Preparing for Nuclear War: CDC's Public Health Response to a Nuclear Detonation

[tnbutterfly - Mary]

Hospitals have been conducting disaster training classes to prepare for mass casualties, active shooters, bombings, and natural disasters. Now a new potential catastrophic disaster looms on the horizon. Nuclear war. This is a very disturbing thought.

The Centers for Disease Control and Prevention is planning a briefing for healthcare professionals on how to respond to a nuclear detonation. The Grand Round briefing will take place at 1 p.m. Tuesday, Jan. 16 at the CDC Global Communications Center in Georgia and will be webcast live and later available on-demand.

Here is the official announcement from the CDC:

While a nuclear detonation is unlikely, it would have devastating results and there would be limited time to take critical protection steps. Despite the fear surrounding such an event, planning and preparation can lessen deaths and illness. For instance, most people don't realize that sheltering in place for at least 24 hours is crucial to saving lives and reducing exposure to radiation. While federal, state, and local agencies will lead the immediate response efforts, public health will play a key role in responding.

Join us for this session of Grand Rounds to learn what public health programs have done on a federal, state, and local level to prepare for a nuclear detonation. Learn how planning and preparation efforts for a nuclear detonation are similar and different from other emergency response planning efforts.

CDC's Public Health Grand Rounds Presents:"Public Health Response to a Nuclear Detonation"

Tuesday, January 16, 20181:00 p.m. – 2:00 p.m. (ET)

Global Communications Center (Building 19)Alexander D. Langmuir AuditoriumRoybal Campus

Next for hospitals in disaster planning: How to prepare for nuclear war.

[areensee]

This is what happens when you have a leader who is desperately looking for distraction and will use every channel in the federal government to do it! Do you think if a nuclear bomb falls, it will be only one? We would retaliate, which means China and possibly Russia would retaliate against us. We're talking nuclear holocaust . . . not a survivable event.

[areensee]

I disagree. If NK lauches a nuclear strike, they are going to throw everything they have at us, small numbers or not. We will retaliate, which means nuclear bombs dropping on China's back door. Do you really think China is going to say, "sure go ahead and incinerate our nearest neighbor as we're quite sure it won't affect us". Of course not! China will retaliate and we will have World War III, despite a very short war! Do you also think that Russia wouldn't hesitate to join in the "fun" and launch their missiles as well? The whole idea of a limited nuclear war is propaganda and an attempt to distract us from what is and has gone on the White House!

[SummitRN, BSN, RN]

@areensee You haven't studied this subject very thoroughly. It is both complex and amazing simple. Your assumptions are deeply flawed.

TLDR; A NK nuclear attack would mean the end of NK. China would never sacrifice their country for NK, nor would Russia. The US would never nuke China first. Read the bolded text.

DETERRENCE: Scary but It Works

Nuclear deterrence works when a rational opponent believes you are also rational but have the credible capability and will to use your nukes if necessary. Your opponent will never risk using their weapons. Thus, the sunshine stays in the can... that is the point of deterrence.

In my last post, I outlined the horrific casualties expected from 1 "small" terrorist 5KT fission bomb. It is easy to see why the world would want to work so hard to prevent terrorists or irrational actors from acquiring a weapon: they are not deterrable nation states.

NK is deterrable: the leadership will rationally act to maintain their fine lifestyles and despotic regime. KJU be cra-cra? Naw, he be frontin'. Trump too. It is Brinksmanship. The danger is painting oneself into a corner.

DETERRENCE FAILURE

The world finds the true danger of a nuclear NK is that it is not a stable state, so deterrence could fail:

1. NK leaders may become irrational when their regime collapses, thus not subject to deterrence.

2. The NK regime has a history of supplying terrorist groups and other unstable states with nasty weapons; deterrence doesn't work against stateless actors (who do you nuke back?)

The other time that classical deterrence does not work: one side has the capability to completely disarm/disable/destroy their opponent because of massive disparity in capability. That has been the case for years between NK and the US. The reason no war has occurred despite NK shenanigans and provocations is that NK has had a chemical/biological/artillery/missile deterrent that holds South Korea and Japan at risk, while the US can obliterate NK if they attack. However, with the development of nuclear weapons and ICBMs, NK threatens the US mainland in addition to proliferating these technologies to other rogue states and terrorist groups.

