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August 3, 1984, Vol 252, No. 5 >
ARTICLE | August 3, 1984

Medical Resources After Nuclear War: Title and subTitle BreakAvailability v Need FREE

Herbert L. Abrams, MD
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Reprint requests to Department of Radiology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (Dr Abrams).


JAMA. 1984;252(5):653-658. doi:10.1001/jama.1984.03350050041024
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References

In defining capacity to "survive" a massive nuclear exchange, it is important to assess the medical resources that will be available in the post-nuclear war world. Approximately 80% of these resources—hospital beds and personnel, blood, drugs, and medical supplies—will have been destroyed, since they are located in or near the densely populated areas that constitute primary targets of attack. Casualty estimates published by federal agencies, together with data from the Hiroshima-Nagasaki experience, suggest the numbers and types of injuries that will afflict the US population. With a probable 48,000 surviving physicians to treat 32 million casualties, there will be one physician for every 663 patients. Of the trauma and burn victims, approximately 55% will require hospitalization; this will mean 64 patients for each available hospital bed. Data from recent wars have been utilized to determine the trauma-related blood requirements in the post-nuclear war world. Of the 64 million units of whole blood needed, only 14,000 will be available. Other medical resources will be in equally short supply. This disparity between need and availability indicates the difficulty of developing a meaningful medical response for the surviving injured.

(JAMA 1984;252:653-658)

