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. Make no attempt to close the wound, regardless of its size, unless authorized by a physician. 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 patients due to burns or 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 If you suspect that you are contaminated, or if detection equipment indicates you are, report to a personnel decontamination facility as soon as possible. Facilities In a large-scale nuclear catastrophe, there may be numerous casualties suffering not only from mechanical injuries and thermal burns, but from radiation injuries and psychological reactions as well. The medical facility should consist of a personnel monitoring station, both clean and contaminated emergency treatment stations, a decontamination station, a sorting station, and various treatment stations. It should be set up so that personnel must pass through a monitoring station prior to sorting for medical care. If there is a need for decontamination, the casualty should be routed through the decontamination station on the way to the sorting station. The physical layout should be arranged so that no casualty can bypass the monitoring station and go directly to a treatment station. Also, casualties who are contaminated should be unable to enter clean areas without first passing through a decontamination station. The medical facility flow chart shown in figure 8-3 illustrates an appropriate schema for handling those exposed to nuclear radiation. TEAMS.—Patients brought in by the rescue teams or arriving on their own should first proceed through the monitoring station to determine whether or not they are contaminated with radioactive material. No medical treatment should be instituted in the monitoring station. Only personnel who have had training and experience as members of Radiological Safety/Decontamination teams or as members of Damage Control parties should be assigned to the monitoring station. Those operating the monitoring station should have a basic knowledge of and experience with radiac instruments. Of the personnel available to the treatment facility, several of those most experienced and knowledgeable in radiological safety and radiation protection should be assigned supervisory jobs in the decontamination station. Also, it is highly desirable to have some personnel with operating room experience to decontaminate patients with traumatic injuries. It is not necessary for the other personnel working in the decontamination station to have any appreciable training or experience other than that given when the medical facility is put into operation. MONITORS.—After the patients are monitored, they are directed or taken down one of four avenues, depending upon their physical conditions. Those requiring immediate lifesaving measures should be considered contaminated and routed directly through the monitoring station to the contaminated emergency treatment station. Definitive monitoring for these individuals may be performed at the decontamination station. Both treatment stations are set up much the same and should have only those facilities necessary for immediate lifesaving forms of treatment. Personnel working in these stations should be better 8-16