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	Nuclear Detonation: Weapons, Improvised Nuclear Devices Nuclear Detonation: General Information Improvised Nuclear Devices (INDs) Categories of Medical Effects Medical Management Communicating After an IND Detonation: Resource for Responders and Officials Shelter in Place: Shielding by Buildings from Fallout and Blast Numbers and Types of Casualties from Various Computer Modeled Nuclear Detonation Scenarios Radioactive Fallout Nuclear Testing Film Clips See also: Damage Zones After a Nuclear Detonation & "Zoned Approach" to the Response Emergency Worker Exposure Guidelines in the Early Phase Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats) Key Response Planning Factors for the Aftermath of Nuclear Terrorism (PDF - 4.52 MB) (Lawrence Livermore National Laboratory, August 2009) Nuclear Detonation Scarce Resources Working Group publications list: medical and public health guidance for planners and responders (DMPHP, March 2011) Modeling Physical and Injury Impacts of an Improvised Nuclear Device Explosion in Cities (Lawrence Livermore National Laboratory) Nuclear Detonation: General Information 1 The energy released in a nuclear explosion derives from the splitting (fission) of radioactive materials, e.g. Uranium-235 and Plutonium-239. Bombs dropped on Hiroshima and Nagasaki, Japan at the end of World War II are examples of nuclear explosions. The explosive energy from a nuclear detonation is quantified in terms of the number of kilotons (Kt) of the conventional explosive TNT (trinitrotoluene) that it would take to create the same blast effect. During and following a nuclear explosion, radiation is released including Electromagnetic radiation: ultraviolet, infrared, visible, gamma and x-ray Particulate radiation: alpha and beta particles, and neutrons A nuclear blast releases massive amounts of energy, which dissipate as a fireball, blast forces/waves, prompt radiation, light and heat (thermal energy), and delayed ionizing radiation (i.e. fallout: nuclear fragments created in the fission process which turn into radioactive elements which attach to vaporized debris particles from the explosion). See Nuclear Detonation Effects (YouTube - 0:41 minutes) (U.S. Government archive) Fireball Vaporization of matter by tremendous heat within the fireball Located at the epicenter of the explosion Everything inside this fireball vaporizes, including soil and water, and is carried upward This creates the mushroom cloud that is associated with a nuclear detonation/blast/explosion (Figure 1) Blast forces/waves: shock waves causing mechanical damage (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6) Direct blast wave pulse overpressure forces (measured in atmospheres of pressure) propagate out from blast Indirect blast wind drag forces (measured in wind velocity) Prompt radiation dose Radiation levels are greatest near the epicenter of the explosion, and decrease rapidly with distance from the point of the burst. Carried predominantly by gamma rays and neutrons produced within the first minutes after the explosion Can cause whole body exposure and Acute Radiation Syndrome, if dose is sufficient Light and heat (thermal energy) Radiated by the fireball Wide range of electromagnetic spectrum, including infrared, visible, and UV Electromagnetic pulse Occurs at the instant of the detonation and ends within a few seconds Disruption of the electrical grid and electronic equipment by this pulse is greatest nearest the epicenter Communications infrastructure (cell towers, telecommunications switches, dishes, radar) will be significantly affected Equipment entering the area after the event will function normally, but function will be related to restoration of the infrastructure Cell phones and handheld radios have relatively small antennas, and if they are not connected to electrical power supplies during the electromagnetic pulse (EMP) they may not be affected Delayed ionizing radiation dose (fallout) (Figure 7, Figure 8) Produced by fission products and neutron-induced radionuclides in the area around the explosion, especially downwind Dispersed downwind with the fireball/debris cloud As the cloud travels downwind, the cooling and falling radioactive material settles on the ground, creating a large swath of deposited material (fallout) Fallout creates large areas of contamination and the ionizing radiation coming off the fallout, which can damage tissues and penetrate through thin walls and glass Fallout can also contaminate the soil, food, and water supply Prohibitions against eating food and drinking water from affected areas will be issued Groundshine (measured in dose rate per hour or cumulative dose over time interval, displayed on fallout maps. See Fallout Map 1, Fallout Map 2) External gamma radiation from fission products deposited on the ground in fallout area More than the beta radiation deposits, groundshine will be the most significant health hazard related to fallout in the first few days See Nuclear Detonation Fallout (YouTube - 1:30 minutes) (U.S. Government archive) See more details about Radiation Fallout on this page Figure 5. Approximate distances for zones with varying yield nuclear explosions <10 KT Explosion The Severe Damage Zone will extend to ~ 1/2 mile (0.8 km) The Moderate Damage Zone will be from ~ 1/2 mile (0.8 km) to ~ 1 mile (1.6 km) The Light Damage Zone will extend from ~ 1 mile (1.6 km) to ~3 miles (4.8 km) 1 KT Explosion The Severe Damage Zone will extend to ~ 1/4 mile (0.4 km) The Moderate Damage Zone will be from ~ 1/4 mile (0.4 km) )to ~ 1/2 mile (0.8 km) The Light Damage Zone will extend from ~ 1/2 (0.8 km) mile to ~2 miles (3.2 km) 0.1 KT Explosion The Severe Damage Zone will extend to ~ 200 yards (0.2 km) The Moderate Damage Zone will be from ~200 yards (0.2 km) to ~ 1/4 mile (0.4 km) The Light Damage Zone will extend from ~ 1/4 mile (0.4 km) to ~1 mile (1.6 km) Source: Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 Figure 1. Nuclear explosion: mushroom cloud Figure 2. Nuclear weapon explosion effects: approximate Source: Armed Forces Radiobiology Research Institute's Medical Effects of Ionizing Radiation Course on CD-ROM (1999) 50% Blast and ground shock 35% Thermal radiation 15% Ionizing radiation 5% Initial/prompt (first minute) 10% Delayed/residual (minutes to years) Figure 3. General patterns of damage from a 10-Kt nuclear explosion on the ground Source: The National Academies and the U.S. Department of Homeland Security Figure 4. Damage zones after a nuclear detonation: idealized maps Source: Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (More detail) Figure 6. Impacts of peak overpressure of blast Peak Overpressure (psi) Type of Structure Degree of Damage 0.15-1 Windows Moderate (broken) 3-5 Apartments Moderate 3-5 Houses Severe 6-8 Reinforced concrete building Severe 6-8 Massive concrete building Moderate 100 Personnel shelters Severe (collapse) Peak Overpressure (psi) Type of Injury to People in the Open 5 Threshold for eardrum rupture 15 Threshold for serious lung damage 50 50% incidence of fatal lung damage Source: Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 Figure 7. Fallout: Relative rate of decline of radioactivity after a nuclear explosion Summary of fallout effects from a hypothetical 10 Kt nuclear explosion. The level of fallout decays quickly, roughly by a factor of 10 for every 7-fold increase in time. Source: Armed Forces Radiobiology Research Institute's Medical Effects of Ionizing Radiation Course on CD-ROM (1999) Figure 8. Factors that affect fallout Particle size: Assuming constant wind and altitude, larger particles land relatively close to ground zero and smaller particles land farther away. Altitude: The higher the initial altitude of a particle, the farther away from ground zero it lands, assuming constant wind speed and particle size. This means that the fallout pattern will be different if there is a ground burst vs. one from an altitude, and increasing altitude will also affect the fallout pattern. Wind: Wind is the most difficult factor to predict. Different altitudes through which a particle falls may have different wind speeds and directions that affect the final destination of the fallout particle. This explains how fallout can occur miles upwind of a detonation. Source: Armed Forces Radiobiology Research Institute's Medical Effects of Ionizing Radiation Course on CD-ROM (1999) top of page Improvised Nuclear Devices (INDs) 2 An illicit nuclear weapon bought, stolen, or otherwise originating from a nuclear state, or a weapon fabricated by a terrorist group from illegally obtained fissile nuclear weapons material that produces a nuclear explosion Built from the components of a stolen weapon or from scratch using nuclear material (plutonium or highly enriched uranium) Produces same physical and medical effects as nuclear weapon explosion Results in catastrophic loss of life, destruction of infrastructure, and contamination of a very large area If nuclear yield is NOT achieved, the result would likely resemble a Radiological Dispersal Device in which fissile weapons material was dispensed locally If nuclear yield is achieved, results would resemble a nuclear explosion described on this page Like nuclear explosions, IND explosions can be evaluated with