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Throughout the world, experience is growing in the development of plans for military-civilian collaboration in disaster preparedness. This involves the complex problems associated with the coordination of various components of military and civilian Emergency Medical Services (EMS) systems and organizational differences between countries.
EMS are dependent on relationships between hospitals, police-fire-ambulance services, and municipal, county and state governments. In an emergency, their integration is accomplished in: (1) detection and assessment; (2) call for ambulance and hospital; (3) organization; and (4) emergency medical treatments.
The “Club of Mainz” for Improved Emergency and Disaster Medicine Worldwide was conceived in 1973 and founded in 1976 by about 10 reanimatologists under the leadership of the late Rudolf Frey (Crit Care Med 6:389, 1978). Its objectives are: “(1) to foster optimal resuscitation and life support methodologies worldwide; (2) to concern itself with a range from everyday emergencies to mass disasters, with appropriate consideration for differences in populations, available resources and other factors; and (3) to informally pursue the objectives by combining the resources of scientific, social and related information and experiences, together with international communication and collaboration.”
The Department of Defense (DOD) must be prepared to deal with the most likely contingency situations. In developing plans, certain medical factors must be considered. One of these is mobilization time. In prior conflicts, we had sufficient time to expand the military medical system to meet the needs of military operations. We did this by organizing medical units, building hospitals, and training personnel. But, given the high state of readiness and mobility of current combat forces, a future conventional conflict could begin with very little warning. If the USA were to be involved in this kind of a situation, our military forces would have to be supported with our present medical capabilities.
In the county of Stockholm with 2 million inhabitants and an area of 6,500 km2 , a trial project with a helicopter ambulance, staffed by physicians, was carried out during the summer seasons of 1978 to 1980. A total of 507 missions were accomplished.
The Trial Project. During the summer a large number of tourists visit the Stockholm archipelago. For these people there is a problem in the event of acute illness or accident to get qualified medical care without delay. A Bell 206 Long Ranger was based at Barkarby airport just outside the city of Stockholm. This was manned by doctors, ambulance personnel and a pilot, and was supplied with an emergency kit, intubation equipment, a portable ECG apparatus and a defibrillator.
Everyday humanity witnesses an opportunity to take a new step forward. Every morning millions of people enter a new day hoping for happiness and joys of life, and believing in a cloudless future. In everyday life with its troubles and problems, most people forget that their future wellbeing and happiness are endangered by thousands of missiles and nuclear warheads aimed at mankind itself. According to United Nations Reports, there are 50,000 nuclear warheads on Earth today. Their explosive energy is equal to over one million bombs of the kind dropped on Hiroshima in 1945. Unfortunately, some politicians and some members of the lay public do not know (or rather do not want to know) the simple truth that mankind has produced and keeps in store a power that can annihilate its creators. Let me recall Jolio Curie's words: “People should not allow the forces they have managed to discover and learned how to handle now be the cause of their destruction.”
Trends in recent warfare show a movement in the proportion of wounded soldiers to wounded civilians from 20:1 in World War I to a conjectured 1:100 in the case of atomic, biological or chemical warfare. Modern methods of waging war mean that for every fighting man, a group is engaged in logistics, and that for every dead soldier, an increasing number are wounded. Furthermore, the number of severely wounded cases is proportionately increasing.
Air transportation missions of seriously ill or injured patients are subdivided into rescue missions and medical evacuation missions. In 1981, for rescue missions, 29 stationed rescue helicopters were available with an operation radius of 50 km. Their task consisted of securing the primary care for vital risk patients as soon as possible. Medical evacuation missions were realized by helicopter, ambulance aircraft, and airliner. Before take-off a medical briefing was held to diminish the transport-trauma. Patients with cardiopulmonary insufficiency are at risk as simultaneous appearance of acceleration, climbing rate, falling cabin pressure and emotional stress may produce serious complications. Additional education of the medical crew is required.
The efficiency of EMS, especially resuscitation of the severely wounded, depends upon speed and skills. This requires well-organized military-civilian collaboration, as shown during recent earthquakes in Ashkhabad and Tashkent. Reasons include the great mobility of military medical units, including field hospitals; communication facilities; specialized means of transportation; readiness of equipment and supplies; as well as skillled military medical personnel.
Besides defense, a military organization can protect a country in two ways: (1) Ensure the integrity of a country despite internal disasters and disturbances; military aid can have a humanitarian role. (2) International responsibilities.
The Canadian Forces participate in peacekeeping and disaster relief all over the globe. This international military job results in increased prestige for Canada and security for Canadians.
