Trauma and the Radiation 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.
- Removing all clothes can eliminate about 75-90% of external contamination when there is not time to conduct 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 radiation internal contamination are time consuming and not widely available.
- See 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 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.
- This algorithm and supporting material provide guidelines, not mandates.
- See REMM Radiation + Trauma page for details.
- See REMM Mass Casualty page for details.