This DomPrep survey focused on mass-casualty preparedness and response in general and responses to a nuclear event in particular. Although many believe that a mass-casualty event caused 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 been a key factor in the Obama administration’s re-evaluation of the U.S. Government’s (USG’s) policies in the field of weapons. President Obama has not only recently announced the signing of the Strategic Arms Reduction Treaty document 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 apparent intent to create a catastrophic event using a nuclear detonation. That threat, of course, has major implications for the U.S. security community and its mission to prevent such an event. It also raises questions about the nation’s domestic ability to respond.

Dr. Craig Vanderwagen, former assistant health and human services secretary for preparedness and response (ASPR), who prepared the survey, has pointed out that the current response “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 would be tested severely by such large-scale events, and the planning requirements are therefore multi-sectoral – even though the focus will continue to be on saving lives and reducing the additional burden of disease. Also not to be underemphasized are the nation’s ability to recover 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 Findings

DomPrep readers and members of the DomPrep40 are generally doubtful over the nation’s ability to manage the consequences of a mass-casualty event.  A solid plurality view regional planning as the crux of a solution.

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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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