a fallout map (See Fallout Map 1, Fallout Map 2) Reference: Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents (PDF - 519 KB) (DHS/FEMA, published in Federal Register, August 1, 2008, Z-RIN 1660-ZA02) top of page Categories of Medical Effects Blast injury | Thermal/burn injury | Radiation injuries Blast injury 3, 4 Immediate effects of blasts and explosions Primary blast injury — direct effects result from barotrauma (e.g., overpressurization and underpressurization) commonly affecting air-filled organs and air-fluid interfaces (Figure 9) Rupture of tympanic membranes: Injury to ear drum: 5 psi Pulmonary damage: Injury to lung: 15 psi Rupture of hollow viscera: Injury fatal (LD50): 50 psi Secondary blast injury Penetrating trauma Fragmentation injuries Tertiary blast injury — effects of structural collapse and of persons being thrown by the blast wind Crush injuries and blunt trauma Penetrating or blunt trauma Fractures and traumatic amputations Open or closed brain injuries Quaternary blast injury — burns, asphyxia, and exposure to toxic inhalants Types of injuries caused by blasts depend on whether blasts Occur outdoor in open air or within buildings Cause the collapse of a building or other structure Conventional bombs generate blast waves that spread out from a point source Blast wave consists of two parts Shock wave of high pressure followed by Blast wind or air in motion Damage produced by blast waves decrease exponentially with distance from the point source Reverberations occur off walls and rigid objects As outward energy dissipates, a reversal of wind back toward the blast and underpressurization occur The resulting pressure effect damages organs, particularly at air-fluid interfaces, and the wind propels fragments and people, causing penetrating or blunt injuries Enhanced-blast explosive devices (e.g., nuclear explosions) have more damaging effects than conventional explosions Primary blast disseminates the explosive and then triggers it to cause a secondary explosion High pressure wave then radiates from much larger area, prolonging the duration of the overpressurization phase and increasing the total energy transmitted by the explosion Cause a greater proportion of primary blast injuries than do conventional devices Thermal/burn injury Direct absorption of thermal energy through exposed the skin or heating or ignition of clothing (flash burns) (Figure 10) Indirect action of fires caused in the environment (flame burns) Burn casualties — and it is expected there would be many — may result from the absorption of thermal radiation energy Eye injuries Flash blindness (See illustration) Caused by the effect on the retina of the initial brilliant flash of light produced by the explosion Victims DO NOT have to be looking at the detonation site, as reflected/diffracted light is sufficient in many cases Victims driving at the time of the event will be unable to see, potentially causing large numbers of traffic accidents During daylight, flash blindness does not persist for greater than about 2 minutes, but lasts generally seconds At night, when the pupil is dilated, flash blindness will last longer Partial recovery may be expected within 3-10 minutes in daylight, longer at night Retinal scarring Retinal burn (See illustration) resulting in permanent damage from scarring results when a fireball is directly viewed May be sustained at considerable distances from the explosion, depending on blast size Location of the scar will determine the degree of interference with vision Central scarring will cause greater disability Radiation injuries During the incident Prompt radiation Gamma and neutron radiation exposure dose received within the first minutes after detonation Depending on dose, patients are at risk for Acute Radiation Syndrome Delayed radiation Fallout (Figure 7, Figure 8): Produced by fission products and neutron-induced radionuclides in surrounding materials (water, soil, structures, nuclear device debris) These radioactive products will be dispersed downwind with the fireball/debris cloud (Figure 7, Figure 8) As the cloud travels downwind, the cooling and falling radioactive material settles on the ground, creating a large swath of deposited material (fallout) (Figure 7, Figure 8) The highest concentrations (creating the most dangerous radiation levels) fall closest to the detonation site The fallout creates large areas of contamination, and the ionizing radiation coming off the fallout contamination damages tissue and can penetrate through thin walls and glass Three ways victims can get a dose of radiation from the fallout: Radiation directly from the fallout as it passes