NATIONAL SECURITY INFORMATION Unou'horiiad Oiidoura Sub]ec1 lo Cilmlnol Sonciioni
Soviel Civil Defense Medical Services
CentralAgtmev Nalttmal Fortxn AMramrnl Onlrr
B
Key Judgments
The Soviets appear Ioomprehensive and elaborate plan for mobilizing all civilian medical assets in time of war or natural disaster under the Civil Defense Medical Service. The plan includes provisions for the orderly transfer of medical personnel from threatened urban medical facilities to organized groups of medical facilities previously established outside the cities.
While no system of medical services is capable of fully coping with the effectsassive nuclear attack, the USSR probably couldignificant measure of medical assistance to casualties If it received sufficient warningthe order of several days.
Despite the comprehensiveness of the medical plan, in the eventeneral nuclear attack, Soviet medical services could not prevent high death rates among the seriously wounded and would allow only relatively low rates of return to duty.
Because of the size and scope of the civil defense medical plan, full implementation probably Is beyond present Soviet capabilities.
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itnff
CONTENTS
Page
KEY
SUMMARY
DISCUSSION
Organisation and Function ol lhe Civil Defense Medical
vel
Field
First Medical Evacuation
Strengths
Weaknesses 'j ', ' '
Second Medical Evacuation
Strengths
Medical Care at Dispersal and Evacuation
Malor Medical Problems Expected
Surgical-Related
Radiation
Health Problems Associated With Shelters
Protection of Food and Water
Water
Food
Number and Quality ol Medical Personnel
Medical
Stockpiles (or Civil
FIGURES
Page
Soviet Medical Organliatlon for Civil Defense
Soviet Medical Evacuation
TABLES
Page
nbltabillty Factorstandard Shelter
I Soviet Food Storage Requirements for Urban
SOVIET CIVIL DEFENSE MEDICAL SERVICES
SUMMARY
Soviet Civil Detente Medical Service hu developed an elaborate two-itage plan for ming ill the wets of the Ministry of Health to evacuate and treat casualties In the event of war or national disaster. In the first stage, mobile first aidconsisting of physician) and paramedical workers from city and local (rayon) healthfirst aid teams from factories and other installations are to be deployed from their shelters to the edge of the "tone of lighthe detachment! and their subordinate medical teams rre to perform emergency life-saving services, decontaminate persons etposed to nuclear materials, provide temporary hospitalization, and evacuate casualties to the hospital base area.
While plans for the operation of thepprar adequate, the site and composition of units could vary significantly In different areas of the USSR depending upon the availability of local assets; In case of war some physicians now assigned to themight be drafted Into the military and thus would not be available for civil defense duties. The Soviets estlm/tle that at leastercent of all casualties will require specialized hospitalization and that an average handling and transit time of abnut three to four days will be required for casualtiesch such facilities We estimate thatndercent of these casualties can be expected lo die because of the delay In receiving definitive medical treatment.
The second stage of the plan consists of providing specialized medical care at hospital bases outside the cities to casualties from the "focus of destruction" The hospital basesombination of eipanded existing medical facilities, converted buildings, and/or mobile lent hospitals of upeds. According to the Soviets, they may be "lens of even hundredi" of kilometers away from the urban target areas they serve, but In no case should they be more thanoours away. Each hospital base manages two or more collection points, and each collection point Is to manage eight types of specialized hospitals, moM of
which will have to be created entirely from local medical assets.
The main hospital of each collection point iseneral hospital with additional assets for nuclear decontamination and burn and shockIn the event of mass casualties, the nvin hospttab are In the greatest danger of sudden overloading because most casualties will be sent there first before being assigned to an appropriate specially hospital.
The comprehensive organization of 'he hospital base Is well thought out but is beyond the present capability of the Soviets to Implement fullv. The acquisition and marshaling Of highly traineespecialized equipment, and essential drugs In the amounts required lo create large numbers of dght-hospitat complexes wouldevere burden on the Soviet ecoromy. The problem of what to do wilh existing hospital patients alto Is larger than the Soviets appear lo anticipate. At present, the Soviets seem lo Indicate that those pailents that can be sent home will be discharged: that those who cannot be moved will be senthere are nu hard Indications of where "elsewhere" would be.
Another Important problem Involves Ihe number and quality of medical personnel. The Soviet medical establishment5 was estimated lo containhysicians (possibly Including ihose In ihr military^hyslclan-lo-population ratio of about onen addition, there areeldshera (doctor'sillion nurses, andther medical workers ca|nhlc uf rendering first aid and other treatment during an emergency. These personnel, all of whomprobably trained In some degree In civil defense medical operations, staff at0 hospital units wllh atillion beds.
If all categories nf medical wnrters are combined, the system contains an estimated one medical wnrler
SCCf^T
dir every H2 jierwins Tills llgurc Is impresslw Init il intiU br> (docrd In perspective Tin- first aid training received liy km-level medical workers and members of fuc'.or) civil defense formations Is rudimentary anil. In any nur, is limited in value brctiaw It is only tlw Inltliil step in thi- treatment process for moderate to severe Injuries. At the levrl of nurses and frldthers, medical training for civil defense is more advanced and Includes selected aspects of trauma management us well as some practical training. At the physician level. Iiowpver. except for specialists. In-servicetraining In tlie management of sevrre tranmu often consists ofew hours of lectures und includes little udvaiicrd clinical cross-train lug. The average narrowly trulned Soviet physician Isoor imtitton to function effectively as, fort.rgctm Rrcause surgery Is the primary medical skill required In emergency treatment uf blast Injuries, anil tin- specialized hospitals require large numbers nf ntlier specialists, the main Iwrdcn for providing definitive medical care rests on existing surgeons and other medical specialists, who are In chronic short supply This limits the Soviet ability to render ilef Inltive treatment to man casualties. To date there Is no Indication that the Soviets have begun aphysician training program in disaster medl* cine sufficient to rejleve this limitation This situation cnuld seriously reduce the Soviet ability to return cosuultlrs lo full productivity.
