The US Must Prepare to Respond to a Nuclear Disaster

 In Forces & Capabilities, CBRN, Nuclear Reactors, Materials, and Waste

On the 75th anniver­sary of the bomb­ings of Hiroshima and Nagasaki, some may like to think the threat from nuclear weapons has reced­ed. But there are clear signs of a growing nuclear arms race and that the U.S. is not very well-pre­pared for nuclear and radi­o­log­i­cal events.

I’ve been studying the effects of nuclear events – from det­o­na­tions to acci­dents – for over 30 years. This has includ­ed my direct involve­ment in research, teach­ing and human­i­tar­i­an efforts in mul­ti­ple expe­di­tions to Chernobyl- and Fukushima-con­t­a­m­i­nat­ed areas. Now I am involved in the pro­pos­al for the formation of a Nuclear Global Health Workforce, which I pro­posed in 2017.

Such a group could bring togeth­er nuclear and non­nu­clear tech­ni­cal and health pro­fes­sion­als for edu­ca­tion and train­ing, and help to meet the preparedness, coordination, collaboration and staffing requirements nec­es­sary to respond to a large-scale nuclear crisis. 

What would this work­force need to be pre­pared to manage? For that we can look back at the legacy of the atomic bomb­ings of Hiroshima and Nagasaki, as well as nuclear acci­dents like Chernobyl and Fukushima.

Approximately 135,000 and 64,000 people died, respec­tive­ly, in Hiroshima and Nagasaki. The great majority of deaths hap­pened in the first days after the bomb­ings, mainly from ther­mal burns, severe phys­i­cal injuries and radi­a­tion. 

The great major­i­ty of doc­tors and nurses in Hiroshima were killed and injured, and there­fore unable to assist in the response. This was large­ly due to the con­cen­tra­tion of med­ical per­son­nel and facil­i­ties in inner urban areas. This exact con­cen­tra­tion exists today in the major­i­ty of American cities, and is a chill­ing reminder of the dif­fi­cul­ty in medically responding to nuclear events. 

What if a nuclear device were det­o­nat­ed in an urban area today? I explored this issue in a 2007 study mod­el­ing a nuclear weapon attack on four American cities. As in Hiroshima and Nagasaki, the major­i­ty of deaths would happen soon after the det­o­na­tion, and the local health care response capa­bil­i­ty would be large­ly erad­i­cat­ed. 

Models show that such an event in an urban area in par­tic­u­lar will not only destroy the exist­ing public health pro­tec­tions but will, most likely, make it extremely difficult to respond, recov­er and reha­bil­i­tate them. 

Very few med­ical per­son­nel today have the skills or knowl­edge to treat the kind and the quan­ti­ty of injuries a nuclear blast can cause. Health care work­ers would have little to no familiarity with the treatment of radiation victims. Thermal burns would require enor­mous resources to treat even a single patient, and a large number of patients with these injuries will over­whelm any exist­ing med­ical system. There would also be a mas­sive number of lac­er­a­tion injuries from the break­age of vir­tu­al­ly all glass in a wide area. 

A major nuclear event would create wide­spread panic, as large pop­u­la­tions would fear the spread of radioac­tive mate­ri­als, so evac­u­a­tion or shel­ter­ing in place must be con­sid­ered. 

For instance, within a few weeks after the Chernobyl acci­dent, more than 116,000 people were evacuated from the most con­t­a­m­i­nat­ed areas of Ukraine and Belarus. Another 220,000 people were relo­cat­ed in sub­se­quent years. 

The day after the Fukushima earth­quake and tsuna­mi, over 200,000 people were evacuated from areas within 20 kilometers (12 miles) of the nuclear plantbecause of the fear of the poten­tial for radi­a­tion expo­sure.

The evac­u­a­tion process in Russia, Ukraine, Belarus and Japan was plagued by mis­in­for­ma­tion, inad­e­quate and con­fus­ing orders and delays in releas­ing infor­ma­tion. There was also trou­ble evac­u­at­ing every­one from the affect­ed areas. Elderly and infirm res­i­dents were left in areas near radioac­tive con­t­a­m­i­na­tion, and many others moved unnec­es­sar­i­ly from uncon­t­a­m­i­nat­ed areas (result­ing in many deaths from winter con­di­tions). All of these trou­bles lead to a loss of public trust in the gov­ern­ment. 

However, an encour­ag­ing fact about nuclear fall­out (and not gen­er­al­ly known) is that the actual area that will receive dan­ger­ous levels of radioac­tive fall­out is actu­al­ly only a frac­tion of the total area in a circle around the det­o­na­tion zone. For instance, in a hypothetical low-yield (10 kiloton) nuclear bomb over Washington, D.C., only lim­it­ed evac­u­a­tions are planned. Despite pro­jec­tions of 100,000 fatalities and about 150,000 casu­al­ties, the casu­al­ty-pro­duc­ing radi­a­tion plume would actu­al­ly be expect­ed to be con­fined to a rel­a­tive­ly small area. (Using a clock-face anal­o­gy, the danger area would typ­i­cal­ly take up only a two-hour slot on the circle around the det­o­na­tion, dic­tat­ed by wind: for exam­ple, 2 – 4 o’clock.)