REFERENCES

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Scheer R: With Enough Shovels . New York, Random House, 1982;.
2 +
Abrams HL, Von Kaenel WE:  Medical problems of survivors of nuclear war: Infection and the spread of communicable disease . N Engl J Med 1981;;305:1226-1232.
3 +
Haaland CM, Chester CV, Wigner EP: Survival of the Relocated Population of the U.S. After a Nuclear Attack , Defense Civil Preparedness Agency Report ORNL-5041. Springfield, Va, National Technical Information Service, 1976;.
4 +
Statistical Abstract of the United States, 1980. US Dept of Commerce, Bureau of the Census, 1980, p 17.
5 +
Federal Emergency Management Agency (FEMA): Short- and Long-term Health Effects of the Surviving Population of a Nuclear War. US Senate Committee on Labor and Human Resources, Subcommittee on Health and Scientific Research. Hearings of the 96th Congress, second session, Government Printing Office, 1980.
6 +
Glasstone KS, Dolan P (eds): The Effects of Nuclear Weapons. US Dept of Defense and US Dept of Energy, 1977.
7 +
Oughterson AW, Warren S: Medical Effects of the Atomic Bomb in Japan . New York, McGraw-Hill Book Co, 1956;.
8 +
Blocker V, Blocker TG Jr:  The Texas City disaster: A survey of 3,000 casualties . Am J Surg 1949;;78:756-771.
9 +
Andrews GA:  Medical management of accidental total-body irradiation , in Hubner KF, Fry SA (eds): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier-North Holland Inc, 1980;, pp 297-310.
10 +
Brooks JW, Evans EI, Ham WT, et al:  The influence of external body radiation on mortality from thermal burns . Ann Surg 1952;;136:533-545.
11 +
Hummel RP:  Triage and transfer procedures , in Hummel RP (ed): Clinical Burn Therapy . Boston, John Wright PSG Inc, 1982;, p 9.
12 +
Moncrief JA:  Logistics of burn therapy— personnel, supplies, and space: Military experience , in Phillips AW, Walters CW (eds): Workshop on Mass Burns, Proceedings . Washington, DC, National Academy of Sciences, 1969;, pp 146-160.
13 +
US Dept of Commerce, Bureau of the Census: County and City Data Book, 1977. Government Printing Office, 1978, p 600.
14 +
Office of Technology Assessment: The Effects of Nuclear War. Government Printing Office, 1979.
15 +
National Center for Health Statistics: Health United States, 1980. Hyattsville, Md, Public Health Service, 1980, p 187.
16 +
National Center for Health Statistics: Health Resources Statistics: Health Manpower and Health Facilities . Hyattsville, Md, Public Health Service, 1976;-1977, p 172.
17 +
Constable JD:  Burn injuries among survivors , in Chivian E (ed): Last Aid: The Medical Dimensions of Nuclear War . San Francisco, WH Freeman & Co, 1982;, pp 202-210.
18 +
McCarroll JR, Skudder PA (eds): Treatment of Mass Civilian Casualties, Public Health Service publication 1071-C-5. Government Printing Office, 1970.
19 +
Mason AD, Bowles EG:  The effect of topical chemotherapy and use of homograft skin as a biological dressing on burn mortality , in Phillips AW, Walter CW (eds): Workshop on Mass Burns, Proceedings . Washington, DC, National Academy of Sciences, 1969;, pp 134-135.
20 +
National Center for Health Statistics: Prevalence of Chronic Conditions of the Genitourinary, Nervous, Endocrine, Metabolic, and Blood and Blood-forming Systems and of Other Selected Chronic Conditions , Series 10, No. (109) . Hyattsville, Md, Public Health Service, 1973;.
21 +
