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Local, State, and Regional Perspectives and Programs

Few state and local health departments have begun to develop concrete plans for an improvised nuclear device (IND) attack, despite considerable guidance from the federal government. Speaker Mitch Stripling, director of emergency planning for the New York City Department of Health and Mental Hygiene, described this problem as one of translation, i.e., turning federal guidance into concrete state and local policies. He offered three strategies to facilitate translation:

1. Focus on developing criteria for which communities are held accountable, rather than focusing on a specific set of capabilities that they do or do not possess.

2. Demystify the science and develop specific tools for cities and outlying communities so that they can assess their risk and initiate planning.

3. Build political support for IND attack planning at local and state levels.

PLANNING FOR AN IND ATTACK: A CASE STUDY

Federal Emergency Management Agency (FEMA) Region 5, in the Midwest of the United States, was one of the first regions to initiate planning for an IND attack. The planning is being conducted through a series of summits, working groups, and workshops. More than 300 local, state, federal, and private-sector partners have participated during the past 2.5 years, including elected officials and governors. The goal of the exercise is to develop a formal plan for the region that also can serve as a template for other FEMA regions throughout the nation, said Andrew Velasquez, regional administrator for FEMA Region V.

The planning is focused on the first 72 to 96 hours after a 10-kiloton (kt) IND detonation in the middle of a working day in the heart of a large metropolitan area’s business district. Based on modeling by the Department of Energy’s national laboratories, Velasquez said, the blast would be expected to incapacitate large segments of federal, state, and local government. The modeling postulates are described in Box 4-1.

Velasquez continued to describe the postulated scenario, saying that secondary casualties would be expected from the brilliant flash of light associated with detonation. The flash can cause temporary blindness lasting seconds to minutes for anyone who is outdoors within 5 miles of the blast. Although the effect is only temporary, the abrupt loss of vision to drivers and pilots could cause roadway and airline crashes and, as a result, might make roads impassable. The staggering extent of casualties would be expected to overwhelm the affected city’s hospitals, where occupancy rates are already likely to be high, as they are generally high across the nation. The planners estimate that only 15,000 free beds would be available for handling hundreds of thousands of casualties. Planners also predict that pharmaceuticals and supporting medical equipment

would be in short supply. These shortfalls would likely reverberate through regional hospitals in outlying communities.

Infrastructure and Personnel Vulnerabilities

Planners are also considering the effects of an IND attack on key infrastructure, namely, electrical, communications, water, sewer, and fuel systems. According to Velasquez, they expect that a failure of one system might lead to failure in another. Damage to the electrical grid from the electromagnetic pulse that may occur after an IND detonation is likely to disrupt communications and medical equipment (Vandre et al., 1993). Planners also expect the city’s water intake and distribution system to be disrupted, with millions of people expected to lose their water supply. Without water, hospitals are unable to operate and firefighters are unable to the control ubiquitous fires set off by the IND’s thermal effects. Planners also anticipate a reduction in fuel because of the failure of the electrical system. Fuel disruption not only affects residents, but also hampers movement of emergency vehicles. The broad damage to infrastructure presents momentous challenges, Velasquez observed.

The planners conclude that first responders must be self-sustaining for a significant period of time because of the damage to the fuel, water, and electrical systems. Based on modeling and the data collected through planning workshops, planners are able to estimate the amount of fuel, water, and power needed to support the response effort through the first 96 hours of operation.

In the next stage of planning, Velasquez expects to develop detailed and concrete plans to focus on core capabilities, including operational communications, public information and warning, mass care services,

critical transportation, public and private services, operational coordination, command and control, and situational assessment. The planning thus far focuses on building strong interagency relationships and an understanding of the resources and assets that exist within the region that can be utilized in an event of this magnitude.

EFFORTS IN A LARGE METROPOLITAN REGION

Alonzo Plough, the director of emergency preparedness and response in Los Angeles County, spoke about the planning activities for that county, which serves a population of 11 million across 88 cities, multiple school districts, and several fire departments. Los Angeles County, he said, is more like a region than a county in terms of its size and complexity.

