Sir: In a major disaster, the usual period during which successful recovery of the seriously injured may occur is the first 72 hours. Trapped injured victims without fluids and support care who survive over 72 hours are the exception.
In the event of a nuclear explosion, the survivors of the blast and flash burns are likely to be also victims of the effects of ionizing radiation. At Hiroshima and Nagasaki, the radiation victims who survived the initial nuclear blast were in the thousands and were able to reach some type of support service; though many died later (36,000 died after the third day) (Oughterson and Warren Citation1956). With the availability of antibiotics and marrow replacement, most of these radiation victims could be rescued (Ende et al. Citation2001, Ende and Azzam Citation2011). However, the timing of administration of antibiotics and marrow replacement is critical.
In patients with hematological malignancies who have been treated with whole body-irradiation, there is a period of time before the transplanted marrow recovers. Currently, in the clinical situation, these patients are treated, prior to radiation therapy, with broad spectrum antibiotics, antifungal and antiviral compounds. The recovery period is more rapid with human leukocyte antigen (HLA)-matched bone marrow than with human umbilical cord blood. However, with the use of human umbilical cord blood, engraftment occurs even with poorly matched HLA cord blood and there is less graft-versus-host disease. Following exposure to lethal and supra-lethal absorbed doses of radiation, the period of time during which the immune system would be partially functional is significantly shortened. With variable degrees, patients even with minor external physical injuries and infection, but with a severely compromised immune system, may die of septicemia.
Our ongoing laboratory studies indicate that from a practical viewpoint, antibiotics should be administered, as soon as possible, to all suspected mass casualties of a nuclear explosion (i.e., individuals with nausea, vomiting and diarrhea). The emergency medical staff may have at least 24 hours or longer to administer cord blood if antibiotics are administered shortly after a potentially lethal radiation exposure. We propose that the early use of broad spectrum antibiotics should be integrated in any plan for the treatment of mass casualties from radiation exposure.
There are possible negative effects associated with the use of antibiotics. However, in a large population, these effects are insignificant compared to the number of individuals who could be saved from infection. An immune-compromised status resulting from irradiation is potentially life-threatening and would outweigh any risk of antibiotic therapy. In the recent cholera epidemic in Haiti, the use of antibiotics was anticipated to avert 8,000–10,000 cases out of a projected total of 779,000 affected individuals, and save 900–2,000 lives (Andrews and Basu Citation2011).
Declaration of interest
The authors declare no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References
- Andrews JR, Basu S. 2011. Transmission dynamics and control of cholera in Haiti: An epidemic model. The Lancet 377:1248–1255.
- Ende N, Azzam EI. 2011. Consideration for the treatment of mass casualties based on pathology of the fatalities of Hiroshima and Nagasaki. International Journal of Radiation Biology 87:443–444.
- Ende N, Lu S, Alcid MG, Chen R, Mack R. 2001. Pooled umbilical cord blood as a possible universal donor for marrow reconstitution and use in nuclear accidents. Life Sciences 69:1531–1539.
- Oughterson AW, Warren S. 1956. Medical effects of the atomic bomb in Japan (National nuclear energy series. Manhattan Project Technical Section. Division VIII, v.8). New York: McGraw-Hill.