Nursing Services Guide (1942)

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Medical Division

Bulletin No 6

United States Dffiee of Civilian Defense

Washington D. C.

OCD 3059

D e c e m b e r 9 4 2


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This Bulletin outlines the program of the Medical Division of the United States

Office of Civilian Defense for nursing services which may be required in wartime to care

for civilians injured by enemy action or other hazards of war.

If they are to participate effectively in Emergency Medical Service nurses must

be informed of the organization of the local Defense Council and the duties of other

branches of the United States Citizens Defense Corps. They should understand the

coordination of the Emergency Medical Service with other protective units of the

United States Citizens Defense Corps and be able to answer the questions of their

patients and the public concerning these activities. As disseminators of information

nurses share the responsibility for public morale.

TABLE F CONTENTS

I I .

III.

Page

age

The Office of Civilian Defense. .......

The Nursing Section of the Medical

A. Regional Nurse Deputies and

B. State Nurse Deputies and

C. Local Nurse Deputies and

The Emergency Medical Service .....

A. Field Casualty Units ................

B. Casualty Stations. ............. ......

C. Casualty Receiving Hospitals..--

D. Care of Patients in Homes ........

E. Emergency Base Hospitals .........

F. Nursing Service in Reception

IV. First-Aid Training for Nurses in the

Emergency Medical Service ....... .

V. Blood and Plasma ..... ...................

V I . C h e m i c a l C a s u a l t ie s . . . . . . . . . . . . . . [ . . . . . .

VII. Sanitary and Public Health Engi

VIII. Volunteers in Health Medical Care

A. Volunteer Services of Registered

B. Volunteer Nurses’ Aides. .......... -_

1 C. Nursing Auxiliaries ...... ......... ....

D. Red Cross Home Nursing ..........

E. Other Volunteers ... ..................

A. Warning System and Control

B. U. S2 Citizens Defense Corps .....

1 . M e d i c a l U n i t . . . _ . . . . . . _ . _ _ . _ _ . _ _ _ _ _

2. Enrollment at Civilian De

fense Volunteer Office ........

C. U. S. Citizens Service Corps ......

D. Civilian Defense Auxiliary

E. Insigne Identification and Dress

F. Personnel File for Emergency

N u r s i n g S e r v i c e . . . . . . . . . . . . . . . . . . . .

1. Graduate Nurses ..................

2 . N u r s i n g A u x i l i a r i e s . . . . . - . . . . . . . . .

3. Volunteer Nurses’ Aides ........

G. Relationship of Red Cross and

H. Self Protection Against Injury

I. Home Water Supply Precautions

J. Regional OHices——States in each

10

10

10

10

10

10

11

11

12

12

12

12

12

13

13

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civilian hospitals. The States are assisted in

making an inventory of nursing resources and

in using the information to facilitate equitable

distribution of nursing services. The Nursing

Section also cooperates with the American Na

tional Red Cross on administrative problems

concerned with the recruitment and training

of Nu1·ses’ Aides the Home Nursing program

and the Red Cross Enrollment Service for re

serves of graduate nurses.

These activities are promoted in the field

through Regional State and local Nurse

Deputies. Nurses in all vulnerable commu-_

nities in the target areas are listed and classified

by neighborhoods so as to be available for im

mediate service with field units in Casualty

Stations and in Casualty Receiving Hospitals

of the Emergency Medical Service. Nursing

executives are also being enlisted for the sup

plementary administration and supervision of

nursing services which may be needed in Emer—

gency Base Hospitals into which casualties will

be evacuated in the event of enemy attack

upon coastal or other communities.

A. Regional Nurse Deputies

Nurse Deputies have been appointed to the

staff of the Regional Medical Officer in certain

Regions.

Field nursing consultants of the United States

Public Health Service the Children’s Bureau

and the American Red Cross are available to

the Regional Medical Officer and Regional

Nurse Deputy to assist them in developing the

nursing services necessary to carry out · the

emergency medical program in their Region.

Duties of Regional Nurse Deputy.

1. To advise the Regional Medical Officer

concerning the nursing program of the Medical

Division U. S. Office of Civilian Defense with

in the Region.

2. To promote plans for nursing participation

in the Emergency Medical Service in States in

the Region in cooperation with the State Nurse

Deputies and with nursing consultants of

the United States Public Health Service the

Children’s Bureau and the Red Cross.

3. To conduct institutes and conferences

for groups of nurses throughout the Region on

subjects pertaining to nursing participation in

the emergency medical program.

4. To keep informed concerning the status

of nursing service available in the States of the

Region and to correlate their nursing programs.

5. To promote and assist State and local re

cruiting and training of Volunteer Nurses’

Aides nursing auxiliaries and paid and vol

unteer assistants for civilian hospitals which

are to function as Casualty Receiving or Emer

gency Base Hospitals.

B. State Nurse Deputies

State Nursing Councils for War Service have

been organized in every State composed of

representatives of the professional nursing or

ganizations of the State the Red Cross the

official State agencies with nursing programs

and medical and lay groups. On the recom

mendation of the Medical Division of the

Office of Civilian Defense a State Nurse

Deputy has been appointed in most States by

the State Chief of Emergency Medical Service

in consultation with the Sta te Nursing Council.

As a member of the State Nursing Council

she consults that group on professional nursing

questions and should be their nursing represent

ative on the State Defense Council.

Duties of·State Nurse Deputy.

The State Nurse Deputy is responsible to the

State Chief of Emergency Medical Service and

will assist him in making plans for nursing par

ticipation in the State emergency medical pro

gram by:

1. Mobilizing the available nursing personnel

of the State in collaboration with local Nursing

Councils for duty in the Emergency Medical

Service.

2. Interpreting the Emergency Medical Serv

ice program to nursing organizations and groups

throughout the State.

3. Assisting local Nurse Deputies by inform

ing them of developments in the Emergency

Medical Service program aiding them in de

veloping an emergency nursing service and

preparing instructional memoranda for their

information.

