Written by world-renowned scientists, this volume portrays the possible direct and indirect devastation of human health from a nuclear attack. The most comprehensive work yet produced on this subject, The Medical Implications of Nuclear War includes an overview of the potential environmental and physical effects of nuclear bombardment, describes the problems of choosing who among the injured would get the scarce medical care available, addresses the nuclear arms race from a psychosocial perspective, and reviews the medical needs--in contrast to the medical resources likely to be available--after a nuclear attack. "It should serve as the definitive statement on the consequences of nuclear war."--Arms Control Today

Contents

• Institute of Medicine
• FOREWORD
• PREFACE
• UNDERSTANDING AND PREVENTING NUCLEAR WAR: THE EXPANDING ROLE OF THE SCIENTIFIC COMMUNITY
• PART I. NUCLEAR WAR WITH MODEM WEAPONS: PHYSICAL EFFECTS AND ENVIRONMENTAL CONSEQUENCES
  • Possible Fatalities from Superfires Following Nuclear Attacks in or Near Urban Areas
    • Introduction
    • Incendiary Effects Of Nuclear Weapons
    • Superfires And Their Environments
    • Estimates Of Noxious Gas Concentrations Within The Mass Fire Region
    • Combined Toxic Effects Of Fire Gases And Elevated Temperatures
    • Mass Fire Experiences Of World War Ii
    • Model For Estimating Fatalities From Superfires
    • Fatality Potential Of Superfires
    • Comparison of Other Target Sets with the Reference Case
    • Conclusion
    • Notes
  • A Review of the Physics of Large Urban Fires
    • Introduction
    • History of Urban Fires
    • Characteristics Of Large-Scale Urban Fires
    • Modeling Large-Fire Environments
    • Summary
    • References
  • Recent Assessments of the Environmental Consequences of Nuclear War
    • New Findings
    • Potential Contribution Of Plastics To Nuclear Winter
    • References
    • Appendix
    • 1. Direct Effects Of Nuclear Explosions
    • 2. Strategies And Scenarios For A Nuclear War
    • 3. The Extent Of Fires And Generation Of Smoke
    • 4. The Evolution And Radiative Effects Of The Smoke
    • 5. Smoke-Induced Atmospheric Perturbations
    • 6. Atmospheric Chemistry In A Post-Nuclear-War Environment
    • 7. Radiological Dose
    • 8. Tasks For The Future
  • Nuclear Famine: The Indirect Effects of Nuclear War
    • Introduction
    • Ecosystem Vulnerabilities
    • Agricultural Vulnerabilities
    • Vulnerability To Disruptions In Food Availability
    • Conclusion
    • Acknowledgments
    • References
  • Nuclear Winter: The State of the Science
  • Atmospheric Perturbations of Large-Scale Nuclear War
  • Possible Toxic Environments Following a Nuclear War
    • Toxic Chemicals
    • Ultraviolet Spring
    • Photochemical Smog Formation
    • Conclusions
    • References
  • Radioactive Fallout
    • Overview
    • Radioactivity From Nuclear Weapons
    • Radioactivity From Nuclear Fuel Cycle Facilities
    • Appendix: The Impact Of Fallout On Humans
    • Acknowledgments
    • References
• PART II. HEALTH CONSEQUENCES OF NUCLEAR WAR
  • Casualties Due to the Blast, Heat, and Radioactive Fallout from Various Hypothetical Nuclear Attacks on the United States
    • Overview
    • Introduction
    • Casualties from "100-Megaton" Attacks
    • Casualties From A Major Attack On U.S. Strategic Nuclear Targets
    • Fallout Casualty Model
    • Conclusions
    • References
  • Acute Radiation Mortality in a Nuclear War
    • Overview
    • Notes
  • Burn and Blast Casualties: Triage in Nuclear War
    • The Concept Of Triage
    • Experience with Mass Casualty Management
    • Burn and Blast Injuries in Nuclear War
    • Conclusion
    • Acknowledgment
    • Notes
  • Food and Nutrition in the Aftermath of Nuclear War
  • Psychological Consequences of Disaster: Analogies for the Nuclear Case
    • Introduction
    • Analysis Of Human Reactions To Disasters
    • Postdisaster Behavior: Impact, Recoil, And Postimpact
    • Conventional Bombing
    • Nuclear Bombing: Hiroshima And Nagasaki
    • References And Bibliography
  • The Immunological Impact of Nuclear Warfare
    • Background
    • Ionizing Radiation
    • Ultraviolet Radiation
    • Burns And Trauma
    • Psychological Factors: Stress, Depression, And Bereavement
    • Malnutrition
    • Discussion
    • Summary And Conclusions
    • Notes
  • Expected Incidence of Cancer Following Nuclear War
  • Genetic Consequences of Nuclear War
    • Introduction
    • Radiation Dose To Survivors
    • Genetic Radiation Effects
    • Populations And Effects
    • Other Effects On Future Generations
    • Genetic Handicaps In The Postwar World
    • The Worse, The Better: A Tragic Paradox
    • Notes
• PART III. MEDICAL RESOURCE NEEDS AND AVAILABILITY FOLLOWING NUCLEAR WAR
  • Medical Supply and Demand in a Post-Nuclear-War World
