national center for disaster preparedness nuclear event-whitepaper

8/8/2019 National Center for Disaster Preparedness Nuclear Event-Whitepaper

1/48

N A T I O N A L C E N T E R F O R D I S A S T E R P R E P A R E D N E S S

Regoal Healh adPublc Healh Prearedess

for Nuclear Terrors:Optimizin Sviv in Lw Piity/Hi Cnqn Di


2/48


3/48

Irwin Redlener, MD

Andrew L. Garrett, MPH, MD

Karen L. Levin, RN, MPH, CHES

Andrew Mener

The Center for Publi Health Prearedne

Ntin Cnt Dit PpnColumbia Univerity Mailman Shool of Publi Health

.cp..c.


4/48


5/48

Cs

Execuue Suar . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Nuclear Terrors: The Real of he Threa . . . . . . . . . . . . . . . . 5

Contrution of a Nulear Weaon. . . . . . . . . . . . . . . . . . . . . . 6

Aquiition of Nulear Weaon or Fiile Material . . . . . . . . . . . . . . . 6

Preventing Imortation of Nulear Material . . . . . . . . . . . . . . . . . . 8

The Deoao of a 10 Kloo (K) Irosed Nuclear Deoao . . . . . 11

Reone Iue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Imat on Poulation and Infratruture . . . . . . . . . . . . . . . . . . . 12

Sural he Gra Zoe . . . . . . . . . . . . . . . . . . . . . . . . . 15

Planning Guideline for Life Saving Oortunitie . . . . . . . . . . . . . . . 15

Resose Sses Caac . . . . . . . . . . . . . . . . . . . . . . . . . 17

Publi Health and Medial Care Sytem . . . . . . . . . . . . . . . . . . . 17

Hoital and Healthare Sytem . . . . . . . . . . . . . . . . . . . . . . 17

Firt Reonder-Pre-Hoital Care . . . . . . . . . . . . . . . . . . . . .20Patient Triage Sytem and Altered Standard of Care . . . . . . . . . . . . . . 21

Workfore Abenteeim . . . . . . . . . . . . . . . . . . . . . . . . . . 21

An Eetive Publi Reone Require Prearedne. . . . . . . . . . . . . . . 23

Federal Emergeny Reone . . . . . . . . . . . . . . . . . . . . . . . . 25

Closg Thoughs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Reommendation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Abbreaos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Ed Noes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Fgure 1-2. 10 K Deoao Effecs; Tes Suare, Ne York C . . . . . . . 14


6/48


7/48

1Exc S

Execue Suar

e United State remain unreared to oe with the oibility of an attak on a major ityby terrorit aable of aquiring and detonating an imrovied nulear devie. Long-held ani-

etie about the non-urvivability of nulear war romulgated during the intene U.S.Soviet

arm rae from the late 1940 through the 1980, and relutane to onider low robability/high

onequene event among loal diater lanning rioritie, are barrier to develoing lan that

ould dramatially ave live in the event of a terrorit-baed nulear detonation.

In a eeh in Prague on Aril 5, 2009, and reiterated in hi 2010 State of the Union meage,

Preident Obama artiulated theme about nulear terrorim that have irulated in U.S. olitial

debate ine the ollae of the Soviet Union, and with greater urgeny ine 9/11:

We mut enure that terrorit never aquire a nulear weaon. i i the mot

immediate and etreme threat to global eurity. One terrorit with one nulear

weaon ould unleah maive detrution. Al Qaida ha aid it eek a bomb and

that it would have no roblem with uing it. And we know that there i uneured

nulear material aro the globe. To rotet our eole, we mut at with a ene of

uroe without delay.1

i aer begin by deribing the reality of the threat of nulear terrorim to the United State

and the enormou ale of live lot and hyial detrution that would reult from the detona-tion of even a mall imrovied nulear devie (IND) in an Amerian ity. It then ytematially

lay out the gro inadequay of urrent reone aabilitie, and highlight the ritial unmet

need for urgent, deliberate and well-funded lanning eort to addre thoe deienie. In

the Reommendation etion, Columbia Univerity National Center for Diater Prearedne

(NCDP) all for targeted ubli health and medial are regional lanning and reone eort

foued on gray zonearea where igniant life aving oortunitie would eit follow-

ing an IND detonation, and where rearedne lanning and roer training an meaningfully

enhane urvival and reovery.

e ollae of the Soviet Union dramatially redued the Cold War doomday threat of nulear

war againt the United State. Yet, the danger of a nulear attak ha not been eliminated; rather

it ha evolved into a new and dramatially dierent threatnuclear terrorism.e rik of a nulear


8/48

R H Pc H Ppss Nc Ts2

weaon being ued today by terrorit i, in fat, a growing threat and our margin of afety i

hrinking.2 Future nulear threat will be dened rt by the deire and then by the ability of

non-tate to roure or develo rude nulear weaon.3

Although the detonation of a low-yield IND in an Amerian ity i one of the 15 lanning enar-

io develoed by the White Houe Homeland Seurity Counil for ue in eurity rearedne

ativitie, loal and regional emergeny lanning ativitie have not given attention ommenu-

rate to thi threat. Barrier to lanning for uh a atatrohi event are not well undertood but

may be related to fataliti belief or onet of imrobability, with many believing that other

diater are more robable and merit the fou of emergeny lanner. e Cold War threat

of nulear war between tate uggeted total detrution, making rearedne meaure futile,

but the ame i not true for nulear terrorim. Furthermore, emergeny lanner are frozen by the

myth of lanning futility, in whih lanner hold on to the belief that nulear detonation are not

urvivable. However, deite the enormou ale of otential live lot and detrution of infra-truture, data from Dr. William Bell and Cham Dalla and from Lawrene Livermore National

Laboratory ugget a gray zone in whih hundred of thouand of live would be aved, and the

injury everity ould be mitigated with aroriately targeted lanning.a

Following a nulear detonation, a reone baed on threat-specic strategies will be essential to

maximize time-sensitive life-saving opportunities. Publi rotetive ation to redue eoure and

injury, ritial within the rt hour, will deend greatly uon a well thought out, re-event me-

aging trategy and the ability to ommuniate eaily-undertood information to the ubli. e

rik for injury and nulear detonation eet doe not end after the initial blat; the ubli mut

undertand the orret rotetive ation and when to take them throughout the reone and

reovery hae.

Long before igniant level of federal and etra-regional aet would arrive, loal and tate

oial would need to launh numerou oerationmany at the ame time. Meeting the enor-

mou ale of health are demand, inluding the vital tak of triage and deontamination a well

a heltering and evauation need, i a logitial hallenge that will require the oordination of

eort at loal, tate, and, mot imortantly, regional level.

e NCDP believe that large-ale and integrated regional and national reone lanning i

needed to reare for a detonation of an IND. e abene of uh lanning i an urgent and unmet

need. To initiate thi roe, emergeny lanner hould rt undertand the reality of the threat

and areiate the unreedented ale of reone that regional government will have to mount.

a Dr. Irwin Redlener, National Center for Diater Prearedne, Columbia Univerity Mailman Shool of Publi Health.


9/48

3Exc S

e detonation of even a mall IND in almot any major Amerian ity would aue maive mor-

tality and morbidity a well a a ollae of infratruture that would reate long lating and far

reahing imat. Regional lanning bodie mut aelerate ubtantive lanning that i framed by

the aumtion that urvivability and reovery an be maimized, and that the ubli undertand-

ing of their role in the reone i vital to thi end. Reonible unit of government at all level

need to etablih regional lanning agenda with alable, realiti objetive, and rigorou eriodi

eerie now, before diater trike.e NCDP urge the develoment of regional reone lan

baed on otimizing urvivability in the gray zone and reommend a number of onrete te to

ahieve that outome:

1. Require all juridition that are federally deignated a high rik IND target ommuni-

tie to develo and utain aroriate rearedne for oible nulear terrorim;

2. Strengthen regional alliane and oalition develoed to imlement eetive

reone trategie;3. Require all federally funded regional alliane to demontrate robut lan for region-wide

health, ubli health and heltering reone to IND detonation;

4. Provide uient funding for all aet of rearedne for IND terrorim;

5. Greatly eand aaity of national reue and reovery eort, inluding relevant federal

agenie, to reond in the event of an IND attak anywhere in the U.S, inluding e-

ialized training with reet to funtioning in high-level radiation event;

6. Clarify inident ommand role and oerational integration roedure among federal,

tate and loal authoritie in the event of an IND attak;

7. Enure that Strategi National Stokile of ountermeaurea well a orreondingtokile on a tate levelare relevant for an IND detonation and are aled u to meet

the likely demand;

8. Aelerateand eeriemulti-etor reone lanning that inlude government

entitie, non-governmental organization and rivate etor aet;

9. Reearh and imlement trategie deigned to ommuniate rik and aroriate ubli

reone to an IND detonation;

10. Purue relevant reearh to imrove eetivene of ountermeaure;

11. Enure that highly redundant and multi-format modalitie of ommuniating with the

ubli during and after IND terrorim are develoed, teted and available; and,

12. Conider re-oening and/or develoing toked ubli helter for oulation in high

rik ommunitie.