We'd rather not lose San Fransisco as a result of a NK coup.

So why hasn't the US struck NK? It is combination of risk consideration and morality. Anytime someone opens up the canned sunshine, there is a risk of it going wider than intended, although the spread beyond direct actors is heavily tempered by deterrence. Even in a "best case," the economic/political/moral "fallout" would be far in excess of the security gain. The US finds the idea of a nuclear first strike morally reprehensible except in the most extreme of situations.

DOCTRINES AFTER DETERRENCE FAILURE (Advanced Theory)

In an odd way, it was that sense or morality that led the US (and USSR) to create smaller and more accurate nuclear weapons capable of targeting an opponent's hardened (protected) nuclear forces, military, and command capability (counterforce doctrine) instead of just hitting in the general vicinity of a soft city center with the largest hydrogen bomb (countervalue doctrine). Counterforce weapons are inherently first strike capable and can still be retasked for countervalue second-strike (retaliation).

Ironically, it takes more weapons to be able to attack an opponent's offensive capability than it does to merely hold their population centers hostage. China has chosen the latter strategy for nuclear deterrence against the US (minimal countervalue deterrence). China has no ability to hold at risk the US ability to strike massively. China's stated policy is no nuclear first strike. The US is not a primary Chinese existential concern, thus only a minority of China's nuke's could theoretically hit the US. China's nukes are primarily to deter Russia, India etc (China has the longest land borders of any country).

SO WHAT IF NK DESTABILIZES AND LAUNCHES THEIR NUKES?

US Response

We would attempt to intercept all of their incoming NK missiles.

A US nuclear response to a NK coutervalue first strike would likely have a prompt decapitating/disarming component (that is targeting NK leadership, command, control, and strategic military installations (nuclear/chemical/biological), including at least 1 nuke into Pyongyang likely causing >2.5 million casualties (10% of the NK population). We have to be careful about counterforce strikes as they usually involve fallout producing ground bursts with Japan/SK downwind (winds don't usually blow towards China). However, we want to ensure NK doesn't fire their nuclear/chemical/biological warheads at Japan or SK. There are few countervalue targets besides Pyongyang, the only NK city over 1 million. NK's second and third most populous cities are smaller than the top 50 US cities. North Korea only has 25 million in the whole country.

Why China Would NOT Respond with Nukes

If NK attacks the US, SK, and Japan, and the US shoots back, why is it that you, @areensee , think China wants to stick their neck out? NK is an ideological relic used mostly as a geopolitical foil by China and Russia against SK/Japan/US... a barking dog to keep us occupied... the dog is now rabid, out of control, off the leash: a risk from China's point of view.

China has multiple megacities with populations nearly equal to the entire population of NK. 260 million Chinese live in just 15 megacities. These are prime nuclear targets.

Say that China chose to strike the US with its entire intercontinental orificenal (while keeping a deterrent force for neighbors), it could land only a few dozen warheads. Doing so would decimate the US population and wreck the US economy. This is morally reprehensible to the Chinese, which is why they swear no first strikes. It would also command a massive US retaliatory response:

One US Trident II missile with 12 warheads each yielding 100KT (equivalent to 6 Hiroshima bombs each) targeted at Beijing would kill over 2 million instantly and injure another 8 million, probably creating another 10 million refugees. That is one missile from an Ohio class submarine that carries 24 such missiles...

One US ballistic missile submarine could kill over 25 million Chinese, injure 100 million, and make another 100 million refugees... 20% of the Chinese population affected directly by one sub. The US has 14 of those missile submarines, plus 440 land based ICBMs, 80+ long range bombers, and plenty more planes that can carry "dumb" nukes.

Such numbers are so horrific as to be nearly beyond comprehension above the level of "avoid at all reasonable costs."

China would do almost everything possible to avoid a US nuclear strike. They would not sacrifice their entire country over NK if NK launched a nuclear first strike. In fact, they have publicly stated that NK is on their own if they strike first.

[SummitRN, BSN, RN]

Do you also think that Russia wouldn't hesitate to join in the "fun" and launch their missiles as well? The whole idea of a limited nuclear war is propaganda and an attempt to distract us from what is and has gone on the White House!

One more thing, the concept of a "limited nuclear war" is not what you described. Limited nuclear war is if two nuclear powers have a nuclear exchange short massive. Such a limited nuclear war is hard to imagine as most scenarios result an initial exchange rapidly escalates into a massive exchange.