4. Assisting the State Hospital Officer in

planning for the recruitment and assignment of

nurses and nursing auxiliaries to Emergency

Base Hospitals if evacuation of patients from

Casualty Receiving Hospitals to these insti

tutions should become necessary.

5. Planning for the recruitment and assign

ment of nursing personnel for reception areas

in cooperation with State .evacuation au

thorities.


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6. Assisting the Red Cross and hospitals V 3. In maintaining an active current iile see

in recruitment, training, and assignment to

duty of Volunteer Nurses’ Aides.

7. Compiling periodic reports summarizing

information from local Nurse Deputies in the

State concerning:

a) Adequacy of nursing services in civilian

hospitals and in public health departments.

b) Plans for correction of nursing dehcien

cies which may impede the war effort.

c) Nurses and Nurses’ Aides available for

emergency duty with medical field units, in

Casualty Stations, and in Casualty Receiving

Hospitals.

· d) Nursing personnel available in various

parts of the State for nursing service in Emer

gency Base Hospitals.

C. Local Nurse Deputies {city

county or other subdivision

of the State

Medical Division Bulletin No. 1 recommends

that the Medical Advisory Board of the local

Emergency Medical Service include a repre

sentative of the local nursing profession. It is

desirable that the responsibility for nursing

participation in the Emergency Medical Serv

ice be delegated to one individual in each

locality. A local Nurse Deputy should-, there

fore, be appointed by each local Chief of

Emergency Medical Service in consultation with

the local Nursing Council for War Service.

The local Nurse Deputy should be a member

of the local Nursing Council and should repre

sent it on the local Defense Council.

Duties of Loca] Nurse Deputy

The local Nurse Deputy is responsible to the

local Chief of Emergency Medical Service for

adequate nursing participation in the local

emergency medical program. She will assist

him:

1. In recruiting and training nurses and nurs

ing auxiliaries for service with Mobile Medical

Field Units, in Casualty Stations, and in _Cas

ualty Receiving Hospitals of the Emergency

Medical Service. This activity is to be carried

on with the assistance of the nursing staffs

of local hospitals and local nursing and health

gencies.

2. In interpreting the Emergency Medical

Service program to local nursing groups.

Appendix F) of all available nursing resources

in the community. This lile or a duplicate

should be available to the local Chief of Emer

gency Medical Service. In large cities it is de

sirable to classify the records according to

districts of the community in which nurses

reside or work, so that they may be available

promptly for service with Mobile Medical Field

Units and at Casualty Stations in their neigh

borhoods. In smaller communities or rural

districts one central file should be adequate.

4. In arranging with hospitals for assign

ment of nurses to mobile field units.

5. In assigning nurses enrolled in the Emer

gency Medical Service to duty in Casualty Sta

tions and in Casualty Receiving Hospitals

during emergencies.

6. In arranging for practice drills and for in

struction of nurses serving with the Emergency

Medical Service.

7. In providing for their iirst aid training,

in collaboration with the Red Cross, and their

instruction concerning self-protection against

gas and procedures for cleansing of chemical

casualties.

8. In establishing centralized facilities for

the use of all local public health nursing re

sources to provide emergency nursing care in

homes and shelters. This activity should be

planned in collaboration with the local health

and welfare departments in order that care and

assistance may be provided for the sick and.

slightly injured through public health nurses

and medical social workers and that the serv

ices of physicians may be conserved in times of

emergency. Centralized recording of the need

for emergency nursing care in homes should be

coordinated with the community plan for

Casualty Information Service. The responsi

bility includes providing nursing care for: a)

Slightly injured casualties sent home or to

temporary shelters after treatment at Casualty

Stations, b) convalescent patients discharged

from hospitals to make room for casualties,

c) ill persons in shelters and rest centers.

9. In assisting local chapters of the American

Red Cross and local Civilian Defense Volunteer

Offices in recruiting candidates for Nurses’ Aide

training; and in requesting the Nurses’ Aide

Committee to assign Nurses’ Aides for service

in an emergency.


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10. In keeping current files on nursing defi

ciencies of local hospitals and health services

so as to be prepared to supplement their per

sonnel during periods of emergency, and in

reporting to the State Chief of Emergency

Medical Service concerning the local nursing

program.

III. THE EMERGENCY MEDICALSERVICE

A. Field Casualty Units

The Field Casualty Units of the Emergency

Medical Service provide medical care for the

injured at incidents and in Casualty Stations,

and ambulance transportation to Casualty

Receiving Hospitals for the severely injured.

In order that mobile teams of the Medical

Field Units may be available for immediate

action in the event of a sudden air raid, it is

desirable that primary units be organized from

the interne and resident staffs of hospitals.

Each mobile medical team consists of one

physician, one nurse, and two or more auxil

iaries. Nurses assigned to iield casualty service

should be experienced in Hrst aid. (For organi

zation of these units, see Medical Division

Bulletins Nos. 1, 2, and 4.)

Similar teams are organized from physicians

and nurses practicing in the community, who

may be mobilized when continuing field serv

ices are needed or when relief service is neces

sary to permit the immediate action tea ms to

return to duty in their hospitals. Plans must

be evolved to have adequate numbers of nurses

on call for this purpose at all times in every

neighborhood.

At the scene of an incident and in Casualty

Stations, nurses will assist physicians in giving

first aid and will supervise the work of trained

nursing auxiliaries. One of the nursing auxil

iaries should be assigned the responsibility of

tagging as soon as possible all casualties, whether

sent to a hospital or to a Casualty Station.

