• Medical Effects of Ionizing Radiation, Fred A. Mettler, Arthur C. Upton, 3rd Edition, Saunders/Elsevier, Philadelphia, PA, 2008
• Mettler FA Jr, Voelz GL. Major radiation exposure--what to expect and how to respond. N Engl J Med. 2002 May 16;346(20):1554-61 [PubMed Citation]
• Mettler FA. Medical resources and requirements for responding to radiological terrorism. Health Physics 2005; 89(5):488-493 [PubMed Citation]
• Koenig KL, Goans RE, Hatchett RJ, Mettler FA Jr, Schumacher TA, Noji EK, Jarrett DG. Medical treatment of radiological casualties: current concepts. Ann Emerg Med. 2005 Jun;45(6):643-52 [PubMed Citation]
• De Lorenzo RA. When it's hot, it's hot. Ann Emerg Med. 2005 Jun;45(6):653-4 [PubMed Citation]
• Musolino SV, Harper FT. Emergency response guidance for the first 48 hours after the outdoor detonation of an explosive radiological dispersal device. Health Phys. 2006 Apr;90(4):377-85 [PubMed Citation]
• Meineke V, van Beuningen D, Sohns T, Fliedner TM. Medical management principles for radiation accidents. Mil Med. 2003 Mar;168(3):219-22 [PubMed Citation]
• Goans RE, Waselenko JK. Medical management of radiological casualties. Health Phys. 2005 Nov;89(5):505-12 [PubMed Citation]
• Flynn DF, Goans RE. Nuclear terrorism: triage and medical management of radiation and combined-injury casualties. Surg Clin North Am. 2006 Jun; 86(3):601-36 [PubMed Citation]
  
• Berger ME, Christensen DM, Lowry PC, Jones OW, Wiley AL. Medical management of radiation injuries: current approaches. Occup Med (Lond). 2006 May;56(3):162-72 [PubMed Citation]
  
• Bushberg JT, Kroger LA, Hartman MB, Leidholdt EM Jr, Miller KL, Derlet R, Wraa C. Nuclear/radiological terrorism: Emergency department management of radiation casualties. J Emerg Med. 2007 Jan;32(1):71-85. [PubMed Citation]

• Waselenko JK, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004 Jun 15;140(12):1037-51 [PubMed Citation]
• Jackson WL Jr, Gallagher C, Myhand RC, Waselenko JK. Medical management of patients with multiple organ dysfunction arising from acute radiation syndrome. BJR Suppl. 2005;27:161-8 [PubMed Citation]
• Dainiak N, Waselenko JK, Armitage JO, MacVittie TJ, Farese AM. The hematologist and radiation casualties. Hematology, (Am Soc Hematol Educ Program). 2003;:473-96 [PubMed Citation]
• Dainiak N. Hematologic consequences of exposure to ionizing radiation. Exp Hematol. 2002 Jun;30(6):513-28 [PubMed Citation]
• Fliedner TM. Nuclear terrorism: the role of hematology in coping with its health consequences. Curr Opin Hematol. 2006 Nov;13(6):436-44. [PubMed Citation]
• Gorin NC, Fliedner TM, Gourmelon P, Ganser A, Meineke V, Sirohi B, Powles R, Apperley J. Consensus conference on European preparedness for haematological and other medical management of mass radiation accidents. Ann Hematol. 2006 Oct;85(10):671-9. [PubMed Citation]
• Radiation Injury Treatment Network
• Weisdorf D, Apperley J, Courmelon P, Gorin NC, Wingard J, Chao N. Radiation Emergencies: Evaluation, Management, and Transplantation. Biol Blood Marrow Transplant. 2007;13:103-6. (PDF - 82 KB)
• Manthous CA, Jackson WL Jr. The 9-11 Commission's invitation to imagine: a pathophysiology-based approach to critical care of nuclear explosion victims. Crit Care Med. 2007 Mar;35(3):716-23. [PubMed Citation]

