If thermonuclear warfare broke out, the health and welfare facilities taken for granted by the civilian populace would disappear, and a 'back-to-basics' commonsense approach to staying alive would take its place; survival of the fittest, indeed... The Community Adviser was briefed on such hideous circumstances, the notes of which are shown here.
A verbatim reproduction of the document: 'Community Advisers: Health and Hygiene' is reproduced below. It was issued in January 1984 by Eden District Council, in East Cumbria.
HEALTH AND HYGIENE INTRODUCTION
1. Environmental health plays an important part in our society in peacetime. Despite all the modern aids at our disposal, it can never be taken for granted; and minor epidemics of typhoid, dysentry etc. still occur even in our carefully controlled society.
2. It is not difficult, therefore, to envisage the additional problems which could arise in the aftermath of a nuclear war. We can expect most services to be seriously disrupted by destruction on an unprecedented scale, and our natural resistance to sickness and disease will be greatly reduced by radiation and other adverse conditions which will obtain in a post strike environment.
3. In effect, the main factors affecting our environment would include:-
(ii) Interruption and pollution of water supplies
(iii) Breakdown of sewage systems
(iv) Lack of refuse disposal facilities.
In turn, these problems would be exacerbated by:-
(i) The failure of power supplies
(ii) Shortage of transport, and disruption of industry, lack of fuel, adequate food, medical equipment and drugs
(iii) Heavy casualties and a shortage of manpower and resources to dispose of the dead
(iv) Total disruption of the Health Service.
4. There can be no complete answer to the massive task facing us, and certainly there is no easy way of dealing with it; but pre-planning and education in the basic principles of first aid and personal hygiene can do much to alleviate the situation.
5. Central Government acknowledges these formidable problems, and has given advice to local authorities who have a mandatory responsibility for the welfare of their communities in peace and war.
HOME OFFICE GUIDANCE
6. Central Government assumes that personal survival measures would, in themselves, be totally inadequate to counter the breakdown of environmental services following a nuclear attack on a significant scale. In particular, there would be an urgent need for improvisation to provide essential services to mitigate the adverse effects on community health.
DISPOSAL OF HUMAN REMAINS
7. Burial of the dead would pose a major problem. In the early post strike phase, the need to ignore religious persuasions and procedures, identification of the remains, or even Coroners Rules, will be repugnant to many. Initially, mass burials or cremation would be the order of the day, with ad hoc decisions in light of prevailing circumstances. Thereafter, although the incidence of deaths from radiation and disease would continue to be high, normal procedures for disposal of the dead would be re-introduced as soon as possible.
8. In the period leading up to nuclear strike, instructions to the public will include advice on the temporary storage of human waste; general advice on this subject is included as an Annex to these notes. Families will be urged to rely on domestic arrangements within households until restrictions on movement outside are eased to the extent where local measures of a more permanent nature for disposal of waste matter can be introduced. Alternatively, communal ablutions and latrines will be constructed at sites where these facilities can be inspected and maintained regularly, e.g. at Community Centres.
FOOD AND WATER
9. It is envisaged that a programme of education on those measures which can be taken within the home to safeguard foodstuffs and water against radioactive contamination will be implemented pre-strike. The main danger, of course, will be in the form of contamination by radioactive dust particles, and the simple precautions of cover and careful handling as outlined in the background paper 'Protection and Survival' must be observed.
10. Even more stringent precautions, under the direction of District Health Directors and Local Authority Environmental Health Officers, will apply to Communal Centres, where the risk of enteric infection will be greater.
REFUSE COLLECTION AND DISPOSAL
11. In the immediate post strike period, there can be no standardised procedures laid down for the collection and disposal of refuse; and Central Government has no plans for stockpiling the basic needs of Waste Disposal Services in wartime. Makeshift measures would be devised and, if necessary, enforced by District Controllers on the advice of their Health Directors.
12. In line with other principal lifesaving emergency services, the Health Authority has formulated its wartime organisation policy on the basis that trained staff will be vital in the recovery period. In light of this, medical personnel will not be deployed into areas of high contamination where casualties would, in any case, have a very slim chance of long term survival.
13. In and around the immediate vicinity of GZ, the problems will be quite overwhelming. Casualties will be massive in numbers and serious in nature, while hospitals serving the area may be demolished or, at best, the roads leading to them completely impassable. Medical staff would probably have been evacuated and, even if willing to return, would undoubtedly find it difficult to do so.
