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

Abstract

Background: The threat posed by the use of weapons of mass destruction (WMD) within the United States has grown significantly in recent years, focusing attention on the medical and public health disaster capabilities of the nation in a large scale crisis. While the hundreds of thousands or millions of casualties resulting from a nuclear weapon would, in and of itself, overwhelm our current medical response capabilities, the response dilemma is further exacerbated in that these resources themselves would be significantly at risk. There are many limitations on the resources needed for mass casualty management, such as access to sufficient hospital beds including specialized beds for burn victims, respiration and supportive therapy, pharmaceutical intervention, and mass decontamination.

Results: The effects of 20 kiloton and 550 kiloton nuclear detonations on high priority target cities are presented for New York City, Chicago, Washington D.C. and Atlanta. Thermal, blast and radiation effects are described, and affected populations are calculated using 2000 block level census data. Weapons of 100 Kts and up are primarily incendiary or radiation weapons, able to cause burns and start fires at distances greater than they can significantly damage buildings, and to poison populations through radiation injuries well downwind in the case of surface detonations. With weapons below 100 Kts, blast effects tend to be stronger than primary thermal effects from surface bursts. From the point of view of medical casualty treatment and administrative response, there is an ominous pattern where these fatalities and casualties geographically fall in relation to the location of hospital and administrative facilities. It is demonstrated that a staggering number of the main hospitals, trauma centers, and other medical assets are likely to be in the fatality plume, rendering them essentially inoperable in a crisis.

Conclusion: Among the consequences of this outcome would be the probable loss of command-and-control, mass casualties that will have to be treated in an unorganized response by hospitals on the periphery, as well as other expected chaotic outcomes from inadequate administration in a crisis. Vigorous, creative, and accelerated training and coordination among the federal agencies tasked for WMD response, military resources, academic institutions, and local responders will be critical for large-scale WMD events involving mass casualties.

Figure 1

Peak blast overpressure and total thermal energy as a function of range from detonation for 12 and 500 Kt weapons. (A) Range dependence of peak overpressure and thermal energy from a 12 kiloton detonation at a height of burst of about 2,000 feet. (B) Similar curves for a 500 kiloton detonation at a height of burst of about 8,000 feet. A comparison of the graphs shows that thermal energy scales much faster than peak overpressure. Reprinted with permission from Figure 8 The Medical Implications of Nuclear War 1986 by the National Academy of Sciences, courtesy of the National Academies Press, Washington, D.C.

Figure 2

Blast, Thermal and Fallout Effects for 20 Kt and 550 Kt Nuclear Explosions in Atlanta. (a) 20 Kt Blast Intensity. (b) 550 Kt Blast Intensity. (c) 20 Kt Thermal Intensity, (d) 550 Kt Thermal Intensity. (e) 20 Kt Fallout, (f) 550 Kt Fallout.

Figure 3

Thermal Impact of 550 Kt Surface Nuclear Detonation on New York City with Weather as of September 17^th, 2004.

Figure 4

Thermal Impact of a 550 Kt Surface Nuclear Detonation on Washington, D.C. with Weather as of April 22^nd, 2004.

Figure 5

Thermal Impact of a 550 Kt Surface Nuclear Detonation on Chicago with Weather as of March 19^th, 2003.

Figure 6

Thermal Impact of a 550 Kt Surface Nuclear Detonation on Atlanta with Weather as of April 23^rd, 2004.

Figure 7

Blast Impact of 550 Kt Surface Nuclear Detonation on New York City with Weather as of September 17^th, 2004.

Figure 8

Blast Impact of a 550 Kt Surface Nuclear Detonation on Washington, D.C. with Weather as of April 22^nd, 2004.

Figure 9

Blast Impact of a 550 Kt Surface Nuclear Detonation on Chicago with Weather as of March 19^th, 2003.

Figure 10

Blast Impact of a 550 Kt Surface Nuclear Detonation on Atlanta with Weather as of April 23^rd, 2004.

Figure 11

Thermal and Fallout Impacts of 550 Kt Surface Nuclear Detonation on New York City with Weather as of September 17^th, 2004.

Figure 12

Thermal and Fallout Impacts of a 550 Kt Surface Nuclear Detonation on Washington, D.C. with Weather as of April 22^nd, 2004.

Figure 13

Thermal and Fallout Impacts of a 550 Kt Surface Nuclear Detonation on Chicago with Weather as of March 19^th, 2003.

Figure 14

Thermal and Fallout Impacts of a 550 Kt Surface Nuclear Detonation on Atlanta with Weather as of April 23^rd, 2004.

Figure 15

Thermal and Fallout Impacts of a 20 Kt Surface Nuclear Detonation on New York City with Weather as of August 8^th, 2003.

Figure 16

Thermal and Fallout Impacts of a 20 Kt Surface Nuclear Detonation on Washington, D.C. with Weather as of April 22^nd, 2004.

Figure 17

Thermal and Fallout Impacts of a 20 Kt Surface Nuclear Detonation on Chicago with Weather as of March 19^th, 2003.

Figure 18

Thermal and Fallout Impacts of a 20 Kt Surface Nuclear Detonation on Atlanta with Weather as of January 2nd, 2004.