Radiation + Trauma (Combined Injury)
General Information
- Combined injury is physical, thermal, and/or chemical trauma combined with radiation exposure at a dose sufficient to diminish the likelihood of overall survival or functional recovery.
- Combined injury will be common in a radiation mass casualty event
- Combined injury patients have a worse overall prognosis than do patients with trauma alone or radiation exposure alone
- Treatment priorities in order are
- Ensure the safety of the responders
- Evaluate and treat patients with life-threatening injuries
- Manage radiation issues, including internal and external contamination and exposure
- Personal Protective Equipment (PPE) must be worn by first responders in the field and
- Trauma treatment resources available to victims will be determined by
- Status and capacity of response infrastructure
- Number of victims
- Mass casualty triage algorithms improve efficiency and outcome; examples include
- Triage tags (PDF - 148 KB), especially designed for radiation incidents, are helpful in a mass casualty event
- Radiation triage tags record radiation dose, type of exposure, distribution of contamination, decontamination procedures performed, and results of decontamination in addition to the standard emergency parameters
- Some tags can also record chemical and biological exposures and treatments
- Burn triage issues must also be considered
- Combined injury
management and the Acute Radiation Syndrome
- Dose guidelines for initiating growth factor therapy may be lower in patients with combined injury
- Decisions concerning use of growth factors depend on
- Size of the radiation mass casualty incident
- Total number of victims
- Nature of their injuries
- Availability of resources
- Managing contaminated open wounds
- Surgery and the Acute Radiation Syndrome
- There may be a 24- to 36-hour window when surgery can be performed prior to the onset of cytopenias in the Acute Radiation Syndrome
top of page
Triage Categories with and without Combined Injury
Priorities in Triage of Patients with and without Combined Injury,
Based on Dose of Radiation (in units of gray) (What is gray (Gy)?)
Modified Military Triage System Used in Mass Casualty Scenarios
D
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 Jun 15; 140(12):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)
top of page
|
References |
- Treatment of Combined Injuries in a Radiation Incident (REAC/TS)
- Dicarlo AL, Hatchett RJ, Kaminski JM, Ledney GD, Pellmar TC, Okunieff P, Ramakrishnan N. Medical Countermeasures for Radiation Combined Injury: Radiation with Burn, Blast, Trauma and/or Sepsis. Report of an NIAID Workshop, March 26-27, 2007. Radiat Res. 2008 Jun;169(6):712-21. [PubMed Citation]
- Singer AJ, Dagum AB. Current management of acute cutaneous wounds. N Engl J Med. 2008 Sep 4;359(10):1037-46. [PubMed Citation]
|
|