Cautionary Notes 1 for Exposure + Contamination Algorithm
in Mass Casualty Events
- The REMM Exposure + Contamination Algorithm is appropriate for events small enough to permit individualized evaluation of each patient/victim.
- Limited resource availability in mass casualty events (e.g., insufficient water, personnel, equipment, medical facilities, laboratories) may necessitate major modification of the Exposure + Contamination Algorithm guidelines.
- Modifications to both the Contamination Algorithm and Decontamination Procedures Guidelines in a mass casualty event may include
- Large numbers of victims seeking decontamination and reassurance may overwhelm the emergency response infrastructure, at least initially.
- Instructing large numbers of ambulatory victims to self decontaminate at home
- Limiting radiation surveys to simplified, one-time screenings of the head, neck, hands, and forearms rather than comprehensive whole body screenings with repeated re-evaluations
- Altering decontamination methods
- Altering target decontamination levels (i.e., accepting decontamination levels in excess of 2 times background)
- Eliminating or curtailing early collection of biological specimens (e.g. radioisotope assays, nasal swabs) if logistical barriers to timely collection, transport, analysis, and reporting results limit their utility
- Initiating isotope decorporation therapy in highly selected, life-threatening circumstances prior to receiving diagnostic test results normally required
- Modifications to the Exposure Algorithm in mass casualty events may also occur.
- Large numbers of acutely ill victims may overwhelm the available medical infrastructure, at least initially.
- Some victims at or near the epicenter may be inaccessible due to radiation levels that would significantly endanger rescue workers.
- Initial logistical barriers may prevent timely collection, transport, analysis, and reporting results of huge numbers of biological specimens normally used to estimate radiation exposure dose, diagnose Acute Radiation Syndrome (ARS) and manage organ dysfunction and trauma.
- When laboratory data are unavailable, geographical factors (location of the victim in relation to the epicenter), historical factors (time to onset of nausea/vomiting after radiation exposure), and clinical signs and symptoms will be the primary means available to diagnose ARS.
- When laboratory data are unavailable, empiric use of hematopoietic growth factors (after FDA Emergency Use Authorization) may be recommended for victims thought to be at high risk of significant ARS based on the factors noted above.
- This algorithm and supporting material are guidelines, not mandates.