Jammet H, Gorgora R, Pouillard P, et al:  The 1978 Algerian accident: Four cases of protracted whole-body irradiation , in Hubner KF, Fry SA (eds): The Medical Basis for Radiation Preparedness . New York, Elsevier-North Holland Inc, 1980;, pp 229-245.
22 +
Phillips AW:  Burn therapy: V. Disaster management—to treat or not to treat? Who should receive intravenous fluids? Ann Surg 1968;;168:986-996.
23 +
Hospital Statistics . Chicago, American Hospital Association, 1981;.
24 +
Katz A: Life After Nuclear War . Cambridge, Mass, Ballinger Publishing Co, 1982;, p 281.
25 +
American Blood Commission: Annual Report of the American Blood Commission 1980-1981 . Arlington, Va, American Blood Commission, 1981;, p 6.
26 +
American Blood Commission: Blood Facts: Answers to Some Often Asked Questions . Arlington, Va, American Blood Commission, 1981;, p 6.
27 +
1981 Annual Report . Washington, DC, American Red Cross, 1981;, p 8.
28 +
Rutman RC, Miller WV: Transfusion Therapy . Rockville, Md, Aspen Systems Corp, 1982;, p 56.
29 +
Nusbacher J:  White cell transfusion , in Hubbel RG (ed): Advances in Blood Transfusion . Arlington, Va, American Blood Commission, 1979;, pp 29-37.
30 +
Hemphill BM:  Blood collection and use by AABB institutional members (1976) . Transfusion 1979;;19:365-366.
31 +
Petz LD, Swisher SN: Clinical Practice of Blood Transfusion . New York, Churchill Livingstone, 1981;, pp 746-752.
32 +
Tullis JL:  The impact of advances in blood transfusion , in Hubbel RG (ed): Advances in Blood Transfusion . Arlington, Va, American Blood Commission, 1979;, p 56.
33 +
Staackman M, Van Horn WH, Foget CR: Damage to the Drug Industry From Nuclear Attack and Resulting Requirements for Repair and Reclamation . Washington, DC, Office of Civil Defense, 1970;, pp 8-10.
34 +
Papper S:  Lactated Ringer's solution—a perspective . Okla State Med Assoc J 1979;;72:327.
35 +
Anderson CG:  Assessment of Postattack Health Resources , prepared for the Office of Civil Defense, Office of the Secretary of the Army, OCD Work Unit No. 2421 E. Bethesda, Md, System Sciences Inc, July 1, 1970 .
36 +
Camp FR, Conte NF, Brewer JR: Military Blood Banking 1941-1973 . Fort Knox, Ky, The Blood Bank Center, US Army Medical Research Laboratory, 1973;.
37 +
Department of Defense: Selected Manpower Statistics, Government Printing Office, May 1977.
38 +
Mendelson J:  The selection of plasma volume expanders for mass casualty planning . J Trauma 1974;;14:987-989.
39 +
Sandler SG, Hermoni D, Sharon R, et al:  Blood transfusion therapy in the rear hospital during the Yom Kippur war (Oct 1973) . Milit Med 1977;;142:51-52.
40 +
Macmillan BG:  Initial replacement therapy , in Hummel RP (ed): Clinical Burn Therapy . Boston, John Wright PSG Inc, 1982;, pp 62-67.
41 +
Barlotta FM:  The New Jersey radiation accidents of 1974 and 1977 , in Hubner KF, Fry SA (eds): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier-North Holland Inc, 1980;, p 152.
42 +
Crutzen PJ, Birks JW:  The atmosphere after a nuclear war: Twilight at noon . Ambio 1982;;11:115-125.
43 +
Turco RP, Toon OB, Ackerman TP, et al:  Nuclear winter: Global consequences of multiple nuclear explosions . Science 1983;;222:1283-1292.
44 +
Ehrlich PR, Harte J, Harwell MA, et al:  Long-term biological consequences of nuclear war . Science 1983;;222:1293-1300.
45 +
Covey C, Schneider SH, Thompson SL:  Global atmospheric effects of massive smoke injections from a nuclear war: Results from general circulation model simulations . Nature 1984;;308:21-25.
46 +
Maddox J:  Nuclear winter not yet established . Nature 1984;;308:11.

