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Originally published in the Guardian on 10 May 1988
Guidelines on who will be selected for treatment, and the millions more who will be left to die without drugs, painkillers or medical care after a nuclear attack on Britain, were published for the first time yesterday by the British Medical Association.
The BMA stresses that it is publishing the discussion document because of the absence of any government advice on selection of casualties for treatment after a nuclear attack. The report estimates that up to 28 million people – half the population of Britain – will be wiped out in a nuclear conflict, and six million more will be seriously injured.
In the first hours after a nuclear bombing, the influx of wounded will resemble "a mass casualty incident magnified to hitherto unknown proportions". Surviving medical facilities will be so overwhelmed that some form of selection is inevitable.
Burns or blast casualties will not be given priority for treatment if they have been exposed to radiation. Early amputation is recommended as "a time-saving alternative for complex limb injuries". Casualties whose injuries are likely to lead to a lasting disability will be given lower priority than those expected to make a full recovery.
Children and young adults should be treated in preference to the elderly. Anyone with full thickness burns over more than 15 per cent of their body should not be given vital fluid replacement therapy as their chances of survival are poor. Because of the poor prospects of survival for older burns patients, fluid replacement should not be offered to anyone over the age of 60.
It could be argued, the BMA says, that as drugs will be scarce, powerful painkillers should not be wasted on the dying but reserved for those with a chance of survival.
The most difficult decisions will come about 10 days after the attack when "measured judgment" becomes feasible. Although the BMA does not advocate selecting people according to the social contribution they might make, it accepts there may be a case for giving priority to "key individuals with skills which are necessary for the survival of the community at large".
Professor James Payne, deputy chairman of the working party, said yesterday that after a nuclear attack the "carpenter will have priority over the nuclear scientist," and the stonemason and the plumber will have priority over businessmen, civil servants and politicians. Professor Payne said those who had drawn up the report had concluded that it showed just how little doctors could do after a nuclear attack.
Aileen Ballantyne
