Hospital Approach to Patients Presenting after a Nuclear Detonation

• Source: Hick JL, Weinstock DM, Coleman CN, Hanfling D, Cantrill S, Redlener I, Bader JL, Murrain-Hill P, Knebel AR. Health Care System Planning and Response for a Nuclear Detonation. Disaster Med Public Health Prep. 2011 Mar;5 Suppl 1:S73-88. See Figure 1 [PubMed Citation], Full Text (PDF - 197 KB)
  • This graphic and article are part of the Scarce Resources Project, a series of 10 articles about medical care after an IND when resources may be scarce and standards of care may not be "normal".
  • This graphics assumes hospital resources are inadequate for demand but not overwhelmed. See Resource Availability and Crisis Standards of Care
  • Abbreviations:
    • ACL: absolute lymphocyte count
    • GCSF: granulocyte colony stimulating factor, a myeloid cytokine
    • ACS: alternate care site
• Additional guidance
  • Attempt to estimate whole body radiation dose
    • Perform targeted physical exam looking for signs and symptoms of Acute Radiation Syndrome
    • If resources available, augment clinical data with biodosimetry lab data (single or serial CBCs and differential)
      • Use Dose Estimator for Exposure: Interactive Tool.
    • Use geographic dosimetry information (Dose reconstruction)
    • As "physical radiation exposure information" becomes available hours after the event, people may be triaged to "not needing radiation assessment" if they are not in radiation zones.
  • Understand that patients with combined injury (significant whole body radiation dose plus trauma/burns) have a worse prognosis than patients with only one type of injury.
  • Temporizing care for severely injured victims may be palliative care only.
  • Consult senior incident managers in your facility to understand whether normal, contingency or crisis standards of care are in place.
  • Re-evaluate radiation victims periodically, as their status and resource availability status may change over time.
  • See also:
    • Scarce Resources Triage Tool
    • Radiation Injury Treatment Network (RITN) Radiation Injury Referral Guidelines (PDF - 1.05 MB) (RITN, 2015)
      • Concise guide for identifying casualties in the aftermath of a radiation incident who may have received a clinically significant dose of radiation and who may need RITN referral
      • Names and locations of all RITN centers
    • RITN Acute Radiation Syndrome Treatment Guidelines (PDF - 2.53 MB) (RITN, October 2020)
    • RITN Cytokine Administration Triage Guidelines for Acute Radiation Syndrome (Adult and Pediatric)
      • The purpose of these guidelines are to give physicians, advanced practitioners and nurses (medical providers) simple myeloid cytokine triage guidelines to assist with the administration of these pharmaceuticals to adult and pediatric casualties in the immediate aftermath of a radiological disaster.
      • Formats available
        • 4x6 card (PDF - 635 KB)
        • 8.5x11 size (PDF - 678 KB)
        • 24x36 poster size (PDF - 129 KB)