The lack of radiation knowledge among the general public continues to be a challenge for building communities prepared for radiological emergencies. This study applied a multi-criteria decision analysis (MCDA) to the results of an expert survey to identify priority risk reduction messages and challenges to increasing community radiological emergency preparedness.

Professionals with expertise in radiological emergency preparedness, state/local health and emergency management officials, and journalists/journalism academics were surveyed following a purposive sampling methodology. An MCDA was used to weight criteria of importance in a radiological emergency, and the weighted criteria were applied to topics such as sheltering-in-place, decontamination, and use of potassium iodide. Results were reviewed by respondent group and in aggregate.

Sheltering-in-place and evacuation plans were identified as the most important risk reduction measures to communicate to the public. Possible communication challenges during a radiological emergency included access to accurate information; low levels of public trust; public knowledge about radiation; and communications infrastructure failures.

Future assessments for community readiness for a radiological emergency should include questions about sheltering-in-place and evacuation plans to inform risk communication.

Using data collected from a Community Assessment for Public Health Emergency Response (CASPER) conducted in Fairfax Health District, Virginia, in 2016, we sought to assess the relationship between household-level perceived preparedness and self-reported preparedness behaviors.

Weighted population estimates and 95% confidence intervals were reported, and Pearson’s chi-squared test was used to investigate differences by group.

Examining responses to how prepared respondents felt their household was to handle a large-scale emergency or disaster, an estimated 7.4% of respondents (95% CI: 4.3–12.3) reported that their household was “completely prepared,” 37.3% (95% CI: 31.4–43.7) were “moderately prepared,” 38.2% (95% CI: 31.6–45.2) were “somewhat prepared,” and 14.4% (95% CI: 10.2–20.0) were “unprepared.” A greater proportion of respondents who said that their household was “completely” or “moderately” prepared for an emergency reported engaging in several behaviors related to preparedness. However, for several preparedness behaviors, there were gaps between perceived preparedness and self-reported readiness.

Community assessments for public health preparedness can provide valuable data about groups who may be at risk during an emergency due to a lack of planning and practice, despite feeling prepared to handle a large-scale emergency or disaster.