Cham E. Dallas, Ph.D. Professor & Director. Institute for Health Management & Mass Destruction Defense University of Georgia. tack

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1 Health System Impact of a 10-kT-Equivalent Nuclear Explosion in an Urban Area Assessing Medical Preparedness for a Nuclear Event IOM Committee on Medical Preparedness for a Terrorist Nuclear Attack tack Cham E. Dallas, Ph.D. Professor & Director Institute for Health Management & Mass Destruction Defense University of Georgia

2 Institute for Health Management and Mass Destruction Defense Development of medical curricula for responding to mass casualty incidents Distribution of medical training to all 50 states in partnership with the American Medical Association, Medical College of Georgia and University of Texas Southwestern Medical School Medical response modeling & resource utilization in mass casualty crisis (i.e. G-8 G 8 Summit)

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4 NDLS Family of Courses A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers.

5 Ten Kiloton Terrorist Nuclear Weapon Impact on Washington

6 Impact of One Kiloton Terrorist Nuclear Weapon on Washington

7 Blast and Thermal Effects of a Ten Kiloton Terrorist Nuclear Weapon Near the White House

8 Distribution of Injuries in a Nuclear Detonation Burns + Wounds + Irradiation 20% Wounds + Wounds + Burns Irradiation 5% 5% Irradiation 15-20% Single Injuries (30% - 40%) Burns 15-20% Combined Injuries (65% - 70%) Wounds < 5% Burns + Irradiation 40% Data from Walker RI, Cerveny TJ Eds., Medical Consequences of Nuclear Warfare, TMM Publications, Falls Church, p 11

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10 Radiation: short- & long-term

11 Radiation body burdens (Chernobyl)

12 Prompt radiation at detonation

13 Large-scale trauma casualties

14 New York Affected Population 10Kt Nuclear Detonation Radiation in REM No Fallout Radiation Ring Population Buildings Flattened % Blast Fatalities % Blast Fatalities % Blast Casualties % Mass Fires % Blast Casualties % Mass Fires Eden Mass Fires rd Degree Burns nd degree Burns Most Glass 1psi Some Glass 0.6psi Radiation Plume Only Detonation at 20m with median June three dimensional weather with cloud above fireball

15 Washington Affected Population 10Kt Nuclear Detonation Radiation in REM No Fallout Radiation Ring Population Buildings Flattened % Blast Fatalities % Blast Fatalities % Blast Casualties % Mass Fires % Blast Casualties % Mass Fires Eden Mass Fires rd Degree Burns nd degree Burns Most Glass 1psi Some Glass 0.6psi Radiation Plume Only Detonation at 20m with median September three dimensional weather with cloud above fireball

16 Chicago Affected Population 10Kt Nuclear Detonation Radiation in REM No Fallout Radiation Ring Population Buildings Flattened % Blast Fatalities % Blast Fatalities % Blast Casualties % Mass Fires % Blast Casualties % Mass Fires Eden Mass Fires rd Degree Burns nd degree Burns Most Glass 1psi Some Glass 0.6psi Radiation Plume Only Detonation at 20m with median February three dimensional weather with cloud above fireball

17 Houston Affected Population 10Kt Nuclear Detonation Radiation in REM No Fallout Radiation Ring Population Buildings Flattened % Blast Fatalities % Blast Fatalities % Blast Casualties % Mass Fires % Blast Casualties % Mass Fires Eden Mass Fires rd Degree Burns nd degree Burns Most Glass 1psi Some Glass 0.6psi Radiation Plume Only Detonation at 20m with median September three dimensional weather with cloud above fireball

18 Los Angeles Affected Population 10Kt Nuclear Detonation Radiation in REM No Fallout Radiation Ring Population Buildings Flattened % Blast Fatalities % Blast Fatalities % Blast Casualties % Mass Fires % Blast Casualties % Mass Fires Eden Mass Fires rd Degree Burns nd degree Burns Most Glass 1psi Some Glass 0.6psi Radiation Plume Only Detonation at 20m with median July three dimensional weather with cloud above fireball

19 San Francisco Affected Population 10Kt Nuclear Detonation Radiation in REM No Fallout Radiation Ring Population Buildings Flattened % Blast Fatalities % Blast Fatalities % Blast Casualties % Mass Fires % Blast Casualties % Mass Fires Eden Mass Fires rd Degree Burns nd degree Burns Most Glass 1psi Some Glass 0.6psi Radiation Plume Only Detonation at 20m with median August three dimensional weather with cloud above fireball

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27 Blast and Thermal 1 psi 90% Mass Fire 2 nd degree 3rd degree MF EDEN 50% Mass Fire 50% Blast Casualties 10% Blast Fatalities 50% Blast Fatalities Buildings Flattened 10% Blast Casualties Fallout Radiation <25 rem 25 to <75 rem 75 to <150 rem 150 to < 300 rem 380 to < 450 rem 450 to <530 rem 530 to < 680 rem >680 rem New York 300 to < 380 rem Hospitals Detonation Point Interstate

28 Washington Hospitals Detonation Point Interstate Blast and Thermal 1 psi 90% Mass Fire <25 rem Fallout Radiation 380 to < 450 rem 2 nd degree 50% Blast Casualties 25 to <75 rem 450 to <530 rem 3rd degree 10% Blast Fatalities 75 to <150 rem 530 to < 680 rem MF EDEN 50% Blast Fatalities 150 to < 300 rem >680 rem 50% Mass Fire Buildings Flattened 300 to < 380 rem 10% Blast Casualties

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30 Factors affecting health care access in urban nuclear attack Surge of worried well blocking access Transportation of patients blocked by traffic gridlock, rubble, power loss, chaos Severe lack of adequate hospital security Inadequate number of hospital beds and medical personnel in accessible areas Lack of screening tools for radiation- related ailments still in latency

31 Worried well crowd surges and access to health care

32 Patient Transport will be hampered.

33 Air Evacuation Limited Resource that will be in great demand Reality of helicopter unavailability (except VIPs) C130 transport planes of significant utility if 4,000 ft runways can be cleared in time

34 Screening tools for radiation exposure

35 Loss of confidence in the government

36 All that is Necessary for the Triumph of Evil Is for Good Men & Women to Do Nothing