Created: 7/1/1984

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Soviet Civil Defense:

Medical Planning

for Postattack Recovery


electorate of

Soviet Qial Defense:

Medical Pfenning

for Posfattack Recovery

Tbii paperpired I

Office of SovietuinnvniV'ilH (JVjJItciaod mav be directed it

SOV A, on

Soriet Gril Defense:

Medical Planning

for Postattack Recover)

ot lhc peric-Ja nuclear allack; or ih:

overall civil defense effort and includes various measures forof theveork force, and genera! porwlalioa.

Accordingoviet tC ritings, ft erciphasiies Use training and prelection of medical isersonoei, siockpilinj of medical reserves,of (he Civil Defense Medical Service for wartime ewa'ioeis. aod evacuation and relocation of urban medical facilities

ia tbe prcatudc period, medical and para medical

personnel would be mobilized! by the Qril Defense Medical Service, and urban modicaJ facilities would relocate or evacuate their patients. The Medical Service would then deploy io exurban areas to assist in the evacuation of the work force aad general population. Medical assistance in (he postattack period would consisto-*tagc evacuation of casualties from targetlhc first stage, emergency treatment would be given by first aid detachments deplored close to the areas targeted, and during the second stage, more spcdalijed treatment would be given in base hospitals located farther away.*.

Our analysisreporting on Soviet medical planning and Soviet civil defense medical texts indicates thai:

Emergency relocation and evacuation plans exist for many medical fact lilies.

Extensive measures have been taken lo provide trained medical and paramedical personnel for ihe Civil Defense Medical Service.

Measures have been taken to facilitate rnobiliralioo of personnel, transportation, and equipment (or cavil defense medical use during wartime.

Large stockpiles of medical supplies fot civil defense exist throughout the


The USSR hasnderground medial treatment and storage facilities, primarily in urban areas and designed to provide for limited treatment of patients and protection of some medical stockpiles.

The Soviets routinely conduct civil defense training and exercises fot medical personnel.

Shelters, designed to protect medical personnel from the immediate effects of nuclear weapons, exist at many urban medical facilities

The Soviet* have invested heavily in planning, training, conducting limited exercises, and in providing personnel for the Civil Defense Medical Service. Noocthdess. (bey still lace urtccruiatics about tbe ability of the Service lo carry out its mission. Wc have seen no major integrated exercises (hat would demonstrate the effectiveness of tic system. Moreover, the length of lime medical sicxfcpilcs could last under conditions of nuclear war and the rireurosiances in which nuclear war might occur remain intractable issues.

9 we .estimated that Soviet wartime casualties would range fromilUon'depending upon civil defense preparations and otherfig^ra'wiH be updated in an interagency study to be completed lalcrthislthough medical preparations for civil defense are eatemive, the Civil Defense Medical Service could easily beb^casualiks if the Soviets had liufe time lorot to implcnuotfcivil defense measures before an attack

The Soviet leadership probably believes that civil defense medical pUnnine enhances tbe prospects for the USSR's postattack recovery, as il would reduce faulh'-^armnne all scsjrnents of the population aivenwamin. tprje.



Soviel Civil Defense:

Medical Planning

for Posla'tacl Recovery

uclear war ihe number of surviving injuredikely to emul or ticecvl'lhe nurabcc of those killed irrvmrdialdy. Tent of milboui of casual Iiea conequire medical Ireatmeriiin ttiepostaiiack period.

lo Soviei unclassified writings, ihe Haled

Ibe Soviei civil defense program ia to rioeol rnodaal resources lor the rwoscclioa 'the topalaiicm and ircaimcni ot the matiivci iyilian casualties ei peeled Civil delrnte mea-fsuYci dcaiincd to "eliminate Ihe medical cense erJerters" of auelcar. biological, or chemical wcapont arc.

of civil'defraase medical personnel and facilitica for Irealiai man casualties.

Special civil defeme training for aU medical personnel

Provision of emergency medical aupptica and tr asportation.

of sanitation and epidemic controllo preveni the oroet of infectious diseases

Mrdieal evacuation of casus It us from urban areaaelocated hospiials.

