Scientist dosimetrist (radiation supervisor) in protective clothing and gas mask with geiger counter checks the level of radioactive radiation in the danger zone

Ukraine, Security Council to citizens: what to do in case of a nuclear attack

By Cristiano Antonino On Feb 6, 2023

First aid in the event of a nuclear attack: Russia’s large-scale invasion of Ukraine has exacerbated fears among Ukrainian and world politicians about the possibility of the Russian Federation using nuclear weapons

Ukraine’s National Security and Defence Council has prepared instructions for doctors and rescue workers on how to help the population in the event of a nuclear attack.

This information must, of course, be contextualised in the war scenario, i.e. with a citizen who in no way can call on the help of rescuers and who must help with what he has at home in a time of war-driven restrictions.

What are nuclear weapons?

A nuclear weapon is an explosive weapon of mass destruction.

During its use, it starts a chain reaction, the special striking factor of which is ionising radiation.

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Types of nuclear weapons

Strategic nuclear weapons are intended for use in territories far from the combat zone. It has a high explosive power.

Tactical nuclear weapons are used to strike targets limited by territory, either in the combat zone or outside it.

It has a shorter range and is not as powerful. For example, its range can be several hundred kilometres.

How nuclear weapons affect people

The impact of nuclear weapons on a person is combined. It is associated not only with radiation, but also with explosive and thermal injuries.

The latter occur during the first seconds after a nuclear explosion.

High-altitude detonations, which are more typical of strategic weapons, cause explosive and thermal effects.

And when tactical nuclear weapons are used, the effect is mainly the radiation factor of the damage.

Specialists in the field of nuclear safety and radiation predict that when weapons are used, about 70% of the victims will suffer mechanical injuries due to the explosive action and burns due to thermal effects.

About 30% will suffer health effects from radiation.

50% of the people who will be within 2.5 km of the blast site will suffer combined injuries: mechanical, thermal and radiation-related.

The 25% of people whose location will be 2.5-5 km from the impact will also be affected.

Most people will die within 2 days from combined injuries.

Nuclear attack, clinical manifestations of nuclear weapons damage

Traumatic injuries

It is worth mentioning that the immediate consequences of the explosion of both strategic and tactical nuclear weapons are damage to buildings or other structures.

The shock wave can cause closed damage to internal organs without visual signs.

A person may be injured under the debris of destroyed structures.

In addition, a strong wind picks up during the impact, so fragments of rubbish or even trees can fly.

This can lead to open or closed injuries to the head, trunk, limbs and even internal organs.

The severity of injuries caused by a shock wave depends on its power, an indicator of excessive pressure.

Mild degree:

slight contusion;
bruising

Medium degree:

dislocations of limbs;
contusions of medium severity;
bleeding from the ears, nose, etc.

Severe grade:

severe contusions;
injuries to the skull and skeleton;
ruptures of abdominal organs.

Extremely severe degree:

organ damage incompatible with life is observed.

Nuclear attack, heat damage

The severity of heat injuries depends on the power of the nuclear fuse, the distance from the epicentre of impact and the use of protective equipment.

The effect of the thermal agent of a nuclear weapon can last several seconds.

Flame burns can also occur from burning clothing, surrounding objects and buildings.

People who have been exposed to radiation may be more likely to suffer thermal injuries.

Thermal energy can damage the eyes and cause temporary or permanent blindness and retinal burns.

The following degrees of damage to the visual organs under the influence of the thermal agent of nuclear weapons are determined

temporary blindness that may last several minutes;
burns of the ocular fundus (looking directly at the explosion);
burns of the cornea and eyelids.

Depending on the intensity and power of the impact of the thermal damage, different degrees of severity of skin damage are determined.

Grade I

reddening and swelling of the skin.

II degree

reddening and swelling of the skin;
appearance of blisters.

Grade III

necrosis of all layers of the skin and adjacent tissues.

