Nuclear Risks Leave No Time To Wait

By Robin Narruhn, Ph.D.

As a nurse professor, I teach future emergency medicine nurse practitioners to respond to a nuclear mass casualty event. I am Marshallese, and I have seen up close how nuclear testing has hurt my people and our home for 70 years, many who now live in Washington due to forced relocation. The Republic of the Marshall Islands was bombed by the United States from 1946 to 1958.

Sixty-seven nuclear bombs exploded there over 12 years, equal to about 1.6 Hiroshima bombs every day. I did not experience the immediate aftermath, but I have seen the long-term consequences: early deaths, rising cancer rates, reproductive issues, and chronic illness have left deep marks on Marshallese families for generations ( Narruhn; Espina, 2022 ). My ancestors were told these tests were “for the good of mankind” and would end all wars, but that promise was not kept.

Even now, 70 years later, war continues, and Marshallese people still deal with chronic illness, contaminated land, forced relocation, poverty, and early death. Our pain is not only about health; it is also about losing our land, culture, and hope. These stories are not just from the past—they are part of our daily lives.

This is not just history—it is a warning. Nuclear escalation is a threat to everyone. The Doomsday Clock , created by the Bulletin of the Atomic Scientists to show how close humanity is to a human-made global catastrophe, with midnight signifying apocalypse, is now at 85 seconds to midnight. Maintained since 1947 by a board of scientists and security experts, the clock is adjusted annually based on evolving global threats, showing how urgent and widespread these dangers are.

However, witnessing the horrors of nuclear radiation in the Marshall Islands did not fully prepare me for the realities I uncovered while researching emergency treatment of nuclear exposure in mass casualty situations. Before diving into the technical aspects, it’s important to recognize that these decisions are not just clinical—they are deeply human, forcing caregivers to balance hope with harsh reality. As healthcare professionals, we must confront not only the human suffering caused by such disasters but also the grim calculations we must make in their aftermath. In nuclear mass casualty events, the standard triage protocols are even more demanding and complex. Triage begins with rapid assessment: Patients are sorted based on the severity of exposure, the speed of symptom onset, and the likelihood of survival with available resources. The key steps include prioritizing those with the best chance of recovery, identifying those needing urgent intervention, and, heartbreakingly, recognizing those for whom care can only be palliative. One tool, Andrew’s Nomogram, is used to predict survivability after radiation exposure. It tells us, with chilling clarity, who might live and who will almost certainly die. Andrew’s Nomogram estimates how much whole-body radiation a person has been exposed to after a nuclear accident or mass casualty radiation emergency. Health care professionals use the time to onset of vomiting as a primary diagnostic clock. When combined with the Andrews nomogram, this timeline dictates a patient’s expected morbidity (illness severity) and mortality (likelihood of dying).

Andrews Nomogram Time-to-Nausea, Illness, and Survival Correlation

 Over 4 hours: Complete survival expected without intensive care.

 1–2 hours: 10–35% mortality; treatable with clinical support and cell-boosting

medications.

 30–60 minutes: 50–70% mortality; requires specialized isolation and intensive

blood transfusions.

 Under 30 minutes: 80–100% mortality; typically, fatal within 24–72 hours, shifting

focus entirely to palliative care.

In the aftermath of a nuclear disaster, the ethical burden placed on healthcare professionals is immense. Triage protocols force clinicians to make decisions that challenge the very foundations of medical ethics—balancing justice, beneficence, and respect for persons when resources are scarce, and outcomes are grim. The obligation to do no harm collides with the reality that, in these scenarios, care may shift from saving lives to providing comfort in death. These choices are not just clinical calculations; they represent moral crossroads that test our humanity. As we prepare for such possibilities, we must also advocate for policies and systems that prioritize prevention and uphold the dignity of every individual, refusing to let ethical standards become another casualty of nuclear conflict.

The Clock We Must Stop from Ticking

As a clinical educator, I train students to read the clock. In emergency medicine, time and resources are the ultimate arbiter of life. A caveat is that in a mass casualty of nuclear radiation exposure, resources will be limited; treatment would be limited. For example, Bloodwork Northwest reported in June 2026 that the blood supply was only sufficient for 24 to 48 hours (https://bloodworksnw.org/wp-content/uploads/2026/06/news-release-code-red-emergency-june-17-2026-web.pdf).

Life-saving medications, including specific colony-stimulating factors and cytokines, would be in limited supply. In such scenarios, many patients would likely not receive adequate medical care. However, it was Andrew’s Nomogram that added to the horror of the fact that we really do not have a meaningful response to radiation exposure. If a patient begins vomiting within thirty minutes of exposure, their fate is already sealed. No amount of specialized hospital isolation, no volume of blood transfusions, and no clinical expertise can save them. Their care shifts to comfort care. We are forced to watch them die. Andrew’s Nomogram reveals a truth that is too terrible to accept quietly: once a nuclear event occurs, there is a point at which the clock runs out, and medicine is reduced to nothing more than holding a hand in the dark. This is the ultimate horror of nuclear weapons. They do not just injure; they render the concept of medical aid entirely obsolete. This stark realization creates a troubling contradiction when witnessing the sensationalized display of military force at the annual Seafair Blue Angels. Reallocating the substantial funds required to host these performances toward accessible healthcare and public education would better serve community well-being.

What We Must Do Now

We must not wait for the global time-to-nausea to begin.  Prevention is much more acceptable than treatment. The Doomsday Clock now stands at 85 seconds to midnight. We are closer to the brink than we have ever been, driven by rising global tensions and a collective failure of leadership. People in the Marshall Islands have lived under the shadow of this catastrophic timeline for seven decades. Our past must not become the world’s future.

We cannot afford to let the countdown reach zero. We must act now, while we still have the agency to turn back the hands of the clock. Faced with these sobering truths, inaction is not an option. We each have a role to play in preventing this future.”

Here are steps that we can take.

 Educate and Raise Awareness: Share the history of nuclear-affected communities; nuclear tests are not a localized tragedy; they are a stark, living warning of the humanitarian consequences of nuclear weapons.

 Advocate for Nuclear Justice: Support legislative efforts and international policies that provide healthcare, compensation, and environmental remediation for nuclear-affected communities and all global downwinders still suffering from the toxic legacy of nuclear testing.

 Demand Diplomatic De-escalation: Write to your representatives and demand that global leaders prioritize nuclear disarmament, renew critical arms-control treaties, and actively lower the geopolitical temperatures that push the Doomsday Clock forward.

 Refuse Comfort Care for the Planet: Reject the passive assumption that nuclear escalation is inevitable. We must refuse to accept a future where our only remaining option is to manage the terminal symptoms of a global nuclear catastrophe.

Given these truths, we cannot afford inaction. Please stand with us and help build a nuclear-free future—your voice and actions matter now more than ever.

Robin Narruhn, Ph.D., is an associate professor in the College of Nursing at Seattle University. She is a member of the Washington Physicians for Social Responsibility’s nuclear weapons task force and a founding member of the Pacific Islander Health Board of Washington .