by or from the fallout that has been deposited on the ground Radiation from fallout contamination on skin, clothing, or possessions, which exposes people until they change their clothing and/or remove the contaminated material Ingestion or inhalation of radioactive material Of these, the most likely to cause injury in the first few days is direct exposure to fallout, which can be protected against using the three basic principles of time, distance, and shielding Exposure to fallout is the most dangerous in the first few hours Fallout decays rapidly with time: Example from a hypothetical 10 Kt explosion: After 3 hours, initial exposure rates are down to 20% 8 hours, down to 10% 48 hours, down to 1% Therefore, sheltering for the first few hours can save lives Long after the incident (potential long-term effects of radiation) Delayed effects of acute radiation exposure Specific organ effects depending on where a given isotope is incorporated Carcinogenesis Mutagenesis (fetal effects) Figure 9. Blast Injuries Source: Armed Forces Radiobiology Research Institute's Medical Effects of Ionizing Radiation Course on CD-ROM (1999) psi = pounds per square inch LD50 = the dose of radiation expected to cause death to 50% of those exposed without medical treatment.   Figure 10. Thermal burn on skin from nuclear explosion Source: Pictures of World War II, U.S. National Archives & Records Administration, 77-MDH-6.55b Skin burn pattern corresponding to the dark portions of a kimono worn at the time of the atomic explosion, 1945. top of page Medical Management 1, 5 Both exposure and contamination can occur. See sections of this Web site for diagnosis and treatment of Exposure Contamination Both Radiation injury Acute Radiation Syndrome (ARS) Hematopoietic Subsyndrome Cutaneous Radiation Syndrome Manage ARS Subsyndromes Time/Dose Effects in ARS Time Phases of ARS Combined Injury Since the event is likely to be a mass casualty situation, the procedures used for diagnosis and treatment of patients may need to be modified from those recommended in events with a smaller number of victims Triage Mass casualty issues after radiation exposure Treatment of Acute Radiation Syndrome: modifications in mass casualty situations with scarce resources Triage category and cytokine (G-CSF) use after a nuclear detonation (Interactive tool) Biodosimetry tools: calculating dose from exposure (Interactive tool) Burn triage and treatment Where to send biodosimetry specimens top of page Communicating After an IND detonation: Resource for Responders and Officials Nuclear Detonation Preparedness - Communicating in the Immediate Aftermath (PDF - 528 KB) (US Government Interagency Nuclear Detonation Response Communications Working Group, Approved for Interim Use, September 1, 2010) top of page Shelter in Place: Shielding by Buildings from Fallout and Blast Buildings provide considerable protection from fallout (Figure 11), and blast (Figure 12) A brick building provides better protection from radiation (Figure 11) and blast (Figure 12) than does a brick veneer building, which is better than that of a frame building. Less radiation exposure (increasing the Protection Factor) is seen at interior locations and below ground The multiple-story office building illustration below shows that the middle floors provide better shielding than the ground floor or exterior locations because fallout that emits gamma radiation covers the ground, exterior surfaces, and the rooftop. Moving to a higher floor in the building increases the distance from the ground source but increases exposure from radiation on the rooftop. Reference: Sheltering in Place During a Radiation Emergency (HHS/CDC, May 2006) Figure 11. Buildings as radiation shielding Figure 11: Example protection factors (PFs) for a wide variety of building types and locations. Numbers represent a "dose reduction factor". A dose reduction factor of 200 indicates that a person in that area would receive 1/200th of the dose of a person out in the open. Source: Key Response Planning Factors for the Aftermath of Nuclear Terrorism (PDF - 4.52 MB) (Lawrence Livermore National Laboratory, August 2009, Page 12, Figure 9) Figure 12. Blast Effects on Dwellings top of page Numbers and Types of Casualties from Various Computer Modeled Nuclear Detonation Scenarios Table estimating medical casualty numbers and types after an IND detonation (PDF - 608 KB): important caveats about casualty numbers in this table Generated expressly for the "Scarce Resources for a Nuclear Detonation Project", for the purpose of assisting with medical response planning. Adapted from Knebel AR, Coleman CN, Cliffer KD, Murrain-Hill