Priority Under The Bomb

How can the Army best care for troops wounded in a nuclear attack? In the ivy-covered Army Institute of Research at Washington's Walter Reed Medical Center, the grim subject came up for review last week at a conference on the "Management of Mass Casualties." Present: Army medical officers, representatives of federal and private health agencies. The conference consensus: nuclear warfare calls for a new definition of the old concept of battlefield treatment.

The Army's new approach, as described by Lieut. Colonel Joseph D. Goldstein, sets up a priority system that automatically gives preference to the wounded who can be returned to duty rather than to those who are closest to death. If the concept is coldblooded, it is also necessary, in the military's opinion. It is based on the assumption that there will never be enough medical personnel on the nuclear battlefronts to cope with the wounded and that even in rear areas doctors and drugs will be in desperately short supply. Accordingly, all wounded, aside from those requiring only medical-aid-station treatment, will be sorted (by doctors if possible, otherwise by noncoms) into three categories:

Immediate Treatment. For people whose injuries have made them unfit for duty but whose lives can be saved and who can be returned to duty by prompt treatment. Included will be victims of hemorrhage from an easily accessible site, quickly correctable respiratory defects, crushed limbs in which amputation is lifesaving, open fractures of major bones.

Delayed Treatment. For seriously injured individuals (noncritical injuries of the central nervous system, second-or third-degree burns of 25% to 40% of the body surface, closed fractures of major bones) whose recovery will not be set back by a delay in treatment--after initial emergency care.

Expectant Treatment. For those expected to die. In this category are men so badly injured (extensive injuries of the respiratory tract or central nervous system, penetrating wounds of the abdomen, multiple severe injuries, extensive burns) that only complicated and prolonged treatment might save them.

In practice, says the Army, the priority system will operate all the way from battlefront aid stations to rear-area hospitals, with immediate-treatment cases going first and delayed-treatment following as facilities are available. The expectant cases will not, in most instances, be moved from where they lie, will get sedatives or opiates.

Without being formally defined, such a priority system has been used on battlefields before. The Research Institute's Colonel Joseph R. Shaeffer points out that the Japanese learned at Hiroshima and Nagasaki that the "only real good they could do" was in treating minor injuries. The system has also been applied in disasters by many a civilian doctor caught with more emergency cases than he could handle. "We don't talk of 'abandoning men,' " says Colonel Shaeffer. "But doctors should not be involved in three-hour operations; they should be out saving lives."

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