Operational Medicine 2001
Field Medical Service School
Student Handbook

RADIOLOGICAL WARFARE CASUALTIES

FMST 0417

17 Dec 99

TERMINAL LEARNING OBJECTIVE:

1.   Given a radiological warfare casualty in a combat environment (day and night) and the standard Field Medical Service Technician supplies and equipment, manage radiological warfare casualties, per the references. (FMST.04.18)

ENABLING LEARNING OBJECTIVES:

1.      Without the aid of reference materials and given a list of symptoms of radiation illness, determine the dose of radiation in RAD’s the casualty has received and determine a prognosis, per the student handbook. (FMST.04.18a)

2.      Without the aid of reference materials and given a simulated nuclear attack, select the correct defensive measures, per the student handbook. (FMST.04.18c)

3.      Without the aid of reference materials and given a list, select the appropriate definition of nuclear warfare, per the student handbook. (FMST.04.18d)

4.      Without the aid of references and given a FMST MOLLE Medic bag and a simulated casualty identify, decontaminate, treat, and monitor the casualty, per the student handbook. (FMST.04.18f)

OUTLINE:

A BRIEF HISTORY OF NUCLEAR WARFARE

At 0815 on August 6, 1945, a single American B-29 plane (the “Enola Gay”) dropped the world’s first nuclear weapon – the atomic bomb over Hiroshima, Japan.  Hiroshima had an estimated population of 344,000.  The bomb was detonated at an altitude of 2,000 feet.  Immediately, almost 4 square miles or approximately 60% of the city was destroyed.  Initial casualties reports were staggering: 78,150 immediate deaths, 13,983 missing, and 107,867 dying from secondary injuries.  A total of 200,000 Japanese adults and children perished in that attack.  The nuclear era had been ushered in!

A.  THREE TYPES OF NUCLEAR BURSTS

1.   Air Burst

a.       Detonates at an altitude below 100,000 feet but high enough that the fireball does not touch the ground.

b.      Air bursts may cause considerable damage. 

1.      Burns to exposed skin may be produced over many square kilometers

2.      Eye injuries may be produced over a greater area than burns to exposed skin

c.       Tactically, air bursts are the most likely to be used against ground forces.

2.   Surface Burst

a.       A surface burst weapon is detonated on or slightly above the surface of the earth so that the fireball actually touches the land or water surface.

b.      The area affected by the blast, thermal radiation, and initial nuclear radiation will be less extensive than for an air burst of similar yield.

c.   It produces the greatest amount of fallout.

3.   Subsurface Burst (as opposed to underground detonation).

a.       A subsurface burst weapon is detonated beneath the surface of land or water.

b.      Cratering of the ground / earth will generally result

1.      If the subsurface burst does not penetrate the surface, the only other hazard will be from ground or water shock.

2.      If the burst is shallow enough to penetrate the surface, thermal and initial nuclear radiation effects will be present, but will be less than for a surface burst of comparable yield.

c.       If the burst penetrates the surface, fallout will be heavy.

B.  TYPES OF INJURIES

      1.  Blast injuries

a.       Two types of blast injuries:

1.      Direct Blast Wave Overpressure Forces

a)      Caused from the initial detonation and resulting shock wave of the nuclear device.

b)      Injuries are a direct result of the shock wave on the body

1)      If the patient is in close proximity to ground zero, the initial blast wave is usually lethal.

2)      Sublethal exposures to the initial blast wave cause lung damage and eardrum ruptures.

2.      Indirect Blast Wind Drag Forces

a)      Definition – the drag forces (indirect blast) of the blast winds

b)      The winds can reach velocities up to several hundreds of kilometers per hour.

c)      Injuries sustained are a result of flying objects impacting on the body, or from physical displacement of the body against objects or structures.

d)      Indirect blast wind drag forces create more injuries than the initial blast wave.

      2.  HEAT INJURIES

a.       Thermal radiation emitted by a nuclear detonation causes two types of burns:

1.      Flash burns

a)  Thermal radiation travels outward from the fireball in a straight line; therefore, the thermal intensity available to cause flash burns decreases rapidly with distance.  Close to the center of the fireball, all objects will be incinerated.

2.      Indirect burns

a)  Result from exposure to fires caused by the thermal effects in the environment, particularly from ignition of clothing.  This could be the predominant cause of burns depending on the number of and characteristics of flammable objects in an environment.

      4.  EYE INJURIES

a.       Flash Blindness

1.      The initial thermal pulse can cause eye injuries in the form of flash blindness and retinal scarring.

a)      Flash blindness

1)      The initial brilliant flash of light produced by the detonation causes flash blindness.

