The U.S. and nuclear Terrorism

The U.S. and nuclear Terrorism

Still DangerouSly unprepareD

August 2006

Authors

ira Helfand, MD

andrew Kanter, MD, ph.D.

Michael McCally, MD, ph.D.

Kimberly roberts, Ma

Jaya tiwari, Ma

ACKNoWLEDgEMENts

The publication of this report was made possible thanks to generous financial contribu-tions from an anonymous donor and the International Physicians for the Prevention of nuclear War. PSR and the report authors are grateful for their support. The authors of this report are indebted to many of their colleagues and issue experts for sharing their insight and comments on various drafts of this report. We extend our sincere thanks to all of these individuals. In particular we wish to recognize Shelley Hearne, dr. PH of Johns Hopkins Bloomberg School of Public Health, Irwin Redlener, Md of the national Center for disaster Preparedness at Columbia University’s Mailman School of Public Health, Tim Takaro, Md of Simon Fraser University, and Ed Lyman Ph.d. of the Union of Concerned Scientists. Their thoughtful comments and critique of report drafts were invaluable.

Authors

Ira helfand, MD

Andy Kanter, MD

Michael McCally, MD, Ph.D.

Kimberly roberts

Jaya tiwari

ContrIbutors

JohnPastore,MD

CatherineThomasson,MD

PeterWilk,MD

Physicians for social resPonsibility

1875 Connecticut Avenue, NW, Suite 1012

Washington, DC 20009

Telephone: (202) 667-4260

Fax: (202) 667- 4201

E-mail: [email protected]

Web www.psr.org

US Affiliate of International Physicians for the Prevention of Nuclear War

TheU.S.anDnuclearTerrorism

Still DangerouSly unprepareD

August 2006

Executive Summary and Recommendations

FiveyearsafterSeptember11,2001,theUnitedStatesremainsdangerouslyun-preparedtodealwiththeaftermathofaterroristattackinvolvingnuclearweap-

ons,dirtybombsorexplosionsatnuclearpowerplants. Thissummeramericamarkstwosomberan-niversaries.Onaugust29,wewereremindedofthedeathanddestructionunleashedontheGulfCoastbyHurricaneKatrina.OnSeptember11,americanswillpausetoremembertheanniversaryoftheworstterroristattackinthehistoryofourcountry. aswemournthevictimsofthesedisastersandcontemplatethelossoflifeandpropertywemustaskwhethertheUnitedStatesispreparedtoprotectitscitizensfromevenmoredevastatingdisasters. Inearly2001,abipartisantaskforceestablishedbytheDepartmentofEnergyconcluded,“ThemosturgentunmetnationalsecuritythreattotheUnitedStatestodayisthedangerthatweaponsofmassdestructionorweaponsuseablematerialinRussiacouldbestolenandsoldtoterroristsorhostilenationstatesandusedagainstamericantroopsabroadorcitizensathome.” nuclearterrorismremainsaveryrealthreat.Since1993theInternationalatomicEnergyagencyhasdocumented175casesofnucleartraf-ficking,18ofwhichinvolvedhighlyenrichedura-niumorplutonium,therawmaterialfornuclearexplosives. ToassessU.S.preparednessfornuclearterror-ism,PhysiciansforSocialResponsibility(PSR)

evaluatedthemedicalconsequencesofthreehypotheticalnuclearandradiologicalattacksce-narios:a12.5kilotonnuclearweaponexplosioninnewYorkCity,anattackonanuclearpowerplantnearChicago,andadirtybombexplosioninWashington,D.C.PSRthenexaminedthestepsthatshouldbetakentotrytominimizethedeathsandinjuriestheseeventswouldcause.

Findings

N FiveyearsafterSeptember11,2001,theU.S.governmentstilldoesnothaveaworkable,pub-licplantorespondtothemedicalneedsofthehugenumbersofpeoplewhowouldbeinjuredinanuclearterroristattack.Thousandsofamericanciviliansinjuredbyanuclearterroristattackmightsurvivewithcarefulpreparednessplanning.

N Thegovernment’sabilitytoquicklyandeffec-tivelyevacuatecommunitiesorshelterpopula-tionsdownwindwillbethesinglemostimpor-tantfactorinminimizingcasualtiesineachofthesethreescenarios.TheUnitedStatesstilldoesnothaveaplanfordeciding,inresponsetoaspecificattackandprevailingweathercondi-tions,whetherpeopleshouldtrytoevacuateorshelterinplace.

N Thereisnoplanforcommunicatingsuchadeci-siontothepublic,forcarryingoutanevacuationifneededorforsupportingpopulationswho

� the u.s. And nucleAr terrorism Still Dangerously unprepared

areaskedtotakeshelterintheirhomes.There-sponsetoHurricaneKatrinasuggeststhereisnoclearlydesignatedindividualorgrouptomakethedecisiontoevacuateorshelterandnoclearlydefinedcriteriaformakingthatdecision.Thefailuretomakesuchplanscouldleadtohun-dredsofthousandsofpreventabledeathsintheeventofanuclearterroristattack.

N Eachofthenuclearterrorismscenariosgener-atesaneedforemergencymedicalcareforhun-dredstohundredsofthousandsofvictims.TheU.S.doesnothaveadequateplansforestablish-ingfieldmedicalcare,formobilizingmedicalpersonnelordeployingadditionalmedicalsup-pliestothesiteofanattack.

N The50DisasterMedicalassistanceTeamsmain-tainedbytheDepartmentofHomelandSecurityanddeployedtotheGulffollowingHurricaneKatrinawereoverwhelmedquickly.Thefailuretodevelopplanstodeployadequatemedicalresourcescouldpreventhundredsofthousandsofamericansfromreceivinglifesavingmedicalcarefollowingaterroristattackinwhichevenmorepeopleareinjured.

N TheU.S.publichealthsystem,whichwouldbearalargeburdeninrespondingtonuclearterrorism,iscurrentlyunder-fundedandun-der-staffed.newsourcesoffundingandotherresourcesaredesperatelyneededtostrengthentheexistingpublichealthsystem,sothattheU.S.canbetterrespondtoawiderangeofthreats.

N ThoughanattackontheU.S.withanuclearweaponordirtybombwouldbeauniquedisas-ter,advanceplanningcansignificantlyreducetheresultingdamage.Currently,thereisnocommunicationwiththepubliconprepared-nessfornuclearterrorismandlittleevidenceofseriousconsiderationofpotentialscenariosbypreparednessplanners.

N Oneofthemostcriticalelementsofaneffectivedisastermanagementplanistheidentificationofacentralcoordinatingauthorityempoweredtoimmediatelystepintodirecttheresponseandrescueefforts.nosuchcentralcoordinatingauthorityhasbeendesignated.

N Clearcommunicationwiththepublicisequallycritical.Withouttimelyandunderstandablein-formationfromtrustedsourcesthepubliccan-notbeexpectedtotakeappropriateordirectedactions.

N Healthcareexpertshaveproposedthathos-pitalsinmajorurbanareasnotbethesiteofhealthcarefirstresponseinadisasterbecausetheycouldbequicklyjammedwithinjured,anx-iousandcontaminatedvictimscompromisingtheabilitytodelivercaretoexistingpatients.Rather,asystemofdisastermedicalcarecentersshouldbepreparedwithpre-positionedsuppliesandequipment.

N acomprehensiveplanforprovidingemergencyandcontinuingpatientcarewillbeeffectiveonlyifcommunitieshaveadequateteamsofhealthprofessionalsavailabletothemandac-cesstoessentialmedicalequipmentandsup-pliesrequiredformasstreatment.Decision-makersmustworktodevelopcreativesolutionstothischallenge.

N Evenwithextensivepreparednessplanning,anuclearterroristattackwouldcreatehumancasualtiesandeconomicdestructiononascaleunprecedentedinournationalhistory.TheU.S.responsetothisthreatmustincludemorevigorousefforttopreventterroristsfromgain-ingtheabilitytocommitsuchactsinthefirstplace.

the u.s. And nucleAr terrorism Still Dangerously unprepared �

recommendAtionsPhysiciansforSocialResponsibilityhasathreepointprescriptiontoaddressthesedangerousdeficienciesinplanning,organization,andcom-munication.PSRrecommendstheDepartmentofHomelandSecurityadoptthefollowingmeasures:Planning:

E Designateacentralcoordinatingauthorityandaclearchainofcommandthatwouldbeactivatedintheeventofanuclearterroristat-tackornaturaldisastertodirecttheresponseandrescueefforts.

E Establishandcommunicateclearcriteriatoguidethisauthorityindecidingwhethertoevacuatepeopleorsheltertheminplace.Establishplansforcarryingoutanyevacua-tionsdeemedappropriateandforsupportingpopulationsinstructedtoshelterinplace.

E Includenuclearscenariosinmostregulardesk-topandfieldplanningexercisesandgivetheU.S.WeatherServicecapacitytomapandbroadcastradiationfalloutplumesinrealtime.

Organization:

E EstablishanadequatenationalDisasterMedicalSystemwithsignificantlyincreasednumbersofDisasterMedicalassistanceTeamsandestablishamechanismforquicklymobilizingexistingmilitarymedicalteamsandintegratingvolunteerhealthprofession-als.

E Pre-positionradiationprotectionandmoni-toringequipmentinareasfelttobehighriskpotentialtargets.Pre-positionstockpilesofmedicalsuppliesthatcanbemovedquicklytotheaffectedareasinresponsetonuclearter-rorismornaturaldisasterssuchashurricanesorfloods.

E Trainandequipfirstresponderssotheycanquicklyidentifyaradiologicalemergencyandperformtheirdutieswhilealsoensuringtheirownsafety.

E EstablishDisasterMedicalCareCentersinhighriskurbanareasandmobilefieldhospi-talsthatcanbemovedquicklytoareaswhereexistingmedicalfacilitiesareoverwhelmed.

Communication:

E Establishaplanforcommunicatingevacua-tionorshelteringdecisionstothepublicandeducatethepublicinadvanceabouttheseissuessothattheywillfollowinstructionsinthechaoticaftermathofanattack.

