Testimony on Resolution Number 695 Before The Philadelphia City Council Conceming Nuclear War, April 21, 1982

Transcription

1 A Cruel Sham Testimony on Resolution Number 695 Before The Philadelphia City Council Conceming Nuclear War, April 21, 1982 STUART H. SHAPIRO Health Commissioner, City of Philadelphia GUEST EDITORIAL Gs;a g~ AM here today as a physician and as Health Commisb sioner. I have spent many years in the study of health a nd the prevention and cure of diseases. In addition to ti J - 5 my general training in medicine and public health, I P have had five years of training in nudear medicine and e9u4;.5~!a the biological effects of radiation. I am certified as a specialist in nuclear medicine by the American Board of Nudear Medicine. Some of my time has been spent practicing medicine one on one; other times I have practiced medicine as a bureaucratrying to make health systems healthy to serve people. Today I am here in both capacities to talk with you about a public health problem of unprecedented proportions. The consequences of nuclear war are so grave-just like cancer-that the only wise policy is one of prevention. The health system of this great city would be destroyed by nuclear attack. It is my judgement that any support of any nudear war crisis relocation plans would be inconsistent with my job as Health Commissioner and the duties and responsibilities of the Department of Public Health as outlined in the city charter. As Commissioner of Health of Philadelphia I come here to state clearly and directly that there is no way, no plan, no gimmick, no illusions about protecting health during a nuclear war. It cannot be done. To make the effects of nuclear war comprehensible, military planners and civil defense specialists usually examine the effects of a single weapon on a single target. The standard unit for such planning is a one-megaton weapon, only a medium-sized warhead in present-day stockpiles but eighty times more powerful than the weapon that levelled Hiroshima. 122 Palgrave Macmillan is collaborating with JSTOR to digitize, preserve, and extend access to Journal of Public Health Policy

2 SHAPIRO * A CRUEL SHAM 123 To describe the effects of a direct hit of one such weapon, I would like now to borrow liberally from the articulate statement of a leading physician, Dr. H. Jack Geiger. He states that one must begin by specifying the variables that influence the location, range and type of a weapon's physical effects, for these obviously are major determinants of the fate of people in the target area. At a given megatonnage, an airburst distributes blast and heat effects over a wider area; a groundburst will concentrate blast and heat more intensely at ground zero, shorten the range of blast and heat effects, but add the hazard of prompt, intense, and often lethal local radioactive fallout. Local atmospheric conditions make a major difference: wind velocity and direction determine the distribution of fallout and influence the number and spread of fires. Increased moisture in the atmosphere will diminish fire damage, but active precipitation will greatly increase fallout; fog, smog, and clouds will reduce visibility, absorb heat, and decrease the number of burns. Other variables are directly related to human social behavior. An attack during the summer is likely to find more people outdoors, lightly clothed, and therefore more vulnerable to the effects of blast and heat. An attack on a weekday, and especially during working hours, will find additional tens or hundreds of thousands of people (or, in very large cities, millions) concentrated in offices, factories, and schools in central city areas. The most devastating one-megaton explosion, therefore, might be an airburst at 6,ooo feet (the altitude that maximizes the area receiving at least twenty pounds per square inch of blast-induced overpressure, and therefore maximizes death and injury even in the strongest buildings), occurring during weekday working hours on a clear, dry, windy day in summer, with ground zero targeted in the heart of the central-city business district. Finally, the amount of destruction-and the number of deaths and injuries-will depend in part on the variables that cannot be predicted accurately. If a mass conflagration develops-a large, moving fire fanned by surface winds-burn injuries and deaths will increase substantially. If a firestorm develops-a huge, intense but stationary fire, burning at temperatures of 8000 c., sucking in cooler air and creating winds of 200 miles per hour or more-the lethal area will be enlarged five-fold and burn deaths will increase enormously. The physical effects of such an explosion are usually expressed as a series of concentric circles around ground zero, each demarking a zone of destruction in which the magnitudes of radiation, blast and heat, and their effects on buildings, other structures and people, can be estimated. This

