A Possible Approach to Large-Scale Laboratory Testing for Acute Radiation Sickness after a Nuclear Detonation

Adalja, Amesh A.; Watson, Matthew; Wollner, Samuel; Toner, Eric

doi:10.1089/bsp.2011.0042

Cited by 3 publications

(4 citation statements)

References 14 publications

(16 reference statements)

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“…At the moment, the LDK assay has the greatest ability to meet this need, with some point of care hematology devices already developed and in use. Cooperative agreements with large commercial laboratories could be used to meet demand requirements (Adalja et al 2011). Regional, national, and international partnerships with clinical cytogenetic facilities can also be used enhance capacity.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

Sullivan¹,

Prasanna²,

Grace³

et al. 2013

Health Physics

165

161

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Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual’s radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual’s dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a stand-alone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, we reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point.

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Section: Discussionmentioning

confidence: 99%

Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

Sullivan¹,

Prasanna²,

Grace³

et al. 2013

Health Physics

165

161

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“…The CBC is a common test available at hospitals and some clinics and national capacity for CBCs performed in reference laboratories is robust 36 . However, difficulties coordinating sample acquisition, transport, and test result communication in the local damaged and chaotic environment will preclude most field-based sampling.…”

Section: Discussionmentioning

confidence: 99%

“…28,34 The CBC is a common test available at hospitals and some clinics and national capacity for CBCs performed in reference laboratories is robust. 36 However, difficulties coordinating sample acquisition, transport, and test result communication in the local damaged and chaotic environment will preclude most field-based sampling. Single-value ALCs are less accurate than serial values, owing to several factors including host variability, partial body exposure, and difficulty defining the exact time the exposure began.…”

Section: Acute Radiation Syndromementioning

confidence: 99%

Proposed “Exposure And Symptom Triage” (EAST) Tool to Assess Radiation Exposure After a Nuclear Detonation

Hick

Bader

Coleman

et al. 2017

Disaster med. public health prep.

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One of the biggest medical challenges after the detonation of a nuclear device will be implementing a strategy to assess the severity of radiation exposure among survivors and to triage them appropriately. Those found to be at significant risk for radiation injury can be prioritized to receive potentially lifesaving myeloid cytokines and to be evacuated to other communities with intact health care infrastructure prior to the onset of severe complications of bone marrow suppression. Currently, the most efficient and accessible triage method is the use of sequential complete blood counts to assess lymphocyte depletion kinetics that correlate with estimated whole-body dose radiation exposure. However, even this simple test will likely not be available initially on the scale required to assess the at-risk population. Additional variables such as geographic location of exposure, sheltering, and signs and symptoms may be useful for initial sorting. An interdisciplinary working group composed of federal, state, and local public health experts proposes an Exposure And Symptom Triage (EAST) tool combining estimates of exposure from maps with clinical assessments and single lymphocyte counts if available. The proposed tool may help sort survivors efficiently at assembly centers near the damage and fallout zones and enable rapid prioritization for appropriate treatment and transport. (Disaster Med Public Health Preparedness. 2018; 12: 386-395).

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“…17 Several other interesting papers on the subject of ARS were also published in 2011. [18][19][20] To conclude, it seems that the Fukushima incident, together with growing concerns about a potential terrorist attack, have provided a strong impetus for the development of emergency response plans and new research to identify drugs capable of ameliorating the effects of ARS. In addition, researchers are already preparing studies of the long and short-term effects of radiation on the population in the area of Fukushima.…”

mentioning

confidence: 99%