Los Angeles County has conducted some planning for an IND or radiation incident and has 25 staff dedicated to a radiation unit. It held a training activity based on modeling by Brooke Buddemeier of Lawrence Livermore National Laboratory. Following this, the county worked for almost a year in collaboration with FEMA and other federal, state, and local agencies on the response during the first 12 to 48 hours after an incident—the time they will have to wait until the arrival of massive federal assistance. Through this effort, Los Angeles County completed a multiple-agency radiation response plan (Kaufman, 2011), which specifies roles and responsibilities of a variety of Los Angeles County agencies in the event of an IND or other radiation event. The plan was completed with support of the Centers for Disease Control and Prevention (CDC), and Los Angeles County is one of few jurisdictions with a plan in place for the early phases of a radiological emergency.

Lessons Learned

Plough spotlighted several lessons learned from the planning experience. The first is that communication with the public is a key factor in effective planning. His experience has been that the success of post-event communication depends on strong pre-event communication and the establishment of trust in health officials among the public. Strong communication is essential to ensuring that the population stays in shelter for the first 12 to 24 hours. Los Angeles County has taken the initiative to de-

velop public communication and warning activities. It has created a joint information center focusing on radiation incidents and has also developed an information card advising each county agency on the steps to take in the first 30 minutes after an incident.

A second lesson Plough highlighted is that fire departments will require special training for an IND detonation. The main reason is that firefighters are drilled in the importance of scrambling to the site of the emergency and thus will find it counterintuitive to refrain from entering the severe damage zone. Another lesson is that the roads are likely to be impassable, given the county’s experience with frequent and massive gridlock. The upside of gridlock is that it may help persuade residents to shelter in place, Plough noted.

His department has not only made plans with the school system for dealing with mass casualties, but has also made similar plans with hospitals. Although the hospital-based exercises are designed to practice response to an earthquake, Plough said, the experience will also be valuable for planning a response to an IND attack. In his view, an IND can be seen as part of a continuum for catastrophe planning. There are important differences between IND attacks and disasters of other types, but experience with other disasters has helped to build capabilities that can be exploited, regardless of catastrophe type.

EFFORTS IN AN OUTLYING COMMUNITY

Ventura County, California, is one of the few outlying communities to have developed a full-fledged disaster plan for responding to an IND detonation in a nearby city, which in this case would be Los Angeles. Ventura County has infrastructure that supports 832,000 residents. According to Robert Levin, the medical director for Ventura County Public Health, the Ventura County Nuclear Explosion Response Plan expects that within a day or two of such a detonation, an additional 2 million people would arrive in the county. These people would need to eat, drink, use toilets, and be able to park at least 1 million additional cars. Many vehicles and gas stations would be out of gas, and vehicles would be littering highways and surface streets. The hospitals would likely be overstretched, Levin said, as there are only 1,500 hospital beds in the county. The county’s plan includes working with law enforcement and hazmat groups as well as with a plume trackers group.

Pre-Event Risk Communication

Through the planning process, Levin and colleagues realized that a top priority was to inform citizenry as to what steps they could take to protect themselves and loved ones and to urge citizens to welcome into their homes friends from Los Angeles. In July 2010, JAMS, a public relations firm in Los Angeles, began working with the public health department in Ventura County to develop a strategy to educate the public on how best to respond to a nearby IND detonation. The plan is based on a series of town hall meetings. With a subsequent CDC grant, the county developed an educational video and a more detailed plan for a public information campaign. The video features Levin, the chief county health official, spreading the shelter-in-place message “to get inside, stay inside, and stay tuned.” The language was coordinated with other nuclear preparedness planners nationwide. The information campaign will be launched through a number of town meetings, and it will be bolstered by an informational website, thanks to an additional grant from FEMA.