3 124 JOURNAL OF PUBLIC HEALTH POLICY - JUNE 1982 movable nuclear bullseye can also be used to express the "medical" effects. It applies equally to all cities, with differences due only to variations in population concentration and in the local terrain. What if ground zero were the heart of downtown Philadelphia? What would happen in each of the circles? The first circle, with a radius of i.5 miles from ground zero, encompassing an area of seven square miles, is the region of nearly total destructionand total lethality. Blast overpressures ranging from 200 pounds per square inch (psi) down to 20 PSI will crush, collapse, or explode all buildings including the most strongly constructed steel and reinforced-concrete structures. Winds of 6oo miles per hour will hurl debris outward at lethal velocties. Temperatures in the fireball above ground zero will exceed 27 million degrees F., and in this area everything will be vaporized; elsewhere in the circle, the heat will melt glass and steel, and concrete will explode. Direct radiation will range from 11,000 rads near ground zero to 1,100 at the circle's rim. All of the human beings in this circle will die almost immediately-vaporized, crushed, charred, or radiated. With no survivors, there are no "medical" problems. Four medical schools and their hospitals would be destroyed-penn, Hahnemann, Temple, and Jefferson. Also the Burn Center at St. Agnes would be useless for it would not exist. City Hall, the Fire Department and Police Department would likewise be rubble, as would Channel 3 and our two major newspapers. The second circle extends 2.9 miles from ground zero and encompasses an additional twenty square miles of Philadelphia and its environs. Blast over-pressures are 10 to 20 PSI, sufficiento collapse and destroy all but the strongest buildings and to sweep out the floors and walls of steel skyscrapers. Winds are 250 to 300 miles an hour, enough to hurl 18o-pound adults 300 feet or more at high speeds. In this circle, so% of the population will die of blast injuries alone: crushed chests and extremities, skull fractures, penetrating wounds of the chest and abdomen, ruptured lungs and other internal organs, crushed vertebrae and transected spinal cords, multiple lacerations and profound hemorrhage. All exposed persons who escape death from blast will suffer third-degree bums unless they are temporarily shielded from the fireball by buildings that have not yet collapsed (the thermal pulse precedes the blast wave). The heat will evaporate aluminum siding, melt lucite windows, and cause spontaneous ignition of clothing. In general, however, blast injuries will predominate; not enough buildings will remain to permit the development or spread of secondary fires. The two other medical schools would be destroyed in this circle along

4 SHAPIRO * A CRUEL SHAM 125 with almost every major hospital in Philadelphiand our other two commercial TV stations. The perimeter of the third circle, with a radius of 4.3 miles, marks the border of the lethal zone. In this circle, which encompasses an additional 32 square miles, overpressures are 5 Psi-enough to exert 18o tons of pressure on the wall of a 2-story house-and winds are 16o miles per hour, capable of hurling adults 20 feet at 14 miles an hour. Factories and commercial buildings of heavy construction will be severely damaged. Debris-pieces of concrete, steel, rock, glass and the like-will be travelling at lethal speeds. The heat-approximately 40 calories per square centimeter-will melt asphalt paving, ignite wood and fabrics (bedding, carpeting, curtains, upholstery, etc.) inside buildings, ignite clothing, and cause major fires in at least 10o of the buildings. Blast-induced trauma will still predominate, though all unprotected persons outdoors will suffer third-degree burns and many others will suffer flame burns. Most persons who make a reflex glance at the fireball will be flashblinded temporarily; many will suffer retinal burns and partial or total blindness; many, in addition, will be made deaf by rupture of the eardrums. In these second and third circles, encompassing more than So square miles of this region's most densely populated areas, so% of the population will die at once and 40% will suffer serious and incapacitating injuries. Infected burns and untreated trauma, killing people slowly, will add many of the injured to the total of fatalities within 30 to 6o days later. The fourth circle has a radius of 4.9n- miles and adds 18 square miles to the area of damage. Overpressures of 4 PSI and winds of 125 MPH-greater than hurricane force-are sufficient to destroy brick and frame houses completely but will leave many stronger buildings standing, available to fuel the fires created not only by the thermal pulse (25 calories per square centimeter, still sufficient to ignite bedding and clothing and cause third-degree burns to unprotected skin) but also by broken furnaces, ruptured natural gas lines, downed high-voltage lines, exploding gasoline stations and fuel tanks, and dry trees and vegetation. At the outer rim of the fifth circle, 6.3 miles from ground zero, 100 MPH winds and 3 PSI overpressures will still be sufficient to blow people out of buildings, sweep away the outer walls of skyscrapers and cause all the varieties of trauma, but burns will predominate. The heat will be sufficient to give third-degree bums to four out of every five unprotected persons outdoors, to ignite dry grass, newspapers and leaves, and to melt neoprenetreated nylon rainwear. In circles four and five together-70 square miles

