Nursing in Civil DefenceAuthor(s): ISABEL BLACKSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 44, No.1 (JANUARY 1953), pp. 9-11Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41980396 .

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Nursing in Civil Defence

ISABEL BLACK, B.S. Consultant in Civil Defence Nursing

Province of Ontario Toronto

A NEW DESIGN FOR A DEFENCE DECADE was the title given a recent conference of women sponsored by the American Council on Education.

The members were aware of the problems created by the last war and met to study ways and means of improving their free way of life. Three principles were relevant to that situation: acceptance of reality, acceptance of responsi- bility, and realization of spiritual values. The same principles, perhaps not con- sciously recognized as such, have been applied by the nursing profession in their approach to civil defence€ Viewing the world situation as it is today, the nursing profession, with a keen awareness of their responsibilities, diligently and soundly devised a plan to train their members, having always foremost in their thoughts "the worth of the individuar' and the realization that no amount of effort and preparation is too great in order to reduce suffering and death.

One year ago, the National Civil Defence Health Planning Group arranged to send a team of five persons, experts in their field, across Canada, to conduct a four-day institute in each province. The objective was to insure uniformity of knowledge, essential because of the planning for interdependence of services. In each province the "chain reaction" of teaching began with a nucleus of approximately 80 instructors, who in turn taught a 12-hour course to the graduate nurses. Today, in Ontario, 337 nurse instructors and approximately 4,500 nurses have been taught the modified course. This is almost the halfway mark to our goal, which is to teach at least 10,000.

Many popular mottoes have come to public attention during the past year. One is "Civil defence is everybody's business." British Columbia has adopted "Prepare for the worst and hope for the best." And there is also the oft-quoted motto first used by the Honourable Paul Martin: "If you never need what you learn, you lose nothing. If you never learn what you need, you lose everything."

What does the graduate nurse of this defence decade need to learn? She needs to be aware that modern war is total war, that the atofmic bomb will affect civilians as well as armed forces. Recently a survey was made in one of the schools in the United States to determine the things children fear most. Fourth on the list was the atomic bomb. The Nurse Instructors Manual is entitled "The Nursing Aspects of ABC Warfare (Atomic, Bacteriological and Chemical Warfare)". In the 12-hour course, one hour of discussion is given to nuclear physics and the atomic-bomb phenomena; and this is followed by

Presented before the Health Officers, Public Health Nursing, and Dental Public Health Sections at the third annual meeting of the Ontario Public Health Association, held in the Royal York Hotel, Toronto, November 3 and 4, 1952.

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10 CANADIAN JOURNAL OF PUBLIC HEALTH Vol 44

three hours on the effects of radiation on man, radiation sickness, and the nursing aspects. Although only 15% of the casualties at Hiroshima suffered from radiation sickness, it is the most-feared after-effect of the atomic bojmb. People will be taught to protect themselves as much as possible from radiation sick- ness and will be assured that it is not necessarily fatal or disabling. At Hiro- shima, blast and heat caused by far the greatest number of casualties; there- fore, the medical care of trauma and burns is dealt with in detail.

Biological warfare has not been used on a mass scale, and to be effective it must be of proportions to cause epidemics. This could be a means to under- mine morale and lower efficiency and productivity. If the known principles of communicable disease control are applied, the effects of biological warfare will be minimized. Accurate reporting from a variety of sources will provide valuable information for the early detection of illness. This information should be obtained from every available reliable source to provide effective treatment and to limit the extent of damage to the population. Records of absenteeism from industry, particularly if they are interpreted by informed industrial medical personnel, can make a major contribution to this detection system and should be integrated into this part of the civil defence program. Public health nurses should teach families to recognize early symptoms of disease and to carry out medical orders satisfactorily. Families should be encouraged to take home-nursing courses as well as first-aid courses.

