Training of clinical triage of acute radiation casualties: a performance comparison of on-site versus online training due to the covid-19 pandemic

Abstract

A collection of powerful diagnostic tools have been developed under the umbrellas of NATO for ionising radiation dose assessment (BAT, WinFRAT) and estimate of acute health effects in humans (WinFRAT, H-Module). We assembled a database of 191 ARS cases using the medical treatment protocols for radiation accident victims (n = 167) and the system for evaluation and archiving of radiation accidents based on case histories (n = 24) for training purposes of medical personnel. From 2016 to 2019, we trained 39 participants comprising MSc level radiobiology students in an on-site teaching class. Enforced by the covid-19 pandemic in 2020 for the first time, an online teaching of nine MSc radiobiology students replaced the on-site teaching. We found that: (a) limitations of correct diagnostic decision-making based on clinical signs and symptoms were experienced unrelated to the teaching format. (b) A significant performance decrease concerning online (first number in parenthesis) versus on-site teaching (reference and second number in parenthesis) was seen regarding the estimate time (31 vs 61 cases per hour, two-fold decrease, p = 0.005). Also, the accurate assessment of response categories (89.9% vs 96.9%, p = 0.001), ARS (92.4% vs 96.7%, p = 0.002) and hospitalisation (93.5% vs 97.0%, p = 0.002) decreased by around 3%–7%. The performances of the online attendees were mainly distributed within the lower quartile performance of on-site participants and the 25%–75% interquartile range increased 3–7-fold. (c) Comparison of dose estimates performed by training participants with hematologic acute radiation syndrome (HARS) severity mirrored the known limitations of dose alone as a surrogate parameter for HARS severity at doses less than 1.5 Gy, but demonstrated correct determination of HARS 2–4 and support for clinical decision making at dose estimates >1.5 Gy, regardless of teaching format. (d) Overall, one-third of the online participants showed substantial misapprehension and insecurities of elementary course content that did not occur after the on-site teaching.

Special issues and computational techniques: the Bernard Wheatley Award for 2021

“…During 2021, the first papers were published in a series that will comprise a Special Issue of the Journal on the medical management of radiation accidents. One of these (Lamkowski et al 2021) was of particular interest. This addresses the issue that, in the event of a major nuclear accident, there will be hundreds to thousands of potentially affected individuals and only limited clinical resources available to deal with them.…”

“…This makes early and efficient triage of potential victims essential and emphasises the need for rapid transfer of knowledge to clinical staff on the early diagnosis and treatment of acute radiation syndrome (ARS). Lamkowski et al (2021) provide a useful review of this topic that includes an excellent summary of indicators of ARS, covering both estimation of the dose received and of the effects likely to arise considering biochemical and clinical responses of the victim and bypassing dose estimation. The paper also includes an account of the effectiveness of on-site and on-line training of students using ARS data from real case descriptions combined with normal data to represent the 'worried well' population requiring triage.…”