The Best-Laid Plans

While the government's medical response to Katrina upset and frustrated Pietro "Peter" Marghella, formerly the top medical response planner for the Joint Chiefs of Staff and now president and CEO of Medical Planning Resources Inc., it did not surprise him. He learned of the government's poor planning for civilian casualties nearly two years ago, and says little has changed.

In September, Marghella toured the devastation in Louisiana to assess medical needs, and what he saw confirmed his expectations. He encountered in New Orleans hospitals patients and doctors who "were hearing rumors that assets were coming their way," he says. "But there weren't assets coming their way.

"There was no plan," he says.

Marghella should know; he was the lead writer for the government's first-and to date only-effort to hash out what to do with the sick and injured in a catastrophe.

The meeting was called the morning of Dec. 21, 2003, just three days before terrorists were planning to detonate nuclear devices in major U.S. cities, according to warnings from intelligence analysts, Marghella says.

Gathered at the Homeland Security Operations Center that day, representatives from federal agencies heard then-DHS Secretary Tom Ridge explain that he had raised the nation's threat level from yellow to orange. "We have information there could be nuclear attacks in the United States," Marghella recalls him saying.

The group was told to devise a plan to handle an attack that would leave 100,000 people dead, 100,000 people injured, and 250,000 needing food, shelter and first aid, according to Marghella and another planner.

Published accounts of the incident last year said the threat involved two "dirty bombs," conventional explosives packed with radioactive material whose impact is much smaller than a nuclear warhead. But a second planner confirmed Marghella's memory of being asked specifically to prepare for the detonation of two nuclear weapons, recalling they were told the weapons could be as large as 10 megatons each.

The attacks could occur any time between Christmas and New Year's, Ridge said. That gave Marghella and the other planners three days to fashion the nation's first plan to handle a catastrophe and the death and injury it would cause.

The group completed a "quick-and-dirty" plan in time for Christmas, according to Marghella and the other planner. Thankfully, the attacks never came.

The planning effort quieted, shifted between managers, got hung up in bureaucratic squabbles and "died a slow death," says Marghella.

Its final incarnation was as the "Catastrophic Incident Supplement" to the government's massive National Response Plan, intended to guide the federal response to disasters of every type and size. It appears never to have been approved.

An epitaph for Marghella's document is buried in an addition to the NRP: "A more detailed and operationally specific NRP Catastrophic Incident Supplement . . . designated 'For Official Use Only' will be approved and published independently," states the report, published in January. To date, no federal official has been able to confirm the existence of an approved, published version of that supplement. Marghella retired in April.