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Analyzing casualties of the earthquake and three successive tsunami waves that struck northeastern Japan on March 11th, March 12th, and March 13th in a time interval of 12h showed [ 37 ] early (< 28 hours) and late (after a two-week interval) mortality groups. Early deaths were due to cardiac arrest and paralysis, whereas late deaths (days to weeks) were due to respiratory and brain injuries. Patients with long-term impairment after the tsunami are rehospitalized for chronic diseases like heart failure, kidney dysfunction, and lung disease. Further, despite substantial shortening of life expectancy (10 to 15 years), survivors have a less than 50% reduced chance of death from all cardiovascular and respiratory diseases compared to the general population [ 37 ]. Within the first 28 days after the explosion a significant reduction of death rates due to cancer, dementia, and cerebrovascular disease (46%) was reported, whereas deaths from infectious diseases and external causes (traffic accidents and suicide) increased [ 37 ].

Mortality after the Hiroshima and Nagasaki atomic bombings was previously reported to be strongly influenced by time passed since the bomb blast as “acute radiation syndrome” develops in proportion to the dose absorbed within a very short time (<1h, 90% death after 0.1Gy, 50% within 7 days) [ 42, 43 ]. Recently, acute radiation syndrome in victims exposed to mixed radiation fields has been described by Hall et al. for the Hiroshima atomic bomb explosions and Nagasaki atomic bombing [ 44 ]. The risk of death or adverse health outcome increases with the severity of the disease and increases with the time elapsed since the exposure. Most of the fatalities occurred within a relatively short interval of three months. The time at which most deaths from acute radiation disease are expected to occur decreases with increasing dose [ 44 ].

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