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Proposed “Exposure And Symptom Triage” (EAST) Tool to Assess Radiation Exposure After a Nuclear Detonation

Published online by Cambridge University Press:  31 July 2017

John L. Hick ,
Judith L. Bader ,
C. Norman Coleman ,
Armin J. Ansari ,
Arthur Chang ,
Adela Salame-Alfie ,
Dan Hanfling  and
John F. Koerner
John L. Hick*
Affiliation:
Hennepin County Medical Center and Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
Judith L. Bader
Affiliation:
REMM (Radiation Emergency Medical Management) website and US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Washington, DC
C. Norman Coleman
Affiliation:
CBRNE Science and Operations, US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management, Washington, DC
Armin J. Ansari
Affiliation:
Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
Arthur Chang
Affiliation:
Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
Adela Salame-Alfie
Affiliation:
Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
Dan Hanfling
Affiliation:
Hospital Preparedness Program, US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management
John F. Koerner
Affiliation:
CBRNE Science and Operations, US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management, Washington, DC
*
Correspondence and reprint requests to John L. Hick, MD, Hennepin County Medical Center, Emergency Medicine, 701 Park Ave. S, Minneapolis, MN 55415 (e-mail: John.hick@hcmed.org).
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Abstract

One of the biggest medical challenges after the detonation of a nuclear device will be implementing a strategy to assess the severity of radiation exposure among survivors and to triage them appropriately. Those found to be at significant risk for radiation injury can be prioritized to receive potentially lifesaving myeloid cytokines and to be evacuated to other communities with intact health care infrastructure prior to the onset of severe complications of bone marrow suppression. Currently, the most efficient and accessible triage method is the use of sequential complete blood counts to assess lymphocyte depletion kinetics that correlate with estimated whole-body dose radiation exposure. However, even this simple test will likely not be available initially on the scale required to assess the at-risk population. Additional variables such as geographic location of exposure, sheltering, and signs and symptoms may be useful for initial sorting. An interdisciplinary working group composed of federal, state, and local public health experts proposes an Exposure And Symptom Triage (EAST) tool combining estimates of exposure from maps with clinical assessments and single lymphocyte counts if available. The proposed tool may help sort survivors efficiently at assembly centers near the damage and fallout zones and enable rapid prioritization for appropriate treatment and transport. (Disaster Med Public Health Preparedness. 2018; 12: 386–395)

Keywords

nuclear weaponstriageradiation injuries
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 12 , Issue 3 , June 2018 , pp. 386 - 395
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

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