First in the Nation Radiation Plan
Yale School of Medicine has helped develop the first “how to” manual in the nation instructing clinicians and health administrators statewide on efficient management of radiation victims, according to an article published this month on development of the manual.
Although general guidelines were in place for triage of victims in the field and for hospitals to plan for a radiologic event, there were few specific instructions for evaluating and managing victims in often frantic emergency rooms. This gap became apparent following the terrorist attack on the World Trade Center September 11, 2001.
“Prior guidelines were developed for triage of radiation victims in the field by the U.S. military,” said Nicholas Dainiak, M.D., clinical professor of medicine, Yale School of Medicine, chairman of medicine, Bridgeport Hospital, and chair of the Connecticut Response Planning Group, which drafted the plan. “Other guidelines provided global recommendations for routine hospital care or critical care. However, these guidelines provided little specificity for healthcare providers in hospital emergency departments which are often very busy and sometimes overcrowded.”
Dainiak said the state needed to develop a practical approach for today’s emergency room professionals who may not be familiar with radiation measurements and effects. The manual, he said, provides a template for Connecticut hospitals to model their radiation emergency response plan.
The Connecticut plan, which represents a collaboration of personnel from several hospitals and state agencies as well as Yale, is a model for other states as they develop their own manuals. Connecticut was considered by members of the voluntary planning group as having a high level of expertise about radiation given the number and quality of its hospitals when compared to its population of 3.4 million people.
According to the article in the International Journal of Radiation Oncology, Biology, Physics, the manual is organized into five broad areas: early system response to notification of a radiologic event; guidelines for classification, triage and early management of people who might have had a radiologic exposure; principles for processing individuals with radiation exposure; responsibilities of different categories of professionals, and policies and procedures for management of contaminated patients.
Sara Rockwell, director of the Office of Scientific Affairs at Yale, professor of therapeutic radiology and pharmacology and member of the planning group, said that wherever possible, the plan makes use of existing emergency response infrastructure, but provides mechanisms for rapidly involving experts in radiation medicine and radiation physics when their expertise is needed.
“The manual is designed as an easy to use reference on what to look for, what to ask, and what to do when evaluating and treating individuals who might have been exposed to ionizing radiation,” she said.
For instance, the 45-page manual distinguishes between radiation exposure and contamination: exposure is when an individual receives a radiation dose from an external source, contamination is when a person has been physically covered by or has absorbed or ingested radioactive material.
Symptoms and signs of a serious exposure, the manual states, include nausea, vomiting, rash, fever, headache, hypotension, neurologic deficits, impaired memory, and cytopenias, which is a decline in the blood counts for white blood cells, red blood cells and platelets. But often, there are no immediate symptoms.
“Unlike other acts of terrorism, incidents involving the use of radioactive material often induce no or few nonspecific symptoms at the time of initial evaluation and triage,” it is stated in the manual. “Dispersal of radioactive materials results in casualties that are less obvious and more difficult to assess than those seen with other forms of trauma, particularly because victims might or might not be contaminated.”
International Journal of Radiation Oncology, Biology, Physics 54: 16-24 (May 2006)