In the report, “Analyzing Evacuation Versus Shelter-in-Place Strategies After a Terrorist Nuclear Detonation,” which is published in the latest issue of Risk Analysis,

The scientific and engineering analysts comprehensively modeled the impacts of a detonation in downtown Washington D.C. and calculated clogged exit roads would pose more significant risks by exposing evacuees to radiation than if people were to remain in place at the center of large buildings or in basements.

“The logistical challenge of an evacuation appears to be beyond current response capabilities,” said author Lawrence M. Wein, the Jeffrey S. Skoll Professor of Management Science, at the Stanford Graduate School of Business. He noted, “Sheltering in basements saves approximately twice as many lives as being above ground” in the Washington, D.C. area.

The authors recommend government encourage businesses and citizens to develop a basement shelter strategy, including the storage of food, water, blankets, and other necessities at facilities and homes located in or near large cities.

I hope that the government authorities will soon begin a discussion of this topic as Homeland Security Secretary Janet Napolitano has said she intends to do. The full study can be found here.

Nine nations now have nuclear weapons and the movie argues that number could continue to grow to over 40 countries as the construction knowledge spreads (and that’s not even including the non-state actors, including terror groups). The documentary, directed by Lucy Walker, effectively shows the great concern among those experts in the political, diplomatic and scientific fields, though it expresses concern that the public does not fully understand the gravity of the situation. The movie is meant as a ‘wake up call’ about the threat of an act of nuclear terrorism, failed diplomacy, or a simple accident.

Ultimately, the movie calls for nuclear disarmament and asks viewers to go to the website of an organization called Global Zero to sign a petition. I wish they had also included steps that citizens can do to protect themselves in case the efforts to stop a nuclear explosion does not completely work.

Nevertheless, it is definitely worth seeing “Countdown to Zero” if it comes to your town or when it comes out in DVD. To check its national opening schedule, check the Global Zero website here.

The study, “Regional Health and Public Health Preparedness for Nuclear Terrorism: Optimizing Survival in a Low Probability/High Consequence Disaster,” is authored by Irwin Redlener, Andrew L. Garrett, Karen L. Levin and Andrew Mener. It was released while this blog was on hiatus so I am posting it now.

The authors contend that our lack of preparedness is in part a result of a lack of understanding that there are things that actually can be done in response:

Although the detonation of a low-yield IND in an American city is one of the 15 planning scenarios developed by the White House Homeland Security Council for use in security preparedness activities, local and regional emergency planning activities have not given attention commensurate to this threat. Barriers to planning for such a catastrophic event are not well understood but may be related to fatalistic beliefs or concepts of improbability, with many believing that other disasters are more probable and merit the focus of emergency planners.

But protective actions will be most useful if they are known in advance:

Following a nuclear detonation, a response based on threat-specific strategies will be essential to maximize time-sensitive life-saving opportunities. Public protective actions to reduce exposure and injury, critical within the first hours, will depend greatly upon a well thought out, pre-event messaging strategy and the ability to communicate easily-understood information to the public. The risk for injury and nuclear detonation effects does not end after the initial blast; the public must understand the correct protective actions and when to take them throughout the response and recovery phases.

The report explains that “in the minutes and hours after the detonation of an IND, the public would need to make a few key decisions in order to maximize their chances of surviving and minimize their injuries and long-term health effects”:

1. Is it better to evacuate now or later?

2. If I stay put, how should I shelter and decontaminate myself to prevent further injury?

3. When I do evacuate, where should I go to avoid placing myself at an increased risk from fallout?

…Individuals will very likely need to make these decisions in the absence of official directions. If local health officials are to dramatically increase the percentage of affected people who can survive, they must make the public aware of the benefits of these initial life-saving responses actions and of knowing what to do in an emergency.

Despite the benefits that these simple protective measures can have, it seems that the widely-known images of the nuclear devastation in Hiroshima and Nagasaki, and subsequent fictionalized portrayals of nuclear conflict in movies and television-program images of total nuclear devastation have led people to conclude either that preparedness is impossible or that the federal government already must have done everything in its power to protect the country. Both assumptions are inaccurate.

The study recommends what the U.S. should do to address this lack of readiness:

In the United States, virtually no public education has taken place about what an individual should do in the event of a nuclear detonation, although there is urgent and critical need for such education, especially for those living in potential target areas. Also lacking are pre-developed, exercised and well-tested communication plans to deliver rapid information from officials to the public following a nuclear incident…

…A public education campaign that addressed these issues could save lives and reduce injury in the gray zone by empowering the public to initiate life-saving actions without the need for official advice, which may never arrive. Immediate protective actions in the first moments after a detonation are critical. Considering that it might be impossible to get emergency messages to the public after a detonation, it is sensible to equip the public now with basic information on how to best protect themselves and their family should they ever confront this type of disaster.

The full report can be found here.

In the post, Nuclear Alert Sirens Fall Short For The Deaf And Hard Of Hearing,” Greg Sunshine points out that in the event of a radiological emergency, people who live within a 10-mile radius of nuclear power plants will hear a system of sirens sound the alert. However, for their deaf and hard of hearing neighbors, the sound of the sirens alone provides no warning whatsoever. He explains:

According to Nuclear Regulatory Commission (”NRC”) regulations, each nuclear power plant must have an emergency notifications system for its surrounding 10-mile “emergency planning zone.” The purpose of the sirens is to let residents know that some type of emergency has occurred, and to tune to their television or radio for specific Emergency Alert System (”EAS”) instructions (the same EAS that interrupts late night television for a weekly test).

Although the Americans with Disabilities Act requires television EAS messages to include closed captioning for the deaf and hard of hearing, without an alternative to the sirens, residents who cannot hear the sirens will not know to check their television in the first place. This creates a significant notification problem for radiological emergencies when getting quick emergency information could save lives.

Although sirens provide no notice to the almost 1,000,000 Americans who are functionally deaf, the NRC inspection manual indicates that sirens are an acceptable means of notifying the populace. In fact, NRC Inspection Procedure 71114.02 – which provides the guidelines for inspecting plants’ alert and notification system – indicates that sirens are the primary means of notification. According to the manual, if a plant’s siren system is adequate, the plant is considered to have met the “notice to the populace” requirement, regardless of how many deaf or hard of hearing residents would receive no such notice.

Though Sunshine points out that there are steps deaf and hard of hearing citizens can take to overcome the notification gap:

First, deaf and hard of hearing residents should call their sheriff’s office to ensure that the computer aided dispatch system has them listed as residents with difficulty hearing. Doing so may allow the residents to receive notice from the sheriff’s office if it implements route alerting (where officers drive a specific route disseminating information via loudspeaker), and would also ensure that a telecommunications device for the deaf (known as a TDD or a TTY) is used for phone conversations.

Residents should also determine whether their county, or a neighboring county, uses some type of text alert system to notify residents via text message of possible local emergencies (most often weather-related). If the county does not have a text alert system, residents should purchase a special needs weather radio. Conveniently, both the text alert and weather radios are also tied to the EAS. Therefore, if the EAS begins to notify residents of a radiological emergency at a nearby nuclear power plant, it is likely that a text alert system would be used to notify those who have enrolled in the service. If EAS is activated, the weather radios will provide notice to residents through means viable to the deaf or hard of hearing, such as “visual and vibrating alarms and simple text readouts.”

People with difficulty hearing should also determine if their county has a reverse 911 system in place, and if so, enroll in it. Reverse 911 acts as an automated calling service that calls residents entered into its database and plays a prerecorded message with emergency instructions. If such a system calls a deaf or hard of hearing resident, that resident’s TDD would translate the message into text.

