The modern military battlefields are characterized by the use of nonconventional weapons such as encountered in the conflicts of the Gulf War I and Gulf War II. Recent warfare in Iraq, Afghanistan, and the Balkans has introduced radioactive weapons to the modern war zone scenarios. This presents the military medicine with a new area of radioactive warfare with the potential large scale contamination of military and civilian targets with the variety of radioactive isotopes further enhanced by the clandestine use of radioactive materials in the terrorist radioactive warfare. Radioactive dispersal devices (RDDs), including the "dirty bomb," involve the use of organotropic radioisotopes such as iodine 131, cesium 137, strontium 90, and transuranic elements. Some of the current studies of RDDs involve large-scale medical effects, social and economic disruption of the society, logistics of casualty management, cleanup, and transportation preparedness, still insufficiently addressed by the environmental and mass casualty medicine. The consequences of a dirty bomb, particularly in the terrorist use in urban areas, are a subject of international studies of multiple agencies involved in the management of disaster medicine. The long-term somatic and genetic impact of some from among over 400 radioisotopes released in the nuclear fission include somatic and transgenerational genetic effects with the potential challenges of the genomic stability of the biosphere. The global contamination is additionally heightened by the presence of transuranic elements in the modern warzone, including depleted uranium recently found to contain plutonium 239, possibly the most dangerous substance known to man with one pound of plutonium capable of causing 8 billion cancers. The planning for the consequences of radioactive dirty bomb are being currently studied in reference to the alkaline earths, osteotropic, and stem cell hazards of internally deposited radioactive isotopes, in particular uranium and transuranic elements. The spread of radioactive materials in the area of the impact would expose both military and civilian personnel to the blast and dust with both inhalational, somatic, and gastrointestinal exposure, in the aftermath of the deployment of RDDs. The quantities of radioactive materials have proliferated from the original quantity of plutonium first isolated in 1941 from 0.5 mg to the current tens of thousands of kilograms in the strategic nuclear arsenal with the obvious potential consequences to the biosphere and mankind. In an event of RDD employment, the immediate goal of disaster and mass casualty medicine would be a synchronized effort to contain the scope of the event, followed by cleanup and treatment procedures. A pragmatic approach to this problem is not always possible because of unpredictability of the terrorist-use scenarios.
Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.