There is a great difference between a thermonuclear war and the detonation of a single nuclear incident. A single device created by a third world country will be a fission device, in contrast to a fission-fusion, of fission-fusion-fission explosive. While the results will be devastating over a small area, a nation will recover. The exact number of nuclear warheads in the world today is not known, but the number is probably in excess of 40,000. I have been disturbed by the lack of intergenerational transfer of knowledge regarding simple decontamination measures, that are equally applicable to a hospital environment of to someone far from a blast where there is fallout. My experience with nuclear weapons dates back forty years when the military still had tactical nukes in the inventory. The following comments are by no means all that should be done or considered.
(1) Hair is scrubbed and scrubbed with detergent and water. The person bends over a sink and has help so the runoff does not contaminate the body. In the event of high contamination , close clipping of the hair is recommended. If there is one hospital in the United States that has an emergency contingency plan involving a barber, and having hair clippers on hand, I don't know of that hospital. People will resist having their hair cut, especially by an amateur. Someone must be designated to clip hair who knows what they are doing.
(2) The individual is told to blow his nose. Then a 500 mg saline intravenous is used (minus the needle), and with the person leaning over a sink a nose douche is used.
(3) For small simple wounds and scratches a venous torniquit is applied to promote bleeding. The lacerations are then cleansed with a pad, surgical soap and water.
(4) Fingernails and pads of fingers may not be decontaminated except with fine emery cloth, Finger pads may need to be sanded free of all finger whorls. If this fails, the hand is placed in a surgical glove, which is work for from 16 to 24 hours. The hand will emerge water-logged, but clean of contamination.
I have had experience with large numbers of people exposed to very hazardous chemicals. They will refuse to relinquish their clothing, let alone their shoes, especially if they have not been physically injured. Incoming patients with contaminated clothing must have that clothing identified. Ideally it should be immediately removed and secured. Magic markers will not be available. I suggest using a bandage scissor to cut a small identifiable slit in the same place on pants, shoes and shirts. Or alternatively cuting a small notch in the cloth. This should be done quickly and inobstrusively, and will enable emergency personnel to determine whether or not a patient is tramping around in contaminated clothing or if clothing had been identified as having been contaminated. If the clothing is decontaminated the small slit can be sewn up, or a second small notch clipped next to the first one.
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