Warday

MESSAGE BY COURIER

SIGNED RECEIPT MANDATORY

TO ALL DIRECTORS, CIVILIAN AND MILITARY MEDICAL FACILITIES

IN THE CONTINENTAL UNITED STATES

FROM U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTERS

FOR DISEASE CONTROL (CDCHDQ) ATLANTA

REGARDING IMPLEMENTATION OF WAR EMERGENCY ACT AND EXECUTIVE ORDER 15

10 FEBRUARY 1989

Pursuant to the War Emergency Act (23 CFR 586, Sections 18-35) and Executive Order 15, you are hereby instructed to implement at once the emergency triage procedures necessary for the treatment of war victims. This action is taken in view of the catastrophic numbers of victims requiring medical attention and the overall burden on existing facilities. The unavailability of adequate numbers of trained personnel and supplies, presently and for the immediate future, poses a major health hazard. The unprecedented nature of the emergency facing this nation mandates the immediate implementation of selection procedures for treatment. Communities can expect severe resistance, but you are reminded that the first task facing this nation is that of survival; existing facilities, personnel, and supplies must be directed to those populations with the greatest probability of survival.

Therefore, as of 1200 hours, 10 February 1989, you are instructed to triage victims according to the following requirements:

1.0 GENERAL INJURIES (Non-radiation-induced)

Mild to Severe: Injuries of this nature, such as burns, fractures, contusions, etc., may be treated as conditions allow.

Severe to Critical: Treatment should be limited to victims with greatest possibilities of recovery. Medical supplies should be limited accordingly.

Severely Critical: No treatment desirable.

2.0 RADIATION-INDUCED INJURIES

Treatment should be accorded on the basis of radiation dosage absorbed. Whole-body measurements should be taken whenever possible: in cases where this cannot be done, interviews should attempt to ascertain proximity to radiation zones and duration of exposure. The following schedule should then be utilized:

0 to 100 REMS	No treatment necessary.
100 to 200 REMS	Treatment limited to radiation symptoms such as flash burns, nausea, vomiting, etc. No other treatment desirable.
200 to 450 REMS	Medical assistance most valuable here. At upper levels (350+), chances of recovery with medical attention are 50 percent.
450+ REMS	No treatment desirable.

It is not known at this time whether radiation injuries are more severe in cases where radiation is absorbed all at once or cumulatively.

Your government is aware of the implications of this order.

Steps are being taken by appropriate military authorities to provide assistance to you in implementation of triage instructions. You will be provided with further information as soon as it is available. You will be instructed as soon as possible regarding the cessation of triage requirements.

Signed: William T. Adcock, M. D.

Director ATCEN/DC