E Ensurethatthecoordinatingauthorityhasaccesstorealtimeinformationandcancom-municatethelocationandexpectedspreadofradioactivefalloutplumes.

A note on nucleAr terrorism PreventionWhilethereismuchworktobedoneintheareaofpreparednessforanuclearterroristattack,PSRrecognizesthateventhebesteffortsinthisareawillnotbeenoughtokeepourcommunitiessafe.Giventhepotentiallydevastatingconsequencesofanuclearterroristattack,preventionstrategiescenteredonmovingtheU.S.andothernuclearweaponspowerstowardtheeliminationofnuclearweaponsarekeytoourlong-termsafety. atthesametime,well-fundedandrigorouslyenforcedprogramsaimedatkeepingnuclearweap-onsandmaterialsoutofthehandsofterrorists,shouldbeconsideredmainstaysofpreventionofnuclearterrorism.TheseshouldincludesecuringthefacilitiesthathousethisdangerousmaterialandreducingandultimatelyeliminatingU.S.reli-anceonnuclearweaponsandnuclearpower.

Understanding Nuclear Terrorism

Whilethemagnitudeofdeathanddestructionassociatedwithanuclearterroristattackisdifficulttocomprehend,itisnotdifficult

toenvisionhowsuchanattackmightoccur.Today,muchoftheknowledgerequiredtobuildacrudenucleardeviceiswidelyavailableinopenliteratureandontheinternet.Theabilitytoputitalltogeth-errequireslittlemorethanabasicunderstand-ingofnuclearphysicsandengineering.accesstonuclearweaponsmaterialisthegreatestbarrierforterroristorganizations.1 However,thisbarrierisnotinsurmountable,andmorethan55countries,includingRussiaandPakistan,havepoorlyguardedmilitaryandcivil-ianfacilitieswhichcollectivelystorehundredsoftonsoffissilematerial.2TheInternationalatomicEnergyagency(IaEa),theorganizationchargedwithmonitoringnuclearmaterialsworldwide,hasdocumentedmorethan175casesofnucleartraf-fickinginthelastdecade,18ofwhichinvolvedhighlyenricheduraniumorplutonium,essentialingredientstomakeanuclearbomb.3

Moreover,terroristsmaychoosetouseourowntechnologyagainstus,astheydidwithjetlinersonSeptember11.nuclearpowerplantshaveprevious-lybeenidentifiedasthetargetsforterrorism,andtheirradioactivecoresandwastestoragefacilitiesalreadyareinplacethroughoutthecountry.4

understAnding current u.s. Policy on nucleAr terrorism PrePArednessThefederalgovernmenthasanabsoluteandclearresponsibilitytopreparefornuclearterroristat-tacks.In2005,theDepartmentofHomelandSecurity(DHS)releaseditsNational Preparedness Goal(nPG)andaseriesofNational Planning Scenarios(nPS)thatanalyzeavarietyofpotentialthreatsandresponses,includingthoseinvolvinganuclearterroristattack.Despiterepeatedwarningsbyhigh-levelgovernmentofficialsandindependentexpertsaboutthelikelihoodofanuclearterroristattack,theDHShasnotdevelopedthecomprehen-siveplansneededtorespondtosuchanattack.5Infact,thebipartisanSeptember11Commission’s

1 MatthewBunn,anthonyWier,JohnP.Holdren,ControllingnuclearWarheadsandMaterials:aReportCardandactionPlan;alsoseeLindaRothstein,CatherineauerandJonasSiegel,“Rethinkingdoomsday”BulletinoftheatomicScientists,november/December2004.

2 CenterforamericanProgress,“agendaforSecurity:ControllingthenuclearThreat”February2005,page7.alsoseeDavidalbrightandKimberlyKramer,“FissileMaterial:StockpilesStillGrowing,”BulletinoftheatomicScientists,november/December2004.

3 International atomic Energy agency, “Calculating the new global nuclear terrorism threat,” IaEa Press Release, november 1,2001.

4 Ibid.5 Samnunn,WilliamPerryandEugeneHabiger,“StillMissing:anuclearStrategy,”WashingtonPost,May21,2002.

� the u.s. And nucleAr terrorism Still Dangerously unprepared

finalreport,releasedonDecember5,2005,gavefailinggradestothefederalgovernment’seffortstopreventoreffectivelyrespondtoalargescaleterroristattack.TheCommissiongavean“F”tothegovernment’seffortstopreventterroristsfromacquiringweaponsofmassdistructionandwarnedthattheUnitedStatesiswoefullyunpreparedtohandleaterroristattackinvolvingnuclearweaponsormaterial.6

Theneedtoreviewexistinginfrastructureandtoplanandpreparefordisastershasbeenrec-ognizedatthehighestlevelsofgovernmentformanyyears.acknowledgingthiscriticalneedforimprovementinU.S.disasterplanningandmitiga-tionefforts,PresidentBushissuedtheHomelandSecurityPresidentialDirective8(HSPD-8)inDecember2003.ThestatedgoaloftheHSPD-8wastoestablish

policies to strengthen the preparedness of the United States to prevent and respond to threat-ened or actual domestic terrorist attacks, major disasters, and other emergencies by requiring a national domestic all-hazards preparedness goal, establishing mechanisms for improved delivery of Federal preparedness assistance to State and local governments, and outlining actions to strengthen preparedness capabilities of Federal, State, and local entities.7

However,almostthreeyearsafterHSPD-8wasfirstissued,movementondisasterpreparednessprogramshasbeenalmostnon-existent.Todate,theonlytangibleprogresshasbeenthedraftofaDepartmentofHomelandSecurity(DHS)papertitled National Preparedness Goal (nPG),whichonlysetsforthgoalsbuthasnoclearplanortimelineforimplementingthem.8

WhileDHShasyettodeveloparobustplanfordisasterpreparednessprograms,itcertainlyrec-ognizesthepotentialthreats—includingnuclearthreats.DHS’sownanalysis,asreflectedinitsapril2005“officialuseonly”reporttitledNational Planning Scenarios (nPS),detailedthedevastatinghuman,economic,andenvironmentalimpactsanuclearbombexplosionoraterroristattackwithadirtybombwouldhaveonaU.S.city.9althoughthenPSreportdoesnotdescribetheimpactofapowerplantcoremeltdownresultingfromaterror-istattack,itdoesacknowledgethatsuchanattackwouldcausesignificantdamage.10

ThenPSreportunderscorestheurgencyofplanningfortheaftermathofapossiblenuclearterroristattack.accordingtothereport,aterror-istattackwithanuclearweaponoradirtybombwouldrequireimmediatemobilizationoffederal,stateandlocalauthorities,aswellasresourcesonascalefargreaterthanthoserequiredforrespond-ingtotheterroristattackontheWorldTradeCenterortoHurricaneKatrina. However,theintentandtherhetoricoftheNPS ortheNPGhavenottranslatedintoafocusedeffortonthepartofthegovernmenttodemon-strablyimprovepreparedness.CongressionalandGovernmentaccountabilityOffice(GaO)inqui-riesintothefederalgovernment’sresponsetoHurricaneKatrinamakesitclearthat,despitethecreationoftheDHSanditsdraftingoftheNationalPreparedness Goal,thefederalgovernmentstillhasnotsettledthemostbasicpreparednessquestions.

A nucleAr exPlosion in A mAjor urbAn center Themostcatastrophicformofnuclearterrorismwouldbethedetonationofanuclearbombina

6 The9-11Commission,FinalReportCardontheGovernment’sPreparednessEfforts,December2005,http://www.9-11pdp.org/press/2005-12-05_report.pdf

7 TheWhiteHouse,HomelandSecurityPresidentialDirective/Hspd-8,December17,2003,http://www.whitehouse.gov/news/re-leases/2003/12/20031217-6.html

8 http://www.marc.org/emergency/meetings/rhscc-hspd8.pdf9 DHS,nationalPlanningScenarios,seescenario#1and11.10 DHS,nationalPlanningScenarios,ii

the u.s. And nucleAr terrorism Still Dangerously unprepared �

denselypopulatedurbanarea.Terroristscouldachievethisbyacquiringanintactnuclearweaponorbyobtaininghighlyenricheduranium(HEU)orplutonium(Pu)andbuildingabomb.Thisisnotjustatheoreticalpossibility,butrepresentsarealdanger.Tomakeasimplenuclearbomb(liketheonedroppedonHiroshimainaugust,1945),lessthan120poundsofHEUwouldbeneeded;somemoreadvanceddesignsusingexplosiveswouldrequireaslittleas75poundsofHEU.HEUishighlydensematerialthatiseasilytransported.Forexample,125poundsofHEUhastheequiva-lentvolumeofeightsodacans.Ifterroristssuc-ceededinacquiringPu,theywouldneedanevensmallerquantityofitthanHEUtobuildabomb.Theplutoniumweapondroppedonnagasakiin

august1945usedapproximately13poundsofPu(theapproximatesizeofagrapefruit).Manymod-ernweapondesignsrequireevenlessPu. TerroristsmaybeabletoobtainHEUorPufromavarietyofsources,suchasweaponslabora-toriesinnuclearweaponstates,civilianresearchcenters,nuclearreactors,andfuelstoragefacilities.TheglobalHEUstockpileisestimatedtobebe-tween1,300and2,100metrictons.Morethan100tons—enoughfor20,000nuclearweapons—ofsurplusbombgradePuiscurrentlystockpiledinunsafefacilitiesinRussiaandremainsvulnerabletotheftorsmuggling. EvenbeforetheSeptember11attacks,thelikelihoodthatfissilematerialorevenintactnuclearweaponswouldendupinthehandsofa

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Figure 1: blast radius and Prompt mortality from a 12.5 kiloton bomb explosion in new york city

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Source:IraHelfand, LachlanFarrow and JayaTiwari,“nuclearTerrorism,” British Medical Journal,Vol.324,February9,2002,356-359.

