Medical defense against radiological warfare is one of the least emphasized segments of modern medical education. Forty years of nuclear-doomsday predictions made any realistic preparation for radiation casualty management an untenable political consideration. The end of the Cold War has dramatically reduced the likelihood of strategic nuclear weapons use and thermonuclear war.

Unfortunately, the proliferation of nuclear material and technology has made the acquisition and adversarial use of ionizing radiation weapons more probable than ever. In the modern era, military personnel and their nation’s population will expect that a full range of medical modalities will be employed to decrease the morbidity and mortality from the use of these weapons. Fortunately, treatment of radiation casualties is both effective and practical.

Prior to 1945, ionizing radiation was deemed nearly innocuous and often believed to be beneficial. Individual exposures to low-level radiation commonly occurred from cosmetics, luminous paints, medical-dental x-ray machines, and shoe-fitting apparatus in retail stores. The physical destruction caused by the nuclear explosions above Hiroshima and Nagasaki and the Civil Defense programs of the 1960’s changed that perception.