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Satyamitra MM, Andres DK, Bergmann JN, Hoffman CM, Hogdahl T, Homer MJ, Hu TC, Rios CI, Yeung DT, DiCarlo AL. Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures: Overlapping science in radiation and sulfur mustard injuries to lung and skin. Disaster Med Public Health Prep 2023; 17:e552. [PMID: 37852927 PMCID: PMC10843005 DOI: 10.1017/dmp.2023.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE To summarize presentations and discussions from the 2022 trans-agency workshop titled "Overlapping science in radiation and sulfur mustard (SM) exposures of skin and lung: Consideration of models, mechanisms, organ systems, and medical countermeasures." METHODS Summary on topics includes: (1) an overview of the radiation and chemical countermeasure development programs and missions; (2) regulatory and industry perspectives for drugs and devices; 3) pathophysiology of skin and lung following radiation or SM exposure; 4) mechanisms of action/targets, biomarkers of injury; and 5) animal models that simulate anticipated clinical responses. RESULTS There are striking similarities between injuries caused by radiation and SM exposures. Primary outcomes from both types of exposure include acute injuries, while late complications comprise chronic inflammation, oxidative stress, and vascular dysfunction, which can culminate in fibrosis in both skin and lung organ systems. This workshop brought together academic and industrial researchers, medical practitioners, US Government program officials, and regulators to discuss lung-, and skin- specific animal models and biomarkers, novel pathways of injury and recovery, and paths to licensure for products to address radiation or SM injuries. CONCLUSIONS Regular communications between the radiological and chemical injury research communities can enhance the state-of-the-science, provide a unique perspective on novel therapeutic strategies, and improve overall US Government emergency preparedness.
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Affiliation(s)
- Merriline M. Satyamitra
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | | | - Julie N. Bergmann
- Radiological/Nuclear Medical Countermeasures Program, Biomedical Advanced Research and Development Authority (BARDA)
| | - Corey M. Hoffman
- Radiological/Nuclear Medical Countermeasures Program, Biomedical Advanced Research and Development Authority (BARDA)
| | | | - Mary J. Homer
- Radiological/Nuclear Medical Countermeasures Program, Biomedical Advanced Research and Development Authority (BARDA)
| | - Tom C. Hu
- Chemical Medical Countermeasures Program, BARDA
| | - Carmen I. Rios
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | - David T. Yeung
- Chemical Countermeasures Research Program (CCRP), NIAID, NIH
| | - Andrea L. DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
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Human Consequences of Multiple Nuclear Detonations in New Delhi (India): Interdisciplinary Requirements in Triage Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041740. [PMID: 33670135 PMCID: PMC7916841 DOI: 10.3390/ijerph18041740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
The human casualties from simulated nuclear detonation scenarios in New Delhi, India are analyzed, with a focus on the distribution of casualties in urban environments and the theoretical application of a nuclear-specific triage system with significant innovation in interdisciplinary disaster management applicable generally to urban nuclear detonation medical response. Model estimates of nuclear war casualties employed ESRI’s ArcGIS 9.3, blast and prompt radiation were calculated using the Defense Nuclear Agency’s WE program, and fallout radiation was calculated using the Defense Threat Reduction Agency’s (DTRA’s) Hazard Prediction and Assessment Capability (HPAC) V404SP4, as well as custom GIS and database software applications. ESRI ArcGISTM programs were used to calculate affected populations from the Oak Ridge National Laboratory’s LandScanTM 2007 Global Population Dataset for areas affected by thermal, blast and radiation data. Trauma, thermal burn, and radiation casualties were thus estimated on a geographic basis for New Delhi, India for single and multiple (six) 25 kt detonations and a single 1 mt (1000 kt) detonation. Major issues related to the emergency management of a nuclear incident are discussed with specific recommendations for improvement. The consequences for health management of thermal burn and radiation patients is the worst, as burn patients require enormous resources to treat, and there will be little to no familiarity with the treatment of radiation victims. Of particular importance is the interdisciplinary cooperation necessary for such a large-scale emergency response event, which would be exemplified by efforts such as the application of a Nuclear Global Health Workforce.
