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The dentist in civil defense
The dentist in civil defense Russell W. Bunting, D.D.S., Ann Arbor, Mich.
with physicians in health services; they are used to dealing with patients in pain, and they are noted for their dexterity. Furthermore, in the war, many dentists in the Armed Forces rendered outstand ing service in caring for the battle casual ties. After the explosion on the U.S.S. Bennington, the Medical Corps was en tirely incapacitated and a Dental Corps officer was the only person on board who could care for the injured. He assumed this task and performed the casualty serv ices so well that he was awarded a cita tion. Similar situations have also occurred on ships in the Pacific and in the Army on the battlefield. Many dentists also acted as assistant surgeons in army hos pitals. This pronouncement, however, came as a distinct shock to dentistry. In the past it has been concerned chiefly with its own specific field of health services, and few dentists have had any training or experience in caring for general bodily injuries. Dentists are not equipped to practice general medicine, nor do they wish to do so. And yet, in view of the exigencies which will arise in any all-out thermonuclear attack, they may be forced to assume some of these responsi bilities. In a consideration of this prob-
What role will dentists play in a national disaster? That is a question that 90,000 dentists have been asking for some time. During the past five years, as dental con sultant in the Federal Civil Defense Ad ministration, it has been my job to de termine the role of dentistry in civil de fense. When I went into the agency in July 1951, I found that the program of casualty care had been well defined in a manual AG 11-1 entitled Health Services and Special Weapons Defense. This has been generally accepted as the “bible” for all civil defense programs. With the in creasing estimate of casualties due to the newer nuclear weapons, however, this manual is now being reviewed with this factor in mind. In this manual, in view of the vast number of casualties and the lack of adequate medical facilities to care for them, the need for auxiliary medical per sonnel was stressed. Among these, the dental profession was given considerable prominence. In the plan of organization dentists and veterinarians were assigned to first-aid stations as assistants to physi cians and surgeons. It was also stated that in case no physician was available, the dentist should take charge and direct the station. This revolutionary idea came somewhat as a shock to the dental pro fession. It is based on the premise that dentists, although limited to a specific field, are trained in the basic medical sciences. They are accustomed to working
Presented before the M edical and Dental Reserve Officers Conference, Great Lakes, III., September 27, 1956. Dental consultant, Federal Civil Defense A dm inistra tion, Battle Creek, Mich. 234
B U N T IN G
V O L U M E 54, FEBRU ARY 1957 • 235
lem by the National Research Council, have presumed to state. In all medical civil defense conferences the dentist is the following statement was made: spoken of as an allied or paramedical A t the request of the Arm y D ental Corps, worker and is included in all casualty the Com m ittee on Dentistry has considered services. the role that the dentist should play in the m edical aspects o f civil defense. As yet, however, no official pronounce T he Com m ittee believes that in the initial ment has come from organized medicine tasks o f first aid and evacuation the dentist, recognizing such dental services or with his basic knowledge o f m edical sciences, recommending training for them. One should be assigned the same role as the physi cia n ; and that in later phases, his capabilities semiofficial statement has been made by should be utilized to the utmost in providing Dr. Harold Diehl, chairman of the Amer treatment for the greatest possible num ber of ican Medical Association Council on Na casualties. tional Defense as follows: It is therefore recom m ended that training in the management o f mass casualties, com parable to that given to m edical students in the p ro gram o f M edical E ducation for National D e fense, be provided for all dentists in the Arm ed Forces and in so far as possible for those in civilian life as well.
Captain Oesterling of the Navy, in dis cussing dental personnel training for emergency in care of mass casualties has said: D uring wartime battle conditions, the dental officer must lay aside his im portant health pursuits to becom e a partner o f the m edical officer in caring for battle casualties. Dental officers w ill be placed with emergency battle dressing station teams and will be expected to be able to assume the many responsibilities of treatment that m a y arise.
The question then arises—what is the attitude of the medical profession to the development of this auxiliary medical service? Does it approve of dentists as suming the treatment of general bodily disorders, even in an emergency, when no medically trained man or woman is available? In writing the manual, TM 11-9, The Role of Dentistry in Civil De fense, I consulted freely with the medical staff of FCDA and with many eminent members of the medical profession who are interested in civil defense. Without exception, they were most cooperative and positive in their opinion that dentists could be of great assistance to physicians in a national disaster. They urged me to include in the manual specific services which they believed dentists could per form, far more than I personally would
These and other demands will create a grave shortage o f physicians. Dentists, because of their specialized training and experience may be called upon as leaders of whole sections of emergency m edical action. Dentists have an opportunity and an obliga tion to work w ith physicians in providing first-aid and em ergency m edical care in the event o f an enemy attack or follow ing a natural disaster. It is the primary responsibility o f each dentist to be trained in all the techniques of emergency lifesaving measures, the extent of which w ould vary, depending upon local m edical and health resources and the extent of casualties.
