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

Source from: http://www.washingtonpost.com
U.S. officials say the nation’s health system is ill-prepared to cope with a catastrophic release of radiation, despite years of focus on the possibility of a terrorist “dirty bomb” or an improvised nuclear device attack.

A blunt assessment circulating among American officials says, “Current capabilities can only handle a few radiation injuries at any one time.” That assessment, prepared by the Department of Homeland Security in 2010 and stamped “for official use only,’’ says “there is no strategy for notifying the public in real time of recommendations on shelter or evacuation priorities.”

The Homeland Security report, plus several other reports and interviews with almost two dozen experts inside and outside the government, reveal other gaps that might increase the risks posed by a nuclear accident or terrorist attack.

One example: The U.S. Strategic National Stockpile stopped purchasing the best-known agent to counter radioactive iodine-induced thyroid cancer in young people, potassium iodide, about two years ago and designated the limited remaining quantities “excess,” according to information provided by the U.S. Centers for Disease Control and Prevention to ProPublica. Despite this, the CDC Web site still lists potassium iodide as one of only four drugs in the stockpile specifically for use in radiation emergencies.

The drug is most effective when administered before or within hours of exposure. The decision to stop stockpiling it was made, in part, because distribution could take too long in a fast-moving emergency, one official involved in the discussions said. The interagency group that governs the stockpile decided that “other preparedness measures were more suitable to mitigate potential exposures to radioactive iodine that would result from a release at a nuclear reactor,” a CDC spokesperson said in an e-mail to ProPublica.

Japan’s ongoing nuclear crisis might prompt officials to revisit that conclusion. With radiation levels higher than expected outside the evacuation zones in some areas, the Japanese government recently asked the United States for potassium iodide. The federal government agreed to send some of its dwindling stockpile of the liquid version used in children or adults, which is due to reach its expiration date within about a year. The government is “finalizing the paperwork,” according to an official with the U.S. Department of Health and Human Services.

Another example: Although hospitals near nuclear power plants often drill for radiological emergencies, few hospitals outside of that area practice such drills. Most medical personnel are untrained and unfamiliar with the level of risk posed by radiation, whether it is released from a nuclear power plant, a “dirty” bomb laced with radioactive material or the explosion of an improvised nuclear weapon.

Many states don’t have a basic radiation emergency plan for communicating with the public or responding to the health risks. Even something as fundamental as the importance of sheltering inside sturdy buildings to avoid exposure to radioactive fallout from a nuclear explosion — which experts say could determine whether huge numbers of people live or die — hasn’t been communicated to the public.

Recently the White House and other federal officials concerned about deficiencies in public readiness met with experts to explore what might be done to make nuclear events more survivable. “The bottom line is that the citizenry are not prepared at all,” said Michael McDonald, president of Global Health Initiatives, who participated in White House and congressional briefings.

The Department of Homeland Security report acknowledges that officials are poorly prepared to communicate with the public and that the current organization of medical care “does not support the anticipated magnitude of the requirements” following an attack with an improvised nuclear device. It says the United States has “limited” treatment options for radiation exposure and notes that staff and materials aren’t in place to carry out mass evacuations after a large-scale release of radiation. “The requirements to monitor, track, and decontaminate large numbers of people have not been identified,” the report said.

Underlying the preparedness problems is the need for additional research. It isn’t known, for example, how a nuclear blast and electromagnetic pulse would affect modern communications infrastructure, or to what extent modern buildings can protect people from nuclear blast, heat and radiation effects.

A report prepared last year by the Council on State and Territorial Epidemiologists was equally pessimistic about U.S. readiness. Based on surveys of public health officials in 38 states, it concluded that “in almost every measure of public health capacity and capability, the public health system remains poorly prepared to adequately respond to a major radiation emergency incident.” Forty-five percent of the states surveyed had no radiation plan at all for areas outside federally mandated nuclear power plant emergency zones. Almost 85 percent of the officials said their states couldn’t properly respond to a radiation incident because of inadequate planning, resources, staffing and partnerships.

More troubling was the fact that the situation hadn’t improved since a similar survey was taken in 2003. “Most of those comparisons appear to indicate either the same poor level of preparedness and planning or a decline in capacity,” the report said.

The nation’s investment in emergency preparedness seems likely to decrease rather than increase, experts say, because of massive federal and state deficits.