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• Medical Effects of Ionizing Radiation, Fred A. Mettler, Arthur C. Upton, 3rd Edition, Saunders/Elsevier, Philadelphia, PA, 2008
• Medical Management of Radiation Accidents, Fred A. Mettler, Angelina K. Guskova, Igor A. Gusev (Eds), 2nd Edition, University of New Mexico, Albuquerque, New Mexico, 2001
• Radiobiology for the Radiologist, 6th Edition, Eric J. Hall, Amato J. Giaccia, Lippincott Williams & Wilkins, Philadelphia, PA, 2006
• The Medical Basis for Radiation-accident Preparedness, the Clinical Care of Victims, Proceedings of the Fourth International Radiation Emergency Assistance Center/Training Site (REAC/TS) Conference, March 2001, Parthenon Publishing Group, New York, NY, 2002

Handbooks about radiation medical response

• Medical management of radiological casualties handbook (PDF - 977 KB) (AFRRI)
• The Medical NBC Battlebook - US Army CHPPM Technical Guide 244, August 2002 (PDF - 9,562 KB)
• Handbook for responding to a radiological dispersal device first responders's guide — the first 12 hours (PDF - 4.26 MB)
  (Conference of Radiation Control Program Directors, Inc., September 2006)

• Health protection guidance in the event of a nuclear weapons explosion (PDF - 29 KB) (WHO, February 2003)
• Protective action guides for radiological dispersal device (RDD) and improvised nuclear device (IND) incidents (PDF - 481 KB) (DHS/FEMA document, published in Federal Register 3 January, 2006, Z-RIN 1660-ZA02)
• "Radiation Bioterrorism", Tochner ZA, Lehavi O, Glatstein E, Chapter 207 in Harrison's Principles of Internal Medicine, eds. DL Kasper, E Braunwald, AS Fauci , SL Hauser, DL Longo, JL Jameson, 16th Edition, pp 1294-1300, McGraw Hill, 2005
• General medical effects of nuclear weapons: diagnosis, treatment, and prognosis, chapter 6, NATO handbook on the medical aspects of NBC defensive operations AMedP-6(B)
• Nuclear weapon accident response procedures (DOD, February 22, 2005) (PDF - 9,683 KB)
• Recommendations for managing a nuclear weapons accident
  (Radiation Emergency Training Center/ Training Site [REAC/TS])
• Feasibility studies of the health consequences to the American population of nuclear weapons tests conducted by the United States and other nations (HHS/NCI/CDC, August 2001) (PDF - 33,016 KB)
• The Medical NBC Battlebook - US Army CHPPM Technical Guide 244, August 2002 (PDF - 9,562 KB)
• Sheltering in place during a radiation emergency (HHS/CDC, May 2006)

• Possible health effects of radiation exposure on unborn babies (HHS/CDC)
• Prenatal radiation exposure: a fact sheet for physicians (HHS/CDC)
• Guidance on the application of dose coefficients for the embryo, fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Health Protection Agency, 2008)
• Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol. 2005 May;6(5):328-33 [PubMed Citation]
• Prasad KN, Cole WC, Hasse GM. Health risks of low dose ionizing radiation in humans: a review. Exp Biol Med (Maywood). 2004 May;229(5):378-82 [PubMed Citation]
• Biological effects after prenatal irradiation (embryo and fetus)
  (International Commission on Radiological Protection, ICRP Publication 90, 2004)
• Doses to the embryo and fetus from intakes of radionuclides by the mother (International Commission on Radiological Protection, ICRP Publication 88, 2002)
• Pregnancy and medical radiation (International Commission on Radiological Protection, ICRP Publication 84, 2001)
• Brent RL. Utilization of developmental basic science principles in the evaluation of reproductive risks from pre- and postconception environmental radiation exposures. Teratology. 1999 Apr;59(4):182-204 [PubMed Citation]
• Pregnancy and radiation (PDF - 222 KB) (Health Physics Society)
• Pregnancy and radiation (PowerPoint® - 189 KB) (Health Physics Society)
• Radiation exposure and pregnancy (PDF - 96 KB) (Health Physics Society)

