Smaller Nuclear Detonations as the New Emergency Preparedness Challenge in Disaster Medicine and Public Health

Recent international developments have brought a broader awareness of the vulnerability to global peace of the increasing likelihood of nuclear events. The increased nuclear threats from Russia in relation to the current Ukraine war have justifiably raised concerns for nuclear war potential with the U.S. and NATO, and the terrifying large-scale outcomes for populations worldwide. Recent surveys have indicated that 75-80% of people surveyed worldwide, and consistently across nations, believe that nuclear war is more likely now than in the recent past.1 Indeed, the fear of nuclear conflict on such a global scale has resulted in a lack of recognition of what is generally recognized as the far greater likelihood of relatively smaller nuclear detonations, at least in the near term.2 Since nuclear detonations have been considered as high impact but low likelihood events in emergency preparedness, there has subsequently been little emphasis on preparing for them, whether large- or small-scale nuclear events. In summary, we therefore find ourselves in the current environment where there is greatly increased awareness of a nuclear threat, though the fear predominates for the less probable large-scale rather than the far more likely small-scale nuclear events, and there is frankly little preparedness for any nuclear event.