Getting Started

Potential Incidents
Planning
Decontamination
Triage
Treatment
Pharmacotherapy

Scenario 1
Scenario 2
Scenario 3
Scenario 4
Scenario 5
Scenario 6

Glossary
Resources
Self Test

Getting Started

Potential Incidents
Planning
Decontamination
Triage
Treatment
Pharmacotherapy

Scenario 1
Scenario 2
Scenario 3
Scenario 4
Scenario 5
Scenario 6

Glossary

Resources

Self Test

Radiological and Nuclear Terrorism:
Medical Response to Mass Casualties

Scenario Instructions

Scenario 1

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In this RDD (dirty bomb) scenario, which of the following statements most accurately describes the casualties that might be expected?

Incorrect! Disaster research indicates the majority of patients will self-refer. Hundreds may indeed seek care, particularly given the fear associated with radiation exposure. Many will need decontamination. Many will need screening for radiological contamination, but will not be contaminated. Many will simply seek reassurance. Psychological assessment, counseling services, and patient information regarding radiation exposure, contamination and potential long-term health effects will be needed. Systemic radiation injury, or acute radiation syndrome (ARS), is not expected to occur in significant numbers. Emergency response planning, preferably done in concert with local response systems, should include scaleable surge capacity plans for high volume radiological screening, ambulatory and non-ambulatory decontamination, and counseling.

Correct! Disaster research indicates the majority of patients will self-refer. Hundreds may indeed seek care, particularly given the fear associated with radiation exposure. Many will need decontamination. Many will need screening for radiological contamination, but will not be contaminated. Many will simply seek reassurance. Psychological assessment, counseling services, and patient information regarding radiation exposure, contamination and potential long-term health effects will be needed. Systemic radiation injury, or acute radiation syndrome (ARS), is not expected to occur in significant numbers. Emergency response planning, preferably done in concert with local response systems, should include scaleable surge capacity plans for high volume radiological screening, ambulatory and non-ambulatory decontamination, and counseling.

Hundreds of patients with combined injuries from significant radiation exposure and traumatic injury may present to hospitals.

Since EMS follows strict protocols requiring patient decontamination prior to transport, few patients will need hospital decontamination.

The majority of patients will arrive by taxi or in private vehicles rather than waiting at the scene as directed by first responders.

Decontamination will be mandatory for all patients arriving at the hospital due to wide dispersal of radioactive dust particles.

None of the above.

Which of the following statements regarding medical response to radiological mass casualties is true?

Incorrect! A 2002 study [Lanzilotti, et al. Hawaii Med J. 2002; 61(8): 162-73] indicated 59% of RNs expressed commitment to help following a chemical incident, versus 45% following a radiological incident. It is highly unlikely that radioactivity associated with a contaminated patient would pose a significant risk to care providers. Significant knowledge of radiation injury is present in the literature, although most ED clinicians do not have radiation injury treatment experience. In-house radiation expertise exists in most hospitals with nuclear medicine and radiation oncology services.

Correct! A 2002 study [Lanzilotti, et al. Hawaii Med J. 2002; 61(8): 162-73] indicated 59% of RNs expressed commitment to help following a chemical incident, versus 45% following a radiological incident. It is highly unlikely that radioactivity associated with a contaminated patient would pose a significant risk to care providers. Significant knowledge of radiation injury is present in the literature, although most ED clinicians do not have radiation injury treatment experience. In-house radiation expertise exists in most hospitals with nuclear medicine and radiation oncology services.

Clinicians are more likely to respond to chemical incidents than radiological.

Treating radiologically contaminated patients poses far greater risk to caregivers than treating chemically contaminated patients.

Limited knowledge regarding treatment of patients with radiation injury is available in the literature.

Hospitals typically do not have in-house staff with expertise in radiation.

All of the above.

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Scenario Instructions

You are about to embark on a practice exercise that will take you through a series of fictitious scenarios depicting hypothetical radiological terrorism incidents.

You will be asked to answer questions that test your ability to provide appropriate medical response. These questions are drawn from the series of lectures in this training, as well the introductory material provided in the CDC training program Medical Response to Radiological and Nuclear Terrorism.

Do not be concerned about getting all the questions correct in this practice exercise. The answers are not scored. These scenarios are designed to teach, not test. Thorough explanations of the correct answer are provided as immediate feedback.