Planning And Response To The Detonation Of An Improvised Nuclear Device

Our nation faces the distinct possibility of a catastrophic terrorist attack using an improvised nuclear device (IND), according to international and U.S. intelligence. Detonation of an IND in a major U.S. city would result in tens of thousands to hundreds of thousands of victims and would overwhelm public health, emergency response, and health care systems, not to mention creating unprecedented social and economic challenges. While preparing for an IND may seem futile at first glance, thousands of lives can be saved by informed planning and decision making prior to and following an attack. In 2009, the Institute of Medicine published the proceedings of a workshop assessing the health and medical preparedness for responding to an IND detonation. Since that time, multiple federal and other publications have added layers of detail to this conceptual framework, resulting in a significant body of literature and guidance. However, there has been only limited planning effort at the local level as much of the federal guidance has not been translated into action for states, cities and counties. According to an informal survey of community preparedness by the National Association of City and County Health Officials (NACCHO), planning for a radiation incident ranked lowest in priority among other hazards by 2,800 local health departments. The focus of Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary is on key response requirements faced by public health and health care systems in response to an IND detonation, especially those planning needs of outlying state and local jurisdictions from the detonation site. The specific meeting objectives were as follows: - Understand the differences between types of radiation incidents and implications of an IND attack on outlying communities. -Highlight current planning efforts at the federal, state, and local level as well as challenges to the implementation of operational plans. -Examine gaps in planning efforts and possible challenges and solutions. -Identify considerations for public health reception centers: how public health and health care interface with functions and staffing and how radiological assessments and triage be handled. -Discuss the possibilities and benefits of integration of disaster transport systems. -Explore roles of regional health care coalitions in coordination of health care response.

While the reality of an improvised nuclear device (IND) being detonated in an American city is unlikely, its destructive power is such that the scenario must be planned for. Upon reviewing the academic literature on the effects of and response to IND events, this report looks to actual responders from around the country. The results from the meetings of public officials in the cities show where gaps exist between theoretical knowledge and actual practice. In addition to the literature, the meetings reveal areas where future research needs to be conducted. This paper recommends that local response planners: meet to discuss the challenges of IND events; offer education to officials, the public, and responders on IND events; incorporate "shelter-first" into response plans; provide information to the public and responders using the 3 Cs; and engage the private sector (including media) in response plans. In addition to these recommendations for the response planners, the paper provides research questions that once answered will improve response plans around the country. By following the recommendations, both groups, response planners and researchers, can help the country better prepare for and mitigate the effects of an IND detonation.

Our nation faces the distinct possibility of a catastrophic terrorist attack using an improvised nuclear device (IND), according to international and U.S. intelligence. Detonation of an IND in a major U.S. city would result in tens of thousands to hundreds of thousands of victims and would overwhelm public health, emergency response, and health care systems, not to mention creating unprecedented social and economic challenges. While preparing for an IND may seem futile at first glance, thousands of lives can be saved by informed planning and decision making prior to and following an attack. In 2009, the Institute of Medicine published the proceedings of a workshop assessing the health and medical preparedness for responding to an IND detonation. Since that time, multiple federal and other publications have added layers of detail to this conceptual framework, resulting in a significant body of literature and guidance. However, there has been only limited planning effort at the local level as much of the federal guidance has not been translated into action for states, cities and counties. According to an informal survey of community preparedness by the National Association of City and County Health Officials (NACCHO), planning for a radiation incident ranked lowest in priority among other hazards by 2,800 local health departments. The focus of Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary is on key response requirements faced by public health and health care systems in response to an IND detonation, especially those planning needs of outlying state and local jurisdictions from the detonation site. The specific meeting objectives were as follows: - Understand the differences between types of radiation incidents and implications of an IND attack on outlying communities. -Highlight current planning efforts at the federal, state, and local level as well as challenges to the implementation of operational plans. -Examine gaps in planning efforts and possible challenges and solutions. -Identify considerations for public health reception centers: how public health and health care interface with functions and staffing and how radiological assessments and triage be handled. -Discuss the possibilities and benefits of integration of disaster transport systems. -Explore roles of regional health care coalitions in coordination of health care response.