Overall figures for medical manpower and hospital beds are available, but the lackreakdown of physicians by medical speciality makes It difficult to determine how many physicians In the critical specialties are available and thuseasonable estimate of thc number of casualties that might be expected lo receive definitive treatment In the speclallml hospitals. The only available data that
r
address tlir rapacity nf alnrtion of tlw Soviet mctlu.il estalilishmenl to functionuts casualty situation concerns tlie results of Nosier, training exercises undertaken several yean ago lhat Involved tactical nuclear strikes In frnntul-s'/cd area* lu these exercises, all medical facilities in lhe sirike /ones would haveew days, and after about two weeks thr accumulation nf untreated casualties would have reached well over one million. The Soviets, therefore, must be aware of at least some of iLr drflclcncfe* of ihelr medical establishment In copinguclear strike. At present we cannot moke an accurate estimate of lhe maximum number nf casualties that the Soviets could adequately treuleneral nuclear attack
Medical support must be provided in dispersal and evacuation areas. For the most part,rsonnel. supplies, and facilities for this service would lie In addition to those serving the two stages of medical evacuation, but there is no hard information on how many medical assets would or could be commuted to this effort. Outbreaks of Infectious disease, possibly facilitated by radiation-Induced suppression of the immune response, wouldignificant health problem, particularly among children In the past the Soviets have had difficulty containing extensive outbreaks of Infectious disease, such as the cholera epidemic in the Black Sea areahe Soviet peacetime capability lo contain Infectious diseases woiikl degenerate rapidlyeneral nuclear attack.
Although the USSR almost certainly lias extensive stockpiles of medical materials, their location nnd thc amount and kinds of material stored are not known. To date, only one medical supply depot for civil defense has been .Identified and located.
DISCUSSION
AND FUNCTION OK TIIK CIVIL DEFENSE MEDICAL SKIWICK.
Tlie USSR opia-an toomprehensive ami elaborate plan for the mnhilimtion of all medical
facilities, equl|>ment.miles In the
evrnl of war or natural disaster. In the event of war, medical support plans apjurentlynn attack onSR with large numbers of nuclear weapons of moderate yield, folkiwrd by chemical and nmslMy hlologlenl weapons where appropriate. Civilian medi-
cal assets arc to be moblllrcdotional organisation referred In as the Civil Defense (CO) Medical Service which is one of several services under the Defense Ministry's Main Administration of Civil Defense (OUCO).
Ministerial Level
Tlw Ministry nf Defense Is the central authorityanaglnc military ami civilian medical asset* for civil defense.'
Military mesllcui asset* (forhealth) an controlled by llipOrrtrul Military Medical Directorateunder the Hoar Services Directorate. Organ!-rutiihis subordinate to CMMD Include: tin- Mrtlical Srrvkr. whkhilitary Medical Directorate In rut Ii nfll Militaryilitary Medical Academy; Military medical researchhlrfentral Militarycientific Medkalhile lltr primary mission of the military mrtlical service Is troop lieu Ilh. military medical units that may In-operatingisaster area are liellevinl lontile civilian casualties If local medical facilities are absent orn additlun. the first aid units of the military Civil Defense Regiment* also appear In accept some civilian casualtiesart ol (hi-li
MIAMNll 1
Civilun medical assets appear In lie controlled in wartime hy CI 'CO whicheadquarters in each military district, union republic, oblast. rayon, and city1 The GUCO lieadquarters al each of these HitmliilMriitlve levels istlufftluiledical service function among its other civil defense services. The organization called the GO Medical Service probably Is managed hy the GUCO staffs mentioned above.*
The UO Medical Service of GUCO Is believed looperatkmol control In wartime over the Medical assets of the Ministry of Health, the Ministry of Medical Industry, and the DOSAAFVUCHCS" organizations at all administrative levels. In jieacr-tlim'. the CO Medical Service mission seem* to lie the formation of doctrine and the planning andof eserclses. The GO Medical Service probably also coordinates the wartime Interface between military ami civilian medical assets.
Tltr Ministry of Health controls essentially all of the civilian medical services and facilities of Ihe USSR In peacetime. This Includes the sanitation and onti-rpldemic operations nf the extensiveitle-iniiiliiglcal Service network throughout the country. For civil defense purposes, the GO Medical Service Is lielievrd lo exercise Its control ovrr Ministry of Health awctsnit called Department I. which Is represented it all Ministry nf ileallh administrative levels from union republic down to rayon amiIm- GO Mrtlical Service alsooordinate with the Ministry of Medical Industry to plan for an
* Voluntary nraantultm for cooperwllh Ihe Army, Air far*Navy.
ron/Rni Crnrent Societies
udequatc stockpile of drugs and medical equipment for civil defense use, Iml the exact organizational link Is not known.ummarizes the general organization of medical assets for civil defense.
Field Organization
The CO Medical Service, using all of the assets of the Ministry of Heullh, has developed on elaborate plan for medical evacuation and treatment In the event of un attack with wcb|hiiu of mass destruction. Tlie medical plan Is Imsedwo-stage evacuation and treatment system In which ihe first stage consists of first aid and emergency treatment In or near iho focus of destruction, followed by evacuation to second stupe specialized hospitalsnspliul base area aulslde the target zone.
First Medical Evacuation Stage
Units of the first medlcul evacuation operate within the urban target zoneass destruction weapons attack. The Soviets divide urban target zones into four sub-zones as follows: total destructionsx/cm*evere destructionom'ight0g/cm*nd possible destruction.*1
CO Medical Service First Aid Detachmentsrganized from local public health and industrial enterprise assets, are deployed to ihe edge of the zone of light destruction. These are mobile units that2 physicians and numliers of nurses ami paramedical (feldshcr) personnel. The OPM ure to sort casualties, provide full emergency life saving services, decontaminate persons exposed lo nuclear materials, provide limited hospitalization for the seriously wounded, evacuate moveable casualties to the hospllul base area, and other services as required. An OPM is programmed to handleasualties per day.*'
PMs deploy and direct the operation of medical teumsnd smaller medical Irani detachments that are formed from Industrial workers nnd members of Red Cross/Hed Crescenthe SDs deploy In the severe destruction zone, receive casualties from GO rescue detachments, apply first aid In the light destruction zone, then trimspnrt the casualties to the OPM. One of the most Important of the OPM functions Is the preparation for each casuallyedical card that Is to conlaln Information on ihe Injuries sustained, the treatment received al the OPM, the treatment needed al the hospital Iwse area, instructions for transportation, and other vital Inlor-
SFCBEI
andpparent that any mistake* made on the medical cards under the chaotic conditions that would wist at the OPM following ancould adversely Influence the whole courseasualty's timely evacuation and definitive medical treatment.
