Mass Casualty Emergencies and Radiation Exposure Algorithm
- The REMM Exposure Algorithm
- Is appropriate for events small enough to permit individualized victim evaluation and treatment
- Algorithm modifications may be needed for large radiation mass casualty emergencies because of
- Limited numbers of medical staff, hospital personnel
- Shortages of equipment and resources
- Physical damage to healthcare facilities including medical laboratories
- Overwhelming numbers of victims presenting for care, some acutely ill
- Exposure algorithm modifications during radiation mass casualty emergencies
- Diagnosing exposure and the Acute Radiation Syndrome (ARS) usually requires clinical laboratory support.
- See Dose Estimator for Exposure
- Without sufficient lab capacity, clinicians may need to estimate dose and ARS severity, initiate triage, and begin treatment by
- Matching the reported location of a victim to estimated radiation levels in the environment at that location
- Using clinical signs and symptoms to diagnose ARS
- Time to onset of nausea/vomiting after radiation exposure
- Signs and symptoms of ARS
- Empiric use of white cell cytokines may be advised for some victims if supplies are available.
- These recommendations would be based on clinical estimates of dose and ARS severity even if laboratory confirmation of dose estimate is not available.
- FDA Emergency Use Authorization may be needed to access medical countermeasures from the Strategic National Stockpile.
- When prioritizing delivery of very scarce resources in radiation mass casualty emergencies, it may be appropriate to consider prognosis related to
- Extent of trauma
- Extent of external whole body radiation exposure and significant exposure from any internal contamination, e.g., Polonium-210
- Extent of burns: percent body surface area and depth (i.e., degree) of burns
- Pre-existing medical conditions that materially affect prognosis of ARS
- Implementation of "Crisis Standards of Care" may be needed in disaster situations.
- The Institute of Medicine has provided extensive guidance.
- Resource limitations may be severe initially, but will improve over time.
- Significant changes to standard triage and medical care of patients may be needed after detonation of an IND: see publications and tools.
- See Mass Casualty page for additional details.
- See Radiation + Trauma for additional details.