Physicians, hospitals, and other health care facilities will assume the responsibility
for aiding individuals injured by a terrorist act involving radioactive material.
Scenarios have been developed for such acts that include a range of exposures resulting
in few to many casualties. This consensus document was developed by the Strategic
National Stockpile Radiation Working Group to provide a framework for physicians in
internal medicine and the medical subspecialties to evaluate and manage large-scale
radiation injuries. Individual radiation dose is assessed by determining the time
to onset and severity of nausea and vomiting, decline in absolute lymphocyte count
over several hours or days after exposure, and appearance of chromosome aberrations
(including dicentrics and ring forms) in peripheral blood lymphocytes. Documentation
of clinical signs and symptoms (affecting the hematopoietic, gastrointestinal, cerebrovascular,
and cutaneous systems) over time is essential for triage of victims, selection of
therapy, and assignment of prognosis. Recommendations based on radiation dose and
physiologic response are made for treatment of the hematopoietic syndrome. Therapy
includes treatment with hematopoietic cytokines; blood transfusion; and, in selected
cases, stem-cell transplantation. Additional medical management based on the evolution
of clinical signs and symptoms includes the use of antimicrobial agents (quinolones,
antiviral therapy, and antifungal agents), antiemetic agents, and analgesic agents.
Because of the strong psychological impact of a possible radiation exposure, psychosocial
support will be required for those exposed, regardless of the dose, as well as for
family and friends. Treatment of pregnant women must account for risk to the fetus.
For terrorist or accidental events involving exposure to radioiodines, prophylaxis
against malignant disease of the thyroid is also recommended, particularly for children
and adolescents.