In 2009, the History Channel ran a movie called the “Day After Disaster,” which was about the detonation of a suitcase nuclear device in the nation’s capital. Over the course of nearly 90 minutes, various experts provided commentary on what the consequences might be for this type of terror attack, not just for the District of Columbia and the national capital region but also for the nation as a whole. Among the implications mentioned, hospitals and other healthcare facilities would face tremendous strain.
Magnitude of the Incident If an event like this were to actually occur, the consequences would be unlike any before in the United States. Some sobering details in the movie highlighted the challenges that the remaining part of any city’s healthcare infrastructure, the adjoining region, and the national response system would face:
- Five thousand or more persons in the 0.6-mile epicenter (Zone 1) would be “vaporized,” including first responders whose assignments place them near the nuclear device at the time of detonation. The blast also would destroy buildings and other tangible items within this zone.
- Ten thousand more people would die from the “flash of light” that would occur seconds after the initial explosion; and 15,000 additional people would be seriously injured from blast-wind debris and scalding heat – including some with temporary and permanent “flash blindness.”
- The subsequent mushroom cloud that would occur a short time later and create a fallout zone of approximately 20 miles would kill and injure thousands more.
- The resulting electromagnetic pulse would sever power to electronic equipment, including but not limited to: airplanes in the sky; vehicles on the ground; and biomedical equipment such as intravenous pumps, ventilators, and electrocardiogram monitors.
Planning & Exercising As with all other types of disasters, preplanning and training for this type of incident would be critical for doing the “greatest good for the greatest number of people.” For decades, government planning has occurred at various levels and has been exercised in rooms and simulation laboratories, but often in secret without involving all members who may be directly affected – for example, the healthcare community. Few communities have conducted well-integrated and realistic functional exercises to rehearse their response to a situation that would last longer and be more devastating than most incidents they are likely to confront.
The healthcare system in the nation’s capital is now addressing this issue by having a multidisciplinary task force write a response plan template to assist all healthcare facilities in designing their own plans. Later in 2014, the District of Columbia’s Emergency Healthcare Coalition will present a two-day seminar to establish a clearer understanding of all the issues the coalition members will face, and realistically lay out how local, regional, and federal assets will come together in an effective response.
Healthcare Facility Struggles Hospitals and other healthcare facilities within 0.6-1 mile of ground zero (Zone 2) would sustain moderate structural damage. Those facilities just beyond 1 mile (Zone 3) would sustain light damage. All of these facilities would confront conflicting priorities, including the need to treat their own injured staff and patients as well as incident survivors who eventually make their way to these hospitals. First responders – police, fire, and emergency medical services – likely would not respond to assist these survivors until hours or days later, when radiation levels have begun to subside and the environment is safe enough for the responders to conduct their lifesaving efforts.
As the hours and days move forward, hundreds of thousands of survivors would seek medical care, which would put unparalleled pressure on available healthcare facilities and clinicians to not only treat the large number of burned and traumatized patients but also manage acute radiation sickness, a condition not seen by many clinicians. Laboratories would face challenges in running the blood tests needed in order to manage these patients. In addition, the demand for ventilators, medications, and critical-care beds would necessitate the still-functioning facilities to employ their modified delivery of critical-care services plan in an effort to optimize the use of scarce resources. Mass-fatality plans also would be tested.
Hospitals in Zones 2 and 3 also would find themselves trying to quickly assess the damages to structures and infrastructure. Restoring lost water, power, and phone lines to a hospital is normally a utility company priority. In this situation, however, lengthy delays are likely and hospitals will have difficulty sustaining temporary workarounds. Staffing shortages caused by injury, death, or spontaneous resignation would exacerbate issues related to the absence of or damage to the needed infrastructure and quickly exhaust equipment and supplies. For all of these reasons and more, the affected healthcare community would require immediate and extensive support from their regional, state, and federal partners.
The detonation of a suitcase nuclear device makes for more than a scary movie. Its serious consequences mandate that healthcare systems – not just their government partners – take a realistic look at their readiness plans and training to determine if they are prepared for the day after a disaster.
Craig DeAtley, PA-C, is director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital; he also is the emergency manager for the National Rehabilitation Hospital, administrator for the District of Columbia Emergency Health Care Coalition, and co-executive director of the Center for HICS (Hospital Incident Command System) Education and Training. He previously served, for 28 years, as an associate professor of emergency medicine at The George Washington University, and now works as an emergency department physician assistant for Best Practices, a large physician group that staffs emergency departments in Northern Virginia. In addition, he has been both a volunteer paramedic with the Fairfax County (Va.) Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. He also has served, since 1991, as the assistant medical director for the Fairfax County Police Department.