The medical response demands of a nuclear attack.
We can take measured comfort in the notion that the most horrific terrorist threat is also probably the toughest one to pull off: detonation of a nuclear device in a major city. Even after the Cold War and 9-11, the prospect seems extremely remote.
Yet the authors of a recent study warn that planners must do more to prepare for a nuclear attack, in particular because such a scenario would not only inflict mass casualties but would also effectively neutralize a region's medical response and healthcare capacity.
William Bell and Cham Dallas of the University of Georgia considered the impact of two different nuclear weapons—20 and 550 kiloton—on four major U.S. cities: Atlanta, Chicago, New York, and Washington, D.C, using standard environmental modeling software.
For comparison, the U.S. atomic bomb dropped on Hiroshima, Japan during World War II, which killed an estimated 140,000, is estimated equivalent to 15 kilotons of TNT. The larger figure, 550 kilotons, reflects a typical device built by the former Soviet Union and now sought by terrorist groups.
Bell and Dallas walk the reader through the variables that can affect a nuclear weapon's degree of lethality, and they discuss the implications of that lethality in chilling detail.
Heavy cloud cover, for instance, coupled with snow on the ground would, through reflection, magnify the impact of thermal radiation through flash fires and burns by a factor of five.
Fallout of radioactive particles downwind from a blast can prove as, or more, deadly than the blast itself. A lesson from the paper: If you survive the initial blast, lock the doors, close the windows, and stay inside.
"[M]any people will try to flee by car or on foot, often in the wrong direction, again exposing themselves to high radiation, as vehicles provide virtually no protection," Bell and Dallas wrote.
Another issue to consider in assessing the impact of a nuclear attack is the concentration of major hospitals in city centers and along potential fallout paths. In many major cities—including the District of Columbia—the major medical facilities are clustered in a small area, the study notes. The impact, for example, on the Washington, D.C. area from a 550 kiloton detonation downtown: in addition to overall damage and casualties, the loss of 57 percent of hospital beds within 20 miles, and loss of 62 percent of healthcare workers.
Bell and Dallas say the government must build capacity for massive and immediate medical response to regions affected by a nuclear attack, in particular with added hospital beds and respirators, the latter a critical tool for keeping trauma and burn victims alive. These assets would ideally be staged far from key healthcare infrastructure, with the capacity for rapid deployment after an attack.
Equally important, say the report's authors, the government must have environmental modeling software at the ready so that emergency managers can almost instantaneously determine where medical response would save the most lives immediately after an attack.
The authors singled out Georgia as an example of a state that is taking appropriate measures. The state has purchased 11,000 portable hospital beds, equivalent to 70 percent of the state's normal capacity. Georgia's efforts are more a response to concerns about a pandemic than radiation, but the study noted that many existing preparedness measures targeting pandemic flu would yield benefits in a nuclear attack. Medical response preparedness and computer modeling would similarly benefit response to other disasters, specifically biological or chemical attacks, the authors said.
Two other recommendations were geared specifically toward hospitals and other healthcare institutions: data backup, and plans for credentialing staff when identification materials are inaccessible.
Dallas says that although the Cold War is nearly 20 years gone, the U.S. government is still aggressively studying the impacts of a potential nuclear attack, with work at places like the Department of Energy's Oak Ridge National Laboratory and at the Defense Threat Reduction Agency.
The results of that work, however, are classified, which explains the run on Bell and Dallas's research. Published earlier this year in the Journal of Health Geographics, their paper was the most downloaded article for four weeks on biomedcentral.com, a major international portal for peer-reviewed medical research.
Dallas speculates that the government's modeling is based on highly refined data. His and Bell's research uses open-source census information and contemporary modeling software.