B. Casualty Stations

At Casualty Stations, for the care of the

minor air raid casualties, a head nurse is to be

assigned to direct the activities of other nurses,

nurses’ aides, orderlies and assistants, and to

assume responsibility for management of the

Station. All nurses assigned to Casualty

Station duty should be familiar with the pre

vention and treatment of shock, know the con

tents and layout of the emergency medical

field kits, and be instructed in Casualty Station

procedures for admitting, treating, and dis

charging patients. If casualties at the station

have not been previously tagged, they should

be officially tagged on admission. The head

nurse must also be responsible for all entries in

the Casualty Record Book.

Practice drills will be held for those who will

be called upon to work together under emer

gency conditions. Such drills are conducted in

collaboration with other protection services

under the direction of the Commander of the

Citizens Defense Corps and the Chief of the

Emergency Medical Service.

C. Casualty Receiving Hospitals

All general hospitals in a community may be

included in the Emergency Medical Service

and may be called upon to serve as Casualty

Receiving Hospitals in time of emergency.

They are entitled to payment by the United

States Public Health Service for care of cas

ualties at a· rate of 3.75 per patient day.

Nurses will serve as employees of the hospital.

Each hospital is specifically related to the Con

trol Center and to certain Casualty Stations

in the district where it is located, or to which

its facilities have been related. (See Medical

Division Bulletin No. 4. The Field Unit

Leader of each hospital will appoint a nurse,

preferably a staff member, to act as superv isor

of nurses and nursing auxiliaries assigned to the

hospital field units.

Graduate and student nurses in the hos

pitals should be instructed in procedures for

the care and protection of patients during air

raids. They should be assigned specific re

sponsibilities in relation to the receiving and

classification of casualties, service in the re

suscitation room, and other emergency duties.

(See Medical'Division·Bulletin No. 3.)

Plians should be made for supplementing the

nursing staffs of Casualty Receiving Hospitals

during periods of acute emergency. Through

the local Nurse Deputy of the Emergency

Medical Service, practicing and retired nurses

residing in the community should be registered

for emergency assignment to Casualty Receiv

ing Hospitals. When possible, nurses selected

for such assignment should have been associated


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previously with thc institution; otherwise, they

should be informed in advance of adminis

trative regulations and the location of special

facilities and equipment of the hospitals to

which they may be assigned.

D. Cure oi Patients in Their Homes

The physician in charge of a Casualty Station

will determine the need for subsequent follow

up nursing visits in the home or in temporary

shelters. Such visits are important to pre

serve post-raid morale, as well as to assu re

adequate medical care. Directions for nursing

care and treatment in the home must be given

by the physician in charge of the patient.

Should subsequent medical care be required,

the patient is to be referred to his family phy

sician or to a clinic or hospital. Payment for

medical and nursing care of Emergency Medical

Service patients outside the hospital will be

made by the U. S. Public Health Service in

accordance with plans now being developed.

The Emergency Medical Service will assume

the responsibility for providing emergency

nursing service in homes. This may be carried

out through the health department or other

health agency, which should arrange to employ

all available public health nursing facilities

during post-raid periods. All agencies em

ploying public health nurses should pool their

resotuces for this purpose.

Each health or nursing agency shou ld be pre

pared. to make its home nursing service avail

able for a local area in accordance with plans

prepared by the local Chief of Emergency

Medical Service and the local Nurse Deputy in

collaboration with the health' omcer and rep

resentatives of the local nursing agencies. A

few nurses in each locality or from each agency

should be organized into mobile groups ,

to meet unusual needs which may arise in any

section of the community.

All public health nurses should be instructed

in these plans, and those who have not recently

done clinical nursing should take a refresher

course. This may be done by attending in

stitutes on home bedside nursing provided by

the local visiting nurses’ association or by the

health department.

E Emergency Base Hospitals

A chain ’of institutions situated in relatively

safe sites in the interior of the coastal States

have been designated as potential Emergency

Base Hospitals for the reception of casualties

and other hospitalized persons whom it may

be necesssary to move from cities under attack.

They are largely mental hospitals, convalescent

homes, and tuberculosis sanitoria, the occu

pants of which can be transferred to other

institutions or to their homes. They possess,

or can readily be provided with, sufficient fa

cilities for the care of casualties or other patients

who may be moved from civilian hospitals of

stricken cities. They will be entitled to pay

ment by the United States Public Health Serv

ice at a per diem rate of 3.7 5 for the care of all

patients whose movement from the Casualty

Receiving Hospitals is neces sitated by enemy

action. Each Emergency Base Hospital will

be administered by its existing administrative

staff or by the staff of the Casualty Receiving

Hospital which it serves. Its medical staff

will, when necessary, be supplemented by a

United States Public Health Service aiiiliated

unit. Each afliliated hospital unit consists of

15 physicians, commissioned in the inactive

reserve of the United States Public Health

Service. All or part of the unit wil l be acti

vated by the Surgeon General upon recommen

dation of the State Chief of Emergency Medical

Service and the Regional Medical Oiiicer to the

Chief Medical Officer of the Office of Civilian

Defense. Medical Consultants of the U. S.

Public Health Service may also be utilized for

part-time service at Emergency Base Hospitals.

A limited number of qualified nursing execu

tives will be given appointments in the United

States Public Health Service for assignment as

nursing supervisors in activated Base Hospitals

or to supplement the existing supervisory staff

of the institution. (See Circular Medical

Series No. 24, December 21, 1942.) Organi

zation of a general nursing reserve for duty at

Emergency Base Hospitals has been deferred

until the need becomes more imminent. How

ever, Nurse Deputies will maintain a roster of

nurses, nurses’ aides, and other auxiliaries in

the community, who will be available if required.

in an emergency.

When on active duty at th e base, the medical

officers and the nursing executives who hold

appointments as special nursing consultants of

the United States Public Health Service will be

paid from Federal funds. All other nurses

and nursing auxiliaries on du ty at a Base Hos

pital are to serve as employees of the institu


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tion, whether administered by the State or

10cal government or as a voluntary hospital.