ProtestMn of medical personnel through sheltering.

Soviet medical manuals on civil defense estimate lhat the iota) loss of life in urban areas could reacho

without iheliennj We have nohowever, on what theii number of civilian casualties could br inwar9 we simulated ihe effeeis oapopulationypMbeticalUS lorrn ssndei dliferent alert conditioto'purpose ol ihr simulation, whichare

i ii was to im ii the effeeiivrnesi of Soviet Civil defente in reducing the magnitude of So>iei cam allieswtkar war ftp ibe purposea lysis we

a lUmrUoiir* mcitnaduti


assumed three differeni levels of civil defense prepara-lionHiule to norse,-sheltering only, aad full sheltering


of urban centers. The population was neither specifically urgeied nor avoided. Our assess neat indicated that alienated Soviet rasas Hies from prejenp* nuckai weapons elfreu and fallout would range from aboulillion (includingillion fatalities)illionillion faulilies) depending on the level uf civil defense irraphtiicnlJiaan and stage of US alert- Casualties from tone-term and secondary effects were not Included {see table I)

The Soviets' recoveryuclear war is heavily dependent upon Iheir ability to provide pottattack mod real support to all sectors of the population Our analysis of the available information indicates lhai ihe Sovieti have invested heavily in planning,conducting limited cacrcisca, and in providing pci so ond lor the Civil Defense Mediul Services

This paper discusses Soviet plans for moMinng. protecting, and deploying medical resources lor civil defense and assesses iheir potential effectiveness ll includes recent informal -o- on the scope of emerge* iy planning for irutmi.'i_il medical facilities, llic role of military commissariats in medical lesouicc allocation, prixrrtioo of mcdsca) personnel, medical storage keiions, and undeiground medieai facilities Although all source information wai unbred in ihe prcpaianon of this paper, the primary sources were emigre re pur is and unclassified Soviet em' defease medical leu books

Peacerimr Planning

So-ieieOie.iare eonirolled in peacetime bv bosh the Ministry ofnd Ihr Mimstriedical Induiiry The Mimsiiyof Health manages ncalmrni lacilities hois. polyclinics.

Table I

Estimate of Se*let Casualties aod Fatalitiesfpotbetleal US RetaJlatoty Anaek


CrVil Mora

Farces en Coiled Akn





awl tan pnHrctln lUvclura


iktoi mcutkn ofcrcoMOf XOckk.


smalldepartments of health at different administrative levels. It alsothe eareaxive net-rork of sanitary and epiderruo-loiOcal stations located throughoot the USSR- TheedicaUrJdustry is responsible rV the nisr.ufxcture of rharmaceoticah anduraraviacs medical stockpiles (see figure *i

The Civil Defense Medical Service is one of several services under the Defense Ministry's Mainof Civil Defense. In peacetime the Medicalconsists primarily of staff personnel responsible lor coordinating tbe civil defense efforts of the Ministries of Health and of Medical Industry. At alllevels of the Ministry of Heahh'.Bnd probably the Ministry of Medical Industry are Secondresponsible for integrating plans for conversion to wartime operations, formulating doctrine, andcivil defense medical exercises Soviet medical facilities alsoecond Depanment headedhysician responsible for planning and coordinating Civil defense training and mobilization. Uponthe medical assets of the Ministry of Health -ouldf the Civil Defense Medical Service

because trredical personnel and resources arc limned.

both ihe armed forces and ibe Civil Defense Medical Service compere for many of the same resources. The Soviets, therefore, face ihe problem of balancing the

medical manpower, training, and transportation rc-crulrtsrsents of the military with those of tbe Civil Defense Medical Service.believe Ihey are at-temptiog to resolve this problem by comUaina'commissariats and civil defense staffs