Radiation damage

There are several types of damage caused by the radiation factor of nuclear weapons:

1) external exposure from radioactive materials that:

airborne (powder, liquid or aerosol);
are deposited on surfaces: on the ground, skin or clothing;
are contained in a radioactive cloud and irradiate people immersed in it.

2) internal radiation from radionuclides :

breathing them in a radioactive cloud;
entering food and water;
entering the body through open wounds.

3) a combination of both types of irradiation.

Acute radiation sickness is a clinical manifestation of the effect of the radiation factor on the damage caused by a nuclear weapon.

It develops as a result of relatively uniform irradiation at a dose greater than 1 Gy (100 rad) during a short period of time.

The clinical course of acute radiation sickness caused by a nuclear attack conventionally consists of 4 periods:

mild, which occurs when exposed to doses of 100-200 rad;
mild, if radiation doses are 200-400 rad;
severe with radiation doses of 400-600 rad;
extremely severe (over 600 rad).

The primary reaction to radiation lasts up to 3 days after exposure

Manifestations:

irritability;
general weakness;
nausea;
vomiting;
headaches;
moderate increase in body temperature;
excitation and thus suppression of mental activity.

There is no latency period in severe forms.

It usually lasts from 3 days to 2-54 weeks.

The victim feels better. But he experiences general weakness, decreased appetite, defecation problems and sometimes sleep disturbances.

The outbreak occurs two weeks after exposure.

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The patient may experience the following symptoms

headaches;
insomnia;
nausea;
general weakness;
gastrointestinal complaints with severe abdominal pain;
body temperature up to 38-40 ℃;
multiple punctiform haemorrhages on the skin and mucous membranes;
bleeding in internal organs: pulmonary, gastrointestinal, renal;
hair loss in the second or third week;
infectious complications: sore throat, pneumonia, lung abscess and general blood infection – sepsis.

How to provide first aid to those affected by a nuclear attack

First aid must be provided to victims depending on the type of exposure.

First aid in the event of a nuclear weapon attack should include

preventive and therapeutic decontamination (removal of radiation factors from the surface of the human body, products, objects, etc.);
providing assistance with injuries;
providing assistance with burns;
transporting the victim to a medical facility or to medical personnel.

How to perform safe decontamination?

Start by gently removing clothing or ask the victim to undress, starting from head to toe.

Removing shoes and clothes can reduce pollution by 90%.

Put all the victim’s belongings in an isothermal container, preferably a bag with a label on which you can write the victim’s name, date, time and place of collection and a radiation warning sign. The bags should be kept in a safe place for further forensic testing and disposal.

Perform a full body radiation test. Mark on the victim’s skin with a waterproof marker the areas with a high level of contamination detected during the radiological test.

If possible, wash the victim’s body with lukewarm water and mild soap.

Some radioactive substances may linger in the outer layer of the skin and remain for 12-15 days until desquamation occurs.

In case of strong external radiation pollution, it is necessary to cover the affected areas with impermeable bandages to limit the spread to other parts of the body.

Cleaning wounds

If a person is injured in any way during a nuclear attack, there is a high possibility that he or she may be exposed to radiation.

Therefore, the following procedure must be performed

cover the skin around open wounds with bandages or waterproof curtains;
wash the wounds thoroughly with plenty of water or saline solution.

It is advisable to use an appropriate radiation meter to assess and monitor medical handling of radioactive fragments in order to protect the medical team.

Decontamination of ears, nose and mouth

Thoroughly clean the openings (ears, nose, mouth) with a sterile applicator moistened with a cotton tip.

Before decontaminating the external auditory canal, ensure the integrity of the tympanic membrane, then wash the passage with warm water or saline solution.

Use an ear syringe to irrigate the external ear canal only if the eardrum is intact.

Treatment of the oral cavity and eyes

The victim should be advised to brush his or her teeth several times with toothpaste and to rinse the mouth and throat frequently with a 3% hydrogen peroxide solution if there are signs of pharyngeal contamination.

Of course, it is essential not to swallow water.

Rinse the eyes thoroughly with plenty of saline solution or water.