Finally, FEMA advises people who are deaf or hard of hearing to “plan ahead for someone to convey essential emergency information to you if you are unable to use the TV or radio.” While this and the aforementioned efforts may not provide the same immediate notice as the sirens, they are better than no notice at all.

Although deaf and hard of hearing residents can take steps to mitigate this notification gap, the difficult reality remains that this group of citizens faces an ongoing safety disadvantage until the system is modified.

Tom Inglesby, director of the Center for Biosecurity, University of Pittsburgh Medical Center, said that the U.S. first and foremost should continue its extensive initiatives to prevent a nuclear terror incident, but that we need to acknowledge the fact that those efforts may not ultimately work. He was interviewed by Randy Larsen, on Federal News Radio as part of its Science and National Security series.

Inglesby said that despite how difficult the scenario may be for Americans to imagine, we have to accept “this could happen” because then people “at least will be familiar with what it could be like” so they can be prepare.

The Center for Biosecurity, a leading academic hub for community readiness and engagement, recently held a conference, “Preparing to Save Lives and Recover After a Nuclear Detonation: Implications for U.S. Policy”. A focus of the parley was reducing the number of casualties in a nuclear incident and the role of the public in that effort. I previously wrote about the conference report highlighting the comments of White House aide, Dr. Tammy Taylor who “noted that it is essential to educate people in advance because officials will not have accurate information immediately, and protective action will be effective only if people know what to do directly following the detonation.”

In the interview (audio file here), Inglesby offered the public advice on what they should know about responding to a nuclear incident. He said the most important step is finding adequate shelter because taking protective actions for 24 hours reduces risk from radioactive fallout. Inglesby differentiated between “good shelter” (inside a building, deeper and lower the better) and ”bad shelter” (in a car or in small single-story structure).

He said that the government is beginning to more openly present this kind of information, particularly with the publication last year of the “Planning Guidance For Response To A Nuclear Detonation” guide from the U.S. Homeland Security Council.

The challenge, of course, as we’ve discussed frequently on the blog is how officials engage the public and the media on this delicate topic in a constructive way that is not dismissed as fearmongering.

The Center “convened the invitational meeting to examine critical issues associated with response to and recovery from a nuclear detonation and to consider the policy implications of those issues.” It took place in late April in Washington, D.C., and I had intended to attend but was not fully recovered from treatment.

An important aspect of the gathering was examining the role of the public before and after a nuclear incident. And, in fact, according to the report, White House aide, Dr. Tammy Taylor (Senior Policy Analyst, National Security and International Affairs Division, Office of Science and Technology Policy, Executive Office of the President, The White House) “noted that it is essential to educate people in advance because officials will not have accurate information immediately, and protective action will be effective only if people know what to do directly following the detonation.”

One of the “challenges” the conference examined was: Advance Education and Post-event Communication. And, according to the report:

The public needs advance knowledge and information: With advance information about nuclear fallout and ways to protect themselves from dangerous exposure, the public could take action after a nuclear detonation that would save tens of thousands of lives. The first and best protective action is to find adequate shelter and stay there until officials provide additional information and instructions.

However, as Mr. [Brooke] Buddemeier [from the Global Security Directorate of the Lawrence Livermore National Laboratories] emphasized, the decisions with the biggest lifesaving effect will be those made in the first minutes or hours following a nuclear attack, but they often are not technically informed decisions and may, in fact, be counterintuitive. For example, people may think first of fleeing when it would be safer to stay put in adequate shelter.

Effective communication will be critical: To save lives, U.S. government (USG) policies and programs should focus on rapid, straightforward delivery of 3 key messages for survivors: A nuclear detonation has occurred nearby; Immediately seek adequate shelter, such as a basement or a room in the interior of a building; and Wait for more information and instruction before evacuating. Sheltered individuals should stay put for at least 24 hours following the detonation unless authorities provide different instructions.

At the end of the report, the Center offers several steps that the U.S. federal government should take now to prepare for effective response and efficient recovery following nuclear detonation:

Pursue pre-event education and communication with communities: Prepare the public to recognize and seek adequate shelter and to refrain from evacuation unless otherwise instructed by government officials.

Improve medical response capacity: Continue to support healthcare preparedness activities and pre-event development of strategies for triage, implementation of crisis standards of care, and transport of large numbers of survivors to locations where they can receive medical care.

Direct research toward better characterization of levels of persistent radiation: This research should be prioritized as it will inform efforts to forecast acceptable levels of radiation. Without that ability, it will be difficult, if not impossible, to encourage repopulation of contaminated areas.

Anticipate and address long-term recovery challenges: Specifically, recovery plans must address mass displacement of populations; the needs of individuals, families, and host communities; and efforts to return people to their homes.

Congress should take action to remedy vulnerabilities in presidential succession, reconstitution of the House of Representatives, and continuity of the U.S. government.

The full conference report — which was prepared by Nidhi Bouri, Ann Norwood, and Tara Kirk Sell — can be found along with the agenda, speaker list, and video of some of the panels here. The conference was sponsored by the Alfred E. Sloan Foundation.

Randy, a friend of this blog, has an illustrious and varied career in the military, homeland security and communications. Most recently, he was the Executive Director of the Commission on the Prevention of Weapons of Mass Destruction and has, along with co-chairs Bob Graham and Jim Talent, formed the Bipartisan WMD Terrorism Research Center. They will be working to implement the Commission’s extensive recommendations. (The Biosecurity Blog’s subhead is: “Improving America’s Capability To Respond to Bio-Threats.”)

Randy is author of Our Own Worst Enemy: Asking the Right Questions About Security to Protect You, Your Family, and America (Grand Central Publications, 2007) and was the co-host of one of my favorite radio shows, “Homeland Security Inside & Out”.

I recommend following the Biosecurity Blog.

The most important overlooked story of the past few weeks was overlooked because it was not surprising. Also because no one really wants to notice it. The weight of 9/11 and all its implications is so much on our minds that it’s never on our mind.

I speak of the report from the Inspector General of the Justice Department, issued in late May, saying the department is not prepared to ensure public safety in the days or weeks after a terrorist attack in which nuclear, biological or chemical weapons are used…

Noonan notes that the Justice IG was not alone in noting the lack of WMD readiness:

The report was not the first of its kind. Six months ago, the bipartisan Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism gave both the Obama administration and Congress failing grades on preparedness for biological attack…

After the Inspector General’s report, Paul McHale, a former Democratic congressman from Pennsylvania who also served as an assistant secretary of defense under George W. Bush, told the Los Angeles Times: “There is a sense of complacency that has settled in nearly a decade after Sept. 11.” The paper also quoted Randall Larsen, the former executive director of the commission that gave the government low marks in January: “They just don’t see the WMD scenario as most likely,” he said.

They don’t? They must be idiots. They must not be reading all the government reports of the past eight years, declaring terrorist attacks on U.S. soil not only likely but virtually certain…No one wants to think about it. I don’t want to think about it. But you have to make plans. You have to imagine, you have to think about the worst case, and then you have to plan for it—literally…

Noonan says that the success in preventing another major attack has been a double edged sword in part by presenting a misimpression about the nation’s preparedness and response abilities:

Our eye is off the ball. The public, in spite of what it knows in the day to day, assumes the government is on the case. And certainly the government is on the case with regard to prevention: Not being hit again since 2001 means something, and our antiterrorism professionals, intelligence and law-enforcement agents, do impressive work. In New York the past week they picked up two apparent would-be terrorists who won’t be playing jihad anytime soon. But public awareness of prevention success gives the impression the government is similarly capable in terms of readiness and response…

On 9/11 we were rocked but held together. In a second and more devasting attack, public safety and public unity would be infinitely more stressed. The event, having had a precursor, would be infinitely more painful. You’d think this would focus the government’s mind.