10/48


11/48

5Nc Ts: T R T

Nuclear Terrors: The Real of he Threa

In an analyi of the U.S. Deartment of Energy nonroliferation rogram with Ruia, a 2001biartian tak fore onluded that nulear terrorim i the most urgent unmet national security

threat to the United States.4During the 2004 reidential amaign, Senator John Kerry and Pre-

ident Buh agreed that nulear terrorim i a leading threat to the eurity of the homeland and,

in a 2008 reort to the United Nation General Aembly, then International Atomi Energy

Ageny (IAEA) Diretor General, Dr. Mohamed ElBaradei, again alerted the world that the

oibility of terrorit obtaining nulear or other radioative material remain a grave threat.5

He alo ommented on the lak of eurity of thee material; Equally troubling i the fat that

muh of thi [miing] material i not ubequently reovered Sometime material i found

whih had not been reorted miing.b Mot reently, at the July 2009 G8 ummit in LAquila,

Italy, Preident Obama reed hi Prague agenda for onfronting nulear terrorim, announing

an international eort to eure vulnerable nulear material within four year, break u blak

market, detet and interet material in tranit, and ue nanial tool to dirut illiit trade in

nulear material.6

e deire and the ability to aquire and ontrut nulear weaon eit in onjuntion with ter-

rorit grou oenly-tated intent to detonate uh weaon. Al Qaeda ha ereed interet in

aquiring nulear weaon. In 1993, member met with Salah Abdel al-Mobruk, a military oer

and former Sudanee government miniter, who reortedly oered to uly the terrorit orga-

nization with weaon-grade uranium in ehange for $1.5 million. In Augut 2001, Oama bin

b During 2004-2007 there wa a 75% inreae of non-reovered lot or tolen material, IAEA, Illiit TrakingDatabae, Fat Sheet

e robability of a nulear weaon one day going o in an Amerian ityannot be alulated, but it i larger than it wa ve year ago. A. Carter, M.M. May, Center for International Security and Cooperation, June 2007.


12/48


Laden met with two former Pakitani nulear oial to nd out if they would hel reruit Paki-

tani ientit with nulear weaon eertie.7 ere i little quetion that if terrorit grou

aquired nulear weaon they would not heitate to ue them.

Construction o a nuclear weapon

e 1945 Manhattan Projet required an interdiilinary team of ientit and weaon eert.

Today, nulear weaon eert unanimouly agree that the ienti knowledge neeary to

ontrut nulear weaon i not a igniant imediment to nulear terrorim. Muh of the bai

iene and tehnial knowledge neeary to ontrut a nulear weaon i widely undertood

and ublily available.8 IND an be ontruted from ile material uh a highly enrihed

uranium (HEU) and Plutonium (Pu). It i eaier to make a rude IND with HEU.9, 10 Aording

to IAEA, a mall quantity of HEU, 25 kilogram, would ue to ontrut a nulear weaon. 11

Furthermore, deite the oniderable level of tehnial kill and eialit required to ontrutan IND, ome weaon uh a a gun-tye devied may not oe the ame tehnial barrier nor

require the aembly of a large ienti team.12

Nulear weaon eert unanimouly agree the larget obtale to nulear terrorim i the aqui-

ition of nulear weaon or the ile material needed to ontrut an IND. Terrorit grou

would need either to teal a nulear weaon from a nation-tate nulear arenal or aquire the

ile material to aemble a rude IND. Terrorit organization likely do not have the aability

to develo ile material on their own at thi time; however aquiring highly enrihed material

i ertainly within the realm of oibility.

Acquisition o nuclear weapons or fssile material

After the ollae of the former Soviet Union, olitial and eonomi intability threatened the

eurity of the former tate vat nulear weaon and ile material tokile, oening oten-

tial athway to their aquiition by terrorit grou. e Nunn-Lugar Cooerative reat Redu-

tion rogram (alo known a the 1991Nunn-Lugar Act) ha rovided aroimately $7 billion of

nanial and tehnologial aitane to Ruia and the ountrie of the former Soviet Union

to identify, deativate, dioe of, and eure the Cold War nulear arenal. Notwithtanding

25 kg of HEU i about the ize of a graefruit and 8 kg i about the ize of a oda an. National Nulear Seurity

Adminitration. (2007, January). Oe of Global reat Redution Strategi Plan, 2. Retrieved from: ttp://nn.ny.v/n_nnpitin/mnt/GTRI_SttiPn.p.

d A gun-tye weaon i the imlet nulear bomb to build. HEU material i red down a gun barrel into a ring ofHEU reating a ritial ma and triggering the detonation. e Hirohima WW II bomb wa a gun-tye devie.


13/48

7Nc Ts: T R T

igniant aomlihment, rogre ha been low and inomlete; not all targeted ite have

imlemented eurity ugrade. Furthermore, large quantitie of nulear material tored at Ru-

ian failitie with inadequate eurity are not art of the U.S.-Ruian ooerative eurity agree-

ment.13 e enormou quantity and geograhi ditribution of remaining HEU ued in failitie

uh a reearh reator, in Ruia and other ountrie, inluding thoe of the former Soviet

Union, oe a igniant threat for theft or diverion.14 Aording to a Harvard Univerity reort

ommiioned by the Nulear reat Initiative (NTI):

Real risks remain, from persistent under-funding of nuclear security systems, weak nuclear

security regulations, widespread corruption, and conscript guard forces rife with hazing

and suicide, coupled with threats ranging from surprise attack by scores of heavily armed

terrorists to sophisticated insider theft conspiracies.15

Unle the United State and Ruia jointly embrae a muh more aggreive timetable for redu-

ing their nulear arenal, it i likely to be deade before the volume of ile material ontained

in eiting warhead eae to be a onern. Ruia urrently ha about 14,000 total warhead,

the U.S. about 10,500.16 Even before Preident Obama and Medvedev announed new, more

ambitiou objetive for arenal redution in May 2009, both ountrie faed huge baklog in

dimantling thoe warhead already lated for elimination and dioing of their ile material.

In the United State, the timeframe etend beyond 2030, in Ruia oibly even later.17

e eurity of Pakitan nulear arenal i of equal (if not greater) onern, given the hroni

olitial intability in that nation, evidene that Al Qaeda bae of oeration i in Pakitan, the

inreaing inidene of terrorit at againt dometi target, and the detabilizing reene ofthe Taliban inide Pakitan border. Sine the end of 2002, North Korea revered reviou om-

mitment to abandon it nulear rogram and retarted failitie it reviouly had hut down.18

Reent nulear teting ativitye and announement of reating nulear deterrent further indi-

ate the Pyongyang government intention to ontinue it nulear-aaity build u, and thu,

e May 25th, North Korea deed world ower and arried out a eond underground tet of a nulear bomb Ruianoial aid wa omarable to thoe that obliterated Hirohima and Nagaaki. MSNBC. (2009, May 25). North

Korea ondut owerful nulear tet. Retrieved from:www.mn.mn.m/i/30921379/. Soon after the tet, theUN Seurity Counil unanimouly ondemned the DPRK rovoative behavior. NTI. (2009, June 25). Iue Brief:North Korea Nulear Tet and it Aftermath: Coing with the Fallout. Retrieved from www.nti./_/3_nt__n_tt.tm.


14/48


oe a grave threat a deribed by Preident Obama.19 U.S. intelligene analyt do not believe

that Iranalthough getting loeha yet ahieved the ability to rodue highly enrihed ura-

nium. e U.S. government i etremely onerned about nulear eurity in thee region.

Eert believe that over 50 nation, beyond thoe reviouly mentioned, maintain oorly ro-

teted ile material tokile.20 Seurity at many torage ite, aording to the NTI, onit

of no more than a night wathman and a hain link fene.21 e author of Seuring the Bomb

2008 deribed an armed break-in at a South Afrian faility where hundred of kilogram of

HEU are tored, the arret of a Ruian olonel for oliiting bribe to overlook violation of

nulear eurity rule, and other eurity breahe that ugget an inreaed oibility of nulear

material reahing terrorit hand.22

When thee eurity onern are read alongide the biartian Setember 11 Commiion 2005

reort, whih gave the U.S. government eort to eure weaon of ma detrution a grade

of D,23 it beome lear that inadequate eurity barrier for nulear material rovide oortu-

nitie that an onnet nulear material to terrorit hand. Preventing the movement of mall

amount of nulear material aro border ha roven to be eeedingly hallenging. Material

an be muggled aro border in variou tranortation method, uh a: being arried in er-

onal ar, walked aro, hidden in truk, or delivered by a mall overt boat navigating below

radar urveillane. In ome area where border eurity i imerfet, material likely ould be

tranorted aro with little eort.

Preventing Importation o Nuclear Materials

Sine nulear tokile in Ameria are, theoretially, tored under etremely high eurity, it ithought that terrorit would need to aquire ile material or re-aembled bomb abroad, and

tranort thoe item into the United State intat or in ready-to-aemble iee.24 e Deart-

ment of Homeland Seurity (DHS), oerating through it Cutom and Border Protetion

(CBP) and Dometi Nulear Detetion Oe (DNDO) unit, ha the rimary reonibility

for enuring that nulear material doe not enter the United State through hundred of eaort

and formal border roing or the thouand of mile of unguarded border with Canada and

Meio.fCBP emloy thouand of uniformed and lain-lothe border guard and ort eurity

f e Deartment of Energy alo ha igniant reonibilitie in thi area, mainly related to the anningin foreign

ortof argo ontainer that are loaded onto hi headed for the United State. An overview of the MegaortInitiative i atwww.nn.ny.v/n_nnpitin/1641.tm.


15/48

9Nc Ts: T R T

oer. e ageny alo gather intelligene to ag uiiou argo, hel hier and imorter

emloy minimal argo eurity oliie and roedure, hel ort oial revent unauthorized

ae to enitive ort failitie, and deloy military-inired urveillane tehnology to monitor

the northern and outhern border.

One of CBP rimary job i to an (or enure that foreign ort oial an) argo ontain-

er a they are loaded onto U.S.-bound hi and a they are unloaded from hi in U.S. ort.

