Mass Casualty Emergencies and Radiation Contamination Algorithm
- The REMM Contamination Algorithm
- Is appropriate for events small enough to permit individualized victim evaluation and treatment, including decontamination
- Algorithm modifications may be needed for 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
- Contamination algorithm modifications during radiation mass casualty emergencies
- 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 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.
- This algorithm and supporting material are guidelines, not mandates.
- See Mass Casualty page for more details.
- See Radiation + Trauma for more details.