Vulnerability of populations and the urban health care systems to nuclear weapon attack – examples from four American cities

Bell, William; Dallas, Cham E.

doi:10.1186/1476-072x-6-5

Cited by 39 publications

(32 citation statements)

References 14 publications

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“…It has been noted in previous publications by this group that the mass thermal burn casualties expected with nuclear weapons are going to be very difficult to treat [1,2]. Typical burn care management involves a high ratio of medical personnel to patients, which can be accommodated when there are only a few burn victims at a time.…”

Section: Resultsmentioning

confidence: 99%

“…Analysis of the impact of nuclear weapon use on American cities has revealed the shocking outcome in mortality and morbidity in densely occupied urban areas. Nuclear weapons with larger than 100 Kt yields were found to generate predominantly thermal and fallout radiation casualties, able to cause burns and generate fires at distances considerably greater than building damage, and to spread lethal levels of fallout for many kilometers, causing radiation casualties many kilometers downwind from detonation [1,2]. The key factors in the dramatic differences in impact of an Iranian/Israeli nuclear exchange will be the lower fission yields, numbers of weapons, and less accurate targeting of the Iranian forces relative to the Israeli nuclear capabilities.…”

Section: Introductionmentioning

confidence: 99%

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Nuclear war between Israel and Iran: lethality beyond the pale

Dallas¹,

Bell²,

Caruso³

et al. 2013

Confl Health

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BackgroundThe proliferation of nuclear technology in the politically volatile Middle East greatly increases the likelihood of a catastrophic nuclear war. It is widely accepted, while not openly declared, that Israel has nuclear weapons, and that Iran has enriched enough nuclear material to build them. The medical consequences of a nuclear exchange between Iran and Israel in the near future are envisioned, with a focus on the distribution of casualties in urban environments.MethodsModel estimates of nuclear war casualties employed ESRI's ArcGIS 9.3, blast and prompt radiation were calculated using the Defense Nuclear Agency's WE program, and fallout radiation was calculated using the Defense Threat Reduction Agency's (DTRA's) Hazard Prediction and Assessment Capability (HPAC) V404SP4, as well as custom GIS and database software applications. Further development for thermal burn casualties was based on Brode, as modified by Binninger, to calculate thermal fluence. ESRI ArcGISTM programs were used to calculate affected populations from the Oak Ridge National Laboratory's LandScanTM 2007 Global Population Dataset for areas affected by thermal, blast and radiation data.ResultsTrauma, thermal burn, and radiation casualties were thus estimated on a geographic basis for three Israeli and eighteen Iranian cities. Nuclear weapon detonations in the densely populated cities of Iran and Israel will result in an unprecedented millions of numbers of dead, with millions of injured suffering without adequate medical care, a broad base of lingering mental health issues, a devastating loss of municipal infrastructure, long-term disruption of economic, educational, and other essential social activity, and a breakdown in law and order.ConclusionsThis will cause a very limited medical response initially for survivors in Iran and Israel. Strategic use of surviving medical response and collaboration with international relief could be expedited by the predicted casualty distributions and locations. The consequences for health management of thermal burn and radiation patients is the worst, as burn patients require enormous resources to treat, and there will be little to no familiarity with the treatment of radiation victims. Any rational analysis of a nuclear war between Iran and Israel reveals the utterly unacceptable outcomes for either nation.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nuclear war between Israel and Iran: lethality beyond the pale

Dallas¹,

Bell²,

Caruso³

et al. 2013

Confl Health

Self Cite

View full text Add to dashboard Cite

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“…Models of such an event predict that upwards of one million people will be affected and require evaluation of their personal radiation exposure levels, and hundreds of thousands of people may receive doses over 2 Gy (Grace et al 2010, Bell and Dallas 2007, Meade and Molander 2006, Buddemeier and Dillon 2009). In addition to the exposure to prompt radiation and fallout, casualties and infrastructure damage due to over-pressure, thermal, and electromagnetic effects will be overwhelming in the 1-mile radius area surrounding the detonation site.…”