We may be witnessing again a failure of imagination, the famous phrase used after 9/11 to capture why the U.S. government was caught so flatfooted and was so stunned that such a terrible thing could occur. They neglected to think of the worst thing that could happen, and so of course they did not plan for it. If agencies within the government now are having a second failure of imagination, it is not forgivable. We’re not being asked to imagine a place we’ve never been, after all, we’re only being asked to imagine where we’ve been, and how it could be worse, and plan for it.

Though Noonan was a speechwriter for Republican presidents Reagan and Bush, her general theme about the need to engage the public on WMD response was echoed by a current top DHS official Tara O’Toole in a speech this week.

Those provisions are part of comprehensivelegislation addressing the WMD threat which is based largely on the recommendations of the Commission on the Prevention of WMD Proliferation and Terrorism’s final report, “World At Risk.”

Of most interest to this blog, the bill has several provisions that deal specifically with public information, a significant focus of the WMD Commission report and its chairman Bob Graham.

The House legislation, sponsored by Rep. William Pascrell (D-NJ) and Rep. Peter King (R-NY), joins a Senate WMD bill. Both aim to codify many of the WMD Commission recommendations. This bill’s submission comes two days after a top DHS official said in a speech that the U.S. has “to start thinking very seriously about what we would actually do the day after [a nuclear or biological] attack”.

The public information provisions, according to the bill’s summary, are:

SEC. 2121. Communication of Threat Information and Alerts. This subsection directs the Secretary of Homeland Security, in coordination with appropriate Federal agencies, to ensure that homeland security information concerning terrorist threats deemed to be credible is provided to State, local, and tribal authorities and to the public within the United States, as appropriate. (ADDRESSES WORLD AT RISK RECOMMENDATION 13.)

SEC. 2122. Individual and Community Preparedness for WMD. This subsection requires the Secretary of Homeland Security, acting through the Administrator of the Federal Emergency Management Agency (FEMA), to assist State, local, and tribal governments in improving and promoting individual and community preparedness and collective response to WMD and terrorist attacks against the nation. The FEMA Administrator shall develop and disseminate guidelines and checklists of recommended actions, compile and distribute best practices, provide training materials, and conduct outreach efforts for individual and community prevention and preparedness. (ADDRESSES WORLD AT RISK RECOMMENDATIONS 1-5 AND 13.)

SEC. 210. Communications Planning for WMD Information Dissemination. This section requires the Secretary, acting through the FEMA Administrator, in consultation with State, local, and tribal governments and in coordination with the heads of other appropriate Federal Departments and agencies, to develop a communications plan for providing information to the public related to preventing, preparing for, and responding to attacks with WMD and acts of terrorism. The FEMA Administrator shall incorporate this plan into FEMA operational plans. This section also directs the FEMA Administrator to develop and disseminate pre-scripted messages and message templates to State, local, and tribal officials so that they can incorporate them into emergency plans, and quickly disseminate critical information to the public in anticipation or in the immediate aftermath of a WMD attack or terrorist incident. (ADDRESSES WORLD AT RISK RECOMMENDATION 13.)

Another important aspect of the bill with direct relevance to the public is the question of how “countermeasures” would be distributed to citizens after (or possibly) before an attack. The bill requires the Administration to come up with a strategy on that question:

SEC. 301. National Medical Countermeasure Dispensing Strategy. This section requires the Secretary of Health and Human Services, in coordination with the Secretary of Homeland Security, the Secretary of Agriculture, and the heads of other appropriate Federal Departments and agencies, to develop and implement a National Medical Countermeasure Dispensing Strategy to enhance preparedness and collective response to an attack on humans or animals with a chemical, biological, radiological, or nuclear agent. (ADDRESSES WORLD AT RISK RECOMMENDATION 1-5.)

The speech was reported in an article by Martin Matishak on the Global Security Newswire:

While preventing a strike involving an unconventional weapon is “absolutely to be preferred, we do have to start thinking very seriously about what we would actually do the day after an attack,” Tara O’Toole, the department’s undersecretary for science and technology, said during an event at the University of California’s Washington campus.

“We could recover from an improvised nuclear device attack but to mitigate the death and suffering and the economic and social consequences we have to … start equating the American public with the notion we could recover,” she told the audience. Advance preparation “is something that we have to take seriously and is a very difficult point to sell to Congress, particularly in these highly pressured economic times,” according to O’Toole. ”God knows these preparations must be affordable,” she added.

A bipartisan group of members of the U.S. House Homeland Security Committee will introduce a bill tomorrow to implement the recommendations of the WMD Commission. The legislation will aim to improve U.S. efforts to prevent, deter, detect, and respond to a WMD attack. In its final report, the Commission emphasized the need to educate the public on these threats along the lines that O’Toole mentioned in her speech.

The article continues:

Today, the government’s responses to a nuclear or biological attack contain many similar elements. They call for the federal government to be in charge of the response and include immediate measures like medical attention for the sick and injured and detection of the source of the attack to properly training first responders to operate within a contaminated area. Longer-term issues include decontamination of the impacted zone….

Earlier this year, the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism gave the Obama administration an “F” grade for bioterrorism defense, saying the United States does not have the capability to rapidly recognize, respond to and recover from a disease-based attack (see GSN, Jan. 26). Last week, the Justice Department inspector general reported that the the agency’s WMD response efforts are severely lacking.

O’Toole said the government has a “better shot” at preventing a nuclear attack than its disease-spreading counterpart.”The difficulty of detecting, interdicting and attributing biological attacks is very, very serious and we have to, particularly in the realm of biological weapons, be prepared to respond to these attacks,” she said, referring to pursuing the perpetrators of a possible strike….

O’Toole said there are several myths in Washington about biological terrorism, including that it is too hard to prepare for; that an attack would be similar in scope to the 2001 anthrax mailings; and that infection could be countered using the antibiotic ciprofloxacin.

The Commission concluded its work as a congressionally-mandated organization on February 26, 2010. The chair was former Senator Bob Graham (recently chosen to co-chair the presidential commission on the Gulf oil spill), the vice chair was former Senator Jim Talent, and the executive director was Col. Randy Larsen. The trio have formed The Bipartisan WMD Terrorism Research Center to continue work on these issues

“We All Have A Role” is a concrete result of the WMD Commission’s public outreach effort, which was central to the group’s mission. Senator Graham told me last year in an interview that informing the public on weapons of mass destruction was an “urgent” priority. And the Commission dedicated the final chapter of its report to the “Role of the Citizen.”

What I think is particularly special about “We Have A Role” is that it not only offers advice to the public on personal preparedness and response. But it also gives them guidance on how to take a leadership role as citizens to determine if their community is prepared for weapons of mass destruction, and if not, how to get it ready.

“We Have A Role” concludes with suggested questions “specifically for nuclear and biological attacks.” To me, that underscores a point I’ve made previously on the blog that the term “WMD” should be clarified for the public with the catastrophic nuclear and biological weapons in one category and serious but lesser weapons (also normally placed within the WMD rubric) such as chemical and radiological, placed in another.

“The purpose of this study is to develop blood tests and urine tests that can tell doctors how much radiation a person has been exposed to. Doctors know how much radiation patients are exposed to in certain medical situations…However, doctors may not know how much radiation patients are exposed to in non-medical situations would be a radiation accident or a terrorist attack.”

“The research study will help researchers develop tests to show how much radiation a person has been exposed to. This would be very helpful information to doctors if people were exposed to. This would be very helpful information to doctors if people were exposed to radiation in an accident, or in a terrorist attack.”

