In a de-stabilized world, the risk of a nuclear power detonating a weapon of mass destruction is greater than it’s been in decades. One of the effects of a nuclear attack that causes death and disease is radiation. Let’s discuss the medical effects of radiation exposure. These are collectively known as “radiation sickness” or “Acute Radiation Syndrome.” A certain amount of radiation exposure is tolerable over time, but your goal as medic is to shelter your group so they receive as small a dose as possible.

To accomplish this goal, we should first describe the different terms for measuring the quantity of radiation. Scientists use a variety of confusing terms such as RADS, REMS, SIEVERTS, BECQUERELS, GRAYS, and CURIES to describe radiation amounts. Different terms describe the amount of radiation being given off by a source, the total amount of radiation that is actually absorbed by a human or animal, or the chance that a living thing will suffer ill effects from exposure:

BECQUERELS and CURIES describe the amount of radiation that, say, a hunk of plutonium gives off into the environment. They’re named after the scientists who were the first to work with (and die from) radioactivity.

RADS represent the amount of the radiation in the environment that is actually absorbed by a living thing. Some use the term “GRAY” similarly. 100 Rads equals 1 Gray.

REMS and SIEVERTS are the measurement of the risks of health damage from the radiation absorbed.

For our purposes, let’s use RADS. RAD stands for Radiation Absorbed Dose and, as I mentioned a second ago, measures the amount of radiation energy transferred to some mass of material, typically humans.

An acute radiation dose is one received over a short period of time. It’s the most damaging type of exposure. For comparison purposes, we’re going to assume that the average person absorbs about 0.6 RADs per year from natural or household sources.

You might not have symptoms until you hit 30-70 RADS of exposure. At that point, you might notice a Mild headache or nausea within several hours of exposure, but recovery is usually rapid.

At 70-150 RADS, nausea and vomiting is seen in about a third of patients. Decreased wound healing and increased susceptibility to infection occurs, but eventual recovery is the usual outcome.

At 150-300 RADS, Moderate nausea and vomiting happens in a majority of patients. Fatigue and weakness is experienced by about half. Infection and/or bleeding may occur due to a weakened immune system. Burns may be seen and medical care will be required for many. Expect occasional deaths at 300 RADS exposure.

At 300-500 RADS. Expect moderate nausea and vomiting, fatigue, and weakness just about all victims. Diarrheal stools, dehydration, loss of appetite, skin breakdown, and infection will be common. Hair loss is visible in most over time. At the high end of exposure, expect at least a 50% death rate.

Over 500 RADS, it’s not good. Spontaneous bleeding, fever, stomach and intestinal ulcers, bloody diarrhea, dehydration, low blood pressure, infections, and hair loss is anticipated in almost all patients. Death rates begin to approach 100%.

All of the effects related to exposure may not happen at the same time and aren’t immediate in many cases. Hair loss, for example, may take 10-14 days to appear. Deaths often occur weeks after exposure.

Be aware that, if knocked off the grid and modern medical care is not an option, worse outcomes than what I’ve mentioned will be the norm.

The treatment goals for radiation sickness are to prevent further radioactive contamination; treat life-threatening injuries like burns and trauma; reduce symptoms; and manage pain.

First is Decontamination. Decontamination lowers the risk of internal contamination from inhalation, ingestion, or open wounds. This involves removing radioactive particles. Removing clothing and shoes eliminates about 90 percent of external contamination. Gently washing with water and soap removes additional radiation particles from the skin.

If you have group members with radiation sickness, you’ll have to treat the effects, things like:

• Headache
• Fever
• Diarrhea
• Nausea and vomiting
• Dehydration
• Burns
• Sores or ulcers
• Bacterial infections
• And, of course, Pain

Medications include pain meds, antibiotics, antidiarrheals, anti-nausea agents, and burn gels and dressings. Materials to provide daily wound care are also important.

Potassium iodide ( available commercially as Thyrosafe, Iosat, and other brands is also used. This is a nonradioactive form of iodine. Iodine is essential for proper thyroid function. If you’re exposed to significant radiation, your thyroid will absorb radioactive iodine (radioiodine) just as it would other forms of iodine, leading to certain cancers down the road.

If you take potassium iodide, it prevents the absorption of radioactive iodine. Potassium iodide is most effective when taken as soon as you’re aware there has been an exposure. Treat the children first, as they’re most likely to end up with cancer later. Treatment for older kids is Thyrosafe 65 mg a day for up to ten days, although if radiation levels are no longer an issue, you can stop the treatment. Adults take 130 mg a day for up to ten days. Usually, however, no more than a few doses are needed. Alternative methods and dosing for small children and pets are discussed further in our Survival Medicine Handbook.

Let’s talk about prevention. The medic’s goal is to prevent exposures over 100 RADS. A radiation dosimeter is a useful item to gauge radiation absorbed. It’s much more useful than a Geiger counter, in y opinion, and is widely available commercially. This item helps predict the likelihood of developing radiation sickness.

There are three basic ways of decreasing the total amount of radiation exposure:

First, Limit time spent in the open. Radiation damage is dependent on the length of exposure. Leave areas where high levels are detected and no adequate shelter is at hand. The activity of radioactive particles decreases over time. After 24 hours, levels usually drop to 1/10 of their previous value or less.

Second, Increase the distance from the radiation source. Radiation disperses over distance and the effects will be decreased in proportion. In nuclear reactor meltdowns, common evacuation patterns include a complete ten-mile circle or, sometimes, a “keyhole” consisting of a several-mile circle and an additional three miles radiating from the direction of the prevailing winds.

The third way to shield people to decrease radiation where they are. In many cases, people may have to shelter in place. Shielding will decrease exposure exponentially, so it is important to know how to construct a barrier between your people and the radioactive source. Denser materials will give better protection.

Shielding effectiveness is measured in terms of “halving thickness.” This is the thickness of a particular material that will reduce gamma radiation (the most dangerous kind) by one half. When you multiply the halving thickness, you multiply your protection.

Here are the halving thicknesses of some common materials:

Lead:                  0.4 inches or 1 centimeter

Steel:                  1 inch or 2.5 centimeters

Concrete:           2.4 inches or 6 centimeters

Packed Soil:       3.6 inches or 9 centimeters

Water:                7.2 inches or 18 centimeters

Wood:                11 inches or 28 centimeters

What does this mean from a practical standpoint? Let’s take concrete as an example. the halving thickness of concrete is 2.4 inches or 6 centimeters. That barrier thickness of concrete will drop exposure to gamma radiation by half. Doubling the thickness of the barrier to 4.8 inches or 12 cm drops it to one fourth (1/2 x 1/2). Tripling it to 7.2 inches or 18 cm will drop it to one eighth (1/2 x 1/2 x 1/2), etc. Ten halving thicknesses drops the total radiation exposure to 1/1024^th of the level in the outside environment. For concrete, that would be 24 inches or 60 cm. If you can do that, people not killed by heat or kinetic energy close to ground zero can wait out the highest radiation levels.

For lead, the thickness of your lead bunker would only have to be 10 cm or 4 Inches thick. If it was made of wood, however, you’d need a barrier 110 inches thick or 2,8 meters.

Right now, the risk of a nuclear confrontation from some rogue power isn’t zero, but it’s small. Let’s hope it stays that way.

Joe Alton MD

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