Section: Definition Of the Emergency Needs For Biodosimetrymentioning

confidence: 99%

A deployable in vivo EPR tooth dosimeter for triage after a radiation event involving large populations

Williams

Dong

Flood

et al. 2011

Radiation Measurements

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In order to meet the potential need for emergency large-scale retrospective radiation biodosimetry following an accident or attack, we have developed instrumentation and methodology for in vivo electron paramagnetic resonance spectroscopy to quantify concentrations of radiation-induced radicals within intact teeth. This technique has several very desirable characteristics for triage, including independence from confounding biologic factors, a non-invasive measurement procedure, the capability to make measurements at any time after the event, suitability for use by non-expert operators at the site of an event, and the ability to provide immediate estimates of individual doses. Throughout development there has been a particular focus on the need for a deployable system, including instrumental requirements for transport and field use, the need for high throughput, and use by minimally trained operators. Numerous measurements have been performed using this system in clinical and other non-laboratory settings, including in vivo measurements with unexposed populations as well as patients undergoing radiation therapies. The collection and analyses of sets of three serially-acquired spectra with independent placements of the resonator, in a data collection process lasting approximately five minutes, provides dose estimates with standard errors of prediction of approximately 1 Gy. As an example, measurements were performed on incisor teeth of subjects who had either received no irradiation or 2 Gy total body irradiation for prior bone marrow transplantation; this exercise provided a direct and challenging test of our capability to identify subjects who would be in need of acute medical care.

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“…Therefore, injured individuals (or others such as children or people with unrelated health problems) may require assessment at levels accurate below 2 Gy. Second, the blast and associated dangers are likely to produce mass fear and confusion, mass exodus with unknown destinations for people who are mobile, difficulty in transporting victims and products out of the area or devices and emergency personnel into the area, severely compromised local health care capabilities along with destruction of medical records and credentials of medical personnel, and severely damaged infrastructures such as buildings to use for triage and treatment, power and water, and communication networks (Gougelet et al 2010; Bell and Dallas 2007). …”

Section: Contexts For Evaluating Biodosimetrymentioning

confidence: 99%

A framework for comparative evaluation of dosimetric methods to triage a large population following a radiological event

Flood

Nicolalde

Demidenko

et al. 2011

Radiation Measurements

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Background To prepare for a possible major radiation disaster involving large numbers of potentially exposed people, it is important to be able to rapidly and accurately triage people for treatment or not, factoring in the likely conditions and available resources. To date, planners have had to create guidelines for triage based on methods for estimating dose that are clinically available and which use evidence extrapolated from unrelated conditions. Current guidelines consequently focus on measuring clinical symptoms (e.g., time-to-vomiting), which may not be subject to the same verification of standard methods and validation processes required for governmental approval processes of new and modified procedures. Biodosimeters under development have not yet been formally approved for this use. Neither set of methods has been tested in settings involving large-scale populations at risk for exposure. Objective To propose a framework for comparative evaluation of methods for such triage and to evaluate biodosimetric methods that are currently recommended and new methods as they are developed. Methods We adapt the NIH model of scientific evaluations and sciences needed for effective translational research to apply to biodosimetry for triaging very large populations following a radiation event. We detail criteria for translating basic science about dosimetry into effective multi-stage triage of large populations and illustrate it by analyzing 3 current guidelines and 3 advanced methods for biodosimetry. Conclusions This framework for evaluating dosimetry in large populations is a useful technique to compare the strengths and weaknesses of different dosimetry methods. It can help policy-makers and planners not only to compare the methods’ strengths and weaknesses for their intended use but also to develop an integrated approach to maximize their effectiveness. It also reveals weaknesses in methods that would benefit from further research and evaluation.

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Vulnerability of populations and the urban health care systems to nuclear weapon attack – examples from four American cities

Cited by 39 publications

References 14 publications

Nuclear war between Israel and Iran: lethality beyond the pale

Nuclear war between Israel and Iran: lethality beyond the pale

A deployable in vivo EPR tooth dosimeter for triage after a radiation event involving large populations

A framework for comparative evaluation of dosimetric methods to triage a large population following a radiological event

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