10 the u.s. And nucleAr terrorism Still Dangerously unprepared

non-stategroupwaswellrecognized.abipartisanDepartmentofEnergytaskforcewarnedinits2001reportthat,“Themosturgentunmetnationalsecu-ritythreattotheUnitedStatestodayisthedangerthatweaponsofmassdestructionorweaponsuse-ablematerialinRussiacouldbestolenandsoldtoterroristsorhostilenationstatesandusedagainstamericantroopsabroadorcitizensathome.”InthelessbureaucraticlanguageofGeneralEugeneHabiger,formerheadoftheDepartmentofEnergy’snuclearanti-terrorprograms,“Itisnotamatterofif;it’samatterofwhen.” TheconsequencesofanuclearbombexplosionwouldbedeathanddestructionunprecedentedinU.S.history.ShortlyaftertheSeptember11at-tack,PSRpublishedastudyintheBritish Medical Journal(BMJ)thatindicatedthata12.5kilotonnuclearbombdetonatedbyterroristsatadockinlowerManhattanwouldkillhundredsofthou-sandsofpeople.11Thescenariowasdevelopedusingspecializedsoftware,theHazardPredictionandassessmentCapability(HPaC)providedbytheDefenseThreatReductionagencyandtheConsequenceassessmentToolSetfromFEMa.ItcontemplatedaterroristattackusinganuclearbombsmuggledbyacargoshipintonewYorkCity. Thisisnotanunlikelyscenario.ThePortofnewYorkranksasthelargestportcomplexontheEastCoast.Withcapacitytohandlethehighestcontainervolumeinnorthamerica,thePortofnewYorkreceivesthousandsofcargoshipmentseachdayfromaroundtheworld.12GiventhatlessthanfivepercentofcargocontainersenteringU.S.portsareeverscreened,adeterminedterroristgrouphasnumerousopportunitiesfortransport-ingaconcealednucleardevice.13 TheBMJcasestudyfoundthatthenuclearbombblastwoulddecimatemuchoflowerManhattan.Theheatandblastfromtheexplosionwouldkillanestimated52,000peopleimmediately,whileas

manyas238,000peoplewouldbeexposedtodirectradiationemanatingfromtheblast.Ofthoseex-posed,aprojected44,000individualswouldsufferradiationsickness;and10,000oftheseindividualswouldreceivelethaldosesofradiation. Figure1depictstheblastradiusandthecorre-spondingcasualtyrateresultingfroma12.5kilo-tonbombexplosioninlowerManhattan. aftertheexplosion,theareasurroundingnewYorkCitywouldexperience“nuclearfallout,”aphenomenoninwhichacloudofradioactivede-brisiscarriedbyprevailingwinds,oftentravelinghundredsofmiles.Dependingonwindpatternsandotherweatherconditions,portionsofLongIslandandotherlocalitieswouldbeaffectedwith-in24-48hours. TheBMJ casestudypredictedthatanotheroneandahalfmillionpeoplecouldbeexposedtora-dioactivedebrisinthefewdaysfollowinganuclearexplosion.Unlesstheexposedpopulationwasevacuatedorsheltered;thisfalloutcouldkillanadditional200,000people,andcauseseveralhun-dredthousandcasesofacuteradiationsickness. Inaddition,carefacilitieswouldfaceamajordisruption.TheBMJ casestudyfoundthatsuchanattackwoulddestroy1,000acutecarehospitalbeds,andanother8,700acutecarebedswouldneedtobeabandonedbecausetheywouldlieintheareaofheavyradioactivefallout.14 Figure2showsthedistancetheradioactiveplumewouldtravelandthecorrespondingexpo-sureslevelfortheaffectedpopulation. Morerecently,inaMarch2005report,theDHSanalyzedaverysimilarhypotheticalscenariodetail-inganattackinwhichterroristsexplodea10kilo-tonbombindowntownWashington,D.C.,blocksfromtheWhiteHouse.15IntheDHSstudy,theim-mediateblasteffectsfromtheexplosionwouldkillanestimated15,000peopleandwound31,000.Thereportalsopredictsthattherewouldbe190,000

11 IraHelfand,LachlanForrow,JayaTiwari,“nuclearterrorism,”BritishMedicalJournal,February9,2002,356.12 ThePortauthorityofnewYorkandnewJersey,CargoCapabilities,availableelectronicallyathttp://www.panynj.gov.13MichaelE.O’Hanlon,“CargoSecurity,”CongressionalTestimony:SenateGovernmentalaffairsCommittee,March20,2003.14 IraHelfand,LachlanFarrow,andJayaTiwari,“nuclearTerrorism,”BritishMedicalJournal,Vol.324,February9,2002,356-359.15 DHS,nationalPlanningScenarios,Scenario1.

the u.s. And nucleAr terrorism Still Dangerously unprepared 11

prompt,orimmediate,deathsand264,000injuriesfromshorttermradiationexposureinanarea19milestotheeastfromtheexplosionifthepopu-lationisnotadequatelyshelteredorevacuated.additionally,theDHSstudypredictsthattherewouldbechronicradiationexposureinanarea198milestothenorthandeastofWashington,D.C.,causing49,000casesofcancer,ofwhich25,000wouldbefatal.16Figure3and4respectivelyshowtheblastradiusandthecorrespondingcasualtiesfroma10kilotonbombexplosionindowntownWashington,D.C.,thedistancetheradioactiveplumewouldtravelandthelevelsofradioactiveex-posurelikelyfortheaffectedpopulation.

Figure 2. radiation exposure to Population and Fallout mortality from a 12.5 kiloton bomb explosion in new york

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Source:IraHelfand, LachlanFarrow, and JayaTiwari,“nuclearTerrorism,” British Medical Journal,Vol.324,February9,2002,356-359.

An AttAck on A nucleAr Power PlAntTheUnitedStatesishometo104nuclearpowerplantsand36non-powerresearchreactorslicensedbythenuclearRegulatoryCommission(nRC).17,18ThesenuclearpowerplantsgenerateeightpercentoftheenergyconsumedintheU.S.19anattackagainstoneoftheseplantshaslongbeenconsid-eredaseriousthreat. asearlyas1982,theargonnenationalLaboratoryconductedastudydetailingthelikelydamagethatacommercialjetplanecouldinflictontheconcretecontainmentwallsprotectingnuclearreactors.atthattime,theconcernwasthatanaccidentalairlinecrashcouldcompromise

16 DHS,nationalPlanningScenarios,Scenario1,appendix1-a,pp1-15to1-17.17 nuclearRegulatoryCommission,“PowerReactors,”availableelectronicallyatwww.nrc.gov/reactors/power.html18 nuclearRegulatoryCommission,“non-PowerReactors,”availableelectronicallyatwww.nrc.gov/reactors/non-power.html19 amoryLovins,EnergySecurityFacts:DetailsandDocumentation,RockyMountainInstitute,June2,2003.


Figure 3. Prompt blast radius of a 10-kiloton nuclear detonation in the central business district of washington, dc

Source:DepartmentofHomelandSecurity, “nationalPlanningScenarios,” CreatedforUseinnational,Federal,State,andLocalHomelandSecurityPreparednessactivities,DraftReport,april2005,1-15.

Figure 4. countours for Acute (24-hour) exposure doses for a 10-kiloton nuclear detonation in washington,dc

Source:DepartmentofHomelandSecurity, “nationalPlanningScenarios,” CreatedforUseinnational,Federal,State,andLocalHomelandSecurityPreparednessactivities,DraftReport,april2005,1-17.


anuclearpowerplant’sprimarycontainmentwallandinteriorstructure.Thescenarioshowedthatevenifonlyonepercentofajetliner’sfuelpen-etratedthecontainmentandignitedafterimpact,thiswouldcreateanexplosionequivalentto1,000poundsofdynamiteinsideareactorbuilding.Suchanexplosioncouldcreatesimultaneousfailuresinkeysafetymeasuresleadingtoalossofreactorcoolantthatcannotbemitigatedandameltdownofnuclearfuel.20

ThePSRstudyconsiderstheeffectsofahy-potheticalattackagainsttheBraidwoodnuclearPowerplant21located60milessouthwestofChicago.22Overall,thereareelevenoperatingreactorsinnorthernIllinois,makingChicagoparticularlysusceptibletoaterroristthreatagainst

anuclearplant.Inthisscenario,weimaginethataterroristgrouphijacksajetplaneandcrashesitintotheplant. Braidwoodisapressurizedwaterreactorpro-ducing2500megawatts(MW)ofelectricityatfullcapacity.Pressurizedwaterreactors,likemostnu-clearpowerplants,requirehugeamountsofwatertocoolthereactorandmaintaincontinuoussteamproductiontopowertheturbines.acatastrophiclossofcoolant,fromeitheradirectattackagainsttheprimarycoolantsystem,orfromareactorves-selbreachresultingfromacommercialjetlineraccident,woulduncoverthecoreofthereactor,causingittomeltandburn. Exposureofthereactorcore,acontainmentbreach,wouldreleasethereactor’ssuperheated

20 Dr.EdLyman,Securityofthenation’s103nuclearReactors,nuclearControlInstituteandCommitteetoBridgetheGapnewsPressConference,September25,2001,transcriptavailableelectronicallyathttp://www.nci.org.

21 TheBraidwoodpowerplantanditsowner,theExelonCorporation,wererecentlysuedbyIllinoisattorneyGeneral.TheBraidwoodunitwasfoundtobeleakingtritiumthatcontaminatedgroundwaterandtritiumhasbeenfoundinprivatewellsofnearbypropertyowners.See,MatthewLWald,“nuclearReactorsFoundtoBeLeakingRadioactiveWater,”ThenewYorkTimes,March17,2006.

22 SimilartotheBMJStudy,thescenariodescribedherewascreatedusingspecializedsoftwarecalledHazardPredictionandassessmentCapability(HPaC)providedbytheDefenseThreatReductionagencyandtheConsequenceassessmentToolSet(CaTS)fromtheFEMa.

