BOX G-1Key Issues 1 Month After Detonation

Competition for federal and regional response resources: Even with deployment of unprecedented high levels of outside personnel and resources, communities hosting evacuees may have to compete for attention with the detonation city; potential for delayed federal response overall.

Loss of jobs, income, schools, health care, and other basics of daily life: An issue primarily among evacuees, but destination residents will not be exempt. Beyond basic shelter, households that have lost everything will need food, water, transportation, schools, and myriad other services to get back on their feet.

Mental health: Unprecedented incidence of acute stress disorder, withdrawal, sleeping disorders, and depression symptoms without resources to service 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.

Overwhelmed local medical and public health systems: Deferral of elective and non-urgent procedures; diminution of response capacity due to evacuation from destination county and unwillingness to report to work; physical security requirements for hospitals and health professionals; limited potential for mutual aid assistance; loss of health insurance by evacuees and residences/loss of payment for health services provided; overworked and demoralized personnel; severe triage and altered standards of care in effect.

Public safety: Evacuee cars obstruct Emergency Management Services (EMS), police and fire service; state police neglect routine highway safety patrols; local law enforcement diverted from public safety responding to evacuee-related 911 calls.

Radiation: Inadequate knowledge of evacuees’ radiation status (both decontamination and total radiation dose sustained); latent acute radiation syndrome coupled with lack of resources to provide supportive care; high rate of immunosuppression and infections among evacuees; lack of information about fallout contamination of water supplies and local agricultural products; cross-contamination due to discarded clothing.

Sanitation: Uncollected garbage in built-up areas; insufficient sanitary facilities in makeshift, spontaneous evacuee encampments; roadside dumping of hazardous materials and human wastes; deferred inspection of restaurants, food markets, institutional food services; appearance of unlicensed and unsupervised opportunistic food and water vendors; insufficient mass fatality management to arrange proper temporary interment.

Shelter: Potential for high incidence of heat exhaustion, hypothermia, and other exposure-related morbidity and mortality; rapid absorption of temporary housing opportunities; abrupt rental housing inflation; competition for housing among evacuees, volunteers, and relief workers.

Social problems: Discrimination against/antagonism toward evacuees; some local service providers “redline” evacuees; evacuees blamed for increased crime rates, higher prices and shortages, “ruining” the community; competition among evacuees and permanent residents for goods and services; taunting, shunning, stigmatizing, and avoidance of evacuees; violence between evacuees and permanent residents.

Vulnerable populations: Children separated from their families/guardians during the evacuation, children with special health care needs, adults with disabilities or chronic medical and mental health conditions, frail elderly, and other identifiable segments of the evacuee population in need of additional attention and resources. Water safety: Evacuee encampments in watershed lands; possible contamination of public water supplies with infectious agents due to inadequate sanitation; possible radiation contamination from fallout.

Suspension and curtailment of routine state and local government public health and safety functions.

From: G, Day 30: The Impact of Mass Evacuations on Host Communities Following Nuclear Terrorism

Cover of Nationwide Response Issues After an Improvised Nuclear Device Attack
Nationwide Response Issues After an Improvised Nuclear Device Attack: Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary.
Forum on Medical and Public Health Preparedness for Catastrophic Events; Board on Health Sciences Policy; Institute of Medicine; Davis M, Reeve M, Altevogt B, editors.
Washington (DC): National Academies Press (US); 2013 Dec 26.
Copyright 2014 by the National Academy of Sciences. All rights reserved.

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