An explosion rocks a local high school. Minutes later, casualties flood into a hospital emergency room.
Only after the first wave of wounded arrive is the hospital informed that the explosion was a result of a dirty bomb -- a weapon designed to scatter radioactive material throughout its blast radius.
And one by one, weaknesses in the system take their toll on emergency efforts.
Hospital administrators call their local radiation safety officer, but he is on vacation and can't be reached.
Health workers search for but cannot locate radiation meters that could help them determine which patients suffered the highest degree of contamination.
Confusion builds as medical professionals wonder about the appropriate way to deal with so many patients as radioactive patients lay waiting for appropriate treatment, possibly contaminating other patients and health professionals.
At the climax of the disaster, the emergency bays of the hospital close down. The system of medical treatment grinds to a halt. All that remains now is a slim hope that casualties and contamination can somehow be kept to a minimum.
Fortunately, the above was just a drill -- one of many conducted in communities across the country since the 9/11 attacks.
But the scenario was frighteningly realistic. And the ways in which the situation was mishandled exposed the weak spots in the medical system of one county when it came to a possible radiological disaster.
"They flubbed it terribly," says Dr. John Moulder, professor of radiation oncology at the Medical College of Wisconsin in Milwaukee. Moulder, who did not reveal the location of the scenario described above, says the missteps in the response could have happened anywhere else in the country.
It is a nightmarish scenario. But federal officials hope a new online tool could help health professionals cope with such an episode more effectively.
Preparing for Impending Disaster
The words "dirty bomb" have been on the lips of health and law enforcement officials since the terrorist attacks of 2001. But even now, a surefire solution for dealing with such a catastrophe has been elusive.
Moulder was part of the team that developed a new resource -- a Web site conceived by the U.S. Department of Health and Human Services -- that provides a readily accessible plan of action.
"The need for this resource was first discussed within a couple of months of 9/11," Moulder says. "It has taken this long to develop because it is a federal document."
The need for such a resource is clear, he says.
"Most medical professionals do not know how to deal with radiation injuries," Moulder says. "And since they will probably never see one, they have little incentive to spend days learning the material."
Other health experts in the field of radiation treatment say the Web site, which includes detailed guidelines for triage and treatment of patients, is a welcome resource.
"I must admit I am very impressed by this Web site," says Dr. Jack Little, professor of radiobiology at the Harvard School of Public Health.
"In the best of all possible worlds, one would never need to consult it. However, having it there and widely available on the Internet is, to my mind, a great service."
But before the algorithms and guidelines of the site can be applied, health professionals must first be familiar with the site. If they are not, the Web site may not be the first stop for useful information.
Web Site May Frighten Public
But while the Web site may represent a boon for health workers, for the public, it may give a terrifying peek into the difficult decisions that would have to be made in the event of a radioactive disaster.
The site is laced with euphemisms. "Expectant" patients are those "who are seriously injured and in whom survivability is poor …"
Recommended treatment: "Provide comfort care."
Numerous flowcharts branch downward into frightening conclusions. Treatment of survivors. Management of the deceased.
Follow the link of the latter possibility, and receive this guidance: "If an autopsy is necessary, refrigerate the decedent and defer the procedure until a health physicist can assist in planning."
For this reason, Moulder says, the site may be best left to health professionals.
"Scattered within the site is stuff at the lay consumer level, but most of the resources in there assume some knowledge of medicine," he says.
Other health experts agree. "I am not sure it is meant for lay people. It is pretty specialized and detailed," says Dr. Ziad Kazzi, medical toxicologist at the University of Alabama department of emergency medicine in Birmingham.
"Radiation is not user-friendly, in general," he adds.
Bobby Scott, senior scientist at the Lovelace Respiratory Research Institute in Albuquerque, N.M., says public worries at the idea of measures that would have to be taken after such an event are to be expected.
"The very thought of having to prepare for the possibility of a nuclear- or radiological-weapon-associated mass casualty event in the U.S. is likely to frighten many members of the public," he says.
But he adds that certain features of the site are not likely to leave lay readers with a feeling of warm reassurance.
"The public may also find somewhat disconcerting the disclaimer statement 'Neither the U.S. government nor any agency thereof, nor any of their employees, make any warranty, express or implied, or assumes any legal responsibility for the accuracy, completeness, or usefulness of any information disclosed,'" Scott says.
Are We Prepared?
Moulder says the Web site is a step in the right direction, but he believes there is still a long way to go before health workers and the government are fully prepared for the unthinkable.
"It's better than anything else we've had before, but I don't think it's good enough yet," he says. "We are not currently equipped to deal with radiation mass casualties.
"Let's hope it's always scenarios and never the real thing."
To visit the U.S. Department of Health and Human Services' Radiation Event Medical Management site, click here.