Initially, after a large mass casualty radiation event, local-regional medical response assets may be diminished significantly, including response personnel, medical facilities, equipment, transportation, communication infrastructure, and availability of countermeasures, including drugs.
Usual "standards of care" for medical activities may need to be modified to reflect actual conditions and reduced availability of resources. Recently, these modifications have been called "crisis standards of care." It is important to remember that initial shortages of resources will change over time as replacement resources are brought to the affected area. However, some heavily damaged facilities may not be brought back on-line quickly or at all.
Local event response leaders will decide when to initiate medical mass casualty protocols reflecting "crisis standards of care" in facilities like hospitals and public arenas in order to meet surge capacity. These plans should be developed and practiced in advance by all partners and stakeholders. (See REMM information about medical surge capacity, and resources from HHS/AHRQ.)
To meet local needs, event response leaders may need to procure additional supplies, including drugs, from the Strategic National Stockpile and/or regional partners.
Mass radiation decontamination of large numbers of ambulatory victims, if needed, will probably need to be performed at home or in large staging areas away from the acute medical facilities, which will be needed for the acutely ill. (See REMM information on decontamination.)