Miliiary enrnnvisurials are administrativesubordinate so the adrolnhiraiien of lhc nulitary district within which Ihey arc located. Their activities irsdadc supervising prandoctioo military training and indeeuination, saining callupa lor military service and reserve training, maintaining rccctrdl on rrserriru. aad issuing deferssenex.o arc responsible for registtrint utional eexanomic rtsourrxi suitable for mJ.iary needs, conducting partial or generalation. and altocaung civilian irintoonaiion forpurposes duringon


alsooleibe civil defcAse trautiag, daiulica-lion, and assignment of medical personnel and in the allocation of civilian transportation for civil defense needs,1 the civil defense ttafft of ihe Baltic republics, for example, were placed under ihe control of miliiary commissariats. If such subordinaiweit are the norm, they may be intended to balance the irvjbihoal re me all of lhc armed forces wiih

f civil defense, including diminilinx ihe posst-jbfliiy of conflicting assignf medical resourcesi occur wiihseparatecivil defense and ?ccVrnnii*aiiai staffs

(The Central Military Medical Directorate oa* Ike .Ministry of Defense's Rcai Services controlsiy anal reserve medical personnel distinct frora (hose allocaiodhe Cm) Dcfeauc Medical Services by Ihe mililary comoiiuariaU. Unclassified Soviet civil defense medical reals discuss Ihe use of mililary medical resourcca for civil defense purposes ia lac potutiack period. Although ihe psirraary mission ofrnilitary medical service ia io sausport ibe mililary. wc bdice thai some af its pc/sonod aad medical stocks may be available for civil defease. Military civil defease regiments also have limited medical treatment eapabililia and could treai some civilian caausllics in wartime The Civil Defense Medical Service probably coordinates the use of militaryresources with the Central Military Medicaldaring wartime

Train'ag. Almost all Soviet medical personnel receive extensive military and civil defense instruction al medical trainingour-yearilitary and civil defense training program at the Stale Medical Institute of Alma Ala is typical. Civil defense training at ihe Instltuic ix mandatory for both males and females, and the courses include combined instruction in basic military subjects and civil defease topics Among ihe civil defense fexpscs taughi are the treatment of nuclear, taotogicil. and chemical casrsal-ircs and ibe use ol protective clothing la some cases traditional militarymphas-red fortlc training for women conceniraica on civil defense topus

Civil defense medical training also it given al other specialired intimites One source participated in an esiensne mandators training program lor nurses al ike Vastus Pedagogicale program feaemriieriefense Irairjag and three semesirrs or mednalpo* graduation, lit rScnti were assignedhe military reserves ai nurses p. ihe miliar)imilaro rusts ainrrviv of I'thgororf la sddiiKHvim'iim. .in genera ll> lupervise fi'lt aid.

civil defense, and prcrnilitary training ofoaihs in Ike Volumary Society for the Ccopcrilioa of the Army.r. r. and Navy (DOSAAF)

Post graduate civil defense training of medicalis Bsually rnovided for by mihtary commitcml defense nails For example, someare assignedoune for residenttaughi al the Balashikha civil defense schoolOblxsi The course is taughiearabouteeks. *report that

hysicians graduate frees the course each year. They probably are then assigned to rnifiiary civil dafcartc units. In some areas, manney commusa iii ts mil! medical personnel to active duty every five years lo receive iwo weeks of civil defense training. The training normally is conducted at the commissariat ftcadquarlcrs by full-llmc personnel from the commisiariai'i medical section j

Civil defense ated-cal trainingivea alfacilities According icthe

amount of eml-rlefcnse-reiaied medical training given ai Soviet medical facilities varies, however, ihenorm isndear The training is planned by the hospital einl defense chief and usually consists of classroom instruction on tbe cxgaruration of the Civil Defense Medical Service and general topics dealing with neatf injuries ssoeiaied with unclear. biological, and chemical wai- -fare In addition, medical training for crnl defease paramedrical personnel in factories. Khoola. institutes, and similar enterprisesiven by hospital civil defense iniir vetoes and Red Cross/Red Crescent Society volunicerr

