Medical management of radiological casualties. Handbook

163 Pages·1.161 MB·English

by  Jacocks J. (Ed.)

Second Edition
MEDICAL MANAGEMENT OF
RADIOLOGICAL CASUALTIES
HANDBOOK
MilitaryMedicalOperations
ArmedForcesRadiobiologyResearchInstitute
Bethesda,Maryland20889–5603
http://www.afrri.usuhs.mil
April2003
Second Edition
MEDICAL MANAGEMENT OF
RADIOLOGICAL CASUALTIES
HANDBOOK
April 2003
Commentsandsuggestionsaresolicited.
Theyshouldbeaddressedto:
MilitaryMedicalOperations
Commercial301-295-0316
DSN295-0316
[email protected]
ArmedForcesRadiobiologyResearchInstitute
8901WisconsinAvenue
Bethesda,MD20889–5603
Clearedforpublicrelease:distributionunlimited.
AFRRISpecialPublication03–1
PrintedApril2003
FirstEdition1999
SecondEdition2003
This publication is a product of the Armed Forces
Radiobiology Research Institute. For more information
about AFRRI publications, visit our Internet Website at
www.afrri.usuhs.mil.Torequestcopiesofthishandbook,
please e-mail [email protected], or telephone
301–295–0316, or write Military Medical Operations,
AFRRI, 8901 Wisconsin Avenue, Bethesda, MD
20889–5603.
DISCLAIMER
Thishandbookprovidesconcisesupplementalreading
material for the Medical Effects of Ionizing Radiation
Course, which is presented by the Armed Forces
Radiobiology Research Institute several times each year
andistheonlygraduate-levelcourseintheDepartmentof
Defensefortraininghealthcareprofessionalsintheman-
agementofuncontrolledionizingradiationexposure.
Mention of specific commercial equipment or thera-
peuticagentsdoesnotconstituteendorsementbytheDe-
fenseDepartment;tradenamesareusedonlyforclarityof
purpose.Notherapeuticagentsorregimenshavebeenap-
proved by the federal Food and Drug Administration
(FDA) for the specific treatment of ionizing radiation in-
jury. Ethical constraints bar the human-efficacy research
protocolsnecessarytoobtainthiscertification.Therapeu-
tic agents described here have been FDA-approved for
otherpurposesunlessotherwisespecified.Itistherespon-
sibilityofthelicensedmedicalprovidertodecidehowbest
touseavailabletherapyinthebestinterestsofthepatient.
Every effort has been made to make this handbook
consistentwithofficialpolicyanddoctrine.However,the
informationcontainedinthishandbookisnotofficialDe-
fenseDepartmentpolicyordoctrine,anditshouldnotbe
construed as such unless it is supported by other
documents.
iii
ACKNOWLEDGMENTS
ArmyColonelJohnJacocksmanagedthesecondedi-
tionofthehandbook,arevisionofthefirstedition,which
wasauthoredbyArmyColonelDavidG.Jarrett.Contribu-
torstothesecondeditionwereArmyColonelRobertEng,
Army Colonel David Jarrett, Army Lieutenant Colonel
CharlesSalter,AirForceLieutenantColonelHoraceTsu,
Army Lieutenant Colonel Carl Curling, Navy Reserve
LieutenantWandaDawson,Dr.WilliamBlakely,Dr.Pat
Prasanna, Rebecca Rink, Donna Solyan, Stephen
Goldstein, Mark Behme, Guy Bateman, Mary Morgan,
and Debby Walder. Contributors built upon the accom-
plishmentsofthosewhosupportedthefirstedition:Army
Colonel Robert Eng, Dr. John Ainsworth, Navy Captain
JamesMalinoski,AirForceColonelGlennReeves,Navy
CaptainStevenTorrey,AirForceColonelCurtisPearson,
ArmyLieutenantColonelCarlCurling,AirForceLieuten-
ant Colonel Richard Lofts, Army Lieutenant Colonel
Charles Salter, Air Force Lieutenant Colonel Ming
Chiang,ArmyLieutenantColonelRossPastel,NavyLieu-
tenant Commander Tyrone Naquin, Army Major Sharon
Barnes, Navy Lieutenant Theodore St. John, Navy Lieu-
tenant Bruce Holland, Navy Lieutenant Gregory Kahles,
ArmyCaptainGerardVavrina,NavyLieutenantRebecca
Sine, Army Captain Christopher Pitcher, Dr. G. David
Ledney, Dr. David Livengood, Dr. Terry Pellmar, Dr.
iv
William Blakely, Dr. Gregory Knudson, Dr. David
McClain, Dr. Thomas Seed, Dr. Pat Prasanna, Donna
Solyan, Mark Behme, Carolyn Wooden, Guy Bateman,
JaneMyers,andotherstoonumeroustomention.Theex-
clusionofanyone ispurelyaccidentalandinnowayless-
ens the gratitude we feel for contributions made to the
Medical Radiological Defense Program of the United
StatesofAmericaandparticularlythishandbook.
v
Introduction
Nuclear Detonation and Other
High-Dose Radiation Situations
Radiation Dispersal Device and
Industrial Contamination Situations
Operational Aspects
Appendices
vii
Acronyms and Abbreviations
AFRRI-ArmedForcesRadiobiologyResearchInstitute
ANC-absoluteneutrophilcount
ARS-acuteradiationsyndrome
BAT-BiodosimetryAssessmentTool
BDO-battledressovergarment
BUN-bloodureanitrogen
CAM-chemicalagentmonitor
CBC-completebloodcount
CE-combateffective
CI-combatineffective
CRS-chronicradiationsyndrome
CSF-colony-stimulatingfactor
DT-demandingtask
DTPA-diethylenetriaminepentaaceticacid
DU-depleteduranium
ECP-entrycontrolpoint
EDTA-ethylenediaminetetraacetate,calciumedetate
ETI-earlytransientincapacitation
FDA-FoodandDrugAdministration
FMC-fieldmedicalcard
G-CSF-granulocytecolony-stimulatingfactor
GI-gastrointestinal
G-M-Geiger-Mueller
GM-CSF-granulocyte-macrophagecolony-stimulating
factor
ix
Gy-gray
HLA-humanleucocyteantigen
IAW-inaccordancewith
IND-investigationalnewdrug
KI-potassiumiodide
LD-lethaldose
MOPP-mission-orientedprotectiveposture
MRAT-MedicalRadiobiologyAdvisoryTeam
MTF-medicaltreatmentfacility
NBC-nuclear,biological,chemical
NVA-night-visionapparatus
OOTW-operationotherthanwar
P.I.E.-proximity,immediacy,expectancy
PD-partiallydegraded
QD-everyday
QF-qualityfactor
rad-radiationabsorbeddose
RAI-radioactiveiodine
RDD-radiationdispersaldevice
rem-radiationequivalentinman
RES-radiationexposurestatus
s.c.-subcutaneous
STB-supertropicalbleach
Sv-sievert
UT-undemandingtask
x
Contents
Acknowledgments ............................iv
Acronyms and Abbreviations...................ix
Introduction .................................1
Nuclear Detonation and Other High-Dose
Radiation Situations ...........................7
Acute High-Dose Radiation...................7
Biological Dosimetry and Radiation Casualty
Management Software Application........20
Management Protocol for Acute Radiation
Syndrome ...........................27
Blast and Thermal Biological Effects ..........33
Radiation Dispersal Device and Industrial
Contamination Situations .....................41
Low Dose-Rate Radiation ...................41
Psychological Effects.......................47
External Contamination .....................51
Internal Contamination .....................54
Depleted Uranium .........................59
xi