The most damage by far would be from fires after the initial blast.
You can count on almost no efforts being made to fight the fires, firstly because there wouldn't be anyone in physical shape to do so close in, secondly rubble would close roads, thirdly, fires in multistory buildings are DAMN HARD to fight (look at the world trade centre for a prime example), and fourthly, who'd be stupid enough to move towards a rapidly expanding mushroom cloud from the relatively lightly damaged surrounding areas?
9/11 generated a hell of a lot of heroism, but that was really just one small area and it didn't glow in the dark. I can't see more than a handful of EXTREMELY dedicated or just plain foolhardy emergency workers doing anything beyond getting the hell out of the area as best they could.
Something else that might have had a major impact is the pretty much standard tactic of dispersing emergency vehicles at the first threat of nuclear attack. If that occurred, any response would only really entail picking at the fringes of the devastation with the aim to restrict the spread of fires rather than attack them directly.
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