Preparedness for a ‘no-notice’ mass-casualty incident: a nuclear detonation scenario

Abstract

Purpose

An effective response for a mass-casualty incident requires understanding the relevant basic science and physical impact; detailed preparedness among jurisdictions; and clear, sequential response planning, including formal operational exercises, logistics, interagency, and public-private coordination, rapid activation of resilience, and continual improvement from lessons learned and new knowledge. This ConRad 2021 meeting report describes steps for civilian medical and public health response planning for a nuclear detonation; the utility of this type of planning for broader application; and extension of this planning to the international community.

Conclusion

A nuclear detonation requires a response within minutes to what will be a large-scale disaster complicated by radiation, including some elements that are similar to a broad range of incidents. The response could be further complicated if multiple incidents occur simultaneously. Required are detailed planning, preparedness and scripting for an immediate operational response, addressing clinical manifestations of evolving radiation illness, and flexibility to adapt to a rapidly changing situation. This need translates into the use of just-in-time information; effective, credible communication; situational awareness on a global scale; and a template upon which to apply capabilities in a multi-sector response. This effort is greatly facilitated using a ‘playbook’ approach, the basics of which are presented.

Keywords:

• Response
• disaster response
• mass-casualty
• nuclear detonation
• radiation accident
• emergency playbook

Acknowledgments

The authors acknowledge that many additional participants are and will be involved in this overall project, too numerous to include in this meeting-related report.

Disclosure statement

This communication is an extended description of a presentation by Dr. Coleman at the Conference on Radiation Topics (ConRad) 2021 meeting held virtually in Munich, Germany, 10–12 May 2021. The content represents the personal opinions of the authors and is not the opinion or policy of their institutions, including the Office of the Assistant Secretary for Preparedness and Response, the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the Department of Health and Human Services. The authors report no conflicts of interest.

Additional information

Notes on contributors

C. Norman Coleman

C. Norman Coleman, MD, is Associate Director of the Radiation Research Program, National Cancer Institute; Senior Medical Advisor in the Office of the Assistant Secretary for Preparedness and Response; and a co-chair of the Radiological-Nuclear Threats Working Group of the Global Health Security Initiative.

Kenneth D. Cliffer

Kenneth D. Cliffer, PhD, is a Senior Program Analyst in the Planning Division of the Office of Strategy, Policy, Planning, and Requirements, the Office of Incident Command and Control, the Office of the Assistant Secretary of Preparedness and Response, Office of the Secretary, the U.S. Department of Health and Human Services, Washington, DC.

Andrea L. DiCarlo

Andrea L. DiCarlo, PhD, is the Director of the Radiation and Nuclear Countermeasures Program, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD.

Mary J. Homer

Mary J. Homer, PhD, is the Chief of the Radiological and Nuclear Countermeasures program, Division of Chemical, Biological, Radiological, and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary of Preparedness and Response, Office of the Secretary, the U.S. Department of Health and Human Services, Washington, DC.

Brian R. Moyer

Brian R. Moyer, MS, CNMT, is a Senior Science Advisor for the Radiological and Nuclear Countermeasures program, Division of Chemical, Biological, Radiological, and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary of Preparedness and Response, Office of the Secretary, the U.S. Department of Health and Human Services, Washington, DC.

Shannon G. Loelius

Shannon G. Loelius, PhD, is a Biologist in the Radiological and Nuclear Countermeasures program, Division of Chemical, Biological, Radiological, and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary of Preparedness and Response, Office of the Secretary, the U.S. Department of Health and Human Services, Washington, DC.

Adam W. Tewell

Adam W. Tewell is an Emergency Management Specialist supporting international health operations in the Office of Emergency Management and Medical Operations, Office of the Assistant Secretary of Preparedness and Response, Office of the Secretary, the U.S. Department of Health and Human Services, Washington, DC., and serves in the Executive Secretariat of the Radiological-Nuclear Threats Working Group of the Global Health Security Initiative.

Judith L. Bader

Judith L. Bader, MD, has been a contractor supporting the Radiological and Nuclear Countermeasures program, Division of Chemical, Biological, Radiological, and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary of Preparedness and Response, Office of the Secretary, the U.S. Department of Health and Human Services, Washington, DC. She has served as the managing editor of the ASPR-sponsored web site REMM (DHHS 2021a).

John F. Koerner

John F. Koerner, MPH, CIH, is a Senior Program Analyst in the Planning Division of the Office of Strategy, Policy, Planning, and Requirements, the Office of Incident Command and Control, the Office of the Assistant Secretary of Preparedness and Response, Office of the Secretary, the U.S. Department of Health and Human Services, Washington, DC.