Regional Health and Public Health Preparedness for Nuclear Terrorism: Optimizing Survival in a Low Probability/High Consequence Disaster

The United States remains unprepared to cope with the possibility of an attack on a major city by terrorists capable of acquiring and detonating an improvised nuclear device. Long-held anxieties about the non-survivability of nuclear war promulgated during the intense U.S.—Soviet arms race from the late 1940s through the 1980s, and reluctance to consider low probability/high consequence events among local disaster planning priorities, are barriers to developing plans that could dramatically save lives in the event of a terrorist-based nuclear detonation. This paper begins by describing the reality of the threat of nuclear terrorism to the United States and the enormous scale of lives lost and physical destruction that would result from the detonation of even a small improvised nuclear device (IND) in an American city. It then systematically lays out the gross inadequacy of current response capabilities, and highlights the critical unmet need for urgent, deliberate and well-funded planning efforts to address those deficiencies. In the Recommendations section, Columbia University‘s National Center for Disaster Preparedness (NCDP) calls for targeted public health and medical care regional planning and response efforts focused on “gray zones“—areas where significant life-saving opportunities would exist following an IND detonation, and where preparedness planning and proper training can meaningfully enhance survival and recovery.