5 126 JOURNAL OF PUBLIC HEALTH POLICY * JUNE 1982 of the Delaware Valley-the fire hazard will be intense. Only 5% of the population will be killed outright, but 45% will be seriously injured. The sixth circle, finally, has a radius of 8.5 miles; it adds another 1oo square miles to the area of damage, bringing the total to 227 square miles. Overpressures are 2 PSI and winds 70 to 8o MPH. Smaller pieces of debris will still be lethal missiles, and windows will fragment into glass shards travelling at speeds close to 100 MPH; 30% of all trees and utility poles will be downed, blocking the roads; brick and frame residences will be moderately damaged. At 5 to 7 calories per square centimeter, every fifth person outdoors will suffer a third-degree bum-but 70% will suffer extensive second-degree burns. The sixth circle is important for another reason. If this were a 20-megaton explosion, this circle would be the first circle-a 227-square mile area of total destruction and 1oo% fatalities. Under the hypothesized conditions, and assuming that a firestorm develops, this single one-megaton explosion will kill 769,ooo people-or 17% of the 4,557,000 people in the Philadelphia metropolitan area. Another 1,3 34,000 will be seriously injured-almost every third person. Total casualties will be slightly more than 1.7 million. But even these are not the true totals; to them must be added substantial numbers of people who will become acutely ill or die as the supplies of insulin or digitalis or cortisone on which their lives depend become unavailable. Patients who require renal dialysis will die of uremia; cardiac pacemakers will be destroyed by the bomb's electromagnetic pulse. And the normal incidence of myocardial infarctions, perforated gastric ulcers, and other life-threatening emergencies will continue to occur among the uninjured. But even the conservativ estimates are beyond anything in all recorded human experience. Never have more than one million people with profound and incapacitating injuries been located in one place at one timeinjuries, furthermore, that require the most complex and technologically sophisticated medical care for effective treatment. The number of victims with third-degree burns alone is likely to exceed 200,ooo-or 100 times more than all the intensive-care burn beds in the United States. The management of these and other injuries would require X-ray units, CT scanners, sterile burn treatment units, modem operating rooms, intensive care units with sophisticated life support systems, and literally millions of units of blood and plasma, huge and varied supplies of drugs, and other specialized resources. For the people of this region after a nuclear war, there will be no health