P, McNally R, Oancea V, Jacobs J, Buddemeier B, Hick J, Weinstock D, Hrdina CM, Taylor T, Matzo M, Bader JL, Livinski A, Parker G, Yeskey K. Allocation of Scarce Resources Following a Nuclear Detonation: Setting the Context. Disaster Med Public Health Prep. 2011 Mar;5 Suppl 1:S20-31. [PubMed Citation], Full Text (PDF - 457 KB) Do not represent comprehensive modeling for all potential consequences of a nuclear detonation. Do not represent data for any specific city Represent only a general order of magnitude useful for medical resource planning considerations Represent US government interagency computer modeling and calculations of 185 distinct nuclear detonation scenarios using many variables including Nuclear detonation yields (0.1-10 kT) Heights of burst (ground and air) Weather conditions US cities top of page Radioactive Fallout After and IND, radioactive material that returns to the ground after it is propelled into the atmosphere is called "fallout". Winds at high levels above ground can carry the radioactive material far from the detonation site. Low-level winds do not predict the direction of fallout. These radioactive clouds have been called the "plume", and the radiation emitted from these "plumes" has been called "cloud shine". When radioactive fallout is deposited on the ground and on buildings, the resulting radiation has been called "groundshine". See video: Nuclear Detonation Fallout (YouTube - 1:30 minutes) (U.S. Government archive) The level of radiation in the environment can be predicted and estimated by computer modeling and actual measurements. Models use information about the size of the crater, height of the mushroom cloud, weather, topography, principles of physics, results from radiation detectors in the air and on the ground, and other parameters. Official government response teams use these tools to create maps of areas expected to be contaminated by fallout and predict how radiation levels are expected to change over time. This will help direct appropriate response activities. A map predicting or reflecting actual radiation levels displays a specific geographic area overlaid with lines or areas of similar exposure or dose. This mapping is similar to a weather map displaying isotherms or isobars. The geographic location of the dose or exposure rate/hour lines from groundshine will change over time, as the radioactive isotopes in fallout decay quickly. Potential medical issues from fallout: brief overview Exposure to radiation from fallout in the first few days is expected to be a far more serious clinical public health problem than either external or internal contamination. A nuclear explosion produces more than 300 isotopes in the fission process and other radioactivity induced by neutrons.17. The four significant nuclides that accounted for nearly three-fourths of the reconstructed whole-body internal dose to people who lived within a few hundred kilometers of one Nevada Test Site were identified as Sr-89, Sr-90, I-131, and Cs-137.18 The majority of internal contamination of individuals in one key study occurred from eating contaminated food. 18  With respect to human uptake of fallout products, ingestion of radioisotopes is likely to be a much greater medical concern than inhalation. 18,19 Minimizing risk from fallout: general principles External exposure from fallout is the most serious radiation-related medical concern for those walking through a fallout area or sheltering in a place with an inadequate Protection Factor. After a nuclear detonation, prolonging the time of sheltering-in-place (for at least 24 hours when possible) in a building with a high Protection Factor will minimize this risk, as radiation decays quickly over time. Those receiving a whole body dose from exposure of = 200 cGy may need urgent evaluation and possibly treatment for Acute Radiation Syndrome. External contamination is likely for those who walk through a fallout field after a nuclear detonation. Prolonging the time of sheltering-in-place (for at least 24 hours when possible) after the detonation will minimize the medical risk, as the radiation decays quickly over time. First responders would be expected to use Personal Protective Equipment (PPE) appropriate for their role and hazard. External decontamination should be performed as soon as feasible for anyone with external contamination. Internal contamination via inhalation and/or ingestion could result from walking through a fallout field, inhaling radioactive dust, or consuming contaminated food and liquids. Prolonging the time of sheltering-in-place (for at least 24 hours when possible) after the detonation will minimize this risk, as