Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter VII: Mass Causalties in Thermonuclear Warfare
United States Department of Defense
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If nuclear weapons are employed within the theater, the entire medical evacuation and treatment system will be severely overburdened and some system of classification and sorting of casualties must be added to the normal procedures of evacuation and hospitalization. In addition, a system must be established to hold casualties who are too seriously injured to remain with their units, but who do not need to or cannot be hospitalized. These two requirements, the sorting of casualties and the holding of the excess numbers, must be planned for as part of the normal organization and operation of the medical support system in a theater of operations.
In applying the principle of providing the greatest good for the greatest number to the management of mass casualties, a field medical system must face and solve several problems. The location and number of casualties must be determined. This requires intact communications, since isolated units on a dispersed battlefield could suffer severe casualties and be unable to notify higher headquarters. Subsequent delay in initiating treatment and hospitalization will result in greatly increased morbidity and mortality.
The casualties must be evacuated. In front-line areas, follow-up enemy action exploiting the use of nuclear weapons could greatly hinder or prevent evacuation. In rear areas, adequate evacuation means may not be available to handle the massive number of casualties produced by an attack. The availability of helicopters would help since they can be diverted from one area to another much more readily than ground transportation. The use of nonmedical transportation systems may be required but cannot be planned on.
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