The Medical Implications of Nuclear War (1986) / Chapter Skim
Currently Skimming:
17 Medical Supply and Demand in a Post-Nuclear-War World
17 Medical Supply and Demand in a Post-Nuclear-War World
Pages 349-380
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 349... ...
ABRAMS, M.D. Stanford University, Stanford, California Any analysis of our capacity to survive a nuclear war must view the medical problems that survivors will confronts in the context of the health care system's capacity to provide a meaningful response.
|
From page 350... ...
The problems of medical supply and demand in the post-nuclear-war world are too numerous and too complex to be dealt with fully here. Instead, this analysis will focus on the most acute needs of the injured population and the most obvious tools of the medical profession those without which it could not begin to handle the casualties that will follow a massive exchange.
|
From page 351... ...
Accounts of the nuclear attacks on Hiroshima and Nagasaki7 ~ provided additional data, as did those of the Texas City disaster (a dockside explosion of a ship carrying ammonium nitrate fertilizer, which caused more than 3,000 casualties, most of them trauma related) .9 ~0 Estimates based on these sources suggest that there will be 93 million survivors, of whom approximately 32 million will have been injured (Table 1~.
|
From page 352... ...
Only With trauma Severe Moderate 23 5 18 13 10 9.8 4.9 4.9 s 4.8 9.1 4.2 4.9 5.3 3.8 aEstimates indicate that there would be 93 million survivors, 32 million of whom would be injured. There would be a total of 41.9 million single and combined injuries.
|
From page 353... ...
. i3 Thus, a facility for the 2.12 million most acutely burned survivors of CRP-2B would require 290 million square feet (about 27 million square meters)
|
From page 354... ...
Current Versus Posta~ack Resources and Requirements Medical Personnel Physicians Physicians, nurses, and allied health personnel are more concentrated in urban areas than is the general population. While 73 percent of U
|
From page 355... ...
If the nurse-patient ratio is modified to one nurse for every three of the 6.7 million patients needing intensive care and one nurse for every seven of the 10.9 million regularly hospitalized patients; and if a nurse visits the 14.4 million ambulatory patients at a rate of 10 patients per hour, or 120 patients in a 12-hour shift; and if we assume that ambulatory patients are all seen the first day, 7.7 million nurses would be required on the first day after the attack. Allied Health Personnel The work of physicians and nurses would be seriously hampered, if not impossible, without the help of a varied and TABLE 3 Number of Hospital Beds and Medical Personnel ResourcePreattackPostattackPostattack Needs Hospital Bedsa1,350,000273,00017,600,000 Burn beds1,34602,100,000 Intensive care beds62,00014,8806,700,000 Physicians371,34348,275666,667 Registered nurses1,200,000158,9907,700,000 Licensed practical nurses387,00048,8802,464,000 Medical technologists129,60016,770231,594 Pharmacists121,50030,375419,479 Radiologic technologists96,79012,583173,771 aNumber of hospital beds minus psychiatric beds.
|
From page 356... ...
If each medical technologist worked only on typing and cross matching for 16 hours a day, it would take them 49 days to cross match blood for the 17.6 million hospitalized injured. Similarly, the 9.8 million survivors with blast injuries would need xrays performed by the 12,600 radiologic technicians who would survive uninjured.
|
From page 357... ...
About 60 percent of this group would have burns over less than 20 percent of the body surface.* Even if these patients were excluded, the number requiring burn beds will be 2.12 million-almost eight times the total number of remaining hospital beds (Table 31.
|
From page 358... ...
If the 2.12 million survivors with burns of over 20 percent of the body surface are moved to intensive care beds, there will be a ratio of 142 burn patients for every one intensive care bed. In Hiroshima, 21 percent of the injured died between days 2 and 20 after the attack.7 In the attack under consideration, 4 these most severely injured survivors would number 6.7 million 450 patients for every remaining bed.
|
From page 359... ...
This estimate is substantiated by the fact that on a random day in January 1981, the American Red Cross- which collects approximately half the blood collected in the United States had an 8.7-day supply of blood on hand in its New England Region. White Blood Cells Since antibiotics are widely available, there is little need to transfuse white blood cells except in patients who are not producing them and who are threatened with infection despite the use of antibiotics.
|
From page 360... ...
After the attack, 680,000 units would remain. Ringer's Lactate and intravenous Solutions Intravenous dextrose solution and saline solutions and Ringer's lactate are widely used for plasma volume expansion and fluid replacement in patients with shock, severe trauma, and burns.34 Both are commercially produced by pharmaceutical companies and have an approximate daily inventory of 7 million liters.
|
From page 361... ...
The remaining 3.4 million with trauma alone or with trauma and radiation sickness will also need transfusions. Using the data from Vietnam and Israel, this latter group would require the following: 15.0 million units of red blood cells or whole blood 27.2 million liters of Ringer's lactate 0.85 million units of platelets 9.3 million liters of 5 percent dextrose 14.8 million liters of 5 percent dextrose-0.9 percent sodium chloride 29.8 million liters of 0.9 percent sodium chloride solution Burns Fluid replacement in massive amounts is an absolute requirement for burn patients, especially during the early hours and days following injury.
|
From page 362... ...
