Preparing the country for nuclear terrorism

The candidates for president of the United States continue to discuss preventing nuclear proliferation and the threat of nuclear terrorism, yet we hear little about how well prepared the nation is to manage the aftermath of terrorist use of an improvised nuclear device. Some may think the notion of such an attack is apocryphal. So allow me to explain just how likely such a possibility is, how devastating the result of such a detonation would be, and—in particular—just how poorly prepared the United States is to respond.

In 2005, Kofi Annan, former secretary general of the United Nations, said, “Nuclear terrorism is still often treated as science fiction. I wish it were. But unfortunately we live in a world of excess hazardous materials and abundant technological know-how, in which some terrorists clearly state their intention to inflict catastrophic casualties. Were such an attack to occur, it would not only cause widespread death and destruction, but would stagger the world economy … [creating] a second death toll throughout the developing world. 

In 2007, US Sen. John McCain was quoted as saying, “My greatest fear is the Iranians acquire a nuclear weapon or North Korea and pass enough highly enriched uranium (HEU) to a terrorist organization. And there is a real threat of them doing that. Just 55 kilograms, roughly 122 pounds of HEU, can be used to make a 10 kiloton IND, similar to the bomb dropped over Hiroshima." 

In 2005, Graham Allison, director of Harvard University's Belfer Center for Science and International Affairs at Harvard University's John F. Kennedy School of Government, asked, "Is nuclear mega-terrorism inevitable? Harvard professors are not known for being subtle or ambiguous, but I'll try to the clear. Is the worst yet to come? My answer: Bet on it. Yes. 

Matthew Bunn, also at the Belfer Center, argued in 2007, “Theft of the essential ingredients of nuclear weapons is not just a hypothetical worry, it is an ongoing reality." 

Nuclear physicist Frank Barnaby has been quoted as saying “The really frightening thing about HEU is that it is so easy to make an atom bomb out of it. You only need a couple of PhD students and a small amount of material. I think we should be very frightened about the possibility of nuclear terrorism; I'm surprised it hasn't happened yet." 

The aftermath of a detonation of a relatively small improvised nuclear device—one that is roughly the yield of the bomb dropped on Hiroshima—in a US city would be almost unimaginably gruesome. In New York City, for example, most buildings within one quarter of a mile would be destroyed. Some 300,000 to 400,000 people would be killed instantly, with several hundred thousand more requiring various levels of medical care. Electrical and communications systems would be severely damaged, at best. And medical and other responders would face radiation dangers and a host of other problems.

In a search of both media and scholarly literature, however, I was able to find only one mention of US preparedness for nuclear terror. “The United States is unprepared to mitigate the consequences of a nuclear attack," Pentagon analyst John Brinkerhoff wrote in a July 2005 confidential memo to the Joint Chiefs of Staff. "We were unable to find any group or office with a coherent approach to this very important aspect of homeland security." 

Several federal agencies have been aggressively working to address this deficit. The Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response has made significant strides in medical and public health preparedness. But much more work needs to be done across the federal behemoth.

After spending untold millions of dollars since its establishment, the Department of Homeland Security—the umbrella agency in which the Federal Emergency Management Agency resides—still does not have adequate radiation detection technology for use in the aftermath of a nuclear detonation and confuses local responders with inconsistent units of measure for radiation emitted by various nuclear isotopes. In Homeland Security advisories to first responders, the terms REM, rad, Sieverts and Gray are thrown about as if interchangeable. They’re not, and knowing the difference is important if responders are to feel and be safe in the aftermath of a nuclear blast.

Because there is such a clear history of concern about the threat of nuclear terrorism, the presidential candidates must cross the bridge from merely accepting the possibility of an attack with an improvised nuclear device, to planning an effective response that reduces the mass morbidity and mortality such an attack inevitably will cause—and then leads beyond the attack, toward recovery.

The road to preparedness. The detonation of a Hiroshima-yield improvised nuclear device in New York would level or significantly damage a significant portion of the city and instantaneously kill and maim hundreds of thousands of people. Trauma, burns, and radiation damage to organ systems are just some of the injuries that would place extraordinary demands on health care systems. In most multi-casualty incidents, there are one or two triage points where victims are taken for assessment and routing to treatment. Following a nuclear detonation in a major city, there could be need of 25 to 75 such triage points—or more—because of the vast geographical footprint of the detonation and the number of victims involved. Coordination will be difficult; much of the communication infrastructure will be demolished or rendered unusable. Moving patients to definitive care will be a monumental task and deciding which patients are triaged for medical care and which are triaged to receive end-of-life services will vary by triage point.

C. Norman Coleman and colleagues at the Department of Health and Human Services have developed criteria for establishing a triage network in the event of a nuclear explosion, but training for emergency physicians and pre-hospital care providers has not been integrated into the fabric of primary or continuing education for those responders. 

Finally, studies—including research I conducted in 2012— have shown that between 30 and 50 percent of critical personnel will not be present at or be unable to travel to work in the aftermath of a nuclear detonation. Many of those non-responding responders will want to be with their families; others will fear the personal health threat of radiation.

This dismal picture of US preparation for an incident of nuclear terrorism could be improved with strong leadership at the White House, particularly from the homeland security advisor to the president. The following areas need support, both in terms of funding and in developing uniform plans for managing a nuclear incident in a major city:

• Threat-based funding is important. We no longer have the luxury of giving money to buy toys—aka equipment that is unlikely to be used—to smaller cities and rural counties. Walla Walla, Washington is a lot less likely to be attacked with an improvised nuclear device than Washington, DC. But hundreds of millions of dollars have been wasted on inappropriate terrorism-response “toys” for small governments that will likely never use them. A robust, mobile medical infrastructure needs to be created—one that is capable of handling tens of thousands of patients at once. The Department of Defense will be central to any response plan developed by Health and Human Services; the White House should make certain they are cooperating on that plan—starting yesterday.
• The president should request and Congress should approve additional funding for communication systems that don’t rely on the local infrastructure likely to be destroyed or heavily damaged in a nuclear terror attack. Satellite-based operability would meet the need, making a seamless transition to undamaged communication channels available in high-threat cities. Competition as to which cities are included in such a system needs to be transparent, and political gamesmanship must be discouraged. The communications issue is too central to any effective response to delay it through influence peddling.
• HHS funding should be increased to accelerate research on medical countermeasures for acute radiation sickness. Such research is being conducted, but at an insufficient scale, given to potential for mass death that an improvised nuclear device poses. This research program should be the new Manhattan Project.
• A commission that includes the best minds in radiation, emergency medicine, emergency medical services, the fire service, law enforcement, the Defense Department, HHS, radiation medicine, and high target states and cities should be formed to address the gaps in response plans for a nuclear detonation. That commission should finalize a report to the new president in 180 days. There is no room for delay.The report should suggest the funding required to close each gap.
• A federal government structure for responding to an improvised nuclear device detonation in a major city should be completed within one year in the new administration.

I realize that the program I've suggested is daunting. But it's absolutely not an insurmountable goal. Millions of lives depend on it. What is more important to an incoming administration than saving millions of lives?