Both Whitley and I have been especially eager to include as much information about the triage as we can, since it affects American life so profoundly.
I don’t have any really good sources at the CDC headquarters in Dallas, so I was very glad for our stopover in Austin. It gave me a chance to visit a friend who works for the CDC here, and who was willing to give me the kind of documents that would be useful.
I wanted information that few people had seen before.
I hit a vein of gold, as it turned out. My friend gave me the three documents reproduced here. For this I thank him and I guarantee his anonymity. It is ironic that more lives have been affected by these three short memoranda than by any number of critically important medical discoveries.
Because of these memos, millions of people have been denied even rudimentary medical care. But the triage has also guaranteed that those who can be helped are given what they need.
During the flu, twenty percent of the population needed emergency help. This occurred against a background of chaotic supply problems, high doctor mortality in affected areas, and a tremendous demand for drugs at a time when the industry was having trouble even maintaining normal production levels.
Perhaps one in ten of the flu victims saw a doctor, one in a hundred entered a hospital.
There is no way to tell if triage saves lives. Not only the triage, but so many other things that we now take for granted—home care for the dying, euthanasia, black market and alternate medicine, the British Relief—came about because the demand for care simply overwhelmed the nation’s medical system.
The existence of the triage means different things to different people. For me it means the constant, niggling fear that my lifedose will creep up and I’ll find myself suddenly denied medicine for some small ailment that will therefore become large and finally kill. For Whitley, the triage means a shortened life. He cannot legally enter a hospital or consult a licensed physician.
Like so many triaged people, he has learned a great deal of medicine. Doctors who can’t treat a triaged person can and do organize seminars for ten or twenty such individuals at a time. And then there are the underground medicals—the witches and the doctors who practice illegally.
And there is always the balance of hope.
These three short memoranda seem innocent enough. But they are not innocent. They are the foundations of postwar American medicine.
ATCEN/DC/35A.1038
[CONFIRMATION BY COURIER]
FOR IMMEDIATE DISTRIBUTION TO STATE/MUNICIPAL GOVERNMENTS
30 OCTOBER 1988
Recent Soviet bombing of U.S. cities of San Antonio, Washington, D.C., New York area, and Upper Central and Western states creates unprecedented numbers of dead and whole-body radiation-induced injuries.
Immediate burial and/or destruction of dead is imperative in order to contain spread of disease. Wherever possible, mass burial with suitable chemical agents is recommended. Civilian populations should be warned of disease potential.
Triage procedures must be implemented to assist individuals with radiation-related injuries. First-degree thermal radiation burns, i.e., “flash burns,” are likely to occur to exposed individuals within 30 miles of detonation point given estimated Soviet weapon yield of 9–10 Megatons. Second- and third-degree burns are likely in unprotected individuals in 15–25-mile range. Appropriate medical treatments should be as prescribed for injuries of this type.
Nuclear radiation injuries caused by gamma rays and neutrons are most serious, and high dosage can be life-terminating.
Populations in two-mile radii from detonation points might have received 1,000+ rems. Critical level is 400– 500 rems where radiation symptoms are strongly evident and casualty rate is 50 percent or higher. Exposures below 200 are not believed life-threatening and little treatment is recommended. Death rate at 1000+ is almost 100 percent.
You are requested to provide every assistance possible to medical authorities to facilitate treatment of victims. Further triage instructions will follow.
TO:
ALL MUNICIPAL GOVERNMENTS, SOUTHWEST AREA
FROM:
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/CENTERS FOR DISEASE CONTROL/EMERGENCY TASK FORCE ON RADIATION INJURIES
DATE:
VOICE TRANSMISSION 15 JANUARY 1989
COURIER DELIVERY 16 JANUARY 1989
SUBJECT: EMERGENCY MEMORANDUM ON ACUTE WHOLE-BODY RADIATION INJURIES
You are being provided herein with guidelines for the identification of suspected radiation dosages based on readily observable physical symptoms. These guidelines are intended for municipal and/or county representatives enlisted to screen civilian populations for subsequent medical treatment or attention. The severe drain on surviving medical facilities requires operating knowledge by all government personnel in order to direct individuals or groups to appropriate medical services.
Most urban centers sufficiently distant from radioactive or zoned areas have created several “screening areas” to process incoming refugees and native citizens: Level One areas are for those with no apparent radiation symptoms; Level Two areas are for those with limited hematopoietic or gastrointestinal symptoms; Level Three areas are for highly traumatized and ataxic victims. Some version of this system is urgently recommended to all municipalities. Refugee movement rates are still inordinately high and unpredictable; virtually all communities in this region have reported high levels of influxing populations.
Similarly, these populations are demonstrating varying levels of whole-body radiation injuries. You have been notified previously of emergency steps necessary to screen physical objects and food supplies for potential radioactivity.
Because trained medical staff are limited and generally unavailable outside of central medical facilities, it is imperative that municipal staff, including police, fire department, civil servants, and temporaries, be aware of radiation-related illnesses. Because of many factors, but particularly because of proximity to bombed area and total radiation exposure, individuals may or may not be viable candidates for medical treatment.
Large emergency treatment centers have been set up in key cities such as Lubbock, El Paso, Beaumont, Baton Rouge, Little Rock, Oklahoma City, New Orleans, and Albuquerque to treat individuals with medium to high levels of radiation dosages. Guidelines for treatment are under preparation and will be distributed to you as soon as available and approved by the Emergency War Recovery Administration.
Guidelines to be employed by municipal authorities in screening war victims are as follows:
No apparent symptoms in this range. Internal blood changes will occur but are not apparent with superficial inspection. Care should be taken, however, to query all victims in order to determine point of origin, proximity to hit areas, and exposure to contaminated foodstuffs and objects from contaminated areas.
Short-term effects include fatigue and general malaise.
