Medical Management of Radiological Casualties

Abstract

Victims of radiological terrorism events require prompt diagnosis and treatment of medical and surgical conditions as well as conditions related to radiation exposure. Hospital emergency personnel should triage victims using traditional medical and trauma criteria. Radiation dose can be estimated early post-event using rapid-sort, automated biodosimetry and clinical parameters such as the clinical history, the time to emesis (TE), and lymphocyte depletion kinetics. For TE < 2 h, the effective whole-body dose is at least 3 Gy. If TE < 1 h, the whole-body dose most probably exceeds 4 Gy. Lymphocyte depletion follows dose-dependent, first order kinetics after high-level gamma and criticality incidents. Patient radiation dose can be estimated very effectively from the medical history, serial lymphocyte counts, and TE, and subsequently confirmed with chromosome-aberration bioassay, the current gold standard. These data are effectively analyzed using the Armed Forces Radiobiology Research Institute Biodosimetry Assessment Tool. The medical management of patients with acute, moderate to severe radiation exposure (effective whole-body dose >3 Gy) should emphasize the rapid administration of colony stimulating factors. All of these compounds decrease the duration of radiation-induced neutropenia and stimulate neutrophil recovery, albeit with some variability, in patients who have received myelotoxic chemotherapy, and all have demonstrated benefit in irradiated animals. For those patients developing febrile radiation-induced neutropenia, adherence to the current Infectious Diseases Society of America guidelines for high-risk neutropenia is recommended.

Advances in Mitigation of Injuries from Radiological Terrorism or Nuclear Accidents

“…While there are sophisticated and widely available instruments for assessing contamination, the available tools for retroactive assessment of radiation doses are either primitive or are not widely available 33,36,37 . If a mass-casualty incident occurs now, the only method for rapid (<12 h) radiation dose assessment would be time to emesis 37 .…”

“…While there are sophisticated and widely available instruments for assessing contamination, the available tools for retroactive assessment of radiation doses are either primitive or are not widely available 33,36,37 . If a mass-casualty incident occurs now, the only method for rapid (<12 h) radiation dose assessment would be time to emesis 37 . This is not actually very useful, since not all irradiated people (even those with large abdominal doses) vomit, and in many mass casualty scenarios, there will be other reasons that will cause people to vomit 36,38 .…”

“…This is not actually very useful, since not all irradiated people (even those with large abdominal doses) vomit, and in many mass casualty scenarios, there will be other reasons that will cause people to vomit 36,38 . If more time was available, dose estimates could be made based on lymphocyte depletion kinetics, but that takes at least a day 36,37 . In theory, doses could also be based on chromosome aberrations in blood lymphocytes, but this assay takes days and requires samples to be sent to central laboratories whose capacity is limited 33,36,37 .…”

“…If more time was available, dose estimates could be made based on lymphocyte depletion kinetics, but that takes at least a day 36,37 . In theory, doses could also be based on chromosome aberrations in blood lymphocytes, but this assay takes days and requires samples to be sent to central laboratories whose capacity is limited 33,36,37 . Recent research has shown that faster and more deployable systems are theoretically possible.…”

Medical Training for Nuclear and Radiological Events: The “Atomic Age” Returns

“…Indeed, radiation expertise in medicine has become almost completely dominated by its use in therapeutic regimens, under tightly controlled conditions. There is now little or no knowledge among nearly all medical and public health personnel concerning the effects generated by environmental radioactivity, which is quite different from therapeutic radiation applications 2,3 . This lack of knowledge of the appropriate treatment of radiation casualties from environmental exposure is matched by a similar lack of training or even effective protocols for the mass casualty demands of thermal burns and trauma injuries also expected in nuclear war.…”