Figure 5: total effective radiation exposure following braidwood nuclear reactor meltdown (distance in miles)

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1� the u.s. And nucleAr terrorism Still Dangerously unprepared

estimatedthatmorethan7.5millionpeoplewouldbeexposedtoradiation(receivinggreaterthanthemaximumallowedannualpopulationdose),ofwhich4.6millionwouldreceiveadoseequivalentofthemaximumallowableoccupationalexposureforoneyear.24Morethan200,000wouldreceivehighenoughdosestodevelopradiationsicknessand20,000mightreceivealethaldose(LD50),accordingtoourprojections. TheacuteexposurelevelsshowninFigure6be-lowrevealtheintensityofradioactivity,therisktofirstresponders,andthesizeofthearearequiringevacuation.RadiationdosesthatarehighenoughtoproduceacuteradiationsicknesswouldaffectanareaencompassingpartsofKankakee,WillandGrundycounties.TheareathatwouldrequireevacuationorotherprotectivemeasuresisshownastheorangeareainFigure6identifiedasEPa

radioactivefuelintotheair.Itisimportanttonotethatnuclearpowerplantcorestypicallycontain20to40timestheamountofradioactivematerialsreleasedinasmallnuclearbombexplosion(astheonedescribedinthefirsthypotheticalscenario).Inthispowerplantattackscenario,theBraidwoodreactorispresumedtohavesufferedacatastrophicfailure.Theresultingplumeofradioactivemateri-alswouldextendnorthfromthereactoritselftothenorthernedgesofmetropolitanChicago,andeastintoIndianaandMichigan. Figure5showsthedistancetheradioactiveplumewouldtravel. Thepopulationwouldbeexposedtodifferentlevelsofradiationdependingonthedistancefromthereactor,durationofexposure(forthissimula-tion,itisassumedthattheexposurewouldcon-tinueforoneweek),andthewindpattern.23Itis

23 Thesefiguresareforthetotaleffectivedoseequivalentwhichisacombinationofexternalradiationandradiationfrominternallyconsumedradioactiveparticles(primarilyinhaled).

24 Populationestimatesarebasedon1990Censusdata.actualnumbersarelikelytobesignificantlygreater.

Figure 6: Acute radiation exposure to Population following braidwood nuclear Plant meltdown (distance in miles)

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PaG(EnvironmentalProtectionagencyPopulationactionGuideline).asshownbythemap,thisin-cludesthemajorityoftheCityofChicago,extend-ingeasttoGaryandSouthBend,Indiana. asimilarstudyofaterroristattackontheIndianPointnuclearpowerplant(located35milesnorthofnewYorkCity)showedanevenhigherdeathtollandgreaterdestructionthanillustratedinthescenariodescribedabove.25Inthisstudy,conductedbyDr.EdwinLymanoftheUnionofConcernedScientists(UCS),ameltdownattheIndianPointpowerplantcouldresultin44,000peopledyingfromradiationpoisoningwithinayearand518,000cancerdeathsovertime.26Inthisscenario,millionsofpeopleinthegreaternewYorkCityareawouldhavetobepermanentlyrelocatedbecausethere-sultingcontaminationwouldleavehugegeographicareasuninhabitableformanyyearsordecades.Economiclossesfromsuchanattack,accordingtotheUCSstudy,couldtop$2trillion.

A dirty bomb exPlosion in An urbAn centeralthoughoftenincludedindiscussionsofWMD,radioactivedispersaldevices(RDDs,ordirtybombs)donotcomparetonuclearweaponsintermsofcasualtiesordestruction.Dirtybombsarealsoeasiertobuildthannuclearweaponssincetheydonotrequiremasteringcomplexphysicspro-cesses,andtheydonotusebomb-gradeplutoniumanduranium,whicharedifficulttoobtain. Theconventionalexplosionwhichoccursinadirtybombcancauselocalinjuriesanddeath.However,themajordangeristheair-bornedisper-salofradioactivematerials,asthepulseofheat

the number oF Acutely ill PeoPle in

this scenario would overwhelm all available

care facilities; about 113 hospitals would

fall within the occupational exposure zone

(including two Veterans administration

hospitals), affecting more than 32,000

potential beds. nearly 20,000 physicians in

five counties would receive greater exposure

than occupational maximums for radiation

exposure from the plume.

First responders, including firefight-

ers, would also be injured. the 2� firefight-

ers of essex Fire Department would likely

receive lethal doses, and the 67 firefighters of

Braidwood and Herscher departments would

suffer from radiation sickness and be unlikely

to provide a sustained response to the emer-

gency. another 10,�00 firefighters in 3�� other

departments would exceed occupational ex-

posures from the plume itself and would be

unavailable to respond within the highly con-

taminated area. police departments also would

be hard hit in essex, Braidwood and Herscher,

with an estimated 3� police officers there re-

ceiving potentially lethal doses of radiation.

andtheblastaerosolizesthesourceofradioactivematerialandspraysitoverawidearea. adirtybombisamodifiedconventionalweap-on,likelymadeofeithercommercialormilitaryexplosiveoranoilandfertilizermixture,com-

25 allfiguresanddetailsofIndianPointnuclearpowerplantcoremeltdownstudycitedhereinaftercomefromEdwinLyman,ChernobylontheHudson?TheHealthandEconomicImpactsofaTerroristattackattheIndianPointnuclearPlant(Washington,DC:UnionofConcernedScientists,September2004);alsoseeMarkThompsonandBruceCrumley,“areTheseTowersSafe?Whyamerica’snuclearPowerPlantsareStillsoVulnerabletoTerroristattack--andHowtoMakethemSafer,”aspecialindepthinvestigation,Time,June20,2005,34.

26 allfiguresanddetailsofIndianPointnuclearpowerplantcoremeltdownstudycitedhereinaftercomefromEdwinLyman,ChernobylontheHudson?TheHealthandEconomicImpactsofaTerroristattackattheIndianPointnuclearPlant(Washington,DC:UnionofConcernedScientists,September2004);alsoseeMarkThompsonandBruceCrumley,“areTheseTowersSafe?Whyamerica’snuclearPowerPlantsareStillsoVulnerabletoTerroristattack--andHowtoMakethemSafer,”aspecialindepthinvestigation,Time,June20,2005,34.


binedwithsomeformofradioactivematerial.27Theyarefairlysimpletoengineer,astheyonlyrequirereadilyaccessiblematerials,suchasra-diumorcertaincesiumisotopesthatareusedinavarietyofmedicaldiagnosticsandtreatments.Othersourcesofradioactivematerialincludefoodorseedirradiationequipment,portablepowersup-plies,andhighlyradioactivefissionproductsfromnuclearpowerplantwaste.28,29

Dirtybombsimulationscanvarysignificantlybasedonthesizeoftheconventionalexplosiveand

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thesourceoftheradioactivecontamination.ThefollowingscenariodescribestheeffectsofadirtybombattackindowntownWashington,D.C. Inthisscenario,aterroristgroupexplodesamoderatesizedirtybomb,containing2000cu-riesofcesium-137(Cs-137),inthevicinityofthe15thandHstreets,northwest,D.C(aroundthecornerfromtheWhiteHouse).Thisscenarioas-sumesthatonly10poundsofTnTisusedastheexplosiveandthatthebombcouldbeconcealedinacaroranothervehicle.Thetimeoftheexplo-

27 Michaela.LeviandHenryC.Kelly,“WeaponsofMassDisruption”Scientificamerican,november,2002.28 CouncilonForeignRelations,“Terrorism:Q&a,”FactSheet,availableelectronicallyathttp://www.terrorismanswers.com/weapons/

dirtybomb.html29 DepartmentofEnergy,nuclearRegulatoryCommission,RadiologicalDispersalDevices:an InitialStudy to IdentifyRadioactive

MaterialsofGreatestConcernandapproachestoTheirTracking,Tagging,andDisposition,ReportpreparedbytheDOE/nRCInteragencyWorkingGrouponRadiologicalDispersalDevicesforthenRCandSecretaryofEnergy,May7,2003,availableelectroni-callyathttp://www.nti.org/e_research/official_docs/doe/DOE052003.pdf


sionisaroundnoon,whenthecitywouldbemostcrowded. Theexplosionandlocalwindswouldspreadradioactiveparticlesovermanymiles,heavilycon-taminatingtheareaintheimmediatevicinityoftheexplosion. Figure7showstheblastradiusandthecor-respondingcontaminationfromthisdirtybombexplosion. ThescenarioalsopredictsthatthefalloutwouldspreadacrossthenationalMallarea,affectingmanyofthefederalgovernmentbuildingsinthevicinity;dependingonweatherandwindcondi-tions,falloutwouldtravelovertheanacostiaRiverinMarylandandtowardandrewsairForceBase. Inmostscenarios,includingtheonedescribedabove,theconventionalexplosionwouldcausethevastmajorityofacuteinjuriesanddeaths.Thesewouldlikelynumberinthetenstohundreds.However,theradiationwouldbespreadoveralargeareaandwouldrequiresubstantialefforttodecontaminate.WhetheroneusesthenuclearRegulatoryCommissioncutoffof25mremperyear,ortheEPamaximumof15mremperyear,thearearequiredtobedecontaminatedwouldincludetheWhiteHouse,thenationalMall,theHouseofRepresentativesofficebuildings,aswellasFortMcnairandthenavyYard.30

Theuseofalargeamountofradioactivemate-rial,ormaterialsuchasnuclearwaste(intheformofaspentfuelrod),couldsignificantlyincreasetheadversehealtheffectsfromtheradiationexposure.also,thelargertheexplosivecapacityofthebomb,thefarthertheradioactivecontaminationwould

spread.Theareaintheimmediatevicinityoftheblastmightrequirelong-termevacuation,asthecesiumcanchemicallybindtothewindows,roads,andbuildings.Fartherout,buildingswouldrequireintensivewashingandevensandblasting.Roadsandsidewalkswouldneedtobeblastedcleanorre-movedentirely.Topsoilwouldneedtoberemovedandmuchofthevegetationwouldneedtobeei-therextensivelycutbackorremoved.31

