Organization of Aid in Emergency Situations

The concentration of patients in a single highly-specialized centre makes it possible to obtain comparable data from the study of various cases of injury. A specialized medical establishment should be able to undertake the necessary work in order to develop a rational course of treatment, to determine the dose received, by both physical methods and biological methods (especially those which quantitatively give the best correlation with physical tests, i.e. determination of the number and form of chromosome breakages in the bone marrow and the peripheral blood culture), and to maintain cytological, karyological and immunological observation to ascertain whether transplanted bone marrow has taken or been rejected. Under normal circumstances (where there is no accident) the centre should perform the function of a haematological and surgical clinic. A singular, though not fully adequate model for acute injury is toxic agranulocytosis, which occurs when patients with tumours of the blood system are treated, with large doses of cytostatic preparations and with whole-body irradiation. This model is used for day-to-day studies aimed at the proper evaluation and treatment of accident cases. Analysis of damage to chromosomes in bone marrow cells during local gamma therapy for patients with a variety of tumours and during whole-body irradiation of two persons suffering from acute leucosis have shown that karyological investigation may be an important link in biological dosimetry and may indicate the degree of non-uniformity of the injury; local gamma irradiation of the ilium and sternum with 220 rads shows up about 60 per cent of the mitoses with chromosome disturbances (0.005 breaks per cell per röntgen); the same proportion of chromosome aberrations can also be detected by whole-body irradiation at the same dose. Casualties should be brought to the centre immediately after the accident and at the same time be given medical attention to alleviate their initial reaction. Those who have been subjected to doses greater than 200-300 rads must be placed in special individual cubicles supplied with near-sterile air. This requirement would be met in the case of one patient by a room 35 m3 in-size. Serious cases receive comprehensive therapy from the moment of their arrival as follows: transfusion of 20-30 000 million freshly prepared bone marrow cells every 5 or 6 days until there are signs that haematopoeisis has begun, antibiotics, gamma globulin and a special diet. After clinical and spa treatment, patients should be given suitable employment in accordance with their trade or profession. (author)