Nationwide Response Issues After an Improvised Nuclear Device Attack Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary (2014) / Chapter Skim
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Appendix G: Day 30: The Impact of Mass Evacuations on Host Communities Following Nuclear Terrorism
Appendix G: Day 30: The Impact of Mass Evacuations on Host Communities Following Nuclear Terrorism
Pages 161-190
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From page 161... ...
conducted its 2008 Workshop on Assessing Medical Preparedness for a Nuclear Event, scientists, policy makers, and public health and emergency management professionals have dramatically increased their focus on preparedness issues related to a terrorist attack with an improvised nuclear device (IND) .1 In a relatively 1 Benjamin, George, McGeary, Michael, McCutchen, Susan R., ed.
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From page 162... ...
This includes an appreciation of the tremendous gaps that remain in every American city's ability to respond to such an event if it were the target, even with the full resources of state and federal government brought to bear. It also has been widely noted, that depending upon the scale of an evacuation that might follow an IND detonation, communities and local governments at the destination end could be overwhelmed, as well.2 This paper sets the stage for a thorough and systematic discussion of an issue that has been widely recognized, but that so far has received little attention: Upon an act of nuclear terrorism in a major city, what would be the mid- to long-term public health and related implications for communities that abruptly and involuntarily become host to large numbers of evacuees?
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From page 163... ...
.6 Therefore, even if efforts to prepare for an IND detonation continue at some scaled-back level within individual hospitals, local health departments, and collaborative venues, it may take years to bridge the identified gaps in IND response preparedness, if it can be done at all. Rather than simply recap prior recommendations concerning regional planning and collaborations, this paper approaches nuclear terrorism as if 3 These are summarized in Redlener, I., Garret, Andrew, Levin, Karen, Mener, Andrew.
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From page 164... ...
The scenario is based on a series of assumptions and it is recognized that changes in the underlying premises could alter the resulting Day 30 conditions in the hypothetical county. The second section reexamines some of the conventional assumptions about how large an evacuation would be following an IND detonation.
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From page 165... ...
There may be some unique differences in the kinds of issues that will confront smaller and more distant destination communities compared to closer and larger ones, but we believe that in most cases, the stresses will be a function of how much health care infrastructure and general response capacity the destination had to begin with, in addition to how big an increase in population it sustains due to the evacuation. Roberts County It is October 1, 30 days after a 10-kiloton improvised nuclear device exploded in midtown Major City on a weekday.
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From page 166... ...
Legislation to provide additional resources to these programs is bogged down in partisan congressional bickering over the extent and distribution of supplemental support for these safety net programs. Because of the direct consequences of the IND event in Major City, the entire region, including Roberts County, is experiencing widespread disruptions of telecommunications, transportation, and health and social
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From page 167... ...
were not fully in place for another week to ten days, and only after the NIC appointed his own Interagency Support Group to compensate for the difficulties in getting the NRT operational. Looking to the National Response Framework, in addition to the standard Emergency Support Function annexes, an IND detonation would invoke the Terrorism Incident Law Enforcement and Investigation Annex, the Catastrophic Incident Annex, the Catastrophic Incident Supplement, the Nuclear/Radiological Incident Annex, and the Mass Evacuation Incident Annex.
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From page 168... ...
Immediately after the detonation, the governor also invoked her disaster emergency powers under the state constitution and laws and activated every available member of the state's National Guard to be deployed among dozens of areas that, like Roberts County, are demanding supplemental assets to assist with newly displaced high-need evacs. After consulting with the Roberts County Commissioner (elected chief executive)
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From page 169... ...
fled their homes, worried about fallout and safety if throngs of Major City evacuees arrived.9 Among the 10,000 Roberts County residents who have not yet come home are 300 county employees (including staff of the health, public works, EMS, and police departments) and at least 200 private doctors, nurses and other healthcare professionals.
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From page 170... ...
Of the 30,000 Roberts County residents who commute to Major City daily, approximately 3,000 died or were critically injured or permanently disabled from the results of the detonation. Most of the remaining commuters cannot get to work because of continuing travel restrictions into and around Major City, or because their workplaces were destroyed or utterly reliant upon other businesses that did not survive.
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From page 171... ...
Since the detonation, the State's health department, which regulates hospitals in the state, has insisted that the Roberts County institutions accept 250 severely injured patients who have been evacuated by air from Major City. Over the past month, thousands of evacuees have gone to county emergency rooms presenting with severe GI distress or high fevers, but have been offered little more than OTC symptomatic relief, usually without seeing a nurse or M.D.
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From page 172... ...
. The governor has promised the Roberts County Executive 10,000 of those units, enough for about one-third of the evacuees who have not obtained adequate temporary housing or lodging.
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From page 173... ...
Whereas in many prior domestic disasters, houses of worship, private homes, and school facilities have opened their doors to volunteers, in Roberts County and the other destination communities, evacuees already have occupied those spaces. As a result, a substantial number of volunteers are compounding the health and safety issues associated with the temporary encampments.
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From page 174... ...
Disaster Medicine & Public Health Preparedness Developing the Science of Health Care Emergency and Response 3(2) :S24–S28; Ruggiero, Kenneth J., PhD, Kirstin Gros, PhD, Jenna L
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From page 175... ...
-funded psychological first aid program executed by community-based mental health workers has been visible in the cities and towns of Roberts County for only 1 week. The governor's executive orders temporarily waived many of the credentialing requirements for out-of-state mental health workers, but even so, the few volunteer mental health professionals now in the county cannot possibly meet the need.
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From page 176... ...