Rescue and Initial first aid and life saving treatment In the first medical evacuation stage may be further supported by military medical companies and platoons of regimental or battallon-iliud combat arms units that may also be In the strikehe degree to which such units may handle civilian casualties, however, is not clearly stated. In particular, it is not clear whether civilian casualties would be sent to military rear area hospitals or to GO Medical Service controlled hospitals In the GO hospital base area.
Strengths
There lldetailed plan for the rescue, Initial treatment, and sorting of casualties from urban strike zones.
Approp-iale medical units have been or are to be formed in peacetime from local medical assets.
Medical units so formed are lo receive regular classroom training and usually some practical training and drills.
Medical supplies for Initial unit supply loads are said to be stored In hospitals or state storage facilities where in theory, they are quickly accessible lo the GO Medical Service uniti
" Transportation and communications are to be furnished by the approprlale CO services (motor vehicle transport, and communications .services).
Weakne$$et
a OPMs and subordinate teams would differ ind personnel composition depending on what assets happen to be availableirttcular urban area.
Training of medical personnel for duty In an OPM often does notnowledge of the specific emergency plan which Is nearly always classified.
Most physicians In medical facilities frnm which OPMs and other medical formations are to he formed have military reserve com-nitments. and manywould not be available for GO service* during war.
because of the uncertainty of physicianan overdependence seems In be olaced on nurses, often for medicaleyond their competence.
ays estimated by the Soviets to be required to sort and treat nuclear casualties and transport them to the hospital base probably would resultercent mortality rate among the seriously wounded.
should receive special management have not tbe training has been
Many physicians who training In severe trauma received such training or Inadequate.
It is doubtful that medical supplies will be readily available for civil defense either Initially or in the post-strike period.
The GO Medical Service will be in competition with all other GO services for limited motor transport and communications facilities, and In the present near aliscnce of an air medical evacuation capability ll Is highly doubtful that numbers of OPMs operating atatients per day level will be able to maintain an adequate and continuous evacuation schedule to the hospital base area. Many of the above weaknesses could be at least partially corrected over the next decade buto Indicationorrective program of adequate Intensity has been initiated.
It seems likely that the most effective medical units operating In urban strike areas will be military medical companies and platoons supported by mobile military field hospital facilities. The militaryand paramedical personnel generally are better Iralmd and equipped than ar- the civilians, and there Is an Increasing military Interest In air medical evacuation. It could be thai the military may be charged with the rescue and treatment of VIP and other key personnel casualties where possible.
Second Medical Evacuation Stage
The second medical evacuation stage consists of delivering specialized medical care to casualties who have received emergeiure In the focus of destruction, This stage Is located In the rxlra-urlsan zone and consists of maximally expanded existing medical facilities, buildings that can be converted Into hospitals, or mobile hospitals of upeds deployed In* The combination of all such facilities managed by CO administrative staffs at nhuW. nr kray level isospital liasehe RR may be located "tens or even hundreds" of
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MLOiCAL EVACUATION STAGE V
MEDICAL EVACUATION STAOE
ZOH" C* *JSSiBif /
MMNUConw-AT
Hiltil FWMi
TmAi OMkMmhI
ihMi CaiMM*
oviet Medical Evacuation Hon
awny from tho urban target areas they serve, but In no case should they be moreours away. The Soviets estimateot less thanercent of the casualties will require specialized medical care.'
Bed* available within the BB arc grouped into lutspitul collection points (MK) These ate demarcated nrros within which are located numbers of hospital facilities. Each BKain hospital, hospitals associatedight cnsualty collection point, and various hospitals that specialize In certain related cutugnrle* of. UK* located nearest lu target areus contain, in addition to thepecial sorting and evacuationll patients that can heor transferred lo their homes. In certain designatedr lo remote arras fmni hospitals committed for use by the nit are In bo released upon an order from the GO Medical Service,
thus freeing as many beds as possible for expectedhe dispersal of large numbers ofsons to other faelllties Is espectH to prove more difficult than the Soviets now appear to anticipate.
Under the control of the BP. soiling and evacuation hmpllal, medical distribution (Mints and evacuee reception points positioned along access routes to the BB receive and sort casualties from tlie destructionfter sorting according to Injury and verification of the Information provided on medical curds prepared at the OPM. casualties are distributed among the BKs. An attempt Is made to loud all BK* concurrently in as not to overload some while leaving others unfiled"
Within the BK, casualties are usually directedlhe soiling and evacuation hospU.il to the main hospital, where the seriously wounded, Including
RET
Injuries (radiation plus other Injurnd personsisease! are treated ami iWpiulued. The main hospital of each UK Iseneral hospital wllh additional asset* For nuclear Jecontainlnitlon and shock treatment. In the es-rnt of nun casualties, it Is the main hospitals that are In the greatest danger of sudden overloading. The remaining patients are re-sorted ami assigned to one of the special zed treatment hospitals on the basis of type of Injury.*
The specialized hospitals* are the principalInstitutions of the BX. and Iheir mission Is to retain patients until recovery or death. The Soviets stress that the luccess of specialized hospital* depends nncientific and administrative rnarugernrnt. competence of physicians In treating severe wounds, training and competence of secondary medicalupon which very heavy reliance li placed, and udrtpmtc ami timely medical renippty.'
Strengths
The hospital base (BB) ami hospital collecting points (BK) ore well thought out and organized nn paper (or handling mass casualties.
