constitute a serious external hazard; however, like alpha particles, they do constitute a serious internal hazard.
Neutrons, which are emitted from the nucleus of the atom, are particles with no electrical charge and a mass of approximately one. Their travel is therefore unaffected by the electromagnetic fields of other atoms. The neutron is a penetrating radiation which interacts in billiard ball fashion with the nucleus of small atoms like hydrogen. This interaction produces high energy, heavy ionizing particles that can cause significant biological damage similar to alpha particles.
Gamma rays are electromagnetic waves having no mass or electrical charge. Biologically, gamma rays are identical to x-rays of the same energy and frequency. Because they possess no mass or electrical charge, they are the most penetrating form of radiation. Gamma rays produce their effects mainly by knocking orbital electrons out of their path, thereby ionizing the atom so affected, and imparting energy to the ejected electron. Neutrons and gamma rays are emitted at the time of the nuclear explosion along with light. Gamma rays and beta particles are present in nuclear fallout along with alpha particles from unfissioned nuclear material. Neutrons and gamma rays are an important medical consideration in a nuclear explosion, since their range is great enough to produce biologic damage either alone or in conjunction with blast and thermal injuries.
TREATMENT OF NUCLEAR CASUALTIES
Most injuries resulting from the detonation of a nuclear device are likely to be mechanical wounds resulting from collapsing buildings and flying debris, and burns caused by heat and light liberated at the time of detonation.
A burn is a burn regardless of whether it is caused by a nuclear explosion or by napalm, and its management remains the same. This is also true of fractures, lacerations, mechanical injuries, and shock. In none of these is the treatment dictated by the cause. For most of the conventional injuries, standard first-aid procedures should be followed.
The following word of caution should be considered when you are treating wounds and burns. Dressings for wounds and burns should follow a closed-dressed principle, with application of an adequate sterile dressing using aseptic techniques, if sufficient medical supplies are available. Make no attempt to close the wound, regardless of its size, unless authorized by a physician. A few variations in treatment have been proposed by researchers in the field, one concerning the use of antibiotics. If signs of infection and fever develop, give antibiotics. When a physician is not available to direct treatment, the corpsman should select an antibiotic on the basis of availability and appropriateness and administer three times the recommended amount. If the antibiotic does not control the fever, switch to another. If the fever recurs, switch to still another. Overwhelming infection can develop rapidly in the pancytopenic state from burn or hematopoietic damage from radiation.
Whenever a broad-spectrum antibiotic is given, administer oral antifungal agents.
To date, there is no specific therapy for injuries produced by lethal or sublethal doses of ionizing radiation. This does not mean that all treatment is futile. Good nursing care and aseptic control of all procedures is a must; casualties should get plenty of rest, light sedation if they are restless or anxious, and a bland, nonresidue diet.
DECONTAMINATION
Each member of the Armed Forces is responsible for carrying out personal decontamination measures at the earliest opportunity. Medical personnel will direct decontamination of casualties who are physically unable to perform this function.
Decontamination of the ship as a whole is the responsibility of the damage control officer.
The principle in personnel decontamination is to avoid the spread of contamination to clean areas and to manage casualties without aggravating other injuries.
It will frequently be necessary to decide whether to handle the surgical condition or the CBR hazard first. If the situation and the condition of the casualty permit, decontamination should be carried out first. The longer the substance remains on the body, the more severe the symptoms and the greater the danger of spreading the substance to other personnel and equipment. Emergency medical conditions should always be addressed (unless significant hazard to medical staff exists) prior to radioactive decontamination.
Within the limits imposed by operating in full protective gear, life-saving procedures, such as controlling massive hemorrhage or administering nerve agent antidote, should be carried out before