Management of the irradiated casualty.
The initial management of any irradiated casualty is the early identification of the possibility of a significant exposure through dose prediction and recognition of prodromal symptoms. Subsequent management is aimed at supporting the effected systems until there is recovery. Where there is haematological failure, transplantation (bone marrow / stem cell) is possible although limited value in a mass casualty scenario. The provision of gold standard therapy within the field is unlikely to occur and early medical evacuation to an Echelon / Role 4 facility with specialist services will be required. Within the field, early assessment using the above systems of classification could be achieved at Echelon / Role 3 and may be enhanced with the establishment of Radiation Assessment Units. These would select casualties that could benefit from the advanced therapies. A summary of the levels of care is shown in Figure 3.
Bland
S A
SA
Defence Medical Services, Royal London Hospital, London E1 1BB. sa.bland@btinternet.com
D001753:Blast Injuries / Q000175:diagnosis / Q000628:therapy*; D003666:Decontamination; D004189:Disaster Planning; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D006801:Humans; D008887:Military Medicine / Q000379:methods / Q000592:standards; D009688:Nuclear Reactors; D009689:Nuclear Warfare; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000175:diagnosis / Q000628:therapy*; D018788:Radioactive Hazard Release