Assessment and treatment requirements of public hospitals to radiation emergencies

Athanasios Zafeirakis 1 * , Ioannis Galatas 2, Panagiotis Efstathiou 3
More Detail
1 Department of Nuclear Medicine, Army General Hospital of Athens, Athens, Greece
2 CBRN Knowledge Center, International CBRNE Institute, Les Bons Villers, Belgium
3 Hellenic Association on Crisis Management in the Health Sector, Athens, Greece
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 5, pp. 23-29. https://doi.org/10.23950/jcmk/11239
OPEN ACCESS 803 Views 666 Downloads
Download Full Text (PDF)

ABSTRACT

Radiological emergencies present unique challenges to the public health care system and carry the potential for major disruptions to clinical care. This review aims to present, first a brief guide of the main clinical and laboratory diagnostic tools for the assessment of the absorbed dose in cases of radiological emergencies and second, the best treatment options for acute whole body and local radiation syndromes. Clinical and laboratory state-of-the-art biodosimetry tools, therapies for acute radiation syndromes according to the severity of the radiation sickness, and isotope-specific preparedness medications as counter-measures for internal contamination are herein proposed as the necessary stockpile of public hospitals against severe radiological accidents.
Keywords: Radiological incidents, radiation emergencies, biodosimetry, acute radiation syndromes, radiation treatment.

CITATION

Zafeirakis A, Galatas I, Efstathiou P. Assessment and treatment requirements of public hospitals to radiation emergencies. J CLIN MED KAZ. 2021;18(5):23-9. https://doi.org/10.23950/jcmk/11239

