"Just-In-Time" Resource for Hospital Receivers of Radiation Incidents: Nuclear Detonations

At a glance

People affected by nuclear detonation could present to hospitals with blast injuries, burns, and radiation injuries and internal contamination. This four-part resource offers "just-in-time" information to help medical facilities prepare for and respond to disaster scenarios resulting from a nuclear device detonation.

A three-person healthcare team stands around the bed of a patient as they administer care


The energy released in a nuclear explosion derives from the splitting (fission) of radioactive materials (e.g., Uranium-235 and Plutonium-239). The explosive energy from a nuclear detonation is quantified in terms of the number of kilotons (Kt) of the conventional explosive TNT (trinitrotoluene) that it would take to create the same blast effect. Much of the federal planning has been focused on an Improvised Nuclear Device (IND) of approximately 10 Kt but has recently been expanded to include other types of nuclear detonations. An IND may also fail to undergo complete nuclear detonation. In this scenario, the effects of the IND would be similar to a Radiological Dispersal Device (RDD) or "dirty bomb".

People affected by nuclear detonation could present to hospitals with blast injuries, burns, and radiation injuries including Acute Radiation Syndrome (ARS), Cutaneous Radiation Injury (CRI), and internal contamination. Hospital-based first receivers should be prepared to treat many ill and injured people in a nuclear detonation event, possibly in conditions that are difficult to navigate because of resulting local infrastructure damage. There will also likely be a large number of "worried well" individuals who will need to be triaged quickly to prioritize care for those who are more severely injured.

As referenced above, nuclear detonation is only one of several possible types of radiation emergencies that may occur.

Radiation effects on the body

Radiation can be found in small, non-dangerous amounts in the environment around us every day, but exposure to radiation in high doses can cause harmful effects to DNA resulting in immediate cellular damage and can also lead to cancer later in life. A single short exposure of a radiation dose is more harmful than the same cumulative dose spread over a longer period of time. High doses can lead in the near term to Acute Radiation Syndrome (ARS), which can be fatal, and Cutaneous Radiation Injury (CRI).

Radiation exposure and radioactive contamination

Radiation exposure, or irradiation, occurs when people are exposed to high energy electromagnetic waves and particles. This may occur when someone gets an x-ray or is near to radioactive materials. Dose from a radiation exposure is dependent on time (how long the exposure lasts), distance (how close the radiation source is), and shielding (how much radiation is absorbed by lead or other high-density materials between the radiation source and the exposed person). A person who is exposed to radiation is not necessarily contaminated with radioactive material. When a person is only exposed but not contaminated, they cannot spread radioactivity to expose others.

Radioactive contamination occurs when radioactive material is either deposited on skin, clothes, or other surfaces (external contamination). Radioactive contamination may also enter the body through wounds, inhalation, or ingestion of radioactive material (internal contamination).

Radioactive contamination can cause high amounts of radiation exposure, as the radioactive materials may be in very close proximity (in or on the body) with little to no shielding between the materials and the cells of the exposed person. Dose is dependent on the amount of contamination, the type of radioactive material, and how long the internal or external contamination lasts.