (daily dosing is needed as long as the child is exposed to the radioiodine) and any suppressive effect of KI on thyroid function has been shown to be minimal, even in young children. The logistics of providing KI to persons too young to take pills are more complicated. KI pills can be crushed and dissolved…” There are no notes of precaution or about follow-up for dosages given to neonates; rather “the FDA has noted that absolute precision in dosing is generally not critical to safety or

efficacy…” the overall benefits of KI far exceed the risks of overdosing, especially in young children.”

New Jersey acquired 722,000 KI pills from the Nuclear Regulatory Commission in April 2002 for pre- and post- incident distribution and stockpiling. The plan is to distribute KI to people living, working, or visiting in areas within a 10-mile vicinity of the state’s four NPPs (New Jersey Department of Health and Senior Services [NJDHSS], 2002a, 2002b). The policy for KI distribution was developed by NJDHSS in collaboration with the state’s Department of Environmental Protection and the NJ State Police Office of Emergency Management. The intervention level identified by New Jersey is a projected 50 mGy (5 rad) to the child thyroid.

In the predistribution anyone living or working within the 10 mile EPZ is offered KI, to be acquired by pickup from the local health department. KI is offered this way on a continuing basis. KI public-education and distribution sessions were held in the evenings on weekday and during the day on Saturday. Identification—such as a driver’s license, paycheck stub, or phone bill—was required as proof that the individual picking up KI resided or worked in the EPZ. As of July 14, 2003, 75,000 dosages of KI had been distributed. Post-distribution would occur at designated evacuation reception centers (NJDHSS, 2002c, 2002d).

New York. New York uses a multitiered distribution program of predistribution (voluntary pickup), stockpiling for the general and special populations, and postaccident distribution. Some 1.2 million tablets were received from the Nuclear Regulatory Commission for distribution. One KI tablet per person was offered for distribution, with the other tablet reserved for stockpiling and postaccident distribution. The distribution program covered people residing or working within the 10-mile EPZ. About 15% of people within the EPZ were covered by the distribution. The state noted that it was expensive to develop the plan. It found that the issuance of the FEMA guidance after Nuclear Regulatory Commission issuance of KI created a public perception problem and that the mass media were not helpful in educating the public. The state developed fact sheets to assist counties with public education—two for the general public and one for physicians. A KI Guidance Document was developed to assist

counties in planning. Most recently, the state’s Nuclear Emergency Preparedness Subcommittee (NEPS) issued recommendations on implementation, including triggering levels (50 mGy (5 rad) to the child thyroid), dosage (one tablet to those over a year old and a half-tablet to those under a year old), the amount to be predistributed (expected time of evacuation in days-rounded up-time tablet/day), and when specified members of the public will be directed to take KI (those evacuated or in evacuated areas) (NY NEPS, 2003).

North Carolina. North Carolina requested 750,000 tablets from the Nuclear Regulatory Commission to cover the EPZ for four NPPs (June 28, 2002 letter from Leah Devlin and Linda C. Sewall to Kathy Gibson of NRC). The full distribution program has yet to be completed, but KI has been distributed through local health departments in a pickup program. In voluntary pickup (two tablets per person), roughly 35% of the population was covered by the predistribution, which occurred in October and November 2002 (NC Division of Public Health, 2003).

Ohio. The Ohio program (Ohio Department of Health, 2003) involves voluntary distribution to residents in the 10-mile EPZ and stockpiling the remainder (not picked up by residents or set aside for transients) at care and receiving centers for those evacuating. That is, excess stocks of KI are to be kept at monitoring and decontamination centers for evacuees but on a priority basis to those contaminated by the plume (Ohio Department of Health, 2002). Two KI tablets were placed in a plastic bag containing the FDA-approval label and the manufacturer’s insert. The public was informed through a mass media campaign. Information about KI was also mailed to each resident in the EPZ. With the information came a coupon for obtaining KI. About 40% of the amount received from the Nuclear Regulatory Commission was distributed to the public by voluntary pickup. Because of the requirements involved in repackaging the 14-tablet packages provided by the Commission, and other logistics surrounding making KI available, $117,000 (more than the $75,000 provided by the federal government) was spent by the state and local health departments.

