PACKAGED DISASTER HOSPITALS:  United States. 1953-1980.  Packaged Disaster Hospitals supported Civil Defense and provided medical facilities capable of surviving the destruction of hospitals during a nuclear exchange.  In 1953 the Federal Civil Defense Agency began development of a field hospital that could be deployed nationwide.  Modeled on the Army’s Mobile Surgical Hospital, a 200-bed prototype known as the Civil Defense Emergency Hospital was constructed.  Because the Army hospitals were equipped with equipment not necessary for civilian purposes, the Civil Defense Emergency Hospital design was refined further into a facility with durable equipment as a Packaged Disaster Hospital.  Originally designed to operate for a few days, the package was expanded to operate independently for 30 days to compensate for limited mobility of the survivors and reduced transportation capabilities.  From 1953 to 1957, the Federal Civil Defense Agency acquired 1800 hospitals.  Although transferred to the U.S. Public Health Service in 1961, there was no loss in the program’s tempo, as 750 additional facilities were purchased and deployed.


Each Packaged Disaster Hospital set weighed approximately 45,000 pounds and required 7,500 cubic feet of storage space.  Assembly required 120 person-hours.  The hospital included 12 functioning units: pharmacy, hospital supplies/equipment, surgical supplies/equipment, IV solutions/supplies, dental supplies, X-ray, hospital records/office supplies, water supplies, electrical supplies/equipment, maintenance/housekeeping supplies.  Supplies ranged from antibiotics, gurneys, and centrifuges to blankets, sheets, and surgical gloves.  Narcotics and surgical scrubs were omitted from the package.  The Packaged Disaster Hospital also had an ax, hammers, screwdrivers, picks, and shovels.  An extensive set of reference materials published by the U.S. Public Health Service was also available, ranging from manuals describing the facility set-up to assembling and installing specialized equipment.  The equipment was supported by a comprehensive training program with texts, lesson plans, lecture formats, and a 27.5 minute film. 


The last Packaged Disaster Hospital set was assembled in 1962.  At the program’s zenith, over 2500 hospitals were deployed throughout the United States. The facilities were well dispersed; even rural states such as Alabama had 53 facilities and Arkansas had 18. The concept was also adopted in Canada, where at least 24 similarly equipped packages were assembled.


As preparedness concepts at state and local levels increasingly addressed a wider range of hazards than just nuclear war, the Packaged Disaster Hospital program evolved as well.  By 1967 some Packaged Disaster Hospitals were shifted from independent storage to an alignment with local community hospitals.  This shift permitted expansion of the existing community hospital or allowed the Packaged Disaster Hospital to be deployed as the originally intended.  Some states, including Arkansas and Alabama, assumed state control of the packages from the Federal government before transferring them to local hospital administrators.  Elements of Packaged Disaster Hospitals were successfully used after several natural disasters - two examples were in New Orleans after Hurricane Betsy in 1965 and in Texas after Hurricane Beulah in 1967.


However, the early support of the medical community for civil defense measures waned as increasingly physicians were encouraged to prevent nuclear war, not prepare for it,  As a result by the 1970s, there was significant resistance to any civil defense medical preparedness.  Concurrently, the size of the program made it increasingly difficult to sustain.  By 1966, the Public Health Service was forced to reconfigure Packaged Disaster Hospitals in an austere package as costs for replacing and repackaging increased. In 1972 Congress refused to appropriate the estimated 7 to 9 billion dollars needed to maintain the hospitals, and the following year the Federal Emergency Management Agency declared the entire inventory to be surplus.


Although this decision was not universally popular, it was greeted with general relief in the Department of Health, Education, and Welfare.   Even prior to Congressional funding cuts, there was considerable pressure to sell hospitals not assimilated by states at reduced cost to foreign governments.  Twelve Packaged Disaster Hospitals were sent to Nigeria in 1969 and 1970 during that nation’s civil war.  This process accelerated after Congress suspended funding; facilities purchased for over $45,000 in the 1950’s (with a market replacement value of over $500,000 twenty years later) were frequently sold to relief agencies for a token $1 fee.  Others were donated as a result of political considerations; former Massachusetts first lady Kitty Dukakis personally intervened to arrange the donation of two hospitals in her state to El Salvador.  Other hospitals eventually ended up in Nicaragua, Ethiopia, Sri Lanka, Mozambique, and the Philippines.


By the late 1980’s, approximately 400 of the original 2500 Packaged Disaster Hospitals remained.  These facilities were in high demand from both relief agencies and commercial profiteers who bought the discounted facilities and sold them to foreign governments at considerable profit.  A new source of competition also emerged -  the United States Government.  The National Disaster Medical System aggressively tried to locate and purchase Packaged Disaster Hospitals and their equipment for domestic use. Equipment from the 30 packages recovered by the National Disaster Medical System was deployed to St. Croix after Hurricane Hugo in 1989 and to free clinics in Los Angeles and Philadelphia.  Most of the durable equipment was still usable, and in many cases, the stainless steel instruments were of higher quality than currently manufactured products.