Levin realized that children and their parents constitute a critical audience that warrants separate messaging, because parents are unlikely to heed the shelter-in-place recommendation if it means they are separated from their school-age children at the time of the event. In 2012 the county began to meet with superintendents of its 23 school districts. In subsequent months, the county produced reports addressing a nuclear explosion classroom disaster plan, a curriculum for teachers, frequently asked questions, and talking points for parent-teacher association leadership.

NEW YORK CITY EMERGENCY MEDICAL SERVICES

The New York City region, the nation’s largest metropolitan area, has 67 emergency medical services (EMS) agencies with more than 1,300 ambulances. The New York City Fire Department runs the EMS system and its communication centers, which are shared with the police department, explained Mordechai Goldfeder, a senior health and medical planner at New York City’s Office of Emergency Management. There are actually two command centers, one of which is far removed from the other, in the event that one of them is compromised by an IND attack or other cata-

strophic event. Through participation in local and regional catastrophic planning groups, New York City has standing memoranda of understanding with nearby counties and the State of New Jersey to bring in extra ambulances and other assets if needed. If the region as a whole does not have the resources needed, which would likely occur in the event of an IND incident, New York City has the option of drawing on the National Ambulance Contract, which was used for Hurricane Sandy. The National Ambulance Contract, which can provide 300 ambulances, 25 air ambulances, and paratransit for 3,500 people to support mass evacuations, has been activated several times since its inception in 2007, supplementing emergency medical transport resources during hurricanes Dean, Gustav, Ike, and Irene and the presidential inauguration in 2009 (AMR, 2011). However, it is important to note that its resources are limited.

As was pointed out in the discussion session by Irwin Redlener of Columbia University, despite available EMS assets, studies suggest that emergency workers may sometimes be unwilling to respond, particularly in pandemic flu and radiological incidents (Barnett et al., 2012; Garrett et al., 2009). Discussants thought that lack of training and education in this area also contributed to the unwillingness and atypical fear of responders to get involved. Redlener also pointed out that the number of ambulances available to New York City—even with surge capability from local, state, regional, and national sources—will be insufficient to deal with mass casualties in the range of tens to hundreds of thousands, as would be predicted for a 10-kt IND detonation in a major city. “The scale is so disconnected to reality,” he said.

In summing up the presentations, John Hick, Hennepin County Medical Center, observed that there were two somewhat opposing themes: One, that there is a great deal of potential resources available, but, two, there is no level of preparedness that will be clearly sufficient for an IND attack because there is no history of events of this type to help guide planning.

SUMMARY

Few U.S. regions, cities, or outlying communities have plans—whether under way or completed—to respond to an IND detonation. FEMA Region V, with state, local, and federal partners, has been working for almost 3 years to develop a region-wide plan. Once the plan is

completed, FEMA hopes that it will serve as a model for other regions. The plan focuses on the first 72 to 96 hours post-detonation and envisions widespread destruction of infrastructure, including loss of power, communication, fuel, water, and sewer systems. Knowing that the National Ambulance Contract is available to cities in need of augmented emergency transport is encouraging, but with the effects of an IND attack rippling beyond one or two communities, it is important for localities to plan together as regions and to understand the limitations of federal resources.

Los Angeles County, after learning specific lessons concerning the importance of strong public communications, the need for specialized firefighter training, and the value of school and hospital partnerships, realized that IND attack planning can be applied to any “all-hazards” planning and that it falls into the continuum of overall preparedness for any incident. The county, after studying which agencies can respond the fastest and with the right capabilities, has completed an integrated multiagency radiation response plan, using 13 playbooks, which clarifies the roles and responsibilities of different county departments. Nearby Ventura County has also developed a formal plan for responding to a detonation in the city of Los Angeles, understanding that it will receive thousands of evacuees, perhaps as many as a million, which would stress the county’s infrastructure and resources. A key feature of the county’s plan is to establish effective risk communication through a robust information campaign. The intent is to ensure that the public has a better understanding of IND risks and vulnerabilities, so that members of the public may better adhere to shelter-in-place recommendations made by authorities. These case studies of different cities tackling nuclear response planning at the local and regional level are examples of beginning steps in the translation of federal guidance into actionable implementation.