Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter VII: Mass Causalties in Thermonuclear Warfare

Diagnosis and Treatment of the Patient with Combined Injuries

United States Department of Defense

As already noted, radiation injury will be associated with other injuries in a large number of patients, in which event the clinical phase of radiation sickness will come sometime during the course of recovery from the other injuries. With supralethal doses of radiation resulting in the gastrointestinal syndrome, the primary clinical picture of the syndrome will predominate and any lesser effects from radiation on other injuries will be secondary. Following lower doses, however; the bone marrow depression will have significant effects upon the clinical course of certain types of wounds and injuries.

In the event of a nuclear detonation those patients with burns and traumatic injuries in addition to radiation should be managed on the basis of their conventional injuries. Further reclassification may be warranted on the basis of prodromal symptoms associated with radiation injury. The prognosis for all combined injuries is worse than for radiation injury alone. Animal studies indicate that, when other injuries are accompanied by sublethal doses of radiation, their effects are synergistic: infections are much more difficult to control, and wounds and fractures heal more slowly. Thus, potentially survivable burns and trauma will be fatal in a large percentage of persons who have also received significant injury from sublethal doses of radiation. Because of the delays in wound healing and the subsequent granulocytopenia and thrombocytopenia with injuries from nuclear weapons, most lifesaving and reconstructive surgery must be performed within 36 hours after the exposure. Then, if possible, no surgery should be performed for the next 6-8 weeks postexposure.

Closed wounds will not be affected greatly, but open wounds, particularly burns, will demonstrate delays in healing. Granulation tissue will disappear and the wounds will become pale. In addition, they will bleed quite easily. Wound infection, caused by both exogenous and endogenous organisms, can become a severe problem. Closed simple fractures will not be markedly affected, although some delay in union may occur. Open fractures, or severe fractures in which infection is a probable complication, are dangerous.

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Operational Medicine 2001

Health Care in Military Settings

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