27.6 million liters of electrolyte solution 33.9 million liters of 5 percent dextrose solution 31.8 million units of red blood cells or whole blood Radiation Radiation damage and its accompanying symptoms-severe nausea, vomiting, and diarrhea will necessitate replacement fluids for another large group of patients. In Hiroshima, 15 percent of the victims with radiation sickness died between days 2 and 20 postattack.8 Those who died had the most severe radiation sickness- a group that would number 3.5 million in the CRP-2B scenario.
|
From page 363... ...
Drug production is concentrated in a few states, largely on the Eastern seaboard. 33 Eighty percent was also applied to the medical supply industry, since it is distributed across the country in much the same pattern as hospital beds, health manpower, and the drug industry.
|
From page 364... ...
Applied to medical supplies, 193 million square yards (about 161 million square meters) of gauze absorbent bandage would be needed when only 6 million would be available; 76 million hypodermic needles with only 6.4 million available; and 5.2 million general operating scissors with only 85,000 available (Table 5~.
|
From page 365... ...
365 Ct ~ to C~ ~ ~ Ct Z 8, ~: ._ ._ C~ ._ Ct C)
|
From page 366... ...
The disparities are large. If there are 14,000 units of whole blood available and 64 million units required, 47,000 units of red blood cells when 64 million are needed, and 1.3 million liters of Ringer's lactate when 96 million liters could be used, then the problems of developing a credible medical response for the millions of surviving injured are readily grasped.
|
From page 367... ...
. ResourcePreattackPostattack Postattack Needs Hospital beds1,350,0001,336,500 352,000 Burn beds1,3461,333 42,000 Intensive care beds62,00061,380 134,000 Physicians371,343367,630 13,333 Registered nurses1,200,0001,188,000 154,000 Licensed practical nurses387,000383,130 49,280 Medical technologists129,600128,304 4,632 Pharmacists121,500120,285 8,390 Radiologic technologists96,79095,822 3,475 aAssuming a one-megaton airburst.
|
From page 368... ...
Additionally, blood products would be in urgent demand, yet there would only be 57,000 units of whole blood with 1.28 million needed; 191,000 units of red blood cells with 1.28 million needed; and 12,000 units of platelets with 15 million needed. Adequate numbers of personnel would be available if they could be transported to the s~icken area.
|
From page 369... ...
The disparities are considerable: 41 burn beds with 42,000 needed, 1,900 intensive care beds compared with 134,000, and 41,000 hospital beds when 352,000 are required. In terms of blood and resuscitative fluids, 1,800 units of whole blood will be available with 1.28 million needed; 6,000 units of red blood cells will be available with 1.28 million needed; and 350 units of platelets will be available, but over 15 million units could be used.
|
From page 370... ...
TABLE 9 Blood, Fluids, Drugs, and Supply Inventory (Case 2: Michigan Resources 7 ~ ~ TypePreattackPostattackPostattack Need Whole blood (U) 2,3151,7591,280,000 Red blood cells (U)
|
From page 371... ...
Developed market economies accounted for 70 percent of total output. Centrally planned economies (Soviet Union, China, and Eastern Europe)
|
From page 372... ...
A major nuclear exchange would cut off this critical source of pharmaceuticals for the developing world. Medical Equipment Like the pharmaceutical industry, the medical equipment market in developing countries is dominated in large part by foreign suppliers, no TABLE 11 Pharmaceutical Market Shares Held by Domestic and Foreign Firms in 10 Selected Countries (percent)
|
From page 373... ...
In 1980, Mexico imported 56 percent of its medical equipment from the United States and 39 percent from Western Europe a combined total of 95 percent. Singapore received 87 percent of its health supplies and instrumentation from the Western developed nations,60 while Venezuela and the Philippines imported 75 and 76 percent, respectively.5962 In 1983 Chile and Colombia acquired 85 percent of their medical equipment from American and European suppliers.52 53 In 1985, Algeria is projected to import 89 percent and Brazil 86 percent.49 As in the drug industry, the United States and Western Europe assume roughly three-quarters of the foreign market share in medical equipment.
|
From page 374... ...
(Market economies do not include the centrally planned economies of the USSR, China, Bulgaria, Romania, Poland, Hungary, Czechoslovakia, German Democratic Republic, and Cuba.) To the figure for world market GDP, the United States contributed 31 percent, and the countries of Europe contributed 33 percent.
|
From page 375... ...
In 1980 the world production of wheat totaled 444,534 thousand metric tons. North Amenca produced 86,319 thousand tons, or 19 percent, a figure 3.5 times greater than its proportion of the world population.
|
From page 376... ...
The United States exported 21 percent, while Europe's share was almost 69 percent.69 In the wake of a massive nuclear war, farming methods may well revert to a primitive level, with the lack of access to modern machinery, fertilizers, and insecticides. The impact on the developing world will be pro
|
From page 377... ...
Like the Northern Hemisphere, the Southern Hemisphere may find itself constrained by a subsistence loop, in which malnutrition begets disease, disease impairs the ability to produce, and decreased production impedes the cycle of recovery (Figure 21.63 ACKNOWLEDGMENT The research presented herein was supported by grants from the Carnegie Corporation, the John D and Catherine T
|
From page 378... ...
1984. Medical resources after nuclear war: availability vs.
|
From page 379... ...
Arlington, Va.: American Blood Commission. 27American Red Cross.
|
From page 380... ...
1981. Country Market Survey: Medical Equipment Chile.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.