Infants' and children's issues in radiation events

Policy issues

• National Advisory Committee on Children and Terrorism (NACCT) (HHS/CDC)
• NACCT recommendations to secretary of HHS (PDF - 623 KB) June 12, 2003
• Schools and terrorism, A supplement to the national advisory committee on terrorism (PDF - 354 KB) recommendations to the HHS Secretary, August 12, 2003

• Pediatric disaster and terrorism preparedness, A national consensus conference and the pediatric expert advisory panel (PDF - 1,218 KB) David Markenson, MD, Columbia University

Resources

• American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American Academy of Pediatrics Committee on Medical Liability; Task Force on Terrorism. The pediatrician and disaster preparedness. Pediatrics. 2006 Feb;117(2):560-5. [PubMed Citation]
• American Academy of Pediatrics Committee on environmental health. Radiation disasters and children. Pediatrics. 2003 Jun;111(6 Pt 1):1455-66 [PubMed Citation]
• American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and American College of Emergency Physicians, and Pediatric Committee. Care of Children in the Emergency Department: Guidelines for preparedness. Pediatrics. 2001 Apr;107(4):777-81 [PubMed Citation]
• Strategies and tools for meeting the needs of children: public health emergencies (HHS/AHRQ, a free Web conference, 4 Web lectures, broadcast January 11, 2006)
• Helping children cope with terrorism and war resources (National Child Care Information Center, September 2008)
• Acute mental health response to children affected by terrorism (PDF - 795 KB) (HHS/CDC)
• Responding to Terrorism and War: Information for Parents (PDF - 93.6 KB) (National Youth Violence Prevention Resource Center)
• Pediatric disaster and terrorism preparedness, by David Markenson, M.D., Columbia University, July 13, 2004 (PowerPoint® - 1135 KB) (Text version))
• ICRP Publication 95: Doses to infants from ingestion of radionuclides in mother's milk, 95 (International Commission of Radiological Protection, ICRP Publication 95, 2004)
• Guidance on the application of dose coefficients for the embryo , fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Health Protection Agency, 2008)
• See Specific Populations — Infants and Young Children for more references.

Techniques for pediatric incident mass casualty triage

• JumpSTART pediatric multiple casualty incident triage (Dr. Lou E. Romig, MD, Team Life Support, Inc.)
• JumpSTART pediatric multiple casualty incidents triage tool (Dr. Lou E. Romig, MD, Team Life Support, Inc.)

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• Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006 Apr 27;354(17):1813-26 [PubMed Citation]
• Daniel Weisdorf, Nelson Chao, Jamie K. Waselenko, Nicholas Dainiak, James O. Armitage, Ian McNiece and Dennis Confer. Acute radiation injury: Contingency planning for triage, supportive care, and transplantation. Biol Blood Marrow Transplant, 2006 Jun;12(6):672-82 [PubMed Citation]
• Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006 Apr 27;354(17):1813-26 [PubMed Citation]
• Radiation Injury Treatment Network

Use of hematologic growth factors

• Kenneth Kaushansky. Lineage-specific hematopoietic growth factors. N Engl J Med. 2006 May 11;354(19):2034-45 [PubMed Citation]
• Smith TJ, Khatcheressian J, Lyman GH, et al. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. 2006 Jul 1;24(19):3187-205. Epub 2006 May 8 [PubMed Citation]
• Kuderer NM, Dale DC, Crawford J, Lyman GH. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol. 2007 Jul 20;25(21):3158-67. [PubMed Citation]

Management of febrile neutropenia

• Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis., 2002 Mar 15;34(6):730-51. Epub 2002 Feb 13 [PubMed Citation]
• Brook I, Elliott TB, Shoemaker MO, Ledney GD, Antimicrobials in the mangement of post-irradiation infection (PDF - 61 KB), (NATO RTG-099, 2005)
• Facts about neupogen (HHS/CDC)
• Kuderer NM, Dale DC, Crawford J, Lyman GH. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol. 2007 Jul 20;25(21):3158-67. [PubMed Citation]

