Triage and Treatment Tools for Use in a Scarce Resources-Crisis Standards of Care Setting After a Nuclear Detonation

Abstract

<jats:title>ABSTRACT</jats:title><jats:p>Based on background information in this special issue of the journal, possible triage recommendations for the first 4 days following a nuclear detonation, when response resources will be limited, are provided. The series includes: modeling for physical infrastructure damage; severity and number of injuries; expected outcome of triage to immediate, delayed, or expectant management; resources required for treating injuries of varying severity; and how resource scarcity (particularly medical personnel) worsens outcome. Four key underlying considerations are: 1.) resource adequacy will vary greatly across the response areas by time and location; 2.) to achieve fairness in resource allocation, a common triage approach is important; 3.) at some times and locations, it will be necessary to change from “conventional” to “contingency” or “crisis” standards of medical care (with a resulting change in triage approach from treating the “sickest first” to treating those “most likely to survive” first); and 4.) clinical reassessment and repeat triage are critical, as resource scarcity worsens or improves. Changing triage order and conserving and allocating resources for both lifesaving and palliative care can maintain fairness, support symptomatic care, and save more lives. Included in this article are printable triage cards that reflect our recommendations. These are not formal guidelines. With new research, data, and discussion, these recommendations will undoubtedly evolve.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2011;5:S111-S121)</jats:p>

Advances in a framework to compare bio-dosimetry methods for triage in large-scale radiation events

“…There are three important follow-up implications to these results: (1) what is the likely accuracy of the COMPARE BIO-DOSIMETRY METHODS FOR TRIAGE results of these test results; (2) what capacity would be required to carry out at these rates per hour and size of populations and (3) what does this say about planning for triage of large events if the methods are treated as independent methods versus 'all' results are needed simultaneously to triage versus the methods are integrated into a tiered system of triage.…”

“…Planning an effective response following a large radiation event such as a nuclear power plant disaster or a terrorist event involving an improvised nuclear device presents many challenges to policy-makers and those responsible for public response (1,2) . These challenges are complicated by not having a comparative framework suitable for evaluating which currently available methods or those in advanced development are capable of addressing the needs in the context of a large disaster.…”

Scarce Resources for Nuclear Detonation: Project Overview and Challenges

“…The resulting articles in this special issue of Disaster Medicine and Public Health Preparedness are not intended to be exhaustive reviews, and they reflect the judgment and opinion of the experts, not those of the governmental agencies or academic institutions that employ them. [14][15][16][17][18][19][20][21][22] The recommendations are based on the available data, recognizing that the human and animal data on radiation injury alone and on combined injury are limited.…”

“…14,21 Understanding the expected injury types has implications for triage decision making as outlined by Coleman and colleagues. 22 Four damage zones are defined in Planning Guidance for Response to a Nuclear Detonation 4 and detailed by Knebel et al 15 : severe dam-age, moderate damage, light damage, and dangerous fallout. The dangerous fallout zone footprint, in which there is sufficient radiation to produce the acute radiation syndrome, will reach its maximal extent after approximately 1.5 hours and then shrink rapidly as fallout decays.…”

“…The resulting articles in this special issue of Disaster Medicine and Public Health Preparedness are not intended to be exhaustive reviews, and they reflect the judgment and opinion of the experts, not those of the governmental agencies or academic institutions that employ them. [14][15][16][17][18][19][20][21][22] The recommendations are based on the available data, recognizing that the human and animal data on radiation injury alone and on combined injury are limited.Model output for casualty types and number are described in a general manner. 15 (The Department of Health and Human Services has detailed models from which the data and guidance in these articles are based for the consequences of nuclear detonation in a range of cities, from a variety of heights of burst, and under a range of meteorological conditions, and for scarcity of specific resources for medical management of acute radiation syndrome.…”