DNDO i reonible for rouring radiation detetor and other high-teh anning equi-

ment that an ni out even heavily-hielded lutonium or HEU hidden in a argo ontainer,

oil tanker, imorted ar or any other item entering U.S. territory. DNDO ha entered into multi-

billion dollar ontrat to develo utting edge radiation anning tehnology.

DHS multi-ronged eort have rodued igniant imrovement in uly hain eurity.

e 2008 reort ard on the 9/11 Commiion Reommendation from the Partnerhi for

a Seure Ameria gave U.S. argo eurity eort a B.25 However, a number of reent GAO

reort have noted ontinuing deienie in CBP rogram to kee nulear material out of

U.S.-bound ontainer and from roing the land border. 26, 27ee reort alo have indiated

that DNDO wa far behind hedule and that onequently, CBP might not be able to deloy

more enitive and aurate radiation detetor until 2012.28 A reent announement from DHS

tated that it will not be able to meet Congre 2012 deadline for 100% reening of U.S.-bound

argo ontainer.29

ee obervation, ouled with the readily available knowledge of how to ontrut a nulear

weaon, unheked ae to inadequately eure nulear tokile, orou border, unheked

argo ontainer, and other ubjetive information ubtantiate the threat of nulear terrorim.


16/48


17/48

11T D 10 K (K) Ips Nc Dc

The Deoao of a 10 Kloo (K)Irosed Nuclear Dece

Response Issues

Under the U.S. National Prearedne Guideline, National Planning Senario 1 deribe the

detonation of a 10 Kt IND in a large U.S. ity.g Although the lanning enario i et within a in-

gle metroolitan area, the overall imat and reone would not be a loal event, by any mean.

A nulear detonation of that magnitude would mot auredly be a atatrohi regionalevent.

It would demand a broad reone, involving juridition that are far from ground zero a an

eodu of urvivor from the imated loal region and the threat of radioative fallout are real-

ized. Yet regional governane in the United State i the eetion rather than the rule. Although

a few major metroolitan area have genuine metroolitan government and intertate omateit for uroe of eonomi develoment and mutual aid, there are no eiting metroolitan

or intertate framework aable of lanning for or oordinating the neeary reone to the

detonation of an IND.

A major hallenge will ertainly be the unreedented ale and oe of emergeny oeration,

tarting with the mobilization and oordination of eiting regional reoure and the need for

a workfore to be brought into the area to uort reone oeration. In the early hour of

reone and ma aualty management, loal inident manager would need to organize and

arry out oeration on the aumtion that igniant federal reoure would not be available

for one to three day. eir immediate onern will be maimizing urvival, raidly obtaining

ituational awarene, undertaking raid damage and need aement, and maintaining oialorder. ee ativitie will lae a huge burden on the overwhelmed loal juridition, tate and

neighboring region.

In order to maimize the imat of limited healthare reoure, it will be eential for oial

to oordinate the variou aet of the health and ubli health ytem. ey will need to know

the real-time tatu of medial are failitie, Emergeny Medial Servie (EMS) and re agen-

ie, law enforement oial, ubli health reonder, rivate etor entitie, and volunteer

aet within the region. It i likely that ertain otential iue will hamer thee oordination

g e fteen National Planning Senario are inluded in the National Prearedne Guideline romulgateduruant to Homeland Seurity Preidential Diretive 8. Retrieved from www..v/iy/t/Ntin_Ppn_Giin.p. e 10-kiloton arameter for the IND i et forth at www..v/i/t/mmtpt/OIG_0607_Nv05.p.


18/48


eort, inluding inoerative ommuniation equiment, oor viibility and ae due to dut

and debri, ani and the limited availability of worker willing to lae themelve at unknown

rik to arry out reone oeration. ere are numerou variable that will hallenge the ability

of a region to reond to an event of thi ale.

Impact on Population and Inrastructure

e atatrohi imat of a 10 Kt nulear detonation dier from other large ale diater not

only in magnitude, but alo with regard to the high inidene of burn and traumati injurie

that will overwhelm the aaitie of loal and regional medial are to rovide aitane. e

immene energy diharged uon a nulear detonation would aue an enormou lo of life,

wideread detrution of infratruture and the ontamination of large geograhi area with

fallout. e detrutive fore are the initial reball at the eienter of detonation, followed by

blat fore, romt radiation and thermal heat. e heat would vaorize all loe-by matter,inluding oil and water, and lift it into the hallmark muhroom loud. Half of the total energy

from the detonation would our in the form of blat fore, one third a thermal energy and

aroimately one ith a radiation. i nal ategory would inlude both initial or romt

radiation (5%) and delayed radiation or fallout (10%) that would lat for minute to year a it

deayed.30 Cloe to the oint of detonation, blat fore and thermal eet would be fatal to all

eron, and aue near-total detrution. However, the detrutivene of thoe fore would

diminih with ditane from ground zero (ee Figure 1, age 14). e ame i true for the romt

radiation releaed during the rt minute following detonation; the intenity and lethality would

diminih quikly with inreaing ditane from the oint of detonation.31 Deending on their

roimity to the detonation, vitim may eeriene radiation eet ranging from raid death toonly delayed, minor ikne. Even with a trong to moderate doe, ome vitim who beome ill

ould urvive with roer medial are. While ome eet of radiation an be immediate, many

of the medial onequene would not manifet themelve for day to week, or even year.

Health rik from romt radiation will eit within aroimately 20 kilometer, and longer-lating radiation in the form of fallout artile will reah the ground downwind from the detona-

tion ite. A the loud of radiation-ontaining debri move downwind, fallout will ontaminate

A ombination of raid heltering-in-lae followed by informed evauation

would likely maimize hane of urvival and reovery.


19/48

13T D 10 K (K) Ips Nc D c

tiue, enetrate thin wall and gla, and ontaminate oil, eoed food and the water uly.32

e fallout i ditated by wind and weather variation and an reate a zone of high radioativity

a far a 100 mile downwind.33 Life aving ativitie likely will fou on laing the ubli out of

harm way either by evauation or heltering-in-lae.

Ditn, iin, and tim are ritial variable in determining the nature and everity of injurie

the oulation would utain from the blat wave, heat, romt radiation or fallout. A eron in a

baement or reinfored building might urvive, wherea a eron in the oen might not. Similarly,

omeone far from the blat would be le likely to be injured than omeone in loer roimity to it.

A ombination of raid heltering-in-lae followed by an informed evauation would likely

redue eoure to radiation and injury and maimize hane of urvival and reovery. Shelter

in thi ene doe not need to be a formal truture built for thi uroe; being in a building or

a baement would rovide igniantly more rotetion than being in the oen or in a ar. An

informed evauation imlie that a eron undertand both when to leave a helter, and whih

diretion they hould head to minimize their eoure to radioative fallout and other hazard.

While many variable ontribute to determining how bet to ombine the eort of heltering

and evauating, eert now believe that romt heltering for everal hour would ave the mot

live, ine the mot lethal radiation level from fallout deay raidly over everal hour after a

detonation. After that, deending on the tye of helter, many would benet from quikly leaving

the area and avoiding eoure to reidual fallout radiation.

In addition to an informed ubli, maimum urvivability deend igniantly on reonder

and medial are rovider having a keen undertanding of the tye of injurie that may our at

variou ditane from the detonation and of the geograhi zone in whih vitim might be ableto urvive. It alo deend uon the immediate diemination of ubli health meage inform-

ing dilaed eole and individual needing deontamination where, how and when to nd and

get to helter and other funtional failitie. While thi ound reaonable to aomlih, the

tehnial and logitial barrier to determining afe vere unafe zone and identifying funtional

failitie after a detonation are maive; it would require unreedented lanning eort and

eetive aumulation and analyi of eential data to be ueful.

Regardle of how the blat detrution, enuing re and radiation read out from the detona-

tion oint, there would eit an areaa gray zonebetween the area that are obliterated and

thoe that oer reaonable oortunitie for urvival without etraordinary meaure. Survivor in

thi gray zone would eeriene a range of medial iue from trauma and burn to entramentand radiation eoure. While ome in the gray zone undoubtedly would utain fatal injurie,

many would be able to urvive deending on the romt ation of ubli health oial and the

ubli to arry out rotetive ation.


20/48


Fi 12. 10Kt Dtntin Et; Tim Sq, Nw Y City

Ring model and data source: Lawrence Livermore National Laboratory Presentation-409771


21/48

15S G Z

Sural he Gra Zoe

Planning Guidelines or Lie Saving Opportunities

In addition to Lawrene Livermore National Laboratory detonation-eet modeling in New

York, reent modeling of the eet of nulear detonation in everal Amerian metroolitan

area by Dr. William Bell and Cham Dalla alo ugget that live an be aved and reovery

eort maimized through romt ation of thoe in the gray zone. e gray zone i deri-

tive of area where non-lethal injurie an be eeted and urvival i oible, but by no mean

guaranteed. e availability of bai healthare treatment within a reaonable amount of time i

eential to maimize urvival in thi grou of injured urvivor. Undertanding zone of dierent

injurie would reult in a more eetive targeted reone.

ere i no way to aurately redit how many vitim would be eoed to more than one eet

(blat, thermal burn, romt radiation and fallout) of the nulear detonation, but it i lear that

a eron eoed to multile eet would have a far wore rognoi than omeone eoed to

only one of thoe eet.h e goal of taking urgent ation after a detonation would be to limit

the eoure to a many of the hazard a oible, a muh a oible.