Platelet transfusion

• Schiffer CA, Anderson KC, Bennett CL, Bernstein S, Elting LS, Goldsmith M, Goldstein M, Hume H, McCullough JJ, McIntyre RE, Powell BL, Rainey JM, Rowley SD, Rebulla P, Troner MB, Wagnon AH; American Society of Clinical Oncology. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol., 2001 Mar 1;19(5):1519-38 [PubMed Citation]

Granulocyte transfusion guidelines

• Stanworth SJ, Massey E, Hyde C, Brunskill S, Lucas G, Navarrete C, Marks DI. Granulocyte transfusions for treating infections in patients with neutropenia or neutrophil dysfunction. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005339. Review. [PubMed Citation]

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• Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2, Biologic effects of ionizing radiation, committee to assess health risks from exposure to low levels of ionizing radiation, National Research Council, 2006
• BEIR VII: Health risks from exposure to low levels of ionizing radiation, (PDF - 166 KB) The National Academies, 2005
• Radiation Epidemiology Course, (HHS/National Cancer Institute/Division of Cancer Epidemiology and Genetics, May 2007)

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• How to recognize and initially respond to an accidental radiation injury - images of radiation skin effects and injury (poster, PDF - 436 KB) (pamphlet, PDF - 322 KB) (Radiation dermatological injuries, IAEA, WHO)
• Cutaneous radiation injury: Fact sheet for physicians (HHS/CDC 5/10/2006)

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• Agency for Healthcare Research and Quality (AHRQ)
• Centers for Disease Control and Prevention (HHS/CDC)
• Department of Energy (DOE)
• Environmental Protection Agency (EPA)
• Food and Drug Administration (HHS/FDA)
• Department of Health and Human Services (HHS)
• Los Alamos National Laboratory (LANL)
• National Council on Radiation Protection & Measurements (NCRP)
• Nuclear Regulatory Commission (NRC)
• Radiation Emergency Assistance Center / Training Site (REAC/TS)
• Occupational Safety & Health Administration (OSHA)

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• Armed Forces Radiobiology Research Institute (AFRRI)
• Defense Threat Reduction Agency (DTRA)
• NATO handbook on the medical aspects of NBC defensive operations (AMedP-6(B), Part 1 - Nuclear,  DOD)
• Nuclear weapon accident response procedures (PDF - 9,683 KB) (DOD)
• Basic radiological dose estimation - A field guide (PDF - 1,843 KB) (DOD, USACHPPM TG-236A, 2001)
• Radiological sources of potential exposure and/or contamination (PDF - 6,745 KB) (DOD, USACHPPM TG-238, 1999)
• The Medical NBC Battlebook - US Army ChPPM Technical Guide 244, August 2002 (PDF - 9,562 KB)

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• United Nations Scientific Committee on the Effects of Ionizing Radiation (UNSCEAR, Vienna, Austria)
• International Atomic Energy Agency (IAEA)
• International Commission on Radiological Protection (ICRP)
• Radiation Emergency Medical Preparedness and Assistance Network of the World Health Organization (REMPAN)
• Radiation Effects Research Foundation — A Cooperative Japan-US Research Organization
• NHS Emergency Planning Guidance 2005 (Department of Health, UK)

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• Disaster preparedness for radiology professionals: Response to terrorism (PDF - 357 KB), (American College of Radiology, 2005, Government Version 3.0)
• Waeckerle JF, Seamans S, Whiteside M, Pons PT, White S, Burstein JL, Murray R; Task Force of Health Care and Emergency Services Professionals on Preparedness for Nuclear, Biological, and Chemical Incidents. Executive summary: Developing objectives, content, and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical (NBC) incidents. Ann Emerg Med. 2001 Jun;37(6):587-601 [PubMed Citation]
• Health Physics Society: Homeland Security Committee
• Radiation Effects Research Foundation (RERF)
• Conference of Radiation Control Program Directors

