"DON'T let an injured person get up.

"DO keep an injured person lying down," read the instructions in the American Red Cross First Aid Textbook, with pictures to emphasize this important lesson.

But if you are going to give first aid to victims of an A or H bomb, you may not always be able to follow these time-honored directions. Your first job may be to get the injured person to safety, regardless of whether he is fainting or has broken bones. If fire is creeping close, if the walls or nearby buildings are about to fall, and if you are alone with half a dozen badly injured persons, you will not be able to "splint them where they lie."

In case of an atom bomb explosion it may be that the most life-saving thing you can do will be to rescue the injured from areas of hazard. It may be possible to give top-notch first aid care to many victims and this should be done wherever possible. But where there are many cases of badly injured and equipment is lacking, many of your carefully learned first aid lessons may need to be changed.

In the first aid course, for example, you learned to be careful about every minor cut and scratch, cleansing them thoroughly and perhaps applying a sterile dressing to guard against infection. In the event of an atom bomb attack, some of your patients may be covered with tiny cuts and scratches from flying glass. But in a critical situation you will pay no attention to these, and if that is all the injury the person has, you will send him on his way home or to shelter, telling him to see his doctor a few days later when things have quieted down.

You learned in the Red Cross first aid class to see what injuries the patient had and to care for the most serious ones first. You will be doing the same thing in case of an atom bomb attack, but on a much larger scale and with one important new feature added.

THE GEOGRAPHY OF FIRST AID

This new feature may well be included in the first lesson you will get in first aid courses revised and expanded to meet the needs of atomic war. This first lesson may be on the geography of an atom bomb attack as it relates to first aid to the injured. Through it you will learn to think of your home town in terms of circles or concentric rings, like the rings that spread out from the center when you drop a stone in a quiet pool of water.

Care for the most serious injuries first.

At the center is the point where the bomb drops, if it is an air burst. What you do in the way of first aid depends on where you are in relation to this central point. Up to one mile out, in all directions, from this central point, will be the area of very heavy destruction from the blast damage and of deadly dosage of radiation. Most of the people in this area will be killed, but a few will survive. Authorities estimate that about 5% of people in this first zone will survive and not even suffer damage from radiation. The figures are based on the Japanese experience. Survival of these few people was due to the fact that they happened to be in places where they were sheltered both from blast and radiation.

For the next mile out in all directions there will be heavy blast damage and this is also the "dangerous dose" area of radiation. Here is where you will apply your modified first aid. This is the hazard area where there may be fire, falling walls and flying debris that could kill you and your patient while you are taking time to apply a splint or a tourniquet to stop bleeding.

Here also is the place where you probably will not have any splints or tourniquets or sterile dressings to apply even if you had the time. They will either have been destroyed or so covered with debris that you could not get at them. So you look first, as always, for signs of shock and bleeding, but also for signs of approaching fire or shaky walls. If the patient is bleeding you put your hand right over the bleeding place, dirt and all, and press hard enough to check the bleeding. You keep up the pressure while you lead the man or woman to safety. More likely, you will have to show the patient where and how to use pressure and send him on his way alone, while you go on to care for the next victim, the next, and the next.

Keep up the pressure while you lead the patient to safety.

You may notice the symptoms of oncoming shock as you have been trained to do, but whether you have the patient lie down and try to keep him warm, to prevent shock, or whether you send him on to safer area or to his home will depend on the situation with regard to the likelihood of further damage and injury.

You do not need to worry or even think about the radiation effects. Up to the present, there is nothing in the way of first aid treatment that will overcome the effects of a heavy dose of radiation. All the things that can be done, including new methods now being tested in laboratories, for helping toward the possible recovery of patients who got heavy doses of radiation, will have to be done by doctors and nurses. Your role as a first aider will be to keep the surviving victims from bleeding to death or getting further fatal injuries before the doctors and nurses have a chance to try to treat them.

Remember this about the radiation from an atom bomb: It is all over in a minute or so. About 99% of the radiation produced comes out in the first fraction of a second after the bomb goes off. By the time you have picked yourself up, realized what has happened and pulled yourself together and begun to think about using your first aid training to help those around you, the danger is over. You will gain nothing by running away. You can safely stay and help those in need.

Quick, proper treatment of leg or arm injuries.