The frequency and thoroughness of inspections of existing restaurants, school and nursing home food service operations, markets, and other food distributors has suffered as a result. The department also has suspended periodic inspections of the county's 60 mobile home parks, residential lead assessments and child lead testing, enforcement of state and county indoor nonsmoking ordinances, prenatal care services, substance abuse prevention programs, youth bureau services, air quality monitoring, and evaluation of new subdivisions for compliance with water supply and wastewater disposal rules (this effectively has halted new residential development in the county)
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From page 177... ...
Not everyone in Roberts County is cooperating fully with the overall effort to accommodate the evacuees. One-quarter of the overwhelmingly volunteer EMS ambulance crews have refused to respond to dispatches to shelters or encampments housing evacs for fear of radiation contamination or for safety concerns.
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From page 178... ...
Beyond basic shelter, households that have lost everything will need food, water, trans portation, schools, and myriad other services to get back on their feet. Mental health: Unprecedented incidence of acute stress disorder, withdraw al, sleeping disorders, and depression symptoms without resources to ser vice those needs; preexisting mental health and behavioral challenges severely exacerbated; limited mental health resources of National Disaster Medical System and delayed deployment of community-based psychological first aid program.
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From page 179... ...
UNCERTAINTIES RELATED TO AN IND-PROMPTED EVACUATION Questions of Scale Many believe that following an IND detonation, there likely would be a large and spontaneous self-evacuation from both the targeted city and its suburbs. For example, in the National Level Exercise 2010 Operations Based Exercise, built around the hypothetical detonation of a 10kiloton nuclear device in downtown Indianapolis, the scenario included 270,000 people evacuating the city (about 30 percent of the total population)
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From page 180... ...
An expert who participated in the earlier Institute of Medicine (IOM) workshop estimated that "more than a million would be displaced by lingering radiation."12 The Department of Homeland Security's March 2010 "Strategy for Improving the National Response and Recovery from an IND Attack" says that the number of evacuees potentially could be in the millions.13 Ventura County's Nuclear Explosion Response Plan rests upon a working assumption that at least 2 million residents of Los Angeles County (about 20 percent of the total population)
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From page 181... ...
Another question, barely recognized in discussions of a potential evacuation, is whether governors have emergency powers and law enforcement resources sufficient to suppress a mass evacuation or at least manage it if they believe that would be in the public interest. The governor of New York State, for example, has broad emergency powers that enable the governor, with minimal constraints, to "temporarily suspend specific provisions of any statute, local law, ordinance, or orders, rules or regulations, or parts thereof, of any agency during a state disaster emergency, if compliance with such provisions would prevent, hinder, or delay action necessary to cope with the disaster."16 The governor may also "alter or modify" the requirements of any provision of law suspended.
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From page 182... ...
publication entitled "A Governor's Guide to Homeland Security" indicates that in some states, gubernatorial emergency powers include "suspending state regulations and statutes; commandeering the use of private property; rationing food, water and fuel; and authorizing emergency funds without prior legislative consent." The NGA, however, has not codified these.17 The mere existence of legal authority to manage an evacuation begs the critical political question: Even in an unprecedented crisis such as an IND detonation, would any governor be willing to assume such extraordinary powers and to make decisions of this magnitude, potentially influencing the long-term health and possibly even the survival, of hundreds of thousands? Or would governors be unwilling to impinge on personal liberty in such a consequential way?
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From page 183... ...
Even if we accept the consensus view than an IND-prompted evacuation would be immense in scale, recent mass evacuations offer few insights as to the public health implications of an IND-spurred mass evacuation for destination communities. Estimates of number of people who evacuated the Tohoku region of Japan in response to the March 2011 tsunami and nuclear power plant accident vary considerably, with the highest official estimate to date being approximately 350,000.19 Although even the high-end estimate appears quite small compared to what one might expect following an urban IND detonation in the United States, it still represents a massive movement of people that potentially could overwhelm destination communities.
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From page 184... ...
However, the only health issue that persistently appears in discussions of the Katrina evacuees in Houston and Baton Rouge is the particularly intense burden on the local mental health and substance abuse prevention and treatment systems, perceived as overtaxed long before Katrina sent a flood of new clients into those two cities.22 21 For various estimates of the number of Katrina evacuees who arrived and remained in these two cities after one year, see Dyer, Scott.
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From page 185... ...
CONCLUSION Public Health Priorities In the scenario presented in this paper, a month after an IND detonation in an American city, the social and functional fabric of society -- at least in the region where the detonation occurred -- would still be stretched to limits never tested before. The response would challenge the resourcefulness, the creativity, the heroism, the compassion, and the en analyzing-the-role-and-needs-of-communities-that-take-in-disaster-evacuees-in-the-wakeof-major-disasters-a disasters-and-catastrophes; Feldman, Claudia.
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From page 186... ...
2011. BP Deepwater Horizon Oil Spill: Incident Specific Preparedness Review.
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From page 187... ...
Governors should understand as fully as possible the potential applications of their emergency powers in response to an IND detonation, even if political considerations ultimately might constrain how governors used those powers. Second, the Coast Guard's internal evaluation of the federal response to the oil spill noted that "superb crisis leadership is essential for effective response to a major national domestic incident" and that "the characteristics necessary for crisis leadership are well documented and identifiable."25 Consequently, the report recommended significant additional investment in how the Coast Guard identifies, trains, and cultivates officers to be future crisis managers.
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From page 188... ...
Understandably, many emergency response professionals and public officials hesitate to contemplate, much less confront, the challenges of an event as improbable and horrific as nuclear terrorism. The scale and scope of the effort and resources required to respond to an IND detonation remain largely beyond the capacity that exists in any local jurisdiction or region.
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From page 189... ...
APPENDIX G 189 x How would we stay in touch with officials from outside the ju risdiction? x How would we handle hostilities that might arise between local citizens and evacuees?
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