Triage Category and Cytokine (G-CSF) Use after a Nuclear Detonation

Video Tutorial (2:41)

When to use: When resource availability is constrained
Where to use: Wherever triage is performed
Caveats: This tool does not use standard triage categories
Full details: When and how to use this tool

Step 1 of 4: Injury type

What type of injury does this patient have?

Radiation only^*
Combined injury^* (radiation and trauma and/or burn)
Trauma or burn only

* Radiation cases include guidance on use of myeloid cytokines

Step 2 of 4: Injury severity

What is the estimated radiation dose for this patient?

Estimate dose using the REMM Dose Estimator (Line 1 to 3)
OR
Enter dose manually (Line 4)

1. Date/time exposure began
(e.g., 01/22/2008, 14:25)
2. Date/time of one or more blood counts	lymphocyte count (x 10⁹)



(e.g., 01/22/2008, 23:00)	(e.g., 1.25)
3. from exposure
4. Dose estimate	95% confidence limits
Gy	Gy

What is the severity of the trauma?

Definitions of trauma categories

Severe
Moderate
Minimal

Do the burns cover >20% body surface area (BSA)?

Yes
No

Step 3 of 4: Resource availability

What is the availability of medical resources?

Definitions of resource availability and standards of care

Normal
Good
Fair
Poor

Step 4 of 4: Triage category and cytokine recommendations

Based on Nuclear Detonation Scarce Resources Working Group publications from March, 2011

Triage category:

Descriptions of triage categories

Minimal

Delayed

Immediate

Expectant

Immediate

The red/black split triage category for >10 Gy indicates that some victims may receive aggressive treatment at discretion of physician, especially if 10 Gy is received over prolonged time period.

Minimal B

Minimal A

Minimal B: Consider repeating both biodosimetry and clinical assessments, especially at high end of this dose range (0.5 - 2 Gy).

Minimal A: Those with physical dose estimates based on location below 0.5 Gy need not report for medical evaluation. Joining a registry may be suggested after the incident.

Cytokine recommendation:

Descriptions of myeloid cytokine categories

Category 1: G-CSF indicated.

Category 2: G-CSF indicated, lower priority than Category 1.

Category 3: G-CSF not indicated.

Expectant - Category 3: G-CSF not indicated.
Immediate - Category 2: G-CSF indicated, lower priority than Category 1.