The above contributions by Professors Chazov and Lown, the comments by Dr. Rebentisch, and the Resolutions by the WAEDM, the Red Cross and the WHO indicate that disaster medicine planning for a response to and civil defense protection in case of nuclear war is senseless, wasteful of resources (which are needed for current vital social programs worldwide), and also dangerous, by giving national leaders the impression that some individuals' medical protection in a nuclear war is possible. Most people, including some national leaders and military experts, believe that limited use of nuclear weapons would escalate to a global nuclear holocaust, and that any medical planning for nuclear war might encourage the irrational belief that nuclear was is winnable. Even if it were “winnable” the resulting death and torture of millions of innocent people and the damage of our planet's ecologic balance, make any consideration of the military use of nuclear explosions morally and medically unacceptable.
A disaster may be defined, for this paper, as “a situation in which an urgent need arises for international assistance to relieve humansuffering.” Disasters are frequently divided into manmade and natural disasters. Many so-called natural disasters have, however, a considerable manmade component in their etiology. The number of people vulnerable to the effects of disasters is increasing, and in the future disasters affecting human beings are likely to occur with greater frequency and severity, Full account must also be taken of the effects of a rapidly expanding world population, of advances in science and technology, and of economic and ecological factors.
On June 2, 1862, William A. Hammond, Surgeon General of the United States Army, announced the intention of his office to collect material for the publication of a “Medical and Surgical History of the War of the Rebellion (1861–1865)” (1), usually called the Civil War of the United States of America, or the War Between the Union (the North; the Federal Government) and the Confederacy of the Southern States. Forms for the monthly “Returns of Sick and Wounded” were reviewed, corrected and useful data compiled from these “Returns” and from statistics of the offices of the Adjutant General (payroll) and Quartermaster General (burial of decreased soldiers).
The German Association for Disaster Medicine published the following declaration for physicians, citizens and governments (J. German Physicians, June 24, 1983, pg. 39): “Disaster medicine defines as the limit of its applicability situations in which violence and the dimension of destruction will make every systematic and organized aid impossible; this would be the case in a nuclear war.” This explanation would show the right way to act for those who reject disaster medicine, as they consider it an alleged preparation for nuclear war — i.e., some members of the peace movement. This declaration also addresses authorities, so that they will not cherish false expectations. Some of these allegations culminate in the statement that the physicians supporting disaster medicine would suggest to the political and military leaders that nuclear warfare could be risked. This is obvious nonsense.
There are high mountains around Oslo, which is located at the foot of the Oslo Fjord. The winter is rough, with snowstorms and secondary roads often closed, and people often ski long distances. Avalanches have buried many people. We started a physician-staffed ambulance helicopter service on June 1, 1978 out of the Central Hospital of Akershus, Oslo, primarily to get a physician to the scene as soon as possible. The helicopter is on alert 24 h a day and can take off in 2 min in the daytime and 15 min at night. In 86% of the cases, the helicopter can land within 50 m of the patient. At night, the landing places have to be more secure. The helicopter is a Bolkow BO 105, which can carry 2 patients, 1 pilot, 1 rescuer or paramedic, and 1 physician. In case of an accident on a lake, the paramedic is a frogman and in case of an avalanche we take a specially trained dog along. The pilot has vase experience with helicopter duty, and the paramedic has good medical and rescue experience. The physician has to be a specialist in emergency medicine and is usually an anesthesiologist. The team is always on duty at the hospital where the helicopter is stationed, only 100 m from the emergency entrance of the hospital.
The only organization presently capable of responding immediately to a mass casualty situation in peacetime in Israel would be the Israeli Defense Forces. They have available the necessary means, organization, trained manpower and equipment. If a state of emergency would be proclaimed in the state of Israel in case of a major earthquake or similar disaster, in any part of the country, the chief military commander would be in charge. His army would take command over that area. All the other civilian institutions concerned with the care of casualties, including fire fighting forces, police and hospitals, would come under his command. With the military in charge, the response would be much shorter. The chief military commander would proclaim a state of emergency if he feels that it is warranted.
This is an age of unprecedented uncertainty. Life is now perilously posed at the precipice of history. Never before has man possessed the destructive resources to make this planet uninhabitable. Having unlocked the Pandora's box of the atom, a new dimension has been provided to our potential for self-annihilation.
An objective assessment indicates no vital national interest that would justify nuclear war. Nonetheless, the nuclear arms race is ever accelerating.