Next in the geography of atom bomb first aid are the areas between two and four miles out from the center where the bomb was dropped. Here the damage will be moderate to slight. Most buildings will be standing; there will not be much fire danger, but there may be many casualties.

About 20 or 25% of the people in these two outer areas of a mile each will be killed. Many others will have severe injuries. There may be bad leg cuts that are bleeding profusely. Quick, proper treatment can save many lives here. And this is the area where top notch first aid can and should be given.

You will have time to do it because there will not be so many injured in your immediate vicinity, and you will have splints and other equipment to use. But even though you may see only two or three or five badly injured persons, the total number will be large because the area is circular. So the total number of trained first aiders must be large if people in this area are to be saved.

You will not, of course, stop to consult a map to see which area you are in after an atom bomb burst. Nor will you be able to tell the exact point where the bomb fell. But you will be able to locate yourself atom-geographically pretty well by the look of things around you.

If most of the buildings are down and you see fire, you are near the central area. If only a few buildings are down, and those mostly the small brick structures, and no large fire seems close, you are probably out in the moderate to light damage area. The one-, two-, three- and four-mile circles may each be larger, depending on the power of the atom bomb dropped.

FIRST AID TREATMENT

Look for 1. serious bleeding, 2. difficult breathing or stoppage of breathing, and 3. poisoning. Treat immediately, in that order, before you do anything else.

That is the Number One rule that will be taught the 20,000,000 persons throughout this nation who will be needed to give first aid in event of an atomic attack. It is the prime rule to remember at any time you are giving first aid, whether to victims of a highway accident or to someone who is accidentally injured at home or at your place of work.

Victims of an atomic attack will suffer many kinds of injuries. There will be all the kinds that would come in an ordinary bombing attack, plus a few peculiar to the atom bomb itself. Flash burns and burns from fire and injuries from blast, from flying debris and from collapsing buildings can be expected in varying degrees, both as to number and severity.

From the bomb itself, of course, will come ionizing radiations, those alpha, beta and gamma rays that are so mysterious and frightening to most people. The damage these do depends on the dose of them that gets inside the body. Within 500 yards of the point where the bomb explodes a high enough dose of ionizing radiation to kill is likely to strike most of the victims. But these same victims are also likely to be killed immediately by blast, fire and collapsing buildings. Even up to 1,000 yards out, ionizing radiation from the bomb will be great enough to kill, though the victims may not die immediately and may die of other injuries than that from the ionizing radiation.

In non-fatal cases of this radiation injury, signs and symptoms usually do not appear until two or three days after and sometimes not until three weeks after.

RADIATION SICKNESS

As a first aider, you will not be worrying about caring for these ionizing radiation injuries themselves. But if, two or three days after the bomb burst, one of your friends or neighbors complains of feeling a little sick, and perhaps has been nauseated and had diarrhea, you might suspect radiation injury and advise him to see a doctor promptly. Many of the borderline cases may be saved by transfusions of whole blood. And perhaps by the time an atom bomb drops in your town, medical scientists will have found other good treatments for the radiation injury from it.

Many of the borderline cases might be saved by transfusions of whole blood.

Some of the victims may complain that they cannot see. Unless the eyes are protected, the flash of the bomb could produce temporary blindness. Normal eyesight will return in about five minutes, on the average, though this temporary blindness may last for several hours. You will help these victims to a safe place, reassuring them, and of course treating any serious injuries they may have. But leave the eyes alone. You don't want to put anything in or on the eyes that might cause infection. Radiation from the bomb can cause serious damage to the eyes. The number of these radiation cataracts so far reported among Japanese victims, however, has been small. They do not develop immediately and, like any other cataract, require treatment by an eye specialist when they do develop.

As a first aider immediately after the bomb goes off, however, you are going to be busy helping people with bad burns, torn and mangled limbs, gaping belly wounds with intestines and other internal organs showing, and people choking and gasping for breath because of pressure on chest and belly or a wound that has pierced the chest. And there will be others with mouth and nose so covered by sand, gravel and other rubble that they cannot breathe.

SERIOUS BLEEDING

If blood is coming fast, it is serious, and you must try to stop it.

Remember you are going to look first for serious bleeding and stop it. Loss of more than two pints of blood at one time can be serious and may be fatal. If a large artery or vein is cut, blood will pour out fast and in large quantities. Bleeding is serious if bright red blood spurts from a wound or if the blood is flowing freely, whether bright or dark. Blood from arteries is brighter than blood from veins and usually comes in spurts corresponding to the beating, or pumping action, of the heart.