• Preparing for Radiological Population Monitoring and Decontamination (HHS/CDC, 2006)
• Medical Response to Nuclear and Radiological Terrorism (HHS/CDC, 2004)
• The Role of Public Health in a Nuclear or Radiological Terrorist Incident (Web on Demand) (HHS/CDC, 2005)
• Barnett DJ, Parker CL, Blodgett DW, Wierzba RK, Links JM. Understanding radiologic and nuclear terrorism as public health threats: preparedness and response perspectives. J Nucl Med. 2006 Oct;47(10):1653-61. [PubMed Citation]

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• National Response Framework
• NRF Resource Center
• NRF Training Courses
• NRF Incident Annexes
• Emergency Support Function #8 — Public Health and Medical Services (PDF - 200 KB)
• Nuclear/Radiologic Incident Annex (PDF - 479 KB)
• Catastrohpic Incident Annex (PDF - 163 KB)
• Worker Safety and Health Support Annex (PDF - 85 KB)

• National Planning Scenarios — created for use in national, federal, state, and local homeland security preparedness activities (PDF - 3.04 MB) (DHS, Version 20.1 Draft, April, 2005)
• See Scenario 1: Nuclear Detonation — 10-Kiloton Improvised Nuclear Device
• See Scenario 11: Radiological Attack — Radiological Dispersal Devices

• NIMS overview
• NIMS document (PDF - 5,181 KB)

• Incident Command System (OSHA)

• Hospital Incident Command System
• What is the Hospital Incident Command System (HICS)?
• Frequently asked questions about HICS
• Is HICS appropriate for both small and large hospitals?
• How has HICS evolved from the 3 earlier versions of HEICS?
• What are the primary differences between HEICS III, HEICS IV, and HICS?
• Additional references

• Emergency department management of radiation casualties (PowerPoint® - 1,006 KB) (Health Physics Society)
• Bushberg JT, Kroger LA, Hartman MB, Leidholdt EM Jr, Miller KL, Derlet R, Wraa C. Nuclear/radiological terrorism: Emergency department management of radiation casualties. J Emerg Med. 2007 Jan;32(1):71-85. [PubMed Citation]
• Factors that decrease exposure dose: Distance, time, shielding
  (Illustration)
• DOE, Office of Worker Safety and Health - Radiation protection policy (DOE)
• Ionizing radiation - standards (OSHA)
• General principles for the radiation protection of workers
  (International Commission on Rdiological Protection, ICRP Publication 75, 1998)
• Assessment of occupational exposure due to intakes of radionuclides safety guide (PDF - 316 KB) (IAEA Safety Reports Series No. RS-G-1.2, 1999)
• Assessment of occupational exposure due to external sources of radiation safety guide (PDF - 307 KB) (IAEA Safety Standards Series No. RS-G-1.3, 1999)
• Shielding for various kinds of radiation (Illustration)
• Safety around radiation sources (REAC/TS)

Physics and radiation safety software tools

• Armed Forces Radiobiology Research Institute
  (AFRRI) - Biodosimetry Assessment Tool (BAT)
• Free downloadable radiation software packages for radiation safety professionals
• Miscellaneous tools for physics calculations
• Tool for measuring uranium toxicity

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• Radiation Emergency Assistance Center/ Training Site
• Guidance for radiation accident management
• Courses in handling radiation emergencies

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• What is Federal Guidance?
• Manual of protective action guides and protective action for nuclear incidents (400 R 92-001, EPA, May 1992)
• Protective action guides for radiological dispersal device (RDD) and improvised nuclear device (IND) incidents (PDF - 481 KB) (DHS/FEMA document, published in Federal Register 3 January, 2006, Z-RIN 1660-ZA02)

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• Publications on Accident Response in Radiation Incidents (IAEA)
• Medical Management of Radiation Accidents, Fred A. Mettler, Angelina K. Guskova, Igor A. Gusev (Eds), 2nd Edition, ISBN: 0849370043 (April 2001), University of New Mexico, Albuquerque, New Mexico
• Chernobyl 20 Years Later: An IAEA In Focus Series (IAEA)
• The Radiological Accident in Goiania (PDF - 6,550 KB) (IAEA, 1988)

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