People upwind would not need to take any action, and most of those down­wind, in areas receiv­ing rel­a­tive­ly small radi­a­tion levels (from the point of view of being suf­fi­cient to cause radi­a­tion-relat­ed health issues), would need to seek only “mod­er­ate shel­ter.” That means basi­cal­ly stay­ing indoors for a day or so or until emer­gency author­i­ties give fur­ther instruc­tions.

The Radiation Effects Research Foundation, which was estab­lished to study the effects of radi­a­tion on sur­vivors of Hiroshima and Nagasaki, has been track­ing the health effects of radi­a­tion for decades. 

According to the Radiation Effects Research Foundation, about 1,900 excess cancer deaths can be attrib­uted to the atomic bombs, with about 200 cases of leukemia and 1,700 solid can­cers. Japan has con­struct­ed very detailed cancer screen­ings after Hiroshima, Nagasaki and Fukushima. 

But the data on many poten­tial health effects from radi­a­tion expo­sure, such as birth defects, are actu­al­ly quite dif­fer­ent from the pre­vail­ing public per­cep­tion, which has been derived not from val­i­dat­ed sci­ence edu­ca­tion but from enter­tain­ment out­lets (I teach a uni­ver­si­ty course on the impact of media and pop­u­lar cul­ture on dis­as­ter knowl­edge).

While it has been shown that intense med­ical X‑ray expo­sure has acci­den­tal­ly pro­duced birth defects in humans, there is doubt about whether there were birth defects in the descen­dants of Hiroshima and Nagasaki atomic bomb sur­vivors. Most respect­ed long-term inves­ti­ga­tions have con­clud­ed there are no sta­tis­ti­cal­ly sig­nif­i­cant increas­es in birth defects result­ing in atomic bomb sur­vivors. 

Looking at data from Chernobyl, where the release of air­borne radi­a­tion was 100 times as much as Hiroshima and Nagasaki com­bined, there is a lack of defin­i­tive data for radi­a­tion-induced birth defects.

A wide-rang­ing WHO study con­clud­ed that there were no dif­fer­ences in rates of mental retar­da­tion and emo­tion­al prob­lems in Chernobyl radi­a­tion-exposed chil­dren com­pared to chil­dren in con­trol groups. A Harvard review on Chernobyl con­clud­ed that there was no sub­stan­tive proof regard­ing radi­a­tion-induced effects on embryos or fetus­es from the acci­dent. Another study looked at the congenital abnormality registers for 16 European regions that received fall­out from Chernobyl and con­clud­ed that the wide­spread fear in the pop­u­la­tion about the pos­si­ble effects of radi­a­tion expo­sure on the unborn fetus was not jus­ti­fied. 

Indeed, the most definitive Chernobyl health impact in terms of num­bers was the dra­mat­ic increase of elec­tive abor­tions near and at sig­nif­i­cant dis­tances from the acci­dent site. 

In addi­tion to rapid response and evacuation plans, a Nuclear Global Health Workforce could help health care prac­ti­tion­ers, pol­i­cy­mak­ers, admin­is­tra­tors and others under­stand myths and realities of radiation. In the crit­i­cal time just after a nuclear crisis, this would help offi­cials make evi­dence-based policy deci­sions and help people under­stand the actual risks they face.

Today, the risk of a nuclear exchange – and its dev­as­tat­ing impact on med­i­cine and public health world­wide – has only esca­lat­ed com­pared to pre­vi­ous decades. Nine coun­tries are known to have nuclear weapons, and inter­na­tion­al rela­tions are increas­ing­ly volatile. The U.S. and Russia are heav­i­ly invest­ing in the mod­ern­iza­tion of their nuclear stock­piles, and ChinaIndia and Pakistan are rapid­ly expand­ing the size and sophis­ti­ca­tion of their nuclear weapon capa­bil­i­ties. The devel­op­ing tech­no­log­i­cal sophis­ti­ca­tion among ter­ror­ist groups and the grow­ing global avail­abil­i­ty and dis­tri­b­u­tion of radioac­tive mate­ri­als are also especially worrying.

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In recent years, a number of gov­ern­ment and pri­vate orga­ni­za­tions have held meet­ings (all of which I attend­ed) to devise large-scale med­ical respons­es to a nuclear weapon det­o­na­tion in the U.S. and world­wide. They include the National Academy of Sciences, the National Alliance for Radiation Readiness, National Disaster Life Support Foundation, Society for Disaster Medicine and Public Health, and the Radiation Injury Treatment Network, which includes 74 hos­pi­tals nation­wide active­ly prepar­ing to receive radi­a­tion-exposed patients. 

Despite the gloomy prospects of health out­comes of any large-scale nuclear event common in the minds of many, there are a number of con­crete steps the U.S. and other coun­tries can take to pre­pare. It’s our oblig­a­tion to respond. 

This arti­cle is an update to an article originally published in 2015 that includes links to more recent research and updat­ed infor­ma­tion on the threat of nuclear inci­dents.

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