Medical response framework for catastrophic burn and radiation mass casualties after a potential Ukraine nuclear event

With the Russian invasion of Ukraine in February 2022, clinicians in Ukraine were urgently faced with expanding burn capabilities to hospitals that were not designated burn centers. In response, international humanitarian groups and non-governmental organizations (NGOs), including national agencies, international burn societies, and many authors of this manuscript, hailed the call for help. One of the biggest concerns identified was the increasing risk of damage to nuclear reactors and powerplants during military operations, and the possible use of tactical nuclear weapons by Russian forces, triggering requests for actionable national medical response planning for nuclear emergencies. This concern led to the creation of the Burn Blast Injury Working Group (BBIWG) in February 2023 by the US Agency for International Development-a multidisciplinary group of civilian and military medical specialists in burns, trauma, and radiation injury; disaster management; public health; and policy. The group evaluated historical data from the 1945 Hiroshima and Nagasaki bombings, as these were on scale with modern "moderate-yield" tactical nuclear weapons (1-20 kilotons). This was supplemented with population impact models to derive a hypothetical cohort of survivors requiring medical care. Based on our collective efforts, this manuscript reports a strategic summary of an actionable civilian readiness plan for the potential survivors of a local nuclear event requiring a large-scale medical response. Although created specifically for contingencies resulting from the current hostilities in Ukraine, the concepts and precedents from this manuscript represent a starting point for anywhere on the globe at heightened risk of a catastrophic nuclear detonation.