TheDHSNational Planning ScenariosreportdescribesahypotheticaldirtybombexplosionindowntownWashington,D.C.Inthisstudy,aterror-istgroupusesstolenseedirradiators(containingapproximately2,300curiesofCs-137)ina3000poundTnTcarbomb.Thestudypredictsthatsuchanattackwouldkill180peoplefromtheblastaloneandcontaminateanother20,000withradio-activematerial.32Theradioactivedebrisfromtheexplosionwouldcontaminateupto36cityblocks. TheDHSanalysispredictsthat,asaconse-quenceofsuchadirtybombattack,anincreaseinmorbidityandmortalityrelatedtocancerwouldalsobeexpectedoverthelongerterm.Inaddition,thestudyestimatesthat5,000-20,000individualswouldrequirementalhealthservicestohelpthemdealwiththepsychologicalimpactofsuchattack. anadditionalimpactofadirtybombattackwouldbethesocialdisruptionassociatedwiththeevacuationandcleanup.Thiseventwouldlikelyrequiredecontaminationoftensofsquareblocksofurbanneighborhoods.TheDHS’National Planning Scenariosdocumentoutlinesthesignificantcleanuprequired,includingdemolitionofbuildings,repav-ingofroads,surfacecleaningofsidewalks,re-roof-

30 Becauseofthedamaginghealtheffectsassociatedwithradiationexposure,regulatorybodiesintheUnitedStates,andinternation-ally,setupandenforceradiationprotectionstandardstoprotectpublichealth.Theseradiationprotectionstandardsarebasedonthemaximumallowablelevelofradiationdoses,orthequantityofradiationorenergy,receivedbythemembersofthepublicorworkers,aspartoftheiroccupationalexposure.Thebasicunitformeasuringionizingradiationreceivediscalledrad(radiationabsorbeddose).Todetermineanindividual’sbiologicalriskandtheprobabilityofharmfulhealtheffect,radsareconvertedtorems.Theremreflectstissuedoseandtakesintoaccountthetypeofradiationabsorbedandthelikelihoodofdamagefromthedifferenttypesofradiation.Becauseexposuresarenormallyinfractionsofarem,amorecommonlyusedunitofexposureandregulatoryenforcementisthemillirem(mrem).ThenuclearRegulatoryCommission,forexample,requires(inaccordancewithTitle10oftheCodeofFederalRegulationsunderPart20)thatanynRClicensednuclearfacilitylimitmaximumradiationexposuretoindividualmembersofthepublicto100mremperyear,andlimitoccupationalradiationexposuretoadultsworkingwithradioactivematerialto5,000mremperyear.Source:http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/bio-effects-radiation.html

31 Michaela.LeviandHenryC.Kelly,“WeaponsofMassDisruption”Scientificamerican,november,2002.32 DHS,nationalPlanningScenarios,Scenario11,page(11-1,11-7)


ing,removalandreplacementofallsurfacesoil,decontaminationofallexteriorbuildingsurfaces,decontaminationofinteriorsofbuildings,andstrippingofallinteriormaterials,inadditiontothoroughcaptureanddisposalofsolidandwaterwastefromthedecontaminationeffort.Thecostofdecontamination,accordingtotheDHSstudy,wouldbeinthebillionsofdollars.33

Theextentofthedamagefromadirtybombattackwouldalsodependonthelocationoftheexplosion.Shouldsuchanattacktakeplaceinaconfinedurbanarea,suchasatunnelorsubwaystation,thenumberofcasualtieswouldbefargreaterthanifitoccurredinanopenareawherethedangerousparticleswouldbemorewidelydispersed.adirtybombexplosionwouldsendra-dioactivedustparticlestotheveryreachesofthedustcloud,leavingeverypersonintheimmediateareaexposedandmakingadequateclean-upanddecontaminationverydifficult,ifnotimpossible. Whileundermostcircumstancestheinitialinjuryanddeathtollfromadirtybombexplosionwouldberoughlythesameasfromaconventionalbomb attack,therewouldbeadditionalinjuriesbe-causeofacuteradiationexposureinthedaysandweeksfollowingtheattack.Therewillbeextensivementalhealtheffectsaspeopleworrythattheyhavebeenexposedtoradiation.These“worriedwell”willfloodlocalhealthcarefacilitiesinalargeareaaroundtheactuallysiteoftheexplosion.34 Theradioactivematerialalsowillcauselongtermeffects.asarecentreportbyanationalacademyofSciencespanelrecentlyconcluded,thereisnodosethresholdatwhichexposuretoradiationissafe.35Oneintenindividualsintheexposedpopulationwouldexperienceanincreasedriskofdeathfromcancerifdecontaminationwere

notavailable.36Insomecases,thecostassociatedwithdecontaminatinganareaforcontinuedhumanhabitationcouldbesohighthattheonlypracticalchoicemightbetoabandonitforaslongasradio-activehazardspersisted.37Inaddition,inhabitantsmightfeeluncomfortableliving,working,ordoingbusinessinthearea,duetofearsofradiationsick-ness.Itcouldbedecadesbeforetheeconomicandpublichealthcostsassociatedwithadirtybombattackarerealized.Itisalsoimportanttonotethatthepotentialcleanupcostintheaftermathofadirtybombattackremainsoneofbiggestworriesforfederalofficialsdealingwithsuchanincident.

resPonding to A nucleAr crisis: Are we PrePAred? aswehaveseen,anuclearbombexplosionoranattackonanuclearpowerplantinalargeurbanareawouldbringaboutdeathanddestructiononanunprecedentedscale,andadirtybombexplo-sionwouldcausesignificantcasualtiesandsocialdisruption.Giventheserealities,thefederalgov-ernmentmusthaveinplaceawell-coordinatedresponseplanthatwilllimitthecasualtiesandinjuriesintheimmediatepost-attackperiod.Thefollowingsectionpresentssomeelementsofanef-fectiveresponsetothescenariosdescribedabove,comparesthesebestpracticeswiththecurrentU.S.stateofpreparedness,andidentifiesweaknessesinexistingplansthatmeritfurtherconsideration.

centrAl coordinAtion oF disAster resPonseaneffectiveresponsetoanuclearattackonalargeU.S.cityrequirescoordinationacrossmany

33 Ibid,page11-1.34 Forexample,duringthe1995SaringasattackonTokyosubwaybyaumShinrikyocult,approximately80percentofthecasualties,

about4000people,arrivingatlocalhospitalswere“worriedwell.”TheseindividualsdidnothaveactualchemicalinjuriesbutbelievedtheywereillorsufferingasaresultofpossibleexposuretoSaringasbecauseoftheirbeinginthevicinityofthenervegasattackanddemandedmedicalattentiontherebyoverwhelmingavailablemedicalresources.See,nationalacademyofSciences,High-ImpactTerrorism:ProceedingsofaRussian-americanWorkshop(Washington,DC:naS,2002),129.

35 HealthRisksFromExposure toLowLevelsof IonizingRadiation:BEIRVIIPhase2 June29,2005,http://fermat.nap.edu/cata-log/11340.html.

36 Michaela.LeviandHenryC.Kelly,“WeaponsofMassDisruption”Scientificamerican,november,2002.37 Ibid.


jurisdictionsandfrommultiplefederal,stateandlocalagencies.Consequently,oneofthemostcriti-caldecisions,intheeventofsuchanemergency,wouldbetoestablishaclearcentralcoordinatingauthoritythatwouldimmediatelystepintodirecttheresponseandrescueefforts.Thelackofsuchabodyhasbeenrepeatedlyidentifiedasakeyweak-nessincurrentU.S.disasterpreparednessandplanningpolicy.WhentheDHSwasdesignatedthemaindisastercoordinatinggovernmentbodyin2002,themovewastoutedasasolutiontotherangeofcoordinationandcommunicationchal-lengesassociatedwithdisasterresponse.Whilethisconsolidationdidforceanumberofdomesticagenciestosharemoreinformation,itdidlittletoestablishanyonebodyasthecoordinatingauthor-ity.ThiswasmadeabundantlyclearinthedaysandweeksfollowingHurricaneKatrina’slandfallinnewOrleansandtheGulfCoastregion.are-centGovernmentaccountabilityOffice(GaO)inquiryintothefederalgovernment’sresponsetothehurricanelistedthe“lackofaclearchainofcommand”and“unclearleadership”asthebig-gestfactorslimitingreliefefforts.38Thereportblamedthelackofacentralcoordinatingauthor-ityandtheunclearcommandissuesatDHSforensuinginternalconfusionandanindecisive,slowandhaphazardresponseatthefederallevel.Thereportfurthernotedthatotherfederalagencieshadan“incompleteunderstandingofrolesandresponsibilities”undertheDHS’newNational Response Plan.39

38 USaToday,“Report:U.S.lackssufficientprepforcatastrophicdisasters,”availableonlineathttp://www.usatoday.com/news/wash-ington/2006-02-01-gao-report_x.htm.

39 USaToday,“Report:U.S.lackssufficientprepforcatastrophicdisasters,”availableonlineathttp://www.usatoday.com/news/wash-ington/2006-02-01-gao-report_x.htm.

evAcuAtion And sheltering Intheaftermathofanuclearexplosionoranat-tackonanuclearreactornearapopulationcen-ter,thelargestnumberofdeathswillresultfromradiationexposure.Thegovernment’sabilitytoquicklyandeffectivelyevacuatecommunitiesorshelterpopulationsdownwindwillbethesinglemostimportantfactorinminimizingthecasualtiesandinjuries.Unfortunately,currentfederalpre-parednessplansdonotmakeclearwhowouldbechargedwithdecidingwhethertoshelterorevacu-ate,andtheseplansdonotincludeclearcriteriatoassistthosechargedwithmakingtheseimportantdecisions.Winddirectionandspeedandestimatesoftheisotopecontentofthefalloutcloudwillallhaveanimpactonhowradiationwillbespread,andthisinformationmustbecommunicatedinrealtimetoanyoneresponsibleformakingevacu-ation/shelteringdecisions.Confusionoverevacua-tionroutesandlackoftransportationformanyun-derprivilegedurbandwellersislikelytocompoundtheseproblems. Furthertheredonotappeartobeplansinplacetoeffectivelycommunicateanevacuation/shelterdecisiontothegeneralpublic,ortocarryoutanevacuationifthatisneeded.Thereisnoclearunderstandingofhowtosupportpopulationswhoneedtoshelterinplaceforseveraldays,noristhereaprograminplacetoadequatelyeducatethepopulationinadvanceaboutthisissuesothatpeoplewillheedinstructionstheyaregiven.Itisimportanttorememberthechaoticcircumstancesunderwhichtheseimportantevacuationandshel-teringdecisionswillbemade.Governmentofficialswillbeforcedtorespondquicklyonthebasisofincompleteinformationandthencommunicatethesedecisionsbothtoresponsibleagenciesandtothepublic.Federalpreparednessplansmusttakeintoaccountpublicfearsandmisconceptionswithregardtotheconsequencesofanuclearattack.Intheeventofanuclearexplosioninacity,one’s