Annotation. Our nation faces the distinct possibility of a catastrophic terrorist attack using an improvised nuclear device (IND), according to international and U.S. intelligence. Detonation of an IND in a major U.S. city would result in tens of thousands to hundreds of thousands of victims and would overwhelm public health, emergency response, and health care systems, not to mention creating unprecedented social and economic challenges. While preparing for an IND may seem futile at first glance, thousands of lives can be saved by informed planning and decision making prior to and following an attack. In 2009, the Institute of Medicine published the proceedings of a workshop assessing the health and medical preparedness for responding to an IND detonation. Since that time, multiple federal and other publications have added layers of detail to this conceptual framework, resulting in a significant body of literature and guidance. However, there has been only limited planning effort at the local level as much of the federal guidance has not been translated into action for states, cities and counties. According to an informal survey of community preparedness by the National Association of City and County Health Officials (NACCHO), planning for a radiation incident ranked lowest in priority among other hazards by 2,800 local health departments. The focus of Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary is on key response requirements faced by public health and health care systems in response to an IND detonation, especially those planning needs of outlying state and local jurisdictions from the detonation site. The specific meeting objectives were as follows:- Understand the differences between types of radiation incidents and implications of an IND attack on outlying communities.-Highlight current planning efforts at the federal, state, and local level as well as challenges to the implementation of operational plans.-Examine gaps in planning efforts and possible challenges and solutions.-Identify considerations for public health reception centers: how public health and health care interface with functions and staffing and how radiological assessments and triage be handled.-Discuss the possibilities and benefits of integration of disaster transport systems.-Explore roles of regional health care coalitions in coordination of health care response.

A nuclear detonation in the United States is one of the most catastrophic incidents imaginable. While the United States Government is working domestically and with international partners to ensure this scenario never occurs, failing to plan for managing the consequences of such an event would be irresponsible. Should a nuclear detonation occur, a crucial task for Federal, State, local, tribal and territorial authorities and private-sector organizations will be communicating clear and consistent messages to the public. All levels of government have responsibility for coordinating and communicating information regarding the incident to the public immediately after a nuclear detonation. State, local and tribal authorities retain the primary responsibility for responding to large-scale incidents, such as a nuclear detonation. Effectively communicating health and safety instructions to the population will be a critical factor in building trust, comforting the nation, saving lives and minimizing injury. This document was developed as a resource for emergency responders and federal, state, and local officials communicating with the public and the media during the immediate aftermath of a nuclear detonation in the United States. An interagency group of communications and radiation technical experts developed the messages in this document, which include key messages for the impacted community and the nation, and anticipated questions and answers for distribution to the public in the immediate aftermath of a nuclear detonation.

A nuclear detonation in the United States is one of the most catastrophic incidents imaginable. While the United States Government is working domestically and with international partners to ensure this scenario never occurs, failing to plan for managing the consequences of such an event would be irresponsible. Should a nuclear detonation occur, a crucial task for Federal, State, local, tribal and territorial authorities and private-sector organizations will be communicating clear and consistent messages to the public. All levels of government have responsibility for coordinating and communicating information regarding the incident to the public immediately after a nuclear detonation. State, local and tribal authorities retain the primary responsibility for responding to large-scale incidents, such as a nuclear detonation. Effectively communicating health and safety instructions to the population will be a critical factor in building trust, comforting the nation, saving lives and minimizing injury. This document was developed as a resource for emergency responders and federal, state, and local officials communicating with the public and the media during the immediate aftermath of a nuclear detonation in the United States. An interagency group of communications and radiation technical experts developed the messages in this document, which include key messages for the impacted community and the nation, and anticipated questions and answers for distribution to the public in the immediate aftermath of a nuclear detonation. Since the 2010 interim use version of the document, the message content was reviewed by state and local responders and tested for comprehension through a series of public focus groups. The document was also reviewed by the Advisory Team for Environment, Food and Health, which is a radiological emergency response group tasked with providing protective action recommendations to state and local governments on behalf of its member agencies, including the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), United States Department of Agriculture (USDA) and the Environmental Protection Agency (EPA). FEMA's Federal, State and local Nuclear/Radiological Communications Working Group also participated in the review and update of this document. The final document takes into account all of the feedback received during these reviews. Ideally, there will never be a need for these messages; however officials at all levels of government have a responsibility to the American people to be prepared to respond and communicate effectively in the event of any type of national emergency, including a nuclear detonation.