6 SHAPIRO - A CRUEL SHAM 127 system. Total hospital beds in Philadelphiand surrounding counties number almost 20,000. Not many of these beds would survive an attack. Most of the medical school teaching hospitals would be destroyed. The major bum centers would be severely incapacitated. Using well established calculations, I believe that the ratio of wounded to available beds would be approximately 8oo to 1. That means that there would be hundreds of people competing for each individual bed. Most of the physicians, nurses, lab technicians, aides, and pharmacists would be dead. As most physicians' offices are clustered in downtown areas, closest to ground zero, there would be few surviving physicians to treat seriously injured victims. Estimates vary from 1 physician to 350 wounded individuals to 1 physician to 1,700 wounded individuals. If we assume a ratio of 1 to 1,ooo, and imagine that every surviving physician finds all the wounded with no loss of time, spends only 15 minutes per patient on every aspect of diagnoses and treatment, and works 18 hours a day, it would still be 8 to i6 days before every surviving patient is seen for the first time. Tragically and obviously, most of the victims will diemany of them slowly and agonizingly without any medical care, without even narcotics to relieve the pain. In fact, life will be so painful, that the "survivors will envy the dead." Flash bums, trauma and blast injuries, flame burns, smoke inhalation, acute radiation, fallout radiation, suffocation and heat prostration, dehydration, malnutrition, and communicable diseases ranging from viral pneumonias and influenza to tuberculosis and diarrheal diseases to typhoid fever, typhus, cholera and plague, will all be rampant, unstoppable and untreatable except in rare cases. The emergency transport system would be incapacitated, as would transportationetworks, electricity, and water supplies. In short, with 11,371 of 12,417 hospital beds destroyed, with all of our medical schools in flames, even from a small one-megaton bomb, we will cease to have any mechanism to provide health care. Each day will produce new, insoluble problems as the diseases of decaying human and animal bodies, impure water, fires, lack of food, uncontrolled insect and vector populationspread. As a civilized society we would, simply stated, cease to exist. I come before you today with an urgent message and a plea for help. Earlier this month I presented a budget message seeking funds to protect and improve the health of the people of Philadelphia. I know and you know that the federal and state government attacks on the health of the

7 128 JOURNAL OF PUBLIC HEALTH POLICY * JUNE 1982 poor, the elderly and in fact all Philadelphians cannot be corrected by local government alone. My budget promises to do the most possible for the people of Philadelphia with the dollars we, as local government, can raise. I am proud of the way in which the Department of Public Health and the medical community are rising to the challenge to keep a semblance of human services available to our people. But, at the same time that the federal government is abandoning human services to a scrap heap, it is lavishing funds on nuclear weapons that make us less secure, and on civil defense and evacuation programs which are a lie and a cruel sham for the American people. In 1953, a leading American statesman said, "Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and are not clothed." That statement has special meaning today when our domestic budget is not providing adequate funds for health and human services, when people are going hungry and naked. Instead the current administration has proposed that we spend $4.2 billion on crisis relocation plans-$4.2 billion that could be spent on feeding the hungry and clothing the cold. Ironically, in 1953, that statement was not made by the liberal presidential candidate, Adlai Stevenson, but by former General and then President Dwight David Eisenhower shortly after he was inaugurated. Today I ask your help to fight this nuclear madness, to quarantine the policies which could destroy us. Your resolution is an exciting and laudatory beginning, but it should go further. It should state loudly and clearly that no one in city government should spend dollars, time, or energy participating or providing input into the development of nuclear war relocation plans. It should be clear to us all that to participate in the development of these plans is a cruel hoax on the citizens of Philadelphia-a hoax that creates the false illusion that the health community in this area could offer any assurance of health protection to the citizens of this great city in case of a nuclear attack. We must withdraw from programs which propose a six day evacuation for a ten minute war. We must say "no" to those who want to develop plans for the unplannable. We must educate our citizens to control military spending and to eliminate the nuclear nightmare wliich haunts our dreams and poisons the future of our children. We must fight for a just and livable society, one worth defending.

8 SHAPIRO - A CRUEL SHAM 129 We must restoressential health and human services programs, for children, for family planning, for clean air, for safe and healthy workplaces and against TB and other communicable diseases. And we must all fight to assure that the world survives, and that the march of progress in health care continues. None of us want to see three centuries of progress ended by nuclear war. This is my job as Health Commissioner and our common task as government. I applaud and supporthis resolution today. But I ask that we see it as a first step in the long road of building peace in and for a healthy society.