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Mass Casualty
General Information
- After a mass casualty radiation event, the local-regional medical response assets may be degraded significantly: response personnel, medical facilities, field equipment, transportation, communication infrastructure, and availability of countermeasures, including drugs.
- Standard medical procedures and protective action guidelines may need to be modified to reflect actual conditions and availability of resources.
- Mass decontamination of ambulatory victims, if needed, will typically be performed in large staging areas away from the acute medical facilities, which will be needed for the acutely ill.
- For events with exposure rather than
contamination, procedures for monitoring large populations will need to be implemented.
- Local event leaders will need to initiate mass casualty protocols in facilities like hospitals and public arenas to meet surge capacity. These plans should be developed and practiced in advance by all assets likely to participate.
- Event leaders may need to procure additional supplies, including drugs, from the Strategic National Stockpile to meet local needs.
- Planning for urgent stem cell transplantation for those with intermediate- to high-dose radiation (4-10 Gy) may be required.
- In mass casualty situations, modifications of standard recommendations may be needed for prophylactic and therapeutic cytokine administration for hematologic consequences of the Acute Radiation Syndrome. Specific recommendations for this have been published and summarized2
- In a mass casualty incident associated with radiation, the traditional triage categories assigned to patients may need to be modified.
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Preplanning and Response
- Templates for the Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors (HHS/CDC, July 2006)
- Radiation Emergencies (HHS/CDC)
- Population Monitoring Following a Nuclear/Radiological Incident: CDC Roundtable (PDF - 335 KB) (HHS/CDC, January 2005)
- Interim Guidelines for Hospital Response to Mass Casualties from a Radiological Incident (PDF - 527 KB) (HHS/CDC, December 2003)
- Dainiak N, Delli Carpini D, Bohan M, Werdmann M, Wilds E, Barlow A, Beck C, Cheng D, Daly N, Glazer P, Mas P, Nath R, Piontek G, Price K, Albanese J, Roberts K, Salner AL, Rockwell S. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24. [PubMed Citation]
- National Response Framework
- National Incident Management System (PDF - 7422 KB) (DHS, March 1, 2004)
- Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19, December 2005, purchase required; see Free Overview (PDF - 219 KB))
- Providing Mass Medical Care with Scarce Resources: a Community Planning Guide, eds Phillips SJ, Knebel A (HHS/AHRQ publication no. 07-001, February 2007)
- Mass Casualty Management Systems - Strategies and Guidelines for Building Health Sector Capacity (PDF - 288 KB) (WHO, 2007)
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References |
- Jackson WL, Gallagher C, Myhand RC, Waselenko JK. Medical management of patients with multiple organ dysfunction arising from acute radiation syndrome. BJR Supplement 2005; 27:161-8. [PubMed Citation]
- Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004 Jun 15;140(12):1037-51. [PubMed Citation]
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