We superimpose a radiation fallout model onto a traffic flow model to assess the evacuation versus shelter-in-place decisions after the daytime ground-level detonation of a 10-kt improvised nuclear device in Washington, DC. In our model, ≈80k people are killed by the prompt effects of blast, burn, and radiation. Of the ≈360k survivors without access to a vehicle, 42.6k would die if they immediately self-evacuated on foot. Sheltering above ground would save several thousand of these lives and sheltering in a basement (or near the middle of a large building) would save approximately ≈1/3 of them. Among survivors of the prompt effects with access to a vehicle, the number of deaths depends on the fraction of people who shelter in a basement rather than self-evacuate in their vehicle: 23.1k people die if 90% shelter in a basement and 54.6k die if 10% shelter. Sheltering above ground saves approximately half as many lives as sheltering in a basement. The details related to delayed (i.e., organized) evacuation, search and rescue, decontamination, and situational awareness (via, e.g., telecommunications) have very little impact on the number of casualties. Although antibiotics and transfusion support have the potential to save ≈10k lives (and the number of lives saved from medical care increases with the fraction of people who shelter in basements), the logistical challenge appears to be well beyond current response capabilities. Taken together, our results suggest that the government should initiate an aggressive outreach program to educate citizens and the private sector about the importance of sheltering in place in a basement for at least 12 hours after a terrorist nuclear detonation.