The obligation of the Federal Government is

limited to the payment of salaries and allow

ances of the officers and of the medical and

nursing consultants ofthe Public Health Serv

ice assigned to duty at the Emergency Base

Hospital, the provision of beds, mattresses and

a limited amount of surgical supplies, and the

per diem payment to the institutions of 3.7 5

per patient day. It is assumed that the re

mainder of the operating cost will be met by

State or local governments.

To supplementregular nursing services at

Emergency Base Hospitals, it will be necessary

to utilize auxiliary nursing personnel of the

institution which has been activated as a Base

Hospital, or personnel recruited from a Cas

ualty Receiving Hospital or other local sources.

In emergencies the American Red Cross, health

departments, and voluntary health `agencies

can be depended upon for assistance in supply

ing additional nursing and auxiliary personnel.

Provisions should be made to increase the pro

portion of nursing supervisors as the nursing

auxiliaries are increased. Under emergency

circumstances, it will be necessary to assign

relatively less important nursing duties to

auxiliaries so as to relieve the limited number of

graduate nurses for services requiring nursing

skill and responsibility.

F Nursing Service in Reception

Areas

Reception areas are localities to which women

and children and the aged and iniirm may be

evacuated from cities under attack. Under

these circumstances the localities under attack

comprise the evacuation area. Plans for evac

uation have been prepared by the Joint Com

mittee on Evacuation which was organized by

the Office of Civilian Defense and the Office of

Defense Health and Welfare Services. In ad

dition to the appointing agencies, its member

ship includes the Children’s Bureau of the De

partment of Labor, the United States Public

Health Service, the United States Office of

Education, and the Bureau of Public Assistance

of the Social Security Board and the Medical

Division of the Office of Civilian Defense.

Under the supervision of Regional and State

Evacuation Officers, evacuees will be trans

ported to designated reception areas when

such action is considered necessary by military

authorities. Plans provide for the evacuation

of children and mothers, pregnant women, the

physically handicapped, the infirm, and those

who are unable to make private arrangements,

or who may wish to join a government party.

The responsibility for the supervision of

nursing service both in the evacuation and in

the reception areas will be assigned to local,

county, or State health departments, but pool

ing of all available public health nursing

resources should be achieved. Specific rec

ommendations for providing nursing services

in evacuation and reception areas will be issued

by the Joint Committee on Evacuation.

IV. FIRST AID TRAINING FDR NURSES IN

THE EMERGENCY MEDICAL SERVICE

The darkness, confusion, debris, and dirt at

most air raid incidents and the increasing in

tensity of air raids precludes administration of

first aid in the field other than covering of

wounds with shell dressings, control of hemor

rhage, prevention and care of shock and ad

ministration of morphine. Much of the first aid

work is performed by rescue workers who

extricate the injured from the debris of demol

ished. buildings and turn them over to the

mobile medical team. The majority of casual

ties are either killed or are so severely injured

that they require immediate transportationto

a hospital where they can promptly receive

shock therapy, blood and plasma transfusions

and skilled surgical care. The mortality among

air raid casualties is extremely high if treatment

of the severely injured is attempted in the field

and at Casualty Stations, or if transportation

to a hospital is delayed.

Casualty Stations have been established at

all hospitals and at sites remote from hospitals

for the care of minor casualties, who usually

comprise about a third of the total number of

injured. Here the nurses and auxiliaries will

have ample opportunity for work. Every nurse

must, therefore, be familiar with modern first

aid methods. Ten hours of instruction in ad

vanced first aid are required for U. S. Citizens

Defense Corps membership, but if no course in

first aid has been taken within 2 years, the 20

hour course is advisable. See Appendix B.)

Student nurses should receive first aid instruc

tion earlier in their training than was formerly

the practice.


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, By arrangement with the Red Cross, grad

uate nurses can complete an instructors’ train

ing course in first aid in 30 h ours. Nurses so

trained should offer to serve as first aid in

structors if there is a shortage of qualiiled lay

first aid instructors in the community. Nursing

personnel will usually be more urgently needed

for other service.

Public health nurses should carry a limited

amount of first aid equipment in their bags in

case they are called upon for help. The amount

and type of such equipment should be decided

by each agency, but shouldinclude two tri

angular bandages, two medium sized shell

dressings, and several sterile compresses.

Nurses are in a position to give valuable

advice to lay people concerning first aid equip

ment and to prevent unreasonable purchase and

hoarding of elaborate iirst aid kits. It is b e

coming increasingly important to conserve

critical medical equipment and supplies for our

armed forces and our civilian hospitals.

V. BLOOD AND PLASMA

The United States Public Health Service and

the Medical Division of the Office of Civilian

Defense are assisting approximately 150 hos

pitals in the United States to establish and

maintain blood and plasma banks for emer

gency use. Funds have been provided for about

65,000 units of liquid and frozen plasma which

will be made available to the Emergency Medi

cal Service for the treatment of civilian cas

ualties. Another 30,000 units of frozen plasma

made from blood collected by the Red Cross

for the Army has been acquired and distributed

in 500 unit lots among the larger cities. In

addition, 50,000 units of dried plasma are being

prepared for the Office of Civilian Defense by

commercial laboratories from biood collected

by the Red Cross for distribution to strategi

cally located depots throughout the country,

from which it can be rushed to any city which

is in danger of exhausting its local supplies.

A unit of plasma is the amount derived from

500 cc. of blood. There will be available,

therefore, a reserve of approximately 145,000

units of blood plasma for emergency needs of

the civilian population.

Because of the importance of plasma in the

care of casualties, all nurses should be informed

of the technique of administering blood and

plasma for the treatment of shock. All gradu

ate nurses and senior nursing students should

receive instruction in modern transfusion

methods, present day therapy for prevention

and treatment of shock, and the preparation

and care of transfusion equipment. Nurses

assigned to resuscitation teams will require

additional training from the team leaders.

