Mass Casualty Emergencies and Radiation Exposure + Contamination Algorithm
- The REMM Exposure + Contamination 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
- Shortage of equipment and resources
- Physical damage to healthcare facilities including medical laboratories
- Overwhelming numbers of victims presenting for care, external decontamination, treatment of internal contamination, reassurance
- Exposure + contamination algorithm modifications during large radiation mass casualty emergencies
- Exposure
- 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 (physical dosimetry)
- 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.
- External contamination
- Limiting/altering radiation surveys
- Conducting one-time screenings of head, neck, hands, and forearms
- Avoiding multiple whole body screenings and re-evaluations during initial triage
- Altering targets for decontamination
- Accepting target decontamination levels in excess of 2 times background
- Directing ambulatory victims away from medical facilities to community reception centers and
- Providing instructions for self-decontamination at home
- Internal contamination
- Bioassays to quantify the level of internal contamination are time consuming and not widely available, particularly in radiation mass casualty events.
- Collection of certain biological specimens (e.g. radioisotope bioassays, nasal swabs) may need to be delayed or omitted.
- Initial simple screening of large numbers of bioassay specimens may be needed to identify those with the highest levels of internal contamination.
- Follow-up evaluation will be recommended first for those whose initial results suggest the highest level of contamination.
- Empiric treatment of internal contamination may be advisable in highly selected, life-threatening circumstances, even in the absence of definitive diagnostic test results.
- For large mass casualty events, countermeasures from the
Strategic National Stockpile may be needed.
- When prioritizing delivery of scarce resources in radiation mass casualty emergencies, it is 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
- Percent body surface area and depth (i.e., degree) of burns
- Pre-existing medical conditions
- 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.
- Suggested treatment sequence for victims of exposure
and contamination
- Treat life- or limb-threatening injuries first.
- Consider Timing of Surgery .
- Perform external decontamination as soon as possible, but do not delay life- or limb-saving emergency surgery
- Assess for exposure and ARS and consider early use of white cell cytokines
- Assess for internal contamination and determine need for treatment
- Significant changes to standard triage and medical care of patients may be needed after detonation of an IND: see publications and tools.
- See REMM Mass Casualty page for details.
- See REMM Radiation + Trauma page for details.