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Bellman J, Wilkinson E, Dant T, Thurman A, Stricklin D. Impact analysis of age on radiation casualty estimations for nuclear detonation scenarios. Int J Radiat Biol 2018; 96:12-21. [DOI: 10.1080/09553002.2018.1532613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Tyler Dant
- Applied Research Associates Inc, Arlington, VA, USA
| | - Alec Thurman
- Applied Research Associates Inc, Arlington, VA, USA
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Diagnostic Criteria for Assessment by General Practitioners of Patients Injured in Radiation Incidents and Cases of Radiological Terrorism. Disaster Med Public Health Prep 2018. [DOI: 10.1017/dmp.2017.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe general practitioner is an important figure in the provision of medical care during radiation incidents and cases of radiological terrorism. Knowing the nature of the radiation injury is essential for correct diagnosis and treatment. Insufficient knowledge of most physicians, and of general practitioners in particular, on the clinical manifestation of radiation injuries is the reason such conditions remain unrecognized and improperly treated. We suggest some simple diagnostic criteria for assessment of the injured by general practitioners, based on the results of our own studies and on the recommendations of prominent international organizations. (Disaster Med Public Health Preparedness. 2018;12:507–512)
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Trauma signature analysis of the great East Japan disaster: guidance for psychological consequences. Disaster Med Public Health Prep 2015; 7:201-14. [PMID: 24618172 DOI: 10.1017/dmp.2013.21] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES On March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japan's eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event. METHODS The trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis. RESULTS Exposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japan's timely, expert-coordinated, and unified activation of an evidence-based mental health response. CONCLUSIONS The eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience.
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Developing a practical algorithm for a pediatric emergency department's response to radiological dispersal device events. Pediatr Emerg Care 2013; 29:814-21. [PMID: 23823260 DOI: 10.1097/pec.0b013e3182983bd6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE In the aftermath of the detonation of a radiological dispersal device (RDD), or "dirty bomb," a large influx of children would be expected to present to the emergency department, including many patients not directly affected by the event who present with concerns regarding radiation exposure. Our objective was to develop an algorithm for efficiently and effectively triaging and appropriately treating children based on the likelihood of their having been contaminated or exposed. METHODS The hospital's disaster preparedness committee with the help of disaster planning experts engaged in an iterative process to develop a triage questionnaire and patient flow algorithm for a pediatric hospital following an RDD event. The questionnaire and algorithm were tested using hypothetical patients to ensure that they resulted in appropriate triage and treatment for the full range of anticipated patient presentations and were then tested in 2 live drills to evaluate their performance in real time. RESULTS The triage questionnaire reduced triage times and accurately sorted children into groups based on the type of intervention they required. Nonmedical personnel were able to administer the triage questionnaire effectively with minimal training, relieving professional staff. The patient flow algorithm and supporting materials provided direction to staff about how to appropriately treat patients once they had been triaged. CONCLUSIONS In the event of the detonation of an RDD, the triage questionnaire and patient flow algorithm presented would enable pediatric hospitals to direct limited resources to children requiring intervention due to injury, contamination, or exposure.
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Coleman CN, Knebel AR, Hick JL, Weinstock DM, Casagrande R, Caro JJ, DeRenzo EG, Dodgen D, Norwood AE, Sherman SE, Cliffer KD, McNally R, Bader JL, Murrain-Hill P. Scarce Resources for Nuclear Detonation: Project Overview and Challenges. Disaster Med Public Health Prep 2013; 5 Suppl 1:S13-9. [DOI: 10.1001/dmp.2011.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Triple Threat Trauma: Evidence-Based Mental Health Response for the 2011 Japan Disaster. Prehosp Disaster Med 2011; 26:141-5. [DOI: 10.1017/s1049023x11006364] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Murrain-Hill P, Coleman CN, Hick JL, Redlener I, Weinstock DM, Koerner JF, Black D, Sanders M, Bader JL, Forsha J, Knebel AR. Medical response to a nuclear detonation: creating a playbook for state and local planners and responders. Disaster Med Public Health Prep 2011; 5 Suppl 1:S89-97. [PMID: 21402817 DOI: 10.1001/dmp.2011.13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For efficient and effective medical responses to mass casualty events, detailed advanced planning is required. For federal responders, this is an ongoing responsibility. The US Department of Health and Human Services (DHHS) prepares playbooks with formal, written plans that are reviewed, updated, and exercised regularly. Recognizing that state and local responders with fewer resources may be helped in creating their own event-specific response plans, subject matter experts from the range of sectors comprising the Scarce Resources for a Nuclear Detonation Project, provided for this first time a state and local planner's playbook template for responding to a nuclear detonation. The playbook elements are adapted from DHHS playbooks with appropriate modification for state and local planners. Individualization by venue is expected, reflecting specific assets, populations, geography, preferences, and expertise. This playbook template is designed to be a practical tool with sufficient background information and options for step-by-step individualized planning and response.
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Affiliation(s)
- Paula Murrain-Hill
- Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, USA.