The general copulation also receives civil defense medical training atschools, and during military semce Thr> trainingiimIwScs basic (irsi ad. Such as ireaiment for barm, artificialsplinting of broken bones, and lieaiment for shock Training (or the general population alsopieveniive measures to reduce caiualttci after


a nuclearfor example, bowiemasks ind radiological and chemical measuringdec onon. and trncral instruction on ibe effects of nuclear weapons

raining through eaercisea appears ioihat many medical

facilities do in fact bold semiannual or anaualfor-paramedical (earns. They arc usuallyby peisonrvel from military commissarlaudefense staffs . a mops led in arrsobsliution cicrclsc called by Ibc Odessacommissariat The eserase included setting upDefense Medical Servtce firsi aidaad insirvc:cio on general cinlivil defense

medical tacrcisc withariicipaiiis in Tokmah in ihe Kirghiz SSR

h,ve reponed. however, lhal many

medical lactliitcs do noi engage in faeMFor eaaarrpk. the All-Union OncologyCenie' of ihe Academy o' Medical Science in-which, aireports, plaits so reio-

eatetale faros iahas uartsci-pated in civil defense csercisea or practiced relocation Lack or" field iraining at medscal facilities could result in severe problems with carrying oui retrxaiion plans in wartime. Although we have evidence lhal small-scale civil defense medical eacrcises arc widespread ihrovghoui ihe USSR, we have no information thaihe Sovietsomprehcauvemedical eaereise K> test ihe enme crvj defease medical net-lira Not having eon such est reives, the Sonets cannot be certain about ihe ability of ibe .yslcnt io accomplishissionarlinM

Urban medical tacililics. accordinghi part of an elaborate mobil nation -

alert notification system maintainedthe local civil defense stalls and operated initheons nun rial* In Riga, for eiamplc docsorson. how ith are required to telephone the Hifi ratal defeme sijlf voce aa alarm in the hosr-tal duty offW* MHimh the tlui) tlovtor then alens ihe hosceial .ivil defense chief and the leu of theift hen I'rnrd ihr hospsialdrlenw t'hiel

coordinates hospital mobilization with Ihe civilstaffs, military commissariats, and ittosc lacili. ties, institutes, and wheels, which may augment ihe naoeelired boar-ial wilb framedersonnel Wc believe ihai mc-cnliiaiion of Soviet nvcdical faeahties is iaiiiaicd by Ihe miliiary coeruBissarsaii aad. like other civil defense activities, is gore:red by changes iia Soviet armed forces readiness levels

Wartime (hgarUulion

Soviet unclasiified liicraiuie devotes much attention to the wartime organization of Ibe Civil Defense Medical Service. Wc think that lhc Mcthcal Service would cacrctsc open tional conlrol in wartime over lhc medical assets of the Ministry of Hcalih. the Ministry of Medical Industry. DOSAAF, and ihr Red Cross/Red Crescent Societies. We believe it also probably would coordinate the allocation of medical resource* wiih ibe Central Miliary Medical Director, aie during wartime

The wartime structure of the Civil Defense Medical Service would be based on ihe organization and personnel ol Ihe Public llcalih Deparimenu and medical facilities at each admi.nni.inie le.tlystem of dual eibordi nation. During warn me the director of ihe local Public Hcalih Depanment would become the head of ihe Crut Defense Medical Service for ihe area concernedember of ihe local civil defense uafl

frroimimCaivnfiei Ihe Civil

Defense Medical Service has developed anfor medical operations in 'he cveniunclassified

literature disclose that ihe plan is based onstages of ireatmrai and evacuation During lhc fustfust aid and emergency irejimeni wouldeaor near rimes of destruction, during ihe second stage, evacuation to specialized rwsi-ialsospital base area outside the target rone would take place ivte figure 1

In lot firti siaxe, firsideuchmeols(OPMi) would deploy to tun area* afler mobilizalWrif medical treatment facilities. Aa OPM cooipriscs physicians, nurses, and paramedical personnel who would ion casualties and provide eoerieocy kfeaav-ingndudiag deououmini lion of laoac ei-fxned io radii tioa aad limited bccpitiliutiM for the seriously (njttred, Casualties would be Ugred accord-iti* citcni of the Injuries, treated, and then; if: theii injuries required mar ipeoabirdi^ni.vacuated to base tost-tali Aaeserted lo> raissdk about JOOay_OPMa wosdd bejg deplored ia unccrrrrsjninaled'areas as close ai. possible to target areas-.lhcT ate heavily rkpcradeottdiolotlealreconnaissance to avoid areas lhai arc severely csmumiru ted or la the path of falkoui

