(This article was originally published in Backwoods Home Magazine)

Given the actions of certain authoritarian regimes in recent times, it stands to reason that the risk of an attack by a nuclear-capable nation may include the detonation of a thermonuclear bomb. Weapons of mass destruction abound in the arsenals of the world’s bad actors. More and more, they seem to have less reluctance to use them to achieve a goal.  In this article, we discuss strategies to prevent and treat medical issues related to a detonation. The family medic must always have a plan of action for every type of disaster.

The medical issue you probably most associate with proximity to a nuclear explosion is, well, death. If you’re at the epicenter of a blast (“ground zero”), you’d be right.  Having said that, survival may be possible if almost anywhere else. Although the atomic bomb  dropped on Hiroshima in 1945 killed 150,000 people, another 250,000 in the area survived long-term.  Indeed, a Japanese citizen named Tsutomu Yamaguchi was in the vicinity of both World War II atomic bomb detonations (Hiroshima and Nagasaki); he survived and lived to reach the age of 93.

The damage caused by a nuclear bomb is related to its “yield,” the amount of energy produced in multiples of a thousand tons of TNT (a “kiloton”). The Hiroshima atomic bomb of 1945 had a yield of 15-kilotons. Just 16 years later, the Soviet Union developed and detonated a 51,000-kiloton weapon. Most modern warheads, however, are in the 100-500 kiloton range. This is because they’re meant to be fired at a target in clusters harder to intercept than a single missile.

In 2023, the most likely scenario uses surgical strikes using “tactical” nuclear weapons (“TACS”).  TACS are several times weaker than the Hiroshima bomb. In the minds of some despots, this makes the prospect of a “limited” nuclear confrontation a viable option. New technology known as “Dial-A-Yield” allows the military to adjust the strength of a detonation.  For example, the yield of U.S.’s B61 nuclear bomb can be 0.3, 1.5, 10 or 50 kilotons.

DAMAGE CAUSED BY NUCLEAR WEAPONS

U.S. government estimates the distribution of damage from a nuclear bomb to be:

• 50% shockwave (kinetic energy)
• 35% heat (thermal energy)
• 5% initial blast radiation
• 10% dispersed radiation (fallout)

The damage pattern of a nuclear detonation is generally circular, but prevailing winds may give it a “keyhole” shape.

Two types of kinetic energy come into play: (1) “overpressure” effects measured in pounds per square inch (psi) over environmental norms and (2) wind effects measured in miles per hour. Overpressure can cause eardrum rupture at a threshold of 5 psi and severe lung injury at 20 to 30 psi. Blast winds can reach hundreds of miles per hour, causing collapse of buildings and creation of flying debris resulting in trauma to anyone in the area. In a 10-kiloton blast, it’s unlikely that anyone within a half-mile of ground zero would survive.

Physical Effects of Overpressure  

10-20 psi:  All solidly concrete buildings collapse or are severely damaged. Survival is highly unlikely.

5 psi        Many buildings collapse or are severely damaged. Deaths are widespread, all are injured.

3 psi        Residential structures collapse. Serious injuries commonly seen, a percentage die.

1 psi:       Glass shatters, causing injuries to those nearby.

Thermal damage is another significant aspect of a nuclear detonation. Those outdoors at the time would receive fatal third degree burns within a mile radius of ground zero. In the center of a large city, this can amount to hundreds of thousands of people. Thermal effect would also cause major conflagrations that would be difficult to control, increasing the risk of death and injury to those inside.

The blast itself generates a brilliant flash of light that would cause temporary (at least) blindness in anyone outside within five miles or so, worse if at night. The victim would not have to stare at the fireball for visual damage to occur. Sudden loss of vision would cause air and ground traffic casualties to skyrocket. Highways would be clogged with debris, making it impossible for medical personnel to reach many victims.

Radiation damage occurs from the initial blast and from long-term exposure. In ground detonations, millions of tons of earth are vaporized and rise with the fireball (the “mushroom cloud”). The radioactive debris falls back to earth as “fallout.” In a 10-kiloton explosion, an area about 10 miles downwind would be in the path of enough fallout to present an immediate danger to life and health. The risk is worst in the first several hours. Those further downwind who have not taken shelter are in danger of developing acute radiation sickness (ARS). ARS is associated with burns, intestinal damage, bone marrow suppression, hair loss, a weakened immune system, and much more. Over time, rates of cancers and cataracts will exceed that of non-affected populations.

MEDICAL INFRASTRUCTURE DAMAGE

 

Assuming the detonation was in the center of a city, hundreds of thousands of survivors would require medical care. Unfortunately, surviving hospital units would be able to handle only a minute fraction of the trauma, burn, and radiation cases presented to them. Indeed, in normal times there are less than 2000 burn unit beds in the entire United States, 80 percent of which are already occupied.

Another factor is the lack of medical personnel. For example, 87% of physicians live in urban areas; many will be casualties. It’s thought that each surviving doctor would have responsibility for 600-700 patients. For these reasons, the responsibility for the well-being of loved ones will fall to the family medic.