All eiistlng facilities tn the area ate Included and few new buildings would be required.
i.x'.il (oblait, rayon) medical administrators and professional [lersonnel arc to be used lo administrate and operate IW/BK facilities and thus would already be familiar with the facilities, area, and people.
Med'cal supplies could be conveniently stock piled In or near the BB facilities.
The concent of trying to treat rubied categories of injure* In special hospitals is medically sound.
Wnknean
'nm and their subordinate DKi will differIn- quality andf medical aueli that would be available for civ iiWnie depending on the part of the country In which they are located.
erly removal of patients from hospitals committed In the RRar alert arenu unlikely because very few facilities are known to be set aside to accommodate such patlenU.
The conversion of large numbers of hospitals and clinics In each of many BK areas In eight different
ortMlnsjn IhehmpltaU
types of specialized hospitals will require theand distribution of far more equipment, supplies, amisonnel tlian we believe the Soviets capable of muklng available In the limited time between mobilization and Ihe Initiation of hostilities.
Miliar bottlenecks beyoiKl that already estimated al the OPM likely wilt develop at (he sorting and evacuation points along the routes to ihe BB anil at the main hospitals of the BKs.
The main hospital In each BK will function like the newly developed Stationar huspilob (municipal trauma centers) and can be expected to suffer from the same shortcomings of poor diagnosis, lack of competent specialists, and poor coordination between depart ments,"
Paperwork associated with the sorting,diagnosis, and treatment phases appears excessive and confusing and probably will prove
Despite the shortage of medical specialists, there Is almost no evidence of advanced training of Soviet civilian physicians (most of whom are narrowly trained general practloners) In the various surgery-related specialities required at the specialized hospitals.
Burn hospitals, because of their great material requirements, probably will not all receive tin-necessary supply of specialized equipment required for treatment of large numbers of burn lasts, and the return to duty rate Is expected to be very low and expenses very high.
Toxicol berapeutlc hospitals, like burn hospitals, require far more specialized equipment forof radioactive and other toxic materials than the Soviets are apt to be able to provide now or over the next few years.
respite specialized hospitals, combinedparticularly those complicated by significant degrees
1 of radiationexpected to experienceortalityery low percentage of return to duty.
jAi waa true In the first medical evacuationimely transportation Is expected to be limitedignificant factor In increased mortality among the seriously wounded.
Is clear Indication that mosl nf llie hospitals nf the RKs will be forced lo place ton muchon nurses and oilier (Kirn medical personnel.
Medical Care at Dispersal and Evacuation Area*
Medical Care mustdelivered lo work:shifts ilo location* oulsidr of target dtlcs and to ihr remaining city population permanently evacuated lo thr countryside The principal medical problems arc -xpevted tn be inkirles Incurred during lite movement lo evacuation areas. Infectious diseases, and radiation injury. Following such treatment as may be affordable to move-incurred Injuries, the main activities mustun nd sanitation and epidemic monitoring and radiation monitoring. The sanitary-epidemiological aspect would be of special Importance if use of biological weapons is suspected.
The GO Medical Service li to organize and deploy Medical points consisting usually of one physician orurse, ond medical orderlies, the exact size depending on the average number of persons per day seeking medical care. Facilities can be any shelter where Iwofor treatment and one foravailable. Eucal elements of theof Public Health are asked to provide medical suppJirs for the Mr lical Points.*
This activity Is vital In the weeks and monthsuclear strike because all of the surviving ixipiil-iiHiii. both urban and rural, and particularly (he children, will Ix- In ihe evacuation areas. Major diseases*ihly facilitated by depressed immune lesponses due lo radiation doses. could result in substantial mortality since most of (lie available medical supplies probably will be commuted to military use or lo the filis. The success or failure of this medical effort will depend primarily on Hi" rapid Identification of Infectious diseases ami prompt Isolation of ibe sick, hopefully In Infection hospltab of the nearest BK The Sanltary-Epidemiologlcal Slallons would figure prominently In Ihis effort. Another factoronsidered It liow many physicians orpersonnel can lie spared from civil defense .ind or miliiary medical facilities In monitor and care for persons in the evacuation areas.
Although ihc Soviets emphasize infectious disease pmpJivlatU. outbreaks nf <najor infect lout disrate* occur frequenlly. ami on moil occasions early warning ami attempted rapid anll-epklemlc actions have proven Inadcq-uch Inadequacies can be expected In worsen substantiallyuclear attack.
MA/OB MF.DICAI. PROBLEMS EXPECTED
Surgical-Related Problems
Surgical personnel working In the zone ofand the extra-urban zone are expected toseriously Inadequate In number" and apparently will be backed up largely by non-surgeon physicians and nurse teems with some practical training inhe few experienced surgeons apparently will be usedlargely In the specialized hospital* of tlie BKs in ihc extra-urban zone.'
Soviet medical articles on surgical care In the stages of medical evacuation emphasize the treatment of shock and discuss in detail surgical repairide range of wounds. In general, the discussions describe Soviet and Western procedures and techniques of, wilh occasional references to more up to date treatments. For example, in the treatment of traumatic shock emphasis is placed on (he use of outmoded dextran-type blood volume expanders, saline solutions Io which areariety of nutripnts and other materials ofvalue, and even theof diluted sea water for physiological saline solution in emergencies. In most coses, (he use of whole blood In the treatment of shock is not mentioned except to indicate that transfusions are generally lo be performed at(blood collection)ortality can be expected to be higher wilh the use of outmoded methods and materials.
While discussions of surgical methods of wound resection often reflect pvacticies and philosophies of the period of World War II and few discussions of civil defense surgical treatment reflect recenlin traumahl* does not mean that most Soviel surgery will be entirely inappropriate under mass casualty conditions. For example, the Soviets have always favored the use of local anesthesia even in major surgery. While pain would be greater with local anesthesia. It permits surgery in cases that would have to be dangerously delayed If general anesthesia were contraindlcated. Also, the use of preventive doses of antibiotics would reduce ihe danger of wound Infection, thus making reasonable delay In surgery tolerable. On the other hand, while the Soviets manufacture and use many modern antibiotics, they continue to use early sulfa drugs such as sulfanilamide that exhibit relatively high toxicities. Also, tbe usefulness of Soviel anllblnllc therapy and preventive treatment may be greatly offset by ihe very low doseslhan those used
SEQJREr
y the USactornd the variableftenoviet antibiotics."