You do not need to decide, however, whether the blood is coming from an artery or vein. If it is coming fast and does not stop by itself within four or five minutes it is serious and you must try to stop it. Remember, the victim may have been bleeding four or five minutes by the time you reach him. So if you see a lot of blood on his clothes or see the blood pouring from a wound, go into action at once.

Direct pressure is the most commonly used way to stop bleeding. You may have to put your hand right on the wound. Sometimes pressing your fingers on the edge of the wound will stop the bleeding. If you have a sterile gauze compress, use it, but don't wait to get one. A clean handkerchief or cloth is better than your hand or fingers, but again, don't wait to find one. Depending on circumstances, you can send someone for a handkerchief or bandage, or the victim may be able to apply pressure while you get one. As soon as you can, substitute a cloth or dressing for you hands and fingers and press firmly on that. If this stops the bleeding, bandage the cloth or dressing tightly. Look at the bandage frequently to see whether bleeding has started again. If it has, you must apply more pressure. Don't take the bandage and dressing off, however. This might disturb or break the clot that is forming.

If the bleeding is from a wound in the neck, you cannot very well bandage a dressing in place. Put your hands above and below the cut and press firmly enough to stop the bleeding and keep up the pressure until a doctor tells you to stop. Because the blood will make the neck very slippery to hold, a compress of the cleanest material immediately available will be a great help in keeping the pressure on.

When bleeding is from the hands, feet, arms or legs, it may help to raise the injured part. If there is a broken bone, however, do not do this. Keep the injured part quiet, aside from the necessary manipulation to apply pressure and bandage and to raise it. Movement may loosen the clot and causing bleeding to start again.

A good way to stop serious bleeding in many cases is to press your hands or fingers on certain "pressure points." These points are where the main artery to the injured part lies close to a bone, which gives a firm object against which to press.

Pressure points on the body.

There are a number of these pressure points, but the two most practical for the first aider to learn and use are:

1. On the inner, or body, side of the arm, below the armpit and about halfway between shoulder and elbow.
2. In the mid-groin as the artery passes over the pelvic bone. Press downward, with your arm straight, pressing the heel of your hand into the middle of the groin.

TOURNIQUETS

You have undoubtedly heard about tourniquets used to stop bleeding. Remember that they are always dangerous. Applied by someone who knows how, they are useful, but they should not be used if bleeding can be checked by other means.

A tourniquet can be made from a belt, stocking, handkerchief or cloth folded to make a flat band at least two inches wide. Never use a rope, wire or sash cord. Tourniquets are most conveniently used on arms and legs. Wrap the flat material twice around the leg or arm. The correct places are around the upper arm about a hand's breadth below the armpit and around the thigh about a hand's breadth below the groin.

Tie the ends in a half-knot. Put a stick or similar article on the half-knot and tie a square knot. Then twist the stick swiftly to tighten the tourniquet. Hold the stick in place by the ends of the tourniquet or another bandage.

Don't bother to put on a tourniquet until you have brought the bleeding under control by pressure on the wound or on the appropriate pressure point.

Tourniquets must be tight enough to stop the flow of blood in the artery. Since this is usually deep below the surface, the tourniquet must be really tight or it will be worse than useless. One way of telling whether it is tight enough is to feel for the pulse at wrist or, if the tourniquet is on the leg, at the instep on the front of the foot between the ankle bones. If the flow of blood through the artery has been stopped, there will be no pulse. But it takes practice to know whether this is the case.

Loosen the tourniquet every fifteen minutes.

When you get the tourniquet really tight, you have cut off all blood to that arm or leg. If the circulation is cut off long enough, the part dies and gangrene sets in. That is why standard first aid lessons direct you to loosen the tourniquet every 15 minutes, tightening it again if bleeding starts. Also, you must be careful not to cover a tourniquet with a bandage or splint, or it may be forgotten and not loosened when necessary. As an extra precaution, you can put the letters TK on the victim's forehead, using pencil, lipstick, a piece of charred wood or whatever is handy for marking.

As you can see, the use of a tourniquet is complicated. Unless you have had enough training to be expert, it may be wiser and safer not to try using this dangerous instrument.