It has nothing to do with every nuclear power opening up the canned sunshine "to join in the fun" as if their populations and national survival were irrelevant. Save that kind of illogical tripe for amusing youtube videos:

[brandy1017, ASN, RN]

A sobering TV movie about nuclear war is The Day After from 1983. I graduated then and only saw it recently on youtube. A person's best chance for surviving without fatal radiation poisoning is to stay in a basement for several days with your own supply of food and water.

What's crazy is all the nuclear silo locations are public knowledge so our enemies would know where to strike to knock them out. Russians regularly do nuclear bomb alerts to prepare, whereas America hasn't mentioned any preparation or protective steps to take since the cold war ended until just recently.

I've read North Korea is poisoning its own people who are dying and mothers have miscarriages and birth defects in the area where he is doing all his nuclear testing. The contamination is going to spill over into South Korea and China and maybe Japan at the rate he's going.

The nuclear weapons of today are much more deadly and destructive than the ones that hit Nagasaki and Hiroshima. Russia has a bomb that could take out all of Texas or France. I wouldn't want to live in a post apocalyptic world. The dead would be the lucky ones!

[SummitRN, BSN, RN]

A sobering TV movie about nuclear war is The Day After from 1983. I graduated then and only saw it recently on youtube.

The Day After is entertainment, not a educational piece. Other movies in this genre are Testament (1983), Threads (1984), and the best of the genre: By Dawns Early Light (1990) with Powers Boothe, Rebecca DeMornay, James Earl Jones, Martin Landau, Rip Torn, and several other familiar faces. Again, these are sobering and entertaining, but quite inaccurate, many times more so than your average medical drama.

A person's best chance for surviving without fatal radiation poisoning is to stay in a basement for several days with your own supply of food and water.

It depends on the scenario. There is a lot of bad info out there.

An accident or terrorist attack that causes a ground level nuclear detonation is going to be dirty and those in the path may need to either evacuate extremely quickly or shelter in place. Similarly, living downwind of a bunker or nuclear missile silo that will be targeted with a ground burst presents major fallout problems.

An airburst destroying a city is much less dire with respect to the long term radiological hazard. Prompt evacuation or shelter-in-place with times of only a day or 2 in the immediate vicinity. Post-attack radiological monitoring would allow advice to survivors to be broadcast by radio/EAS. (I'm offering considerations for a NK 250KT warhead detonate greater than 500m AGL.)

What's crazy is all the nuclear silo locations are public knowledge so our enemies would know where to strike to knock them out.

They are easy to spot from the air or by satellite, so no reason for secrecy. They are hardened against attack and most of our nuclear orificenal is in our submarines which are stealthy and mobile: the survivable component of our deterrent force that could carry over 4000 warheads (but carry

Russians regularly do nuclear bomb alerts to prepare, whereas America hasn't mentioned any preparation or protective steps to take since the cold war ended.

Who remembers what a fallout shelter sign or a civil defense (CD) logo looks like? I bet some Hawaiian's do because they still us the old CD logo and have CD sirens for tsunamis... and nuclear attack warning: For the first time since the end of the Cold War, Hawaii will test nuclear sirens - CNN

It's a hard topic to get people to take seriously. The easiest example is that everyone gets sarcastic about duck and cover, but it does actually help drastically reduce injury.

Russia has a bomb that could take out all of Texas or France.

No. But, Putin did make headlines making that silly claim.

Nobody has ever made a bomb that big. It is not possible.

The biggest warheads the Russians are fielding are about 1MT with the goal of digging out bunkers and silos. A ground burst would cause total destruction of wood frame houses within 3 miles and nasty fallout.

Back in the 60s the USSR made the "King of Bombs" mostly as a show piece. Too big for a missile, it had to be dropped from the plane. They tested it at half power and it nearly destroyed the aircraft that dropped it. It was inefficient and impractical. They never built a second.

I wouldn't want to live in a post apocalyptic world. The dead would be the lucky ones!

It depends what happens. Russia vs China? India vs Pakistan? Iran vs Israel? NK vs USA? All of these would be horrific events, but for most Americans, life would be worth living.

US vs Russia? Life would suck.