Dm- to antiquated swglcal practices plus certain questionable medical methods that are uniquelyany surgeons inSSR operating under mass casualty condiltons probably would experience higher patient molality and significantly lower return to duty rates than would be expected from US or most NATO surgeons This shortcoming would be largely overshadowed, however, by the increased losses [ esulting from the performance of surgery bywith inadequate surgical training. Also, to the Soviets, surgical resection ofrobably could not be performed earlierays followinghis alone could produce0 percent mortality among lhe seriously wounded.'
Radiation Sickness
The Sovieis appear to consider tbe short and longer range effects of nuclear Ionizing radiation to be the most dangerous consequenceuclear strike.'*na general countrywide nuclear attack, the short-rangeazard would include prompt casualties from initial radiation and fallout casualties from local bursts and from bursts upwind. Fal'out from upwind bursts may arrive after local fallout has abated lo non-lethal or even safe leveb and after people have vacated the shelters. Residual radiation from fallout wouldonger-range hazard of weeks and even months duration.
Soviet literature on the treatment of radiation sickness appears quite complete and Indicateshey have drawn heavily on Western researchxperience In lhe development (on paper) of their wartime treatment plan. Blood supplies, laboratory facilities, and qualified medical personnel,robably cannot be made available in amounts sufficient to deal effectively with masshe Soviets realize thai dosesonizing radiationads will produce acute first degree radiation syndrome andads will prove lethal toercent of the population sone-time exposure loads Is given by the Soviets as the standard permissible dose beyond which some signs of radiation syndrome will appear that would require medical aid from the already heavily strained CO Medicaladiation pnitiTtlnn rather than treatmentill be emphasized. The Soviets indicate that persons having receivedads are consiilered terminal land will receive only palliative treatment*
HEALTH PROBLEMS ASSOCIATED WITH SHELTERS
Decent reports suggest that Soviet civil defense shelter design became standardized during5 period and lhat tliese shelters constitute most nf lhe ones now beingascmenl type shelters arc preferred in which the shelter iseparate structure from lhe building on top of it. heavily roofed and withm or so ol sand or earth between the shelter and the first floor of the building on top There is some indicationumber of rider shelters are being brought up to the newer standards. Capacities of these standard shelters appear lo. and there are pluns for
Data on these shelters that directly affect habit-ability are shown Inr"
Most of the standardized shelters now being built in target areas appear to be of the type employing air regeneration facilities, plus small amounts of outside air. and backed up by an unknown supply of compressed air in tanks" This option allows for periods of complete hermetic sealing andriods of tempetalure and humidity Increase whenair would be needed Shelters that obtain all air from lhe outside would be more apt lo be built In relatively open areas some kilometers remo-ed from probable target zones so ai to minimize theor periodic hermetic sealing. Allowable periods of hermetic scalingack-up air supply are particularly sensitive to climatic conditions and overcrowding. Totally sealed shelters for VIPs appear to be relallvely few In number and will not be considered here because very few details on their habltablllty factors are known
Table 1
Habltability Factorstandard Shelter
Sovielleal
hie
per person
n'
m1
value
kf/can*-
aitety (adnr)
pii
(actor
ol air per
per hour
m'
content
dioxide
max.
max.
maximums
C
C
mattmitmi
iti until per person
or 73
i -
SEC
The standard shelters can be judged grnerally adequate for habt lability under llf nuclear attack conditions apparently planned for The uliVgrd per person allowunccm' of living space woulduite adequate, but reporli differ on this point undange'm'. Shelter occupants could survive withm1 and lm* of living space An allowancem' per hour per person of air is judged to be adequate under resting conditions. The uir regeneration system mentionedupplemented with particle and toxic chemicaloutside air plus an internal emergency air supply, should afford acceptable protection under most nuclear attack conditions. Shelters in targe, areas using filtered outside air as the sole source may have to hermetically sealed in the eventire storm above that would burn off the outside oxygen. Such shelters usually con be sealed for several hoursioxld" levels rise substantiallyercent, depending on packing factor and conditions of temperature and humidity.
Ventilation specifications tabulated above aswere slated by the Soviets to be adequate for sustained periods (presumably several days) without harming health or working ability. Actually, ihis judgment is overly optimistic at best. Thehumidity, and gas percentages would allow only for short periods of minimum exertion. Under such conditions, any overcrowding would be dangerous, and individual tendencies toward cardiac otdisease or claustrophobia wilh resultant panic would be exacerbated."
