Emergency response to radiological and nuclear accidents and incidents

Abstract

Summary Bone marrow damage is an important consequence of exposure to acute high‐dose whole‐body radiation. As such, haematologists can play an important role in managing this complication. However, these accident and incident scenarios are complex and often involve injuries to other organs and tissues from heat, projectiles and chemicals. In the case of a large‐scale event there will likely be severe infrastructure disruptions and injury or death to medical personnel. Accurate estimates of dose and uniformity of exposure are needed to intelligently direct appropriate interventions, which range from antibiotics, antifungals and anti‐virus drugs, molecularly‐cloned haematopoietic growth factors and, in rare instances, haematopoietic cell transplants. These therapies are ones that haematologists often use in the context of anti‐cancer therapy, especially therapy of haematological cancers like leukaemia. However, most haematologists have little knowledge of radiation biology and should consider updating this aspect of their expertise in continuing medical education. As in other areas of medicine, prevention is better than cure and haematologists should be active in decreasing risks of a nuclear war.

Analysis of the Proteomic Profile in Serum of Irradiated Nonhuman Primates Treated with Ex-Rad, a Radiation Medical Countermeasure

“…8 Radiation MCMs that are safe, easily administered, and effective at reducing or eliminating adverse health consequences to individuals and the public are urgently needed to ensure an adequate level of nuclear and radiological preparedness. 5,6,19 Several potential MCMs are currently under development, including the novel, small-molecule kinase inhibitor Ex-Rad, a chlorobenzyl sulfone derivative (organosulfur compound) that has received US FDA investigational new drug (IND) status. 20,21 This agent has been demonstrated to be an effective radiation MCM for hematopoietic as well as gastrointestinal acute radiation syndrome, and is effective through both parenteral and oral routes.…”

“… 8 Radiation MCMs that are safe, easily administered, and effective at reducing or eliminating adverse health consequences to individuals and the public are urgently needed to ensure an adequate level of nuclear and radiological preparedness. 5 , 6 , 19 …”

Sargramostim (rhu GM-CSF) Improves Survival of Non-Human Primates with Severe Bone Marrow Suppression after Acute, High-Dose, Whole-Body Irradiation

“…Studies of non-human primates that have received TBI indicate that intensive supportive care with individualized antibiotic therapy and blood transfusions improves survival (6,27). However, it is anticipated in a mass causality situation that such resources may not be available because of extensive infrastructure disruptions and lack of appropriately trained medical personnel (27)(28)(29). Consequently, our study used experimental conditions designed to mimic this scenario.…”

Repurposing Pharmaceuticals Previously Approved by Regulatory Agencies to Medically Counter Injuries Arising Either Early or Late Following Radiation Exposure

“…Exposure to intense ionizing radiation will evoke invariably significant damage to selective tissues of vital organ systems of the body; most notably, the vascular, blood-forming, gastrointestinal, and reproductive systems. Following such intense irradiation, acute lymphohematopoietic tissue damage rapidly manifests as evidenced by rapid changes in clinically relevant blood parameters, namely by fast, time-dependent decreases in blood cell concentrations (specifically lymphocytes, granulocytes, and thrombocytes/platelets) ( Gale et al, 2019 ).…”