State health departments display substantial gaps in preparedness for a major radiation emergency, including acts of terrorism and unintentional releases of radiation, according to survey results published in the journal Disaster Medicine and Public Health Preparedness.

The survey responses by 38 state health departments indicated that 45% of states do not do the “most fundamental step of preparedness,” which is the development of a response plan, other than for nuclear power plant emergencies, according to the article. “Without a comprehensive plan, states in which a radiation emergency occur are likely to mount inefficient, ineffective, inappropriate or tardy responses that could result in (preventable) loss of life,” wrote the authors. “A large portion of the U.S. population is at increased risk should a radiological event occur within the country’s borders,” they wrote.

The survey also found that for some measures, as much as 85% of responding states reported “insufficient capability to respond to a radiation incident.”

The survey was conducted by the Council of State and Territorial Epidemiologists with financial support from the Association of State and Territorial Health Officials and the Centers for Disease Control and Prevention.