“We need to be able to have somebody who

is clearly responsible and accountable to the

president, who has the authority of the president

to deal with the overall response,”

—GaOComptrollerGeneralDavidWalker,onFebruary1,2006,presentingtheinitialGaOreportonthefailureofthefederalgovernmentinresponding

tohurricaneKatrinatoaSpecialHouseInvestigativePanel.


instinctwillbetofleethearea.But,dependingonthewindconditions,itmaybesafertotrytoshel-terinplaceforaperiodoftime.InagovernmentanalysisofahypotheticalnuclearbombattackonWashington.D.C.,peoplewhotriedtoevacuateinthefirst24hoursreceivednearlyseventimesasmuchradiationasthosewhoshelteredintheirbasementsfor72hoursbeforetryingtoevacuate.40Thefederalgovernmentmustworkwithstatesandleadersinthepublichealthcommunitytoeducatethepublicaboutthebeststrategiestokeeptheirfamiliessafeintheeventofanattack.

hosPitAl surge cAPAcityIntheeventofanymajorurbandisaster,hospitalscanexpecttoseethousandsofpatientsinneedofintensivemedicalcare(orhundredsofthousands,ifradiationsicknessisoneofthehazards).Inanuclearattack,manyhospitalsthatliewithinthefalloutzoneofanuclearexplosionmayhavetobeabandonedbecausetheywillhavebeendestroyedorcontaminatedwithradiation.Thus,therewillbeanurgentneedfortemporaryfieldhospitals.Theseshouldbelocatedcloseenoughtothesceneforeasyevacuationofpatients,butfarenoughtoavoidongoingradiationexposureandcontamina-tion.acoordinatedsystemmustbeinplacefortransportingpatientstofieldhospitalsandmakingbedsavailableatexistingfacilities.

nosuchnationalsystemiscurrentlyinplace.arecentstudybytheTrustforamerica’sHealthwarns,“…hospitalsinnearlyone-thirdofstates…arenotsufficientlyprepared,throughplanningorcoordinationwithlocalhealthagencies,tocareforasurgeinextrapatientsbyusingnon-healthfacilities,suchascommunitycenterssportsare-nas,orhotels.”41ThisassessmentisconfirmedbyananalysisconductedbytheamericanHospitalassociation,whichconcludesthatmosthospitals,particularlyinthemajormetropolitanareas,haveonlyfourtosixpercentoftheirtotalbedsavailableforapotentialinfluxofpatientsinanemergencysituation.42nationally,62%ofallhospitalssur-veyedreportedcapacityproblemsduringroutineoperation.43Givenincreasinglystrictcriteriaforhospitaladmission,fewhospitalizedpatientscanbedischargedprematurelywithoutseriouslycom-promisingtheircare.Manyhospitalemergencyrooms,especiallyinlargemetropolitanareas,arefullofpatientsawaitingtheavailabilityofinpatienttreatmentrooms,makingitunlikelythattheycanaccommodateasuddeninfluxofnewpatients. TheDHSNational Preparedness GoaldocumentemphasizestheurgentneedtostrengthenU.S.medicalsurgecapacity,becauseitwouldplayacrit-icalroleindetermininghowtohandleeffectivelylargenumbersofpatientsrequiringimmediatehospitalizationfollowingamajorterroristattack.44TheNPGcallsforthedevelopmentofasystemwhereEmergencyMedicalService(EMS)“resourc-esareeffectivelyandappropriatelydispatchedandareabletoprovidepre-hospitaltriage,treatment,transport,trackingofpatients,anddocumenta-tionofcareappropriatefortheincident,whilemaintainingthecapabilitiesoftheEMSsystemforcontinuedoperations.”45Suchasystemcouldbeac-tivatedin“anticipationofamasscasualtyincident

40 DHS,nationalPlanningScenarios,scenario#1,appendix1-a,p1-29.41 Trustforamerica’sHealth,“ProtectingthePublic’sHealthfromDisease,Disasters,andBioterrorism,”Washington,D.C.,December

2005,page3.42 PeterD.Marghella,“SurgeCapacityPlanninginHealthCareOrganizations:HittingtheMarkonEnhancingnationalPreparedness,”

HomelandDefenseJournal,September2005,page12.43 TheLewinGroupanalysisofaHaEDandHospitalCapacitySurvey,2002.44 DHS,nationalPreparednessGoal,page20.45 DHS,nationalPreparednessGoal,page11.

“In the absence of timely and decisive action and clear

leadership responsibility and accountability, there were

multiple chains of command.”

—GaOComptrollerGeneralDavidWalker,February1,2006,presentingtheinitialGaOreportonthefailureofthe

federalgovernmentinrespondingtoHurricaneKatrinatoaSpecialHouseInvestigativePanel.


thatrequiressupplementingtheaggregatesurgecapacityoflocalhospitalswithaninfluxofsupple-mentalhealthcareassetsfrommutual-aidpartners,theState,andtheFederalgovernment.”46However,nosuchsystemhasyetbeendeveloped.

disAster medicAl cAre centersInthecaseofamajordisaster,itwouldbeimpor-tantthathospitalsnotbethesiteoftriageandhealthcarefirstresponseinadisaster.Rather,asystemofcommunitysitesshouldbepreparedwithpre-positionedsuppliesandequipmenttoconducttheinitialmedicalresponse.47Thegoalwouldbetoeliminatecrowding,reducetravel,preventinfec-tionandcontamination,andmaintaintheabilityofhospitalstooffercomplexservicestotheirexist-ingandreferreddisasterpatients.Onepossiblesolutiontotheproblemofhospitalsurgecapacityisthecreationofasystemofdisastermedicalcarecenters.Disastermedicalcarecenterswouldbebasedinexistingfacilities,suchassportsarenasorschoolsthatwouldbepre-suppliedwithmilitary-likefieldequipment,includingmedicalsupplies.Inaddition,asystemofmobilefieldhospitalsshouldalsobeestablishedtoprovidecoverageforcitieswithoutdisastermedicalcarecentersandasback-upforthosewithsuchcenters.Thesefieldhospitalsalsowouldbeusefulwherethereispo-tentialforanaturaldisaster,suchasamajorhur-ricanes,earthquakes,ordiseaseoutbreaks.

mobilizAtion oF key resources: medicAl Personnel And suPPliesInallthreescenariosdescribedinthisreport,localmedicalpersonnelwouldbequicklyover-whelmedbythenumbersofcriticallyillpatients.Manyfacilitieswouldnothaveeffectiveradiation

monitoringequipment,decontaminationfacili-ties,orpersonneltomanagethem.Toadequatelyaddressthecareandtreatmentofvictims,anim-mediatemobilizationanddeploymentoftrainedmedicalprofessionalsandsuppliesfromoutsidetheaffectedareawouldberequired.48 Recognizingthisneed,theNational Preparedness Goaldocumentenvisionsapublic-healthsystemwhere,intheeventofanationalemergency,emer-gency-readymedicalpersonnel,hospitals,andoth-erhealthcarefacilitieswouldcollaboratetohandlerapidlyamyriadofinjuries,includingphysicalandpsychictrauma,burns,infections,bonemarrowsuppression,andotherchemical-orradiation-in-ducedinjury.49 WhiletheNational Preparedness Goalofferssomeusefulrecommendationsforaddressingtheshort-ageofmedicalpersonnel,itdoesnotaddressthemeanstoquicklydeployadditionaldoctors,nurses,andotherhealthprofessionalstoadisasterzone.TheDHS’snationalDisasterMedicalSystemcur-rentlymaintainsmorethan50DisasterMedicalassistanceTeams(DMaT).IntheaftermathofHurricaneKatrina,allDMaTweredeployedtotheGulfCoastarea.Itisquiteclearthatthislevelofcapacityistotallyinadequatefordealingwiththecasualtiesanticipatedinanuclearterroristattack.Infact,theDMaTinthenewOrleansareawerecompletelyoverwhelmedbytherelativelysmallnumberofpatientstheyhadtodealwithduringthatcrisis.50

ThereisacriticalneedfortheFederalEmergencyManagementagencytoincreasethenumberofDMaTatitsdisposalandtoestablishasystemthatcanquicklymobilizemilitarycombatsupporthospitalsandnationalGuardperson-nelinanemergency.FEMaalsoshouldcreateasystemthatwillabsorbandquicklyintegratedoc-tors,nurses,andotherhealthprofessionalswho

46 DHS,nationalPreparednessGoal,page20.47 Ref:Kipnis,K.OverwhelmingCasualties:Medicalethicsinatimeofterror.In the Wake of Terror: Medicine and Morality in a Time of Terror

J.D.MorenoeditorMITPressCambridgeMa2004pp95-107.48 DHS,nationalPreparednessGoal,20.49Ibid.50 SarahaLister,“HurricaneKatrina:ThePublicHealthandMedicalResponse,”CongressionalResearchService,Washington,D.C.,

September21,2005,page13.


volunteertheirservices.In2005,manydoctorsandnurseswhovolunteeredtohelpandeventraveleddirectlytotheareasaffectedbyHurricaneKatrinacouldnotbeputtousebecausetherewasnosys-temforintegratingthemintoacoherent,function-ing,healthcareteam.ManyhealthprofessionalsvolunteeredbyapplyingontheDepartmentofHealthandHumanServices(DHHS)websitebutwerenevercontacted. Lastly,tobestensureanadequateandcontinu-ousflowofcriticalmedicalsuppliesandequip-ment,thefederalgovernment,incooperationwithstateandlocalgovernments,mustdevelopastrategyforpre-positioningtheseessentialmateri-alsandcommunicatingthisplantothosewhowillneedthesuppliesandequipmentintheirtreatmentofpatients.TheNational Preparedness Goalappropri-atelydesignatesthisasaprioritycapabilitybuildingareaforaneffectiveresponsetoaterroristattackoramajornaturaldisaster.51Theremustbeadequatestockpilesofbandages,IVsolutionsandequip-ment,antibiotics,painmedication,andothercom-monmedicines,aswellastheabilitytomobilizeadequatesuppliesofbloodandbloodproducts.