REFERENCES

  • International Atomic Energy Agency. School of Radiation Emergency Management. Vienna: ΙΑΕΑ 2015.
  • Olivieri C, Ingrassia PL, Della Corte F, Carenzo L, Sapori JM, Gabilly L, et al. Hospital preparedness and response in CBRN emergencies: TIER assessment tool. Eur J Emerg Med. 2017 Oct; 24(5):366-370. doi: 10.1097/MEJ.0000000000000399.
  • Canestra J. Australian Clinical Guidelines for Radiological Emergencies. Commonwealth of Australia 2012; ISBN: 978-1-74241-834-6.
  • Wathen LK, Eder PS, Horwith G and Wallace RL. Using biodosimetry to enhance the public health response to a nuclear incident. Int J Radiat Biol. 2020 Sep 21:1-4. doi: 10.1080/09553002.2020.1820605.
  • World Health Organization. Consultation on the Development of Global Biodosimetry Laboratories Network for Radiation Emergencies: BioDoseNet; Meeting Report, Headquarters. Geneva; WHO, 2007.
  • Sproull MT, Camphausen KA and Koblentz GD. Biodosimetry: A Future Tool for Medical Management of Radiological Emergencies. Health Secur. 2017 Nov/Dec; 15(6):599-610. doi: 10.1089/hs.2017.0050.
  • Camarata AS, Switchenko JM, Demidenko E, Flood AB, Swartz HM and Ali AN. Emesis as a Screening Diagnostic for Low Dose Rate (LDR) Total Body Radiation Exposure. Health Phys 2016; 110(4):391-4. doi:10.1097/HP.0000000000000476.
  • Demidenko E, Williams BB and Swartz HM. Radiation dose prediction using data on time to emesis in the case of nuclear terrorism. Radiat Res 2009; 171(3):310-9. doi.org/10.1667/RR1552.1.
  • International Atomic Energy Agency Diagnosis and Treatment of Radiation Injuries Safety Reports Series No. 2. Vienna: ΙΑΕΑ 1998. ISBN 92-0-100498-2.
  • Okunieff P, Chen Y, Maguire DJ and Huser AK. Molecular markers of radiation-related normal tissue toxicity. Cancer Metastasis Rev. 2008 Sep;27(3):363-74. doi: 10.1007/s10555-008-9138-7.
  • Goans RE, Holloway EC, Berger ME and Ricks RC. Early dose assessment following severe radiation accidents. Health Phys. 1997 Apr;72(4):513-8. doi: 10.1097/00004032-199704000-00001.
  • Crespo RH, Domene MM and Rodriguez MJ. Biodosimetry and assessment of radiation dose. Rep Pract Oncol Radiother 2011; 16:131-137. doi:10.1016/j.rpor.2011.06.003.
  • Kulka U, Ainsbury L, Atkinson M, Barquinero JF, Barrios L, Beinke C, et al. Realising the European Network of Biodosimetry (RENEB). Radiat Prot Dosimetry. 2012 Oct; 151(4):621-5. doi: 10.1093/rpd/ncs157.
  • Coleman CN and Koerner JF. Biodosimetry: Medicine, Science and Systems to support the medical decision-maker following a large scale nuclear or radiation incident. Radiation Protection Dosimetry 2016; 172, (1-3): 38. doi:10.1093/rpd/ncw155.
  • International Atomic Energy Agency. Cytogenetic Dosimetry: Applications in Preparedness for and Response to Radiation Emergencies. Vienna: ΙΑΕΑ, 2011.
  • Alsbeih GA, Al-Hadyan KS, Al-Harbi NM, Bin-Judia SS and Moftah BA. Establishing a Reference Dose–Response Calibration Curve for Dicentric Chromosome Aberrations to Assess Accidental Radiation Exposure in Saudi Arabia. Front. Public Health 2020; 8:599194. doi:10.3389/fpubh.2020.599194.
  • Kang CM, Yun HJ, Kim H and Kim CS. Strong Correlation among Three Biodosimetry Techniques Following Exposures to Ionizing Radiation. Genome Integr. 2016 Dec 30; 7:11. doi: 10.4103/2041-9414.197168.
  • Romm H, Beinke C, Garcia O, Di Giorgio M, Gregoire E, Livingston G, et al. A New Cytogenetic Biodosimetry Image Repository for the Dicentric Assay. Radiat Prot Dosimetry. 2016 Dec; 172(1-3):192-200. doi: 10.1093/rpd/ncw158.
  • García O, Rada-Tarifa A, Lafuente-Álvarez E, González-Mesa JE, Mandina T, Muñoz-Velastegui G, et al. The BioDoseNet image repository used as a training tool for the dicentric assay. Int J Radiat Biol. 2019 Dec; 95(12):1659-1667. doi: 10.1080/09553002.2019.1665211.
  • Bader JL, Nemhauser J, Chang F, Mashayekhi B, Sczcur M, Knebel A, et al. Radiation Event Medical Management (REMM): Website Guidance for Health Care Providers. Prehosp Emerg Care 2008; 12:1-11. doi:10.1080/10903120701710595.
  • Rump A, Stricklin D, Lamkowski A, Eder S, Abend M and Port M. Reconsidering Current Decorporation Strategies after Incorporation of Radionuclides. Health Phys. 2016 Aug; 111(2):204-11. doi: 10.1097/HP.0000000000000473.
  • Kultova G, Tichy A, Rehulkova H and Myslivcova-Fucikova A. The hunt for radiation biomarkers: current situation. Int J Radiat Biol. 2020 Mar; 96(3):370-382. doi: 10.1080/09553002.2020.1704909.
  • Armed Forces Radiobiology Research Institute. Medical management of radiological casualties handbook, military medical operations. AFRRI, 2003; 2nd ed., Bethesda.
  • Gorin NC, Fliedner TM, Gourmelon P, Ganser A, Meineke V, Sirohi B, et al. Consensus conference on European preparedness for haematological and other medical management of mass radiation accidents. Ann Hematol. 2006 Oct; 85(10):671-9. doi: 10.1007/s00277-006-0153-x.
  • Kuniak M, Azizova T, Day R, Wald N, Suyama J, Zhang A, et al. The Radiation Injury Severity Classification system: an early injury assessment tool for the frontline health-care provider. Br J Radiol. 2008 Mar; 81(963):232-43. doi: 10.1259/bjr/25373719.
  • Smith JM and Spano MA. Interim Guidelines for Hospital Response to Mass Casualties from a Radiological Incident; CDC, 2003.
  • National Council on Radiation Protection and Measurements. Guidance on Radiation Received in Space Activities, NCRP Report No. 98: 1989; Bethesda, Maryland.
