Closer Than We Think: the Management of a European Nuclear Exchange

Abstract

Introduction:An exhausted, isolated, increasingly desperate Russia, still in possession of over 4,400 nuclear warheads, puts the world at risk. Since the outbreak of war in Ukraine, Russian rhetoric and military doctrine have evinced an increasing nonchalance toward the employment of tactical nuclear weapons as stockpiles of conventional weapons are depleted. Poor targeting control (or outright perfidy), demonstrated by recent events in Poland possibly violating NATO’s collective defense clause, have only incensed an imminently combustible situation. Given this threat, it behooves medical professionals to gain thorough acquaintance with Acute Radiation Sickness (ARS), including an assessment of sources of exposure, presentation, prognostic indicators, immediate treatments, long-term concerns, and sources of consultant support.Method:Through thorough review of military and civilian sources, training courses, historical cases, injury mechanisms, first-responder concerns, hospitalization parameters, and laboratory indicators, the ARS spectrum will be explored. Surgical, anesthetic, and intensive care implications will be discussed, as will infection and nutritional concerns. Emerging practices, specialized therapy, and long-term medical sequelae will be covered.Results:A thorough discussion of potential sources (civil and military), clinical recognition, and presentation of ARS will focus on best clinical guidance, providing the most up-to-date treatment strategies, and will give clear guidance regarding how best to prepare, treat, and obtain specialist consultation.Conclusion:It is the earnest hope of the presenter (a senior naval physician with nuclear power experience, anesthesiology consultant/board examiner, and intensivist, who studied radiation safety and injury for much of his career and wrote a Diploma in the Medical Care of Catastrophes dissertation on radiologic injury management) that the audience will never face the horror of a single radiologic casualty. However, the likelihood of such wishful thinking seems as remote as ever. Attendees will not only learn guidance for treatment and prognostication, but will know how to obtain support and expert consultation.