Sennetefease puses call for arban hospitals to provide cadres for OPMi each snthersonnel, of whichould be doctors Large hospitals would provide cadres lufTicicnt for two OPMi, while imallcr hoapitali and polyclinics would provide cadres for one. Soviet planning also calls 'or the OPMe augmented by teams of paramedical perararaad from factories, minium, and sasvalarIn Kiev atone, we have repeating oneaig-naicd OPMs. each requiring augmentationatamedici

The OPMs arc to deploy and direct the operationmedical teams, each consisting ofparamcdiet whoderts. -orken aadof ihe Red Crrau/Rcd Crescent Societieswould deploy to severely damaged aicaswould receive casualties from civil defenseand give first aid. iben theythe seriouity injured to the OPM.give more citcnsrvc medical care ForAll-Unvan Scien-

tific Research Institute lor Ihe transport of Natural Cat in Kiev had twoarns, each Mil four five-member luuads. Upon mobiliaaiioo one team -ould irpori io ihe Lcmniaaya Regional Hoapilal in the oshei wpuM aid evacuees ami >setsrrn va or Mar polCMsal of deslnaelvon

In ihruorr spreialirrd mrdicate gnen lo ij !r.ho had received cmrrgrnct careAl i This care would be given in hospital

bases formed from the more spccialiicd huspitah aadesearch and trsining isutituics, wtieh would have relocated to eiurban areas. These bases, with ipeeialifed surgical stctiocs for treating severe Inju. ries. would be directly subordiaite lo oblasl or kray civil defense medical services. Soviet aactassificd sources assert that tbese bases could be as far aaoours' travel time from OPMi

A hmpiial base"would include ill lo'cight hospital collection points. Each hespita Wwl.'ctSoo point wouldain hospital, casualtycrallection points, ael Ken pi tail llsai BMhIm i" "aniui ea;eioriei of irijury. Collection points (bat arc nearest the target arcai also wouldpecial soiling and evacuation hospital. Less critically injured patients, who could be discharged or transferred lo their harries, probably would be released upon order of the Civil Detente Medical Service, freeing as many bods as passible

Casualties would be received and sorted at the lonlng and evacuation hospital, medical da tribe lion points, and evacuee reception pcarsts along access routes io tbe base area. After arming accordingnjury and verification of theor ma lion on medical lagsai Ihe OPM. casualties would be distributed among the hospiollexiioa points The Sonets would attempt locotocatc bosonst-collection points so patients could be evenly distributed among main boapilali

Ai the main huaraul. ihe seriously wenurdeda. those with avaltiplt injuries including rsrlii'.-o- espo.those with contagious diseases would br hoaptiatircd and treated Tbe main hospital isa gcncril hospital with additional assets for nuclear decontamination andest meal Pa-ilenii rcowring trrairncni not ivailabie ai ihe mam hospital would be assigned in one ol tbeatmeni beaspauli. which are the principal thciapeu-i. institutions of ihe collection pom

Akbough the OPMs probably could give rud.menury firsi aid io large numbers of caiualno. we believe thai Ihe Semen lace significant uncertainties about

ibe provision ofpecial iced medical cait in the poslaitaci period. Dclayt in transporting casualties ficen ibe OPMs lo he*piuI bases could result in many fatalities. Morcovef, the collection points al hospital bases co.ll be oven.helmed with casualties dsiting the medical eradiation. Shoelace* of trainedmedical supplies, or eouipcncnt in hastily eatab-lisbed hospital bates could cause additional problems.

