Management Modifiers for Contamination Algorithm


Burns and the Radiation Contamination Algorithm


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Trauma and the Radiation Contamination Algorithm


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Mass Casualty Emergencies and Radiation Contamination Algorithm


  • The REMM Contamination Algorithm
    • Is appropriate for events small enough to permit individualized victim evaluation and treatment, including decontamination
  • Algorithm modifications may be needed for radiation mass casualty emergencies because of
    • Limited numbers of medical staff, hospital personnel
    • Shortage of equipment and resources
    • Physical damage to healthcare facilities including medical laboratories
    • Overwhelming numbers of victims presenting for care, external decontamination, treatment of internal contamination, reassurance
  • Contamination algorithm modifications during radiation mass casualty emergencies
    • External contamination
      • Limiting/altering radiation surveys
        • Conducting one-time screenings of head, neck, hands, and forearms
        • Avoiding multiple whole body screenings and re-evaluations during initial triage
      • Altering targets for decontamination
      • Directing ambulatory victims away from medical facilities to community reception centers and
      • Providing instructions for self-decontamination at home
    • Internal contamination
  • When prioritizing delivery of scarce resources in radiation mass casualty emergencies, it is appropriate to consider prognosis related to
    • Extent of trauma
    • Extent of external whole body radiation exposure and significant exposure from any internal contamination, e.g., Polonium-210
    • Percent body surface area and depth (i.e., degree) of burns
    • Pre-existing medical conditions
  • Implementation of "Crisis Standards of Care" may be needed in disaster situations.
  • This algorithm and supporting material are guidelines, not mandates.
  • See Mass Casualty page for more details.
  • See Radiation + Trauma for more details.

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Timing of Surgery and the Radiation Contamination Algorithm


  • External contamination + trauma requiring emergency surgery
    • Formal external decontamination is appropriate.
    • When clinical urgency does not permit formal decontamination
      • Removal of contaminated clothing can eliminate about up to 90% of external contamination.
      • Traditional surgical skin prep will also help eliminate skin contamination.
      • Avoid pre-op shaving, if possible, to help maintain an intact skin barrier against radioactive materials.
  • Activate hospital emergency radiation response plans
    • If contaminated patients are admitted to the hospital in a mass casualty situation.
    • To ensure the health and safety of hospital staff and healthcare team
    • To manage/minimize potential contamination of hospital spaces, including operating and radiology suites
  • This algorithm and supporting material provide guidelines, not mandates.

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Blood Products Use and the Radiation Contamination Algorithm


  • Patients with certain kinds of internal contamination (e.g., Polonium-210) can be at risk for Acute Radiation Syndrome (ARS)
    • Patients with ARS will be immunosuppressed.
    • They are at risk for post-transfusion graft versus host disease (GVHD).
    • Guidelines suggest that these patients should receive blood products that have been both
      • Irradiated and
      • Leuko-reduced
    • If irradiated, leuko-reduced blood is unavailable,
      • Emergency transfusions may still be considered.
      • Attention should be paid to possible post-transfusion GVHD.
  • Most patients with external contamination but no known radiation exposure
    • Are unlikely to develop ARS
    • Should be evaluated for ARS before receiving blood products
  • This algorithm and supporting material provide guidelines, not mandates.
  • See Blood Products page for more details.

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At-Risk / Special Needs Populations and the Radiation Contamination Algorithm


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