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1 +
Scheer R: With Enough Shovels . New York, Random House, 1982;.
2 +
Abrams HL, Von Kaenel WE:  Medical problems of survivors of nuclear war: Infection and the spread of communicable disease . N Engl J Med 1981;;305:1226-1232.
3 +
Haaland CM, Chester CV, Wigner EP: Survival of the Relocated Population of the U.S. After a Nuclear Attack , Defense Civil Preparedness Agency Report ORNL-5041. Springfield, Va, National Technical Information Service, 1976;.
4 +
Statistical Abstract of the United States, 1980. US Dept of Commerce, Bureau of the Census, 1980, p 17.
5 +
Federal Emergency Management Agency (FEMA): Short- and Long-term Health Effects of the Surviving Population of a Nuclear War. US Senate Committee on Labor and Human Resources, Subcommittee on Health and Scientific Research. Hearings of the 96th Congress, second session, Government Printing Office, 1980.
6 +
Glasstone KS, Dolan P (eds): The Effects of Nuclear Weapons. US Dept of Defense and US Dept of Energy, 1977.
7 +
Oughterson AW, Warren S: Medical Effects of the Atomic Bomb in Japan . New York, McGraw-Hill Book Co, 1956;.
8 +
Blocker V, Blocker TG Jr:  The Texas City disaster: A survey of 3,000 casualties . Am J Surg 1949;;78:756-771.
9 +
Andrews GA:  Medical management of accidental total-body irradiation , in Hubner KF, Fry SA (eds): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier-North Holland Inc, 1980;, pp 297-310.
10 +
Brooks JW, Evans EI, Ham WT, et al:  The influence of external body radiation on mortality from thermal burns . Ann Surg 1952;;136:533-545.
11 +
Hummel RP:  Triage and transfer procedures , in Hummel RP (ed): Clinical Burn Therapy . Boston, John Wright PSG Inc, 1982;, p 9.
12 +
Moncrief JA:  Logistics of burn therapy— personnel, supplies, and space: Military experience , in Phillips AW, Walters CW (eds): Workshop on Mass Burns, Proceedings . Washington, DC, National Academy of Sciences, 1969;, pp 146-160.
13 +
US Dept of Commerce, Bureau of the Census: County and City Data Book, 1977. Government Printing Office, 1978, p 600.
14 +
Office of Technology Assessment: The Effects of Nuclear War. Government Printing Office, 1979.
15 +
National Center for Health Statistics: Health United States, 1980. Hyattsville, Md, Public Health Service, 1980, p 187.
16 +
National Center for Health Statistics: Health Resources Statistics: Health Manpower and Health Facilities . Hyattsville, Md, Public Health Service, 1976;-1977, p 172.
17 +
Constable JD:  Burn injuries among survivors , in Chivian E (ed): Last Aid: The Medical Dimensions of Nuclear War . San Francisco, WH Freeman & Co, 1982;, pp 202-210.
18 +
McCarroll JR, Skudder PA (eds): Treatment of Mass Civilian Casualties, Public Health Service publication 1071-C-5. Government Printing Office, 1970.
19 +
Mason AD, Bowles EG:  The effect of topical chemotherapy and use of homograft skin as a biological dressing on burn mortality , in Phillips AW, Walter CW (eds): Workshop on Mass Burns, Proceedings . Washington, DC, National Academy of Sciences, 1969;, pp 134-135.
20 +
National Center for Health Statistics: Prevalence of Chronic Conditions of the Genitourinary, Nervous, Endocrine, Metabolic, and Blood and Blood-forming Systems and of Other Selected Chronic Conditions , Series 10, No. (109) . Hyattsville, Md, Public Health Service, 1973;.
21 +
Jammet H, Gorgora R, Pouillard P, et al:  The 1978 Algerian accident: Four cases of protracted whole-body irradiation , in Hubner KF, Fry SA (eds): The Medical Basis for Radiation Preparedness . New York, Elsevier-North Holland Inc, 1980;, pp 229-245.
22 +
Phillips AW:  Burn therapy: V. Disaster management—to treat or not to treat? Who should receive intravenous fluids? Ann Surg 1968;;168:986-996.
23 +
Hospital Statistics . Chicago, American Hospital Association, 1981;.
24 +
Katz A: Life After Nuclear War . Cambridge, Mass, Ballinger Publishing Co, 1982;, p 281.
25 +
American Blood Commission: Annual Report of the American Blood Commission 1980-1981 . Arlington, Va, American Blood Commission, 1981;, p 6.
26 +
American Blood Commission: Blood Facts: Answers to Some Often Asked Questions . Arlington, Va, American Blood Commission, 1981;, p 6.
27 +
1981 Annual Report . Washington, DC, American Red Cross, 1981;, p 8.
28 +
Rutman RC, Miller WV: Transfusion Therapy . Rockville, Md, Aspen Systems Corp, 1982;, p 56.
29 +
Nusbacher J:  White cell transfusion , in Hubbel RG (ed): Advances in Blood Transfusion . Arlington, Va, American Blood Commission, 1979;, pp 29-37.
30 +
Hemphill BM:  Blood collection and use by AABB institutional members (1976) . Transfusion 1979;;19:365-366.
31 +
Petz LD, Swisher SN: Clinical Practice of Blood Transfusion . New York, Churchill Livingstone, 1981;, pp 746-752.
32 +
Tullis JL:  The impact of advances in blood transfusion , in Hubbel RG (ed): Advances in Blood Transfusion . Arlington, Va, American Blood Commission, 1979;, p 56.
33 +
Staackman M, Van Horn WH, Foget CR: Damage to the Drug Industry From Nuclear Attack and Resulting Requirements for Repair and Reclamation . Washington, DC, Office of Civil Defense, 1970;, pp 8-10.
34 +
Papper S:  Lactated Ringer's solution—a perspective . Okla State Med Assoc J 1979;;72:327.
35 +
Anderson CG:  Assessment of Postattack Health Resources , prepared for the Office of Civil Defense, Office of the Secretary of the Army, OCD Work Unit No. 2421 E. Bethesda, Md, System Sciences Inc, July 1, 1970 .
36 +
Camp FR, Conte NF, Brewer JR: Military Blood Banking 1941-1973 . Fort Knox, Ky, The Blood Bank Center, US Army Medical Research Laboratory, 1973;.
37 +
Department of Defense: Selected Manpower Statistics, Government Printing Office, May 1977.
38 +
Mendelson J:  The selection of plasma volume expanders for mass casualty planning . J Trauma 1974;;14:987-989.
39 +
Sandler SG, Hermoni D, Sharon R, et al:  Blood transfusion therapy in the rear hospital during the Yom Kippur war (Oct 1973) . Milit Med 1977;;142:51-52.
40 +
Macmillan BG:  Initial replacement therapy , in Hummel RP (ed): Clinical Burn Therapy . Boston, John Wright PSG Inc, 1982;, pp 62-67.
41 +
Barlotta FM:  The New Jersey radiation accidents of 1974 and 1977 , in Hubner KF, Fry SA (eds): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier-North Holland Inc, 1980;, p 152.
42 +
Crutzen PJ, Birks JW:  The atmosphere after a nuclear war: Twilight at noon . Ambio 1982;;11:115-125.
43 +
Turco RP, Toon OB, Ackerman TP, et al:  Nuclear winter: Global consequences of multiple nuclear explosions . Science 1983;;222:1283-1292.
44 +
Ehrlich PR, Harte J, Harwell MA, et al:  Long-term biological consequences of nuclear war . Science 1983;;222:1293-1300.
45 +
Covey C, Schneider SH, Thompson SL:  Global atmospheric effects of massive smoke injections from a nuclear war: Results from general circulation model simulations . Nature 1984;;308:21-25.
46 +
Maddox J:  Nuclear winter not yet established . Nature 1984;;308:11.

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