Disaster Medicine and Public Health Preparedness

Research Article

State-Level Emergency Preparedness and Response Capabilities

Sharon M. Watkins c1, Dennis M. Perrotta, Martha Stanbury, Michael Heumann, Henry Anderson, Erin Simms and Monica Huang


Background: Prior assessments of public health readiness had identified gaps in radiation preparedness. In recent years, preparedness planning has involved an “all-hazards” approach. Current assessment of the national status related to radiation public health emergency preparedness capabilities at the state and local health department levels was needed.

Methods: A survey of state health departments related to radiation readiness was undertaken in 2010 by the Council of State and Territorial Epidemiologists (CSTE). States with nuclear power plants were instructed to consider their responses exclusive of capabilities and resources related to the plants given that the emergency response plans for nuclear power plants are specific and unique.

Results: Thirty-eight (76%) state health departments responded to the survey, including 26 of the 31 states with nuclear power plants. Specific strengths noted at the state level included that the majority of states had a written radiation response plan and most plans include a detailed section for communications issues during a radiation emergency. In addition, more than half of the states indicated that their relationship with federal partners is sufficient to provide resources for radiation emergencies, indicating the importance states placed on federal resources and expertise. Specific weaknesses are discussed and include that most states had completed little to no planning for public health surveillance to assess potential human health impacts of a radiation event; less than half had written plans to address exposure assessment, environmental sampling, human specimen collection and analysis, and human health assessment. Few reported having sufficient resources to do public health surveillance, radiation exposure assessment, laboratory functions and other capabilities.

Discussion: Levels of planning, resources and partnerships varied among states, those with nuclear power plants were better prepared. Gaps were evident in all states; however and additional training and resources are needed to ensure adequate levels of preparedness.

Conclusion: Overall results of this assessment indicate that in most measures of public health capacity and capability, states are poorly prepared to adequately respond to a major radiation emergency event. Specific recommendations are noted in the discussion.

(Disaster Med Public Health Preparedness. 2011;5:S134-S142)

(Received January 06 2011)

(Accepted January 18 2011)

Key Words:

  • radioactive hazard release;
  • radiation effects;
  • emergency medical services;
  • regional health planning;
  • public health preparedness;
  • state government;
  • disaster response;
  • emergencies;
  • radiation;
  • emergency preparedness;
  • state-level capabilities;
  • disaster;
  • radiation preparedness planning


c1 Correspondence: Address correspondence and reprint requests to Dr Sharon Watkins, Senior Environmental Epidemiologist, Florida Department of Health, 4052 Bald Cypress Way, Bin A08, Tallahassee, FL 32399 (e-mail: Sharon_Watkins@doh.state.fl.us).

Author Affiliations: Dr Watkins is with the Florida Department of Health, Division of Environmental Health; Dr Perrotta is with the Texas A&M Health Science Center; Ms Stanbury is with the Michigan Department of Community Health, Division of Environmental Health; Mr Heumann is with the Oregon Public Health Division; Dr Anderson is with the Wisconsin Division of Public Health; and Ms Simms and Ms Huang are with the Council of State and Territorial Epidemiologists.

The CSTE conducted this assessment with financial support from the Association of State and Territorial Health Officials and the CDC (cooperative agreement 1U38HM000454). The views and opinions expressed in this document are solely those of the CSTE Workgroup, unless otherwise indicated, and may not necessarily represent the views and opinions of the member associations of NARR or the CDC. Although the information in this document may be used by the CDC to develop effective public health guidance and guide future actions, any statements made or actions taken in response to this report do not necessarily constitute endorsement or agreement by the CDC or NARR of the findings, conclusions, and recommendations contained in this article.