Ohio recommends that dosages be administered at levels in the FDA-approved manufacturer’s guidance to minimize confusion

between differing FDA guidance regarding dosage. That is, Ohio recommends that children over a year old and adults receive one 130-mg table and children under a year old receive a half-tablet. The Ohio Department of Health (2002) notes that the lower dosage recommended by FDA in alternative guidance is the “minimum effective dosage”.

Pennsylvania. Little information was available to the committee on Pennsylvania’s distribution of KI. Before KI was made available to the states by the Nuclear Regulatory Commission, a KI working group consisting of state government and other experts concluded that the state should expand its KI distribution program beyond its policy of providing KI to emergency workers and special difficult-to-evacuate groups (Pennsylvania Department of Environmental Protection, 2001). Pennsylvania recently acquired KI from the Commission and offered free tablets to all residents living within the 10-mile EPZ of the states five nuclear facilities (Pennsylvania Department of Health, 2003). Of the more than 640,000 people covered by this offering, 34% picked up KI. KI was also offered to businesses and schools.

South Carolina. In October 2002, South Carolina requested 800,000 dosages of KI for predistribution (letter from Commissioner of Health Services C. Earl Hunter and Deputy Commissioner Lisa F. Waddell to Kathy Helvay Gibson of the Nuclear Regulatory Commission). The state is distributing KI to residents living within 10 miles of NPPs, as indicated in press releases available on the Internet (SC Department of Health and Environmental Control [DEH], 2003a and 2003b). Sites for distribution to the public included school locations. Dosage information, provided in a fact sheet (SC DEH, 2002), is the same as that given in the most recent FDA guidance.

Vermont has just initiated a KI distribution program. The goal of the program is to make available to every citizen within the 10-mile EPZ of the Yankee Nuclear Power Reactor an opportunity to receive KI before a radiological event. That involves six towns: Brattleboro, Dummerston, Guilford, Halifax, Marlboro, and Vernon. The state acknowledges its responsibility to maintain adequate stockpiles of KI near the EPZ for use in the event of a radiological

emergency by persons who either do not have their own KI or cannot access their own KI. The State has three methods of distribution:

• People who live or work within the EPZ will be offered the opportunity to obtain their own personal dosage of KI, one dosage per person. That will be accomplished through outreach and education efforts by the Department of Health in concert with locally stationed public-health nurses.

• Within and just outside the EPZ, offsite response organizations (OROs) will store sufficient quantities of KI. In the event of a radiological emergency, the OROs will be used for mass distribution of KI. OROs will be in local fire departments, police barracks, and other central, easily secured structures.

• Special population segments will have their own specific distribution systems in or near their own settings. Such populations as those served in hospitals, nursing homes, schools, and child- and adult-care facilities will be provided KI in this manner.

The formal request for KI was made by the state’s health commission on January 31, 2002. Predistribution was begun on April 15. People wanting predistribution have to complete applications, which are available at a variety of locations (libraries, town clerks, health department offices, various other government offices, and on the Internet). Parents must submit informed-consent forms for children. People with contraindications require medical releases. After 6 months fewer than 5% of residents had requested dosages, 3,000-4,000 dosages had been distributed to public schools, and there had been partial distribution to child-care facilities, hospitals, nursing homes, and private schools. The state indicated that it was using multiple channels of communication to convey information about its program to the public, including the broadcast media, the Internet, and community groups. A mass mailing is being contemplated for the second year, and other means of distribution are being considered.

The state calculated that 92,756 tablets were needed—two tablets for each resident, transient, and school-age child in the EPZ.

KI ingestion will be advised when the estimated radioiodine dose approaches the FDA recommended intervention level. The health-services coordinator may recommend that KI be administered when specific exposure is not known.