Recently, I also happened to see an Associated Press article, “Dirty-bomb test for terror may aid cancer research,” which reports on new findings that will potentially benefit both cancer patients and terrorism victims:

With a few drops of blood, scientists are creating a way to tell who has absorbed dangerous radiation levels, part of the government’s preparations against a terror attack, and advance research that just might point toward new cancer care, too.

Duke University’s work aims to allow rapid triage in the aftermath of a dirty bomb explosion or other radiological emergency, to sort out who among potentially thousands of panicked people need treatment for radioactive fallout and who can go home. At the same time, it illustrates an evolving new approach to developing so-called “medical countermeasures” for defense: They ought to have an everyday use, too.

The piece focuses on Irwin Redliner, the head of Columbia’s National Center for Disaster Preparedness, who points out there are actually things that citizens can do to prepare for and respond to such an event. Though the article also notes the challenge in getting people to believe that:

The idea of preparedness, during the Cold War, was absurd, a fantasy; a full-tilt exchange of warheads would have been unsurvivable, and so, as people came to recognize the futility of the Eisenhower- and Kennedy-era placebos and sops (duck-and-cover, Bert the Turtle, back-yard fallout shelters), they stopped thinking about preparing. Prevention was all. But a terrorist attack is different: harder to prevent, easier to survive.

“There has been a transition from a nuclear-annihilation scenario to an isolated-terrorist-nuclear-bomb scenario,” he said. “But we’re still locked into a mind-set that nuclear war would be so overwhelming that any kind of preparedness would be futile.” Redlener took out a loaf of bread and began making a peanut-butter-and-jelly sandwich. “There’s a fatalism that clouds the planning process. It’s frustrating. It’s been shown that your odds of survival can be significantly improved with a relatively small amount of planning. I could put it all on a card.”

In the article, Redlener sketches out a possible nuclear bomb scenario in Manhattan and explains what citizens should do:

So suppose a ten-kiloton bomb—smaller than the one that fell on Hiroshima—detonated on Wall Street, eight miles south. Redlener looked out the window. “The first thing we’d see is a tremendous flash of light,” he said. “Don’t look at it, if you can help it. It could blind you.” But if you can see it, how can you not look at it? Never mind. “We’d have between fifteen and thirty seconds to get over to the core,” he went on—meaning the center of the building, by the elevators, away from the windows, which the blast wave would shatter. He grabbed a little red emergency kit and started down the hall, ambling past the cubicles, at a dry-run pace. The kit contained sixteen ounces of water, a battery-operated radio, nutrition bars, a whistle, a flashlight, and some gauze pads. The peanut-butter-and-jelly sandwich he left behind.

By the core, you collect yourself, and then take the stairs down to the basement, or to the most accessible sheltered area, in preparation for the first shower of highly radioactive fallout, fifteen or so minutes after the blast. Redlener headed down five stories to the parking garage. The fallout-shelter signs that you still see all over the city, hardy relics of the early sixties, are ghosts; the well-fortified basements they allude to are no longer stocked with supplies. But in a one-bomb scenario they might still do the trick. “Fallout shelters are like bell-bottoms,” he said. “They’ve gone in and out of favor. They are now coming back into favor.”

Redlener explained that, in the event, he would spend at least four hours in the parking garage, monitoring the radio for news regarding the orientation of the radioactive plume, to plot an evacuation route. “Don’t go to Long Island,” he said. It’s something of a dead end. You want a place to escape to, hours outside of town—an agreed-upon rendezvous spot for family members. To get messages to and from them, you should have an out-of-state landline number, of, say, a cousin or a friend.

Wein along with two graduate students developed a mathematical model of a 10-kiloton improvised nuclear device detonated at ground level in the National Mall in Washington at 10 a.m. on a weekday morning (one of the 15 disaster scenarios used by the Department of Homeland Security for its planning purposes).

According to the model, if the public knew when to ’shelter in place’ it could save tens of thousands of lives:

Approximately 80,000 people would die from the immediate effects of the blast and heat and the radiation generated in the first minute. (These numbers are rough estimates and depend upon a number of irreducible factors, including the precise weather conditions.) Additionally, fallout–radioactive material carried by the explosive force and prevailing winds for up to 20 miles–would kill 20,000-40,000 pedestrians (i.e., commuters and residents without access to a vehicle) and 20,000-60,000 people in vehicles. The lower range represents the case in which most people shelter in basements or large buildings (office or residential) for 12-24 hours after the blast; the upper range represents the case in which most people attempt to immediately evacuate (by foot or vehicle).

Of course, as we’ve discussed on the blog including in the previous post, it would be helpful if the public were more informed about dealing with these possibilities — as Americans once were. Wein writes:

…as a society, we have forgotten about the importance of sheltering–a mainstay of Cold War-era civil defense training. This is partly because there isn’t a scientific consensus on the shelter versus evacuation decision. Recommendations range from “evacuate if you can do it quickly” to “everyone shelter-in-place.” Subtler strategies include “shelter unless you’re in an area that will receive a potentially lethal dose of radiation” and “evacuate if your shelter isn’t very good and you can rapidly get away from the plume.

Our analysis suggests that there is only a tiny fraction of people who would be better off by evacuating. And we should note that these people won’t know who they are when the decision about evacuation needs to be made. Accurate plume information–the cloud can be irregularly shaped due to different wind directions at different altitudes–and travel-time estimates won’t be available, and the ability for the government to communicate to those impacted by the attack will be extremely limited, perhaps restricted to battery-powered radios.

Wein contends that even if information and communication were perfect, history indicates that the public compliance on evacuating might be far from it:

Although just 3,500 people within a 5-mile radius of Three Mile Island were told to evacuate when the plant melted down in 1979, 200,000 people within a 25-mile radius actually evacuated. Further, a 2007 survey found that the self-evacuation after a dirty bomb attack would be 65 percent in the absence of government advice and 39 percent if the government advised against evacuation. Moreover, our traffic-flow calculations suggest that even if a small percentage of those who aren’t supposed to evacuate do so anyway, all of the evacuees will be stuck in traffic jams and therefore, exposed to much more radiation, especially because vehicles provide almost no protection from fallout.

Wein argues that the smartest strategy therefore is to advise all citizens to shelter in place in the event of a nuclear explosion.

“To start implementing such a planned response, the government must first relinquish control of consequence management to our citizenry and then initiate an aggressive public-education campaign. The irony is that U.S. government websites currently contain excellent advice–including ‘everyone should shelter’ –but they have neglected to tell people about them. Consequently, Homeland Security needs to get its message out creatively (how about Kiefer Sutherland, a.k.a. Jack Bauer, as the department’s primary spokesman?); simply (”stay indoors for 12-24 hours”); and broadly (ask companies near large cities to have simple sheltering strategies).

The cost for such an educational campaign would surely be less than what we spend on other catastrophic terror threats ($877 million contract for an anthrax vaccine). The bottom line: The public must be educated about this issue now, because it’s a lesson we don’t want to learn from experience.”

As you would imagine, I agree with much of what Wein says in this piece. The fact is that some information on these serious unfamiliar threats can be useful to the public in advance. How best to do it still requires some study and nuance. For example, whether or not it makes sense for their to be a blanket policy for citizens to ’shelter in place’ in a nuclear event might be debated. But I think it is unassailable to tell the public before an incident — whether it be a nuclear bomb or the less potent dirty bomb — what advice they might be hearing from authorities during one.

The full study will appear in the next issue of the journal Risk Analysis.

According to the Department, three scenarios – at minimum, moderate and maximum hazard levels – were created for the survey, starting with a single dirty bomb released in the region, but not near the survey respondent. The maximum level involved a situation with multiple dirty bombs released throughout the region and exposing the population to radiation. The scenarios were varied to learn the effects of four factors: the level of hazard, whether the respondent was at home or at work, whether there was prior notice of the event, and the source of information and instructions about the event.