VI. CHEMICAL CASUALTIES

All nurses‘should be taught self-protection

against gas and procedures for cleansing of

chemical casualties. They should be instructed

also in the first aid and definitive treatment of

· chemical injuries affecting the skin, eyes, and

respiratory tract. Courses for nurses on med

ical and nursing aspects of chemical warfare

should be provided in each community. Pri

ority in admission to these courses should be

given to nurses assigned to mobile field units

of the Emergency Medical Service and to Cas

ualty Receiving Hospitals.

Nurses properly informed about war gases

can render an important service to their com

munities by dispelling fear of chemical warfare.

They should be in a position to assist the local

Senior Gas Officers in teachingthe public that

self-cleansing is the only method which will

work in the face of the limited amount of time

available for treatment and the fact that gas

cleansing stations are feasible only for the

cleansing of injured persons and civilian pro

tection workers. See Appendix H.)

VII. SANITARY AND PUBLIC HEALTH

ENGINEERING

The Sanitary Engineering Section of the

Medical Division is composed of officers of th e

United States Public Health Service. Through

a field staff of Sanitary Engineers in the Re

gional Offices of the Office of Civilian Defense,

it assists States and local communities in plan

ning for the protection and maintenance of safe

and adequate supplies of water, milk, and food

in the event of enemy action. This Section also

gives consultation to State and local health

departments and municipal officials concerning

emergency measures for the maintenance of

sewer service and refuse collection and disposal.

· All nurses, but especially those engaged in

public health nursing activities, should be

familiar with this problem. They must be ready


10/16

to supply accurate information to thc public on

emergency measures, should these vital services

be interrupted. Instructions concerning emer

gency water and other sanitary precautions are

the responsibility of the State and local health

0Hicers. A list of home water supply precau

tions has been recommended by theiSanitary

Engineering Section of the Medical Division of

the Office of Civilian Defense in Sanitary Engi

neering Bulletin No. 1. )(See also Appendix I.)

VIII. VIILUNTEERS IN HEALTH,

MEDICAL CARE, AND NURSING

A. Volunteer Services of Registered

urs s

Nurses volunteering to assist in the war pro

gram should confine their activities to the type

of service for which they are best prepared

nursing. Although they may be requested to

serve as air raid wardens or in other Civilian

Defense activities, they are more urgently

needed for nursing duties.

Examples of volunteer services which active

and retired nurses can best offer are:

1. Recruiting candidates for nursing schools.

2. Recruiting candidates for Nurses’ Aide

Courses in cooperation with Civilian Defense

Volunteer Omces and Red Cross N urses’ Aide

Committees.

3. Serving part-time in Casualty Receiving

Hospitals and with Medical Field Units.

4. Teaching Home Nursing and Nurse-s’ Aide

classes.

5. Supervising the care of children in day

nurseries.

Volunteers participating in the last two

activities are eligible for membership in the

U. S. Citizens Service Corps. See Appendix

C.)

Most of these volunteer services will be on a

part-time basis. They can, therefore, be carried

out a) by retired mu·ses· who have home re

sponsibilities, (b) by older nurses who are able

to work only part time, or (c) by those who give

extra time outside their regular nursing work.

It isthe patriotic duty of all inactive nurses

ablelto do so to return to full-time nursing for

the duration of the war.

Nurses should assnune responsibility for pro

moting the use of volunteer service in hospitals

and health agencies. Health and welfare serv

ices provided by national, State and local agen

cies must be strengthened and extended to meet

rapidly mounting wartime needs. The per

sonnel of these organizations is seriously re

duced by the demands of the military services

and of the war industries, and additional vol

unteer help must be obtained if hospitals,

health departments, and voluntary health

agencies are to continue to function effectively.

B. Volunteer Nurses’ Aides

To meet the anticipated need for expansion

of nursing facilities, the United States Ofiice of

Civilian Defense in August 1 941, requested the

American Red Cross to expand its Volunteer

Nurses’ Aide Corps and to revise and intensify

its training program for Nurses’ Aides. A

program sponsored by the two agencies was

immediately inaugurated for the training of

100,000 N urses’ Aides. In collaboration with

the Medical Division of the Omce of Civilian

Defense, the curriculum was revised to meet

war needs. For details of curriculum and

regulations regarding training of N urses’ Aides,

see Guide for Training Nurses’ Aides, · pub

lished by the United States Oiiice of Civilian

Defense, in collaboration with the Red Cross;

also Appendix F.)

The Red Cross has instructed each local

chapter undertaking a Nurses’ Aide Training

Program to organize a Nurses’ Aide Committee

composed of nurses and lay representatives,

the local Chief of Emergency Medical Service

and a representative of the local Civilian De

fense Volunteer OHice. To this committee is

assigned the responsibility for:

1. Determining local policies and safeguard

ing standards.

2. Recruiting candidates in cooperation with

the Civilian Defense Volunteer Omce.

3. Selecting volunteers meeting Corps re

quirements in` regard to age, education, and

availability.

4. Providing properly qualified nurse in

structors.

5. Administering and supervising the train

ing of the Corps.

6. Assigning Aides after completion of train

ing to service in hospitals, health departments,

visiting nurse organizations and other health

agencies.

7. Coordinating the Aide service with the

emergency medical and nursing program of the

local Emergency Medical Service.


11/16


12/16

cvcry community. Suggestions for the ways in Health, Medical Care and Nursing pub

in which volunteer assistants may be trained lished by the United States 0Ece of Civilian

for service are given in the' bulletin V01unteers Defense. (See also Appendix C.)

A Warning System and Control

Center

The presence of enemy airplanes is reported

by the Aircraft Warning Service of the Army

to its Regional Information Centers. A Civil

Air Raid Warning OHicer notiies District

Warning Centers, which in turn notify the

Control Centers in the path of the invading

planes to prepare for a possible air raid. The

Control Center of a community is the head

quarters of the Commander of the Citizens De

fense Corps and his technical staff, which in

cludes the Chief of Emergency Medical Service.

