# Presentation: 346623

## Radiation Event Medical Management (REMM)

**Radiation Event Medical Management (REMM)**

- Guidance on Diagnosis and Treatment of Radiation Events for Health Care Providers
**http://remm.nlm.gov**
- Stacey Arnesen, Florence Chang, Marti Szczur
- Specialized Information Services
- National Library of Medicine

## REMM Partners

**REMM Partners**

- 	Department of Health and Human Services (HHS)
- Assistant Secretary for Preparedness and Response (ASPR)
- National Institutes of Health (NIH)
- National Library of Medicine (NLM)
- National Cancer Institute (NCI)
- Centers for Disease Control and Prevention (CDC)

## Need for REMM

**Need for REMM**

**Need to know how to respond to mass casualty radiation events**:
- Provide guidance for health care providers about clinical diagnosis and treatment during mass casualty radiological/nuclear events
- Provide evidence-based, practical information for those *without* formal radiation medicine expertise
- Provide web-based information that is also downloadable in advance, for availability even if the Internet is not accessible during a disaster

## Are we prepared?

**Are we prepared?**

- Most physicians/health care providers are not trained to handle mass casualty radiation events
- Disaster preparedness and response:
- Hospitals need to develop response plan that includes radiation events
- Need practical information and guidance before, during, and after the event

## Is your institution prepared?

- Do you know how to access REMM on the internet?
- Do you have REMM downloaded on one or more computers?
- Have you trained (or even told) health care providers about REMM?

## Slide 6

## Types of events

- _Four types of events covered in REMM_:
- RDD (Dirty bomb)
- Nuclear explosion (nuclear bomb)
- Nuclear reactor accidents
- Transportation accidents
- _Health effects from_:
- Contamination (external or internal)
- Radioactive material gets on or into the body
- Exposure
- X rays = low dose; no adverse effects
- Acute radiation syndrome = very high dose to entire body

## External and Internal Contamination

**External and Internal Contamination**

**Animations demonstrating the concepts of external and internal contamination**

## Dirty Bomb Scenario - Contamination

**Dirty Bomb Scenario - Contamination**

**Patient management algorithm**
- How do you know an event occurred
- Initial onsite activities
- Decontamination procedures for external contamination
- Assess internal contamination/identify isotopes
- Countermeasures/Treatment

## Dirty Bomb - Contamination

## Isotopes of Interest Properties, Treatment, and Fact Sheet

**Isotopes of Interest** Properties, Treatment, and Fact Sheet

## Countermeasures

**Countermeasures**

## Exposure  ScenarioNuclear Weapon, Improvised Nuclear Devices, Hidden Sealed Source

**Exposure  Scenario****Nuclear Weapon, Improvised Nuclear Devices, Hidden Sealed Source**

**Patient Management Algorithm**
- How do you know an event occurred
- Initial onsite activities
- Estimate exposure dose (use dose estimators)
- Symptoms
- Lab values
- Acute Radiation Syndrome treatment
- ARS subsyndromes management

## Radiation Exposure

## What else is in REMM?

**Sample hospital order template, triage tag, body survey diagram, follow-up instructions**

## What else is in REMM?

**What else is in REMM?**

## Summary

**Summary**

- _REMM can be used for_:
- Disaster Preparedness and Response
- Recognize a radiation or nuclear event
- Know how to respond to an event
- Hospital planning
- How to develop a radiation response team
- Equip an emergency room for decontamination
- Training module for health care providers
- Part of hospital preparedness activities
- Practices and drills
- Resource for researchers and teachers

## Next Steps

**Next Steps**

- Tutorial/Other training tools
- CD distribution to all NN/LM members
- PDA version
- Management of chronic effects of radiation
- Population monitoring
- Collaboration with other agencies

## Visit and Download REMM

**Visit and Download REMM**

- _[http://remm.nlm.gov](http://remm.nlm.gov/)_
- Contact information:  	nlmremm@nlm.nih.gov