The “atomic age” is considered to have begun in 1945 with the use of the two nuclear weapons on Hiroshima and Nagasaki in Japan at the close of World War II. Since that time, many nuclear weapons have been tested, but never again used intentionally on human populations. However, there have been several nuclear reactor accidents, which have heightened concerns about radiation exposure, the frighteningly real and also wildly inaccurate perceptions of potential radiation effects, and the appropriate medical response to radiation. The expanding global proliferation of nuclear power and nuclear weapons is of concern to many, including the thought leaders of disaster medicine and public health.

The reason for the increased interest in training and protocols for response to radiation exposure and the other mass casualty effects of nuclear detonations is captured in four photographs on the cover. This peaceful picture of the Three Mile Island Reactor in Pennsylvania, U.S., was the scene of a 1979 accident that resulted in a dramatic slowdown of the nuclear power industry in the United States, though no one was hurt and there was little actual environmental damage. The fire and subsequent release of large amounts of radioactivity into the atmosphere from the No. 4 reactor in the Chernobyl nuclear power complex in the Soviet Union in 1986 left the heavily damaged reactor in the second photograph. Dozens of immediate deaths, thousands of thyroid cancers, severe mental health impacts, and widespread environmental contamination resulted. In the third picture, radioactive smoke can be seen rising from the Fukushima reactor complex in Japan in 2011, when a 9.0 Richter scale earthquake occurred nearby and a 30 foot tsunami wave engulfed the complex, resulting in radiation released from four reactor buildings. This unique earthquake/tsunami/nuclear triple disaster has not identified any radiation related deaths, yet widespread evacuations ensued, and intense monitoring of the population for cancer and other health effects is ongoing, as well as environmental impact evaluation. Finally, the threat of nuclear war from the thousands of nuclear weapons globally is depicted by the April, 1953 BADGER nuclear weapon test at the Nevada Test Site (picked because it happened close to the author's birthday and he grew up with it). Nuclear weapons are spreading to more and more nation states, including unstable ones declaring their intent to use them.