    • Supply Versus Demand: A Massive Exchange
    • Supply Versus Demand: A One-Megaton Airburst over an Urban Center
    • Supply Versus Demand: The Developing World
    • Acknowledgment
    • Notes
  • The Consequences of Nuclear War: An Economic and Social Perspective
    • Introduction
    • Warnings Of War
    • The Direct And Immediate Impact Of War
    • The Lingering Effects of Nuclear War
    • Conclusions
    • Acknowledgments
    • References
• PART IV. IMAGES AND RISKS OF NUCLEAR WAR: PSYCHOSOCIAL PERSPECTIVES
  • Children's and Adolescents' Perceptions of the Threat of Nuclear War: Implications of Recent Studies
    • Overview
    • Introduction
    • Systematic Sampling
    • Relative Weight of Nuclear War Versus Other Issues
    • International Studies
    • Qualitative Studies
    • Discussion
    • Implications
    • Hope and the Future
    • Notes
  • Scandinavian Youth View the Future: A Preliminary Report of a Large Questionnaire Survey
    • Study Methods
    • Results
    • Discussion and Summary
  • Adult Beliefs, Feelings, and Actions Regarding Nuclear War: Evidence from Surveys and Experiments
    • Modal Beliefs about Nuclear War
    • Modal Feelings about Nuclear War
    • Modal Actions Regarding Nuclear War
    • Sources of the Consensual Beliefs, Feelings, and (In) Action
    • Predispositions to Action
    • Conclusion
    • Acknowledgments
    • References
  • Hope and the Denial of Stress in the Nuclear Age
  • The Nuclear Arms Race and the Psychology of Power
    • Introduction
    • Personal Characteristics of Leaders
    • Emotional Instigators of Violence
    • The Image of the Enemy
    • Violence and Nuclear Weapons
    • Nuclear Weapons and Conceptual Inertia
    • Nuclear Weapons and Demonstration of Resolve
    • Grounds for Hope Created by New Technologies
    • Conclusion
    • References
  • Managerial Demands of Modern Weapons Systems
  • Sources of Human Instability in the Handling of Nuclear Weapons
    • The Character of the Work and Its Impact
    • Alcohol, Drug Use, and Psychiatric Disorders
    • Psychiatric Problems
    • Substance Abuse and Psychiatric Disorders as a Security Risk
    • The Personnel Reliability Program
    • Weaknesses of the Personnel Reliability Program
    • Strengthening the Prp
    • Improving the Working Conditions of PRP Personnel
    • Appendix Nuclear Missions of Each Military Service
    • Acknowledgments
    • References
  • The Impact of Crisis-Induced Stress on Decision Making
    • Mental Health
    • Stress And Coping: Impact On Information Processing
    • Effects Of Stress On Performance: The Inverted U Curve
    • Indicators Of Acute Stress And Its Consequences
    • The Policymaking System: The Individual, Small Group, And Organization Subsystems
    • Coping With Value Complexity And Uncertainty
    • Impact Of Crisis-Induced Stress On Foreign Policy Decision Making
    • Impact Of Stress On Small Group Dynamics
    • Impact Of Stress On Organizational Behavior
    • Toward Prescriptive Theory
    • Acknowledgments
    • References
• PART V. LONG-TERM CONSEQUENCES OF AND PROSPECTS FOR RECOVERY FROM NUCLEAR WAR: TWO VIEWS
  • View I
  • View II
    • Introduction
    • Uncertainties In The "Nuclear Winter" Scenario
    • Current Capability To Predict Biological And Ecological Consequences
    • What Is Needed to Predict Biological and Ecological Effects?
    • Speculations On The Long-Term Consequences And Prospects For Recovery
    • Other Reactions to the Material Presented
    • Acknowledgment
    • Notes
• CONCLUDING REMARKS
  • Summary and Perspective: With Some Observations on Informed Consent
• GLOSSARY
• BIOGRAPHIES OF CONTRIBUTORS

NOTICE: The symposium reported in these proceedings was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the symposium were chosen for their special competences and with regard for appropriate balance.

These proceedings have been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

Conclusions and views expressed by the authors of papers are their own and do not necessarily represent those of the program sponsor, the Institute of Medicine.

The Institute of Medicine was chartered by the National Academy of Sciences to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.

The National Academy of Sciences was established in 1863 by Act of Congress as a private, nonprofit, self-governing membership corporation for the furtherance of science and technology, required to advise the federal government upon request within its fields of competence. Under its corporate charter the Academy established the National Research Council in 1916, the National Academy of Engineering in 1964, and the Institute of Medicine in 1970.

Based on papers presented at a symposium held at the National Academy of Sciences, Washington, D.C., Sept. 20-22, 1985 and organized under the auspices of the Institute of Medicine.