Transplant Centers Prepare
for Mass Casualties
of a Radiation Incident
Representatives of hematopoietic cell transplant centers and government agencies met in Bethesda in late September for a day-long symposium on the health effects and medical management of the victims of a possible nuclear event.
The meeting was sponsored by the Radiation Injury Treatment Network (RITN), a collaboration of ASBMT and the National Marrow Donor Program (NMDP).
Because recent terrorist events suggest that an attack using nuclear materials is a real possibility in the United States, several government and private organizations are preparing to respond to such an event. The most catastrophic scenario, an improvised nuclear device, could expose hundreds of thousands of people to ionizing radiation, resulting in varying degrees of acute radiation syndrome (ARS). The symposium participants were informed about a series of terrorism response models developed by the Department of Health & Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response. The models are being used to prepare for emergency medical response and patient transport to predetermined hospitals that are prepared to accept casualties.
Severity Categories
Injuries suffered by victims of a radiological incident will vary widely:
· For individuals with limited radiation exposure (<2 Gy), survival is likely with supportive care.
· Significant radiation exposures (>6-10 Gy) are likely to be fatal despite aggressive treatment.
· Between these extremes are the victims for whom long-term survival is possible, but only with intensive medical care including hematopoietic cell transplantation.
The symposium included presentations on the identification and medical management of patients with treatable ARS, including the need for standardized and automated biodosimetry methods to triage patients into low and high-risk groups.
Symposium participants were told that a large-scale incident is likely to cause panic, and property devastation will hamper evacuation and treatment of the injured. A presentation of the events that followed Hurricane Katrina showed that communication systems may be nonexistent and local medical facilities damaged or destroyed. A presentation about an accidental dissemination of radioactive cesium in Goiânia, Brazil, demonstrated the potential for even relatively small radiological incidents to cause widespread anxiety and significant impact on the local economy.
RITN Tasks
The symposium also included a presentation of the RITN network and its four main tasks:
· developing comprehensive guidelines for the evaluation and treatment of ARS
· expanding the existing treatment network
· providing emergency communication systems
· training tertiary care personnel.
The development of RITN has been made possible through cooperative partnerships with the Office of Naval Research, Center for International Blood and Marrow Transplant Research (CIBMTR) and participating NMDP transplant centers. Since its inception in 2001, the membership of RITN has grown to include more than 50 primary and secondary transplant centers, cord blood banks and donor centers.
Detailed information on the medical management of radiation events is available online at Radiological Event Medical Management (www.remm.nlm.gov). Additional online information also is available about the Radiation Injury Treatment Network (www.nmdp.org/ritn).