Objective In this study, based on a hypothetical dirty bomb attack scenario in a certain country, the demand challenges and response strategies for on-site medical rescue in large-scale nuclear and radiological emergencies are explored, and suggestions and reflections for improving China′s nuclear emergency response capabilities are provided.

Methods The time required for whole-body surface radioactive contamination screening was calculated on the basis of the standard body dimensions of Chinese minors and adults. Combined with the health hazard consequences caused by a hypothetical dirty bomb attack in a certain country, the demand for on-site medical rescue forces and supplies in large-scale nuclear and radiological emergencies was systematically evaluated.

Results (1) The time required for whole-body surface radioactive contamination screening of representative populations in China is accurately calculated, which is 231 s for adult males, 203 s for adult females, and 189 s for minors. In screening 20,000 people with radioactive contamination on the body surface, at least 150 detection personnel are needed to continuously detect for 8 h. (2) In regions with national or provincial nuclear emergency teams, the existing local rescue forces cannot cope with large-scale nuclear and radiation emergencies. To improve the rescue efficiency and avoid social chaos, potential professionals such as those from nuclear medicine departments and Centers for Disease Control and Prevention must be integrated. (3) Provincial nuclear emergency management agencies must establish a reserve of health emergency supplies for nuclear and radiation emergencies and update it dynamically. For key equipment that cannot be self-guaranteed (such as α/β surface radioactive contamination monitors) and medical chests (such as decontamination chests and emergency chests for nuclear accidents), strategic reserves within enterprises must be established.

Conclusion On-site medical rescue in large-scale nuclear and radiological emergencies remains a critical challenge for nuclear emergency response. By integrating potential rescue forces such as those from nuclear medicine departments and Centers for Disease Control and Prevention, establishing a dual-use mechanism integrating peacetime and wartime needs for material guarantees, maintaining dynamic reserves of key supplies, and dynamically reserving key materials, the on-site medical rescue capabilities of China for large-scale nuclear and radiation emergencies such as dirty bomb attacks can be effectively improved. Consequently, public safety and social stability can be ensured.