Medical assistance: we work from wheels
Medical assistance: we work from wheels

The technological disaster in Chernobyl has no analogues in its scale. Radiation infection of the Ukrainian territory amounted to 54.6 thousand km2 – it means 9% of the total area of the country. In total, 3 million 363 thousand people have suffered, of which a third are children. According to statistics, the number of injured in only one Kiev region is 912 thousand people, and 119 thousand victims in the neighboring Chernihiv region, which also found itself in the zone of radiation risk.

The number of evacuated population, the volume of work to eliminate the consequences of the accident were extensive: the instruction and training of specialists of the medical defense civil service that were carried out before the accident only contributed to the acquisition of experience in dealing with radiation hazard and could not provide for the factors most important for protecting the population.

As it turned out, the Ministry of Health of the Ukrainian SSR did not even have an action plan in case of extreme situations at nuclear power plants, including the Chernobyl nuclear power plant. Therefore, medical support for its employees was provided by the medical unit subordinate to the Moscow authorities.

In turn, the Ministry of Health of the RSFSR, as well as other Republican Party and state bodies, could solve all issues related to the liquidation of an accident and its consequences only with the permission of higher authorities.

Anatoly Nikolaevich Zelinsky, an Honored Doctor of Ukraine and candidate of medical sciences, recalls: he worked in the healthcare system in various positions in 1950-2002 – from the doctor of the district hospital to the first deputy minister of health in 1970-1987.

… At 9:00 a.m. on April 26, 1986, the government telephone was interrupted by a disturbing working atmosphere in the office of the Deputy Minister of Health of the USSR. The probation officer of the Chairman of the Government of the Ukrainian SSR A.P. Lyashko warned of an urgent connection with the “boss”. Always calm A.P. Lyashko spoke excitedly this time. I learned from him about the fire at the Chernobyl nuclear power plant and was instructed to contact the medical unit of the Chernobyl nuclear power plant, to determine the need for assistance from the republic’s medical service. However, it was not possible to connect with it that day – numerous attempts were strangely interrupted, and there was no answer. It turned out that the State Security Committee monitored and blocked telephone calls. There remained the only source of information – the III Main Directorate of Health of the USSR. First, I received information about the fire at the facility, and at 11 a.m. about the explosion of the reactor, radiation hazard and the creation of a special union government commission, headed by Deputy Prime Minister B.E. Shcherbina. The commission included the first deputy of the USSR Ministry of Health E.I. Vorobyov, whose instructions we were obliged to obey implicitly, but he never made contact. As it became known later, no information was received from him, as was actually from his immediate superior, the Minister of Health of the USSR. I immediately contacted by telephone with the Minister of Health of the Byelorussian SSR. The latter, like the head of the Belarusian government M.V. Kovalev, first heard about the accident from me, both were extremely nervous.”

Doctors admit: we were not ready

Meanwhile, A.M.Zelinsky summoned a retired medical colonel and a radiologist, formerly the chief radiologist of the Belarusian military district, V.P.Antonov to the Ministry of Health. Together, they began to study plans and reports on the instruction and trainings of the civil defense medical service and all available literature on radiation medicine, including that received urgently from the medical library.

The Chernobyl disaster was the first extremely serious test of the entire organization of medical care in the face of massive radiation damage to the population. The measures developed at that time to eliminate the consequences of the accident at nuclear power plants and to protect the population were incomplete and imperfect.

At that time, there was no established system of dosimetric service, a system for monitoring the quality of water in reservoirs, and a system for monitoring the radiation safety of food products. In a word, we were not ready for such a global problem as post-emergency radiation monitoring and safety.

Health authorities and institutions had to solve all these problems in the conditions of a catastrophic lack of time, limited human resources, material and technical forces and means, as they say “worked from the wheels.”

A set of priority problems was identified before the doctors in the first days after the Chernobyl accident, which needed to be urgently resolved. The organization of dosimetric measurements of the state of radiation pollution of air, water and food were among them.

The result of the analysis: a study of water in Pripyat, the Dnieper and the Kiev reservoir showed an extremely disappointing picture in relation to the increase in radiation pollution.

What has been taken:

Due to the high risk of developing thyroid diseases as a result of the harmful effects of radioactive iodine, the prevention of the population with iodine preparations immediately began using all available supplies of medicines.

The main pharmacy department sent all stocks of iodine preparations to the Kiev region. Over a short period of time, preventive work reached over 500 thousand people, including about 150 thousand children.

What has been organized:

A survey of the state of public health was organized in order to identify patients and victims. The organization of mobile outpatient clinics was carried out for the treatment and prevention with the aim of approaching and maximizing the availability of qualified assistance.

Special teams were formed and sent to the Chernobyl nuclear power plant for the purpose of stationary work of the sanitary and epidemiological services. The work of washing stations for the evacuated population, dosimetric monitoring, and decontamination of clothes and shoes were established.

