Warday

TO:

ALL MUNICIPAL GOVERNMENTS. SOUTHWEST AREA

FROM:

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/CENTERS

FOR DISEASE CONTROL/EMERGENCY TASK FORCE ON RADIATION INJURIES

DATE:

VOICE TRANSMISSION 15 JANUARY 1989

COURIER DELIVERY 16 JANUARY 1989

SUBJECT: EMERGENCY MEMORANDUM ON ACUTE WHOLE-BODY RADIATION INJURIES

You are being provided herein with guidelines for the identification of suspected radiation dosages based on readily observable physical symptoms. These guidelines are intended for municipal and/or county representatives enlisted to screen civilian populations for subsequent medical treatment or attention. The severe drain on surviving medical facilities requires operating knowledge by all government personnel in order to direct individuals or groups to appropriate medical services.

Most urban centers sufficiently distant from radioactive or zoned areas have created several “screening areas” to process incoming refugees and native citizens: Level One areas are for those with no apparent radiation symptoms; Level Two areas are for those with limited hematopoietic or gastrointestinal symptoms ; Level Three areas are for highly traumatized and ataxic victims. Some version of this system is urgently recommended to all municipalities. Refugee movement rates are still inordinately high and unpredictable; virtually all communities in this region have reported high levels of influxing populations.

Similarly, these populations are demonstrating varying levels of whole-body radiation injuries. You have been notified previously of emergency steps necessary to screen physical objects and food supplies for potential radioactivity.

Because trained medical staff are limited and generally unavailable outside of central medical facilities, it is imperative that municipal staff, including police, fire department, civil servants, and temporaries, be aware of radiation-related illnesses. Because of many factors, but particularly because of proximity to bombed area and total radiation exposure, individuals may or may not be viable candidates for medial treatment.

Large emergency treatment centers have been set up in key cities such as Lubbock, El Paso, Beaumont, Baton Rouge, Little Rock, Oklahoma City, New Orleans, and Albuquerque to treat individuals with medium to high levels of radiation dosages. Guidelines for treatment are under preparation and will be distributed to you as soon as available and approved by the Emergency War Recovery Administration.

Guidelines to be employed by municipal authorities in screening war victims are as follows:

LEVEL ONE SYMPTOMS: 0 to 100 REMS

No apparent symptoms in this range. Internal blood changes will occur but are not apparent with superficial inspection. Care should be taken, however, to query all victims in order to determine point of origin, proximity to hit areas, and exposure to contaminated foodstuffs and objects from contaminated areas.

LEVEL TWO SYMPTOMS: 100 to 200 REMS

Short-term effects include fatigue and general malaise.

Gastrointestinal effects may include nausea and vomiting on the first day. A two-week “latent period” may ensue in which symptoms disappear but then reappear in milder form. Generally, the more severe the symptoms in the beginning, the slower the process of recovery. Individuals with these levels of radiation dosages are excellent candidates for recovery.

LEVEL THREE SYMPTOMS: 200 to 600 REMS

Individuals with dosages in this range can display symptoms ranging from mild to severe. Nausea, vomiting, diarrhea, lack of appetite, etc., are the most obvious characteristics. The more severe the symptoms, the higher the radiation dosage absorbed may be assumed. Again, there may be a latent period of a week or perhaps only several days. Higher dosages produce skin hemorrhages, bleeding in the mouth and urine, and, with dosages above 200 rems, a loss of hair. A swelling of the throat is not uncommon. In the 600+ rem stage, high uncontrollable fevers may be present, as well as emaciation. Death in these cases is probable in 80 to 100 percent of the cases; Judgments as to the extent of medical services to be provided are therefore advised.

LEVEL FOUR SYMPTOMS: 600 to 1000+ REMS

Gastrointestinal symptoms are the most obvious: extreme vomiting, diarrhea, nausea, prostration, ataxia (loss of motor control) , and difficulty in breathing. Individuals displaying these symptoms will almost certainly die within several days to two weeks. You are not likely to see individuals with such severe symptoms. All subjects arriving in a coma or comalike state should immediately be referred to medical authorities for handling.

Undoubtedly, these guidelines are not complete, nor are they intended to be inflexible. However, the immediate need to process large numbers of incoming civilians is crucial in order to assure adequate distribution of medical supplies and attention, food and clothing, shelter, and relocation services.