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Coleman CN, Weinstock DM, Casagrande R, Hick JL, Bader JL, Chang F, Nemhauser JB, Knebel AR. Triage and treatment tools for use in a scarce resources-crisis standards of care setting after a nuclear detonation. Disaster Med Public Health Prep 2011; 5 Suppl 1:S111-21. [PMID: 21402803 DOI: 10.1001/dmp.2011.22] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Based on background information in this special issue of the journal, possible triage recommendations for the first 4 days following a nuclear detonation, when response resources will be limited, are provided. The series includes: modeling for physical infrastructure damage; severity and number of injuries; expected outcome of triage to immediate, delayed, or expectant management; resources required for treating injuries of varying severity; and how resource scarcity (particularly medical personnel) worsens outcome. Four key underlying considerations are: 1.) resource adequacy will vary greatly across the response areas by time and location; 2.) to achieve fairness in resource allocation, a common triage approach is important; 3.) at some times and locations, it will be necessary to change from "conventional" to "contingency" or "crisis" standards of medical care (with a resulting change in triage approach from treating the "sickest first" to treating those "most likely to survive" first); and 4.) clinical reassessment and repeat triage are critical, as resource scarcity worsens or improves. Changing triage order and conserving and allocating resources for both lifesaving and palliative care can maintain fairness, support symptomatic care, and save more lives. Included in this article are printable triage cards that reflect our recommendations. These are not formal guidelines. With new research, data, and discussion, these recommendations will undoubtedly evolve.
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Affiliation(s)
- C Norman Coleman
- Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Rockville, MD 20852, USA.
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Hick JL, Weinstock DM, Coleman CN, Hanfling D, Cantrill S, Redlener I, Bader JL, Murrain-Hill P, Knebel AR. Health care system planning for and response to a nuclear detonation. Disaster Med Public Health Prep 2011; 5 Suppl 1:S73-88. [PMID: 21402815 DOI: 10.1001/dmp.2011.28] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The hallmark of a successful response to a nuclear detonation will be the resilience of the community, region, and nation. An incident of this magnitude will rapidly become a national incident; however, the initial critical steps to reduce lives lost, save the lives that can be saved with the resources available, and understand and apply resources available to a complex and dynamic situation will be the responsibility of the local and regional responders and planners. Expectations of the public health and health care systems will be met to the extent possible by coordination, cooperation, and an effort to produce as consistent a response as possible for the victims. Responders will face extraordinarily stressful situations, and their own physical and psychological health is of great importance to optimizing the response. This article illustrates through vignettes and supporting text how the incident may unfold for the various components of the health and medical systems and provides additional context for the discipline-related actions outlined in the state and local planners' playbook.
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Affiliation(s)
- John L Hick
- Hennepin County Medical Center, University of Minnesota, Minneapolis, MN 55415, USA.
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Caro JJ, DeRenzo EG, Coleman CN, Weinstock DM, Knebel AR. Resource allocation after a nuclear detonation incident: unaltered standards of ethical decision making. Disaster Med Public Health Prep 2011; 5 Suppl 1:S46-53. [PMID: 21402811 DOI: 10.1001/dmp.2011.14] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article provides practical ethical guidance for clinicians making decisions after a nuclear detonation, in advance of the full establishment of a coordinated response. We argue that the utilitarian maxim of the greatest good for the greatest number, interpreted only as "the most lives saved," needs refinement. We take the philosophical position that utilitarian efficiency should be tempered by the principle of fairness in making decisions about providing lifesaving interventions and palliation. The most practical way to achieve these goals is to mirror the ethical precepts of routine clinical practice, in which 3 factors govern resource allocation: order of presentation, patient's medical need, and effectiveness of an intervention. Although these basic ethical standards do not change, priority is given in a crisis to those at highest need in whom interventions are expected to be effective. If available resources will not be effective in meeting the need, then it is unfair to expend them and they should be allocated to another patient with high need and greater expectation for survival if treated. As shortage becomes critical, thresholds for intervention become more stringent. Although the focus of providers will be on the victims of the event, the needs of patients already receiving care before the detonation also must be considered. Those not allocated intervention must still be provided as much appropriate comfort, assistance, relief of symptoms, and explanations as possible, given the available resources. Reassessment of patients' clinical status and priority for intervention also should be conducted with regularity.
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Affiliation(s)
- J Jaime Caro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University.
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Coleman CN, Knebel AR, Lurie N. Preparing and planning for a catastrophic incident of a nuclear detonation. Foreword. Disaster Med Public Health Prep 2011; 5 Suppl 1:S11-2. [PMID: 21402802 DOI: 10.1001/dmp.2011.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- C Norman Coleman
- Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, USA.
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