StnilttT'Epldtmiologlcal opil

dcxtstcuogital nulls hanrpids} abo wouldey role in Soviet civil defense medical Operations. 5esnr-pos aie adnsiniaScnd ia pcacaLrrsc by Ibe Ministry of Fublae HeaJib. Tbeir peacetime Vogsnnfofc'ic* are inooeulaLing aad vacd-Lsiing the ceaveral pobJsc;and rodentater, dairy, and meal moni-torinsi and ladusirial andygiene They usually arc equipped with mobile la bora tiny and inspection CQulpmcnt and arc normally headedhysieiar

wartime, aanurruafs


OP Ml and baseassrban areas and providecalih care

responublc lot mast immunizations of iheto curb Infectious diseases ihat could result from radial ion-Induced tuppicstion of the body's immune lyiicm.

Ibai massive amountseon lamina led -aire would be available for OPM and hoapiul base operations.

lhc drsrscul of corpses aad of lane amounts of human wasterevent tbc spread of infectious diseases

from large urban areas would specialeaamplc. in Kiev ihe Shevehenko Rayon to be the IscaeJcruariers

fur raieus rpidemie eeinirol. Another aawvpref wouldfor waste control,hudihe disposal of corpses

thataintain current deploy mem plans and sulTieicnl equipment lo carry out their assignedmissions

wartime tasks. Fot ciamptc. during lhcepidemicidiirnaielylo control tbc spread of disease, bul tbc levelwas Quite large for the site of iheloaawaryafafj would

have such targe resourcca available so tkVcan in ibc nostaiucknlikely Similarly, larupidi have been only partially successful in controlling epidemics in Afghanistan In Ibe afSeeusalh of large sa krachanges, imtteptdi might be of hmatcdin coping with the cut break of snfe:iJous diseases

Rtlocmlif ana* Entemutio* ofoviet anedical facili-

ties localed Inftlcs plaa io evacuaie or relocate lo esurban areas In wartime. Of these.lan to evacuate whilelan lo relocate. Itikely,of the praniaun on trainednclesrall urban medical facilities would provide cadres for first aid detachciecii and hoapiial bases rather than merely evacuate personnel together with the patients. The presence ol emergency relocation and evacuation plans at these medical facilities indicates that the Sovietsgeet and evacuation ofand lantpld operations in wartime

Soviet medical facilities appear to beelatively high priority in evacnaiioa and relocation operations Unclassified Soviet civil defease medical manuals assert thai relocated medical facilities would assist in lhc dispersal or relocation C* the essential work force and the evacuation of the generalGiven adequate warning time, we believe ihai civil defense medical facilities probably wouldafter tbe leadership bad relocated so esurban command potts, bur before the diSprrsal. evacuation, or relocation of ibe otherf ihe papa Lima iseend appendix A

A major problem for the Soviets is providingbuilding space in which relocated medicalcouldhatsuch as ihe Lopokkin Special School outside

Soviets lace sigmlicani uncertainties about the ataliu .u" ihese teams to carry oui then assigned

Lcningiid. tux been designed for cnnvcision to emergency medical facilities during wartime. Hie dciign Includes apodal electricalareas suitable for anbuUsvces. aod Imag areas that would brume patient wards. Dual*purpose desiga of oluca -Nona! ind Otber buildings couldrge aersowat of space foe relocated Iv3tp.uls We arc usuurc bow many buildings sstceUDOratt such designs, however

Pcisc-norl Allocation nod Protection

' In peacetime, medical personnel generally areinto the aimed forces upon graduation orreserve military service booklets,

booklet, issued by.miliary coenmissart-

in. con liilitary specialty code. reponJagutoo mobil. ration, and other service-relatedMilitary medical personnel aof active duty are issued smnLirUse Soviet ta* on universal asalatarylhc reserve retirement agend length of servscc-

ej miliary commissariais"generaH/carry male medical reservists on miliiary reserve rosters until age is, when ihey are assigned permanently to civil defense reserves. Female medical reservists usually are assigned to civil defense reserves al age 50

