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TREATMENT OF NUCLEAR WARFARE CASUALTIES AND LOW-LEVEL

1,61

RADIATION INJURIES

223

stron

3852

UNITED STATES ARMY

2000

rok

TABLE OF CONTENTS

PREFACE .vi

CHAPTER 1. INTRODUCTION

1-1. The Threat of Nuclear Warfare and Low Level Radiation Against United States Forces and

Civilian Populations .1-1

1-2. Physical Principles of Ionizing Radiation .1-4

1-3. Immediate Causes of Death.1-4

1-4. Radiation Injuries 1-5

1-5. First Aid.1-6

1-6. Triage.1-6

1-7. Contamination and Exposure 1-7

1-8. Internal Contamination1-8

1-9. Combined Injury1-9

1-10. Treatment of the Radiation Casualty.1-10

CHAPTER 2. THE NUCLEAR THREAT

Section I. Nuclear and Radiological Weapon Technologies .2-1

2-1. General 2-1

2-2. Nuclear Weapons.2-1

2-3. Isotopic Weapons 2-2

2-4. Nuclear Terrorism .2-3

2-5. Regional Threats2-5

2-6. Nuclear Weapons Employment.2-9

2-7. Casualty Estimates in a Tactical Nuclear Environment 2-10

Section II. Nuclear Incidents and Low Level Radiation 2-15

2-8. General 2-15

2-9. Natural Radioactive Sources .2-15

2-10. Sources from Nuclear Reactors and the Nuclear Fuel Cycle.2-18

2-11. Biomedical Sources .2-22

2-12. Industrial Sources 2-24

2-13. Sources From United States Forces Commodities and Foreign Material 2-26

2-14. Depleted Uranium Armor and Munitions2-28

2-15. Hazards of Nuclear Weapons Incidents.2-30

2-16. Examples of Nuclear Incidents and Low-Level Radiation Emissions.2-33

CHAPTER 3. ENERGY PRODUCTION AND IONIZING RADIATION

Section I. Mechanisms of Energy Production3-1

3-1. General 3-1

3-2. Conventional Chemical Explosives.3-1

3-3. Nuclear Detonations 3-1

3-4. Matter 3-1

3-5. Nuclear Reaction .3-3

3-6. Fission .3-4

3-7. Fusion 3-5

Section II. Ionizing Radiation .3-6

3-8. Nuclear Radiation3-6

3-9. Units of Measure .3-10

3-10. Shielding3-12

3-11. Interaction with Matter 3-13

CHAPTER 4. EFFECTS OF NUCLEAR EXPLOSIONS

Section I. General .4-1

4-1. Overview .4-1

4-2. Nuclear Detonation4-1

4-3. Initial Energy Transfer and Formation of the Fireball.4-2

4-4. Types of Bursts4-3

Section II. Blast 4-4

4-5. Formation and Propagation of Blast Wave4-4

4-6. Static and Dynamic Overpressures4-7

4-7. Blast Waves in Other Mediums.4-8

Section III. Thermal Radiation 4-9

4-8. Formation of Thermal Radiation .4-9

4-9. Range and Intensity of Thermal Radiation4-10

4-10. Thermal Effects .4-10

Section IV. Nuclear Radiation and Fallout.4-11

4-11. Initial Radiation .4-11

4-12. Residual Radiation 4-12

4-13. Fallout4-13

CHAPTER 5. BLAST AND THERMAL MEDICAL EFFECTS OF A NUCLEAR EXPLOSION:

DIAGNOSIS, TREATMENT, AND PROGNOSIS

Section I. Blast Injury 5-1

5-1. General 5-1

5-2. Direct Blast Injury .5-1

5-3. Indirect Blast Wind Drag Forces .5-2

5-4. Missile Injury.5-3

5-5. Crush and Translational Injuries5-4

5-6. Diagnosis .5-5

5-7. First Aid.5-5

5-8. Treatment.5-9

Section II. Thermal Injury 5-10

5-9. Thermal Effects .5-10

5-10. Examples of Blast and Thermal Scenarios5-14

5-11. Diagnosis .5-16

5-12. First Aid.5-18

5-13. Treatment.5-19

CHAPTER 6. BIOLOGICAL AND MEDICAL EFFECTS OF IONIZING RADIATION: DIAGNOSIS,

TREATMENT, AND PROGNOSIS

Section I. Basic Biophysical Action and Cellular Effects of Ionizing Radiation.6-1

6-1. General 6-1

6-2. Ionizing Radiation .6-1

6-3. Relative Biological Effectiveness6-3

6-4. Linear Energy Transfer Quality Factor and the Radiation Weighting Factor.6-4

6-5. Cellular Effects of Ionizing Radiation.6-5

6-6. Relative Organ Radiosensitivity6-7

6-7. Radiation-Induced Chromosome Damage.6-10

Section II. Systemic Effects of Whole Body Radiation.6-11

6-8. General 6-11

6-9. Radiation-Induced Early Transient Incapacitation 6-12

6-10. Reproductive Cell Kinetics and Sterility.6-10

6-11. Recovery6-14

Section III. Radiation Syndromes 6-15

6-12. Acute Radiation Syndrome6-15

6-13. Acute Radiation Syndrome Component Syndromes .6-16

6-14. Pulmonary Syndrome 6-21

6-15. Cutaneous Radiation Syndrome 6-21

6-16. Acute Local Radiation Injury 6-23

Section IV. Treatment of Radiation Syndromes.6-24

6-17. Diagnosis .6-24

6-18. First Aid.6-26

6-19. Triage of Radiological Casualties6-26

6-20. Biodosimetry and Laboratory Testing .6-28

6-21. Management of the Hematopoietic Syndrome Patient 6-30

6-22. Therapeutic Support for the Severely Irradiated Patient: Gastrointestinal Syndrome 6-38

6-23. Summary of Medical Aspects of Acute Radiation Injury6-39

Section V. Combined Injury--Radiation, Trauma, Chemical, and Biological Weapons6-45

6-24. General 6-45

6-25. Hematopoietic Effects of Combined Injury.6-45

6-26. Burns and Radiation 6-46

6-27. Wounds and Radiation 6-47

6-28. Orthopedics6-50

6-29. Enteric Feeding6-50

6-30. Chemical Weapons and Radiation.6-50

6-31. Biological Weapons and Radiation .6-51

6-32. Immunization and Radiation .6-51

6-33. Nuclear Warfare Treatment Briefs 6-51

Section VI. External Contamination Casualties.6-52

6-34. Internal/External Contamination .6-52

6-35. External Contamination and Treatment.6-52

Section VII. Internal Contamination and Treatment6-54

6-36. Internal Contamination Sources and Hazards .6-54

6-37. Internal Contamination Mechanisms.6-55

6-38. Internal Contamination Treatment.6-57

6-39. Contamination Measurement.6-60

Section VIII. Delayed/Late Effects6-61

6-40. General 6-61

6-41. Pathologies of Concern6-63

6-42. Carcinogenesis.6-63

6-43. Cataract Formation 6-65

6-44. Reproductive Tissue Disturbances 6-66

6-45. Cutaneous Effects6-66

6-46. Chronic Radiation Syndrome 6-68

Section IX. Psychological Effects of Nuclear Warfare.6-70

6-47. General 6-70

6-48. Radiation Dispersal Devices6-70

6-49. Nuclear Detonation6-72

6-50. Fallout Field.6-72

6-51. Psychosocial Sequelae of Radiation Exposure6-73

6-52. Treatment.6-75

6-53. Prevention and Risk Communication6-75