MEDICAL SERVICES IN AN ATOMIC DISASTER

we Face the prospect with a variety of attitudes things to worry about most just never do come true I can't imagine anything like that ever happening here besides nobody would ever permit it to use the it oh I'm so sorry of course what's the bidding Monica these are the loveliest cards that go s time is not far off when in case of war the United States could be wiped out by a single atomic bomb unless adequate controls are adopted the destruction of atomic war will be inevitable now what does this mean to us an entirely new way of life an existence underground it means moving our Factor our production there isn't going to be any War not the way we imagin it oh I don't know I've been listening to that guy for some time now you remember what he said about wait a minute you don't get my point I mean if there is a war L be over in a day or two inside a few hours we'll all be dead I wonder that's a pretty strong statement I always thought that an I know I have it on good authority very good authority I assure you I have some pretty important context down in Washington still others face the atomic future with a constructive hope that peaceful ideals will ultimately Prevail and that the Nations will submit to International control of atomic energy by but until these peaceful ideals are realized national security must depend upon immediate protective measures the responsibility of preparing for Atomic disaster rests in large part on the medical profession both individually and collectively more than that it's our business and there's a very good reason for this we as doctors are particularly qualified by training and experience to deal with disaster two world wars have taught us much um the handling of shock uh blood banks antibiotics are all recent developments that have been stimulated uh in part by War Expert Medical Care of the injured in recent civilian emergencies reflects our what time experience but now with the atomic bomb we must once more revise our estimates raise our sights prepare to face disaster on an atomic scale yet there there's nothing in our experience to prepare us for a catastrophe of the SI and scope that may face Us in the coming years we have a population of about a quarter of a million let's look at the problem in terms of our own locality if we superimpose the uh known pattern of atomic destruction on this city uh we get a very graphic idea of the scope of the damage and resulting casualty effect it's not a pretty picture nor one we can afford to ignore um at least 60% of the residential sections would be heavily damaged with the relatively moderate damage to the outer suburbs uh within radius of about um half a mile of the detonation practically everything is destroyed uh city government Transportation Communications Power and Light the atomic bomb is primarily a weapon against cities and and particularly against cities of a quarter million inhabitants or more in the United States there are about 40 such cities many because of their size and strategic importance might justify the expenditure of more than one bomb few of these cities are beyond the range of possible air attack against Air Attack a strong and alert defense will intercept great numbers of the invading aircraft but some may penetrate the defense one plane one bomb one city I suppose the members of this group include every specialty in medicine from Pediatrics to gerer but in atomic bombing specialization becomes for the moment uh secondary we'll all be treating a syndrome of burns trauma and radiation radiation because of its novelty has excited a great deal of Interest however it is Burns and Trauma which will constitute by far the greatest medical problem the number of casualties can be uh estimated with a fair degree of accuracy certainly they will number in the scores of thousands now active military defense is of course not our problem it is our responsibility to prepare the necessary Medical Services in case of disaster it's largely a matter of supply and personnel a single patient sustaining serious Burns or trauma consumes a substantial amount of medical services and supplies he may require surgical dressings drugs plasma antibiotics splints whole blood his treatment involves the services of doctors nurses technicians and auxiliary Personnel not to mention a variety of medical equipment and Facilities a thousand casualties occurring simultaneously would sorely tax the medical facilities of a large city an atomic bombing could easily cause a 100,000 casualties at the same time greatly reducing the effectiveness of the local medical organization the problem is greatly magnified by an environment of widespread destruction the stricken City paralyzed by disaster is dependent for assistance upon surrounding communities Mutual defense and assistance are essential each Community although prepared to exert a measure of self-help must look to its neighbors for Effective Aid since the need is immediate help must come from nearby it follows that all community within the stricken area must be mutually supporting and that the overall area must be self-supporting and independent of outside assistance whole blood and Plasma in immense quantities are essential to the treatment of burns trauma and radiation sickness for this reason entire populations must be blood typed and tagged in advance instantly available in case of emergency technicians must be trained in venie puncture transfusion techniques and blood crossmatching Universal donors particularly must be tested and tagged as at present whole blood cannot be stored for long periods reserves of plasma must be increased 100 or a thousandfold since no one locality can meet the blood requirements of atomic bombing there must be a mobilization of whole blood on a wide Regional basis in anatom iomic bombing adequate supplies of fresh blood will represent the difference between thousands of living and thousands of dead many Layman must be instructed in advance in simple blood count techniques as a method of estimating the degree of radiation injury classes must be established in first aid and the Practical handling of casualties now is the time when conditions are ideal to train first aid workers so thoroughly that each of them will be able to meet any emergency with the calm resourcefulness of veterans everybody ready all out as a part of the same training program local inhabitants must be instructed in Convoy driving not only for the evacuation of casualties but also for transportation of Essential Medical Supplies all right where's the devil having trouble and you know what she did she turned right around and redoubled oh I was Furious you know I was so mad I could have knocked her over with a proverbial sender it's oh oh I keep forgetting you're supposed to have something horribly wrong with you well here we go kids preventive medicine must not be neglected with many Burns and mechanical injuries expected plus disorganization of hygiene and sanitation normal immunization measures must be extended to cover tetanus typhoid and paratyphoid inoculation of children and adults as in any Community Endeavor publicity must play its full part medical relief measures must be based upon a vigorous campaign of public education educational exhibits dramatizing the problems associated with atomic energy have two important functions