No amount of modeling an aurately ature all of the variable that would eit when a deto-

nation ourred in an urban environment. e onentri irle of damage that are ommonly

een on ma illutrating the eet of a detonation are baed uon data from old war era nulear

weaon tet that the U.S. onduted in oen deert area ontaining few water bodie, build-

ing or other truture. It i very unlikely that the eet of an IND detonation in a dene urbanarea would reult in area of damage that were a learly demarated and whih ould be eaily

dened. e inability to ondently redit ditint zone of antiiated injurie and damage

would greatly omliate the eort of reonder. However, reone lanner an adot the

onet of urvival in thee gray zone and fou eort on raidly identifying aroriate area

for minimizing fatalitie and uering.

h Of oure, any one of the fore releaed at or near ground zero will, by itelf, annihilate all life unfortunate enoughto be there.


22/48


23/48

17Rsps Sss Cpc

Resose Sses Caac

Public Health and Medical Care Systems

e ubli health reone to a nulear detonation will have to begin immediately after a detona-

tion. Aroriate authoritie will have to make time-enitive deiion and raidly ommuniate

with the ubli in harm way in order to failitate evauation, heltering, deontamination, and

ma medial and mental health are. In an event of thi magnitude and urgeny, a regionally

ditributed network of ubli health takeholder would fae even greater hallenge eaking

with one voie and ommuniating emergeny intrution to the ubli, than would be the ae

in other emergenie. erefore, rik ommuniation lan for uh an inident mut already be

in lae, and they mut be familiar to thoe who are reonible for roviding thee ervie to

the ubli.

e Aoiation of State and Territorial Health Oial (ASTHO) reently ublihed a tatu

reort ummarizing tate and loal rearedne aaitie i year after the initiation of the

Center for Dieae Control and Prevention (CDC) Publi Health Emergeny Prearedne

Program.34 e reort, a omilation of urvey reone from member of four major orga-

nizationASTHO, the Aoiation of Publi Health Laboratorie, the Counil of State and

Territorial Eidemiologit, and the National Aoiation of County and City Health Oial

found that i year of CDC funding of rearedne lanning had rodued many imrove-

ment, but that ritial ga remained. Many loal health deartment lak lan for ma atient

are and fatality management and fae inadequate tang and work-fore develoment. One

third of reondent indiated a need for imrovement in medial and hoital urge aaity,radiation reone, and diater reovery.35

Hospital and Healthcare Systems

e lo of healthare reoure and emergeny reone aaity in the aeted area would

ubtantially omliate reone and reovery oeration. Hoital remaining oen following

an IND detonation an eet a tremendou, unreedented urge of atient with ome om-

bination of burn, multile trauma from the blat eet and radiation ikne from the high

romt radiation doe. In addition, it hould be eeted that large number of uninjured or

mildly aeted individual would ruh to healthare failitie eeking to onrm otential radia-


24/48


tion eoure. While mot tudie do not uort the notion that oulation ani during and

after large-ale diater, we rooe that radiation ani may be a otential henomenon in

the aftermath of an IND attak.

e demand for aement and treatment would overwhelm available ulie, eronnel, har-

maeutial, and hoital ae in the nation urban enter or the region that urround them. At

reent, hoital, EMS ytem and other healthare reoure do not have the aability to han-

dle the etreme volume of atient that would follow a nulear detonation.36 Given the likelihood

that uh an attak would damage health are failitie, damage the infratruture and imede

the delivery of health and rt reonder ervie, and redue the number of available healthare

rovider, rearedne lanner have not adequately aounted for the unreedented hallenge

that will omliate healthare delivery. An innovative aroah i needed to rovide medial

treatment to the large number of eole ikened and injured by a nulear eloion. While the

DHS Concept of Operations doument detail an organizational model for oitioning triage andtreatment reoure for vitim both inide and outide of the gray zone, thi tye of theoretial

lan will have little value if it ha not been eeried before a diater our.37

Some hoital and emergeny reone agenie have reited develoing genuine nulear re-

aredne lan beaue they ereive a ombination of overwhelming demand and few work-able olution. A reort from the Center for Bioeurity at the Univerity of Pittburgh Medial

Center (UPMC) note, Hoital often do not have the time or reoure to undertake om-

rehenive diater rearedne lanning, and ome are unaware of their reumed role and

reonibilitie within larger ommunity diater lan.38 e aer argue that with 30% of

hoital loing money, hoital are imly not likely to alloate enough reoure to diater re-

aredne. For eamle, a 2006 urvey of 19 aute are hoital in the Maryland region revealed

that only 11 maintained a dediated reerve uly of harmaeutial to treat radiologial event

vitim.39 And the total ulie of thee material in the 11 tokile would only rereent a

minute fration of what might be needed in the event of a roimal IND detonation. e urvey

alo note that, harmaeutial rearedne for radiologial inident remain leat addreedat the regional level. Limited ulie of otaium iodide and helating agent [ueful in ome

tye of radiation and nulear inident] for radiation eoure were found regionally.40

e availability of bai healthare treatment within a reaonable amount of

time i eential to maimize urvival.


25/48

19Rsps Sss Cpc

Congre reated the Strategi National Stokile (SNS) in 1999 to ulement and relenih

tate and loal medial and harmaeutial reoure and enure availability and raid deloy-

ment of life-aving medial ountermeaure during and after a diater. Mot hoital eet to

reeive emergeny ulie within 48 hour from thi federally oordinated tokile, although

it i unertain if, under the ondition that would eit after an IND detonation, thi timeline

ould be met. e Center for Bioeurity tudy note that ulie from the SNS hould theoreti-

ally be available within 12 hour.i However, the Maryland harmaeutial rearedne urvey

indiate that [the] logitial hallenge of the atual delivery, ditribution, and diening to

eole in need may ontribute to delay.41 e logiti and ditribution hallenge following an

IND attak would likely dwarf the irumtane whih imeded relief eort in the Haiti earth-

quake of January 2010. In hort, loal authoritie and medial rofeional imly annot rely on

immediate availability of tate and federal reoure in the aftermath of a diater and mut lan

to funtion indeendently for an etended eriod.

Following an IND detonation, many hoital alo would fae evere hortage of the eialized

equiment and highly-trained health are eronnel they would need in order to rovide are for

burn and trauma vitim and atient requiring intenive are and reiratory theray, not to men-

tion the reoure they would need for harmaeutial intervention and ma deontamination.

Aording to a 2001 tudy ublihed in the Annals of Emergency Medicine, 73% of the hoital

urveyed believed they were unreared to handle a nulear inident.42 i i a ritial reared-

ne ga; aording to a 2002 diater enario ublihed in the Britih Medial Journal, a 12.5

kiloton ground-level eloion in a New York City ort would detroy 1,000 hoital bed from

the blat and ontaminate 8,700 more bed with uient radiation to aue radiation ikne.43

Aording to Dr. Dalla, the eet of a nulear detonation on healthare reoure in the UnitedState would be devatating. He ommented, e nationwide trend of loating a majority of the

major urban healthare intitution in downtown area would reult in a taggering lo of the

total intitutional health are delivery following nulear weaon ue.44 Dr. Dalla etimate that

if terrorit uefully detonated a 20Kt bomb in New York City, the reulting fallout ould

deending on the wind atternwie out mot of the healthare ytem in Manhattan.45 Even

with a 10 Kt IND, it i lear that a igniant erentage of healthare failitie, deending on

loation, would be detroyed or dyfuntional at varying level of aaity and aabilitie.

e magnitude of the eet on healthare reoure in other itie would be imilar. A 20 Kt

bomb in the Wahington D.C. area would aet more than half of the hoital in the D.C. area.

i SNS Miion tatement i to releae from federal SNS and deliver to State SNS Coordinator within 12 hour; Statewill then deliver to loal SNS Program for loal DOH to reeive and ditribute to general ubli within 48 hour.


26/48


However, in Chiago and Atlanta, an eloion of that ize devie would leave many uburban

hoital hyially unaeted and funtional,46, 47 albeit omletely overwhelmed by atient.

Suburban hoital alo might be le reared than urban aademi medial enter to handle

the tremendou inu of trauma atient and atient uering from radiation oioning. With

healthare reoure in an entire region everely omromied, it i unlear where atient aught

in the gray zone would be able to go for lifeaving hel.

First Responders

Firt reonder after a nulear inident inlude eronnel with ubli afety, reue, emergeny

medial, life afety, ritial infratruture, and ubli health reonibilitie. A mall nulear deto-

nation would omletely overwhelm even the mot ohitiated and aable urban rt reone

ytem. Tetifying in the Senate about nulear rearedne in Aril 2008, John Gibb, the Dire-

tor of the New York State Emergeny Management Oe aid:

Tere is no ready system in place or planned for that would result in the victims of this type

of event receiving pre-hospital or denitive care in any reasonable time frame.48

A reliane on either EMS or hoital to aborb the urge in demand for medial are during a

nulear diater i unrealiti. e danger aoiated with reonding to a nulear inident would

far eeed the tyial rik aoiated with being a rt reonder, whih may limit the number

of eronnel willing to reort for duty. In addition to wideread re, oor viibility, and moun-

tain of dangerou debri, radiation level will everely limit the time reonder ould be in the

aeted area and further omromie reue and reovery oeration. e tyial ouationalguideline for radiation eoure will be diult or imoible to follow after a nulear detona-

tion. For eamle, Gibb note that New York State tyially doe not eet rt reonder to

eoe themelve to more than a minimal doe of radiation during reue oeration. However,

following a nulear detonation Gibb argue that there would be life-aving and eurity miion

in area eoed to dratially higher radiation levellevel that ould have eriou or even fatal

health onequene for the rt reonder. Gibb argue, We need to re-eamine and rovide

guidane and alternative aroahe to federal, tate and loal emergeny lanner that will allow

u to addre thi iue.49 In other word, the ubli and government mut enure that IND

event rearedne model rovide guidane to inident ommander in balaning the rik to

rt reonder againt the need to arry out lifeaving oeration. ey mut develo uh guide-lineand other that addre the unique hallenge of nulear terrorimin onultation with

the eole whom theyre eeting to lae themelve in harm way.