One uspect of the standardized shelter where some Soviet heilth authorities an* reported lo have voiced objections is in the septic lank venting system Until corrected, this condition Is said to make occupancyayse presume lhat gases, particularly methane, produced by the sewagethe principal health hazard referred tn. The standard shelter also Is reported looilel perccup.1'" This would Ire closeinimum number of toilets and would present an Increased danger of Individual toilet failure or of complete Inadequacy In the event of an outbreak oftllseuse.ituation could well produce toxic vupors tliul would force premature evacuation of ihe shelter al the worst, or In the case of shelters with no Internal air options, require continuous venllng of the Inside air and lis replacement wllh nulskle air regardless of external atmosphere conditions
Tbe rrqulrernents for resistance of standard shelters lo ovrrprrssurr and ionizing radiation penetration
ET
have been reportedsig/cm')rotectionF).t is important to note that an overpressure not exceedingsi assumes0ercent survival of the shelter and Its occupants The actual uvrrprrs-sure resistance (safety factor) built into ihe shelter may be anywhereimes4 psi value. The PFrobably would protect in most cases the average shelter occupant against radiation exposures overad. For example. In order for standard occupants lo0 rad prompt radiuliun dose and an overpressure ofsi. the shelter would have to beilet optimum heiehlafety factor of as little4 psi would protect from the overpressure. As another example,iles downwindl ground burst would0 rads over Iwoallowing onlyadi of exposure insidehelterf
Soviet standard shelters appear to be structurally adequate to offer reasonable occupant protection against the effects of relatively low-yield nuclear weapons depending on distances from ground zero Factors limiting habitability most likely would involve failure or Inadequacy of the Internal air regeneration system, outside air filter failure, sewage backups or leaks, overcrowding, contamination of stored food or water, or. In the case of standard shelters using only outside air. being forced to seal hermeticallyeriod in excess of lhat recommended. Ten days to two weeks al capacity occupancy under the most favorable conditions probably would represent the maximum period of reasonably safe use. Most Soviet open literature and intelligence reporting seem tolanned occupancy ofays orhere are Indications for example,ew shelters (capacity unspecified) may storeays of food1*
PROTECTION OF FOOD AND WATER RESERVES
Water
Reporting on Ihe protection of pulJlc water supplies against fallout has hern sparse, but whatuggesti lhal surface water and some strata of underground waler are apt lo become con..minutedome reporting Indicates lhat water storage facilities al treatment plants are bunkered nud guarded Imt lhat ihe bunkering would protect only against falloul ami not ugalnsl blast. Oilier reports Indicate thai some of the bunkered water storage ureu* may offer limited
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processed foods stored in the shelters or used in dispersal or evacuation areas. In the longer term, some fullosit contamination problem may arise If evacuation area occupants must use fresh unprocessed local foods, but such foods are easily checked for radioactive contaminants. One problem thut has been noted with canned foods Is that often ihey have been stored for looime ami spoilage has been reported. An outbreak of food poisoningrowded shelter could hove highly dangerous consequences."
! It has been estimatedetweenillion1 million urban dwellers can be sheltered In theuclear attack against the USSR. The Soviets recommend that persons occupying shelters for periods of up lo two weeks receive an average ofalories per day. Other Soviet statements concerning food allotments, however, suggest lhatalories per person per day would be acceptable.ndicates the approximate number of metric tons of food that would have lo be stockpiled toalories per day.toillion andillion peoplewo-week period. Protein probably will be provided primarily as canned meat, fats as lard andils, and carbohydrates as mixed grain flour.
Over the next few years, we expect someIn the preservation and storage of processed foodsesult of food processing and packaging research carried oul under the Soviet manned space program. Protection of grain, livestock and produce from fallout contamination may be improvedby modifying existing storage facility designs as necessary. Attempts lo protect crops In lherobably would not be feasible. Over the next decade, the USSR is capable of stockpiling large amounts of foods appropriate for useuclearituation. We cannot assess, however, whether Ihe amounts and the means for distribution will be adequate.
/
Masthis appcan lo mean lhal water already treated ami stored fur use at the lime of un upwind nuclear strike could be safe, but water presented for In-otment In lhe post-strike period may be ciinlanilruiled and possibly useless Unless the Sovieis are planning for Ihe storage for civil defense purposes nf large amounts of treated water, then only thai watrr already in shelters or piped in from already treated local storage facilities could be counted on until fallout radiation reached safeor months later.ew shelters are believed to be kept stocked with water."
Tlir- Soviets probably are planning to lap and use deep strata water, including artesian sources, in place of surface water In areas where heavy fallout is expected, buto indication at present how much deep strata water has been accessed for civil defenseurface water contaminated with radiouctlve particles probably can be cleaned up reasonably well by passing it through micro-filters and Ion exchange resins. Because of the substantial expense Involved in trying to use resin and filler purificationational basis, we doubt thai Ihe Soviets will employ such methods except possiblyack-up role In selected VIP shelter* or relocation areas.
Over the next decade the Soviets probably will elect to emphasise deep strata water for civil defense purposes, particularly In dispersal and evacuation areas. Despite the obvious danger of radioactive contamination of water, tbe greatest danger will remain contamination with sewage and other organic materials.
; .
Food
NUMBER AND QUALITY OF MEDICAL PERSONNEL
The Soviet medical establishment5 was estimated to containhysicians'hysiciart-to-population ratio of aboul one. In addition, there arerldshers (doctors0 nurses,therworkers eonable of rendering first aid ami oilier treatment during an emergency. Since nil? nf the lotuloviet populationillion Is staled
Reporting on food storage and protection against thi' effects of nuclear weapons Is sparse. Underground storage iteputs thai may be hardened have been reported, and tentative assessments of amounts nf food so stored have been" Most other storage sites rrported would offer some degree of fallout protection but little or tin blast protection.Some reports indlcute that In rural towns and farms downwind of target cities, grain and produce protection will consist of covering the exposed food with whatever covering materiuU thai may beresh,ftwtdt would be difficult If not Impossible to protiTieneral nuclear war.
Tnicesscd foods lhat require no rooking an* tlw only ones useable In most Soviethesere easily stored and protected from fallout. We expect little or un fallout contamination problems will
Table 2
Soviel Food Storage Requirements for Urban Shelters
ofWP.r
illion peoplel III on people
illion peopleillion people
Amotion la Mrtne Tea. fofriod
mull
be urban, an equitable distribution of physicians could be assumed to be* urban6r i* estimated, however, that physician distribution Is distinctly weighted In favor of urban areu. If one estimates that as mucht,. of the available physicians are urban based, then the physician*to-urban population ratio would beighly favorable one.
The general competence of these civilian medicalonsidered significantly lets than for comparable US personnel. All of these personnel, however, are believed to be trained to some degree In civil defense medical operations. These personnel staff at0 hospital units with atillion beds.'
If all categories of medical workers are combined, the system contains an estimated one medical worker with some training for everyersons. The military establishment probablyomparable ratio. The most significant weakness is lhat despite large overall numbers, the Soviets are chronically short in the civilian sector of skilled surgeons and other clinical specialists capable of managing severeilitary forces, on the other hand, are not believed to be deficient In surgeons and other trauma specialists.
