Priorities in Triage of Patients with and without Combined Injury, Based on Dose of Radiation*
Modified Military Triage System Used in Mass Casualty Scenarios
Conventional Triage Categories for Injuries without Exposure to Radiation |
Changes in Expected Triage Categories after Whole-Body Radiation |
|
<1.5 Gy |
1.5-4.5 Gy |
>4.5 but <10 Gy |
Delayed |
Delayed |
Variable** |
Expectant |
Immediate |
Immediate |
Immediate |
Expectant |
Minimal |
Minimal |
Minimal*** |
Minimal*** |
Expectant |
Expectant |
Expectant |
Expectant |
Absent |
Ambulatory monitoring |
Ambulatory monitoring with routine care and hospitalization as needed |
*The military triage system was modified to develop priorities for therapy of individuals with radiation exposure and combined injury (i.e., significant mechanical trauma or burns). Priorities change as a function of radiation dose (range based on acute photon-equivalent exposures). At a whole-body dose <1.5 Gy, triage categories remain the same: 1) delayed treatment for those who are medically stable with significant injury but who may survive until definitive treatment is available; 2) immediate therapy for those with high survivability and significant injury, provided that immediate therapy is available; 3) minimal therapy for medically stable patients with minor injury; and 4) expectant therapy for patients who are seriously injured and in whom survivability is poor. All patients with the combined injury syndrome and an exposure dose >4.5 Gy should be treated expectantly, except for those with minimal or no injury. Patients with radiation injury alone (i.e., without combined injury) should be triaged to the ambulatory setting if dose <1.5 Gy. For those with a higher exposure dose, routine care should include therapy with cytokines, antimicrobial agents, blood transfusion, and frequent outpatient follow-up with laboratory monitoring. Hospitalization may be required.
**Triage category depends on the nature and extent of physical injury.
***Although other injuries may be minimal, treatment guidelines for Acute Radiation Syndrome should be followed for patients receiving a whole-body radiation dose greater than 2 Gy.
Adapted from:
- 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; Vol. 140:1037-51. [PubMed Citation]
- Walker RI, Cerveny RJ, eds. Medical Consequences of Nuclear Warfare. Falls Church, VA: Office of the Surgeon General; 1989 (PDF - 414 KB) (AFRRI)
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