Preparing for a Nuclear Terrorist Attack on an American City: Report from the National Academy of Sciences.

Davis, M. et al. 2013. Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary. National Academy of Sciences.

Our nation faces the distinct possibility of a catastrophic terrorist attack using an improvised nuclear device (IND), according to international and U.S. intelligence (Jenkins, 2008). Detonation of an IND in a major U.S. city would result in tens of thousands to hundreds of thousands of victims and would overwhelm public health, emergency response, and health care systems, not to mention creating unprecedented social and economic challenges.

An IND is a nuclear weapon bought illicitly, stolen from a nuclear state, or fabricated by a terrorist group from illegally obtained nuclear weapons material (e.g., plutonium or highly enriched uranium). An IND explosion on the ground yields the same physical and health effects as detonating a nuclear weapon in the air, similar to the hydrogen bombs dropped during World War II.

Although it is generally accepted that larger U.S. cities likely represent the highest-risk targets for an IND terrorist attack, the ripples from an IND detonation would overwhelm the surrounding communities and spread nationwide.

An IND is not to be confused with a radiological dispersal device (RDD), informally known as a “dirty bomb.” An RDD is a weapon that combines explosives with radioactive material. The explosion vaporizes or aerosolizes radioactive material, propelling it into the air, but the explosion does not trigger a fission reaction that releases the mammoth amounts of energy or fission products that are associated with a nuclear detonation. The effects of an RDD extend over an area the size of multiple city blocks, whereas the consequences of an IND detonation extend for miles. Buddemeier explained that most of the nuclear hazard of an RDD attack is due to people breathing radioactive dust in the immediate area of the explosion (although there is some external radiation), whereas with an IND attack, most of the nuclear hazard is from fallout, which emits radiation of sufficient strength to burn or penetrate the skin and travel into the body cavity to trigger acute radiation syndrome. Fallout particles, though, are too large to become a breathing hazard.

Fallout is generated by thousands of tons of debris—from collapsed buildings and other structures destroyed by the blast—combined with radioactive fission products and catapulted upward by the extreme heat of detonation. The radioactive debris-filled cloud rapidly ascends through the atmosphere up to 5 miles high for a 10-kiloton (kt) device. Highly radioactive particles coalesce and drop back down to earth as they cool to form fallout. Within 10 to 25 miles of the detonation, fallout particles are the size of table salt or sand as they fall back to earth, contaminating all surfaces, including clothing, skin, and hair. The particles give off penetrating radiation—primarily gamma and beta radiation—that can injure people inside cars or in inadequate shelters. The path of fallout depends on wind direction and speed and other environmental conditions (e.g., terrain and weather). Fallout’s radioactivity decreases with distance and decays rapidly with time, with the greatest danger occurring within the first few hours after the detonation. A ground-level detonation produces more fallout than one exploded above ground, as was the case for the atom bombs dropped on Hiroshima and Nagasaki. Fallout is the primary source of radiation exposure in outlying communities. The best method of reducing radiation exposure from fallout is to remove outer clothing and remove particles from hair when entering a safe shelter.

In the case of a 10-kt detonation in Washington, DC, it is likely that 45,000 people would perish immediately and 100,000 would be at risk of death. An additional 320,000 people would be likely to be seriously injured, and another 175,000 would likely have minor injuries.

Being unaffected physically, outlying communities are likely to be in the best position to save lives following an IND attack. However, these communities will experience an unparalleled number of evacuees who will need emergency medical care for blast, burn, and radiation injuries; screening for contamination and acute radiation syndrome; and provision of radiation countermeasures, shelter resources, and mental health and material support. Yet, most outlying communities have not considered the potential burden they may experience and so have not undertaken planning for an IND detonation in a nearby city, making them drastically underprepared. The influx of tens of thousands of displaced victims will require dedicated command, control, and resource capabilities from across the region and nation to ensure a successful response.

Areas that could positively influence state and local planning progress:

  • High-level political support and direction to supplement available guidance
  • Translation of federal guidance into actionable local tools
  • “Socializing” preparedness—getting the public to take personal responsibility for being prepared—to increase resiliency and decrease public dependency on already taxed services
  • Need for education of first responders, local leadership, and health care providers on types of radiation attacks and different vulnerabilities
  • Coordinating transport systems: Radiation Injury Treatment Network, National Disaster Medical System, Civil Reserve Air Fleet, and regional/local transports
  • Robust risk communication, including pre-event messaging if possible
  • Expanding health care coalitions to include a wider, more diverse range of partners
  • Integration of public health and medical services into command and control infrastructure, emergency operations centers, and unified command
  • Core capabilities that receiving communities should focus on related to an IND—and corresponding commonalities with the Public Health Emergency Preparedness/Hospital Preparedness

There is a lot more to this 257-page report which is free at:




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