27/48

21Rsps Sss Cpc

Patient Triage Systems and Altered Standards o Medical Care

Deiion making to determine whih vitim will reeive immediate veru delayed are i an

additional eial medial reoure in aualty management. Following a nulear detonation, theheer enormity in number of vitim within the ontet of limited reoure would beome

immenely hallenging and would require very dierent aroahe from urrent tandard triage

rotool. e level of medial are, where available at all, mot likely would be ubtantially lower

than eeted in other emergenie.

A 2008 GAO reort alo highlight the need to adot alternative medial tandard during a ma

aualty event that overwhelm available reoure. e reort note that ome tate had not begun

work on altered standards of care guidelines [itali added], or had not omleted drafting guideline,

beaue of the diulty of addreing the medial, ethial, and legal iue involved50 It i lear

that limited reoure would make delivering bet-ratie medial are imoible.

e United State Deartment of Health and Human Servie (HHS) triage model i deigned

for mall event and i oted with the following dilaimer: Caution: Algorithm guideline mod-

iation will be required in ma aualty event.51 At reent there i no generally-aeted tri-

age rotool that aount for the evere reoure hortage that would eit following a nulear

event. In fat, Dr. David Cone and Kriti Koenig of Yale Univerity laim no ma aualty tri-

age heme ha beome aeted a a gold tandard.52 However, they rooe a very imliti

triage ytem to be ued following a nulear detonation that deerve ome attention; Dr. Cone

and Koenig rooe a ytem where atient are laied baed on their ability to indeendently

walk, breathe and follow ommand.53 Although their ytem i not omrehenive and doe

not attemt to addre the full array of medial, ethial and legal iue that medial ta would

enounter when alloating are reoure, it doe rovide a bai to rioritize atient in the

immediate aftermath of a nulear event. Prearedne eort mut be attentive to the realitie of

etraordinarily high need and etraordinarily limited reoure, or medial failitie would imly

not funtion in the wake of a nulear detonation.

Workorce Absenteeism

One of the mot diult fator to aount for in drafting a omrehenive nulear diater

reone lan would be the lak of information regarding who atually would reort to work

after thi tye of inident. Peronnel from rt reonder to hyiian and ity emergeny man-

agement emloyee would onfront ometing rioritie. Many would have to hooe between


28/48


reorting to work and attemting to take are of their family, friend and roerty. While mot

emergeny ervie emloyee reort a high level of ommitment to ervie, eole have not

alway reorted to work in at diater.

ere i limited undertanding of reonder willingne to reort to work following a nulear

detonation, yet ome onluion an be drawn from a Columbia Univerity NCDP urvey of

EMS rovider that inquired about workfore willingne to reond to a radiologial dieral

devie (RDD or dirty bomb) event. e 2003 urvey onluded that only 83.4% of rovider

would be able to reort to work and only 73.8% of rovider would be willing to reort to work

following an RDD eloion in a hool that injured 500 hildren.54 While thee data indiate

that many EMS worker would aet the eronal rik of reorting to work following an RDD

inident, they alo emhaize that more than a fourth of EMS might not reort to work due to

logitial iue relating to family or home need, or a eronal fear of beoming injured or ik. It

i imortant to aknowledge that the ereived eronal rik of reonding to a nulear detona-tion are likely to be muh greater than thoe aoiated with reonding to an RDD, and that the

number of reonder unable or unwilling to reort to work following the detonation of an IND

would ertainly be muh higher.

A 2008 GAO reort noted that tate have imilar onern about hoital ta hortage. e

reort note:

While 19 of 20 states we surveyed reported that they could increase numbers of hospital beds

in a mass casualty event, some state ocials were concerned about stang these beds because

of current shortages in medical professionals, including nurses and physicians.55

In the ontet of a nulear diater thi aement indiate that even if the hoital in the gray

zone, where the infratruture may be hyially intat and funtional, ould aommodate a

atient urge, hoital would likely lak the medial eronnel to are for the aualtie.

While thi information about medial eronnel willingne to work may eem to at doubt on

the eay of medial rearedne eort in general, the 2003 NCDP urvey ited reviouly

inlude everal tatiti that how otherwie. For eamle, 83% of EMS rovider urveyed

ited a ene of reonibility and 77% of EMS rovider ited the ability to rovide are a

the rimary reaon to reort to work. Of thoe who tated that they would not reort to work,

44% ited onern for family a their foremot reaon.56 i may indiate that if a diater laninlude innovative aroahe that rovide eial rotetion to the familie of medial eron-

nel, ome ortion of thoe who otherwie would tay at home, may reort to work.


29/48

23Rsps Sss Cpc

A a regional event, an IND detonation will everely hallenge the ability and willingne of

emergeny eronnel to reort for duty. A reent tudy by the NCDP elored the barrier to

hoital emloyee reorting for duty during a ubli health emergeny, and found that the mot

igniant barrier inluded the need to are for a hild or adult at home, and a fear for the afety

of themelve and their family57. Many of thee iue will be deal-breaker for all tye of emer-

geny eronnel at all level. A uh, it i imortant for emergeny lanner to fator etreme

level of abenteeim at all level into the region emergeny oeration lan.

An Eective Public Response Requires Preparedness

e Amerian ubli i onerned about terrorit eloding a nulear bomb on United State

oil.58 In a erie of nationwide fou grou, onduted by the Saga Foundation, Amerian ited

nulear terrorim a a to fear and believed that if a terrorit organization aquired nulear

weaon, it would ue them.59 Furthermore, reearher Wray, Beker, et al. (2008), found thatfaed with the threat of a ubli health emergeny, the ubli would reond by eeking ro-

tetive information and taking elf-rotetive ation.60 ee nding ugget that the ubli

ability to reeive, undertand, and believe emergeny meage, and then at uon them would

igniantly enhane urvivability and health outome. A reently releaed DHS Concepts of

Operation guide tate the mot eetive life-aving oortunitiein the rt 60 minute [after

a nulear detonation]would be the deiion to afely helter or evauate eole in eeted

fallout zone.

A nn t tpiiity n ttn U.S. i

Unit Stt wi pin n tt witin y

Tit niztin iA Q wi qi nwpn v t nt

I tit niztinqi n wpn itwi tm

62%

49%

59%

73%


30/48


Ditane and hielding, reviouly deribed within thi aer, are eential onet in trategie to

maimize urvival and mitigate illne, yet thee eronal rik redution and rotetive ation are not

well undertood by the general ubli. A many a 90% of the reondent in Wray and Beker tudy

tated they may not follow intrution to helter-in-lae even if they reeive the meage to do o. 61 j

In the minute and hour after the detonation of an IND, the ubli would need to make a few

key deiion in order to maimize their hane of urviving and minimize their injurie and

long-term health eet:

1. I it better to evauate now or later?

2. If I tay ut, how hould I helter and deontaminate myelf to revent further injury?

3. When I do evauate, where hould I go to avoid laing myelf at an inreaed rik

from fallout?

Individual will very likely need to make thee deiion in the abene of oial diretion. If

loal health oial are to dramatially inreae the erentage of aeted eole who an ur-

vive, they mut make the ubli aware of the benet of thee initial life-aving reone ation

and of knowing what to do in an emergeny. Deite the benet that thee imle rotetive

meaure an have, it eem that the widely-known image of the nulear devatation in Hiro-

hima and Nagaaki, and ubequent tionalized ortrayal of nulear onit in movie and

televiion-rogram image of total nulear devatation have led eole to onlude either that

rearedne i imoible or that the federal government already mut have done everything in

it ower to rotet the ountry. Both aumtion are inaurate.

In the United State, virtually no ubli eduation ha taken lae about what an individual

hould do in the event of a nulear detonation, although there i urgent and ritial need for uh

Survival in the gray zone, while by no mean aured, will be highly deendent

on eetive re-event lanning inluding evauation and helter-in-lae

lan ommuniated to the general ubli and ratied.

Dr. Irwin Redlener, May, 2008

j e tatu of family member, eeially hildren in hool and knowledge of rearedne lan for family memberin other loation are determining fator for adherene to helter-in-lae diretive.


31/48

25Rsps Sss Cpc

eduation, eeially for thoe living in otential target area. Alo laking are re-develoed,

eeried and well-teted ommuniation lan to deliver raid information from oial to the

ubli following a nulear inident.

e advoay grou Phyiian for Soial Reonibility (PSR), in a 2006 reort about Ameria

rearedne for nulear terrorim, noted the abene of either a entral oordinating authority

emowered to immediately te in to diret the reone and reue eort62 or any ommuni-

ation with the ubli on rearedne for nulear terrorim...63 e deentralized reonibility

for and lak of ubli ommuniation about nulear rearedne highlighted by the PSR reort

might hel elain the reviouly-diued ubli unawarene of nulear terrorim rearedne.

A ubli eduation amaign that addreed thee iue ould ave live and redue injury in the

gray zone by emowering the ubli to initiate life-aving ation without the need for oial

advie, whih may never arrive. Immediate rotetive ation in the rt moment after a detona-

tion are ritial. Conidering that it might be imoible to get emergeny meage to the ubli

after a detonation, it i enible to equi the ubli nowwith bai information on how to bet

rotet themelve and their family hould they ever onfront thi tye of diater.

