This document uses clinical observations from a military population, presumably mostly young men.
Thus, although the NATO document presents specific clinical effects expected for each radiation dose range, actual clinical findings in the "general population" would probably be more variable and nuanced than those seen in the relatively homogeneous NATO population of young males in the military.
A "general population" includes persons at extremes of age (from newborns to the elderly), persons at extremes of health (from the very healthy to the chronically and/or acutely ill). These factors will modify the expected timing and severity of adverse health effects associated with each radiation dose level. Therefore, clinicians should not expect that a specific dose or dose range will inevitably or invariably lead to the same clinical outcome in every victim.
The tables and illustrations in this section are intended to convey the clinical continuum of ARS, with increasing radiation dose resulting in increasingly severe clinical effects which develop over a shorter period of time.
The clinical outcomes in the original NATO document also do not reflect the potential efficacy of newer techniques for aggressive supportive care, which may enable salvage in some patients previously thought to be lethally irradiated.
The dose ranges used in this NATO document are arbitrary. Other ranges to describe ARS effects are presented in other classic documents on ARS. One example is the REMM illustration of the Time Phases of ARS based on an IAEA document2, which is based primarily on radiation effects in radiation workers.
Clinicians may also wish to review other classic documents about ARS that use other dose ranges to present expected ARS effects over time. 2,3,4
Clinical variability after radiation exposure may reflect
The population affected, e.g., young male soldiers1 only vs. a more varied "general populaton" of civilians3
Uncertainties about the dose actually received in a mass casualty event
Presence/absence of prompt, sophisticated, appropriate medical care, as would be needed after a mass casualty radiation event
Worse clinical outcomes are generally associated with
Higher whole or partial body dose and higher dose rate