PROTOCOL FOR THE FIRST 1979 MEDICAL SURVEY IN THE MARSHALL ISLANDS y The 1979 Medical Survey will take place January 15 - February 14. Attached is the expected itinerary (Enclosure I) and a list of participating personnel (Enclosure II). TRAVEL The MAC plane (C-141, Army) will be used between Honolulu and Kwajalein and Air Micronesia (Continental) between Kwajalein and Majuro. We have chartered a 115' oceanographic vessel (Enclosure III) that should be a vast improvement over previous ships. We will attempt to do all of our screening work aboard. SUPPORT Agencies, besides BNL, include DOE-Honolulu, US Army and Global Assoc., Kwajalein and Trust Territory, Majuro and Ebeye. Kwajalein is the main support base (with Mr. Ted Murawski as liasion for Global). The survey is carried out in conjunction with the Department of Health Services of the Trust Territory, headquarters in Saipan, Mariana Islands and the District Headquarters at the hospital at Majuro (Dr. Ezra Riklon). BACKGROUND AND OBJECTIVES Before outlining the examination procedures a brief summary of the background material and objectives are presented below. Details of medical findings can be found in published reports. Also a copy of Form 189 is enclosed outlining the program. Early Effects The fallout accident in 1954 resulted in exposure of the Marshallese on Rongelap, Ailingnae and Utirik atolls to fallout radiation before they were evacuated by about 2 days. There were also 28 military personnel exposed on Rongelap atoll receiving about the same exposure as the Ailingnae group, and 23 Japanese fishermen exposed on the Lucky Dragon. Whole-body exposure from penetrating gamma radiation gave an estimated 175 rads to the_64people living on Rongelap, 69 rads to the 18 people on Ailingnae (these were Rongelap people on a fishing trip to this nearby atoll during the fallout) and 14 rads to 158 people living on Utirik atoll. In addition, there was internal absorption of radionuclides from inhalation and ingestion of contaminated food and water and fallout deposited on the body caused significant skin exposure in the Rongelap and Ailingnae groups. The radiation to the skin was spotty and superficial and the dose, though indeterminate, was probably greater than 1000 rads. Except for radioisotopes of Iodine, the radionuclides absorbed from the fallout are not believed to have resulted in significant internal exposure. The magnitude of the dose to the thyroid glands from radioactive iodines was not appreciated until later when thyroid nodules unexpectedly developed and reevaluation of the dose showed that the early estimates had to be revised upward, particularly in the children. The Rongelap and Ailingnae people were the only Marshallese to develop acute effects of exposure (transient nausea and vomiting, hemopoietic depression and widespread beta skin burns and epilation, but with no detectible acute SUSTES4