Opinions expressed in the Correspondence section are those of the authors, and not necessarily of the editors, ACEP, or UAEM. The editors reserve the right to edit and publish letters as space permits.

CORRESPONDENCE H u m d r u m Conformity: Will It Over take Us?

To the Editor: T h e r e is a new sadness pervading our specialty - - and

some fear. With the recent announcement by the American Board of Emergency Medicine that all residency programs in emergency medicine will need to be three years in dura- t ion starting in 1987, the exci tement and free spirit of emer- gency physicians, which has allowed our specialty to flour- ish, may go by the wayside. With money getting tighter for medical education, it can be anticipated that most of the program expansions wil l come as PGY-I slots. This will es- Sentially e l imina te those interes t ing individuals who en- tered the two-year programs after several years of training in other areas, real work experience, or both. H u m d r u m con-

formity may overtake us. Some good programs may not be able to financially afford expansion. Both events would be unfo r tuna te . The hope is tha t our spec ia l ty is m a t u r e enough to avoid it being catastrophic. [Originally published as a note from the president in the March 1984 issue of STEM Letter, the monthly newsletter of the Society of Teachers of Emergency Medicine.]

Kenneth V Iserson, MD, FACER Director Emergency Medicine Residency Program Arizona Health Sciences Center Tucson

A Unif ied Voice to Denounce the Nuc lear Arms Race

To the Editor: I read with great interest recent letters in the Annals on

the subject of nuclear war and disaster management IMarch 1984;13:212-210. I was impressed by the writers ' reliance on moral arguments to just ify massive preparat ions to treat vic t ims of a holocaust. They believe i t is immora l for us, as physicians, to avoid allocating resources for shelters, clean water, IV fluids and, presumably, several megatons of silver sulfadiazine.

How can we, as doctors, say we are moral when we wish to abet our country 's defenses wi thout a blistering at tack on the offensive horrors our armed forces are prepared to un- leash? It is fine for Switzerland and Sweden to have a mas- sive and effective civil defense they don' t possess offen- sive nuclear weapons and they are not targets.

How can we, as Americans, speak of morality, when we possess and acquiesce to the existence of 30,000 nuclear warheads on our soil? We easily have many t imes the mere 100 megatons needed to cause a nuclear winter,1 a disaster that could well cause the ext inct ion of ours and many other species as well.

The Hart-Goldwater commit tee z recently unearthed from previously close-kept mi l i tary sources that our warning sys- tems have about 2,000 false alarms every year, wi th about five per year of high enough conf idence levels to force closure of the NORAD Cheyenne fortress doors. If a ter- rorist or small nuclear power bomb were exploded on US soil, as Dr Schwartz deems l ikely at some point, how much chance is there for a l imi ted exchange, wi th our touchy warning systems and our hair-trigger poised arsenal?

Should a single megaton bomb be exploded in, say, San Diego, a sure target for counterforce doctrinaires, conser- vative esumares of 100,000 to 400,0003 burn vic t ims alone are projected. The bum u m t in San Diego has eight beds. Is it not extreme hubris to th ink we can care for these inlured? Is i t not immoral to delude the public that we can?

Civil defense and medical preparations for nuclear at tack are laudable, but to be even part ial ly effective wil l involve bill ions of dollars and mil l ions of manhours. Logically, this

should be diverted from our swollen and mi snamed "de- fense" department.

Let us not squabble. Let us uni te our forces as emergency physicians. Let us raise our voice both against the follies of living on the edge of extinction, and for some realistic disas- ter planning. Let us remember that our offensive weapons will prevent effective defense. Even ff we blasted the USSR and sustained not a single nuclear explosion on our own soil, it is l ikely that ozone depletion, fallout, nuclear winter, and the l ike would do us in. Similarly shelters and t rauma and burn management will not save us from the epidemics, poisoned water and food, and blood dyscrasias which will follow an at tack on US soil.

Before we talk of morality, let us remember that every 200-kiloton warhead on our soil is a potent ial Auschwitz. Every Trident sub carries 240 portable Buchenwalds. The fact that the USSR has the same does not lessen the fact - - m the eyes of any neutral observer, both are at once idiotic and obscenely immoral .

I am all for disaster preparation. But I believe if our efforts are diluted we, as emergency doctors, may miss our chance to help effect a sensible change in our nation's policies. Our unified effort mus t first be a voice of sanity and anger de- nouncing the arms race.

Glenn S Vanstrum, MD San Diego, California

1. Turco RE Toon OB, Ackerman TP, et ah Nuclear winter: Global consequences of mult iple nuclear explosion. Science !983;222:1283-1292.

2. US' Senate, Committee on Armed Services: Report of Senator Gary Hart and Senator Barry Goldwater to the Committee on Armed Services: Recent False Alerts from the Nation's Missile Attack Warning System, October 9, 1980, Washington, DC, Gov- ernment Printing Office, 1980.

3. US Arms Control and Disarmament Agency: Urban Popula- tion Vulnerability in the United States. Washington, DC, 1979.

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