may be the best possible way to survive under such threatening circumstance as long as flight is not blocked and escape routes are often mass panic is unlikely to occur and is therefore in from fifteen to twenty percent of the survivors actual danger will produce alertness and increased efficiency prior training or experience will increase the likelihood of this favorable reaction however the majority of individuals will be unable to cope with such a catastrophic experience immediately particularly if it is unexpected or prolonged the sudden obliteration of their surroundings the sound and fury  blast will make it difficult to respond or react from play and effectively great fear will interfere with the ability of many to understand what is happening on to decide what they must do after seconds or minutes now ever most of them should recoil and develop sufficient awareness to take steps for personal survival during this required period and breath time thereafter such survivors may be influenced by the commands and activities of leaders or other survivors perhaps five to twenty percent will not rebound immediately they will continue to lean on effective for hours but rarely for days some may continue to be stunned or days it is to this group alone that the designation psychological casualty may be properly applied or to use the terminology of world war two think jim of combat f most of the survivors of a nuclear attack will react in ways which must be regarded as normal responses to stress and such severity these reactions are not necessarily disabling and may render individuals only temporarily non effect these people will experience sensations and will behave in ways commonly encountered among disaster victims some may have tension headaches a momentary breezing of muscular activity temporary difficulty with speech trembling or occasional growth shaking others may suffer from nausea and vomiting some overexcitable a day with laughter or tearfulness and restlessness all these symptoms are normal disaster reaction individual suffering them will be unhappy uncomfortable and distressed but they will be non affected for only a very short time and should not require specialized medical treatment or management if their difficulties are not to be prolonged it is important that nature and significance of their reactions be understood by their leaders and by those about them such persons who are immediately available must provide them with direction firmly encourage their proper in turn to affect in function the reassurance and support of nearby and familiar medical personnel may help in this brave but i highly effective type of psychological first  only when despite such efforts the abnormal behavior persists should psychological casualties be considered psychiatric problems requiring specific medical treatment for their combat  fatigue about fifty to seventy percent of those who symptoms persist will be suffering from a mild incapacity some of these may connect their fears and anxieties with strong believes that they are suffering from heart disease irradiation sickness concussion stomach trouble and the like symptoms ordinarily associated with internal injuries or disorders they may wander about aimlessly doing meaningless things others are this mild type may exhibit restlessness and become over talkative because they cannot concentrate on our complete a single task they will be almost unable to function with others approximately thirty to forty percent of the psychological casualties will be of a moderate type they will look s disabled they may have difficulty talking others may be agitated with marked anxiety and tension some in this moderate group may suffer from a reactive depression they may have lost a body in the attack and may display obvious green they will exhibit actual tears only occasionally still others may suffer from hysterical blindness deafness loss of memory or voice some may have a paralysis of one or more extremities brought on perhaps by a minor injury or by the blast wave they will characteristically present a bland indifference until average are made to remove the symptom of them tension mixed with finally in this moderate group there may be those who continue to be stunned then days by their experience they may exhibit surveyor apathy questions will be answered only in monosyllables there will be no evidence of tears depression or anxiety because they seem absorbed in themselves or puzzled by their experiences they will exert little effort to do or to say anything they will seem unable to understand what is happening to them approximately one to three percent of the psychological casualties will be in the severe group clearly out of contact with reality exhibiting uncontrolled actions which are purposeless and undirected because respond without discrimination self injury may result it will be impossible to reason with them and the incoherent shoving will sometimes occur also in this severe grope will be some way exhibit a complete withdrawal from their environment to a helpless infant all state they will be new motionless with little reaction to stimulation but such manifestations may change in a matter of minutes rather than hours or days usually the change will be in the direction of improvement with increased self control and more effective behavior even the severe psychological casual can be expected to improve within hours within days at most depending upon the kind of treatment he receive there are certain basic principles to be followed in the treatment and management of mass psychological casualties this must be remembered most of these casualties will be suffering only temporary emotional disturbances they can be expected to improve as the danger lessens there for treatment must be made available as soon as possible and as near as is practical to the scene of the nuclear disaster most of the mild cases by their commissions or noncommissioned officers many of the casualties will be readily influenced by suggestion and other simple measures to recover self control for this reason early treatment can produce an improvement before time and continued helplessness have fixed a temporary condition into a chronic disorder this will prevent psychological casualties from overloading evacuation channels and medical facilities necessarily immediately after the blast they use bestseller days must be reserved for the treatment of casualties with physical injuries however individuals who do not recover their effectiveness as a result of reassurance leadership and direction should be evacuated to the nearest aid station or medical sorting team only as absolutely necessary nuclear warfare the battle group surgeon will normally assume the role of up front line psychiatry will bust conserve the fighting strength of his unit at a time when every man will be vitally needed own cases if they reach medical sorting teams or aid stations will be placed in a holding category they will be allowed to rest talk to others and regain self control careful sorting and early corrective treatment that the aid station level can probably restore a vitally needed trained manpower urgently required for defensive and rescue t psychological casualties should be encouraged by reassurance to recover a to a them and accepting their condition as being only temporary encouragement by the treatment personnel can help provided it is stated with conviction calm acceptance of the casualty and their attitude that the symptoms are only temporary it can produce the desired improvement within a matter of hours and especially after certain treatment procedures have been follow these procedures should be simple and brief not only because of the lack of personnel and time but because straightforward simplicity of boys the suggestion of serious illness early measures to relieve thirst pain and minor injuries can provide the most rable conditions for return to duty available small doses of a sedative with warm milk soup or cocoa can promote relaxation although the warm drink alone can often serve the purpose adequate a rest period of several hours is also indicated later if time permits the psychological casual they should be interviewed bravely and should be encouraged to relate these experiences in the disaster this will give the casualty an opportunity to talk about himself and express some of the feelings and attitudes that may be responsible for his symptoms it will also encourage him to respond to others so that he can be motivated to return to duty rescue or medical mission with this return to activity their ability to work with others will improve and they will be led further toward resuming their normal activities immediately after a nuclear attack the transport for medical evacuation will be reserved primarily for the physically injured however when these facilities become available though they are persistent psychiatric cases should be evacuated this will normally be to the division psychiatric treatment center after the emergency has passed and the situation has stabilized the psychiatry's will resume his active specialized medical function in some array all military personnel must be prepared to treat the psychological casualties which can be expected in nuclear warfare they must realize that the common psychological reaction is to be expected after a nuclear attack will be states of temporary disturbance can be expected to improve rapidly as the danger lessons and without specific medical treatment most of these individuals can be aided by those about the treatment of psychological casualties should be based upon principles that include it meant that as soon as is practical and as near as possible to the disaster area assurance of recovery and brain simple procedures to include feeding read and interview remember treatment should be studied in the field sorting and if at all possible active treatment should be provided by any medical facility receiving psychological casualties proper sorting and management can be highly affected in preserving manpower most important in the early phases of a nuclear attack directed work and other steps to improve effectiveness will not only shorten the period of abnormal behavior but will save lives reduce disability and in general lessen the inevitable confusion and chaos resulting from a nuclear attack