[brandy1017, ASN, RN]

Summit were you in the military? Years ago I took a class on Russia where they discussed the deterrence philosophy to prevent nuclear war. At the time the US was beginning to develop a nuclear missile defense system and it was viewed as a destabilizing force, yet I'm glad we now have it. Still I wouldn't want to have to rely on it because from what I've read it's not near 100% and some nuclear weapons would most likely get past it. I hope we never have to find out!

[kbrn2002, ADN, RN]

This is such a serious topic and I don't want to minimize it any way. But all I could think of when I first read this post's title was those drills we did as kids in grammar school in the 1950's and early 1960's (Cuban Missile Crisis era).

Hide under our desks! That was it for the time.

How does one 'webcast live'? I'd be interested to watch.

Those drills lived on into the 70's. I was born in '65 and remember those drills during my early elementary school years in Milwaukee, I lived there from K-2nd grade so they were still happening at least through 1973 when my family moved. We didn't do those drills in the town we moved to by the way and I have not a clue when they finally stopped doing them in Milwaukee.

Of course our next nuclear scare period was during the cold war years and by then the school systems must've figured out exactly how useless hiding under a desk would be so instead they just showed us movies about the consequences we would face if a nuclear war happened. Like that was any better. All that accomplished was scaring the bejeesus out of a bunch of kids that couldn't do a darn thing to prevent such a thing or have the skills or knowledge to do anything to survive after it happened.

[SummitRN, BSN, RN]

Summit were you in the military? Years ago I took a class on Russia where they discussed the deterrence philosophy to prevent nuclear war. At the time the US was beginning to develop a nuclear missile defense system and it was viewed as a destabilizing force, yet I'm glad we now have it. Still I wouldn't want to have to rely on it because from what I've read it's not near 100% and some nuclear weapons would most likely get past it. I hope we never have to find out!

I never served in the military.

I agree that Ballaistic Missile Defense (BMD) systems are potentially destabilizing, but it depends.

BMD in a massive deployment is destabilizing because it offers incentive to a country with a counterforce orificenal to strike first, destroy the opponents offensive capability, and BMD would negate the opponents surviving second strike force. Much like MIRV, this also encourages the enemy to Launch on Warning (fire based on early warning systems that may give false data) leading to the so-called "hair trigger."

You may have heard that it is more economical to develop counter measures to defeat BMD (using MIRV/MARV/PenAids) than it is to build more BMD. Above is how one overcomes the issue of BMD being much cheaper to defeat on a per-interceptor basis: you attack first so that you have a high proportion of BMD capability against the opponents surviving force.

The ABM Treaty of 1972 recognized this problem, and both the US and USSR signed it, limiting BMD to one site per country. Back then, both the US and USSR deployed nuclear tipped BMD missiles. The US deactivated its missiles in 1976. Russia has upgraded its 84 nuclear tipped BMD missiles that ring Moscow.

Meanwhile both the US and Russia have devloped non-nuclear BMD.

I will argue that small BMD forces, such as the US deployed, are not necessarily destabilizing against large powers like Russia and China. A large nuclear power will still have a credible deterrent due to the large size of their survivable deterrent force vs the small size of US BMD (only 48 non-nuclear GBI interceptor missiles that can stop an ICBM).

Small BMD forces offer protection against small and less advanced orificenals, such as North Korea or Iran. US interceptors in AK and CA are aimed squarely at the NK missile threat.

The US wanted to place a BMD installation in Europe which really irritated the Russians even though the small numbers were clearly meant to shield Europe from Iranian missiles.

The problem is, as you pointed out, are these systems 100%? Anything less than 100% is very scary when failure means a nuclear bomb goes off above a major city. The new problem will be if NK can develop penetration aids and MIRV to overwhelm our small BMD system. It is economically feasible to have an arms race with NK, with them improving their ICBMs while we build more interceptors, but eventually the increasing interceptor numbers becomes a destabilizing factor vs China/Russia causing them to need to build more ICBMs, causing Russia to withdraw from treaties that limit missiles and MIRV.

The scary part is right now the situation is strongly to the the US/SK/Japan's favor. Time will work to the strategic advantage of NK and the worsening in calamity if NK should become unstable. This situation is obvious to all parties, but the cost in lives and moral currency of a preemptive action is too great vs an uncertain future calamity. So the can will be kicked down the road...