The Control Center receives air raid warnings

and transmits them to the proper recipients;

it orders the sounding of air raid alarms; it re

ceives reports from wardens concerning air

raid damage; and it dispatches operating units

of the protective services to the site of an inci

dent. Details of the operation of the Control

Center with particular regard to the Emergency

Medical Service are described in Medical Di

vision Bulletin No. 4. Nurses will be sum

moned for emergency service in accordance

with the plan developed in each community.

B United States Citizens Defense

Corps

The United States Citizens Defense Corps

is an organization of citizens trained to carry

out the protective measures necessary in the

event of enemy attack. It should be organized

in each locality with an adequate number of

deployable units under local control.

Regulations of the OH·ice of Civilian Defense

prescribe the eligibility, training, and duties of

the members of the Citizens Defense Corps

entitled to wear or use its prescribed insignia.

(See Regulations 3, U. S. Citizens Defense

Corps, amended to August 1942.)

Members of each unit are required to take an

official oath faithfully to discharge their duties.

1. Medical Unit.—The personnel of the

Medical Unit of the U. S. Citizens Defense

Corps——doctors, nurses, nurses’ aides, other

nursing auxiliaries, orderlies, rescue workers,

and members of stretcher teams—enroll as

members of the Citizens Defense Corps through

the local Chief of Emergency M edical Service.

For membership, graduate nurses are required

to complete the advanced first aid course (10

hours). They may also be required to take

such other courses as may be prescribed by the

Office of Civilian Defense.

2. Enrollment at Civilian Defense Vol

unteer Office.-——The local Civilian Defense

Volunteer Office enrolls all persons in the com

munity who wish to volunteer their services.

A complete file of volunteers at this office re

veals the total volunteer personnel of the com

munity. Cooperation with it is necessary in

order to maintain a comprehensive appraisal of

the number and classification of citizens of the

community who are prepared to defend the

home front. Although professional members

of the Medical Unit may not be required to

register individually at the Volunteer Office,

the Chief of Emergency Medical Service should

arrange to have the names of physicians and

nurses who are members of the Medical Units

recorded there.

As agreed by the Office of Civilian Defense

and the American Red Cross, all Nurses’ Aides

should be registered at the local Civilian De

fense Volunteer Office. The Nurses’ Aide Com

mittee of the Red Cross is responsible for keep

ing the Volunteer Office informed of the number

and names of those who have completed train

ing~and who have been enrolled in the Red

Cross Nurses’ Aide Corps and in the Nurses’

Aide Unit of the Citizens Defense Corps.

C United States Citizens Service

Corps

The U. S. Citizens Service Corps is an or

ganization of volunteer civilian workers who

carry out the many civilian war jobs necessary

in every community. It is the policy of the

Citizens Service Corps to encourage to the

fullest extent the work of established agencies.


13/16

For existing volunteer groups working with

such agencies, membership in the U. S. Citizens

Service Corps is a recognition of the service

which they are already rendering. In addition,

there may be volunteers organized directly

under committees of the local Defense Council

when new activities are required which cannot

satisfactorily be performed through existing

agencies. Members of the U. S. Citizens

Service Corps are registered in the local Civilian

Defense Volunteer Oflice. Qualiiications and

regulations for membership and prescribed

insigne are described in the handbook, The

U. S. Citizens Service Corps.’

D. Civilian Defense Auxiliary Group

Not all nurses are assigned to emergency

service in medical units. Essential services in

hospitals and elsewhere must be continued dur

ing and following an air raid or other disaster ,

and those responsible for such services may be

enrolled in the Civilian Defense Auxiliary

Group. When it is necessary for them to move

through restricted areas, they will be identified

by armbands with the basic Civilian Defense

insigne, all in blue, not the medical unit

insigne. The word nurse may be stenciled

on the band outside the insigne.

Nursing assistants and attendants in hos

pitals or in other essential services may also be

members of the Civilian Defense Auxiliary

Group. If it is necessary for these workers to

move during or immediately following an air

raid, identification will be required, and they

will wear armbands with the Civilian Defense

Auxiliary Group insigne.

Upon recommendation of the local Chief of

Emergency Medical Service, nurses and nursing

auxiliaries may be authorized by local Defense

Councils to be included in the Civilian Defense

Auxiliary Group and to wear and use its pre

scribed insigne.

E. lnsigne, Identification, and Dress

for Nurses

Insigne.———Nurses who are enrolled members

of a Medical Unit of the U. S. Citi zens Defense

Corps wear the insigne prescribed for that unit,

the Caduceus on the basic Omce of Civilian

Defense design. The arm band with this

insigne is worn only while actively engaged in

the performance of duties or while in transit to

or from places of duty to identify the nur se as

a member of the unit. The wear or use of a

civilian defense lapel emblem or other oiiicially

•prescribed article with the same insigne is a

matter of local option. But whether it be arm

band or other oHicial article, its wear or use

must be restricted to those nurses who have

been appointed by the Chief of Emergency

Medical Service as active or reserve members

of a Medical Unit and enrolled by the local

Defense Council.

Identification cards are ordinarily pro

vided for `all members of the Citizens Defense

Corps. This card bears the individual’s signa

ture and the signature of the authorized repre

sentative of the local Defense Council, and

states that the member is entitle d to wear the

insigne of the unit to which he or she is assigned.

Dress.——No special uniform has been recom

mended for nurses enrolled in the Emergency

Medical Service because it is important at this

time to conserve materials and labor for mil

itary needs. Nurses do not need a special

uniform to show that they are performing essen

tial wartime duties.

The way in which nurses dress for emergency

field service is determined locally. Outer

clothing to be worn in an emergency should

be assembled and put aside, ready for immedi

ate use, to avoid delay in reporting for duty.

