Lessons from Hawaii: A Blessing in Disguise

It is a tragic failure of human endeavor that, over 70 years since Hiroshima and Nagasaki starkly illustrated the human consequences of nuclear warfare, we continue to live under the threat of these weapons. All available diplomatic and policy solutions to end that threat should be pursued. Yet, so long as the threat persists, we must prepare for those consequences and take achievable actions to increase the number of survivors.

On January 13, 2018, for less than an hour, Hawaii residents thought they were facing nuclear war. They subsequently learned that the alert was an error caused when a Hawaii emergency management employee sent a ballistic missile warning via the state's emergency warning computer program.^1,2 Much news coverage of this event focused on the disruption of more than a million lives caused by this “false alarm.” ³ While the disruption was real and significant, we suggest that this event inadvertently created a natural experiment that provides critical lessons regarding gaps in our preparedness for nuclear catastrophe and other disasters. Those lessons are discussed below.

1. Proper actions can save many lives, even in a nuclear detonation. Alerts, both before and after a detonation, should include essential information to increase survivorship and not compel individuals to seek that information elsewhere.

Much has been said about the lack of information provided in the Hawaii false alarm warning. Some commentators suggested warnings should include web links to detailed guidance. Unfortunately, the minutes before an imminent detonation are not likely to foster calm internet research, as a panicking individual would have to winnow extensive information to choose what to do in the limited minutes remaining. ³

Warnings instead should include, in the immediate text, that concise information most likely to increase the number of survivors of a nuclear detonation. Many individuals at or close to “ground zero” will either be killed immediately or receive soon-to-be fatal exposures from the direct effects of the detonation: blast, thermal radiation, and prompt ionizing radiation. But the far greater number outside that area can very reasonably be expected to survive, especially with timely information. ⁴ One of the best ways to protect survivors outside the zone of immediate fatal exposure is to minimize their exposure to radiation from the ensuing radioactive fallout. If we can prevent people's natural impulse to immediately flee the area after detonation, in many cases inadvertently traveling through highly radioactive fallout (and, if in vehicles, likely being trapped in traffic gridlock in its midst), we can save them from avoidable fatal exposures to incident radiation in the critical first hours and days after the detonation.

Fallout radiation is deadliest in the first 24 hours after detonation and mainly in a relatively narrow plume dictated by the prevailing winds at the time. ⁵ After this critical period, some fallout radiation levels rapidly decrease as short-lived radionuclides decay to nonradioactive isotopes and some of the remaining fallout settles in areas away from human exposure (eg, rooftops, ditches). The first warnings therefore should direct recipients to immediately get into shelter, remain there for 1 or more days, and tune in to available media for further instruction. The “get inside, stay inside, stay tuned” messaging from the Centers for Disease Control and Prevention (CDC) is an excellent model. ⁶

While advance preparation undeniably is the best approach (ie, stockpiling supplies of water, food, medicines, a radio, etc, as described on the Department of Homeland Security's Ready.gov website ⁷ ), healthy people can survive at least 1 day without food and water. Waiting just 24 hours before evacuating results in significantly less radiation exposure and far fewer radiation casualties. Furthermore, because fallout largely will be confined to a relatively narrow plume downwind of the detonation (and the majority of the area outside the immediate danger zone at ground zero is typically outside the plume), authorities can alert people in that majority outside the plume that they can safely leave shelter.

2. States should not be solely responsible for nuclear detonation warnings. A robust national system is needed to deliver alerts and guidance before and after the event.

Hawaii used a state-based alerting system for messaging. But states lack both the sophisticated infrastructure required to detect a missile launch and the extensive resources needed to respond to a nuclear detonation. The warning of an incoming missile strike, which will be only minutes away from impact, will most quickly be issued by federal entities that detect launches rather than introducing additional delays by relaying warnings through various levels of government. ⁸ Additionally, all other states need simultaneous warnings to allow them to start preparations for interstate consequences such as fallout drift, migration of affected persons, the need for mutual aid, and disruption of commerce and resources such as interstate electrical grids and transportation systems.

A robust federal communications system provides a necessary adjunct to state resources. The Federal Emergency Management Agency's (FEMA's) Integrated Public Alert and Warning System (IPAWS) allows simultaneous messaging via modes including broadcast and cable radio and television, cell phones, email, sirens, weather alert radios, and roadside electronic signs. ⁹ Simultaneous messaging across multiple communications modes is essential to maximize coverage; one of the authors, living in Hawaii, did not have a cell phone in the house and so was not alerted. But to minimize delays, IPAWS must be primed with pre-scripted messages that convey the needed information. If these already exist, they were not on display in the Hawaii event. Indeed, the timeliness of the system reportedly has not yet been tested. ⁸

Nor has media coverage of the event described what communications systems would have been used to provide health and safety guidance after the detonation, when local communications infrastructure likely will be disabled. Broadcasters in adjacent cities and states (or in Oahu's case, on other islands) with coverage in the affected area could provide post-event information. When ground-based cell phone infrastructure is damaged, airborne cellular systems could be deployed to restore emergency messaging capacity, and broadcast media services could be restored using existing military aircraft capable of both radio and television broadcasting.^10,11 The lifesaving benefits of these communications capacities are not limited to nuclear events and will serve in diverse catastrophes, including earthquakes, hurricanes, and widespread electrical power loss, but they will be useful only if messaging and deployment plans are in place before the event.

3. An imminent strike from a ballistic missile expected to carry a nuclear warhead should immediately trigger response preparations in diverse federal agencies.

Absent in the news coverage of the Hawaii event has been any discussion of alerts received, or response preparations initiated, by federal agencies other than FEMA and the Department of Defense. Ironically, the alert occurred a day after the CDC unexpectedly postponed a webinar, scheduled only 4 days later, to discuss the public health response to a nuclear detonation. ¹² Given that national emergency plans assign responsibility for coordinating the response to public health and medical consequences of a nuclear detonation to CDC as part of its parent Department of Health and Human Services, a seminar with a frank discussion would have provided a timely update on how these and other agencies plan to meet these challenges, how they would swing into operation in such an event, and what additional preparations or resources are needed, including international cooperation in such a massive event. ¹³

4. State and local health departments and nongovernment response partners also need defined communications and response plans for a nuclear detonation.

Much of the burden of communicating with, and supporting, the affected population will fall to local and state health agencies and their response partners, including the American Red Cross. These organizations' nuclear response roles and capacities are uncertain. Most currently lack specific operational plans and resources to respond. A majority of local health departments surveyed in a 2016 survey reported being “not at all” or only “slightly” prepared for an accidental radiation release; the survey did not ask about preparedness for the more catastrophic intentional nuclear detonation.^14,15

The gaps displayed in the Hawaii event provide valuable instruction on what is needed for an effective public alerting and information system in disasters, including a nuclear detonation. The technology and components of such a system already exist. It remains only to integrate them into a functioning, robust national system that can save lives by alerting and informing the public in disasters, including missile strikes.