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U.S. Department of Health and Human Services


State & Local Planners Playbook for Medical Response to a Nuclear Detonation

Radiation symbol About this Playbook Artistic rendering of plume Background Information Picture of responder Action Steps  
Information icon Additional Information Sources   Picture of supplies being loaded on a truck Manuscript List Picture of acronym list Acronyms

Casualties from a nuclear detonation result from blast, heat (thermal energy), and ionizing radiation.  Rescue efforts after a nuclear detonation will be complex due to potentially high radiation levels, severe infrastructural damage, the number and severity of causalities, and the inaccessibility of many victims at least initially.


A summary of the key principles of the medical and public health response of the nuclear detonation are found in the State and Local planners Playbook. This is a living document that will be updated periodically on this website. Users are encouraged to submit comments through the website and to join the REMM ListServ to receive notice of important changes to the Playbook and the REMM website.

Icon of radiological-nuclear symbol About This Playbook

This State and Local planners Playbook is a resource developed by non-government and government subject matter experts from the Nuclear Detonation Scarce Resources Working Group. It is not a "must follow" structured road-map. It is offerred as a guide to assist State, regional, local, tribal, and territorial medical and public health planners and other subject matter experts preparing their venues for a nuclear detonation.

Artistic rendering of plume Background Information       
Summary descriptions of important capabilities, organizational concepts, and anticipated operations.
Responders putting patient in ambulance Action Steps
Detailed time-phased, sector-oriented approaches to response activities with linked references.


Phase 0: Pre-Incident Planning Phase I: 0-24 Hours Post-Detonation Phase II: 24-96 Hours Post-Detonation Phase III: Beyond 96 Hours Post-Detonation


Information icon Additional Information Sources
Links to references, resources, and guidance with more in depth information to assist preparedness and response.
Image of stockpile resources Nuclear Detonation Scarce Resources Working Group - Manuscript List
Bibliography of peer-reviewed publications from March 2011 providing detailed information about the medical and public health issues related to planning for and responding to a nuclear detonation.
Icon of acronym Acronyms

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  • This page last reviewed: March 22, 2018