The good news, so to speak, is that over the years guidance systems have improved and the typical warhead yield has dropped. Military leaders have predicted that it is very likely that we will have a nuclear device detonated in CONUS, it's just a matter of when. Over the course of history, when have we invented a new weapon and never used it? There are several possible scenarios, including: (1) one or more "dirty" bombs that use conventional explosives to contaminate population centers with radioactive debris, (2) high-altitude burst to cause EMP effect in an attempt to disable electronics, and (3) all-out nuclear war. In the first, a relatively few number of people die in the blast, but chaos ensues, as it is a weapon of terror. An EMP attack probably warrants its own thread, but could cripple the nation if it were successful. Finally, in the third scenario, an enemy nation state would presumably target key leadership areas (Washington, Mount Weather, NORAD), nuclear facilities (ICBM farms in the midwest), and key military targets (all the major bases, especially with retaliatory nuclear capability, including sub and bomber bases).
For someone living in a priority target area, survival would require a blast shelter (much bigger undertaking than a fallout shelter) and would also require advance notice to get in the shelter. Probably not going to be very achievable for the Average Joe, but certainly possible for Washington elites and a few in the military. Keep in mind that SLBM attack could land a missile on target in less than 10 minutes from launch- not much time to work with.
But, much of our population does not live in an actual high priority target zone, and could likely survive easily with a proper fallout shelter. I think Cresson Kearney's text lays out the threat and how to mitigate it for the average man very well. Applying the principles of time/distance/shielding, one can develop a plan that would work in much of the country- provided that you aren't directly in a blast zone.
Here's one of many on-line blast calculators that can help one gauge the impact of a nuclear detonation:
http://nuclearsecrecy.com/nukemap/
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