Table 2

Soviet Physicians, by Specially

3it_ iis


I Maul mcdldae




ll_ 1*





Gcacral fraeiiiianeii

are uncertain at lo the numberhai would be allocated lo the armedcivil defense afier mobilisation, but wnnravaiUbat for ciil defense after the needs ofiorecs were met Even though lhcof medical persoone! would be to supportaccordingsome medical

reserve personnel anighi be assigrsed lo civilian hosp.-uti allcr mornji

We estimate lhal lhc total number ol medicalavailable io both the Soviet armed loices and civil defense in wartime would beillion There areillionhe USSR isee iiW<here are9 million medical peftonnrl including /elafiAenane*bburator) lechaatiars medical or dcrl-ei and rather astasia ana Weo reliable figurn lot medical workers bs eategory sinee theseeneiiem -ere /rWihr'l. M) peiceni -eirerceni hnaciansoi oihei medical personnel

Medical personneley resource for poattiinch recoveiy Consequently, protecting them inriority of ewsl defense Wc have ick-ii-fied or have reporting oraedical facatilica with personnel shelters We believe that ihese tbellcrs are designed primarily lo protect medical personnel when warning time it inadequate to allow for relocation or evacuation of the medical facility. In medical factli-lacsiied shelter space, we believe lhal medical personouldrioresaiiciste.

Trans aortaiio*

The military and civil defense compete for transport as -ell as for medical personnel During risobthtaiion. the Soviets planransportation assets from the civilian economy to meel ihe needs of the armed

lorccs and Civil defense: allocations ofI would

be made through ihe milns'y commnsariati One source reports thai the Moscow Main Administration

ofiron would transferncoii of its bitty trucks, JO percent of its lifting machinery, andercent of ill fuel-cart ying vehicles to theMost of lhc rest would be available lor use in civil defense We believe that, oei completion of mobilira-tun. the military commissiriais would make addition -al transportation assets available for tbe medical evacuation and supply of civilians. Militarya bo maintain rotters of civilian imbalances lo be mobilized io wartime

Wc estimate that ihe USSR hasX were built1 alone Although some of these buses would be used to support tbe military, many probably would belor civil defense. Modification kits for converting buses to soibulsraces have been available since atut wc are uncertain ashe numbers andf these kits. The conversion process,requiring four to si< hours, involves tbe addition of It tiers aad rraediCal equipment and the painting of windows. Onceus can accommodateo JO tt re letters

Soviei unclassified sources also mention ibe arte of special ambulance trains and waicr transport tocasualties However, wenfocmalion on the esieni of planning fot use of ihese transport it ion alien by ibc Civil Defense Medical Service in war-lime


The So-lets baretockpiles of medical equipment and supptres for CM defense We hart


facilities ihai maintain medical reserves These range Irons simple fun aid kxs stored in personnel sheltersartime pharmaceutical stocks kept in medical depots. Must of the firsi aid kus1 medical kits that contain banc support. inn painkillers, bandages, and ilrrichen Such km are earned b> ihe OPM medical teams Many shelters are stockedaid kni. but noi all are equipped1medical slurki In 'he, the Sovirii eprxarcnili changed iSwttci guidebncs and deleted the requirer medical kilt Ihosehr Itersere brlcie the change in cnilfUiue lilel' etpl'naiionthat ibri ait pan ol ibe cquinnsenaedical itarnearn whea uits doiemteit Or".'

Medical trealrncnt lacslilies arc required toolo-three-day supply of medical stocks fcuse only They are generallyospiial basements and are requirede rotated periodically. Warehouses and pbarmacica also are required to maintain emergency sleeks for treatf chemical and henOgical casualties as well at othei essential wartime medicines; Ihey probably have wartime plans to provide medical supplies lo relocated hospitals eport ihat ibere arc special civil defense medical reserve supply depots only for wartime use Outside Odessa there are three groups of wartime reserves capable ofatients iabospitals The Odessa Mocks reportedly are under ihe direct control of the civil defenseof the Ministry of Public Healit

