Preparing Hospitals for Use as Fallout Shelters

by Kirk Paradise

Working under a Metropolitan Medical Response System (MMRS) federal grant, Huntsville, Alabama, officials developed a “fallout shelter” option for three local hospitals and two clinics that would enable those facilities to continue operations during what is described as a high-level-radiation environment.  Development of the fallout-shelter option involved three tasks.  First, toentify the specific areas in those buildings that would provide the best protection from radiation.  Second, to develop a plan to organize the hospital and clinic staffs into “Shelter Management Teams” that would be capable of dealing with the threats unique to fallout radiation.  Third, to train key staff personnel to implement the plan. Although evacuation from the projected path of a fallout cloud is in many if not all situations a viable option for the general public, and/or for a small or medium-sized city, it is not for a hospital.  Once the medical and other staff personnel evacuate the hospital, they become just additional refugees in a virtual flood of humanity and can no longer function as members of organized teams.  Moreover, very little of the highly specialized equipment of a hospital can be moved – there just is not enough time – and the medical facilities themselves cannot be transported to another location. Mostly for those reasons, the possibility of operating a hospital not only as a medical facility but also as a fallout shelter itself became an emergency option that at least had to be considered.  The reasoning was, basically, that if the potentially protective areas of a hospital and/or clinic are known, and if the medical staff has been organized and trained to function as Shelter Management Teams, the medical facilities and staff not only could endure and survive, but also could continue to carry out their medical operations. In 2005, a contract was awarded that authorized a survey of the MMRS facilities in The possibility of operating a hospital not only as a medical facility but also as a fallout shelter became an option that had to be considered the Huntsville area to determine which areas of certain buildings might offer acceptable protection from radiation.  The survey contractor used methods developed by the Federal Emergency Management Agency (FEMA) to quantify the degree of protection needed.  The FEMA methods focus on the measurement of a number of factors, which can be broken down into three basic categories: the dimensions of the building being surveyed; the masses and types of the various construction materials involved; and such miscellaneous factors as the percentage of apertures (windows and doors) included in the measurements as well as the specific building geometry involved.  The Survival Quotient and Other Considerations Still following the FEMA guidelines, the measurements taken were inserted into a series of equations to produce a quotient, called a Fallout Protection Factor (FPF, or simply PF) for each area of each of the buildings surveyed.  Diagrams were then generated not only for each area of those buildings but also for each floor of each building to develop the PF quotients for those areas and floors.  The areas given a PF of 10 or higher rating were approved for use as fallout shelters.  Here is how the system works: A PF of 10 means that 90 percent of entering radiation is attenuated; in other words, the occupants of that area receive only 10 percent of the outside dose rate.  PFs of up to 100 (1 percent of the outside rate) were calculated in some parts of the buildings surveyed, and PFs of 20-40 (2.5-5.0 percent) were common.  For practical purposes, the very meaningful reductions indicated by those PFs translate into the difference between a lethal vs. a relatively minor accumulated dose of radiation.  In a high-level-radiation incident, areas just a few feet outside the building could see radiation dose rates reach lethal levels in an hour or less.  However, persons – i.e., patients and/or medical staff – selectively sheltered in the areas with the highest PFs could receive as little as one hundredth of a fatal dose – not enough, in other words, to suffer even minor physical symptoms of radiation illness.  True survival depends, though, on more than just radiation protection.  Purposeful leadership under a Shelter Manager is just as essential.  Even highly educated and professional people, when confronted by a lethal and unfamiliar threat, can make irrational and sometimes fatal mistakes.  Firm leadership not only gives them direction, it also gives them purpose, so that, when they exit the shelter, they would have not just survived, they would have survived intact – i.e., able to fully function and to carry out all of their assigned tasks.


Additional Information ~

1. In August 2006, a Fallout Shelter Management Course trained hospital staffs how to organize and use the Fallout Shelter Managers Guide, a manual/plan for shelter living and operations.  The Fallout Shelter Managers’ Guide, Fallout Shelter Management Course for MMRS Facilities as Micro Soft Power Point slide, and related information are posted at 2. The DHS (Department of Homeland Security) planning guidance for casualties and displaced persons (i.e., those needing shelter) is discussed in the following extract from the MMRS section of the department's fiscal year 2005 report on DHS grant programs:

Radiological medical and health effects preparedness

  • Research lessons learned about potential unknown human health effects of a radiological release/nuclear detonation. Consider "lessons learned" from documented and alleged human-health consequences of the World Trade Center incident, where individuals were potentially exposed to chemical byproducts released by an explosion of mixtures of several unknown chemicals, potentially enhancing their toxicity in exposed individuals. In establishing/enhancing the capabilities described above, the revised MMRS threshold-capacity levels for catastrophic incident response planning for a radiological release/nuclear detonation are as follows. Detailed guidance on the implementation of the HSC Planning Scenarios may change these thresholds.
  • Jurisdictions ranked 1-21 by population on the UASI (Urban Area Security Initiative) Program list:
    • 25,000 immediate deaths; 100,000 contaminated victims (50,000 acutely exposed and 50,000 moderately exposed); and 300,000 displaced persons.
  • Jurisdictions ranked 22-50 by population on the UASI Program list:
    • 15,000 immediate deaths; 50,000 contaminated victims (25,000 acutely exposed and 25,000moderately exposed); and 200,000 displaced persons.
  • Remaining MMRS jurisdictions:
    • 7,500 immediate deaths; 25,000 contaminated victims (10,000 acutely exposed and 15,000 moderately exposed) and 100,000 displaced persons.