Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group

15 June 2004 | Volume 140 Issue 12 | Pages 1037-1051

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.

Author and Article Information

From Walter Reed Army Medical Center and Catholic University of America, Washington, DC; Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland; Armed Forces Radiobiology Research Institute and National Institutes of Health, Bethesda, Maryland; Strategic National Stockpile Program, Centers for Disease Control and Prevention, Office of Emergency Preparedness and Response, Atlanta, Georgia; Oak Ridge Associated Universities, Oak Ridge, Tennessee; National Marrow Donor Program, Minneapolis, Minnesota; University of Nebraska, Omaha, Nebraska; and Yale-New Haven Health System and Yale University School of Medicine, New Haven, Connecticut.

Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not necessarily those of the U.S. Army, the Department of Defense, or the Centers for Disease Control and Prevention. Mention of specific commercial equipment or therapeutic agents does not constitute endorsement by the U.S. Department of Defense or the Centers for Disease Control and Prevention; trade names are used only for the purpose of clarification.

Acknowledgments: The authors thank R.C. Ricks, PhD, for allowing access to the database maintained at the Radiation Emergency Assistance Center/Training Site; J. Osmolik for outstanding secretarial support; W.E. Jackson for assistance in preparation of the biodosimetry tables; and D.G. Jarrett, MD, R. Goans, MD, PhD, and R.C. Myhand, MD, for review of the manuscript.

Potential Financial Conflicts of Interest:Honoraria: T.J. MacVittie (Amgen), J.O. Armitage (Amgen); Stock ownership or options (other than mutual funds): P.C. Lowry (Amgen); Grants received: T.J. MacVittie (Amgen); Patents received: W.F. Blakely.

Requests for Single Reprints: Nicholas Dainiak, MD, Department of Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610; e-mail, pndain{at}bpthosp.org.

Current Author Addresses: Dr. Waselenko: Walter Reed Army Medical Center, 6900 Georgia Avenue, WD78, Washington, DC 20307.

Dr. MacVittie: Greenebaum Cancer Center, University of Maryland, 22 South Greene Street, Baltimore, MD 21201.

Dr. Blakely: Armed Forces Radiobiology Research Institute, 8901 Wisconsin Avenue, Bethesda, MD 20889-5603.

Dr. Pesik: Strategic National Stockpile Program, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333.

Drs. Wiley and Lowry: Radiation Emergency Assistance Center/Training Site, Oak Ridge Associated Universities, 150 Vance Road, Oak Ridge, TN 37830.

Drs. Dickerson and Tsu: Armed Forces Radiobiology Research Institute, 8901 Wisconsin Avenue, Bethesda, MD 20889-5603.

Dr. Confer: National Marrow Donor Program, 3001 Broadway Street, NE 500, Minneapolis, MN 55413.

Dr. Coleman: National Cancer Institute, National Institutes of Health, Building 10, B3869, Bethesda, MD 20892-1002.

Dr. Seed: Catholic University of America, 620 Michigan Avenue NE, Washington, DC 20064.

Dr. Armitage: University of Nebraska, 987680 Nebraska Medical Center, Omaha, NE 68198.

Dr. Dainiak: Department of Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610.

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