Management Modifiers for
Treating Radiation Exposure
Burns and the Radiation Exposure Algorithm
- Both thermal and radiation burns may occur in radiation emergencies.
- Thermal burn + radiation exposure =
combined injury
- Prognosis is worse than the same burn injury or exposure alone.
- When prioritizing delivery of scarce resources in radiation mass casualty emergencies, it is appropriate to consider prognosis related to
- Implementation of "Crisis Standards of Care" may be needed in disaster situations.
- This algorithm and supporting material provide guidelines, not mandates.
- See Burns page for details about thermal burns.
- See Cutaneous Radiation Syndrome page for details about radiation burns.
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Trauma and the Radiation Exposure Algorithm
- Trauma + radiation exposure =
combined injury
- Prognosis is worse than the same traumatic injury or exposure alone.
- When prioritizing delivery of scarce resources in radiation mass casualty emergencies, it is appropriate to consider prognosis related to
- Implementation of "Crisis Standards of Care" may be needed in disaster situations.
- Suggested treatment sequence for victims of trauma with
exposure
- This algorithm and supporting material provide guidelines, not mandates.
- See Radioactive Shrapnel for guidance on management.
- See Radiation + Trauma page for details.
- See Mass Casualty page for details.
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Mass Casualty Emergencies and Radiation Exposure Algorithm
- The REMM Exposure Algorithm
- Is appropriate for events small enough to permit individualized victim evaluation and treatment
- Algorithm modifications may be needed for large radiation mass casualty emergencies because of
- Limited numbers of medical staff, hospital personnel
- Shortages of equipment and resources
- Physical damage to healthcare facilities including medical laboratories
- Overwhelming numbers of victims presenting for care, some acutely ill
- Limited resources (people, training, procedures and equipment) in the emergency phase of a large radiological or nuclear emergency may also require changes in the normal routines used to monitor, assign, document, and control dose among responders, ancillary workers and the general public.
- In depth recommendations have has been provided by this document: Guidance for Emergency Response Dosimetry, (NCRP Report 179), Bethesda, MD, 2017, including the following:
- “With minimal dosimetry resources, how to responders make decisions to control the total dose and associated risk?
- How are doses assigned to responders when not every responder is issued a dosimeter before exposure occurs?
- What is the regulatory framework for responders who are not trained as radiation workers?”
- Exposure algorithm modifications during radiation mass casualty emergencies
- Diagnosing exposure and the Acute Radiation Syndrome (ARS) usually requires clinical laboratory support.
- Without sufficient lab capacity, clinicians may need to estimate dose and ARS severity, initiate triage, and begin treatment by
- Matching the reported location of a victim to estimated radiation levels in the environment at that location
- Using clinical signs and symptoms to diagnose ARS
- Empiric use of white cell cytokines may be advised for some victims if supplies are available.
- When prioritizing delivery of very scarce resources in radiation mass casualty emergencies, it may be 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
- Extent of burns: percent body surface area and depth (i.e., degree) of burns
- Pre-existing medical conditions that materially affect prognosis of ARS
- Implementation of "Crisis Standards of Care" may be needed in disaster situations.
- Significant changes to standard triage and medical care of patients may be needed after detonation of an IND: see publications and tools
- See Mass Casualty page for additional details.
- See Radiation + Trauma for additional details.
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Timing of Surgery and the Radiation Exposure Algorithm
- Radiation exposure + trauma requiring emergency surgery
- Attempt to take surgical emergencies to the operating room
- Within 36-48 hours after high-dose radiation exposure
- Before decline of white blood cell and platelet counts
- Pre-operative administration of white cell cytokines may extend the time window for surgery.
- This algorithm and supporting material provide guidelines, not mandates.
- See Radiation Effects on Blood Counts page for details.
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Blood Products Use and the Radiation Exposure Algorithm
- Patients with significant whole body radiation exposure (Acute Radiation Syndrome) will be immunosuppressed.
- They are at risk for post-transfusion graft versus host disease (GVHD).
- Guidelines suggest that these patients should received blood products that have been both
- Irradiated and
- Leuko-reduced
- If irradiated, leuko-reduced blood is unavailable
- Emergency transfusions may still be considered.
- Attention should be paid to possible post-transfusion GVHD.
- This algorithm and supporting material provide guidelines, not mandates.
- See Blood Products page for details
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At-Risk / Special Needs Populations and the Radiation Exposure Algorithm
- See the At-Risk / Special Needs Populations page
- Describes groups especially vulnerable to the effects of radiation
- These populations may require
- Effective and ethical allocation of medical resources is crucial for all populations.
- This algorithm and supporting material provide guidelines, not mandates.
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