The military medical esubllshment may assist civil defense medical forcea to some extent in disaster areas that happen to contain military medical units.otal estimated strength of betweenndhoiuand. the military appears to have sufficient numbers of adequately trained military physicians and paramedical personnel to carry out the military medicalach divisionedical battalion withfficersnlisted men programmed toatientshour period. Each regimentegimental medical point withfficers andnlisted men and offers emergency surgery and blood transfusion services. At
baltullon level thereattalion feldshrr with lour ssislants who evacuate casualties from the comiiuny level to the battalion level where emergency first aid treatment Is given and casualties are classified. At the company level, there Is an aid point with one medical Instructor and aidmen (number unknown) who render first aid only. These medical units are backed up at the frontal level by sis typesercent mobile field hospitals wilheds each.'
Tins basic military medical organization has been in effect probablyecade or longer. On the basis of Soviet computer-simulated training exercises run in the, however, there is now some question as to the adequacy of these numbers of personnel and facilities for operationsass casualtyThe results of the exercise indicated that ali medical facilities In the strike zone became saturated within two days and that after two weeks the accumulation of untreated casualties 'cached well million.**
over one
The military civil defense regiments, at least one In each militaryrobably would coordinate any cooperation between military and civilian medical units in support of population protection and rescue missions.
TRAINING
Medical training afforded the nonmedical civilian population for civil defense purposes Is limited to first aid. This training probably Is sufficient for persons with no formal medical training. Despite conflicting reports on theent and effectiveness of ihc civil defense training program for the population, exposure to such training can be expected to develop some awareness of problemsuclear altark and to develop some confidence In the population that by following the civil defense plan theveasonable chance of surviving such an attack. Even wilh Its shortcomings, the Soviet program probably provides Its populationelter chance of survival lhan nearly any Western power.
The extent and quality of the training for medical workers Is In some doubt. Tbe official Soviet literature and reports from physicians and other medical workers are often In conflict, Soviel articlesapparentlymedical iiersnimelconsiderable civil defense medical training' but Individual reports suggest that the training comists mostly of lectures. Is relatively rudimentary, dull, and rejietlllve. Since ihc training often occupies free time und Is compulsory. II Is frequently attended by
resentment andh* present Sovieton civil defense training probacy Is aimed at overcoming these shortcomings and Improving the practical value of the training. The building of training villages lo promoto realistic conditions and enable large-seal* exercises would support tbe latter assumption.1
Soviet physicians, feldshers. and other medical workers are reported torable training in lhe medical aspects of civil defense. Physicians, for example,art-time lecture course in radiological, chemical, and biological warfare defense while In medical school The course stresses protective measures thai Include the use of protective clothing
and masks and techniques of emergency therapy.
Thereafter, many physicians and medical workers
receive up loours of lectures per year (one hour
per.
Members of medical unitsefined civil defense role receive additional training in radio-biology, bacteriology, epidemiology, and toxicology. Personal hygiene and food and water sanitation are stressed to prevent outbreaks of natural diseases following an attack with weapons of mass destruction Practical exercises are held at some hospitals and
For ihe population al large, civil defenseandatory. Fifth grade students, for example, receive first aid Instruction as well as training In the use of shelters and gas masks. In lhe premllltary basic course given ninth and tenth grade students.ercent of the course is concerned wllh civil defense and Includes basic first aid. Civil defense ikllls Including first ltd are also taught lo teenagers through paramilitary competitive games.**
The working populationinimum ofours of instruction annually, often on Its own lime, on self-protectionuclear war. Civil defense local leadership cadres may receive up toours of Instruction. Details of lhe medical aspects of the training are unknown but are presumednclude first aid and rstaalbly advanced first aid Inhnur
w
Soviet civil defense exercises currently emphasize the performance of Individual* and groups and also the coordination of the exercises wiih clly, rayon, military, and other civil defense authorities. Over lhe next decade, the present level of training effort probably will be sustained.
In general, il can be said lhat the adequacy of medical training for civil defense is greatest for those with no medical training, less adequate forworkers, and leasl adequate for physicians.
MEDICAL SUPPLIES
The USSR produces most of its common drugs, antibiotics, and blologlcals although certaindrugs are imported from the West In small amounts. Medical, surgical, and laboratory equipment is cither manufactured or imported from Eastern Europe. The quality of most Soviet-produced drugs is adequate, but problems In quality control tend to produce variations inoor planning and coordination within the pharmaceutical industry often result in shortages of raw materials and chemical Intermediates, which tends lo delayistribution problems also ariseimportant shortcoming Is the substandard packaging of finishedthat restricts long-termfforts are sold lo be under way to remedy this problem, but few overall Improvements have been noted.
Surgical and other Instruments generally are of acceptable quality and arc produced In sufficient amounls. Few of these products, however, areore sophisticated electronic medical equipment generally Is obsolete by Western standards but appears to perform adet, alely. Thc greatestack of standardization of spare parts and chronic shortages due to poor planning nnd coordination of production* The Soviets have elaborate systems of Inspections andontrol, but their existence is often not reflected inquipment Itself. In the post. Ihe Soviets have been slow to improve or modernize their medicalor correct chronic production problems. There is no indication to date that things have changed.
or Civil Defense
The Soviets are believed to have adequate slocks of acceptable drugs and other medical supplies thai can be used In the event of nuclear war- Amounts are unknown, Substandard quality control,packaging, problems of timelynd problems of overstocking of some items,ay well limit the effectiveness and availabilityumbers of drugs. There ore indications that storage conditions vary In quality from location lohus tending lo diminish significantly the medical value of some drug
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stockpiles are maintained bv agency of thei.ici-iI of MlnMers. The shxkpilrs contain drugs, antlhtfriics, vaccines, serums. blood plasma, plasma expanders. Iiones fnr transplants, MM marrow, surgical dressings, medical and surgical Instruments, hospital und laboratory equipment,ayThese strategic reservesaintained at all limes regardless of shortages thai may develop in the civilian sector Strategic stores are said lo be repl 'Ced ast is suspected lhat much of the dnigs supplied by the USSR to underdeveloped areas may be drugs rotated from the strategic stockpile thai are nearing their expiration dates. The locutions, item Inventories, and number of days of supply of the strategic medical stockpile are nolarticular deficiency is believed to exist In the Soviel blood
collection and preservation program for national disaster. In general, the Soviets cannot store whole blood for more tlian aboutays and the) storemall fraction of thai which is stored in (he US for daily bospilal .
