The “RTR” Medical Response System for Nuclear and Radiological Mass-Casualty Incidents: A Functional TRiage-TReatment-TRansport Medical Response Model

Abstract

Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The “RTR” system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other sites such as nursing homes and outpatient clinics, nationwide expert medical centers (such as cancer or burn centers), and possible alternate care facilities such as Federal Medical Stations. Assembly Centers for displaced or evacuating persons are predetermined and spontaneous sites safely outside of the perimeter of the incident, for use by those who need no immediate medical attention or only minor assistance. Decontamination requirements are important considerations for all RTR, Medical Care, and Assembly Center sites and transport vehicles. The US Department of Health and Human Services is working on a long-term project to generate a database for potential medical care sites and assembly centers so that information is immediately available should an incident occur.

A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures

“…The development of prototype handheld field triage instruments that include a radio frequency device (RFD) capability to track patients, equipment and responders as well as the ability to document care and triage status were discussed in several studies; 36,37,95,96 however, none has been validated under MCI conditions. Several studies also discuss the design and use of computerized disaster information systems 97–99 but none has been tested under an actual MCI.…”

Public Health and Medical Preparedness for a Nuclear Detonation

“…Radiation exposure will be assessed based on the person's location at the time of the detonation and during the period of fallout deposition and by symptoms and laboratory measurement. In that the responders need a system to account for the presence of radiation, the Radiation Triage, Treatment, and Transport System was developed to help manage radiation injury and has been used in a number of exercises and regional planning efforts (Hrdina et al 2009). …”

Towards automated self-tagging in emergency health cases

“…They supplement the strengths of already existing, widely accepted MCI triage strategies. In [5], the authors optimize MCI medical response to a nuclear incident by proposing unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. [6] provides a Field Triage Decision Scheme (FTDS) that is takes into consideration the facilities and the services of available trauma centers.…”