Six years ago today, the terrorist attacks on America triggered a mobilization of national defense, preparedness, and resources that has no historical blueprint to follow. Plans to counter one of the most menacing threats - radiation contamination by nuclear explosion, "dirty" bomb, or some other device - have been developed with the help of NCI experts in radiation medicine.

The medical community around the globe has learned a great deal about how best to respond when people are exposed to radiation, based on decades of clinical experience with mass casualty radiation events: the atomic bombs dropped on Hiroshima and Nagasaki, nuclear reactor accidents such as Three Mile Island and Chernobyl, and accidental exposures during the transport of radioactive material.

The dilemma is that such knowledge resides primarily among experts and specialists, of which there are a limited number, and these experts may be especially scarce if the emergency were catastrophic and widespread. Also, the rarity of such an event means that up-to-date information is the optimal solution for health care providers.

This potential disconnect is addressed by Radiation Event Medical Management (REMM), a new Web site developed by planners, physicians, radiation specialists, and other subject matter experts working with the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the U.S. Department of Health and Human Services (HHS) in collaboration with the National Library of Medicine (NLM). The Web site was originally conceptualized by experts from NCI, ASPR, and NLM and the unique system was created by Dr. Judith Bader of NCI and a team from NLM (led by Florence Chang and colleagues).

Several of the key personnel on this project are on detail from NCI, including team leader Dr. Norman Coleman of NCI's Radiation Research Program in the Division of Cancer Treatment and Diagnosis.

"REMM was established to provide just-in-time information and guidance on diagnosis and treatment to health care providers - primarily physicians - who do not have formal radiation medicine expertise,” explains Dr. Coleman.

He emphasizes that REMM is just one piece of the large government network being assembled by HHS and the Department of Homeland Security. Dr. Coleman and the REMM team are part of the Office of Preparedness and Emergency Operations (OPEO). Rear Admiral W. Craig Vanderwagen is the assistant secretary for preparedness and response; the OPEO team is led by Drs. Kevin Yeskey and Ann Knebel. In OPEO, they plan for the unthinkable regarding chemical, biological, radiological, and nuclear events and scenarios, as well as planning for natural disasters.

Part of REMM's solution to this challenge is a series of decision-tree algorithms for the nonexpert physician to follow at the scene. Because access to the Internet may be compromised during an emergency, the core of REMM also comes in the form of a diagnostic and treatment toolkit that can be downloaded in advance and stored on a local computer or storage device.

For REMM, the expert NLM content team gathered guidelines, protocols, procedures, and background from scores of sources, inside and outside of the federal government, and from scientific sources abroad. The initial Web site was reviewed by some 50 subject specialists from around the world and continues to be enhanced.

— Addison Greenwood