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Commentary from Westminster

Civil Defence: the NHS after a Nuclear Attack

THE risk of war in Europe is now judged to be very low, theGovernment states. But there can be "no absolute and

permanent guarantee" that the UK will not be involved,directly or indirectly, in war, possibly nuclear. That is theassessment underlying the issue of a new set of guidelines onpreparations for civil defence from several Government

departments, including the DHSS. The issue of the

guidelines seems to herald a new seriousness in officialattitudes to preparedness for nuclear war. There is as yet nosign of Government willingness to spend money on nuclearblast or fallout shelters for the civilian population. (Apartfrom a huge elaborate shelter for selected politicians and topcivil servants only 400 yards from Parliament, into whichpolitical journalists will not be invited when the apocalypsearrives.)Nevertheless the Government clearly hopes to improve the

probable rates of survival in a nuclear attack by taking varioussteps in planning and management beforehand. They includeadvising the public on how to make their homes slightlymore protective (which only the most optimistic seem to findreassuring); suggesting to farmers how their livestock’schances of unpolluted survival might be increased; andplanning for the maximum possible survival of healthservices during and after nuclear destruction. All healthauthorities, family practitioner committees, and the bloodtransfusion services have been sent a draft document on this

subject for consultation.In their present form the plans require that doctors, nurses,

and other health-service personnel should be designated forspecific roles in the management of health services before,during, and after nuclear war. These people would help toplan and operate the response to the unthinkable, since thepresent NHS, according to a piquant phrase in the DHSScircular, "would need adaptation". Contingency planning isa fundamental part of general management responsibilitiesand key personnel should be clearly identified in advance, theDHSS declares. But some doctors believe that to join in thesecivil defence preparations is irresponsible, because the

preparations help only to maintain a delusion that a nuclearattack of any size greater than a couple of "demonstration"missiles on Britain is "survivable" in any worthwhile sense.It would be more useful, some doctors believe, to underlinethe full extent of the horror and destruction which nuclearwar would bring. The Government clearly thinks otherwise,and it proposes contingency plans in which the essentialelements could be implemented in 48 hours, and the restwithin 7 days. Such might be the maximum period availablebetween drastic deterioration of international relations and anuclear attack. Many lives could be saved which wouldotherwise be lost, and much suffering avoided, the DHSSasserts, if plans were made for the NHS to cope along thefollowing lines.As international tension grew, the Secretary of State would

give orders, under his emergency powers, for the dischargefrom hospitals of all patients whose retention there was notmedically or socially essential. Outpatient clinics would beclosed. The selection of patients for discharge should takeaccount of the facilities available to care for them in the

community. Accident and emergency services wouldcontinue to operate. Medical supplies and equipment would

be rapidly dispersed by health authorities, since concentratedstocks are vulnerable to attack. Peacetime planning shouldinclude efforts by health authorities to stockpile drugs,dressings, and anaesthetic agents, against the eventuality ofwar. Most ambulances and their staff should also be

dispersed. As soon as patients had been sent home, the DHSSadds, all medical staff not required to operate an emergencyservice should be sent home themselves, or dispersed withinthe region. Stocks of blood collecting and giving equipment,grouping reagents, and plasma volume expanders should alsobe dispersed. Provision should be made for an emergencyindependent refrigeration service.Designated medical and local government personnel would

by this stage have taken over their emergency duties. Theperiod of tension might well end with a conventional attackon Britain, which would probably cause localised, if heavy,casualties, the DHSS continues. Then the nuclear attackwould come. It might be the delivery of one or two

demonstration nuclear warheads, which need not disrupt theNHS too widely. But it might equally well come in the shapeof an attack aimed at completely destroying the civil andmilitary functioning of the country. In these circumstances,the DHSS concedes, "almost inevitably there would becasualties on a scale which would overwhelm survivinghospital resources, though over how great an area woulddepend on the scale of the attack". Then, emergency medicalcentres would have to concentrate on triage, supportive care,and basic medical treatment. They might have to acceptsevere limitations in the availability of anaesthetics. Fluidreplacement therapy would be required by many patients andwould be a "constant problem". Strict priorities would have

. to govern the admission of patients to such hospital facilitiesas were available. There was no specific treatment forradiation sickness, and these patients should be cared for inthe community, where spontaneous recovery might beassisted by hydration and careful nursing. Treatment ofburns and blast injuries, also, might have to be selective,depending on the stores available and the prospects for

recovery of individual patients under the prevailingconditions.There is plenty of impressive understatement in the

DHSS’s suggestions. Mass casualties and widespreaddestruction would inevitably "present serious problems".Destruction of water and electricity supplies, fuel, andsewerage could seriously affect the ability of hospitals andhealth services to function and planners should take thesefactors into consideration. Communications networks couldbecome overloaded or, later, disrupted. Epidemics would bean ever-present risk. Health regions would be liable to

"requests" for sharing of their resources. Fallout would

impose severe restraints on movement.The basic contention of the DHSS, however, is that

whatever the damage inflicted by an attack, "the

responsibility to do as much as human and other resourcespermit would nevertheless remain." Furthermore, if planshad been adequately laid, it would be reasonable to expectthat in any area peripheral to the target where there weresurvivors, there would be some kind of health care, even iflimited. Afterwards, it is suggested, at least a primitivenetwork of health care could be built up around the shatteredremains of the NHS.

Government Funding of ResearchThe Education Secretary, Sir Keith Joseph, admitted in a

Commons debate on Government funding of scientificresearch that he is now very concerned about reports that