14, In any event, many survivors - although alive - will have received fatal radiation doses, and could not be saved even with the best of medical care. Those who had received smaller and non fatal doses of radiation could not be properly treated. In effect, hospitals may only have a very limited role to play in terms of providing medical succour to survivors in the immediate post strike period.
LOCAL ORGANISATION AND PLANNING
15. Although it might be reasonable to assume that Cumbria will not be a prime target area for nuclear strike, this does not mean, for example, that power and water supplies will be unaffected, It follows, therefore, that during the time taken to restore any breakdown in these services, including the treatment of sewage, the general situation could deteriorate and expose survivors to disease if proper and reasonable precautions are not observed. Perhaps, more importantly, such precautions would help to ease the task of the County Health Authorities whose already limited resources would be stretched to breaking point.
COUNTY HEALTH AUTHORITY
15. It is the responsibility of Health Authorities to prepare plans to deal with casualties and to provide a health service in war. The aim must be to establish an organisation capable of implementing all measures necessary to prevent disease and maintain the health of the population. To meet this requirement in Cumbria, and in keeping with many other local authority wartime functions, the Health Service has been integrated into the local authority wartime control and administrative structure.
17. The Area Medical Officer, as professional head of the Health Authority serving the County, will take up his appointment as County Health Director in the Main War Control Headquarters; and District Health Directors will be similarly established at District HQs. The Authority's task will be enormous in any post strike situation, and it is imperative that its wartime plans should provide for:-
a. the selection of hospitals for the critically ill;
b. earmarking of premises outside target areas which are considered suitable for reception and treatment of casualties, and for the storage of medical supplies;
c. the designation of qualified staff and auxiliaries for wartime hospitals.
18. Early and continuous consultation between the Health Service and the Controller (designate) or his Emergency Planning Officer is essential to ensure the co-ordination of measures which need to be taken during the immediate pre-strike period. The most important of these are:-
a. Activation of skeleton manning of Health Service Establishments and Administrative Control Centres.
b. Dispersal of vehicles, medical supplies and Blood Transfusion Service etc.
c. Re-deployment of staff, and "enlistment" of voluntary orqanisations (St. John Ambulance, Red Cross) and individual volunteers.
d. Discontinuation of the National Health Service involving the discharge of those patients whose retention in hospitals, nursing and convalescent homes is not considered medically essential. Such measures are primarily intended to free the hospitals to receive war casualties, while at the same time allowing a significant reduction in staff and redistribution of equipment, drugs and foodstocks.
e. Requisitioning of premises, vehicles, equipment and medical supplies.
f. Assignment of G.P's to Casualty Collecting Centres.
g. Setting up First Aid Posts and Casualty Collecting Centres.
h. Collection and distribution of drugs from manufacturers.
j. Crash training programme for staff.
19. Clearly, if the manning or preparation time is very short - a matter of days instead of weeks - most of the pre-strike measures detailed in para.18 could not be implemented fully. This would mean that medical treatment of casualties would devolve upon surviving communities in their own homes and in the First Aid Centres manned largely by members of voluntary aid societies. Casualty Collection/Clearing Centres, manned by doctors, nurses and supporting staff capable of administering more advanced treatment, will be established in selected buildings. Only sick and injured patients with better than average prospects of recovery are likely to be admitted to hospital.
COMMUNITY MEDICAL RESOURCES
20. Medical personnel (including retired members of the profession), should be identified, and any medical equipment and supplies should be conserved and strictly controlled within the community. Such items are unlikely to be available again for a very long time, and possible substitutes must be sought and advice taken on their use. Herbal remedies and locally available chemicals should be considered. In essence, reliance would have to be placed on all available local resources as well as on the ingenuity of personnel to improvise according to needs.
21. The successful implementation of plans and personal health and hygiene measures is dependent upon:
a. A change in general attitudes, bearing in mind that we have all been conditioned to expect the best possible individual treatment; this would not be available in the abnormal circumstances resulting from nuclear warfare, We would have to adjust to a society in which ingenuity and basic principles were the order of the day, so that maximum effect with minimum resources could be achieved.
b. Standards of treatment would also have to change. No longer would there be sophisticated drugs and equipment available - medical treatment would be simple and basic.
c. Standards within the medical profession would fall with the introduction of volunteers with a comparatively limited knowledge of medicine.
GENERAL HINTS ON HYGIENE AND HEALTH
1. The following general advice is intended for the period when limited movement again becomes possible; that is, when radiation levels from deposited fallout diminish. Personal hygiene during the recovery period will continue to be as vital to minimise the risk of epidemics as it was during the "heads down" phase in shelters.
