Management Modifiers for
Treating Radiation Exposure


Burns and the Radiation Exposure Algorithm


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Trauma and the Radiation Exposure Algorithm


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Mass Casualty Emergencies and Radiation Exposure Algorithm


  • The REMM Exposure Algorithm
    • Is appropriate for events small enough to permit individualized victim evaluation and treatment
  • Algorithm modifications may be needed for large radiation mass casualty emergencies because of
    • Limited numbers of medical staff, hospital personnel
    • Shortages of equipment and resources
    • Physical damage to healthcare facilities including medical laboratories
    • Overwhelming numbers of victims presenting for care, some acutely ill
  • Limited resources (people, training, procedures and equipment) in the emergency phase of a large radiological or nuclear emergency may also require changes in the normal routines used to monitor, assign, document, and control dose among responders, ancillary workers and the general public.
    • In depth recommendations have has been provided by this document: Guidance for Emergency Response Dosimetry, (NCRP Report 179), Bethesda, MD, 2017, including the following:
      • “With minimal dosimetry resources, how to responders make decisions to control the total dose and associated risk?
      • How are doses assigned to responders when not every responder is issued a dosimeter before exposure occurs?
      • What is the regulatory framework for responders who are not trained as radiation workers?”
  • Exposure algorithm modifications during radiation mass casualty emergencies
  • When prioritizing delivery of very scarce resources in radiation mass casualty emergencies, it may be 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
    • Extent of burns: percent body surface area and depth (i.e., degree) of burns
    • Pre-existing medical conditions that materially affect prognosis of ARS
  • Implementation of "Crisis Standards of Care" may be needed in disaster situations.
  • Significant changes to standard triage and medical care of patients may be needed after detonation of an IND: see publications and tools
  • See Mass Casualty page for additional details.
  • See Radiation + Trauma for additional details.

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Timing of Surgery and the Radiation Exposure Algorithm


  • Radiation exposure + trauma requiring emergency surgery
    • Attempt to take surgical emergencies to the operating room
      • Within 36-48 hours after high-dose radiation exposure
      • Before decline of white blood cell and platelet counts
    • Pre-operative administration of white cell cytokines may extend the time window for surgery.
  • This algorithm and supporting material provide guidelines, not mandates.
  • See Radiation Effects on Blood Counts page for details.

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Blood Products Use and the Radiation Exposure Algorithm


  • Patients with significant whole body radiation exposure (Acute Radiation Syndrome) will be immunosuppressed.
    • They are at risk for post-transfusion graft versus host disease (GVHD).
  • Guidelines suggest that these patients should received 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.
  • This algorithm and supporting material provide guidelines, not mandates.
  • See Blood Products page for details

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


  • See the At-Risk / Special Needs Populations page
    • Describes groups especially vulnerable to the effects of radiation
  • These populations may require
  • Effective and ethical allocation of medical resources is crucial for all populations.
  • This algorithm and supporting material provide guidelines, not mandates.

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