[SummitRN, BSN, RN]

by then the school systems must've figured out exactly how useless hiding under a desk would be so instead they just showed us movies about the consequences we would face if a nuclear war happened. Like that was any better. All that accomplished was scaring the bejeesus out of a bunch of kids that couldn't do a darn thing to prevent such a thing or have the skills or knowledge to do anything to survive after it happened.

Politics of Duck and Cover

I hate to say it, but it was political. A powerful ideological faction believed that doing anything to prepare to survive a nuclear war was a legitimization of nuclear warfare and admission that nuclear warfare was an acceptable outcome because it was survivable. I disagree with that logic, but if you agree with it, their reaction is a logical alternative: it was better to scare people so they would put pressure on the government to avoid nuclear war and sell the idea that nuclear war was not survivable.

Why Duck and Cover Works

The truth is that getting people to duck and cover (or at least stay away from windows) prevents blast and shrapnel injuries and also reduces burns and flash blindness.

Like lightening, it takes time for the blast to arrive after the flash, giving people precious seconds to take cover.

The blast from a 250KT NK nuke would crush wood framed houses over a 24sqmi area... but it might not fully destroy any reinforced concrete buildings, meaning those who take duck and cover while inside would not be burned or blasted. That same blast will also blow out windows over 130sqmi without destroying the structure. If people naturally go to the window to see what that bright light is, they get face/eyes full of broken glass where they would have experienced minor or no injuries if they ducked/covered.

In the 1998 Nairobi US Embassy bombing, the terrorists set off a small hand grenade a few moments before detonating a truck bomb. Everyone in the surrounding downtown office buildings came to their windows to see what the noise was. When the truck bomb went off, several thousand of people took glass to the face.

The thermal pulse that causes burns is delivered not instantaneously, but over many seconds in these larger nukes and is capable of causing 3rd degree burns to exposed skin over 53sqmi in this example, distances far beyond the radius where the blast is crushing houses. Hitting the deck, even behind a curb gutter, behind a car, behind a fence or building can cut exposure to the thermal pulse and reduce what would have been a 3rd degree burn to a to 2nd or 1st degree, plus offering shielding from shrapnel.

Minor Injury Reductions = Many Lives Saved

When you consider the overwhelming casualties created by a bomb, reducing these types of injuries is incredibly important to an individual would find their burns or penetrating wounds potential deadly when the healthcare system cannot care for them or provide antibiotics, particularly in the setting of sub-fatal doses of radiation: the first system to be affected by low doses is the hematopoietic system so immune response suffers and folks die of sepsis from otherwise survivable injuries/radiation doses. (This is the crux of combined injury syndrome, See Medical Management of Radiological Casualties references on pg 1 for more).

[akulahawkRN, ADN, RN, EMT-P]

In the nuclear realm, I'm not too worried about detonations. @SummitRN covered the reasons. Ground detonations, while very dirty, initially have only very local effects and if you know which way the prevailing winds are blowing, you can move to avoid the fallout. Most of the highly radioactive stuff decays in a few hours to days. Airburst is much cleaner, but you have a lot more blast to deal with. Consequently if you see the flash and take cover, you're far less likely to suffer injury related to the blast (well, unless you're close enough that simple overpressure kills you...) as it's the flying debris that can cause significant injury. Also taking cover quickly greatly limits the thermal exposure. The more powerful the bomb, the longer (and greater) the thermal exposure is. Once the blast is over, you can move upwind and escape any potential fallout.

What scares the heck out of me is the potential for radiologically dirty conventional bombs. Every country that has access to radioactive material and explosives can make these... and the radioactive material doesn't have to be uranium or plutonium as the device doesn't (by design) undergo nuclear fission. It might even take a while to figure out that it wasn't "just a bomb." I doubt there is a country that doesn't have some kind of access to radioactive material and explosives.

There may actually be few casualties with such a bomb, but the worst part will be public terror... which is the purpose of such devices.

[3ringnursing, BSN]

This is such a serious topic and I don't want to minimize it any way. But all I could think of when I first read this post's title was those drills we did as kids in grammar school in the 1950's and early 1960's (Cuban Missile Crisis era).

Hide under our desks! That was it for the time.

How does one 'webcast live'? I'd be interested to watch.

We still did those drills (at least on the east coast) in the early 1970's Nixon administration era up to 1st grade.

Wow ... I haven't thought of that in years! Holy Janie Mac Batman!