Justification for a Nuclear Global Health Workforce: multidisciplinary analysis of risk, survivability & preparedness, with emphasis on the triage management of thermal burns

Abstract

Major challenges and crises in global health will not be solved by health alone; requiring rather a multidisciplinary, evidence-based analytical approach to prevention, preparedness and response. One such potential crisis is the continued spread of nuclear weapons to more nations concurrent with the increased volatility of international relations that has significantly escalated the risk of a major nuclear weapon exchange. This study argues for the development of a multidisciplinary global health response agenda based on the reality of the current political analysis of nuclear risk, research evidence suggesting higher-than-expected survivability risk, and the potential for improved health outcomes based on medical advances. To date, the medical consequences of such an exchange are not credibly addressed by any nation at this time, despite recent advances. While no one country could mount such a response, an international body of responders organized in the same fashion as the current World Health Organization’s global health workforce initiative for large-scale natural and public health emergencies could enlist and train for just such an emergency. A Nuclear Global Health Workforce is described for addressing the unprecedented medical and public health needs to be expected in the event of a nuclear conflict or catastrophic accident. The example of addressing mass casualty nuclear thermal burns outlines the potential triage and clinical response management of survivors enabled by this global approach.

Human Consequences of Multiple Nuclear Detonations in New Delhi (India): Interdisciplinary Requirements in Triage Management

“…Emergency management of nuclear detonations in an urban setting is influenced by a number of factors such as availability of medical personnel and resources, evacuation capabilities, and dissemination of information to the general public regarding the incident [ 13 ]. Even in the minimal triage group, it can be expected that there will be millions of people that will require basic care such as first aid and debridement of wounds.…”

“…Triage and treatment of wounded survivors should be complimented by evacuation efforts, particularly for populations projected to be in the path of the fallout radiation plume [ 13 ]. Three major factors will influence evacuation of victims.…”

“…In all wars, over time more mortality occurs from destroyed public health infrastructure and protections (up to 70–90%) than deaths from direct weaponry [ 24 ]. This is rarely appreciated and must become a priority as recovering triage categories become increasingly dependent on these protections [ 13 ].…”

The nursing profession: a critical component of the growing need for a nuclear global health workforce

“…Individuals farther away from the blast, but in the path of fallout, may experience health effects from fallout on the outside of the body or clothes (external contamination) or on the inside of the body (internal contamination), from contaminated food, air, water sources, or contact with contaminated surfaces. Extensive modeling has been done of a potential detonation of a nuclear weapon in various locations [ 14 , 15 ] with all studies indicating the daunting task for medical response.…”

“…A nuclear event will result in an unprecedented mass casualty incident with large scale morbidity and mortality, requiring a massive medical response [ 16 ], allocation of scarce resources and the rapid deployment of mobile, self-contained, self-sufficient health care facilities [ 15 ]. According to the nuclear workforce framework put forth by Burkle and Dallas, medical support to triage, provision of care to those with the opportunity to survive, palliative care for those who will die, and care for those individuals less affected or who have evacuated will be needed [ 1 ].…”