  • Singh VK, Romaine PL, Newman VL and Seed TM. Medical countermeasures for unwanted CBRN exposures: part II radiological and nuclear threats with review of recent countermeasure patents. Expert Opin Ther Pat. 2016 Dec;26(12):1399-1408. doi: 10.1080/13543776.2016.1231805.
  • Fliedner TM, Powles R, Sirohi B, Niederwieser D; European Group for Blood and Marrow Transplantation (EBMT) Nuclear Accident Committee (NAC). Radiologic and nuclear events: the METREPOL severity of effect grading system. Blood. 2008 Jun 15;111(12):5757-8. doi: 10.1182/blood-2008-04-150243.
  • Case C Jr. 10 Years of Preparedness by the Radiation Injury Treatment Network. Curr Hematol Malig Rep. 2017 Feb; 12(1):39-43. doi:10.1007/s11899-017-0360-7.
  • Elliott TB, Bolduc DL, Ledney GD, Kiang JG, Fatanmi OO, Wise SY, et al. Combined immunomodulator and antimicrobial therapy eliminates polymicrobial sepsis and modulates cytokine production in combined injured mice. Int J Radiat Biol. 2015; 91(9):690-702. doi: 10.3109/09553002.2015.1054526.
  • Appelbaum FR. The clinical use of hematopoietic growth factors. Semin Hematol. 1989 Jul; 26(3 Suppl 3):7-14. PMID: 2477905.
  • International Atomic Energy Agency. The Radiological Accident in Goiânia; IAEA, 1988; Vienna: ISBN 92-0-129088-8.
  • International Atomic Energy Agency. The Radiological Accident in San Salvador; IAEA, 1990; Vienna: ISBN 92-0-129090-X.
  • International Atomic Energy Agency. The Radiological Accident in Soreq; IAEA, 1993; Vienna: ISBN 92-0-101693-X.
  • International Atomic Energy Agency. The Radiological Accident in Nesvizh; IAEA, 1996; Vienna: ISBN 92-0-101396-5.
  • Dainiak N and Ricks RC. The evolving role of haematopoietic cell transplantation in radiation injury: potentials and limitations. BJR Suppl 2005; 27: 169-174. doi:10.1259/bjr/31003240.
  • Fliedner TM. The need for an expanded protocol for the medical examination of radiation-exposed persons. Stem Cells. 1995 May;13 Suppl 1:1-6. PMID: 7488935.
  • International Atomic Energy Agency. The Chernobyl Accident: Updating of INSAG-1 — A Report by the International Nuclear Safety Advisory Group, Safety Series No. 75-INSAG-7; IAEA, 1992; Vienna: ISBN 92-0-104692-8.
  • Hall EJ and Giaccia AJ. Radiobiology for the radiobiologist. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2012. ISBN 978-1-60831-193-4.
  • Leiterer A, Bardot I, Ménétrier F, Bardot S, Grémy O, Bérard P, et al. Medical countermeasures after a radiological event: an update from the CATO project. Int J Radiat Biol. 2014 Nov; 90(11):1043-7. doi: 10.3109/09553002.2014.922715.
  • Centers for Disease Control and Prevention. Radiation emergencies radioisotope brief: iodine-131. Department of Health and Human Services; CDC, 2004.
  • World Health Organization Iodine thyroid blocking Guidelines for use in planning for and responding to radiological and nuclear emergencies. Geneva; WHO, 2017. ISBN 9789241550185.
  • Reiners C and Schneider R. Potassium iodide (KI) to block the thyroid from exposure to I-131: current questions and answers to be discussed. Radiat Environ Biophys. 2013 May; 52(2):189-93. doi: 10.1007/s00411-013-0462-0.
  • Melo DR, Lipsztein JL, Leggett R, Bertelli L and Guilmette R. Efficacy of Prussian blue on 137Cs decorporation therapy. Health Phys. 2014 May; 106(5):592-7. doi: 10.1097/HP.0000000000000035.
  • Peterson J, MacDonell M, Haroun L, Monette F, Hildebrand RD and Taboas A. Radiological and chemical fact sheets to support health risk analyses for contaminated areas; 2007. Argonne National Laboratory Environmental Science Division and U.S. Department of Energy.
  • National Council on Radiation Protection and Measurements. Management of persons accidentally contaminated with radionuclides. NCRP Report No. 65. NCRPM, 1980; Bethesda.
  • Centers for Disease Control and Prevention. Radiation emergencies radioisotope brief: uranium. Department of Health and Human Services; CDC, 2004.
  • ICRP. Protecting people against radiation exposure in the event of a radiological attack. ICRP Publication 96. Ann. ICRP 2005; 35(1).
  • Centers for Disease Control and Prevention. Radiation emergencies radioisotope brief: americium. Department of Health and Human Services; CDC, 2004.
  • Centers for Disease Control and Prevention. Radiation emergencies radioisotope brief: cobalt. Department of Health and Human Services; CDC, 2005.
  • Centers for Disease Control and Prevention. Guidance for public health departments and clinicians caring for individuals who may have been recently exposed to polonium 210 (Po-210). Department of Health and Human Services; CDC, 2006.
  • Scott BR. Health risk evaluations for ingestion exposure of humans to polonium-210. Dose Response. 2007 Apr 20; 5(2):94-122. doi: 10.2203/dose-response.06-013.Scott.
  • Harrison J, Leggett R, Lloyd D, Phipps A and Scott B. Polonium-210 as a poison. J Radiol Prot. 2007 Mar; 27(1):17-40. doi: 10.1088/0952-4746/27/1/001.
  • World Health Organization. Model List of Essential Medicines (PDF) Geneva; World Health Organization. Geneva; WHO, 2013.
  • Moore BL, Geller RJ and Clark C. Hospital preparedness for chemical and radiological disasters. Emerg Med Clin North Am. 2015 Feb; 33(1):37-49. doi: 10.1016/j.emc.2014.09.005.
  • Sharp TW, Brennan RJ, Keim M, Williams RJ, Eitzen E and Lillibridge S. Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Atlanta Olympic Games. Ann Emerg Med. 1998 Aug; 32(2):214-23. doi: 10.1016/s0196-0644(98)70139-8.