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“It’s not a matter of if; it’s a matter of when.”

General Eugene Habiger, head of American strategic weapons until 1998, referring to the likelihood of a terrorist act in the United States involving a radiologic device.

Humans evolved in a universe where ionizing radiation is a fact of life. Yet for many it remains a mysterious force, deadly, unseen, and impossible to detect with our senses. Atomic energy and the atomic bomb loom large in a public psyche shaped by post-WWII geopolitics. For these reasons, public concern with atomic energy, nuclear waste, and the risk of nuclear terrorism probably exceeds that of any other agents. The world is filled with a variety of sources of ionizing radiation, and consequently, many experts consider the likelihood of a terrorist act involving nuclear material to be simply a matter of time. For decades, life on earth was threatened by the Cold War. In the post-September 11 world, the nuclear threat is more limited and ironically more unpredictable. This chapter provides a brief synopsis of the possible scenarios in which terrorists could use nuclear weapons or nuclear material (Table 29–1).

Table 29–1 Classification of Radiological Terror

The destructive potential of a nuclear weapon is enormous, encompassing explosive force, radiation, and extreme heat. The latter two are discussed in terms of medical management. An attack on a nuclear reactor would be more an issue of radioactive fallout rather than one of thermonuclear explosion. The detonation of a nuclear bomb is the most complicated event, both in scale of damage and in mechanisms of injury.

In the event of a nuclear bomb detonation, the energetics of impact are accounted for in the following ways: the blast itself accounts for roughly 50% of the released energy and occurs in the form of pressure waves. Heat (thermal radiation) and light account for 35% of the energy. This includes lower energy radiation such as infrared, visible, and ultraviolet light. Temperatures at sites closest to the blast reach over 20 million degrees Fahrenheit. It is the heat and light that give the classic feature of the flash followed by the mushrooming fireball. Ionizing radiation, in contrast, accounts for only 5% of the energy released by a nuclear weapon, primarily in the form of gamma ...

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