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EFFECTS OF A NUCLEAR
EXPLOSION
by Ira Helfand, M.D., PSR Past-President
The Effects of a
Nuclear Explosion on a Major American City
Major Injuries Caused by a
Nuclear Explosion:
The Effects of Radiation Sickness
The Effects of a Nuclear
Explosion on Medical Care
In 1961, Physicians for Social
Responsibility was organized by Boston area physicians to educate the public about the
medical effects of nuclear testing and nuclear war. Thirty five years later, the nuclear
arsenals of the United States, Russia and the other six declared and undeclared nuclear
weapons states have grown significantly. Despite the dissolution of the Soviet Union, the
threat of nuclear war persists, particularly in the event of accidental or unauthorized
launch -- a possibility that has grown larger with the deterioration of Russia's nuclear
command and control system.
In May of 1962, the Special Study Section of Physicians
for Social Responsibility published a series of groundbreaking articles in the New England Journal of Medicine (1) describing the
physical and medical effects of a major nuclear attack on an American city. Their study
demonstrates that even today, there is no practical medical response to a deliberate or
accidental nuclear attack - except to prevent such an event from ever happening. As
physicians accustomed to the labor of applying practical solutions to life-threatening
situations, PSR has recommended that policy-makers reduce the nuclear threat by taking
rapid steps to take nuclear forces off alert and by taking swift action to reduce and
eliminate all nuclear weapons.
The Effects of a Nuclear Explosion on a Major
American City
The 1962 articles in the New England Journal of
Medicine described the destruction and medical implications of the detonation of a 20
megaton thermonuclear ground-burst explosion above Boston, Massachusetts. Changes in
nuclear weapons targeting strategy make it more likely that a number of smaller-yield
weapons - with possibly even greater cumulative destructive impact - would be used in the
event of a modern-day nuclear strike.
The following summary of effects is based on a 20-megaton
ground-burst nuclear detonation above a city with a population of 2.8 million during the
day time when many people from outlying areas would be in the city working or shopping.
| Ground Zero to Two Miles: |
Within 1/1000th of a second, a fireball would form
enveloping downtown and reaching out for two miles in every direction from ground zero,
the point where the bomb went off. Temperatures would rise to 20 million degrees
Fahrenheit, and everything--buildings, trees, cars, and people--would be vaporized.
| Two Miles to Four Miles from Ground
Zero: |
Out to a distance of 4 miles, the blast would produce
pressures of 25 pounds per square inch and winds in excess of 650 miles per hour. These
titanic forces would rip buildings apart and level everything, including reinforced
concrete and steel structures. Even deep underground bomb shelters would be crushed.
| Four Miles to Ten Miles from Ground
Zero: |
As far as six miles from the center of the explosion, the
heat would vaporize automobile sheet metal. Glass would melt. Out to a distance of ten
miles in all directions, the heat would still be intense enough to melt sheet metal. At
this distance, the blast wave would create pressures of 7 to 10 pounds per square inch and
winds of 200 miles per hour. Reinforced concrete buildings would be heavily damaged and
all other buildings--masonry and wood frame--would be leveled.
| Sixteen Miles from Ground Zero: |
At a distance of 16 miles from the center, the heat would
ignite all easily flammable materials--houses, paper, cloth, leaves, gasoline, heating
fuel--starting hundreds of thousands of fires. Fanned by blast winds still in excess of
100 miles per hour, these fires would merge into a giant firestorm more than 30 miles
across and covering 800 square miles. Everything within this entire area would be consumed
by flames. Temperatures would rise to 1400 degrees Fahrenheit. The death rate would
approach 100%.
Firestorms of this type, though on a smaller scale,
developed in Hamburg and Dresden and in parts of Tokyo after conventional bombing attacks
during World War II. The information gained from these experiences has particular
relevance to the question of fallout shelters. In these earlier firestorms only those who
left their bomb shelters had any chance of surviving. Those who remained in underground
shelters were killed, roasted as their bunkers were turned into ovens and suffocated as
the fires consumed all of the oxygen in the air.
| Beyond Sixteen Miles: |
At 21 miles from ground zero, the blast would still
produce pressures of two pounds per square inch, enough to shatter glass windows and turn
each of them into hundreds of lethal missiles flying outward from the center at 100 miles
per hour. At 29 miles away from the center the heat would be so intense that all exposed
skin, not protected by clothing, would suffer third degree burns. To a distance of 32
miles second degree burns. Even as far as 40 miles from ground zero anyone who turned to
gaze at the sudden flash of light would be blinded by burns on the retina at the back of
their eyes.
Major Injuries Caused by a Nuclear Explosion:
Casualties
Within minutes after the bomb exploded 1,000,000 people
would die. Among the 1,800,000 survivors more than 1,100,000 would be fatally injured.
Another 500,000 would have major injuries from which they might recover if they received
adequate medical care. Less than 200,000 people would remain without injuries.
Burn Wounds
In the immediate post attack period, burns would
constitute the most common and serious medical problem. Hundreds of thousands of people
would have sustained major second and third degree burns, some from the direct effects of
the heat flash on exposed skin, others injured in the thousands of fires that would rage
on the periphery of the great firestorm. These people would need urgent and intensive
medical therapy. It would not be available.
Facilities for Treating
Burn Wounds
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.
Other Types of Injuries
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.
The Effects of Radiation Sickness
The Effects of Fall-Out
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.
Effects of High Doses of Radiation Sickness
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.
Effects of Low Doses of Radiation Sickness
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.
Chances For Survival From Radiation Sickness
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.
The Effects of a Nuclear Explosion on Medical Care
Effects of a Nuclear Explosion on Health Care Professionals
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.
Ability of Health Care Professionals to Treat the Wounded
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.
Source The New England Journal of Medicine, Volume
266, Number22,May31, 1962,pages 1127-1155: Frank R. Ervin, John B Glazier, Saul Aronow,
David Nathan, Robert Coleman, Nicholas Avery, Stephen Shohet, Cavin Leeman, Vic Sidel,
Jack Geiger, Bernard Lown, Herbert Leiderman, and Jack H. Mendelson. |