The type of duty to which the nurse is assigned,

climate, and local conditions must obviously

determine modification of nurses’ dress. As

a member of a medical team assigned to

work in a Casualty Station, the nurse could

have -a topcoat ready to put on over her white

uniform and, by exchanging her cap for a helmet

and putting on her arm band, be ready on

short notice to leave the hospital with her team.

For outdoor service at incidents, a white uni

form would be impracticable because of the

debris, dust, and dirt caused by bombing.

A dark-colored wash dress for summer and a

dress of heavy material or a sweater and wool

skirt for winter would be advisable. Helmets

must be worn if available; otherwise a small

close-fitting hat or cap could be substitu ted.

In some localities nurses have decided that a

short white butcher or carpen ter apron, known

as a blitz apron , is practical for wear in

Casualty Stations. Nurses have made these

aprons themselves, providing generous pockets

to carry such articles as flash light, skin pencils,

or identification tags. Such aprons. may prove

useful in an emergency situation, but the de


14/16

cision to make and use them is left to local Nursing Auxi1ia1·ies.—The local Nurse

Deputy should have access to a iile of the

ption.

The public health n urse may wear her regular

uniform and uniform coat adding a helmet

and arm band, if she is working as an enrolled

member of a Medical Unit. Her regular indoor

uniform would be suitable for wear in a Cas

ualty Station . If she is called into the hospi tal

to give emergency service, she may wear her

public health indoor uniform, if the hospital

approves. No arm band is necessary when

working in the hospital.

F Personnel File for Emergency

Nursing Service

Personnel {iles should be arranged alpha

betically according to geographic subdivisions

of the city so that the names of those residing

in each section or neighborhood of a city or

rural area may be readily available. This is

essential to facilitate emergency assignment of

nursing personnel in their immediate or ad

jacent neighborhoods. In large cities, a dupli

cate sectional list should be kept at the district

control center or at a hospital, a health sta

tion, o r other central place of registry for each

geographic division.

Graduate Nurses.—The local Nurse Dep

uty should have the following information on

tile for every graduate nurse available for

emergency service:

1. Full name and year of graduation from

nursing schools

2. Home address and telephone number.

3. Business address and telephone number.

4. Name of agency where employed.

5. Type of present nursing work.

6. Speciiic assignment for emergency nursing

service.

7. Hours available for emergency service

(applies particularly to married nurses with

families).

8. Availability for nursing work away from

home community.

9. States in which registered as a registered

nurse.

10. Completion of First Aid Course.

11. Completion of other courses for emergency

service (specify).

12. Special experience, such as surgical or

operating room supervisor, anesthetist, X—ray

assistant, maternity supervisor, hospital ad

ministrator, public health.

names of those in the community who are avail

able to assist nurses in an emergency. The

names in such a file would include those of

practical nurses, undergraduates who left the

hospi.tal before completing nursing training,

persons who have completed hospital training

projects under the auspices of the National

Youth Administration or Works Progress Ad

ministration, hospital attendants, and others

who have had auxiliary training.

The information on file for this group should

include:

1. Full name.

2. Home address and telephone numberf

3. Business address and telephone number.`

4. Type of present work.

5. Name of agency where employed.

6. The amount and kind of training for

auxiliary nursing service.

7. Completion of First Aid Course.

8. Availability for work away from home

community.

Volunteer N urses’ Aides.-—A complete cur

rent roster of Nurses’ Aides is kept at t he local

Red Cross Chapter Volunteer N urses’ Aide

Headquarters. I n large citi es the N urses’ Aide

file should be classified according to the dis

tricts of the city in which aides reside so that

they will be available for emergency assignment

in their neighborhood. The Chief of Emergency

Medical Service or his Nurse Deputy can then

summon help for any section of the city by

calling the Nurses’ Aide Committee member or

representative of that district. In a similar

manner hospitals could be supplied promptly

with additional Nurses’ Aides from the roster o f

those residing in their vicinity.

G Relationship of Red Cross and

D

To secure unity o f effort and avoid duplica

tion of facilities in meeting civilian needs aris

ing from enemy action, a joint statement was

issued on May 21 1942 by the Chairman of

the American National Red Cross and the

Director of the U. S. Office of Civili an Defense,

for the guidance of lo cal Red Cross Chapters

and Defense Councils. This statement pro

vides, in par t, as follows:

In the event of bombing or other enemy

attack, it is the responsibility of local Defense

Councils as the representati ves of Government


15/16

to scc that adequate provision is made for all

nccdcd services. During enemy attack, all

services are directed from the control center b y

the Commander of the Citizens Defense Corps.

Responsibility for the care of those injured as a

result of enemy action rests with the Emerg

ency Medical Service of the Citizens Defense

Corps under the direction of the Chief of the

Emergency Medical Service.

Red Cross Chapters assist the Emergency

Medical Service by a) training and furnishing

lists of persons trained in First Aid to be en

listed by the Emergency Medical Service as

members of stretcher teams; b) recruiting and

training Volunteer Nurses’ Aides who will be

utilized by the Emergency Medical Service at

hospitals, Casualty Stations, and First Aid

Posts; c) providing dressings, bandages, and

supplementary equipment as the Chapter may

decide in consultation with the Chief of Emerg

ency Medical Service; d) equipping and oper

atifig emergency ambulances to be assigned to

the Emergency Medical Service and to serve

under its direction; e) providing supplement

ary transportation for slightly injured and for

Emergency Medical personnel. During the

emergency period, ambulance units will be

under the direction of the Chief of Emergency

Medical Service or his Transport Officer.

During natural disasters the Emergency

Medical Service of the Office of Civilian De

fense will be utilized by the Red Cross in giving

its usual disaster service.

H. Self Protection Against Injury

From \Vur Gases

Certain general rules which apply to all gases

must be followed, since it is hazardous to base

gas defense on exact diagnosis of the gas by

an individual.