Federal Emergency Response

A reviouly mentioned, a nulear detonation will have igniant regional level imat that

ut aro ity and tate boundarie. Conequently, regional reoure will be ritial in the hour

before federal aitane arrive. And once external resources do arrive, coordination among local,

regional, federal and other assets will require highly complex systems-integration capacities in a dynamic

and unpredictably expanding scenario.

In the earliet hae of an IND reone, the federal government ould only make limited

reoure available to augment loal and tate reone aabilitie. Loal and tate rt reond-

er and medial rofeional annot aume that the federal government would be able to materi-

ally uort their loal ativitie for the rt few day. For eamle, even when the Deartment of

Homeland Seurity ativated all of it more than 50 Diater Medial Aitane Team (DMAT)j

to rovide urgent medial are to vitim of Hurriane Katrina, the aitane wa inuient to

aommodate the atient load.64 A nulear detonation would rodue a vatly greater number of

atient with more omle and life-threatening injurie. e need for deontamination would

further omliate an already daunting medial hallenge. erefore, loal healthare rofeion-

al hould not aume that federal reone team would be able to rovide the needed urge

k DMAT team are ivilian team of medial rofeional and uort ta, adminitered through HHS via theNational Diater Medial Sytem (NDMS)


32/48


aaity. Furthermore, although HHS alo oerate National Pharmay Reone Team (on-

iting of harmait, harmay tudent and harmay tehniian) to hel raidly ditribute

mediation in a diater region, thee reoure would be groly inuient to aommodate the

inreaed demand following a nulear detonation.

In the U.S. federal ytem, tate and loal government and non-rot organization alway have

houldered the rimary rearedne and reone burden. Oerating under the rinile of

Home Rule, tate and loal authoritie maintain the vat majority of ower and ontrol over a

diater reone and oordinate, in their area, the reue and reovery oeration a well a the

ot-diater leanu. A multile aement of the Federal Emergeny Management Ageny

(FEMA) adminitration of the Staord At have noted, obtaining federal diater aitane an

be a umberome, rotrated roe. State mut rt ondut aement, verify reoure ent,

and then delare that they need federal hel. FEMA mut review uh requet and the Preident

mut delare a diater before the federal government an rovide diater aid.65, 66

For the federalgovernment to rovide an immediate reone, Congre need to revie the rotool governing

reidential diater delaration o that there will be an automati Preidential delaration uon

any nulear detonation. It i not known if uh rotool reviion already eit, however.

A nulear detonation would almot auredly overwhelm loal, tate and regional reoure to the

oint where they would truggle to rovide an aurate aement of the ituation. It alo would

invoke reone from an unreedented number of loal and regional and etra-regional agenie

and eronnel and trigger deloyment of multile federal agenie in the interet of national eu-

rity and law enforement. e Federal Bureau of Invetigation (FBI) i the deignated lead federal

ageny for the invetigation of all terrorim inident. In addition to traditional diater reone

agenie uh a FEMA and HHS, eialized ivilian and military uort team have been etab-lihed to rovide tehnial eertie to federal reonder. e reone would undoubtedly be

omliated and rotrated a federal aet, tate reonder and loal agenie onverged to ae

the ituation, ommuniated with the ubli, oordinated an evauation, iued emergeny intru-

tion, etablihed health are ytem, and began an invetigation. Abent ubtantial re-lanning,

the amaing of numerou federal and loal agenie following a nulear inident would aet eit-

ing loal ommand and oordination lan and reate onfuion a to how thee variou agenie

hould interat.

Some emergeny rearedne advoate argue that the federal government hould re-aign the

military an inreaed role in the reone to a large diater a they already oe the advanedeld aabilitie in the area of damage aement, earh and reue, tranortation, logiti,

ommuniation, medial are, and in maintaining order.67 Reent announement from the

Deartment of Defene (DoD) indiate that te are being taken to rovide thi tye of ai-


33/48

27Rsps Sss Cpc

tane with the develoment of dometi Raid Reation Fore. Initial reort indiate that nearly

5,000 ative duty troo are available for thi uroe at thi time, with the number eeted to

grow to 20,000 by 2011. ee troo would work under the United State Northern Command

(USNORTHCOM), etablihed in 2002 to uort the homeland eurity miion and ivil u-

ort role of the DoD. In addition to the ivilian DMAT team available through HHS, the DoD

ha a robut aability to deliver eld medial are through the ue of a tiered ytem intended for

deloyment during oeration. ee inlude Battalion Aid Station, Forward Suort Medial

Battalion, Forward Surgial Team, and the modular Combat Suort Hoital. While the ue

of thee aet remain an otion for federal oial, their integration into the ivilian healthare

ytem a art of a regional reone to an IND event would be hallenging without igniant

relanning. Eeriene from the 9/11 terrorit attak demontrated that under the urrent y-

tem it take at leat 3-7 day to authorize and deloy federal ative duty or reerve troo.68 It i

aumed that many of the roee have been treamlined, however, in the ubequent nine year.

To inreae the military role in dometi emergenie beyond that ontemlated for USNORTH-

COM would require a igniant reaement ofboth oliy onerning the ue of military fore

to erform dometi law enforement funtion andthe tatute that ha governed that domain for

over a entury, the 1878 Poe Comitatu At (PCA). i law generally rohibit the ue of the

military in ivilian law enforement and uort rotetion of individual ivil libertie, although

relief oeration are not retrited under the legilation. e PCA alie to ative and reerve

unit of the Army, Air Fore, Navy, and Marine but not to the Coat Guard (In 2003, the Coat

Guard ame under the auie of the Deartment of Homeland Seurity). A a rule, a tate

National Guard i onidered a tate aet, i.e., under the ommand of it own Governor. While a

tate aet, the National Guard i not ubjet to the limitation of PCA and the Governor may all

u the Guard for law enforement ativitie and other dutie uon a diater. However, in thoe

infrequent ourrene when the Guard i federalized by Preidential authority, it i ubjet to

the limitation of PCA.69 Furthermore, variou federal tatute rovide ere eetion to the

PCA, inluding uon emergenie involving nulear material.70

e federal government mut rene it role in diater reone if the U.S. i to be reared for deto-

nation of an IND. e urrent ytem doe not ontain urge aaity or rovide lanning uort

ommenurate with the hallenge of uh a diater. Given the legal framework of the PCA and

eiting tatutory eetion, legilator and other oliymaker need to larify the otential fun-

tion of the U.S. armed fore following an IND detonation. In January 2008, Congre aknowl-

edged the urgeny of addreing thee iue by mandating the reation of an adviory anel toarry out an aement of the aabilitie of the Deartment of Defene to rovide uort to

United State ivil authoritie in the event of a hemial, biologial, radiologial, nulear or high-

yield eloive (CRBNE) inident.71 i anel began it work in Setember 2009.72


34/48


35/48

29Cs Ts

Closg Thoughs

e very real threat of nulear terrorim i evidened by terrorit well-doumented deire to uenulear weaon againt the United State and the ability to roure, develo and ue nulear

weaon. Although it i imoible to quantify thi threat with any reiion, the availability of

oorly-eured ile material in many loation, imerfet ontrol on the entry of eole and

argo, general knowledge about nulear ion tehnology and, a reviouly diued, the oliti-

al intability of Pakitan and otential intability of other nulear tate, have led mot oberv-

er to believe that the threat i real and imminent enough to demand the highet riority from

lawmaker and oiety a a whole. e eet of even a 10 Kt nulear detonation in an urban

area would be overwhelming. Yet, although there would be enormou lo of life, houing and

infratruture, an IND detonation i a urvivable event for many. Well thought out and reheared

diater reone lan ould literally make the dierene between life and death for hundred of

thouand of eole.

Counter-roliferation initiative, ooerative nulear eurity rogram, trong uly-hain,

argo and border eurity rogram and robut, multi-layered ounter-terrorim, intelligene and

law enforement rogram, olletively rovide our bet hoe of reventing nulear terrorim in

the United State. Yet thee and other revention eort thu far have been limited and met with

barrier and delayed goal. Equally troubling, revention rogram eit within an environment of

untable government and eriou and dangerou traking of nulear material, tehnology and

ienti eertie. A diued reviouly, however, no et of revention eort i fool-roof,

and the onequene of a ingle failure ould be diatrou.

Senator Joe Lieberman, Chair of the U.S. Senate Committee on Homeland Seurity and Gov-

ernment Aair, learly artiulated our reonibility to onfront the nulear threat when he aid,

Al Qaeda has demonstrated a clear intent to develop and use nuclear weapons to achieve its

violent jihadist goals. Tis is daunting and jarring information, but it is our responsibility

to bring it forth and do something about it. Our purpose today is not to encourage unrealis-

tic fear but rather to confront the fear ful realities we face in the world today so that we can

then deal with them in defense of our country and people and our way of life. 73

Senator Lieberman tatement i an undeniable harge to the United State government and thegeneral ubli. It hould be an injuntion to emergeny lanner at all level to move forward now

and develo and eerie rearedne and reone mitigation lan for otential nulear terror-


36/48


it attak within our ountry. Eleted oial and emergeny lanner at all level of government

mut undertand the reality of the nulear terrorim threat and ome to gri with the almot

ertain atatrohi eet on a regional oulation, infratruture and health, not to mention far

reahing onequene that inlude damage to national ondene and yhe a well a a global

eet. e ubli and our emergeny lanner mut get beyond Cold War notion of total nulear

devatation and adot lanning aumtion around survivability. Our re-event lanning would

be deiive in determining our reone ometenie and outome hould uh a dreadful event

ever our.