SUPPLIES FOR THE EFFECTIVE MEDIC

In order to be effective in the role of medic in this scenario, it’s important to have supplies. Trauma supplies should concentrate on the results of high-impact injuries, such as hemorrhage, crush injuries, and broken bones. For burns, dressings to cover injured areas of skin, prevent infection, and a way to hydrate victims is needed. For radiation, a way to determine the level of exposure will give a good idea of the chance for survival. Supplies that, today, are mostly available for purchase by the average citizen include:

TRAUMA SUPPLIES

• Hemostatic dressings
• Tourniquets
• Dressings and bandages, various sizes, sterile and non-sterile
• Non-stick burn dressings
• Gauze rolls, sterile and non-sterile
• Compression dressings, various sizes
• Self-adherent wraps (Coban)
• Medical tapes, duct tape
• Vented chest seals
• Chest decompression needles
• Sterile cotton-tipped applicators
• Airways, oral and nasal, various sizes

PERSONAL PROTECTION GEAR

• CPR protective masks
• Bag valve masks
• Sterile and non-sterile gloves
• Surgical face masks 3-ply, blue

WOUND CARE SUPPLIES

• Hand sanitizers and soap
• Alcohol, BZK, iodine, chlorhexidine antiseptics
• Dakin’s solution for wound care
• Hydrogen peroxide
• Bacitracin antibiotic ointment
• Waterproof pads (Chux®)
• Wound irrigation syringes, 12cc and 60cc sizes
• Sterile cotton-tipped applicators
• Adhesive bandages, assorted sizes
• Suture and stapler Kits
• Steri-Strips or butterfly bandages
• Tincture of Benzoin, swabs or wipes (to secure Steri-Strips)
• Burn gel
• Petroleum jelly

EQUIPMENT

• Pulse oximeters and extra batteries
• Reflex hammer
• Head lamps, penlights
• Blood pressure cuff & stethoscope kit
• Thermometer
• Magnifying glass
• Scalpels, sterile
• Bandage scissors or EMT shears
• Tweezers
• Iris/nail scissors
• Curved and straight clamps
• Needle Holders
• Solar/Mylar blankets

ORTHOPEDIC SUPPLIES

• Cervical collars
• Ace Wrap elastic bandages w/clips
• Triangular bandages with safety pins
• Malleable padded splints, assorted sizes
• Casting materials
• Instant and reusable hot/cold packs
• Pain reliever ointment or creams
• Moleskin sheets

EYE ISSUE SUPPLIES:

• Eyewash
• Eye Cups
• Eye pads, sterile
• Eye patches
• Plastic eye shields

 WATER/REHYDRATION SUPPLIES:

• Water purification tablets
• Water filters
• Rehydration salt packets

ADDITIONAL MEDICATIONS:

• Potassium iodide tablets (used for radioactive iodine)
• Prussian Blue (used for radioactive cesium)
• Acetaminophen (generic Tylenol)
• Aspirin
• Diphenhydramine (generic Benadryl)
• Ibuprofen (generic Advil)
• Nasal decongestant (phenylephrine HCl 10mg)
• Loperamide (generic Imodium)
• Laxatives
• Bismuth subsalicylate (Pepto-Bismol)
• Anti-fungal cream
• Hydrocortisone cream

Radiation dosimeters are required for daily wear to rule out excessive radiation exposure. A dosimeter is different from a Geiger counter. A Geiger counter is used for detecting the presence of ionizing radiation, while a dosimeter identifies the radiation “dose” received by an exposed individual.

Certain life-saving human and veterinary antibiotics are also part of the survival medicine cabinet and can be obtained through online aquarium outlets and other limited sources. Also, intravenous line needles, tubing, and fluids would be useful additions for those skilled in their use.

Unfortunately, supplies are of little use without the knowledge of how to use them. It may take time and effort but, armed with some know-how, you might save lives. Consider a copy of The Survival Medicine Handbook: The Essential Guide for when Help is NOT on the Way or other austere medicine manual for your off-grid library.

PREVENTION

Surviving a nuclear war requires a sound plan of action to prevent injuries and sickness. Your prospects depend on three main factors: time, distance, and level of available protection.

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

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

If you’re in a vehicle at the time of detonation, you’ll be exposed to significant radiation. Cars don’t provide a significant protective barrier, so if there is access to a large concrete building or underground structure nearby, go there immediately.

DISTANCE: Increase the distance from ground zero. Living in the center of a large city places you at a prime spot for severe trauma due to blast effects. If you survive the initial explosion, you would likely be one of many thousands that require medical care. Medical facilities that remain would be overwhelmed and, for your purposes, non-existent.

From a radiation standpoint, remember that the pattern of fallout spread is a “keyhole” that depends on prevailing winds. Radiation disperses over distance and the effects will be decreased in proportion.

PROTECTION: The third way to decrease the risk of death and injury is to have a functioning shield. Away from the immediate vicinity of the blast, a shelter will decrease the risk of injuries and radiation sickness. Shielding will decrease exposure exponentially, so it is important to know how to construct a barrier between your people and the radioactive source. It stands to reason that denser materials 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 1/1024th 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.

DECONTAMINATION

If you’re outside in a nuclear event and cannot get to shelter immediately, you may breathe in radioactive particle from fallout. Covering your face with a mask or other barrier can help reduce the inspiration of radioactive material. A mask would also be helpful while decontaminating children and pets.

Once inside, It’s important to remove fallout from your body as soon as possible. Just taking off and discarding outer layers of clothing can eliminate up to 90 percent of radioactive material. Place contaminated clothing in a plastic bag or other sealed container.

Next, Take a warm shower if possible. Use soap to gently wash your skin, but don’t scrub or scald it: Skin protects your internal organs, and any injury to it can worsen contamination. If you have open wounds, keep them covered while washing. It’s acceptable to shampoo, but conditioner can cause radioactive material to stick to hair.

If a shower isn’t an option, at least wash hands, face, and other exposed parts with soap and water or at least cleansing wipes. Gently blow your nose and wipe your eyes to remove particles in the nasal cavity, eyelashes, and eyelids.

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, but if you’re going to be medically prepared, this is one in which you’ll definitely  be using your skills and equipment.

Joe Alton MD

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