Among the overall findings from the report (which was done for the state by the University of Virginia Center for Survey Research and the Center for Risk Management of Engineering Systems):

* Of those at home during the event for all three scenarios, nearly 80 percent decided to stay home.

* For those at work during a minimal event (in which no shelter-in-place order is given for the respondent’s area), only 41 percent would stay at work, with 33 percent leaving to go home.

* For those at work during a moderate or maximum event when a shelter-in-place order is given, approximately 70 percent would stay at work.

Other findings include:

*The president, the Department of Homeland Security and the governor were cited as the most trustworthy sources of information, with the youngest respondents giving the president the highest level of trust.

*During the first 48 hours after a major local emergency, whether they chose to stay or to evacuate, residents expect emergency managers to supply information about the emergency and help with any needed decontamination, more than they expect food distribution or anti-looting patrols.

*About 54 percent have prepared a personal emergency plan, an emergency supply kit, or arranged a meeting place away from home for use by family members. Only 13 percent had done all three.

This appears to be a thorough, comprehensive study of an important issue — how the public would react to a dirty bomb — that has been discussed extensively on the blog. The findings would seem to report the good news that most citizens would be willing to ’shelter in place’ in their homes if that was the correct response and would follow instructions from authorities during a dirty bomb emergency. It also appears to show a relatively high level of knowledge about the dirty bomb threat among Washington-area residents.

As officials will be using the report to help develop emergency plans for the National Capital Region and surrounding areas, I would offer a couple of thoughts. I would be encouraged by the findings. But I do think that the unfamiliarity and newness of a radiological device that Americans have never experienced is something that really cannot be fully captured in a survey. These numbers might lead the authorities to think that there isn’t as much need for public education about the dirty bomb and other threats or more explanation about ’shelter in place’ vs. evacuation, or discussion of how workplaces and schools would be integrated into the response (ie. will parents be willing to stay home or at work if they don’t know what their kids are doing). That would be the wrong conclusion.

I am also concerned that there may be a little too much confidence among the survey respondents in the capacity of emergency responders (including the survey result: “During the first 48 hours after a major local emergency, whether they chose to stay or to evacuate, residents expect emergency managers to supply information about the emergency and help with any needed decontamination.”) That may not be the case in a post radiological situation. There needs to be more information provided on what those expectations really should be when it comes to radiation. And, the time to do it is not after the incident has occurred.

The survey will not only provide data for emergency planning but also help raise the profile of the issue of dirty bomb civilian response. I hope the authorities in National Capital Region and across the nation will also use it in helping to better educate and prepare their residents for this important — and unfortunately somewhat likely — possibility.

That’s why this story was so striking. It showed how the City, along with federal officials, have developed an impressive operation to combat radiological weapons — since 9/11, the New York Police Department has assigned 1,000 officers to counter-terrorism — but also underscored how uninformed and unprepared the public is for such an attack. Though the authorities have worked extensively on their plans, they have yet to really include the citizenry. According the WNYC story:

[New York Office of Emergency Management Deputy Commissioner] Kelly McKinney says one of the biggest challenges for city planners is having to inform the public about a specific emergency while at the same time educating people about an invisible threat they know little about. “Radiation is a risk that is perceived very differently by the public than it is by the experts,” McKinney says.

Lisa Gordon-Hagerty, a health physicist and one of the nation’s top experts on radiological event response, agrees. “It’s not something that is taught in schools, and it is not something that gets a proper and objective view,” she says. Gordon-Hagerty has served in leadership posts at the U.S. Department of Energy and the National Security Council and says it’s hard to inform the public about relative risk if they don’t know that radiation at background levels already occurs naturally or that forms of radiation can save lives.

“More often than not, you hear people talking about the horrific effects of being exposed to radiation,” she says. “Well, we live with it in our everyday lives and we are exposed to it in the countless numbers of people that have been saved from cancer treatments to other types of treatments involving other kinds of radioactive materials.”

Hagerty explains why the lack of citizen knowledge is dangerous:

She says without a basic understanding of radiation the public will fall back on their survival instincts, and this could have dire consequences for them and their families. “When being exposed to radiation, we have the desire, as humans, to fight or flight. Sometimes sheltering in place is the best way of minimizing exposure. So staying in the house, closing off ventilation systems, and things like that are often the most suitable way of protecting yourself,” Gordon-Hagerty says.

Dr. Michael Edelstein, a social psychologist and professor at New Jersey’s Ramapo College, noted in the story the delicate balance involved in briefing the public on these issues:

…while officials have to worry about not panicking the public, they can’t be perceived as having a hidden agenda either. He says the job for New York City officials coping with a radiological attack will be complicated by public skepticism. The Environmental Protection Agency under the Bush Administration hurt the government’s credibility, Edelstein says, when it announced that air quality around the World Trade Center after September 11 was all clear.

This may not seem like an easy discussion, but it is time for officials on the national and local levels to start it. Because as the story indicates and I have been writing on this blog, the public’s lack of knowledge is a weak link when it comes to terror readiness. David Shenk, who wrote Slate’s Survivalist column and is the author of the new best -selling and well reviewed book, The Genius In All Of Us, brought this radio story to my attention. He had his own suggestion on how to address it: “They ought to have a half-dozen Saturday press conferences with the mayor etc. educating the public about the basic to-dos and not-tos in specific emergencies.”

In a speech last week, DHS Secretary Janet Napolitano said Americans deserve a “clear appraisement” of terrorist threats. Part of that appraisement should include more specific information. It is not enough to say citizens face ‘dirty bombs’ — or nuclear, biological, chemical and other threats for that matter — without specifically explaining what they would entail and how would the public be expected to deal with them.

The warning came in a White House document, “Planning Guidance for Response to a Nuclear Detonation,” which was sent to state and local government officials earlier this year. But I’m sure that news did not come as a surprise to any of them. The article quotes a couple of experts who point out the public’s lack of knowledge and preparedness when it comes to a possible nuclear incident. But they say that even a little information could turn out to be very useful:

The prospect [of a nuclear explosion here] is anything but far-fetched, says Rick Nelson of the Center for Strategic and International Studies. “Do I think in my lifetime I’ll see the detonation of a nuclear device? I do.”

One challenge he says, will be to persuade survivors to stay indoors, shielded from dangerous radiation until they’re given the all-clear or told to evacuate. “In all likelihood, families will be separated,” he says. “It’s going to be scary to sit tight, though it’s the right thing to do.”…

…Disaster experts say local governments aren’t prepared for a nuclear attack. “There isn’t a single American city, in my estimation, that has sufficient plans for a nuclear terrorist event,” says Irwin Redlener of Columbia University’s Mailman School of Public Health.

The message for families is simple, he says: Stay put. Wait for instructions. If you’ve been outside, dust off, change, shower. “What citizens need to know fits on a wallet-sized card,” Redlener says. “A limited amount of information would save tens of thousands of people.”

Much of the focus of the Summit is to continue to monitor and improve the control of nuclear materials from around the world and keep them out of the hands of terrorists and rogue nations. The hope is that this work will prevent the actual use of a nuclear weapon. However, as this is such an important issue, I would argue that the government should also be doing more to inform and prepare the public for a possibility of such an incident. Because contrary to popular opinion, there may be concrete steps that citizens might be able to do to mitigate the impact of such a disaster.

