U.S. health-care system unprepared for major nuclear emergency, officials say

“We think we’re one of the few states that’s really designed a statewide system that can deliver these countermeasures,” Fales said. In the case of one particularly expensive drug provided by the federal government, “my sense is in a lot of states it’s sitting in a warehouse in the state capital, hopefully secure and warm. On a Saturday night if something goes boom in a location on another side of the state, how long will it take to get it to where it’s needed?”

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One of the top priorities in preparing for a major nuclear disaster is readying ordinary citizens for the role they will have to play. “The common misperception is any nuclear blast means everybody’s vaporized,” McDonald said. “That’s just wrong.”

But experts say the government has done little to educate the public about its responsibilities.

When police and fire departments have run nuclear exercises in conjunction with federal authorities, “they haven’t included the public,” McDonald said. “They’ve basically treated it like a classified event.”

The motivation might be to safeguard the public from fear and panic, McDonald said, but “it does almost no good for the federal government to be talking about this with the top officers and not have the public understand what to do.” Although government Web sites including ready.gov and cdc.gov contain useful preparedness information, there is no single Web site the public can turn to for up-to-the-minute public health information in disasters.

One of the crucial things the public must know is when to evacuate and when to shelter underground or in a heavily constructed building. Yet making decisions on sheltering and evacuation and communicating those decisions to the public is precisely what the Homeland Security report found government agencies aren’t inadequately prepared to do.

Sheltering in place could make a major difference in how many people live or die, because the danger of fallout decreases rapidly as radioactive elements decay and debris is dispersed. The dose rate drops 90 percent every seven hours.

“You can’t wait until the event to put out this information,” said James James, director of the American Medical Association’s Center for Public Health Preparedness and Disaster Response.

Many experts predict that without more education, people probably would flee as many are doing in Tokyo and as many Americans did after the Three Mile Island nuclear accident in 1979. An estimated 144,000 people — many times more than the number advised to do so — needlessly left the area because of fear and inadequate information.

“Such an exodus would extend panic and devastation far beyond the locus of the event, draining food, water, medicines, gasoline and other resources from surrounding communities and potentially causing gridlock that would severely compromise many elements of the official disaster response,” according to a modeling study published by University of Chicago researcher Michael Meit and colleagues in the same issue of the journal.

Not knowing what to do would be especially harmful to those who are least likely to be able get out of harm’s way: children and the elderly, people with disabilities, and patients with chronic illnesses requiring regular treatment. The federal government enacted a number of reforms after elderly and disabled people died after Hurricane Katrina. But those reforms aren’t necessarily reflected in critical front-line emergency plans. A federal court in California recently found the city of Los Angeles violated the Americans with Disabilities Act and other laws for failing to consider the needs of the disabled in its emergency response plans.

Eric Toner, a senior associate at the University of Pittsburgh Medical Center’s Center for Biosecurity in Baltimore, said the key to protecting as many people as possible during an emergency is offering them frank communication about what is known and unknown.

“Nature abhors a vacuum. If credible officials aren’t out there constantly, that void will get filled with people who don’t know what they’re talking about or have different agendas.”

Still, there is no guarantee the public will act on information once they get it. Several years ago Michigan, like many other states, sent vouchers for potassium iodide to people living within a 10-mile radius of a nuclear power plant. The goal was to give them the medication free of charge from local pharmacies, so they wouldn’t risk their lives searching for the drug in an emergency, when they should be sheltering in place or evacuating.

But only about 6 percent of the residents picked up their allotted supply, said Fales, the Michigan regional medical director, a rate that’s similar to some other states. “So much for pre-event planning,” he concluded.

ProPublica’s Sasha Chavkin contributed to this report.