Collection of Patient Data
in Radiation Emergencies
- Introduction
- Sample Data Elements Potentially of Interest: Selected List
- TMT Handbook Forms, Questionnaires, and Information
- External Radiation Contamination Tracking Forms
Introduction
- Incident managers, medical care venues, and individual medial providers may wish to collect data about individuals they care for and staff they supervise during a mass casualty radiation incident
-
The data collected will vary by
- Type of radiation incident
- Number of casualties
- Who is doing the data collection
- Purpose of collecting the data
- Amount of time available for collecting data
-
Location and nature of population where data is
collected, for example
- In the field, as with
- In a community reception center
- Field medical stations
- Other venues, including hospitals
- Suggestions for selected data elements are listed below.
- These do not represent official HHS policy or policy of any HHS agencies.
- Some data elements are relevant to radiation incidents and others are relevant to any large incident where there is significant population displacement.
-
HIPAA Issues (Health Insurance Portability and
Accountability Act of 1996)
- Consult HIPAA rules as appropriate when collecting clinical data.
- See official HHS guidance for HIPAA Privacy in Emergency Situations (PDF - 148 KB) (HHS/Office for Civil Rights, November 2014)
- Be cognizant of those who are at-risk and have special needs.
- See also Public Health Emergency Researchers
Sample Data Elements Potentially of Interest: Selected List
-
CDC
-
ATSDR
-
Radiation incident form for registering patients
and responders
(CDC/ATSDR)
- Rapid Response Registry: Survey form (PDF - 127 KB)
-
Radiation incident form for registering patients
and responders
(CDC/ATSDR)
-
National Center for Environmental Health
-
A Guide to Operating Public Shelters in a
Radiation Emergency
(HHS lead, US government interagency with input from
state and local agencies and professional societies,
Feb 2015)
- Contamination Assessment Form (PDF - 1.66 KB) (Appendix C)
- Community Reception Center Registration Form (PDF - 1.88 MB) (Appendix E)
-
A Guide to Operating Public Shelters in a
Radiation Emergency
(HHS lead, US government interagency with input from
state and local agencies and professional societies,
Feb 2015)
-
Radiation Studies Branch
- Forms for Registration, Tracking, Management at Community Reception Centers (CRCs), (See "Forms" section.) (HHS/CDC/RSB: Virtual Community Reception Center, December 2011)
-
ATSDR
-
Vermont
-
Forms for Radiation Incident Population Registration
(Courtesy of William Irwin)
- Epidemiological Medical Follow-up Registration Form (Electronic Version) (PDF - 166 KB )
- Radiaton Event Epidemiologic Follow-up Form (PDF - 17 KB )
-
Forms for Radiation Incident Population Registration
(Courtesy of William Irwin)
-
New York State
- Form for registering and/or tracking patients in community reception centers (PDF - 90 KB) (New York State Department of Health)
-
Other publications
-
Long-Term Health Monitoring of Populations Following
a Nuclear or Radiological Incident in the United
States, Proceedings of a Workshop
(NASEM, 2019)
- Reviews the process for preparing a radiation registry for monitoring long-term health effects of populations affected by a nuclear or radiological incident.
- Assesses existing information, useful practices, and tools for planning a radiation registry that will enhance incident monitoring and response methods.
- Sample Data Elements for Community Reception Center after an IND detonation (Source: Coleman CN, Adams S, Adrianopoli C, Ansari A, Bader JL, et al., Medical planning and response for a nuclear detonation: a practical guide. Biosecur Bioterror. 2012 Dec;10(4):346-71. [PubMed Citation]
-
Long-Term Health Monitoring of Populations Following
a Nuclear or Radiological Incident in the United
States, Proceedings of a Workshop
(NASEM, 2019)
Data Elements
-
Dose Estimator for Exposure: Interactive Tool
- Whole body dose from exposure estimate may become part of the medical record.
-
Assessment of Severity of ARS Subsyndromes: Interactive
Tool
-
Results may assist in
- Clinical management of radiation injury
- Decision about where to send patient for continuing care (Response Category)
-
Results may assist in
- Suggested data elements from IAEA response document (PDF - 113 KB)
TMT Handbook Forms, Questionnaires, and Information
-
Triage, Monitoring and Treatment of people exposed to
ionising radiation following a malevolent act
(PDF - 11 MB) (TMT Handbook Partners, March 2009)
See Annex 3, pages 392-425 for prototypes of several forms developed by this consortium of non-US countries.
These forms may/may not be applicable in the US.-
Contamination monitoring
- Information sheet for Environmental Monitoring Team
- Results of field measurement made by the Environmental
- Monitoring Team
- Registry form for person involved in the emergency
- External contamination survey report
- Internal contamination report form
- Radionuclide/Organ specific measurements
- In vitro bioassay measurement report
- Individual dose assessment report form
- Emergency personnel dose follow up form
- Example report letter to members of the public for measurements less than the method detection limit
- Example report letter for assessed doses less than 1 mSv
- Example report letter for assessed doses greater than 1 mSv and less than the lower action level (maximum 20 mSv)
-
Medical information
- Medical information form
- Information for family doctors in the event of an incident involving radiation
- Information for people who have been found to be contaminated with radioactive material
- Information to people who might have been exposed to radiation/radioactive material
-
Press/Media forms
- Examples of press releases
-
Contamination monitoring
External Radiation Contamination Tracking Forms
- Simple form to record external radiation contamination (PDF - 166 KB)
- Example of form to record results of external radiation contamination survey (PDF - 90 KB) (NY State Department of Health Community Reception Center)