1. If indoors when the warning of gas is

sounded, stay there. This warning will be

given by the local air raid warden by use of

large wooden hand rattles.) Close doors and

windows; turn off air conditioning; stop up

fireplaces; avoid basements; go upstairs. If

out of doors, get out of the gassed area by

walking, not running, preferably against the

wind or at right angles to it.

2. War gases may affect the eyes, skin, or

lungs. Prevention of injury depends largely

upon prompt use of simple remedies which

persons otherwise uninjured can best apply to

themselves.

3. If exposed to war gases:

a) Get out of the area as directed in rule 2,

and into a building. Before going inside, if you

have been in direct contact with the gas,

remove outer clothing and shoes and leave

them outside.

b) Wash hands with soap and water.

c) Irrigate or wash out the eyes at once

this must be done within 5 minutes or not

at all), with generous amounts of a solution of

baking soda one tablespoon ful of baking soda

to a quart of water). If no soda is available, use

plain water.

d) If liquid gas gets on the skin:

1) U se pieces of cloth or cleansing tissues to

blot as much of the liquid as is possible

from the skin. Do not rub the skin, as

this will spread the liquid.

2) To the contaminated areas of the skin,

apply a household bleaching solution full

strength. If not immediately available

do not waste time looking for the solu

tion; bathe immediately with soap and

running water.

e) Take a shower or bathe with running

water, using plenty of soap.

f) If respiratory distress develops, lie down

and remain quiet until seen by a phy sician.

g) Do not get excited. Follow these in

structions without wasting time. Seek medical

attention as soon as possible.

Remember: Soldiers require gas masks be

cause they must remain in the ;gas-contam

inated area. Civilians who have no responsi

bility in civilian protection, requiring them to

remain in exposed areas, can get out of the

gassed area and can safely protect themselves.

Self-help is best because it is quickest.

I. Homo Waltor Supply Precautions

The following home water supply precautions

are recommended by the Sanitary Engineering

Section of the Medical Division of the Office of

Civilian Defense:

1. Keep available at least one quart b ottle

filled with drinking water for each person in the

house. Interrupted water service may not be

restored immediately.

2. Turn water faucets off everywhere in the

house, if water service fails. When the water


16/16

comes on if open faucets have been forgotten

water will be wasted damage may result from

Hooding, and water pressure may be lowered

0ver the city.

3. Do not fill bath tubs with water during or

following air raids. Such action, if taken

simultaneously in many homes will seriously

reduce water pressure, limit the volume of

water and cause a dangerous shortage of water

for fire fighting.

4. Leave water valves alone. Trained work

ers will shut off all necessary valves. The

Water Department will know if the service has

been turned off.

5. A telephone report is not necessary. The

air raid warden will promptly report troubles

in his area. Telephones are needed for im

portant omcial calls.

6. Discontinue, immediately, use of Hush

toilet if water service goes off. Follow the

directions of the Health Department. Body

wastes will accumulate in the bowl and the

small volume of water stored in the home is

insufiicient to continue Hushing.

A sanitary excreta bag has been developed

which consists of an outer bag of waxed paper

and a water proof lining completely lined with

an absorbent material. This bag may be used

in any supporting frame container or may be

bag can be rolled down forming a small pack

age and tied with a string; disposal may be in

trash or garbage cans collected by the regular

municipal collection service or by such other

means as may be prescribed by local authorities.

Information concerning the availability of

sanitary excreta bags may be secured from the

Sanitary Engineers in OCD Regional Omces or

in local or State Health Departments.

7. Protect health by boiling drinking and

cooking water if the Health Department so

advises. Disruption of water mains by bomb

ing may drain sewage from sewers or house

plumbing into the water main. Boil all drink

ing and cooking water for five minutes during

the first 24 hours after water service is restored.

8. Accept chlorine tastes in drinking water

without complaining. I t is a sign of safety.

Because of a water main break or for some

other reason, the health and water depart

ments may increase the amount of chlorine

temporarily.

9. Do not drink water obtained from sources

other than the tap or drinking water carts

operated by the authorities. It is dangerous

to use water of unknown quality from wells and

springs when the public water supply fails.

10. Do not believe or repeat rumors con

cerning water. The health authorities know

the water supply facts and will advise the

public. The origin of rumors may be sub

versive. Rely on the health and water

departments.

J. Regional Gfiices

States in Each Region

Region 1-17 Court Street, Boston, Mass.:

Connecticut, Maine, Massachusetts, New

Hampshire, Rhode Island, Vermont.

Region II—Chanin Building, 122 East 42d

Street, New York, N. Y.: Delaware, New

Jersey, New York.

Region III—Room 1554, Baltimore Trust

Building, Baltimore, Md.: District of Col

umbia Maryland Pennsylvania Virginia.

Region IV—Candler Building, Atlanta, Gia.:

Alabama, Florida, Georgia, Mississippi,

North Carolina South Carolina Tennessee.

Rggion V—l530 Standard Building, Cleveland,

Ohio: Indiana, Kentucky, Ohio, West

Virginia.

Region VI——2620 Civic Opera Building, 20

North Wacker Drive Chicago Ill.: Illinois

Michigan Wisconsin.

Region VII——City National Bank Building,

Omaha, Nebr.: Colorado, Iowa. Kansas,

Minnesota, Missouri, Nebraska, North Da

kota, South Dakota, Wyoming.

Region VIII—Mercantile National Bank

Building Dallas Tex.: Arkansas Louisiana

New Mexico, Oklahoma, Texas.

Region IX—1355 Market Street, San Fran

cisco Calif.: Arizona California Idaho

Montana, Nevada, Oregon, Utah, Wash

ington.

For nursing consultation by Federal Agency

Field Consultants requests should be sent to

Regional Medical Officers. For nursing con

sultation by the State Nurse Deputy requests

should be sent to the State Chief of Emergency

Medical Service.

U s c o v z n u m s u r r n m r m c o m c : 5 0 4 7 2 7

/

Documents

Nursing Services Guide (1942)