Immediate Actions to Take When a Nuclear Detonation Occurs

Key points

Upon recognition that a nuclear detonation has occurred, hospitals should immediately activate their disaster response plan and Incident Command System (ICS). First receivers should review any applicable guidelines within the general and incident-specific disaster plans. Depending on the location and timing of the detonation, people affected may arrive several hours or days later or immediately after if the facility is in the affected area.

A four-person healthcare team rolling a patient draped in blue on a gurney through a hospital hallway

Immediate actions to take when a nuclear detonation occurs

Obtaining information about the scope of the incident is critical in planning immediate and short-term response. If possible, try to obtain the following information:

  • Who: how many people were affected? How many will arrive to this facility?
  • What: was there a full nuclear detonation (including infrastructure damage) or just a radiation dispersal incident?
  • When: how soon will affected people arrive at this facility?
  • Where: how far away was the incident? Is there a direct risk to this facility from fallout that would require evacuation? Are they located upwind or downwind from the incident?
  • How: how will affected people arrive to this facility [walk-in, EMS, etc.]?

Identify and/or designate the following critical response staff, including back-ups and relief teams (in case the incident requires a prolonged response):

  • Radiation safety officer
  • Incident commander
  • Triage/treatment teams
  • Decontamination teams

After identifying critical staff, retrieve, take stock of, and distribute critical equipment, including the following:

Finally, identify or designate areas for carrying out specific operational functions, with staff and equipment assigned as needed to complete designated tasks. Dividing the Emergency Department (ED) into the following operational areas and limiting patient and staff movement between areas will help control radioactive contamination and reduce its spread:

  • Decontamination lanes
  • Triage area
  • Treatment areas
  • Staff rest/recuperation areas

Additional measures to reduce spread of contamination can include covering floors in high-traffic areas with absorbent material (e.g., wrapping paper, butcher paper, cloth sheets), marking off controlled (contaminated) from non-controlled (uncontaminated) areas with tape on floors, and selecting areas with isolated ventilation systems (separate from the rest of the hospital) to prevent spreading radioactive contamination by air circulation within the hospital.

More information about REMM: Techniques of Contamination Control.

Decontamination

Nuclear detonations will release large amounts of radioactive material that can contaminate clothing, skin, wounds, and belongings of people who are near or travel through areas near the detonation site. This radioactive contamination can cause radiation exposure in the contaminated person, as well as in anyone that comes into close contact with them. However, a person who has only been exposed to radiation but not contaminated does not pose a risk to others.

Decontamination refers to the process of removing as much radioactive contamination as possible to reduce the risk to the affected person and first receivers. While controlling contamination is important for the safety of first receivers and continued operations of receiving hospitals, patient care remains a higher priority. Do not delay life-saving treatment over fears of contamination or exposure from patients.

Throughout decontamination and care of affected people, first receivers should use appropriate personal protective equipment (PPE) to reduce their own exposure to radioactive contamination.

More information about PPE:

There are multiple methods available to perform decontamination. The decision on which methods to use may be based on available resources, including decontamination equipment (water, soap, etc.), staff trained in decontamination techniques, availability of personal protective equipment, and safe locations to perform decontamination without increasing exposure to others. More information about REMM: Procedures for Radiation Decontamination.

For most people who are contaminated with radioactive materials, self-decontamination will be the fastest and easiest method to reduce radiation exposure. Hospital first receivers can provide instructions and a secure location to assist affected persons in performing self-decontamination. Self-decontamination involves removing the contaminated clothing and taking a shower if available, or washing exposed skin in a sink or using a wet cloth or wet wipe if sinks are not available.

More information on self-decontamination:

Special attention should be paid to the wounds of those who were injured in an area with high radioactive contamination or travelled through a contaminated area prior to receiving treatment for wounds. Contaminated wounds can lead to significant uptake (internal contamination) of radioactive materials. People can be screened for external contamination using hand-held radiation survey equipment. Proper decontamination will reduce radiation exposure in both the patient and medical care providers. However, immediate life-saving treatment should take priority over full decontamination.

More information

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Content Source:
National Center for Environmental Health