for one they enlist cooperation and participation in the work of planning and training even more important they have the psychological effect of molding a sane objective and panic free attitude toward Atomic realities this is Centerville USA a typical American city this is Centerville not next next month not next year but some imaginary day in the atomic future on this imaginary day an enemy longrange bomber fights its way through our air defenses and approaches the city an air defense radar station picks up the plan's image on the radar screen a warning as radio to the control point of the areaa immediately the alarm goes out through a Communications Network the surrounding communities are alerted condition read attack expected now the weeks and months of rehearsal are ended now the Lessons Learned in exercises and mock drills are carried out in dead Earnest there is an orderly movement of all inhabitants to prepared and provisioned shelters business and Industrial activities cease in the expected Target area against Atomic bombing appropriate shelters and adequate distance from the target are the best protection in the bombed area the uninjured helped the injured at the instant of disaster self-help and survival are synonymous without delay all surrounding communities send their support toward the scene of the devastation at well stocked depos strategically placed in the suburbs of the bomb City squads of first aid workers load their improvised ambulances with all the essentials of relief clothing water medicine bandages splints stretchers Aid and sucker for the wounded the rescue squads follow thorough fairs which have been carefully chosen to give the best access to the city the lifeline of supply and evacuation is established when the debris of Fallen buildings blocks the way bulldozers smash through the obstacles ah head lies an area of utter destruction with thousands of men women and children in critical need of assistance when Vehicles can progress no further rescue teams proceed on foot now the rescue squads for the first time face the terrible human wreckage of atomic bombing yet from the initial excitement and confusion a pattern of order and efficiency will soon emerge as training and discipline exert their steadying influence reports are radioed back to the central control point to forecast the flow of casualties radio is the only reliable means of communication the evacuation of the injured proceeds according to plan at casualty collecting stations in the suburbs of the target City well-trained personnel are ready to administer emergency care to successive waves of wounded stretcher cases and fatory cases Burns fracture loss of blood the entire gamut of atomic injury the work of medical relief progresses directed from the main control Point purposely located in a protected site far outside the city as in any battle all information is recorded and evaluated on a master map of the area around the map the strategy and tactics of relief are planned and activities in the field directed and synchronized throughout the disaster evacuation of casualties continues to casualty collecting stations outside the bombed area from their places of safekeeping medical supplies pour into the devastated City at the casualty collecting stations patients are separated into three groups according to the severity of their injuries in the first group are those with minor injuries have his dressings examined and as soon as he feels able put him to work we need every bit of help that we can get minimum treatment and immediate discharge clears the way for more urgent cases the second group includes those who are seriously injured and yet can be evacuated for intensive treatment evacuate him immediately to the radiation Center and have him kept under constant observation the third group is made up of those who are critically injured and who cannot be evacuated for these survival if possible at all depends upon emergency life- saving Care on the spot here you better hold him here for observation it may be a lethal dosage still you you can't always the degree of radiation exposure is determined by the individual's position relative to the bomb Center and by the protection afforded by solid material after the casualties are examined those who are seriously wounded and who can be moved are evacuated to special treatment centers nearby where specialized Medical Care can be administered at the treatment centers all available doctors nurses and medical personnel are at work handling the immediate immediate needs of the injured operating on surgical casualties dressing Burns and fractures administering plasma and whole blood refugees and those discharged from treatment centers are directed to temporary shelters in surrounding communities at the same time public public health is energetically protected when infectious diseases break out Public Health authorities establish rigid quarantines to reduce the spread of the disease as a further Public Health measure water food and sewage are kept under strictest control throughout the crisis all activities are synchronized from the central control Point only through centralized control careful planning and extensive preparation can Personnel supplies and transportation be utilized efficiently in the interests of a stricken population well what do you think of our show we're kind of proud of it very interesting you uh people must have put a great deal of work in I can't understand where you find the time my days are all so busy here you read this I think you'll find you have the time once you make up your mind in fact I think it's pretty interesting oh well all right we'll read it yeah we'll uh give it the old over where do you uh learn all about this uh First Aid business why um we have special courses every Monday and Wednesday afternoon at the high school how about evenings all day I'm at the barber shop I don't make mistakes oh yeah remember what you told me about a war not lasting more than 24 hours well Mr you're wrong I ought to know I've got important contacts too we mustn't exaggerate the problem certainly we must not minimize the atomic bomb however terrible is not an absolute weapon its Effectiveness can be materially reduced when employed against a population well prepared physically psychologically and medically we as doctors have a great responsibility in carrying out these measures of preparedness our thought and planning will be reflected not only in the present welfare of the community but in its capacity for survival but one thing we must remember all our efforts will be valueless unless based upon the wholehearted cooperation of the community authorities and and the general public thank you in the event of atomic war the fate of any City will depend in large part upon the skill and knowledge of the entire medical profession assisted by medical technicians in great numbers directing their combined efforts towards full preparedness the life of the community will also depend upon the energetic and farsighted planning of community officials but no single group or profession alone can cope effectively with problems of such size and complexity since atomic war is in a very special sense Total War it must evoke a total effort most important in this effort will be the full participation of the entire local population in a broad program of mutual protection