It is no secret that terrorists have shown interest in acquiring and using weapons of mass destruction, including nuclear weapons. While the United States has programs in place to stop terrorists from acquiring nuclear materials, deter other nations from helping them launch a nuclear attack, and intercept any attack before it can succeed, we still must consider the possibility that a nuclear attack will occur.

The Department of Homeland Security asked the Institute of Medicine in 2008 to conduct a workshop to evaluate medical preparedness for a nuclear detonation. The workshop, titled “Medical Preparedness for a Nuclear Detonation in a Major U.S. City,” was held in two parts in June and August 2008. The workshop assessed the ability of emergency services, healthcare, and federal, state, and local authorities to respond to a nuclear weapon equivalent to 10 kilotons of TNT detonated during a workday in a central business district of a large U.S. metropolitan area. Though the first response inevitably would be local during the first few days after the explosion, the workshop focused on national (i.e., state and federal as well as local) medical and public health preparedness to respond to the unthinkable.