Following the events of September 11, a litany of imaginable horribles was trotted out before an anxious and concerned public. To date, government agencies and academics are still grappling with how to best respond to such catastrophes, and as Senator Lieberman's quote says above, now is the time to plan and prepare for such events. One of the nation's worst fears is that terrorists might detonate an improvised nuclear device (IND) in an American city. With 9/11 serving as the catalyst, the government and many NGOs have invested money into research and development of response capabilities throughout the country. Yet, there is still much to learn about how to best respond to an IND event. Understanding the state of knowledge, identifying gaps, and making recommendations for how to fill those gaps, this paper will provide a framework under which past findings can be understood and future research can fit. The risk of an improvised nuclear device (IND) detonation may seem unlikely; and while this is hopefully true, due to its destructive capability, IND events must be prepared for. Many people still live under the Cold War mentality that if a city is attacked with a nuclear weapon, there is little chance of survival. This assumption, while perhaps true in the case of multiple, thermonuclear weapons exchanges, does not hold for the current threat. If a single IND were detonated in the United States, there would be many casualties at the point of impact; however, there would also be many survivors and the initial response by two major groups will mean the difference between life and death for many people. These groups are the first responders and the public. Understanding how these two groups prepare, react and interact will improve response to nuclear terrorism. Figure 1 provides a visualization of the response timeline of an IND event. For the purposes of this assessment, it is assumed that to accurately inform the public, three functions need to be fulfilled by response personnel, namely planning, developing situational awareness, and developing a public message. Planning varies widely from city to city, and to date no comprehensive study has been completed to assess how individual cities are progressing with preparation plans. Developing situational awareness about an IND detonation has been well researched over the years, yet it is far from fully understood. While messaging is an integral component to response, it is one that suffers from a dearth of knowledge. The public will have a certain level of education and preparation. After the detonation the public will respond naturally and upon receiving the responders message will react to the message and may modify their behavior accordingly. Reviewing the nodes under both headings, responders and public will help better prepare the country to meet the challenges of an IND attack.

This paper discusses command and control issues relating to the operation of Incident Command Posts (ICPs) and Emergency Operations Centers (EOCs) in the surrounding area jurisdictions following the detonation of an Improvised Nuclear Device (IND). Although many aspects of command and control will be similar to what is considered to be normal operations using the Incident Command System (ICS) and the National Incident Management System (NIMS), the IND response will require many new procedures and associations in order to design and implement a successful response. The scope of this white paper is to address the following questions: 1. Would the current command and control framework change in the face of an IND incident? 2. What would the management of operations look like as the event unfolded? 3. How do neighboring and/or affected jurisdictions coordinate with the state? 4. If the target area's command and control infrastructure is destroyed or disabled, how could neighboring jurisdictions assist with command and control of the targeted jurisdiction? 5. How would public health and medical services fit into the command and control structure? 6. How can pre-planning and common policies improve coordination and response effectiveness? 7. Where can public health officials get federal guidance on radiation, contamination and other health and safety issues for IND response planning and operations?

A nuclear attack on a large U.S. city by terrorists-even with a low-yield improvised nuclear device (IND) of 10 kilotons or less-would cause a large number of deaths and severe injuries. The large number of injured from the detonation and radioactive fallout that would follow would be overwhelming for local emergency response and health care systems to rescue and treat, even assuming that these systems and their personnel were not themselves incapacitated by the event. The United States has been struggling for some time to address and plan for the threat of nuclear terrorism and other weapons of mass destruction that terrorists might obtain and use. The Department of Homeland Security recently contracted with the Institute of Medicine to hold a workshop, summarized in this volume, to assess medical preparedness for a nuclear detonation of up to 10 kilotons. This book provides a candid and sobering look at our current state of preparedness for an IND, and identifies several key areas in which we might begin to focus our national efforts in a way that will improve the overall level of preparedness.

Response in the aftermath of a nuclear detonation will be extremely challenging. The risk of radiation exposure requires additional protections and actions by first responders and other individuals conducting response and rescue operations. To provide planners and responders a better understanding for addressing the unique risks encountered in the post-IND environment, DHS and our interagency partners developed the "Health and Safety Planning Guide for Planners, Safety Officers, and Supervisors for Protecting Responders Following a Nuclear Detonation" and accompanying quick reference guide. This guidance is intended to aid in preserving the health and safety of response personnel in order to sustain lifesaving and critical infrastructure support for the duration of the emergency. The guidance provides response planners, safety officers, and supervisors with specific information and recommendations to protect responders from the effects and impacts of an extreme event: a 10 kiloton (KT) improvised nuclear device (IND) within the first 72 hours of a detonation.