the fallout decays quickly over time. First responders would be expected to use formal respiratory protection to minimize the risk from inhalation. Those without access to formal respiratory protection could use informal protection like a handkerchief across the nose and mouth. Avoiding eating contaminated food and drink is the most effective Protective Action in this circumstance. Public health officials may recommend medical countermeasures for internal contamination in very specific circumstances. See also: Time Sequenced Size of Dangerous Fallout Zone and 0.01 R/Hour Boundary after a Hypothetical 10kT Nuclear Detonation at Ground Level Approximate prompt and delayed fallout effects from a 10 kT detonation top of page Nuclear Testing Film Clips Historical Test Films (Department of Energy) See Nuclear Detonation Fallout (YouTube - 1:30 minutes) (U.S. Government archive) See Nuclear Detonation Effects (YouTube - 0:41 minutes) (U.S. Government archive) top of page References Tochner ZA, Glatstein E, "Chapter 216: Radiation Bioterrorism," in Harrison's Principles of Internal Medicine, 17th Edition, Fauci AS, Longo DL, Kasper DL, Braunwald E, Jameson JL, Loscalzo J, Hauser SL, eds., pp. 1358-1364, McGraw Hill, 2008. Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents (PDF - 519 KB) (DHS/FEMA, published in Federal Register, August 1, 2008, Z-RIN 1660-ZA02) Adapted from CDC Web site: Radiation Emergencies (HHS/CDC May 10, 2006) Radiation Emergencies: Frequently Asked Questions About a Nuclear Blast (HHS/CDC December 23, 2003) Radiation Emergencies: Casualty Management After Detonation of a Nuclear Weapon in an Urban Area (HHS/CDC May 20, 2005) Radiation Emergencies: Casualty Management After a Deliberate Release of Radioactive Material (HHS/CDC May 20, 2005) Blast Injuries Blast Injuries: Fact Sheets for Professionals (HHS/CDC August 20, 2008) Radiation Emergencies: Blast Lung Injury: What Clinicians Need to Know (HHS/CDC June 14, 2006) Radiation Emergencies: Blast Lung Injury: An Overview for Prehospital Care Providers (HHS/CDC June 14 2006) Radiation Emergencies: Explosions and Blast Injuries: A Primer for Clinicians (HHS/CDC June 14 2006) DePalma RG, Burris DG, Champion HR, Hodgson MJ. Blast injuries. N Engl J Med. 2005 Mar 31;352(13):1335-42. [PubMed Citation] NATO Handbook on the Medical Aspects of NBC Defensive Operations (Part 1 - Nuclear), (AMEDP-6(B)), (Departments of the Army, Navy, and Air Force), Washington, DC, 1996. Recommendations for Managing a Nuclear Weapons Accident (Radiation Emergency Assistance Training Center/ Training Site [REAC/TS]) A Feasibility Study of the Health Consequences to the American Population from Nuclear Weapons Tests Conducted by the United States and Other Nations (HHS/NCI/CDC, August 2001) Weisdorf D, Chao N, Waselenko JK, Dainiak N, Armitage JO, McNiece I, Confer D. Acute radiation injury: contingency planning for triage, supportive care, and transplantation. Biol Blood Marrow Transplant. 2006 Jun;12(6):672-82. [PubMed Citation] Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med 2004; Jun 15;140(12):1037-51. [PubMed Citation] The Medical NBC Battlebook US Army ChPPM, Technical Guide 244, August 2002 Radiation Emergencies: Sheltering in Place During a Radiation Emergency (HHS/CDC, May 2006) Preparing to Shelter in Place — Practical Tools for Households, Work Places, Schools and Early Childhood/Youth Programs, and Governments (Redefining Readiness, Center for the Advancement of Collaborative Strategies in Health at the New York Academy of Medicine) Nuclear Attack, News & Terrorism - Communicating in a Crisis (PDF - 112 KB) (Fact sheet from the National Academies and the U.S. Department of Homeland Security) Manthous CA, Jackson WL Jr. The 9-11 Commission's invitation to imagine: a pathophysiology-based approach to critical care of nuclear explosion victims. Crit Care Med. 2007 Mar;35(3):716-23. [PubMed Citation] Darley DS, Kellman RM. Otologic considerations of blast injury. Disaster Med Public Health Prep. 2010 Jun;4(2):145-52. [PubMed Citation] Morley MG, Nguyen JK, Heier JS, Shingleton BJ, Pasternak JF, Bower KS. Blast eye injuries: a review for first responders. Disaster Med Public Health Prep. 2010 Jun;4(2):154-60. [PubMed Citation] Glasstone S, Dolan PJ, The Effects of Nuclear Weapons, 3rd ed. Washington, D.C.: US Government Printing Office, 1977. Peterson KR, Shapiro CS. Internal dose following a major nuclear war. Health Phys. 1992 Jan;62(1):29-40. [PubMed Citation] Levanon I, Pernick A. The inhalation hazard of radioactive fallout. Health Phys. 1988 Jun;54(6):645-57. [PubMed Citation]

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