Other similar statements have been made by leaders in medical civil defense, notably Dr. Harold Lueth, chairman of civil defense in the American Hospital Association. Thus it appears that dentists, in any great emergency, since their specific den tal services cannot be performed, should work with physicians in the care of the injured as far as their capabilities will permit. This means that dentists should be integrated into health services plan ning for civil defense. It also means that dentists should be preparing to assume such responsibilities. It is recognized that the average dentist in private practice would be of very little assistance in an operating room. He would have to be told every move he made and there would be no time for that. But, if he had had some training in first aid and some hospital experience in casualty care he might be of very great assistance. In an FCDA Emergency Hos
236 • THE J O U R N A L O F THE A M E R IC A N D EN T A L A S S O C IA T IO N
pital exercise held in Brooke Army Medi cal Center, I surveyed the simulated casualties as they came into the Forward Treatment Center. From them I ob served that a trained dentist might give valuable assistance to the surgeon at the operating table in 50 per cent of cases. For another 25 per cent he might have done all that was necessary, alone. In only 25 per cent were the injuries too critical for him to undertake, but he could have given some assistance. In accord with this idea, the FCDA and the American Dental Association, during the past five years, have vigorously pushed a program of casualty care train ing in local dental societies. This consists of Red Cross first-aid and advanced casualty care services to be taught by the local medical society. In this, the seven training films released by the Navy have been widely used. As a result, many dental societies in all parts of the country have organized classes in training and have given large numbers of dentists basic casualty care instruction. This program has been well received whenever it was properly executed. The FCDA has given three very suc cessful courses for leaders in dental civil defense, many of whom have become outstanding workers in many states. Dur ing the past two years a Dental Civil De fense News Letter has been issued to a list of nearly 1,500 civil defense dentists. It is evident that it would be impos sible to indoctrinate every dentist in this country by any such program. Some progress has been made, but if any perma nent and far-reaching results are to be obtained, other avenues must be ex plored. Among them are the dental schools. At the present time over half the schools are including training in emergen cy casualty care in their curriculums. If every school adopted this policy, each year over 3,000 young graduates would be entering practice with at least the basic knowledge of emergency medical services.
In addition there is a large group of dentists who each year are entering the Dental Corps of the Armed Forces. After two years most of them will go into pri vate practice. Now that practically all the Armed Forces are giving the Dental Corps training in casualty care, each year there will be a large number of dentists so trained. Furthermore, the reserve corps of each of the armed services and the United States Public Health Service constitute an important pool which should be trained for emergency casualty care. The American Dental Association made a strong statement to the Military Operations Subcommittee of the Commit tee on government operations of the House of Representatives June 21, 1956, which was printed in the September 1956 issue of T H E J O U R N A L O F T H E A M E R I C A N d e n t a l a s s o c i a t i o n . In this, the whole field of dental civil defense participation has been well presented and includes the following statement: . . . our experience would indicate the need for a closer relationship of this program with the programs o f the m edical and dental corps of the armed services, particularly their re serve programs. Although it is recognized that these corps have a first duty to members of the military, they seem to be fitted by training and mission to assume a m ajor role in the civilian casualty care program , particularly in the area o f planning and training. Further, in an actual emergency, it is quite probable that these corps w ould be the proper organization to coordinate both military and civilian aspects of casualty care. In such an event, the total population o f the disaster area w ould un doubtedly be under martial law, and perhaps, undergoing some degree o f mobilization so that the military w ould be a rallying point for all civilians. Thus, the relationship be tween civilian and military responsibility and activity in the event o f an atom ic disaster w ould, in our opinion, be so close as to require a consideration at this time of developing a similar relationship between the civilian casualty care program and the mission o f the m edical and dental corps o f the armed serv ices. A t the very least an effective program o f civilian casualty care will require the closest cooperation with the military and its plans for such an emergency.
