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

Abstract

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).

Nuclear and Radiological Emergencies: Biological Effects, Countermeasures and Biodosimetry

“…As of now, the most productive and available triage technique is the utilization of consecutive complete blood counts to evaluate lymphocyte exhaustion that is associated with assessed whole-body dose radiation exposure. If fast blood testing would not be conceivable, dose assessment can be at first evaluated dependent on basic boundaries, i.e., correlations between the extent of the body exposed to the radiation and the % of the radiation levels estimated in the environment; victim’s shielding activities after the explosion; and signs and side effects from exposure to radiation or early radioactive particles’ aftermath [ 24 ]. The radiation dose classes allude to dosages affecting the whole body or a large portion of the body (partial exposure).…”

United States medical preparedness for nuclear and radiological emergencies

“…A new resource was created in 2018 - the “Exposure And Symptom Triage” (EAST) Tool to Assess Radiation Exposure After a Nuclear Detonation [ 12 ], “to assist responders in making the initial triage and help direct patients who need immediate medical attention to the proper next station/facility and send those without life-threatening conditions home for now or to care beyond the disaster scene.” An overarching key reason that planning and a well-organized response is necessary is to avoid a crisis standards of care setting, which occurs when there are not sufficient resources for each patient, and some patients who might otherwise survive are triaged to an “expectant” category, until resource balance is attained [ 13 ]. A key concept in triage is that patients must be re-triaged when resources do arrive, which could alleviate a crisis standards of care situation.…”

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE)

“…Modeling can also help project why, where, and how to best modify routine triage priorities in initial austere conditions and how to optimize staff functions and prioritize scarce resources using ethical and effective protocols as detailed in the Appendix. [13][14][15] Modeling can also help identify long-term issues needing consideration. For a nuclear detonation, these issues include, but are not limited to, (1) chronic radiation injury, particularly at higher doses; (2) radiation-induced cancer at lower doses;…”