Diater lanning i a ore reonibility at all level of government. In fat, many juridition

have enouraged their ubli to reare for a variety of natural and man-made diater, inluding

an outbreak of andemi inuenza. Moreover many non-government reone agenie and ri-

vate etor entitie have imlemented diater ontingeny reone lan. Planning for a nulear

detonation enario, however, ha not been on the table in any deliberate or utained way. We

hould follow the logi of revention and give ourelve the kill to inreae our hane of ur-

viving and reovering from an IND diater a well. It i time to yntheize known threat and

lauible onequene into ation. To thi end, the NCDP reommend a range of regionally

lanned IND-ei reone trategie, inluding:

1. Require all juridition that are federally deignated a high rik IND target ommuni-

tie to develo and utain aroriate rearedne for oible nulear terrorim;

2. Strengthen regional alliane and oalition develoed to imlement eetive

reone trategie;

3. Require all federally funded regional alliane to demontrate robut lan for region-wide

health, ubli health and heltering reone to IND detonation;

4. Provide uient funding for all aet of rearedne for IND terrorim;

5. Greatly eand aaity of national reue and reovery eort, inluding relevant federalagenie, to reond in the event of an IND attak anywhere in the U.S , inluding e-

ialized training with reet to funtioning in high-level radiation event;

Survivability in the gray zone mut be a rinile guiding reone,

mitigation, and reovery lanning at all level of government and non-

government reone agenie.


37/48

31Cs Ts

6. Clarify inident ommand role and oerational integration roedure among federal,

tate and loal authoritie in the event of an IND attak;

7. Enure that Strategi National Stokile of ountermeaurea well a orreonding

tokile on a tate levelare relevant for an IND detonation and are aled u to meet

the likely demand;

8. Aelerateand eeriemulti-etor reone lanning that inlude government

entitie, non-governmental organization and rivate etor aet;

9. Reearh and imlement trategie deigned to ommuniate rik and aroriate ubli

reone to an IND detonation;

10. Purue relevant reearh to imrove eetivene of ountermeaure;

11. Enure that highly redundant and multi-format modalitie of ommuniating with the

ubli during and after IND terrorim are develoed, teted and available; and,

12. Conider re-oening and/or develoing toked ubli helter for oulation in high

rik ommunitie.

In the meantime, Congre hould urgently eand funding to enhane our undertanding of the

barrier to nulear rearedne lanning and to ubtantially bolter and larify the aaity and

legal authority of the federal government to deloy maive reoure in the event of a nulear

terrorim attak anywhere in the nation. Until lanning barrier are reolved and onrete te

are taken, nulear-threat-ei regional lanning remain an urgent and unmet need.


38/48


39/48

33As

Abbreaos

ASTHO e Aoiation of State and Territorial Health OialCSI Container Seurity Initiative

CBP Cutom and Border Protetion

DoD Deartment of Defene

DHHS Deartment of Health and Human Servie

DHS Deartment of Homeland Seurity

DMAT Diater Medial Aitane Team

DNDO e Dometi Nulear Detetion Oe

EMS Emergeny Medial Servie

FBI Federal Bureau of Invetigation

FEMA Federal Emergeny Management Ageny

GAO Government Aountability Oe

HEU Highly Enrihed Uranium

IND Imrovied Nulear Devie

IAEA International Atomi Energy Ageny

Kg Kilogram

Kt Kiloton

NCDP National Center for Diater Prearedne

NEST Nulear Emergeny Suort Team

NTI Nulear reat Initiative

PSR Phyiian for Soial Reonibility

Pu Plutonium

PCA Poe Comitatu At

RDD Radiologial Dieral Devie or dirty bomb

SNS Strategi National Stokile

USCG United State Coat GuardUSNORTHCOM United State Northern Command

UPMC Univerity of Pittburgh Medial Center


40/48


41/48

35E Ns

Ed Noes

1. New Releae. (2009, Aril 5). Remark by Preident Barak Obama. Retrieved February 1, 2010 from:www.

wit.v/t_p_/RmByPintBOmInPADiv.

2. Graham, B., & Talent, J. (2008, Deember 3). World at rik: e reort of the ommiion on the reventionof weaon of ma detrution roliferation and terrorim. New York: Vintage Book.

3. Rolf Mowatt-Laren quoted in (2008, Aril 2). Lieberman, Collin eamine threat to the homelandfrom nulear terrorit attak. Retrieved February 1, 2010 from: ttp://.nt.v/pi/in.m?FAtin=P.MjityNw&CntntR_i=81151367410430451&Rin_i=&I_i=71648377474193897632528191.

4. e tak fore reort i quoted in Allion, G. (2001, November 18). It the Plutonium, Stuid .Lo AngeleTime. Retrieved February 1,2010 from: ttp://nt..v./pitin/1157/it_t_ptnim_tpi.tm.

5. Quoted in Mafarquhar, N. (2008, Otober 28). Rate of Nulear eft Diturbingly High, MonitoringChief Say. New York Time.

6. Addreing the Nulear reat: Fullling the Promie of Prague at the LAquila Summit, July 8, 2009.Retrieved February 1, 2010 from www.wit.v/t_p_/AintNtFintPmiPttLAqiSmmit.

7. Zimmerman, P. D., & Lewi, J. G. (2006, November/Deember). e Bomb in the Bakyard.Foreign Poliy, 33.

8. (1998). e military ritial tehnologie lit: Weaon of ma detrution tehnologie, Setion 5-NulearWeaon Tehnology. Wahington, DC: Deartment of Defene, Oe of the Seretary of Defene forAquiition and Tehnology. Retrieved Februaruy 1, 2010 from:www../ip/tt/mt982/p205.p.

9. Ferguon, C. D., & Potter, W. C. Imrovied nulear devie and nulear terrorim (No. 2), 1. RetrievedFebruary 1, 2010 from:www.wmmmiin.//N2.p.

10. Carter, A. B., May, M. M., & Perry, W. J. (2007). e day after: Ation in the 24 hour following a nulearblat in an Amerian ity, 4. Harvard and Stanford Univeritie. Retrieved February 1, 2010 from: ttp://nt..v.//ytwppt_my2007.p.

11. Ferguon, C. D., & Potter, W. C. Imrovied nulear devie and nulear terrorim (No. 2), 1. RetrievedFebruary 1, 2010 from:www.wmmmiin.//N2.p.

12. Ibid., 7.

13. Bunn, M., &Wier, A. (2006, July). Seuring the bomb 2006. Nulear reat Initiative, vi-vii. RetrievedFebruary 1, 2010 from:www.nti./_/t06w.p.

14. Ferguon, C. D., & Potter, W. C. Imrovied nulear devie and nulear terrorim (No. 2). RetrievedFebruary 1, 2010 from:www.wmmmiin.//N2.p.

15. Bunn, M. (2007, Setember). Seuring the bomb 2007. Nulear reat Initiative, v-vi. Retrieved February 1,

2010 from: www.nti./_/intm07.p.


42/48


16. Carnegie Endowment for International Peae. (2009, February). World nulear arenal 2009. RetrievedFebruary 1, 2010 from:www.ninwmnt./pitin/in.m?=viw&i=22710&p=zp&pj=znpp.

17. Eiler, P. (2009, May 13). U.S. warhead dioal in 15 year baklog. USA Today, .1A. Retrieved February 1,2010 from: www.ty.m/nw/miity/20090512n_N.tm.

18. Nikh, L.A. (2006, Otober 5). CRS reort for ongre: North Korea nulear weaon rogram.Congreional Reearh Servie, the Library of Congre. Retrieved February 1, 2010 from ttp://p.tt.v/mnt/niztin/74904.p.

19. Feller, B. (2009, June 16). Obama label nulear-armed NKorea grave threat. Aoiated Pre. Retrievedfrom: February 1, 2010 ttp://nw.y.m//p/20090616/p_n__p_w/__.

20. Helfand, I., et. al. (2006). e US and nulear terrorim: Still dangerouly unreared. Wahington, DC. 7.

21. Harvard reort quoted in Zukerman, M. J. (2006). Nulear doomday: I the lok till tiking? Retrievedfrom:www.ni./pt/13/my/in_w.tm.

22. Bunn, M. (2008, November). Seuring the Bomb 2008, 24,40. Nulear reat Initiative. Retrieved February 1,2010 from: www.nti./_/in_t_m08.p.

23. Kean, T., et al. (2005, Deember 5). Final reort on 9/11 ommiion reommendation, 9/11 ubli diourerojet, 4. Retrieved February 1, 2010 from:www.911pp./p/20051205_pt.p.

24. Bunn, M. (2008, Aril 2). e rik of nulear terrorimand net te to redue the danger, 5. CommitteeOn Homeland Seurity and Governmental Aair, United State Senate. Retrieved February 1, 2010 from:ttp://nt..v.//nnntitt08.p.

25. Finlay, B.D. (2008, Setember). Nulear terrorim: U.S. oliie to redue the threat of nulear terror.Partnerhi for a Seure Ameria. Retrieved February 1, 2010 from:www.pnin./wn/NUCLEAR%20pt%2082808.p.

26. GAO. (2008, January). Suly hain eurity: Eamination of high-rik argo at foreign eaort haveinreaed, but imroved data olletion and erformane meaure are needed, GAO-08-187. RetrievedFebruary 1, 2010 from:www..v/nw.itm/08187.p.