Last summer, I wrote a post about an Institute of Medicine report, “Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report.” It said that while a home-made nuclear bomb detonated in U.S. city would likely kill hundreds of thousands of people, there are actually things that can be done to increase the survivability for many others. That is, the committee argues, if the public is informed of those steps in advance. According to an article in New Scientist magazine:

as catastrophic as such an attack would be, it would not level an entire city, and a timely response could save many lives. Recent advances in techniques for mapping the path of radioactive fallout after an attack, combined with novel therapies for treating radiation victims, will improve survival chances, the report says.

“Clearly there would be loss of life, but it’s not hopeless,” says Georges Benjamin, head of the panel of doctors and public health officials that was convened by the National Academy of Sciences to assess the nation’s level of preparedness for such an attack. “We feel that there are things that one can do to mitigate it.”

Just knowing about the value of ’shelter in place’, for example, could be a lifesaver, according to the report:

For many people, the safest option would be to seek shelter in buildings or underground. Just staying inside could slash the immediate death toll from radiation by up to a factor of 100, or even 1000, [Fred] Mettler [of the New Mexico Veterans Administration Health Center] says. However, people must be told this in advance. “Without prior education, it would be a horrible issue,” he says.

President Obama At The Nuclear Security Summit (Reuters Photo)

In 2008, the Senate Homeland Security Committee held a series of interesting hearings on nuclear preparedness which also produced some tangible things people might be able to do in the event a nuclear attack. I wrote in a post, “What You Should Do If A Nuclear Bomb Explodes Nearby“:

The headline might strike some readers as tongue in cheek — as if you can really do anything if a nuclear bomb explodes nearby. And, clearly if you are too close, there is little you will be able to do. However, it is less well know that there are things that to you can do if you are in the vicinity that might help you and your family survive such a catastrophe.

That was the message of a number of witnesses at a Senate Homeland Security Committee hearing in April, which is part of the same series of hearings on nuclear preparedness mentioned in the last post. Since I just argued that there was a need for more public education in that area, I decided to do a little of it on the blog.

Though the hearings have fargely focused on the policy and implementation issues around the work of first responders, there have been some helpful tips for the public discussed as well. And I thought I would pass them on.

I don’t expect anyone to commit every tip and instruction to memory. But I think it can be very helpful if people have heard some of the advice at least once. I think it’s even helpful to know that there are actually some actions to mitigate the impact of a nuclear explosion, which is not what many people think.

In fact, the Committee’s ranking Republican, Sen. Susan Collins (R-ME), said during the hearing that she thinks Americans have “gone backwards” since the 1950s and 1960s when it comes to knowing the facts about what to do in the event of a nuclear attack.

One important point that came up in the hearing is that fleeing a nuclear blast is often not the best strategy. According to an article by CQ’s Daniel Fowler:

“The natural inclination is to flee and what they’re going to do is they’re going to get caught in gridlock,” said Cham E. Dallas, director of the Institute for Health Management and Mass Destruction Defense at the University of Georgia. “They’re going to get caught in gridlock because everyone else will be fleeing, and that is not viable. Most people should not flee” because they won’t be affected.

Ashton B. Carter, co-director of the Preventive Defense Project at the John F. Kennedy School of Government, echoed the sentiment. “Certainly most of my friends and family who don’t do this, they think that a nuclear weapon levels an entire city and that anybody nearby better get out of the way or they’re going to get covered in radiation,” Carter said after the hearing. “That’s just not true.”

In fact, Dallas’ written testimony said, “The highest impacts of radiation generally occur when people are caught in the open, or are tied up in traffic jams trying to escape in vehicles which provide little protection against fallout.”

As part of his testimony, Dallas presented visuals of the impact of a 10-kiloton (kt) detonation near the White House. He said the bombs dropped on Hiroshima and Nagasaki were only slightly larger. Both Dallas and Carter said 10 kt is the standard reference.

“It could be expected that there would be at least 150,000 serious injuries and that at least 70 percent of these could involve fatalities,” Dallas said in his written testimony. “Depending on the resources made available at the time, it is likely that there would be an attempt to evacuate as many as 500,000 people from the area, though the efficacy of such an attempt is dubious.”

“This would be the worst disaster to befall the country, but it’s not the case, as many believe, that the entire city would be destroyed,” Carter said after the hearing. “Most of the people in this city would be unaffected — and those that were affected but not killed would have a great chance to save themselves.”

Carter said most Washington residents wouldn’t need to leave their homes even if the nuclear weapon went off downtown “because the radioactive debris would be carried downwind from them.”

In response to a question from Chairman Joseph I. Lieberman (I-CT) about what the most important thing the federal government can do to be prepared to respond the day after a nuclear attack, Dallas said his priority would be to get the truth out about the limited, but serious, impact of such a scenario.

“The misconceptions of the public about radiation are incredible,” he said.

Clearly, the first priority in nuclear security is trying to prevent the use of the weapons as is the objective the Summit. However, as part of the nation’s nuclear preparedness some attention should be paid to informing and readying the public just in case.

FEMA has scheduled its 2010 “National Level Exercise” (formerly called TOPOFF) — which is designed to test the capabilities of local, state and federal responders to catastrophic events — for Las Vegas in May. The planned scenario is a mock nuclear blast; 10,000 responders are expected to participate in the drill.

However, the Las Vegas Visitors and Convention Authority, backed by the state’s senior senator, Majority Leader Harry Reid, is asking FEMA to postpone the drill, and if not at least change the scenario from a terrorist attack to natural disaster, citing the city’s economic woes.

Reid sent a letter to U.S. Homeland Security Secretary Janet Napolitano arguing:

“At a time when Las Vegas is beginning to recover from these economic ills, to simulate a nuclear detonation in the heart of the city would unacceptably harm the Southern Nevadan economy…at this time, economic recovery efforts would be stymied, or reversed entirely, by artificially creating anxiety surrounding tourism and investment in Las Vegas.”

The senator’s web site has this addendum:

“While Reid acknowledges the importance of these training exercises and appreciates FEMA’s recognition of Las Vegas as a high profile target, holding such an event at this time would create unnecessary anxiety and harm efforts to boost tourism and investment in Las Vegas.”

I realize the concern is that the exercise will highlight the fact that Sin City is a top potential terror target. But it probably is, something Reid acknowledges in the letter. I find somewhat farfetched to believe that having a drill there will impact tourist/conventioneer decisionmaking? I covered the TOPOFF 3 drill in 2005 in New Jersey and Connecticut, which also included a weapons of mass destruction simulation. I don’t think that had much of an effect on slot playing at Atlantic City and or Connecticut’s Foxwoods & Mohegan Sun casinos.

The opposition to the disaster drill is a bit ironic as the #1 movie on screens across the U.S. for the past couple weeks has been “2012″ in which the entire Vegas Strip is dramatically destroyed in a…disaster. Do you think audiences are changing their travel plans upon leaving the theater?

THE LAS VEGAS STRIP IN THE CURRENT DISASTER MOVIE “2012″ (ABOVE)

The thing that bothers me most here is not about the exercise itself, but the contention that somehow having a practice drill with a nuclear weapon would scare Americans from traveling to Vegas. It just plays into the narrative (I would say canard) that the public cannot handle any discussion of serious potential terror threats (particularly involving weapons of mass destruction) without becoming scared out of their wits. And as a result, it prevents our leaders from having an open dialogue which might actually improve our ability to respond to a scenario — which has been acknowledged as a possibility by U.S. Presidents of both parties.

One of the major themes of this blog is that there is a need for government officials to raise potentially ’scary’ topics with the populace but do it in a responsible, constructive way  – and that public can deal with that information if it is delivered in a trustworthy manner in the proper context. Conducting a nuclear explosion drill does not mean that officials expect such an incident to happen in Vegas any time soon, but the possibility makes it useful to train for such a catastrophic occurrence — and I believe Americans will comprehend that.