B U N T IN G . . . V O L U M E 54, FEBRU ARY 1957 • 237
The Army has, in the past, actively co operated with the FCDA. It has been active in the development of the FCDA Emergency Hospital and has conducted two major exercises in testing it at Fort Meade and at the Brooke Army Medical Center. It has offered courses in training in emergency casualty care at frequent intervals at Walter Reed and Brooke during the past five years, in which 135 dentists have been enrolled. It also is now offering training to the active Den tal Corps and reserve officers. The Navy has always been conscious of the need for training Dental Corps officers in medical casualty services and has given it considerable attention. The Navy also has developed very valuable teaching aids, such as the “bleeding dummy,” the artificial arm and neck, as well as audio-visual aids which they have made available for civilian training. These are valuable contributions. Members of the dental profession stand
ready to cooperate with the medical pro fession to the fullest extent, as far as their abilities permit, in any great emergency. They only ask two things; one, that a clear definitive statement be made by medicine as to the nature and extent of such dental cooperation desired, and sec ond, that the members of the medical profession and the Medical Corps of the Armed Forces lend their aid and encour agement in training dentists to meet these responsibilities. The dental profession should prepare to serve in any national disaster by learn ing how to administer casualty services outside of the mouth. They should know what to do for general bodily injuries. This will require training in local dental society casualty care programs and in hospitals, in student training in all dental schools, and in the active and reserve corps of each of the Armed Forces branches. 2224 Vinewood Boulevard
H unger Versus A p p etite • For an understanding o f the activities o f the gastrointestinal system, it is valuable to recognize the differences between hunger and appetite. H unger is typified by two sensory com ponents: the first is a vague generalized weakness that may be related to sensory nerve impulses from the digestive tract and perhaps to lowered b lood sugar; the second com ponent is the more acute sensation in the epigastric region o f hunger pains, intermittent short periods o f tension or pressure. These contractions appear to be inherited with relatively little m odification by the experiences o f the individual. T h ey have a relatively fixed pattern of occurrence with about 30 minutes o f activity after one and a half or two hours o f inactivity. H unger can be stopped by solids in the stom ach regardless o f the degree of nourishment contained in the solids. A ppetite, though it com m only accom panies hunger^ may b e present without it or present long after hunger is satisfied. T h e com ponents o f appetite are principally psychological and are the result of the past experiences o f the individual. H ence, we learn to like and dislike foods from ch ildh ood on until the patterns o f food distribution, quantity, and so on, becom e thoroughly fixed in adult life. T h e most pronounced disorder o f appetite, overeating, leads to obesity and may be related to the use o f food as a means to allay tension, anxiety, guilt, frustration, anger, self-depreciation, sorrow or depression. In these cases, food ingestion patterns can only be altered effectively when circumstances provide “ n on -food ” supplies from the needed sources. James H. Shaw.
with physicians in health services; they are used to dealing with patients in pain, and they are noted for their dexterity. Furthermore, in the war, many dentists in the Armed Forces rendered outstand ing service in caring for the battle casual ties. After the explosion on the U.S.S. Bennington, the Medical Corps was en tirely incapacitated and a Dental Corps officer was the only person on board who could care for the injured. He assumed this task and performed the casualty serv ices so well that he was awarded a cita tion. Similar situations have also occurred on ships in the Pacific and in the Army on the battlefield. Many dentists also acted as assistant surgeons in army hos pitals. This pronouncement, however, came as a distinct shock to dentistry. In the past it has been concerned chiefly with its own specific field of health services, and few dentists have had any training or experience in caring for general bodily injuries. Dentists are not equipped to practice general medicine, nor do they wish to do so. And yet, in view of the exigencies which will arise in any all-out thermonuclear attack, they may be forced to assume some of these responsi bilities. In a consideration of this prob-
What role will dentists play in a national disaster? That is a question that 90,000 dentists have been asking for some time. During the past five years, as dental con sultant in the Federal Civil Defense Ad ministration, it has been my job to de termine the role of dentistry in civil de fense. When I went into the agency in July 1951, I found that the program of casualty care had been well defined in a manual AG 11-1 entitled Health Services and Special Weapons Defense. This has been generally accepted as the “bible” for all civil defense programs. With the in creasing estimate of casualties due to the newer nuclear weapons, however, this manual is now being reviewed with this factor in mind. In this manual, in view of the vast number of casualties and the lack of adequate medical facilities to care for them, the need for auxiliary medical per sonnel was stressed. Among these, the dental profession was given considerable prominence. In the plan of organization dentists and veterinarians were assigned to first-aid stations as assistants to physi cians and surgeons. It was also stated that in case no physician was available, the dentist should take charge and direct the station. This revolutionary idea came somewhat as a shock to the dental pro fession. It is based on the premise that dentists, although limited to a specific field, are trained in the basic medical sciences. They are accustomed to working
Presented before the M edical and Dental Reserve Officers Conference, Great Lakes, III., September 27, 1956. Dental consultant, Federal Civil Defense A dm inistra tion, Battle Creek, Mich. 234
B U N T IN G
V O L U M E 54, FEBRU ARY 1957 • 235
lem by the National Research Council, have presumed to state. In all medical civil defense conferences the dentist is the following statement was made: spoken of as an allied or paramedical A t the request of the Arm y D ental Corps, worker and is included in all casualty the Com m ittee on Dentistry has considered services. the role that the dentist should play in the m edical aspects o f civil defense. As yet, however, no official pronounce T he Com m ittee believes that in the initial ment has come from organized medicine tasks o f first aid and evacuation the dentist, recognizing such dental services or with his basic knowledge o f m edical sciences, recommending training for them. One should be assigned the same role as the physi cia n ; and that in later phases, his capabilities semiofficial statement has been made by should be utilized to the utmost in providing Dr. Harold Diehl, chairman of the Amer treatment for the greatest possible num ber of ican Medical Association Council on Na casualties. tional Defense as follows: It is therefore recom m ended that training in the management o f mass casualties, com parable to that given to m edical students in the p ro gram o f M edical E ducation for National D e fense, be provided for all dentists in the Arm ed Forces and in so far as possible for those in civilian life as well.
