In the entire United States, there are only 2000 special beds for burn patients. In most major metropolitan areas there are only 100 burn beds and most of these would have been destroyed by the bomb. At best, a tiny fraction of the hundreds of thousands of burn patients would receive appropriate medical care. The rest would die.

In addition to these burn patients there would be many thousands of other injuries. People blinded by the blast flash or deafened when the pressure wave ruptured their ear drums. People with lungs collapsed by the tremendous pressures. People with stab wounds of the head chest and abdomen who had been struck by flying debris. People with bones broken when they had been hurled through the air by the hurricane force winds or trapped under collapsing buildings.

Shortly after the explosion, there would be added to this list of casualties tens of thousands of others suffering from a unique form of injury: radiation sickness. The precise extent of radiation injuries would depend to a great deal on weather conditions; particularly the direction and speed of the wind at the time of the explosion. These factors would determine how far, and in what direction, the fallout would spread.

People who were exposed to very high doses of radiation, 4000 to 5000 Rads, would suffer what is known as the central nervous system syndrome. Their brain tissue, damaged by the radiation, would swell, causing nausea, vomiting, explosive diarrhea, and progressive difficulty walking talking and thinking clearly. They would develop convulsions and pass into a coma and die, usually within the first day or two after the bomb. Once someone had been exposed to doses in this range, there would be no effective treatment.

Effects of Medium Doses of Radiation Sickness

People exposed to lesser doses of radiation, down to about 400 to 600 Rads, would suffer a gastrointestinal form of radiation sickness. They would experience nausea, vomiting and diarrhea soon after exposure which would last for several days and then seem to improve. But, after a few days to a week, the symptoms would return and become worse. The diarrhea and vomit would become bloody as the lining of their stomachs and intestines, damaged by the radiation, began to shed. The majority of these patients would also die, despite the most intensive medical therapy.

People with even smaller radiation exposure, in the 100 to 300 Rad range, would suffer from the hematologic radiation syndrome. They also would suffer nausea, vomiting and diarrhea for a few days, but these symptoms would resolve. About three weeks after exposure, their bone marrow would stop producing normal numbers of blood cells. As their white blood cell count fell, they would become prey to infection. Sores would form in their mouths. Burns and other wounds suffered in the initial attack would become infected and fail to heal. They would also have a fall in the number of platelets, the cell fragments that help blood to clot. They would hemorrhage into their skin, and new bleeding would begin in the intestines and stomach.

Those who had received doses in the lower end of this range would have a very great chance of surviving if they received adequate care. Those at the upper end of the exposure scale would have a much worse prognosis, even if they received intensive therapy. Unfortunately it would be impossible to tell how much radiation a given patient had received. Except at the very highest doses, the initial symptoms would be the same. The already overwhelming problem of caring for the wounded would be complicated by an inability to decide who might benefit from therapy and should receive whatever resources might be available.

There would be only the most limited medical resources available to care for the million and a half casualties. Doctors, who tend to live and work in and near big cities, would be killed and wounded at rates even higher than the general population. Nearly 70 percent of the doctors in the metropolitan area would be killed outright or fatally wounded, and another 15 percent would suffer from lesser wounds. Less than 1000 doctors would survive uninjured. That would mean more than 1500 seriously injured patients for each doctor.

If each of these doctors spent only 10 minutes with each patient, and worked 20 hours each day, it would take 2 weeks before each injured person was seen for the first time. Even this grim picture is extremely optimistic. It assumes that all of the wounded were efficiently brought to medical facilities, a near impossible task in the twisted wreckage that would remain after the blast, where even roads would have been torn up or filled with rubble. It assumes that the available doctors would have the strength, both physical and emotional, to work 20 hours a day caring for these horribly injured patients. That they would be willing to abandon their family responsibilities and to expose themselves to continued radioactive contamination in order to meet their professional responsibilities. That they would spend no time caring for pre-existing medical problems, or for new acute problems --heart attacks, strokes-- that would occur, independent of the bomb, at the usual expected rates. That they would spend no time comforting, or even talking to the bereaved. That they would not have to take time to see people who were not actually physically injured, but thought they were. That their would not be interrupted by frantic parents demanding more attention for their wounded and dying children.

Resources Available to Health Care Professionals Following a Nuclear Explosion

But even assuming that each patient did receive ten minutes of medical care, what difference would it make? Doctors would be working without any of the supplies and equipment that are essential to modern medicine. There would be fewer than 200 general hospital beds left in the entire metropolitan area. There would be few X-ray machines and no electricity to run those that were not destroyed. Whatever stocks of medicine were not consumed in the initial blast and fire would be rapidly exhausted. There would be no antibiotics to treat infection, no sterile surgical instruments to debride the wounds. There would be no blood, plasma, or intravenous solutions to maintain those who were bleeding or unable to drink. In fact, there would be almost no water for those who could drink, and what scant supplies remained would be contaminated with radioactive debris, and probably also with bacteria. There would be no bandages to dress the burns and no plaster to set the broken bones. There would not even be narcotics to ease the pain. And so this ten minutes of medical care would matter very little to those who were seen.

But, of course, most would not find their way to care. They would suffer alone, trapped in the wreckage, and untended. And they would die. Even among the half million wounded whose injuries were not necessarily fatal, most would die. During all of World War II some 400,000 Americans were killed. One bomb, dropped on one American city of 2.8 million people, would kill more than six times as many Americans as killed in WWII. The total toll, including those killed outright and those who died of their wounds within the first month, would be greater than 2,500,000.