I understand that Senator Reid is just trying to be responsive to his constituents. But is his opposition here really serving Nevadans best interests? An article in the Las Vegas Review-Journal last week indicated that FEMA has already agreed to move the exercise off of the main Vegas Strip to another location in the County. With the Majority Leader up for reelection in 2010, I imagine there may be some armtwisting done on DHS to make further changes, including postponing the drill. But if the FEMA believes the Vegas nuclear exercise is important, I hope the agency ends up making the decision based on preparedness rather than politics.

Lieberman and ranking member Sen. Susan Collins (R-ME) introduced a bill that would implement many of the extensive recommendations of the commission’s report, World at Risk. “The mental images of mushroom clouds and nuclear blasts are powerful and frightening,” Lieberman said. “But as the Graham -Talent Commission rightly notes, the more likely terrorist threat is from a biological weapon,”

While there is some debate among experts on which weapon of mass destruction, biological or nuclear, is more likely (and which is the more serious threat), there is general agreement that both would be very serious and  would probably be much worse than the other two threats — chemical and radiological — that are usually included in the term’ WMD’ (including by the Commission itself). Yet, as the Commission itself reports, the latter two are not weapons of mass destruction in the same category as the first two. It’s not that chemical or radiological attacks would not kill ‘mass’ numbers of people, but the potential magnitude is much different.

The question of ‘WMD’ nomenclature came up yesterday with the indictment of Najibullah Zazi for conspiring to use “weapons of mass destruction” in connection with a terror plot, news reports say, to set off explosives here in New York City along the lines of the July 2005 bus attacks on London’s subway and bus system. Those bombings were horrific; 56 people were killed and many more people could have died. But the scope of casualties from a ‘traditional’ explosives is likely not be at the level of what potentially could happen in a biological or nuclear incident. I would guess that there was probably some confusion among the public upon hearing Zazi’s bombing plot being characterized in the indictment as a “weapon of mass destruction.”

In a post after the WMD Commission released its report, I argued that the term ‘WMD’ should be redefined and why I think it matters and isn’t just semantics. An excerpt is below:

In its report, the WMD Commission argues that the incoming Administration should make an effort to inform and engage the public on the subject of WMD’s. I agree. And, I suggest officials consider starting that process by defining (or redefining) what a WMD actually is. At present, it is most common to define a WMD for the public as a chemical, biological, radiological, and nuclear (or “CBRN”) weapon.

The Commission report, however, focuses primarily on the dangers of biological and nuclear terrorism, both of which could be absolutely catastrophic. By contrast, a chemical or radiological (better known as a ‘dirty bomb’) weapon could be very serious but would likely not cause as much lasting damage. In fact, both a chemical and radiological attack would likely be a one-shot event seriously impacting those directly near the event, closer in result to a ‘traditional’ terrorist bombing. A nuclear bomb or biological incident, however, could have wide and long-lasting ‘mass destruction’ impact to humans, property and the society itself.

As the report’s Executive Summary explains:

“While the mandate of the Commission was to examine the full sweep of the challenges posed by the nexus of terrorist activity and the proliferation of all forms of WMD-chemical, biological, radiological, and nuclear-we concluded early in our deliberations that this report should focus solely on the two types of WMD categories that have the greatest potential to kill in the most massive numbers: biological and nuclear weapons.”

When I speak to experts, they tend to divide nuclear and biological from chemical and radiological. I believe they should be communicating that dichotomy to the public. In fact, I believe that a vital part of educating and engaging citizenry on terrorism is giving them a more precise sense of potential terror weapons. It turns out that some of those threats are actually not as scary the more you know about them. But the time to tell people is before an incident not during it. That’s important because it allows policymakers and responders to focus time, money and public attention on the most dangerous threats.

The Obama Administration has taken the advice of the Commission and will appoint a WMD Czar, Gary Samore. I would hope that one aspect of his job is public education — and that defining (or redefining) what exactly WMD’s are is part of that effort.

Obviously, what we call these weapons is far less important than to preventing their use. But words do matter particularly on these sensitive, serious matters. And, therefore, I do think that better defining WMD’s for the public is something worth taking up.

…as catastrophic as such an attack would be, it would not level an entire city, and a timely response could save many lives. Recent advances in techniques for mapping the path of radioactive fallout after an attack, combined with novel therapies for treating radiation victims, will improve survival chances, the report says.

“Clearly there would be loss of life, but it’s not hopeless,” says Georges Benjamin, head of the panel of doctors and public health officials that was convened by the National Academy of Sciences to assess the nation’s level of preparedness for such an attack. “We feel that there are things that one can do to mitigate it.”

Just knowing about the value of ’shelter in place’, for example, could be a lifesaver, according to the report:

For many people, the safest option would be to seek shelter in buildings or underground. Just staying inside could slash the immediate death toll from radiation by up to a factor of 100, or even 1000, [Fred] Mettler [of the New Mexico Veterans Administration Health Center] says. However, people must be told this in advance. “Without prior education, it would be a horrible issue,” he says.

One crucial factor will be for the authorities to get an instant picture of where the fallout is going and its quantity and speed. This will make it possible to figure out who should seek shelter and who should evacuate – and in which direction. It will also ensure that rescuers are not sent on “suicide missions” into areas of high radiation.The National Atmospheric Release Advisory Center (NARAC) at the Lawrence Livermore National Laboratory in California has for years been charged with providing predictions to emergency planners within a few minutes of serious incidents involving a release of radioactivity. NARAC’s model would be used to guide planes and helicopters equipped with radiation detectors, whose measurements would in turn refine the model’s predictions.

NARAC is now working to improve its modelling software to take into account variations in wind speed and direction in three dimensions and fluctuations over time; the last version assumed winds vary only with height. It will also take into account the way rain can scrub fallout from the air and deposit it on the ground. While this would prevent fallout drifting so far, it would also mean that larger amounts of radiation are deposited sooner and in different places than if there were no rain.

Even with prompt predictions and the possibility of broadcasting them by radio, it is likely that many people would not be aware of what they need to do or would fail to reach shelter in time. The result would be exposure to high levels of radiation, which inflicts its most immediate damage on rapidly dividing cells such as bone marrow and the lining of the gut.

Damage to bone marrow leads to reduced production of key immune cells and blood-clotting platelets. Very low levels of platelets can trigger dangerous bleeding even without any injury. Damage to the gut lining triggers internal bleeding, which is worsened by a lack of platelets. This in turn allows bacteria to leak into other parts of the body, resulting in potentially deadly infections, which are made worse by the lack of immune cells.

Two drugs approved last year could help cut down such complications, says panel member Nelson Chao of Duke University in Durham, North Carolina. Amgen’s Nplate (romiplostim), and GlaxoSmithKline’s Promacta (eltrombopag) were approved for use in people with a rare condition that keeps their platelets in chronically short supply. Chao says they might also help boost platelet numbers in radiation victims, preventing dangerous blood loss and infections.

To me, this report underscores the need to inform and engage the public on preparedness for even seemingly low probability/high impact emergencies such as nuclear terrorism. Just knowing a couple of small, easy to remember steps such as sheltering in place or not looking into the flash might be very useful.

The report can be purchased or read online for free at the National Academies Press website here. Thanks to David Shenk for bringing this article to my attention.

That was the message of a number of witnesses at a Senate Homeland Security Committee hearing in April, which is part of the same series of hearings on nuclear preparedness mentioned in the last post. Since I just argued that there was a need for more public education in that area, I decided to do a little of it on the blog.

Though the hearings have fargely focused on the policy and implementation issues around the work of first responders, there have been some helpful tips for the public discussed as well. And I thought I would pass them on.

