Measuring radiation doses in mass-casualty emergencies

For the first time since 1981, when China deployed the DF-5 intercontinental ballistic missile, a new state has gained the capability to target the United States with a nuclear weapon. On July 4 and again on July 28, North Korea launched the Hwasong-14—a two-stage, liquid-fueled ballistic missile that demonstrated the capability to reach the continental United States. The US intelligence community assesses that North Korea has nuclear warheads compact and light enough to fit on the Hwasong-14 and that North Korea will be able to deploy a nuclear-armed intercontinental ballistic missile within one or two years. North Korea demonstrated another new capability on September 3, testing what it claimed was a thermonuclear weapon. While the exact configuration of this “advanced nuclear device” remains unknown, the device’s estimated yield is 140 kilotons, so the test represents a quantum leap in the destructive potential of North Korea’s nuclear arsenal.

Tensions between the United States and North Korea escalated dramatically in the wake of these missile and nuclear tests. Donald Trump and Kim Jong-un engaged in a frightening war of words. The tensions prompted Hawaii, Guam, and California to increase their preparedness for a possible nuclear strike.

The medical consequences of even a single nuclear detonation would be horrific. According to Jerome Hauer, former director of emergency management for New York City, no city in the United States is prepared for the casualties, chaos, and destruction that would follow a nuclear detonation. Medical management in particular would be complicated by damage to infrastructure and communication systems, lack of sufficient first responders, scarce resources, complicated triage needs, and an overwhelming number of patients.

But Hauer highlights another set of crucial challenges—those associated with the diagnosis and treatment of radiation-related injuries:

Beyond the difficult front lines of triage, survivors of a nuclear explosion will have a variety of injuries, some well known to modern hospitals but others more difficult to diagnose and develop a plan for. Acute radiation syndrome, in particular, results from exposure to radiation and does not have to coincide with any other injury. It may be the only effect a survivor suffers, and it may not manifest soon after exposure.

Fortunately, new types of diagnostics to address this critical need are being developed in the field of radiation biodosimetry. Radiation biodosimetry is the estimation, through observation of biological variables, of received dose from previous radiation exposure; the new diagnostics use changes in various biological markers to estimate the severity of radiation doses. Progress in radiation biodosimetry science is beginning to translate into advanced, field-deployable technologies. The United States could significantly improve its preparedness for a radiological or nuclear disaster if, while better leveraging its existing capability for biological dosimetry assessments, it also integrated emerging technologies into its radiological emergency planning and response.

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Source: Bulletin Of The Atomic Scientists