PrePAredness PlAns: new york, chicAgo, And wAshington, d.c.Whilethemagnitudeofanuclearterroristattackdemandsthatthefederalgovernmentassumeprimaryresponsibilityforthisthreat,thereisanimportantroleaswellforlocalgovernments.asur-veyofstateandcity-specificpreparednessplanningforthethreecitiesselectedinthisstudyindicatesthatstateandlocalgovernmentshavemadesomeimprovementsinthemanagementofhealthcon-

sequencessincethelastmajorterroristattackonSeptember11,2001.However,thereremainfun-damentalproblemswiththecity-specificrecom-mendationsandaclearneedforathoughtfulandeffectiveplanforpreparingcommunitiesintheeventofanuclearattack.

New York CityTheCityofnewYorkhaspublishedaprepared-nessguidethatisavailableon-lineatwww.nyc.gov/readyny.Morethantwomillioncopiesineightlanguageshavebeendistributedtothepublic,inanattempttoinformnewYorkersofthecity’sdisasterpreparednessandevacuationplan.SincetheSeptember11attacks,thecityalsohasmadevastimprovementsinitsabilitytocommunicatewiththepublicbyradioandtelevision.Inasurveyofdisasterpreparednessforamerica’sfiftylarg-estcities,theamericanDisasterPreparednessFoundationrankednewYorkasthesecondbest-preparedcitygivingithighmarksforpubliceduca-tionandcommunicationofitsdisasterplanningandfirstresponderstraining.52 ThecapacityofnewYorkCityofficialstocom-municatewitheachotherandamongvariousagencies,however,remainsseverelylimited.Mostimportantly,fouryearsaftertheSept.11attacksandoneyearafterHurricaneKatrina,therestillisnosingleplantoevacuateallofnewYorkCity.53Orderlyandsafeevacuationforacityofmorethaneightmillionpeople,themajorityofwhomarewithoutcars,isconsidereddifficulttoimpossible,evenbytheofficialsresponsibleforcarryingoutsuchanevacuation. accordingtoJosephF.Bruno,newYorkCity’sEmergencyManagementCommissioner,thecityis

51 DHS,nationalPreparednessGoal,20.52 americanDisasterPreparednessFoundation,“HowPreparedisYourCity?aStudyofthePreparednessoftheLargestMetroareas

intheU.S.,”January2006,page24.Usingdatacompiledfromseveralsources,includingcitydisasterplans,countydisasterplans,meetingrecords,disasterrecords,mitigationplans,newsreports,censusdata,governmentpublications,interviewswithemergencymanagementandothergovernmentemployees,non-governmentalorganizationreports,accreditationrecords,interviewswithresi-dents,andothersources,theamericanDisasterPreparednessFoundationreportrankedselectedcities’preparednesslevelsbasedonanumberofcriteria.Thereportusedcriteriasuchasacity’sdisasterpreparednessplanning,training,publiceducation,generalawarenessofthecity’sdisasterplan,communication,thecity’sabilitytohelpitsmostvulnerableandpoorcitizens,technology,infra-structure,externalsupporttoassigngradesofa-F.

53 SamRoberts,“PlanningtheImpossible:newYork’sEvacuation,”newYorkTimes,September11,2005.


Acute rAdiAtion syndrome

one condition that surely will challenge health

care workers following a nuclear incident is

radiation sickness (acute radiation syndrome

(arS). arS is a serious illness that occurs when

the entire body (or most of it) receives a high

dose of radiation, usually over a short period

of time. Many survivors of the Hiroshima and

nagasaki atomic bombs in the 1��0s, and many

of the firefighters who first responded after the

chernobyl nuclear power plant accident in 1��6,

became ill with arS.

people exposed to radiation will get arS only if:

E the radiation dose was high (doses from

medical procedures such as chest X-rays are

too low to cause arS; however, doses from

radiation therapy to treat cancer may be high

enough to cause some arS symptoms):

E the radiation was penetrating (that is, able to

reach internal organs):

E the person’s entire body, or most of it, received

the dose: and

E the radiation was received in a short time,

usually within minutes.

the first symptoms of arS are typically nausea,

vomiting, and diarrhea. these symptoms will begin

within minutes to days after the exposure, will last

for minutes or up to several days, and may come

and go. then the person usually looks and feels

healthy for a short period of time, after which

he or she will become sick again, with loss of

appetite, fatigue, fever, nausea, vomiting, diarrhea,

and possibly even seizures and coma. this

seriously ill stage may last from a few hours up to

several months.

people with arS typically also have some

skin damage. this damage can start to show

within a few hours after exposure and can include

swelling, itching, and redness of the skin (like a

bad sunburn). there also can be hair loss. as with

the other symptoms, the skin may heal for a short

time, followed by the return of swelling, itching,

and redness days or weeks later. complete healing

of the skin may take from several weeks up to

a few years, depending on the radiation dose

received by the person’s skin.

the chance of survival for people with arS

decreases with increasing radiation doses. Most

people who do not recover from arS will die of

exposure within several months. in most cases,

the cause of death is the destruction of the

person’s bone marrow, which results in infections

and internal bleeding. For the survivors, the

recovery process may last from several weeks

to as long as two years. treatment may include

blood transfusions, antibiotics, and the use of

hematopoetic stimulating agents. if these fail,

bone marrow transplant in specialized units is

required.”

Excerptedfrom:TheCentersforDiseaseControlandPrevention,FactSheetonacuteRadiationSyndrome(May20,2005).availableathttp://www.bt.cdc.gov/radiation/ars.asp


onlypreparedtomovefrom400,000totwomillionpeopleoutofthepathofahurricane,achallengemadealittlelessdauntingbyadvancewarning;knowingwhichflood-proneareastoevacuate;andidentifyinghowmanypoor,elderly,disabled,andnon-Englishspeakerslivethere.54Thisreflectstheenormityoftheprobleminevacuatingthemajor-ityofnewYorkCityresidentsfollowinganuclearattackwithlittlenotice.ItseemsclearthatmanyofnewsYorkCity’spopulation,ifnotmost,wouldneedtoshelterinplaceintheeventofamajornu-clearattack,butthereisnosystemtosupportthemwithbasicnecessitieslikefoodandwater.

ChicagoTheamericanDisasterPreparednessFoundationrankedChicagoasoneofthefifteenbest-preparedcitiesamongthe50largestcitiesintheU.S.55ThestudygaveChicagoanoverallC+,withhighmarksfortechnologyandfirstrespondertrainingand

lowscoresforuniformityofresponse,publiceduca-tion,andgeneralawarenessofdisasters.Thestudycitespoorcommunicationofevacuationplanstothepublicasthemajorconcern.ThestudyfaultsChicagoforbeingoneofthemosttight-lippedcit-iesindisseminatingpublicinformationondisasterpreparedness.Cityofficialsrefusetoreleasedisas-ter-preparednessplanstothepublic,whichmakesitdifficulttoexaminethecity’sstrengthorweak-nessinthisarea.56

Chicago’sfirstrespondershaveparticipatedinmockcatastropheexercises,foreventsrangingfromaterroristattacktoamajordiseaseoutbreakoranaturaldisaster.Thecityisequippedwithhigh-techdeviceslikeemergencynotificationsys-temsandsensorsthatcoulddetectthepresenceofcertainbiologicalagentsandchemicals.Cityofficialsplantoacquireradiologicalsensorsinthenearfuture.However,itappearsthatChicagofirstrespondersareneitherpreparedfullynorequippedtoquicklydistinguisharadiologicalornuclearattackfromotheremergencies. Sincethecitygovernmenthasnotcommunicat-edadequatelywiththepublic,theaverageresident,andevensomeinvolvedataplanninglevel,remainunawareofthedetailsofChicago’spreparednessplanning.Theofficialadviceintheeventofadi-sasteristoseekshelterandtuneintolocalradioandTVstationsforevacuationinformation.

54 Roberts,newYorkTimes.55 americanDisasterPreparednessFoundation,“HowPreparedisYourCity?aStudyofthePreparednessoftheLargestMetroareas

intheU.S.,”January2006,page24.56 ChristinaLeBeau,“Thinkingtheunthinkable,”December2005.availableelectronicallyathttp://www.chicagobusiness.com/cgi-

bin/mag/article.pl?article_id=25103&postDate=2005-12-31.

“As a resident of Chicago, I know very little of what they

are doing. This is the same level of irresponsibility we

saw in New Orleans: denial of the problem, reassurance

without substance and lack of leadership.”

—CharlesBaum,Vice-PresidentofHealthaffairsforthealexianBrothersHospitalnetworkinarlingtonHeights

andamemberoftheCookCountyDepartmentofPublicHealthPandemicDiseaseResponseTaskForce

“Would it be difficult to move two million people?

Absolutely,’’ Mr. Bruno said. ‘’I hope we never have to

do it.” This means that evacuating eight million would

be beyond difficult. ‘’We have plans for area evacuations,

and if you take them to their logical conclusion an area

could be the entire city of New York,’’ Mr. Bruno said.

‘’Those are doomsday type things, a nuclear attack. We’re

definitely not throwing our hands up. But it would be a

catastrophic event that would be extremely difficult for

New York City to have to deal with.’’ How long would it

take to virtually empty the city? ‘’I wouldn’t even hazard

a guess,’’ Mr. Bruno replied.