2. The appropriate level of post strike control will need to organise a positive and sustained publicity campaign aimed at increasing the standards of public and personal hygiene. There will be few areas in which a continuance of the water supply can be relied upon for very long. Dustbin collections will not resume for some considerable time, especially in rural areas, as priority will undoubtedly be given to urban areas as services are restarted.
3. The human body has an in-built resistance to infection, but whenever this resistance is lowered, or a large number of germs gain entry to the body, the resistance may be overcome and the person succumb to overwhelming infection.
4. Poor diet and even moderate non fatal doses of radiation markedly decrease resistance to infection, and contaminated water and inadequate refuse disposal provide an ideal breeding ground for germs. Add to that a large number of people living close together, and we have a recipe for disaster.
HOW INFECTION SPREADS
5. We breathe in germs and eat germs in small numbers every day and usually manage to deal successfully with them. In the post strike phase little can be done with regard to airborne infection, but diseases such as dysentery, cholera and typhoid which are caused by eating contaminated food or water can often be prevented.
6. Let us suppose that someone has dysentery causing him severe diarrhoea. He will almost certainly, if inadvertently, soil his hands with excrement containing the dysentery germs. Anything he touches will then become infected, especially food. There will be no fridges working, so the food will be warm and the germs will multiply quickly, and anyone eating the food will contract dysentery.
7. If excrement remains exposed to the air, flies are immediately attracted. Their bodies become covered with excrement and bacteria multiply rapidly; if they land on uncovered food, they will automatically deposit the germs, which will then be eaten.
8. Rats and other rodents, similarly attracted to refuse which may be contaminated, will spread disease as they travel. They may also infect areas with their urine. The great bubonic plague in 1565 was spread in this way. Dumping excrement, in slowly running water, or even rats urinating in stagnant pools of water, is enough to contaminate the water supply and affect hundreds of people.
9. In the event of a nuclear strike there will be little medical treatment available for these diseases; and it should be noted that infectious disease will not be admitted to hospitals because of the high risk of those patients in the hospital contracting it.
PREVENTION OF INFECTION
10. To prevent or minimise infections:-
a. Boil all water.
b. Keep all food covered.
c. Wash all food before eating.
d. Wash hands before and after meals, and after toileting.
e. Burn or bury human waste and general refuse.
f. Use soakaways, incinerators and fly traps as required.
g. Take special care not to contaminate water supplies.
LATRINES AND IMPROVISED SANITATION
11. In areas with sewage systems operating under pressure, failure of electricity supplies would cut out the pumping stations and quickly lead to blockages. Use of W.C's would not, therefore, be possible for long after restoration of power supplies. The early provision of emergency facilities would thus be a priority after release from shelter conditions; and great care should be taken not to foul water sources - wells, streams, ponds etc.
12. Latrine buckets must be emptied daily, and chloride of lime may be used for washing the buckets and sprinkling in latrine trenches. Communal latrines should be regularly inspected and serviced.
13. The spread of disease by flies can be reduced by covering waste and food; the former with earth, and the latter with improvised covers. In this context, remember that disinfectants will be in great demand, but medicinal needs must be met first.
14. Water is highly susceptible to contamination from various sources and the potential dangers to the health of the public and animals cannot be disregarded. Boiling or chlorination of drinking water are simple safeguards against bacterialogical contamination, but neither process has any effect on water which has been contaminated by radioactive particles of dust.
Distillation and filtration are the recommended immediate measures to counter such contamination? but, when this is not practical, the alternative is to treat the water as if it were radioactive and avoid using it for such time as it takes for natural decay to reduce the danger.
15. After attack, all communities must be prepared to institute local disposal of household and kitchen waste. Rubbish should be sorted for salvage and the remainder buried or burnt.
a. Burnable Waste. Kitchen material not kept for composting should be burnt in improvised incinerators. Don't waste "fuel" ; a 'tank' of water on top will provide hot water!
b. Unburnable solids. Tins and bottles in re-usable condition should be cleansed and kept. Other items of no possible use, if not retained for salvage, should be flattened and buried.
c. Liquid Waste. If pumping stations have no power or only intermittent supplies, the drains will soon be blocked and unusable. The remnants of liquid food, and used water from the kitchen usually contain grease. If thrown on the ground they will form a scum which will become foul, attracting flies and other disease carriers.
16. In particular all communal kitchens must have a refuse pit for unburnable solids. Waste material should be covered with a 3" layer of earth daily. Tins, bottles and plastic rubbish should go in a separate pit. Refuse bins without liners should be washed out with disinfectant solution after emptying.
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