The debate over program viability continued into the 1980s. By 1979 concerns were being raised about some outdated supplies, and others found the lack of modern equipment to do blood chemistries disappointing.  Doubts remained as to whether enough trained persons would survive a nuclear attack to move and unpack the 660 crates and assemble them into a functional facility.  The absence of essentials such as gasoline, batteries, extension cords, and light bulbs was questioned, as was the assumption that vendors supplying these items would also survive a nuclear attack.  And the lack of key pain reliving drugs or drugs to respond to a chemical attack raised doubts.  Some considered the Packaged Disaster Hospital  program a failure and applauded their donation to foreign governments as a way to salvage national pride from a disgrace.  However, civil defense advocates continued to support the program to the end - Max Klinghoffer in 1979 refuted attacks on the packages and concluded that, in the event of a nuclear exchange, the hospitals might have been the only medical capability the nation would have left.   A year later he positively described his experience using a Packaged Disaster Hospital to augment a hospital in the Chicago area, but it is important to note that even in this case, the package was considerably modified with 40% of its original equipment deleted.


by Mark F. Gentilman


Sources: “52 Package Disaster Hospitals Dot State and Await SOS,” Journal of the Medical Association of the State of Alabama, Vol. 38, March 1969.  Boyer, Paul, “Physicians Confront the Apocalypse – The American Medical Profession and the Threat of Nuclear War,” Journal of the American Medical Association, Vol. 254, August 2, 1985.  Brown, Clarence J., “Medical Preparedness in Atomic Defense,” Medical Annals of the District of Columbia, Vol. 17, April 1948.  Cottingham, Jack, “Emergency Medical Equipment Will Stay in Arkansas,” The Journal of the Arkansas Medical Society, Vol. 70, November 1973.  Day, Barbara, “The Medical Profession and Nuclear War – A Social History,” Journal of the American Medical Association, Vol. 254, August 2, 1985.  “Ether in Packaged Disaster Hospital Found Hazardous,” Purchasing Administration, Vol. 3, September 1979.  Greentree, Leonard B., “The Medical Realities of Civil Defense,” The New England Journal of Medicine, Vol. 284, May 6, 1971.  Huntley, Henry C., “Natural Disaster Hospitals,” AORN Journal 9, February 1969.  Jacobsen, Leon, et al., “Physicians in an Atomic War,” Journal of the American Medical Association, Vol. 139, January 15, 1949. Klinghoffer, Max, “Survival and Charity,” Journal of Civil Defense, Volume X, April 1979.  Klinghoffer, Max “What If We Still Had Our Packaged Disaster Hospitals?” Journal of Civil Defense, Vol.  X, June 1989.  LeFort, Sandra, “Ready for Any Emergency – 200 Bed Hospital in a Box,” The Canadian Nurse, Vol. 73, May 1977.  Mustell, Peter, Letter to the Editor, New England Journal of Medicine, Vol. 285, October 17, 1971.  Oakes, Guy, The Imaginary War: Civil Defense and American Cold War Culture, New York, Oxford University Press, 1994. “Packaged Disaster Hospitals,” Journal of the Medical Association of the State of Alabama, Vol.  36, August 1966.  Price, Robert L., “Use of the Packaged Disaster Hospital in Nigeria,” Public Health Reports, Vol. 85, August 1970.  Richards, J. T., “Hospitals Versus the Atomic Bomb – Part I,” Modern Hospital, Vol. 75, December 1950.  Schweisheimer, W., “Packaged Disaster Hospital,” Nursing Mirror & Midwives Journal, Vol. 132, June 18,  1971.  Shanholtz, Max, “Redirection of Medical Disaster Program,” Virginia Medical Monthly, Vol.  94, December 1967.  Taravella, Steve, “Packaged Hospitals Get Second Chance in Third World,” Modern Healthcare, Vol. X, November 25, 1991.  United States, Department of Health, Education, and Welfare, Assembling Equipment in the Packaged Disaster Hospital, Washington, D.C., U.S. Department of Health, Education, and Welfare, Public Health Service, Division of Health Mobilization,1966.  United States, Department of Health, Education, and Welfare, Establishing the Packaged Disaster Hospital, Washington, D.C., U.S. Department of Health, Education, and Welfare, Public Health Service, Division of Health Mobilization, 1966.  Walton, Michael M., “PDHs – Our Disgrace or Our Pride?” Journal of Civil Defense, Vol. X, February 1979.  Wilson, William L., “Medical Planning for Atomic Disaster,” The Journal of the Florida Medical Association, Vol. 37, October 1950.


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