Virginia received 660,000 dosages of KI from the Nuclear Regulatory Commission to cover the estimated 330,000 people who live, work, or visit within 10 miles of the two NPPs in the state (Virginia Department of Health, 2002a,b). One dosage of KI was available for pickup during September and October 2002; the remainder was stored for postincident distribution. Proof of residence was required for pickup. Some health department offices, community centers, schools, and fire departments were designated as pick-up locations on specific dates. In the event of an incident, the state health commissioner would issue a recommendation regarding who should take KI. The FDA 2001a guidelines were provided for recommended dosage levels with the caution that “taking a higher dosage than recommended or taking KI more often than recommended can result in allergic reactions and other side effects” (Virginia Department of Health, 2002b). Pregnant women would be advised to take KI for their own protection and to protect their fetuses, although it was recommended that repeat dosing be avoided because of the risk of blocking fetal thyroid function. Dosing was also recommended to protect lactating women. However, it was noted that “stable iodine in breast milk may also pose a risk of hypothyroidism in nursing neonates”, and that repeat dosing should be avoided unless there was continuing severe contamination, in which case it was recommended that nursing neonates be monitored for hypothyroidism. The advisory noted FDA’s recommendation that neonates receiving KI be monitored for hypothyroidism and that thyroid-hormone therapy be instituted if it is found to occur. Administration to those over 40 years old was recommended against unless a large internal radiation dose was expected. The precautions regarding neonatal exposure were repeated in a fact sheet, but not the general precaution regarding those over 40 years old (Virginia Department of Health, 2002c).

West Virginia. As of July 11, 2003, a plan for KI distribution for West Virginia had not been fully developed. The state is developing a working group in the West Virginia Department of Health and Human Resources. The plan would cover residents in Hancock County who reside within 10 mile of the EPZ in Shippingport, Pennsylvania.

California Office of Emergency Services. Potassium iodide order form. Office of Emergency Services, Potassium Iodide Distribution Program. 2002.

Delaware Health and Social Services. DPH, DEMA Distribute Tablets to Protect Against Radiation. DHSS, July 22, 2002. 2002a.

Delaware Health and Social Services. News. Division of Public Health and the Delaware Emergency Management Agency (DEMA) Announce Final Distribution Dates for Potassium Iodide. Delaware Health and Social Services, October 8, 2002. 2002b.

Delaware Health and Social Services. Fact about KI. Preparing for a Nuclear Emergency. Available at the state of Delaware Web site www.state.de.us/dhss/dph/hsp/factsaboutki.txt. 2002c.

Delaware Emergency Management Agency. Delaware requests potassium iodide from Nuclear Regulatory Commission. Available at http://www.state.de.us/dema/pages/press_rel.htm. 2002.

FEMA (Federal Emergency Management Agency). Fact Sheet. Radiological Accidents. Available at the FEMA Web site: http://emergencymanagement.wi.gov/media/pdf/radiological_accidents.pdf. 1993a.

FEMA (Federal Emergency Management Agency). Fact Sheet. Nuclear power plant emergency. Available at the FEMA Web site: http://emergencymanagement.wi.gov/media/pdf/nuclear_power_plant_emergency.pdf. 1993b.

Illinois Emergency Management Agency. Important information on the use of potassium iodide (KI) tablets. IEMA, Division of Nuclear Safety. Available at the state Web site www.state.il.us/idns/html/emergencyinfo/kibrochure.asp. 2002.

Illinois Homeland Security. Security Update. May 29, 2002. www.illinois.gov/security/preparedness/052902_update.htm. 2002a.

Illinois Homeland Security. Security Update. April 5, 2002. Available at www.illinois.gov/security/preparedness. 2002b.

Iowa Department of Public Defense. Fact Sheet: Nuclear Power Emergency. Iowa DPD Emergency Management Division. Available at Iowa Department of Public Defense Web site: www.state.ia.us/government/dpd/emd/ResourceRoom/Factsheets/FactNuke.htm. 2003.

Iowa Department of Public Health. Update. Iowa Department of Public Health, Bureau of Family Health. January 27, 2003.

Louisiana Department of Health and Hospitals. Policy Statement. Use of potassium iodide (KI) in Louisiana for emergencies at fixed nuclear facilities. Louisiana DHH Office of Public Health, 325 Loyola Avenue, New Orleans, Louisiana 70160. 2003.

Massachusetts DPH (Massachusetts Department of Health). Notice to Employers within the Emergency Planning Zones (EPZs). DPH Radiation Control Program. 2002a.

Massachusetts DPH (Massachusetts Department of Health). Letter to “All Interested Parties” from Howard Koh, Commissioner of Health, June 25, 2002. 2002b.

