In Case Of Emergency, Read Blog

An Institute of Medicine panel has released a report saying that while a home-made nuclear bomb detonated in U.S. city would likely kill hundreds of thousands of people, there are actually things that can be done to increase the survivability for many others. That is, the committee argues, if the public is informed of those steps in advance. According to an interesting article in New Scientist magazine by David Shiga,

…as catastrophic as such an attack would be, it would not level an entire city, and a timely response could save many lives. Recent advances in techniques for mapping the path of radioactive fallout after an attack, combined with novel therapies for treating radiation victims, will improve survival chances, the report says.

“Clearly there would be loss of life, but it’s not hopeless,” says Georges Benjamin, head of the panel of doctors and public health officials that was convened by the National Academy of Sciences to assess the nation’s level of preparedness for such an attack. “We feel that there are things that one can do to mitigate it.”

Just knowing about the value of ’shelter in place’, for example, could be a lifesaver, according to the report:

For many people, the safest option would be to seek shelter in buildings or underground. Just staying inside could slash the immediate death toll from radiation by up to a factor of 100, or even 1000, [Fred] Mettler [of the New Mexico Veterans Administration Health Center] says. However, people must be told this in advance. “Without prior education, it would be a horrible issue,” he says.

One crucial factor will be for the authorities to get an instant picture of where the fallout is going and its quantity and speed. This will make it possible to figure out who should seek shelter and who should evacuate – and in which direction. It will also ensure that rescuers are not sent on “suicide missions” into areas of high radiation.The National Atmospheric Release Advisory Center (NARAC) at the Lawrence Livermore National Laboratory in California has for years been charged with providing predictions to emergency planners within a few minutes of serious incidents involving a release of radioactivity. NARAC’s model would be used to guide planes and helicopters equipped with radiation detectors, whose measurements would in turn refine the model’s predictions.

NARAC is now working to improve its modelling software to take into account variations in wind speed and direction in three dimensions and fluctuations over time; the last version assumed winds vary only with height. It will also take into account the way rain can scrub fallout from the air and deposit it on the ground. While this would prevent fallout drifting so far, it would also mean that larger amounts of radiation are deposited sooner and in different places than if there were no rain.

Even with prompt predictions and the possibility of broadcasting them by radio, it is likely that many people would not be aware of what they need to do or would fail to reach shelter in time. The result would be exposure to high levels of radiation, which inflicts its most immediate damage on rapidly dividing cells such as bone marrow and the lining of the gut.

Damage to bone marrow leads to reduced production of key immune cells and blood-clotting platelets. Very low levels of platelets can trigger dangerous bleeding even without any injury. Damage to the gut lining triggers internal bleeding, which is worsened by a lack of platelets. This in turn allows bacteria to leak into other parts of the body, resulting in potentially deadly infections, which are made worse by the lack of immune cells.

Two drugs approved last year could help cut down such complications, says panel member Nelson Chao of Duke University in Durham, North Carolina. Amgen’s Nplate (romiplostim), and GlaxoSmithKline’s Promacta (eltrombopag) were approved for use in people with a rare condition that keeps their platelets in chronically short supply. Chao says they might also help boost platelet numbers in radiation victims, preventing dangerous blood loss and infections.

To me, this report underscores the need to inform and engage the public on preparedness for even seemingly low probability/high impact emergencies such as nuclear terrorism. Just knowing a couple of small, easy to remember steps such as sheltering in place or not looking into the flash might be very useful.

The report can be purchased or read online for free at the National Academies Press website here. Thanks to David Shenk for bringing this article to my attention.