Priorities in Triage of Patients with and without Combined Injury,
Based on Dose of Radiation*
Modified Military Triage System Used in Mass Casualty Scenarios
| Conventional Triage Categories for Injuries without Exposure to Radiation |
Changes in Expected Triage Categories after Whole-Body Radiation |
| |
<1.5 Gy |
1.5-4.5 Gy |
>4.5 but <10 Gy |
| Delayed |
Delayed |
Variable** |
Expectant |
| Immediate |
Immediate |
Immediate |
Expectant |
| Minimal |
Minimal |
Minimal*** |
Minimal*** |
| Expectant |
Expectant |
Expectant |
Expectant |
| Absent |
Ambulatory monitoring |
Ambulatory monitoring with routine care and hospitalization as needed |
*The military triage system was modified to develop priorities for therapy of individuals with radiation exposure and combined injury (i.e., significant mechanical trauma or burns). Priorities change as a function of radiation dose (range based on acute photon-equivalent exposures). At a whole-body dose <1.5 Gy, triage categories remain the same: 1) delayed treatment for those who are medically stable with significant injury but who may survive until definitive treatment is available; 2) immediate therapy for those with high survivability and significant injury, provided that immediate therapy is available; 3) minimal therapy for medically stable patients with minor injury; and 4) expectant therapy for patients who are seriously injured and in whom survivability is poor. All patients with the combined injury syndrome and dose from exposure >4.5 Gy should be treated expectantly, except for those with minimal or no injury. Patients with radiation injury alone (i.e., without combined injury) should be triaged to the ambulatory setting if dose from exposure <1.5 Gy. For those with a higher dose, routine care should include therapy with cytokines, antimicrobial agents, blood transfusion, and frequent outpatient follow-up with laboratory monitoring. Hospitalization may be required.
**Triage category depends on the nature and extent of physical injury.
***Although other injuries may be minimal, treatment guidelines for Acute Radiation Syndrome should be followed for patients receiving a whole-body radiation dose greater than 2 Gy.
Adapted from:
- Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004; Vol. 140:1037-51. [PubMed Citation]
- Walker RI, Cerveny RJ, eds. Medical Consequences of Nuclear Warfare. Falls Church, VA: Office of the Surgeon General; 1989
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