Although the Soviets maintain extensile medical stockpiles, we are ascertain atow long these supplies would last under conditions of nuclear war. Even during peace lime the Soviets experience periodic shortages of medical suppl.ei ia certain areat. and sleek piles in other areas art not inspected and rotated Alto. Soviet medicines generally areeaser quality than those commonly found in the Weil Moreover, certain drags, available only from Western sources, presumably -Ould be unavailablehe Sovietsvartimt

Underground Medical FacihlrM

We have rcprtrtuig onnderground medical facili-nea located pnmarily in urban areas Most areequipped dispensaries in special basement-type shelters in boazariait and rolyctiGiC* Others have Cltcnsrvc underground Theots fact lily was constructed7 liasomall treatment rooms, coniains reserve medical supplies and equipment, is connectedhe mam buildingetwork of urderground paxiagcways. and it hermeneally sealed

"mi on some eaurbanfacilities designed to support Ihei-ipu!jlion For er_ s<rua<oaountainil isupport the emlua porMlairoucity after evacuation. Other undergroundarc designed at iterate depots foemedial roufi In

7'c*erve hospitals, ejuipped wiih medical supplies [round racililics, ate maintained by cadre for wartime use by the Civil Defense

1 our-evidence indieaiciargerban hotpiuls planelocate or evacuate ia wartime, we believe that tbe urban underground medical Inet are designed to provide limited rned-cal support lor ihe leadership, essential wort force, and mher personnel who must remain in these areas dunng wartime. Tnese facilities aVan terve as shdlers lorersonnel who may not be able lo evacuate or relocate in wartime. Ei urban facilities are designed lo serve casualties who would be evacuated from Sovki eillei and to afford additional protection atainit radioactive fallout Although we hiv; report, ing on onlysuch fgsiliiies.elieve thai many

more rfill


The ava>Ulw r> iOer.eethai ibe So-mis bin liken rueume meatuieiedical ivivO" for ihei[ ilse posiaitacl pood They prubabl) believe that these prepaiai'Oni enhance their prospc'"reducing fataliiies should nuctcaiMtur

Although ihrir apnea's tooieniiil for oonHict briween rnilitai) anddelenier ihr si>bu<di nation oldilnstallsilit.riin tome areasl nwdieai

peiwuinrl and evnlun iiantroiiaiian asuis Nr-ei

ihr Wii fae*vneciamiro

Vs> ol ibe Cm) Oelense!

rr-Iwrwi Msmillion ha* Ihtsr


tai.imi-jiamfa.ntabar lo moU-lii.iliv"


- Lack of iaicgrated rruaJkal exercises designedest ibe Oil Defense Medical Service'a abanty to mobihsc, relocate, and operate medical facilities

ag wartime.

of appropriate medical supplies andireal thenumber of casualties expected.

of medical personnel despite Ihe emphasisivil defense training for large numbers ofand paramedical penooacL

with MHr/td eoeraiions ia peacetime lhat bring irao question ihe ability of the immtrntdi to jccocnpliih their wartime mission.

implements lion of staled civil defensegoals and Ihe consequent abiliiy ol mcd'ca' personnelerform their wattinve roles

Despite these underlain!id. the civil defense medical program continues to receive sutu tan till emphasis The Soviets probably wsH coniiamtork an improve their abilityrovide posuttaek medical supporihe population Subordination of an! delenie staffs to military Cwmmnssriais in other regions ton Id improve medical mobiIllation and resource allocation inThe Soviets probablycontinueipand medical stockpiles, lo eontliwci Shelters ai hospiiMs and polyclinics, anduild undriground medical facilities Iirteiy ihai ihe-Ji

IO improve lh> qwahiv and' '

1 riming for medical personnel

Soviei civil delcnse medical planning has iinpu'tani implications for iltc United Stalestn estimaicd Ihe loial colt of ih* program, ihestcd heavily n. medicallor nuetcai wai Tbe scour ol ihrse niivuoihai sue* gaeoarations yiifi CuuM rr

dud laialrim among-*hnVr.aair vjimnrj imw


fh< Snvici* oivbaMymolnlifi ihebe'oren thoughei<,

C_ rw

Original document.

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