27. GAO. (2005, May). Homeland eurity: Key argo eurity rogram an be imroved, GAO-05-466T.Retrieved February 1, 2010 from:www..v/nw.itm/05466t.p.

28. GAO. (2009, January). Nulear detetion: Dometi nulear detetion oe hould imrove lanning tobetter addre ga and vulnerabilitie, GAO-09-257. Retrieved February 1, 2010 from: www..v/nw.itm/09257.p.

29. Hall, Mimi. (2008, Otober). 2012 deadline to an all ort argo wont be met. USA Today. RetrievedFebruary 1, 2010 from:www.ty.m/nw/wintn/20081020_N.tm.

30. Radiation event medial management, nulear eloion: Weaon, imrovied nulear devie. RetrievedFebruary 1, 2010 from:www.mm.nm.v/npin.tm#t.

31. Homeland Seurity Planning Senario, Senario Nulear Detonation, 10Kiloton Imrovied Nulear Devie.

32. Radiation event medial management, nulear eloion: Weaon, imrovied nulear devie. Retrieved

February 1, 2010 from:www.mm.nm.v/npin.tm#t. 33. Lawrene Livermore National Lab (LLNL) Preentation- 409771: Modeling imrovied nulear devie

(IND) imat to tier I itie. Deartment of Homeland Seurity, Oe of Health Aair.Soure data: Buddemeier, BR; Carnell, RJ; Mahera, SC; Udated modeling for Nulear TerrorimConequene, Lawrene Livermore National Laboratory, LLNL-PRES-409159.


43/48

37E Ns

34. Aoiation of State and Territorial Health Oial (2008). Publi Health Emergeny Prearedne, SiYear of Ahievement. Retrieved February 1, 2010 fromwww.p./ppm/p//Dmnt/PHEP_Ptn_Rpt.p.

35. Ibid.36. Intitute of Mediine (2007). Emergeny medial ervie at the roroad, future of emergeny are.

37. Homeland Seurity Counil Interageny Poliy Coordination Subommittee for Prearedne and Reoneto Radiologial and Nulear reat. (2009, January 16) Planning Guidane for Reone to a NulearDetonation: Retrieved February 1, 2010 from:www.i..mi/t/p/pnninin.p.

38. Maldin, B., Lam, C., Frano, C., Pre, D., Waldhorn, R., Toner, E., et al. (2007). Regional aroaheto hoital rearedne. Bioeurity & Bioterrorim, 5(1): 43. Retrieved February 1, 2010 from: www.pmiity./wit//pitin/2007_iti/2007_ti_p/20070409inpppitpp.p.

39. Hu, E.B. et al. (2006). Are Regional Hoital Pharmaie Preared for Publi Health Emergenie?Bioeurity & Bioterrorim 4(3): 240.

40. Ibid: 242.

41. Ibid: 238.

42. Treat, K., William, J., Furbee, P., Manley, W., Ruell, F., & Jr., C. S. (2001). Hoital rearedne forweaon of ma detrution inident: An initial aement. Annal of Emergeny Mediine 38(5): 562.

43. Helfand, I., Forrow, L., & Tiwari, J. (2002). Nulear terrorim. Britih Medial Journal, 324(7333): 357.

44. Bell, W. C., & Dalla, C. E. (2007). Vulnerability of oulation and the urban health are ytem to nulearweaon attakeamle from four Amerian itie. International Journal of Health Geograhi, 6(5):12.

45. Ibid: 13.

46. Ibid: 13-15.

47. Ibid: 16-17.

48. Gibb, J. R. (2008). Nulear terrorim: Confronting the hallenge of the day after. Wahington, DC: USSenate, 7. Retrieved February 1, 2010 from: ttp://.nt.v/pi/_/041508Gi.p.

49. Ibid: 6.

50. GAO. (2008, June). Emergeny rearedne: State are lanning for medial urge, but ould benet fromhared guidane for alloating are medial reoure, GAO-08-668, 6. Retrieved February 1, 2010 from:www..v/nw.itm/08668.p.

51. Radiation event medial management: Eoure + ontamination. Retrieved February 1, 2010 from:www.mm.nm.v/pntm.tm.

52. Cone, D. C., & Koenig, K. L. (2005). Ma aualty triage in the hemial, biologial, radiologial, or nulearenvironment. Euroean Journal of Emergeny Mediine, 12(6): 291.

53. Ibid: 298.

54. Dimaggio, C. (2005). e willingne of US emergeny medial tehniian to reond to terrorit inident.Bioeurity and Bioterrorim-Biodefene Strategy Pratie and Siene, 3(4). 333.


44/48


55. GAO. (2008, June). Emergeny rearedne: State are lanning for medial urge, but ould benet fromhared guidane for alloating are medial reoure. Wahington, DC: 22-23.

56. Dimaggio, C. (2005). e willingne of US emergeny medial tehniian to reond to terrorit inident.

Bioeurity and Bioterrorim-Biodefene Strategy Pratie and Siene, 3(4). 333.57. Garrett A, Park YS, Redlener I. (2009) Reduing Abenteeim in the Hoital Workfore During a

Pandemi. Diater Mediine and Publi Health Prearedne. 2009.3 (Su 2): S121-A131.

58. SAGA Foundation. (2008, January 2). Survey reveal nulear terrorim i Ameria To Fear. RetrievedFebruary 1, 2010 from:www.ntin./SPRMt.p.

59. SAGA Foundation. (2007, Setember 4). e language of nulear terrorim. Retrieved from:www.ntin./SLntzSvyn.p.

60. Wray, R. J., Beker, S. M., et al. (2008). Communiating with the ubli about emerging health threat:Leon from the re-event meage develoment rojet. Amerian Journal of Publi Health, 98(12).

61. Ibid.

62. Helfand, I., et al. (2006). e US and nulear terrorim: Still dangerouly unreared. Wahington, DC. 4.

63. Ibid: 4.

64. Ibid: 4.

65. Mikel, J. F. (2006). Diater reone and homeland eurity: what work, what doent. Praeger SeurityInternational, i: 162.

66. Mener, A. (2007). Diater reone in the US of Ameria: An analyi of the bureaurati and olitialhitory of a failing ytem. College Undergraduate Reearh Eletroni Journal. Retrieved February 1, 2010from: ttp://pity.pnn./i/viwntnt.i?ti=1068&ntt=j.

67. Redlener, I. (2006). Amerian at rik : why we are not reared for megadiater and what we an do now.New York: Knof, 1t Ed (vii).

68. Johannigman, J. A. (2005). Diater rearedne: It all about me. Critial Care Mediine 33(1).

69. Trebilok, M. C. T. (2000, Otober). e myth of oe omitatu. Journal of Homeland Seurity. RetrievedFebruary 1, 2010 from:www.mnity./jn/S.p?=ti.

70. e Inurretion At (10 USC 331-334) and 18 USC 831.

71. (2008, January 28). Publi Law 110-181 Se. 1082, the 2008 National Defene Authorization At.

72. Federal Regiter / Vol. 74, No. 165 / urday, Augut 27, 2009 / Notie, retrieved February 1,2010 fromttp://wt1..p.v/iin/PDFt.i?WAISID=827498177343+0+2+0&WAIStin=tiv.

73. (2008, Aril 2). Lieberman, Collin eamine threat to the homeland from nulear terrorit attak. RetrievedFebruary 1,2010 from Senator Joe Lieberman on-line newroom: ttp://imn.nt.v/nwm/.m?i=295440.


45/48

39A N C Dss Ppss (NCDP)

Abou he Naoal Ceer for Dsaser Prearedess (NCDP)

e NCDP i an aademially-baed reoure enter dediated to the tudy, analyi andenhanement of the nation ability to reare for and reond to major diater, inluding ter-

rorim. e NCDP ha a wide-ranging reearh, training and eduation, and advoay agenda,

with a eial interet in megadiater. Senior faulty and ta have tetied at Congreio-

nal hearing, reented at numerou onferene and meeting, and onulted with govern-

mental, healthare, non-rot, indutry, and ommunity leader. Founded in 2003 by Irwin

Redlener, MD, the NCDP engage the ubli health workfore and ommunitie in rear-

ing for atatrohi event, while heling to integrate rearedne eort into the nation

eiting infratruture. e Center enomae the CDC-funded Center for Publi Health

Prearedne at Columbia, whih ha trained over 15,000 reonder in ubli health reared-

ne, inident management, and reognition and reone to inident involving weaon of ma

detrution uing table-to drill, eerie, and ditane learning tehnologie.

www.np.mimn.mi.

About the Authors

Dr. Irwin Redlener

Dr. Redlener i a Profeor of Clinial Publi Health at the Columbia Univerity Mailman Shool

of Publi Health and Diretor of the NCDP. He i alo a Commiioner on the Congreionally-

etablihed National Commiion on Children and Diater and the Preident and Co-Founder

of the Children Health Fund.

Dr. Andrew L. Garrett

Until January, 2010, Dr. Garrett wa the Diretor of the Planning and Reone Diviion at the

NCDP. He i a ubli health reearher, ediatriian, and EMS/diater mediine hyiian with

broad eeriene in eld reone and emergeny medial ervie.

Karen L. Levin RN MPH CHES

M. Levin i Diretor for the NCDP Center for Publi Health Prearedne and i the Aoiate

Diretor of the Planning and Reone Diviion. M. Levin ha broad eeriene in ubli health

emergeny rearedne and reone at the tate and loal level.

Andrew Mener

Mr. Mener i a medial tudent at George Wahington Univerity, and erved a a reearh ai-

tant at the NCDP.


46/48


47/48


48/48

national center for disaster preparedness nuclear event-whitepaper

Documents