The explosion of a nuclear weapon, either as an act of war or as a terrorist act, in any city will present the greatest potential threat to both national and international security, economy and public health. It would seem prudent to prepare an emergency response for such a horrific event, but unfortunately, the medical and emergency responses would be very limited. As with any serious public health threat, prevention would be far more effective than any possible therapy.
Planning an emergency and health care response to the explosion of a 10-kiloton nuclear device, such as one that might be smuggled in and detonated in Los Angeles, New York or any American city, is an ongoing exercise. Multiple governmental agencies are often involved, including FEMA, Departments of Defense, Energy, and Human Services, Homeland Security, Transportation, and Veterans Affairs, and the Environmental Protection Agency, NASA, and the Nuclear Regulatory Commission. These plans focus on evacuation, shelter, and radioactive decontamination. On the periphery of such an explosion, some hundreds and perhaps a few thousand people might be helped by these plans. However, within a one mile radius of the center of the explosion and along the path of the radioactive fallout, there could be no possible help for over 100,000 people.
Herbert Abrams of Stanford University estimates, for example, that a nuclear explosion of 12.5 kilotons at L.A. City Hall would result in 130,000 blast-related injuries, 122,000 burn injuries, 66,000 blast and burn injuries, 49,000 severe burns requiring extensive hospitalization, and 23,000 injuries to the head, thorax, abdomen and extremities. Such tremendous numbers would swamp the medical facilities of L.A. County, which has only 13 trauma centers with 7500 beds. In fact, in all of the U.S. there are only 1500 burn beds, with only 300 -500 available on any given day. So, there would be no way to prevent the blast and burn deaths of 118,000 people within the first 24 hours, and an additional 96,000 people would die of radioactive fall-out in the same 24 hours.
Preventing a nuclear disaster
The best prevention would be an enforceable international understanding to never use nuclear weapons and a verifiable process to dismantle and eliminate all nuclear weapons. President Obama declared his vision of a world without nuclear weapons in his speech delivered in Prague last April. This vision of abolishing nuclear weapons is also advocated by these bipartisan elder American policy experts Colin Powell, Henry Kissinger, George Schultz--all who are former secretaries of state and William Perry, former secretary of defense, and Sam Nunn, former head of the Senate Arms Services Committee.
Making vision a reality
The first step is to revise current and future U.S. nuclear policy, and this nuclear policy is being reviewed now by the Obama administration. The president is scheduled to present the Nuclear Posture Review (NPR) to Congress in the next week. The NPR outlines the U.S. position on the role nuclear weapons will play in our security to our allies and the world. A revised NPR could help the United States to persuade other nations to join us in the efforts to deter the use of nuclear weapons, to stop the proliferation of these weapons, to negotiate deeper cuts in nuclear arsenals, and to take all nuclear weapons off hair-trigger alert.
The long-standing purpose of nuclear weapons has been to deter a nuclear attack against this country or its allies. This was the basis of the Mutually Assured Doctrine (MAD) of the cold war, which threatened the Soviet Union with devastating nuclear retaliation in the event of a nuclear attack upon the U.S. or its allies. Likewise, the Soviet Union threatened the United States with a devastating nuclear retaliation in the event of an American nuclear attack.
However, the NPR of the Bush-Cheney administration allowed the use of nuclear weapons in a preemptive strike against any nation having or developing weapons of mass destruction, and these "weapons of mass destruction" included biological and chemical weapons, not just nuclear weapons. In addition, the Bush administration proposed developing usable nuclear weapons, such as the Robust Nuclear Earth Penetrator, the so-called bunker buster. Fortunately, the Congress refused to fund them.
President Obama should declare in the new NPR that the sole purpose of having nuclear weapons is to deter a nuclear attack against this country or its allies. Given America's vast conventional military superiority, nuclear weapons are really not needed for any offensive or preemptive purpose. Nor are nuclear weapons useful for defense, except in their role as a deterrent to a nuclear attack by a rational opponent.
The president needs to press the Senate to approve the Comprehensive Test Ban Treaty and to ratify the new "Start follow-on" treaty. He will be trying to revive the multilateral talks with North Korea and to work with allies to pressure Iran to curtail their nuclear programs.
As physicians we are committed to saving lives and protecting the public health. Our mandate is to prevent what we cannot cure. We would encourage everyone, from all political parties, to support the president and the U.S. Congress to take these steps toward our vision of a world without nuclear weapons. The U.S. can and must lead by example.
Commentary by L. Stephen Coles, M.D., Ph.D., and Robert Dodge, M.D., who are Board Members, Physicians for Social Responsibility Los Angeles