As President Barack Obama declared this week [presumably based on the highly classified intelligence that he routinely reads] that Al Qaeda is still intent on attacking the United States with a nuclear weapon, emergency public health preparedness for a catastrophic, mass casualty attack – or natural disaster – continues to deteriorate, say federal, state and local authorities and NGOs.

"The single biggest threat to US security, both short-term, medium-term and long-term, would be the possibility of a terrorist organization obtaining a nuclear weapon," Obama said, adding “this is something that could change the security landscape of this country and around the world for years to come. We know that organizations like Al Qaeda are in the process of trying to secure a nuclear weapon - a weapon of mass destruction that they have no compunction at using."

Al Qaeda’s intentions and efforts to acquire weapons of mass destruction capability were detailed in the January Homeland Security Today report, The WMD Connection, and have been covered in-depth by HSToday.us.

The US Intelligence Community (IC), Congress’ WMD Commission, assessments by former IC WMD counterterrorists, and Secretary of State Hillary Clinton have all recently stated that they consider weapons of mass destruction in the hands of terrorists to be the most serious threat faced by the US.

But preparedness for the aftermath of a crippling WMD attack remains lax. Budgets have either become stagnant or have been significantly cut, officials said, complaining that at the federal level, "creeping complacency" has set in.

Most recently, the paper, “Environmental Decontamination Following a Large-Scale Bioterrorism Attack: Federal Progress and Remaining Gaps” by Crystal Franco and Nidhi Bouri in the June 2010 print issue of Biosecurity and Bioterrorism sponsored by the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism  (WMD Commission) “identifies gaps in decontamination policy and technical practice at the federal level and provides practical recommendations that will better enable the US to undertake a biological decontamination response.”

“Following the 2001 anthrax attacks, the government and private sector undertook the task of cleaning up anthrax-contaminated facilities – a job that had never before been attempted on that scale. Decontaminating congressional office buildings, postal facilities, and media buildings cost hundreds of millions of dollars, and some of the facilities could not be reopened for more than two years,” the WMD Commission stated this week.

But “nine years later, what progress have we made in policy and practice that would make decontamination easier in the event of another attack?” the Commission asked.

The recent assessment by Franco and Bouri “found that the process of environmental decontamination would still be very difficult and costly and that the lines of responsibility at the federal level are still unclear … a large-scale biological release could potentially result in hundreds of thousands of illnesses and deaths and could cost trillions of dollars to clean up. An attack on a US city could contaminate both indoor and outdoor areas, including buildings, street, parks, and vehicles,” the WMD Commission stated.

But it’s not just preparedness for a biological attack that is remiss. Studies have also shown that the response capabilities for a catastrophic terrorist attack using a nuclear weapon is equally lacking, and would quickly overwhelm federal, state and local resources in the region where such an attack occurred.

Meanwhile, hospitals (including hospitals with trauma care departments) and specialty care medical facilities across the country are closing their doors or are in such fiscal dire straits that they could soon find themselves having to also close their doors.

Closures of these facilities means less beds and critical care will be available in the event of a mass casualty attack requiring an inventory of enough spare bed and care capacity for the “surge” of injured from an attack.

More than 60 doctor-owned hospitals across the country that were in the development stage are expected to be canceled, said Molly Sandvig, executive director of Physician Hospitals of America (PHA).

“That’s a lot of access to communities that will be denied,” Sandvig told CNSNews.com. “The existing hospitals are greatly affected. They can’t grow. They can’t add beds. They can’t add rooms. Basically, it stifles their ability to change and meet market needs. This is really an unfortunate thing as well, because we are talking about some of the best hospitals in the country.”

Hospitals that could be crucial to meeting the surge from a catastrophic attack.

Meanwhile, there's a rapidly growing paucity of doctors. It's predicted that there will be a shortage of 150,000 in just 15 years. Among the declining number of doctors that are needed are the kind of specialty physicians that are required in trauma and emergency departments, according to Connie Potter, executive director of the Trauma Center Association of America, which also has repeatedly highlighted the growing inability of many hospitals to be able to handle large-scale mass casualty events.