Your Thoughts Compared with DomPrep40's National Experts on...Mass-Casualty Preparedness &Response

Although many believe that a mass-casualty event triggered by a nuclear detonation is highly unlikely, evidence from the intelligence community suggests a high probability of occurrence within the next 3-5 years. This information may have informed the Obama administration’s re-evaluation of the U.S. Government’s (USG’s) policies in respect to nuclear weapons. The President not only recently announced the signing of the Strategic Arms Reduction Treaty (START) but also released a statement of re-focused USG policy on nuclear threats that highlighted the need to focus on non-state actors and their alleged intent to create a catastrophic event by using a nuclear detonation. That threat has major implications, of course, for the nation’s security community and its mission to prevent such an event. The threat also raises questions about the ability of U.S. domestic agencies and organizations to respond.

In this survey, the DomPrep40 has addressed seven questions – which focus on mass- casualty preparedness and response capabilities in general, and the potential response to a nuclear event in particular. Dr. Craig Vanderwagen, former assistant secretary of the U.S. Department of Health and Human Services (HHS) for preparedness and response (ASPR), who prepared the survey, points out that, “Your environment may be more focused on other causes of mass casualties – large earthquakes, chemical exposures, or a bio event involving a large population and such – but the dynamics of managing a large number of individuals needing medical care and public health interventions apply directly to nuclear detonation.”  The nation’s human and physical assets will be tested equally in such large-scale events, and – even though the primary focus will be on saving lives and reducing the burden of disease – the planning requirements are multi-sectoral. Also not to be under-emphasized are the matter of recovery from such an event and the resiliency of the American people and institutions in swiftly ameliorating the impact of the event on everyday functioning.

Key Finding Members of the DomPrep40 are generally doubtful of the nation’s ability to manage the consequences of a mass-casualty event.  A solid plurality see regional planning as the crux of an effective solution.

How does this assessment square with your observations?  As you respond to the survey, please draw upon your own assessment of the nation’s current state of preparedness and ability to respond to mass casualties in general. But also consider the specific aspects of readiness necessary in a nuclear event following the detonation of a 10-kiloton device in a large city in your environment – creating a situation that might well include, as the primary health and safety concerns, the requirement to manage hundreds of thousands of casualties suffering from burns, trauma, and/or radiation exposure. Of equal importance will be the ability of your community to survive and recover from this daunting challenge.

Take the survey and compare your answers with those of the DomPrep40 – shown here with the summary results Not surprisingly, nine out of ten DP40 members said that a critically important assumption for mass-casualty planning is the need to be prepared to manage the event without federal support for the first 48 hours.

Fifty-two percent said that management of a mass-casualty response requires not only a regional effort but also, and more importantly, regional planning – with state and local involvement specifically included. One fourth of the DP40 put greater emphasis on state and local planning.  On the other hand, one fifth said that the nation as a whole should plan to manage primarily at a federal level – supported, though, by regional, state, and local involvement.

As regards the application of resources toward developing plans for mass-casualty events, about 50 percent envisioned some federal support as well as some local support for the regional planning process.  One in six also indicated, though, that there has not yet been enough of either – federal support or local support – for regional planning.  Another 24 percent said that federal and local support is adequate at present.  Overall, a guardedly optimistic assessment.

Six out of ten DP40 members expressed the opinion – not particularly reassuring – that the United States has planned sufficiently for alternative sites of care and alternative standards of care. “Preparing for the use of alternate sites and standards is a proactive requirement that must be addressed,” counseled Dr. Vanderwagen. “Plan for these and exercise their use.”

The DP40 was generally somewhat doubtful about the effectiveness of information- sharing tools in planning for mass-casualty events. Slightly more than a third of the DP40 said that there are at present no truly effective information-sharing tools. “It is clear that development of a better information-sharing tool needs to be given priority,” Dr. Vanderwagen observed. “The critical need for pre-event communication and joint planning is primary across the sectors, but the lack of an information-sharing capability during an event will be catastrophic. The tools exist; it is time to reach a consensus and move forward on a means to assure that we all are using them.”

Most DP40 members (60 percent of those responding) strongly emphasized the need for the nation’s health and medical sectors to plan more closely with the public-safety sector for mass-casualty events.  One fifth said that there also must be joint planning with the public housing/mass sheltering sector.  This response suggests that there has not been enough public discussion on the effect of mass-casualty events on public order and/or how to preserve it.

With regard to a nuclear mass-casualty event, the DP40 was almost evenly divided in their assessments of some of the currently “missing components” of consequence management – e.g., an effective medical countermeasure for Acute Radiation Syndrome (ARS) and a timely way to get it to those in need, as well as long-term environmental mitigation and, in particular, a better public-education program on how to survive a nuclear detonation.  “Educating the public and assuring that we have means to communicate in near real time with them about sheltering in place and where and when to get countermeasures,” Dr. Vanderwagen concluded, “must be developed with our public safety partners and the media.”

W. Craig Vanderwagen

Rear Admiral W. Craig Vanderwagen, M.D., was appointed the Department of Health and Human Services (HHS) Assistant Secretary for Public Health Emergency Preparedness and promoted to the rank of Rear Admiral, Upper Half, U.S. Public Health Service (USPHS) in July 2006. He now serves as the Deputy Assistant Secretary for Preparedness and Response and Chief Preparedness Officer. In this position, he is the HHS Secretary's principal advisor on matters related to bioterrorism and other public health emergencies. The mission of his office is to lead the nation in preventing, responding to, and reducing the adverse health effects of public health emergencies and disasters. Admiral Vanderwagen has significant public health emergency and disaster-response experience. Most recently, he was the deputy secretary's special assistant for preparedness and led the teams that implemented the changes at HHS recommended in the White House Report Katrina Lessons Learned. He also: was the senior federal health official in the response to Hurricanes Katrina and Rita in Louisiana; led the public health team deployed on the hospital ship USNS Mercy to Indonesia to assist in the 2005 tsunami recovery; served as chief of public health for the Coalition Provisional Authority and Ministry of Health in Iraq; and directed some of the health care operations initiated to help Kosovar refugees during the 1999 Balkans conflict.

John F. Morton

John F. Morton is the Strategic Advisor for DomPrep. He is also the Homeland Security Team Lead for the Project on National Security Reform (PNSR). A member of the DomPrep team since its founding, he has served as managing editor for writer assignments and interviewer for scores of DomPrep audio interviews.



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