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6 Health Effects of Radiological Weapons
6.3.4 Triage and Prioritizing Patients
Following a major disaster there will be people with injuries of various degrees of
severity. Those who are seriously injured and for whom even the smallest delay might
be significant must be treated first; those who are lightly injured can likely wait to
be seen; those who are likely to die even with the best medical treatment cannot
be saved, but can be made more comfortable. The purpose of triage is to quickly
determine which category each person falls into so that the available resources (time,
personnel, treatment rooms, medications, etc.) can be used to accomplish the greatest
amount of good for the greatest number of people.
In the case of patients who have been exposed to high levels of radiation or who
have taken in large amounts of radioactivity rarely succumb to radiation sickness in
less than a few weeks to several months post-exposure. Accordingly, the Radiation
Emergency Assistance Center/Training Site (REAC/TS) and the National Council
on Radiation Protection and Measurements (NCRP) both recommend prioritizing
the treatment of life-threatening injuries first. In fact, the very first questions on
the NCRP Radiation Patient Treatment flowchart [6] address this point. After the
patient is stabilized and their injuries and life-threatening medical concerns have
been addressed then it will be time to assess the radiological concerns.
Having said this, internal radioactivity can call for rapid action if the amount of
intake is sufficiently high—in excess of 10 Clinical Decision Guidance levels, or 10
CDG (1 CDG is that amount of internal radioactivity that will produce an exposure of
250 mSv—25 rem—the lowest dose that can produce clinically significant effects).
A person with an intake of 10 CDG will receive a radiation exposure that can be lifethreatening in the absence of medical care, especially in combination with injuries
and other medical issues. Administering decorporation agents such as those noted
in the following table can help to reduce internal radiation exposure by speeding the
elimination of radionuclides from the body (Table 6.1).
With regards to prioritizing radiological risks, the NCRP and REAC/TS flowcharts
call for evaluating exposure to external radiation as well as external and internal
contamination. Any of these that is found to be medically significant should be
addressed appropriately through medical care and appropriate medications. In the
event of internal contamination, REAC/TS recommends minimizing further uptake
and facilitating excretion using appropriate decorporation agents.
More information on these decorporation agents, as well as information on additional agents can be found, among other places, in NCRP reports 161 and 166 [6,
7], and can also be provided during consultation with REAC/TS in the event of an
uptake. Medical response to radiological and nuclear attacks will be discussed in
greater detail in Chap. 17.
6 Health Effects of Radiological Weapons
6.3.4 Triage and Prioritizing Patients
Following a major disaster there will be people with injuries of various degrees of
severity. Those who are seriously injured and for whom even the smallest delay might
be significant must be treated first; those who are lightly injured can likely wait to
be seen; those who are likely to die even with the best medical treatment cannot
be saved, but can be made more comfortable. The purpose of triage is to quickly
determine which category each person falls into so that the available resources (time,
personnel, treatment rooms, medications, etc.) can be used to accomplish the greatest
amount of good for the greatest number of people.
In the case of patients who have been exposed to high levels of radiation or who
have taken in large amounts of radioactivity rarely succumb to radiation sickness in
less than a few weeks to several months post-exposure. Accordingly, the Radiation
Emergency Assistance Center/Training Site (REAC/TS) and the National Council
on Radiation Protection and Measurements (NCRP) both recommend prioritizing
the treatment of life-threatening injuries first. In fact, the very first questions on
the NCRP Radiation Patient Treatment flowchart [6] address this point. After the
patient is stabilized and their injuries and life-threatening medical concerns have
been addressed then it will be time to assess the radiological concerns.
Having said this, internal radioactivity can call for rapid action if the amount of
intake is sufficiently high—in excess of 10 Clinical Decision Guidance levels, or 10
CDG (1 CDG is that amount of internal radioactivity that will produce an exposure of
250 mSv—25 rem—the lowest dose that can produce clinically significant effects).
A person with an intake of 10 CDG will receive a radiation exposure that can be lifethreatening in the absence of medical care, especially in combination with injuries
and other medical issues. Administering decorporation agents such as those noted
in the following table can help to reduce internal radiation exposure by speeding the
elimination of radionuclides from the body (Table 6.1).
With regards to prioritizing radiological risks, the NCRP and REAC/TS flowcharts
call for evaluating exposure to external radiation as well as external and internal
contamination. Any of these that is found to be medically significant should be
addressed appropriately through medical care and appropriate medications. In the
event of internal contamination, REAC/TS recommends minimizing further uptake
and facilitating excretion using appropriate decorporation agents.
More information on these decorporation agents, as well as information on additional agents can be found, among other places, in NCRP reports 161 and 166 [6,
7], and can also be provided during consultation with REAC/TS in the event of an
uptake. Medical response to radiological and nuclear attacks will be discussed in
greater detail in Chap. 17.