Trauma and the Radiation Exposure + Contamination Algorithm
- Trauma + radiation exposure = combined injury
- Prognosis is worse than the same traumatic injury or exposure alone.
- Trauma + radiation contamination
- External contamination
- By itself, will not usually worsen trauma-related prognosis
- Performing emergency life- and limb-saving tasks/surgery before completing formal external decontamination is appropriate.
- Removal of contaminated clothing can eliminate about 75-90% of external contamination when there is not time to complete formal decontamination.
- See Timing of Surgery for details.
- Internal contamination
- Some trauma victims may need life- and limb-saving surgery before the level of internal contamination is known.
- Bioassays to quantify internal contamination are time consuming and not widely available.
- See REMM Radioactive Shrapnel for management guidance
- 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 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 trauma with exposure and contamination
- Treat life- or limb-threatening injuries first.
- Consider Timing of Surgery
- Assess for exposure and the Acute Radiation Syndrome (ARS) and consider early (pre-operative) use of white cell cytokines
- Perform external decontamination as soon as possible, but do not delay life- or limb-saving emergency surgery.
- Assess for internal contamination and determine need for treatment.
- This algorithm and supporting material provide guidelines, not mandates.
- See REMM Radiation + Trauma page for details.
- See REMM Mass Casualty page for details.