Alarmism and cowardice are not our method, comrades!

On April 28-29, 1986, 244 ambulances with medical personnel, 12 mobile laboratories, including 45 laboratory assistants, 17 hematologists, 115 mid-level medical personnel and 62 dosimeterists, were sent to the Kiev region. On April 29, 1986, the Minister of Health of the USSR, S.P.Burenkov, and the chief radiologist of the Ministry of Health of the USSR, academician L.A. Ilyin, arrived in Chernobyl.

When measuring the level of radiation during their flight over the Chernobyl nuclear power station, the needle of the dosimeter went off scale. Later, they expressed unanimous opinion in their memoirs that having arrived at the Chernobyl nuclear power plant, they were horrified to see a picture typical of wartime.

Having analyzed the real state of affairs, taking into account the testimony of radiation reconnaissance and the forecast of the Hydrometeorological Center, on April 30, 1986, B.E. Shcherbina tried to convince the then General Secretary of the CPSU Central Committee M.S.Gorbachev at a meeting of the Republican Politburo to cancel the May Day demonstration in Kiev, which was regarded as a biased analysis, premature negative conclusions, alarmism and cowardice.

On this day, medical equipment, iodine preparations, and essential medicines were dismantled and removed from the mobility reserve by a government decision, which made it possible to deploy a network of dosimetry points, radiological and clinical diagnostic laboratories, washing and decontamination points, and expanding the iodine prophylaxis of the population in neighboring areas, and in territories with an increased level of radiation background.

A little later, information began to come about intense radiation pollution of the territories south and west of the Chernobyl nuclear power plant in connection with a change in the direction of the wind. The specified information was urgently brought to the attention of the public health authorities of the city of Kiev, Zhytomyr, Cherkasy, Vinnitsa, Chernihiv and other regions.

The first week was difficult …

Not all issues were managed in a timely manner: there were miscalculations and untimely decisions. However, it was precisely in these early days that physicians carried out a number of important measures aimed at taking control of the situation.

On May 2, 1986, a decision was made to send representatives of the Ministry of Health to the Borodyansky and Makarovsky districts of the Kiev region, where the authorities planned to resettle the evacuated population.

The scale of further evacuation and the increase in the number of evacuated population to 90 thousand people required a decision to be sent to the places of resettlement of an additional number of medical workers and ambulances from all regions of the republic.

Subsequently, temporary medical units were created from among the arrived medical workers. These medical teams and mobile outpatient clinics were transferred to rural medical stations in the places of resettlement of the evacuated population.

Mobile hematology laboratories were urgently called from other regions. Hematologists and laboratory assistants, mid-level medical workers, arriving to provide assistance to victims of the Chernobyl accident, underwent brief instruction in the management of medical preventive care.

Particularly active participation of doctors from the Kiev Institute for the Improvement of Medical Personnel was noted. Its specialists, not waiting for instructions from above, guided by a patriotic duty, voluntarily went to work in medical teams for the examination and treatment of the evacuated population already in the first days of the accident.

Children and pregnant women are at risk

Observation was also carried out by 303 laboratories of other departments. At the stage of evacuation, medical assistance to the victims was provided by teams of escort specialists. They worked with high-risk groups, children and pregnant women, in the pre-sorting process.

Persons with suspected radioactive damage were sent to specialized hospitals. Specialized medical care was provided in district, city, regional hospitals and specialized research institutes. The population covered by medical care in the Kiev region exceeded 500 thousand people already in the first period after the accident.

Miners and mine builders were involved in the implementation of measures to eliminate the consequences of the accident. The work of medical and paramedic health centers was organized in the places of their accommodation and residence. The work of the Chernobyl District Polyclinic, staffed by medical personnel arriving from other regions, was resumed.

Strict control over the observance of the sanitary regime, the organization of washing facilities, and the decontamination of clothes and shoes was carried out by the Sanitary and Epidemiological Service. Physicians consulted patients in polyclinics, and if necessary, hospitalized them, already in the first days after the accident.

In the early days of May 1986, the information received on the state of radiation pollution of the environment was disappointing and caused great concern regarding the health of the children who lived in these territories, especially in Kiev and the Kiev region.

In this regard, the Ministry of Health of the USSR prepared and sent for consideration by the government commission reasonable proposals on the feasibility of conducting in the summer of 1986 a health campaign to transport children to ecologically safe regions.

It was supposed to use the existing network of health resorts, health facilities, recreation centers. Soon, more than 200 thousand children from Kiev and the region were organized by rail to the places of summer recreation and rest.

The disaster at the Chernobyl nuclear power plant has become one of the most difficult trials for most employees of Ukrainian medical institutions, which have befallen them, both professional and personal.