I remember visiting Hiroshima, in 1985. I went with a doctor buddy of mine. It was a strange and yet fascinating place. Our guide was a lovely Japanese woman who said her grandmother survived the blast and recounted the horrors that followed. Everything around the memorial was now built up, with only the ruins of the Hiroshima Prefectural Industrial Promotion Hall as a remembrance.
I remember as a child during the height of the Cold War, listening to the air raid drills and being told by our teachers to “duck and hide.” We would all stop what we were doing and crawl under our desks until the drill was over.
The Russian war against Ukraine is on everyone’s mind, and I have had many patients express their concern that there will be a nuclear war. Far too many patients are asking how they should prepare for such a war.
While I feel the news media is scaring people to hook viewers, the fear is real and I suppose the threat is real too, however unlikely.
So, what does an emergency department look like in such a war? If the emergency center is too close to the blast, then there really is no ER, and this would be a very short story.
If not, then it really depends upon several factors, including the size of the bomb and the proximity to the blast. The bomb at Hiroshima was 15 kilotons. An estimated 100,000 people died from the atomic blast and both short and long term radiation exposure. The largest nuclear weapon ever detonated was that of the Tsar Bomba nuclear test on Oct. 30, 1961, on a Russian Arctic island.
There were no deaths, but windows were reportedly shattered some 480 miles away.
There are five major initial concerns from a nuclear blast. I am sure we could all add another dozen or so to this list.
The first obvious one is the massive fireball, which will obliterate everything in its path. The second is the shock wave, which will outpace the fireball as the blast expands and levels buildings and rips out trees. The third concern is the flash of the blast and the permanent blindness that can result. Then there’s radiation. Gamma rays are initially released and will penetrate most anything. They will penetrate into and destroy your cells. Finally, we have the electromagnetic pulse (EMP). This can really affect emergency rooms (as if the prior four concerns weren’t bad enough), since an EMP can lead to widespread power outages, including malfunction of many medical life-saving devices.
While the initial gamma rays are a concern, radioactive debris will continue to spread with the fallout. The radioactive particles from the initial blast coalesce and then fall back down to earth as “black rain.” This is why it’s important to seek shelter quickly and remove or wash off all exposed clothing. It’s best to remain in shelter for as long as possible, at least 48 hours, but the longer the better.
It’s very sad that this quote from more than half a century ago is still so pertinent.
Albert Einstein once said: “Our world faces a crisis as yet unperceived by those possessing power to make great decisions for good or evil. The unleashed power of the atom has changed everything save our modes of thinking and we thus drift toward unparalleled catastrophe.”