In addition lo tlie strategic medical tfork|Hle. lhe Ministry of Health maintains medical dcjiots and medical sections In military general supply"Tlie Ministry of Health also maintains reserves of medical materials at Urge hospitals and other medicalhe civilian system of pharmacies also maintains warehouses of drugs al certain distribution points throughout thes is lhe case with lhe strategic stockpile, the reserves of the Ministry of Health and pharmacies are replenished periodically, lhe older materiab being dispensed first.
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and Comment* on the Specialized Hospitals ot Ihr Secondtcuallon Stage
The specialized hospitals are divided Into the following specialties.'
NcunmurgicalEach hospital collection point (BK) contains one. Wounds of the spinal column, brain, organs of ihe head and neck are treated. The Soviets note lhat substantial amounts of sophisticated electronic monitoring and diagnostic equipment will be necessary; that urologists will he needed to deal with frequent urological complications, and lhalerceni of all trauma patients in peacetime show cranial and spinal injuries, surgeons In all specialties must also learn some neurosurgery.are In very short supply.
ThoracoabdominalEach BK appears lo have one. This hospital contains thorostc, abdominal, and urological departments but eliminatesA section to deal with pelvic bone injuries is appended to the urology department. The Soviets note that surgeons will make up the largest part of the professional staff but do not mention the presence of such specialties as thorasic surgery or cardiovascular surgery. Since surgeons are known to be generally in short supply, it may be that specialist-surgeons are not numerous enough to mentionivil defense content. While the thoracoabdominal hospital Is listedpecial facility, for practical purposes It contains almost as much as the main hospital (general hospital) and, therefore, uses about the same amounts and variety of medical supplies.
Burnbum hospitals are said to be necessary because of the large numbers of burn casualties expected and the fact that serious burns cannot be luccetifully treated In the first stage of medical evacuation. The location of the burn hospital near ready-access routes Is necessary becauseed treatment must be Institutedours. Burns are divided Into three groups-ithercent of the body surface affected;ercent; and0 percent.s eipected to be the most numerous and will receive the most attention. Thoae Inre considered very poor risks and are Isolated and treated
with pain killers, relaiants, and fluid replacement. Hospital personnel are to be organized Inlu five teams that operate on an assembly-line principle The Soviets recognizereat deal of special equipment Is required for burn management bul do not comment on where It will come from In the amounts that appear necessary. It It also Indicated that at least six medical specialties would be required to staff each burn hospital The source of these scarce personnel also Is in serious question Under mats casualty conditions, only casualties Inhat are uncomplicated with other serious Injury could be treated successfully enough to permit any reasonable percentage of return to duty. Some casualties at the lower end ofight eventually be returned lo light duty provided that third degree burn Involvement were minima) and collateral serious Injuryotentially serious discrepancy exists between the Soviel statement lhal burn therapy must be Institutedours, and iheir statementays may pass between rescue and the receipt of specialized medical care.
Traumatologic*!type of hospital specializesosed and urteiposed Injuries of the upper and lower extremities except the pelvis and large joints. The Soviets point oul lhatospitaU requireay facilities and special cast making facilities lhal Include special rooms for applying and drying the casts. The techniques described for cast making appear to be oferiod. Orthopedic surgeons are believed to be In particularly thorl luppty. Again, the Soviets appear to use nurses to perform medical services beyond their training.
roxlcolnerapfiinchospitalIn the treatment of radiation Injury. The principal components of this facilitylinicalable to do complete determinations of radioactive matter In body fluids andlood unit with whole blood, blood fractions, and blood substitutes,lomatology unit. Il appears unlikely lhat tbe Soviets can deploy any numbers of these hospitals due to lack of sufficient numbers nf competent specialized physicians and paramedical technicians. lack of enough specialized laboratory equipment,ack of facilities outside major cities that can nbtaln, fractionate, preserve, and store various blood products
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leclllty specializes in the diagnosis and treatment of infectious diseases likely to bcruk outass destruction weapons utlack. wiih emphasis on biological warfare ageniv Principal components of this type of hospital include the rcitulur and isolation wards, diagnostic laboratory, etc. Facilities of the Sanitary-Epidemiological Service proliahly will make up the bulk of these hospiLib Since this service has many stations throughout the nation, it Is likely that significant numbers of Infection hospitals can be deployed. The keystone of the Soviel medlcul system Is prevention, particularly Ihenf Infectious diseases, and (he Soviets should he expected lo perform well In thia area On the otheroviet military training division In the Khabarovsk area suffered an outbreak of dysentery in Augusthat spread quickly despite all efforts to contain the disease. Although this outbreak occurred under non-emergency conditions in the military, whichetter medical system than theeneral panic developed and serious mistakes were mode that led to manv more Infections than might have liecii the case otherwise. This occurrence Is noted
here to suggest thai ifhing can happen even in areasenerally good capability is known to exist and under near kleal conditions, far worse can be expected under mass casualty conditions.
P:ychlatricfacility treats primarily neurological injuries and mental ^islurbances resulting from head Injuries. It Is unlikely lhat every BK of the hospital base (BB) willsychiatric Ineurnpsy-chlalrlc) hospital. There is reason to believe llial there may be only one such facility per hospital base.
Light catualtv collecting pointreceives and treats light casualties from the mass destructionospitalhe main facility, but other hospitals In the BK can serve light casualties on an outpatient basis. The Sovieis also envision using public buildings lo house right casualties and using ambulatory patients and local civilians lo help care for new arrivals. The PSLP also may employ ambulatory patients for public works.xpectedarge percentage of the lignt casualties will be returned to work or to some civil defense duty,
This report teas prepared bw
the Office of Scienttftc IntclttgencvryursTions may be addressed to
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Original document.
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