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Radiation Triage, Treat, and Transport System (RTR) after a Nuclear Detonation:
Venues for the Medical Response

Triage, Transport, Treatment of Zones After a Nuclear Detonation

The RTR system for a nuclear detonation response: theoretical zones in a 10 KT nuclear explosion at ground level

Source: Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats, Figure 4.1)

  • RTR1 - Sites would have victims with major trauma and relatively high levels of radiation. This limits responder time and would be associated with relatively severe victim injuries; many victims may be expectant. The location will be near the severe damage (SD) zone external border and/or in the moderate damage (MD) zone. Rubble may prevent entry into this zone.
  • RTR2 - Sites will be for triaging victims with radiation exposure only or possibly with minor trauma. The location will be along the outer edges of the Dangerous Fallout (DF) zone and the Light Damage (LD) zone and will have some elevated levels of radiation. Most victims are expected to be ambulatory.
  • RTR3 - Sites are collection points where radiation is not present and will allow occupation for many hours or more. Victims are anticipated to have limited trauma, such as glass injury, and most victims will be ambulatory, including people displaced by the explosion who have no injury or exposure. Extensive self-evacuation is likely to be observed at these sites. These may occur in the LD zone and beyond. RTR3 sites are likely to form in various locations spontaneously or by direction of the Incident Commander as opposed to preplanned Assembly Center (AC) sites. Changes in the fallout pattern due to wind shifts may require some RTR3 sites to change roles (to RTR2) or possibly be abandoned.
  • Medical care (MC) sites - includes hospitals, healthcare facilities and alternative care sites for those who need immediate medical care
  • Assembly centers (AC) - collection points for displaced persons or those who do not need immediate medical attention.
  • Evacuation centers (EC) - for organized transportation

  • More Details about RTR System: Where Clinical Activities Occur
    More details about RTR System: Where Clinical Activities Occur


    Type

    Location

    Operator

    Time

    Function

    RTR1

    Damage zones and around blast area

    Local

    < 48 hrs

    Trauma assessment, triage, stabilization

    RTR2

    Edge of the fallout zones

    Local

    < 48 hrs

    Trauma assessment, triage, stabilization (decon if possible)

    RTR3

    Outside damage and fallout zones

    Local

    < 48 hrs

    Trauma assessment, triage, stabilization (decon if possible)

    Assembly/ Screening Centers

    In local area and region outside danger zones

    Local, NGOs, MRC

    1 day – 1 week

    Radiation screening, gross decon, initial assessment

    Medical Centers

    In local area and region

    Local, NGOs, (VHA, NDMS, FMS)

    1 day – 1 month

    Radiation screening, decon, triage, trauma and emergency care

    Local / Distant ESF#6 Shelters

    In local area and region / outside region

    ESF #6

    1 day – months

    Mass care, routine medical, hematology, outpatient (distant)

    Evacuation Centers

    In local area and region

    LSTTF, DOD, NDMS

    < 1 week

    Staging for casualty or patient transport

  • The graphic above shows where various types of clinical activities are likely to occur
  • The table above provides more details, including timing.

 

Community Response Locations after a Nuclear Detonation

Community Response Locations after a Nuclear Detonation

RTR = Radiation Triage, Treatment, and Transport
AC = Assembly Center,
MC= Medical Care facility,
EC = Evacuation Center,
CRC = Community Reception Center.

 

Original Source: Modified from Hrdina CM, Coleman CN, Bogucki S et al., The "RTR" Medical Response System for Nuclear and Radiological Mass-Casualty Incidents: A Functional Triage-Treatment-Transport Medical Response Model. Prehospital Disaster Medicine. 24(3):167-178.
This figure adapted from Hick JL, Coleman CN: Population-based triage, treatment, and evacuation functions following a nuclear detonation. HHS/TRACIE monograph, page 5



Differences between CRC and AC

 

Assembly Center (AC)

Community Reception Center (CRC)

Location

Close to detonation

Far from detonation

Resources in community

Scarce

Adequate

Goal

Rapid assessment for total body radiation exposure

Detailed assessment for external and internal residual radiation

Resources required

Minimal

Extensive

Decontamination

Gross/Containment

Technical

Registration/Interview

Minimal

Detailed

Other functions on site?

Likely - some medical care, cytokine administration, possible shelter/support operations

Unlikely

Time to initial operation

18-24 hours

48-96 hours or more

Source: Hick JL, Coleman CN: Population-based triage, treatment, and evacuation functions following a nuclear detonation. HHS/TRACIE monograph, page 7.

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