Captain Oesterling of the Navy, in dis cussing dental personnel training for emergency in care of mass casualties has said: D uring wartime battle conditions, the dental officer must lay aside his im portant health pursuits to becom e a partner o f the m edical officer in caring for battle casualties. Dental officers w ill be placed with emergency battle dressing station teams and will be expected to be able to assume the many responsibilities of treatment that m a y arise.
The question then arises—what is the attitude of the medical profession to the development of this auxiliary medical service? Does it approve of dentists as suming the treatment of general bodily disorders, even in an emergency, when no medically trained man or woman is available? In writing the manual, TM 11-9, The Role of Dentistry in Civil De fense, I consulted freely with the medical staff of FCDA and with many eminent members of the medical profession who are interested in civil defense. Without exception, they were most cooperative and positive in their opinion that dentists could be of great assistance to physicians in a national disaster. They urged me to include in the manual specific services which they believed dentists could per form, far more than I personally would
These and other demands will create a grave shortage o f physicians. Dentists, because of their specialized training and experience may be called upon as leaders of whole sections of emergency m edical action. Dentists have an opportunity and an obliga tion to work w ith physicians in providing first-aid and em ergency m edical care in the event o f an enemy attack or follow ing a natural disaster. It is the primary responsibility o f each dentist to be trained in all the techniques of emergency lifesaving measures, the extent of which w ould vary, depending upon local m edical and health resources and the extent of casualties.
Other similar statements have been made by leaders in medical civil defense, notably Dr. Harold Lueth, chairman of civil defense in the American Hospital Association. Thus it appears that dentists, in any great emergency, since their specific den tal services cannot be performed, should work with physicians in the care of the injured as far as their capabilities will permit. This means that dentists should be integrated into health services plan ning for civil defense. It also means that dentists should be preparing to assume such responsibilities. It is recognized that the average dentist in private practice would be of very little assistance in an operating room. He would have to be told every move he made and there would be no time for that. But, if he had had some training in first aid and some hospital experience in casualty care he might be of very great assistance. In an FCDA Emergency Hos
236 • THE J O U R N A L O F THE A M E R IC A N D EN T A L A S S O C IA T IO N
pital exercise held in Brooke Army Medi cal Center, I surveyed the simulated casualties as they came into the Forward Treatment Center. From them I ob served that a trained dentist might give valuable assistance to the surgeon at the operating table in 50 per cent of cases. For another 25 per cent he might have done all that was necessary, alone. In only 25 per cent were the injuries too critical for him to undertake, but he could have given some assistance. In accord with this idea, the FCDA and the American Dental Association, during the past five years, have vigorously pushed a program of casualty care train ing in local dental societies. This consists of Red Cross first-aid and advanced casualty care services to be taught by the local medical society. In this, the seven training films released by the Navy have been widely used. As a result, many dental societies in all parts of the country have organized classes in training and have given large numbers of dentists basic casualty care instruction. This program has been well received whenever it was properly executed. The FCDA has given three very suc cessful courses for leaders in dental civil defense, many of whom have become outstanding workers in many states. Dur ing the past two years a Dental Civil De fense News Letter has been issued to a list of nearly 1,500 civil defense dentists. It is evident that it would be impos sible to indoctrinate every dentist in this country by any such program. Some progress has been made, but if any perma nent and far-reaching results are to be obtained, other avenues must be ex plored. Among them are the dental schools. At the present time over half the schools are including training in emergen cy casualty care in their curriculums. If every school adopted this policy, each year over 3,000 young graduates would be entering practice with at least the basic knowledge of emergency medical services.