Chemical warfare involving the civilian population would produce defence problems unlike those of either atomic or biological warfare. Nerve gases are considered a major threat. Nurses should be alert at all times for new informa- tion concerning war gases.

The psychological aspects of mass disaster are a necessary part of the nurse's training. Panic can be created with little effort by means of mass rumour subtly propagated and disseminated by the enejmy. Dr. Frank Fremont Smith, con- sultant to the U.S. Air Force in the dynamics of human behaviour, recently offered these three suggestions for reducing the threat of panic:

1. Explain to every citizen that, even though A-bombs do fall in a given area, his chances of survival are good.

2. Emphasize the idea of mutual aid. "If residents of all stricken cities know that residents of all other cities are well prepared and anxious to help, all will feel more secure."

3. Make sure that each person has a job to do. "From experience abroad, we know that nothing does more to obviate threat of panic than a civilian defence set-up in which everyone, including children, is trained to perform a particular job. A small boy who knows it is his responsibility to have flashlights in good condition in his home seldom will panic."

The nurse must be emotionally prepared to give care only to those who can survive. This is a new philosophy and contrary to our traditional belief.

What is the organization for civil defence? Civil Defence Manual No. 1 con- tains all the information.

The nurses are organized for civil defence under the direction of the local Director of Civil Defence Health Services, who in turn is under the direction of the local Civil Defence Director. The local organization is patterned after

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Jan. 1953 NURSING IN CIVIL DEFENCE 11

the Provincial and the Federal organizations. Health Advisory Committees have been formed to advise the directors at the Provincial and Federal levels and in many of the larger cities.

Because, there are many other services in the civil defence organization, it is necessary for the nurses to become familiar with the roles played by each of these, for it is apparent that no one service can function without the assistance of at least one or more of the other services. The medical services need the assistance of the transportation services to handle the casualties. The welfare services need the police and warden service to direct people who have lost their homes or who require food and clothing.

Nurses will function as members of a team in first-aid stations, existing and improvised hospitals, emergency lodgings, and other installations where large groups of people present health problems. Nurses in a target area, who have received this instruction, are aware of their responsibilities as compared with the responsibilities of those living in a mutual-aid area or a reception area.

One of the major difficulties in planning for civil defence nursing service is the shortage of nursing personnel. The two factors to be considered are:

(a) The change in the role of the professional nurse who will necessarily have to assume some of the functions of medical personnel. The burden for the medical personnel can be envisaged when it is estimated that the number of living casualties in an average metropolitan area would be 30,000.

(b) The expansion of nursing services through the wide use of auxiliaries. Thousands of auxiliaries must be trained to assist in providing care for the

casualties and to replace anticipated casualties among nurses. The ratio is estimated to be one professional nurse to ten auxiliaries.

The graduate nurses who have taken the course in A.B.C, warfare are now instructing these auxiliaries in classes organized by the Canadian Red Cross Society or the St. John Ambulance Association. Their training in home nursing includes as well: adequate psychological preparation to prevent hysteria; self- protection and self-aid; participation in mutual aid; and their place and duties on a team.1

What are our goals for the future? They are: 1. To teach as many graduate nurses as we are able to reach. 2. To assist with the teaching of auxiliaries. 3. To plan refresher studies for the inactive married and retired nurse who

desires to be brought up to date with the new knowledge and procedures in nursing. Hundreds have already indicated their need for lectures on chemo- therapy, for first-aid training, practice in venepuncture and the delivery of babies. In the latter connection, a new leaflet entitled "Bomb-born Babies" has recently been written.

At newstands the general public can obtain copies of the booklets, "Personal Protection under Attack" and "Hiroshima", and an excellent booklet on "How to Survive an Atom Bomb". After our professional group has been covered, it may be that we shall take an active part in disseminating information to the general public, thus fulfilling the intent of the motto, "Civil defence is every- body's business."

1Nursing Aspects of A.B.C. Warfare, p. 104. Ottawa: Department of National Health and Welfare, 1951.

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