Maine Bureau of Health. Statement on stockpiling of KI. Bureau of Health, Department of Human Services, Augusta, Maine. Available at the Maine Bureau of Health Web site http://www.state.me.us/dhs/eng/rad/Me%20KI%20policy.htm. 2003.

Michigan Department of Environmental Quality (2003). The Potassium Iodide Issue. Available at the Michigan Department of Environmental Quality Web site www.michigan.gov/deq/0,1607,7-135-3312_4120_4243-10401--,00.html. 2003.

Minnesota Division of Emergency Management. Radiological Emergency Preparedness Handbook. Minnesota Department of Public Safety, Division of Emergency Management, 444 Cedar Street, Suite 223, St. Paul, Minnesota, July 20, 2001.

Missouri State Emergency Management Agency (MSEMA). Nuclear Power Plants (Fixed Nuclear Facilities). SEMA. August 1997. Available at Missouri State Emergency Management Agency Web site http://www.sema.state.mo.us/sh%20annex%20j.pdf. 1997.

New Jersey Department of Health and Senior Services. News Release. State Unveils Potassium Iodide Distribution Plan. June 19, 2002. http://www.nj.gov/health/news/p20619a.htm. 2002a.

New Jersey Department of Health and Senior Services. News Release. State Receives Potassium Iodide Pills. April 22, 2002. Available at the state Web site http://www.nj.gov/health/news/p20423a.htm. 2002b.

New Jersey Department of Health and Senior Services. News Release. Potassium Iodide Distribution Dates Announced. July 3, 2002. Available at the state Web site http://www.nj.gov/health/news/p20703a.htm. 2002c.

New Jersey Department of Health and Senior Services. News Release. Potassium Iodide Distribution Begins. July 13, 2002. Available at www.nj.gov/health/news/p20715a.htm. 2002d.

New York State Nuclear Emergency Preparedness Subcommittee (NY NEPS). Implementation of the Use of Potassium Iodide (KI) as a Protective Action for the Public. NEPS Technical Issues Task Force. March 2003.

North Carolina Division of Public Health. North Carolina’s Potassium Iodide Program. Available at the state Web site www.dhhs.state.nc.us/dph/ki/htm. 2003.

Ohio Department of Health. Distribution and use of potassium iodide for the 10-mile emergency planning zone population, Ohio Department of Health, April 29, 2002.

Ohio Department of Health. Ohio Department of Health Potassium Iodide Distribution Plan. Ohio Department of Health, Bureau of Radiation Protection, January 2003.

Pennsylvania Department of Health. Press Release. Health Secretary notes success of PA’s potassium iodide distribution. Residents picked up 436,300 KI pills between Aug. 15 and 21. August 22, 2003.

Pennsylvania Department of Environmental Protection. Report to the Radiological Emergency Preparedness Advisory Committee (REPAC) from the Potassium Iodide (KI) Working Group. June 2001.

South Carolina Department of Health and Environmental Control (SC DEH). Fact Sheet. Potassium Iodide Facts for Medical Professionals. SC DEHC, October 2002.

South Carolina Department of Health and Environmental Control (SC DEH). News Release. KI distribution set for Oconee, Pickens counties. July 28, 2003. 2003a.

South Carolina Department of Health and Environmental Control (SC DEH). News Release. KI distribution set for York County. April 24 2003. 2003b.

Texas Department of Health (TDH). Radiation Fact Sheets. What people need to know about potassium iodide (KI). Accessed at www.r04.tdh.state.tx.us/ERT/radiaition/KI.htm. 2003.

Virginia Department of Health. News. State Health Commissioner Announces Distribution Plans for Potassium Iodide Near Virginia Nuclear Power Plant. Virginia Department of Health, Office of Public Affairs, September 16, 2002. Available at www.vdh.state.va.us/news/PressReleases/2002/091602KIPlans.asp. 2002a.

Virginia Department of Health. Prophylactic use of potassium iodide in nuclear power plant emergencies. Virginia Epidmeiology Bulletin 102(8-9):1-2. 2002b.

Virginia Department of Health (2002c). Frequently asked questions on potassium iodide. Virginia Department of Health, Division of Health Hazards Control, Richmond VA. 2002c.