I don’t expect anyone to commit every tip and instruction to memory. But I think it can be very helpful if people have heard some of the advice at least once. I think it’s even helpful to know that there are actually some actions to mitigate the impact of a nuclear explosion, which is not what many people think.

In fact, the Committee’s ranking Republican, Sen. Susan Collins (R-ME), said during the hearing that she thinks Americans have “gone backwards” since the 1950s and 1960s when it comes to knowing the facts about what to do in the event of a nuclear attack.

One important point that came up in the hearing is that fleeing a nuclear blast is often not the best strategy. According to an article by CQ’s Daniel Fowler:

“The natural inclination is to flee and what they’re going to do is they’re going to get caught in gridlock,” said Cham E. Dallas, director of the Institute for Health Management and Mass Destruction Defense at the University of Georgia. “They’re going to get caught in gridlock because everyone else will be fleeing, and that is not viable. Most people should not flee” because they won’t be affected.

Ashton B. Carter, co-director of the Preventive Defense Project at the John F. Kennedy School of Government, echoed the sentiment. “Certainly most of my friends and family who don’t do this, they think that a nuclear weapon levels an entire city and that anybody nearby better get out of the way or they’re going to get covered in radiation,” Carter said after the hearing. “That’s just not true.”

In fact, Dallas’ written testimony said, “The highest impacts of radiation generally occur when people are caught in the open, or are tied up in traffic jams trying to escape in vehicles which provide little protection against fallout.”

As part of his testimony, Dallas presented visuals of the impact of a 10-kiloton (kt) detonation near the White House. He said the bombs dropped on Hiroshima and Nagasaki were only slightly larger. Both Dallas and Carter said 10 kt is the standard reference.

“It could be expected that there would be at least 150,000 serious injuries and that at least 70 percent of these could involve fatalities,” Dallas said in his written testimony. “Depending on the resources made available at the time, it is likely that there would be an attempt to evacuate as many as 500,000 people from the area, though the efficacy of such an attempt is dubious.”

“This would be the worst disaster to befall the country, but it’s not the case, as many believe, that the entire city would be destroyed,” Carter said after the hearing. “Most of the people in this city would be unaffected — and those that were affected but not killed would have a great chance to save themselves.”

Carter said most Washington residents wouldn’t need to leave their homes even if the nuclear weapon went off downtown “because the radioactive debris would be carried downwind from them.”

In response to a question from Chairman Joseph I. Lieberman (I-CT) about what the most important thing the federal government can do to be prepared to respond the day after a nuclear attack, Dallas said his priority would be to get the truth out about the limited, but serious, impact of such a scenario.

“The misconceptions of the public about radiation are incredible,” he said.

While we are on the topic, I thought I would add a few more tips to help address some of those misconceptions. They come from a recent San Francisco Chronicle article about a National Academy of Sciences conference this month on medical preparedness for a nuclear attack.

– If there is any warning, take cover – in a basement or heavily reinforced building.

– Lie flat on the ground and cover your head. If the explosion is some distance away, it could take 30 seconds or more for the shock wave to hit.

– Do not look at the flash or fireball, which can blind you.

– Avoid windows, which can shatter and injure.

– Listen to official instructions. If authorities say it is safe to evacuate, do so quickly.

– Otherwise, remain sheltered in place – even if you are many miles from the blast site, because wind can carry radioactive fallout for hundreds of miles.

To be precise, Lieberman asked the hearing witnesses to rate how ready the U.S. is for a nuclear attack (not specifically the public) on a scale of 1 to 10, with 10 being “totally prepared” and one being “totally unprepared,” according to a story by CQ’s Daniel Fowler:

“I would say . . . representing the locals that it’s probably in the four to five range,” said James H. Schwartz, chief of the Arlington County Fire Department, who was speaking on behalf of the International Association of Fire Chiefs. “And, I realize we’re being somewhat arbitrary here.”

At the other end of the spectrum was Federal Emergency Management Agency Administrator R. David Paulison, who gave the highest score of the three federal officials who testified. Paulison rated the preparedness to respond at a seven, while Health and Human Services’ W. Craig Vanderwagen said it was “probably around a six, maybe a five,” and the Defense Department’s Paul McHale ranked it at “probably a five.”

The officials agreed that a good deal of improvement in preparedness has been made since 9/11.

“I would say on Sept. 11, we would have struggled to be a two,” Mc Hale said. “Today, we are probably a five. And to improve our capabilities in the face of a challenge that is almost impossible to calculate, the consequences of a 10-kt nuclear detonation in the heart of a major American city, I think from a DOD standpoint, now that we have designed the right kinds of capabilities . . . we’ve got to bring an operational reality to the concepts that we’ve developed.” McHale suggested it would be possible to move from a five to an eight.

I mention this hearing, as it regards citizen preparedness, for two reasons:

1) If Lieberman’s question had been to rate the public’s preparedness for a nuclear explosion, I can’t believe any of the officials could have given anything more than a “1″. Though overall first responder readiness for such a major catastrophe has markedly improved since 9/11, the public’s knowledge and preparedness has not. It needs to, and these hearings are good first step towards determining what needs to be done in that area.

2) The fact that the Defense Department’s McHale only promised making the level of preparedness an 8 is a good lesson for the public. We should not expect 10’s either in preparedness or response. We should expect competence and strive for excellence, but we are not going to stop every attack and respond perfectly to every catastrophe. Even if it was possible, it would cost too much. We should not be promising 10’s to the public, and they should not expect it.

In fact, though yesterday’s hearing was called “Nuclear Terrorism: Providing Medical Care and Meeting Basic Needs in the Aftermath”, a good deal of the witness statements focused on public communications shortfalls. There was a consensus in the hearing that there is a real need for far better public communications before and during a nuclear attack. According to Committee Chairman Senator Joseph Lieberman (I-CT) improving that area could ”save a lot of lives.”

The hearings have reinforced my strong belief there is a need to develop a new strategic plan for public communications before and during a nuclear attack but also for any catastrophic emergency.

At today’s hearing, witnesses agreed that the American public is not at all prepared or informed enough about the nuclear threat. There were a number of reasons discussed to explain for the current situation. But I was struck most by Senator Lieberman’s observation that emergency response officials — both national and local — shy away from talking about the possibility of a nuclear incident with the public. In fact, he observed that officials are very happy to discuss hurricane plans with their citizenry but not other more ’scary’ threats like nuclear terrorism. It is something that I have seen as well and have expressed concern about.

In his testimony, Joe Becker of the Red Cross pointed out:

“The investment in telling American citizens ahead of time what to do in a nuclear scenario has not been made on the appropriate scale. We need to make it easy for Americans to know — and to have accessible in advance — what steps to take in a nuclear terrorism event.”

Ira Helfand of Physicians for Social Responsibility offered a specific example in his statement:

“We need to have in place an effective means of communication an order to evacuate or to shelter the public, and we need to do enough prior education so that people ordered to shelter in place will be able to understand why this is the best thing to do instead of jumping in their cars and trying to drive as fast as they can away from that terrible mushroom cloud hanging over their city.”

Columbia University’s Irwin Redliner pointed out the need to correct some some myths about a nuclear attack, including “The Myth of Extreme Improbability” and ”The Myth of Planning Futility”, so the public (and their leaders) understood the situation. In the questioning, Redliner even offered some concrete tips (ie. don’t stare into the fireball) about reacting to nuclear explosion that he has told his kids who live in New York and that he feels every American (including Senator Lieberman’s kids who live there as well) should be told in advance.

As these hearings have underscored, there is a real need to look at our existing disaster communications for citizens — from DHS, CDC, FEMA, states, cities, the Red Cross, etc. — and begin to build a new model reflective of the threats and challenges of the 21st Century.