2)      The flash of light swamps the retina and bleaches out the visual pigments and produces a “blindness.”

3)      Is a temporary condition, which can last:

(a)    Up to 2 minutes if exposed during daylight hours

(b)   Up to seven minutes, if exposed during the nighttime hours.  Recovery may take up to thirty minutes for full nighttime adaption to occur.

b)      Retinal Scarring

1)      Is permanent damage to the retina caused by looking directly into the fireball.

2)      Is a relatively uncomon injury.

C.  TYPES OF RADIATION

1.   Alpha Particles

a.       Is the least penetrating of all forms of radiation

b.      Is a potent ionizing agent within the body

c.       Alpha particles are stopped by almost all barriers – i.e. skin, clothing, paper

d.      Alpha particles become a medical concern when they are inadvertently ingested through contaminated food or water sources, or are absorbed through open, unprotected wound sites. 

2.   Beta Particles

a.       Less ionizing than alpha particles

b.      More penetrating than alpha particles, however, usually not capable of penetration into the body

c.       May cause external radiation burns in concentrated amounts.

d.      Most serious hazard exists when allowed to enter the body, usually through contaminated food sources, or through breathing in contaminated dust.

3.  Gamma Rays

a.       Electromagnetic waves similar to x-rays of the same frequency.

b.      Gamma rays have the most penetrating power and ionizing power of the three particles. Exposure to significant amount of gamma radiation will produce symptoms within one to four hours.

c.       Gamma ray is of greatest medical consideration since its range is enough to produce biological damage alone or in conjunction with the blast and thermal injuries.

D.  DIAGNOSIS OF RADIATION CASUALTIES

1. Clinical features are dependent upon the dose of ionizing radiation received by the individual (as a whole body dosage and/or the rate at which he receives that dose).  This discussion considers those exposure doses of ionizing radiation and their clinical symptoms.

Figure 1 – Clinical Symptoms by Dosage in RAD’s

E.  SYMPTOMS COMMON TO IONIZING RADIATION                                

1. 90% of those exposed to significant ionizing radiation will exhibit symptom within one to four hours after exposure.

a.       Symptoms include:

1.      Nausea

2.      Vomiting

3.      Profuse sweating

4.      Malaise

b.      If vomiting does not occurs by the end of the fourth hour after exposure, the dose was probably mild.

c.       Symptoms appearing within one hour after exposure may indicate an overwhelming dose of radiation or a severe psychological reaction.

F.  TREATMENT AND RECOVERY TIME

1.  Treatment of individuals is based on the symptoms displayed, not on the amount of radiation received.  Antibiotics will be a basic part of any infection management after radiation exposure. When using a combination of antibiotics, (such as penicillin and ampicillin), 3 times the normal dosage is prescribed.Normal recovery time is from 8 to 15 weeks.

G.  PERSONNEL PROTECTION MEASURES

1.Immediate protective measures to observe during nuclear detonation:

a.       Drop flat on the ground or to the ground or to the bottom of your fighting hole.

b.      Don’t look at the explosion, and close your eyes and mouth.

c.       While in fighting hole, cover head with arms, place face against legs, and place fingers in ears.

d.      Stay down until shock wave has passed, and debris has stopped falling.

e.       Don protective mask.

f.        Button and secure all clothing covering as much exposed skin as possible.

H.  DECONTAMINATION PROCEDURES

1. Early removal of radioactive “contamination” will reduce radiation burns, radiation dosage and the chances of inhaling or ingesting radioactive material.

a.       Remove radioactive “hot” spots (concentration of radioactivity).

b.      Use soap and water combined with creams such as hand cleaner or some types of  ointment.  Then wipe it off carefully.

c.       Shower thoroughly using soap and water, giving special attention to body orifices, skin folds, and hairy areas.  Re-showering may be required to ensure removal of all contamination.

d.      Carefully remove contaminated clothing of garments.

e.       Deposit contaminated garments in a garbage bag or disposable container for disposal by burial in deep trenches or at sea.

I.  NATO RADIATION WARNING MARKER

1.      A triangular shaped marker measuring 11” x 8” x 8” with white background and the word “ATOM” printed in black letters.

REFERENCE (S):

1. Emergency War Surgery

2. Handbook of the Hospital Corps, Chapter 13

3. Medical Considerations of NBC Warfare

4. NVC Defense (FMFM 111)

5. NBC Defense (FM 2140)

6. Medical Management of Chemical Casualties

Field Medical Service School
Camp Pendleton, California

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Operational Medicine 2001
Health Care in Military Settings

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