In addition there is a large group of dentists who each year are entering the Dental Corps of the Armed Forces. After two years most of them will go into pri vate practice. Now that practically all the Armed Forces are giving the Dental Corps training in casualty care, each year there will be a large number of dentists so trained. Furthermore, the reserve corps of each of the armed services and the United States Public Health Service constitute an important pool which should be trained for emergency casualty care. The American Dental Association made a strong statement to the Military Operations Subcommittee of the Commit tee on government operations of the House of Representatives June 21, 1956, which was printed in the September 1956 issue of T H E J O U R N A L O F T H E A M E R I C A N d e n t a l a s s o c i a t i o n . In this, the whole field of dental civil defense participation has been well presented and includes the following statement: . . . our experience would indicate the need for a closer relationship of this program with the programs o f the m edical and dental corps of the armed services, particularly their re serve programs. Although it is recognized that these corps have a first duty to members of the military, they seem to be fitted by training and mission to assume a m ajor role in the civilian casualty care program , particularly in the area o f planning and training. Further, in an actual emergency, it is quite probable that these corps w ould be the proper organization to coordinate both military and civilian aspects of casualty care. In such an event, the total population o f the disaster area w ould un doubtedly be under martial law, and perhaps, undergoing some degree o f mobilization so that the military w ould be a rallying point for all civilians. Thus, the relationship be tween civilian and military responsibility and activity in the event o f an atom ic disaster w ould, in our opinion, be so close as to require a consideration at this time of developing a similar relationship between the civilian casualty care program and the mission o f the m edical and dental corps o f the armed serv ices. A t the very least an effective program o f civilian casualty care will require the closest cooperation with the military and its plans for such an emergency.
B U N T IN G . . . V O L U M E 54, FEBRU ARY 1957 • 237
The Army has, in the past, actively co operated with the FCDA. It has been active in the development of the FCDA Emergency Hospital and has conducted two major exercises in testing it at Fort Meade and at the Brooke Army Medical Center. It has offered courses in training in emergency casualty care at frequent intervals at Walter Reed and Brooke during the past five years, in which 135 dentists have been enrolled. It also is now offering training to the active Den tal Corps and reserve officers. The Navy has always been conscious of the need for training Dental Corps officers in medical casualty services and has given it considerable attention. The Navy also has developed very valuable teaching aids, such as the “bleeding dummy,” the artificial arm and neck, as well as audio-visual aids which they have made available for civilian training. These are valuable contributions. Members of the dental profession stand
ready to cooperate with the medical pro fession to the fullest extent, as far as their abilities permit, in any great emergency. They only ask two things; one, that a clear definitive statement be made by medicine as to the nature and extent of such dental cooperation desired, and sec ond, that the members of the medical profession and the Medical Corps of the Armed Forces lend their aid and encour agement in training dentists to meet these responsibilities. The dental profession should prepare to serve in any national disaster by learn ing how to administer casualty services outside of the mouth. They should know what to do for general bodily injuries. This will require training in local dental society casualty care programs and in hospitals, in student training in all dental schools, and in the active and reserve corps of each of the Armed Forces branches. 2224 Vinewood Boulevard
H unger Versus A p p etite • For an understanding o f the activities o f the gastrointestinal system, it is valuable to recognize the differences between hunger and appetite. H unger is typified by two sensory com ponents: the first is a vague generalized weakness that may be related to sensory nerve impulses from the digestive tract and perhaps to lowered b lood sugar; the second com ponent is the more acute sensation in the epigastric region o f hunger pains, intermittent short periods o f tension or pressure. These contractions appear to be inherited with relatively little m odification by the experiences o f the individual. T h ey have a relatively fixed pattern of occurrence with about 30 minutes o f activity after one and a half or two hours o f inactivity. H unger can be stopped by solids in the stom ach regardless o f the degree of nourishment contained in the solids. A ppetite, though it com m only accom panies hunger^ may b e present without it or present long after hunger is satisfied. T h e com ponents o f appetite are principally psychological and are the result of the past experiences o f the individual. H ence, we learn to like and dislike foods from ch ildh ood on until the patterns o f food distribution, quantity, and so on, becom e thoroughly fixed in adult life. T h e most pronounced disorder o f appetite, overeating, leads to obesity and may be related to the use o f food as a means to allay tension, anxiety, guilt, frustration, anger, self-depreciation, sorrow or depression. In these cases, food ingestion patterns can only be altered effectively when circumstances provide “ n on -food ” supplies from the needed sources. James H. Shaw.