Washington, DC ThesameamericanDisasterPreparednessFoundationreportcitedaboverankedWashington,D.C.seventhforitspreparednesseffortsgivingitaB-.57CityofficialshaveparticipatedinmockWMDterroristattackresponsetrainingaspartoftheTopOfficials,orTOPOFFterrorismresponseexercises. TheD.C.governmentplansdonotspelloutthedesignatedauthoritytomakedecisionsonevacuation.Thisiscritical,asD.C.hasnogover-nortomakethenecessarydecisions.CityofficialshaveidentifiedfourteenevacuationroutesoutofdowntownWashingtonD.C.thatcommuterscoulduseforanemergencyevacuation.Themapispro-videdontheD.C.DepartmentofTransportationwebsite,andthecitygovernmenthasattemptedtopublicizeitthroughlocalmediaandonthepub-lictransitsystem.58TheofficialevacuationplanshowsevacuationroutesextendingtowardtheCapitalBeltway. However,therearenoroadsignstoidentifyemergencyroutes.Duringamajordisaster,theD.C.plancallsfortrafficsignalstobere-timedto

allowamaximumnumberofcarstoleavethecityandforsometrafficsignalstooperateonfour-minutecycles.TheevacuationplanprovidesnospecificsabouthowtheDistrictofColumbiawouldcoordinatewithsurroundingstates—VirginiaandMaryland—orwheretheevacuatedindividualsshouldgotooncetheyareoutoftheD.C.citylim-its.Thus,itisdifficulttoimaginehowthecitywouldmanagethesafeevacuationofhundredsofthou-sandsofpeopleatonce,giventhetrafficcongestiononI-495duringanormalrushhourcommute.

57 americanDisasterPreparednessFoundation,“HowPreparedisYourCity?aStudyofthePreparednessoftheLargestMetroareasintheU.S.,”page24.

58 The map is available at http://ddot.dc.gov/ddot/frames.asp?doc=/ddot/lib/ddot/information/pdf/ddot-event-map-large.pdf&open=|32399|

note

When one goes to the Dc government

webpage’s emergency information section

and selects the link for information on nuclear

and radiological emergency, a blank page

comes up with the following link: File:/eic/

liB/eic/cwp~��~��723~3~62�7~13�30.

cwp

Recommendations

Thethreatofanuclearterroristattackorotherlarge-scaleurbandisasterisreal,andthepotentialconsequencesaredisastrous.FiveyearsafterSeptember

11,thefederalgovernmentstillhasnotdevelopedanadequateresponsetothesethreats.TheDHS’sNational Preparedness GoalandtheworkthatwentintodevelopingtheNational Planning Scenariosrep-resentusefulpreliminarysteps,butafullydevel-opedandworkingplaniscritical. PhysiciansforSocialResponsibilityhasathreepointprescriptiontoaddressthesedangerousdeficienciesinplanning,organization,andcom-munication.PSRrecommendstheDepartmentofHomelandSecurityadoptthefollowingmeasures:

PlAnning

N designate a central coordinating authorityandaclearchainofcommandthatwouldbeactivatedintheeventofanuclearterroristat-tack,ornaturaldisaster,todirecttheresponseandrescueefforts.

N establish and communicate clear criteriatoguidethisauthorityindecidingwhethertoevac-uatepeopleorsheltertheminplace.Establishplansforcarryingoutanyevacuationsdeemedappropriateandforsupportingpopulationsin-structedtoshelterinplace.

N include nuclear scenariosinmostregulardesk-topandfieldplanningexercisesandgivetheU.S.WeatherServicecapacitytomapandbroadcastradiationfalloutplumesinrealtime.

orgAnizAtion

N establish an adequate national disaster

medical system withsignificantlyincreased

numbersofDisasterMedicalassistanceTeamsandestablishamechanismforquicklymobiliz-ingexistingmilitarymedicalteamsandinte-gratingvolunteerhealthprofessionals.

N Pre-position radiation protection and moni-

toring equipmentinareasfelttobehighriskpotentialtargets.Pre-positionstockpilesofmedicalsuppliesthatcanbemovedquicklytotheaffectedareasinresponsetonuclearterror-ismornaturaldisasterssuchashurricanesorfloods.

N train and equip first responderssotheycanquicklyidentifyaradiologicalemergencyandperformtheirdutieswhilealsoensuringtheirownsafety.

N establish disaster medical care centersinhighriskurbanareasandmobilefieldhospitalsthatcanbemovedquicklytoareaswhereexist-ingmedicalfacilitiesareoverwhelmed.

communicAtion

N establish a plan for communicating

evacuationorshelteringdecisionstothepublicandeducatethepublicinadvanceabouttheseissuessothattheywillfollowinstructionsinthechaoticaftermathofanattack.

N ensure that the coordinating authority has

access to real time information andcancom-municatethelocationandexpectedspreadofradioactivefalloutplumes.

PSR’sstudyhasraisedanumberofkeyfocusareasforthosechargedwithprotectingcommuni-tiesfromthethreatsposedbymajordisasters.Itisimportanttonotethatthecontextinwhichweareraisingtheseissues.TheU.S.publichealthsystem,whichwouldbeartheburdenofrespond-


ingtoeventslikethese,iscurrentlyunderfundedandunderstaffed.anythoughtfulstrategyonad-dressinganuclearterroristattackmusttakethisintoconsideration.Futureplansmustconsiderpreparationsforanuclearattackinthebroadercontextofcompetingpublichealthprioritieslikeflupreventionornaturaldisasterresponse.Wecannotaffordtopullfundingawayfromexisting

publichealthneedstofundnewpreparednessinitiatives.Wemustacknowledgethatnewsourcesoffundingandotherresourcesareneededandmustbesuppliedtostrengthentheexistingpublichealthsystemandguaranteethatapreparednesssystemisinplacetoensureaneffectiveresponsetoawiderangeofthreats.

A note on nucleAr terrorism PreventionWhile there is much work to be done in the area of preparedness for a nuclear terrorist attack, we also must

recognize that even the best efforts in this area will not be enough to keep our communities safe. given the

potentially devastating consequences of a nuclear terrorist attack, a clearly focused program of prevention

strategies centered on having the u.S. and other nuclear weapons powers move toward the elimination of

nuclear weapons would be the key to our safety. in tandem with this, well-funded and rigorously enforced

programs aimed at keeping nuclear weapons and materials out of the hands of terrorists, including securing the

facilities which house this dangerous material and reducing and ultimately eliminating u.S. reliance on nuclear

weapons and power in the longer term should be considered mainstays of prevention of nuclear terrorism.

specifically, Psr recommends that the federal government:

1. Limit the availability of nuclear weapons and materials by:

E providing adequate funding to complete security upgrades of all vulnerable sites where nuclear weapons

or materials are stored

E promoting and supporting policies that would secure u.S. borders, such as mandating stricter cargo

shipment requirements

E leading all nuclear weapons states in meeting their legal obligation under article Vi of the nuclear

nonproliferation treaty by pursuing nuclear disarmament in good faith and setting a timetable for

reducing and ultimately eliminating nuclear arsenals

2. Protect nuclear power facilities by:

E Working with the nuclear industry to ensure the security of all nuclear reactors in the country against any

possible threat, leading to a permanent, nuclear industry-funded and nrc monitored security system

E Strictly enforcing a no fly zone over nuclear power reactors and installing anti-aircraft missiles on guard

towers. Serious steps must also be taken prevent the threat of a truck bomb or bomb from surrounding

bodies of water

E Mandating the storage of spent nuclear fuel on-site, below ground, in hardened dry cask storage to

lessen vulnerability to a terrorist attack, while continuing to develop a long-term storage solution

ultimately, the only protection from a terrorist threat against nuclear power plants and the considerable

radioactive waste they generate is to move the u.S. away from nuclear power and towards renewable

and less dangerous energy sources. nuclear power plants provide enticing targets, and the continued

production of fissile materials as waste or as potential bomb-making material threatens the health and

safety of our children and future generations. Furthermore, nuclear power plants increase the likelihood

of nuclear proliferation and create a double-standard where certain countries have the right to produce

nuclear fuel and others do not.

Who is Psr?

Guided by the values and expertise of medicine and public health,Physicians for Social Responsibility works to protect human life fromthe gravest threats to health and survival. PSR is a nonpartisan,nonprofit organization representing 26,000 physicians, public healthprofessionals, and concerned citizens working to eliminate nuclearweapons and address the public health and environmental legacy createdby our military and civilian nuclear enterprise, including the testing,production and stockpiling of nuclear weapons. Since its foundingforty-five years ago, PSR has dedicated its efforts to educating themedical and public health community, the public, policymakers and themedia about the menace of accidental or intentional nuclear war andproliferation of nuclear weapons and materials.

PSR also has a long history of bringing to light the fallacy of U.S.nuclear weapons policy and inadequacy of U.S. public healthinfrastructure in responding to a full-scale nuclear war scenario.Throughout the Cold War years, PSR physicians published articles andstudies in medical journals, such as the New England Medical Journal andthe Journal of American Medical Association, detailing the medicalconsequences of a nuclear war between the United States and the SovietUnion. Through research, public education and advocacy, PSR, with ourinternational federation the International Physicians for the Preventionof nuclear War, highlighted the health effects associated with testing,production and stockpiling of nuclear weapons and the nation’s continuedreliance on nuclear weapons and nuclear power. This work was recognizedglobally when IPPnW was awarded the nobel Peace Prize in 1985, in which PSR shared.

Over the last two decades, PSR’s work has focused on educating thepublic and policy makers about the continuing threat of nuclearproliferation and the health legacies of nuclear weapons build-up duringthe Cold War. PSR continues to advocate for rapid reduction and eventualelimination of U.S. and global nuclear stockpiles — ultimately theonly sure way to eliminate the threat of the use of nuclear weaponswhether by an adversary state or by a terrorist group.

Recognizing that new dangers now threaten us, PSR in 1992 expanded itsmission to include environmental health, addressing issues such asglobal climate change, proliferation of toxics, and pollution.

Physicians for social resPonsibility

1875 Connecticut Avenue, NW, Suite 1012

Washington, DC 20009

Telephone: (202) 667-4260

Fax: (202) 667- 4201

E-mail: [email protected]

Web www.psr.org

US Affiliate of International Physicians for the Prevention of Nuclear War

Documents

The U.S. and nuclear Terrorism