Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group

Who developed these guidelines? The Strategic National Stockpile (SNS) is a government-sponsored organization that works with government and nongovernment partners to upgrade the public health capacity of the United States to respond to national emergencies. One mission of the SNS is to supply large quantities of essential medical material to the public during an emergency. What is the problem and what is known about it so far? Radioactive materials are among the potential weapons that terrorists might use in an attack. During such an attack, people could suffer from the acute radiation syndrome. This syndrome is the collection of bodily effects resulting from exposure to large amounts of radiation. The SNS developed recommendations to help health care professionals respond appropriately in the event of an attack involving radiation exposure. How did the SNS Radiation Working Group develop these recommendations? The SNS assembled a working group with representatives from the Centers for Disease Control and Prevention, the U.S. Armed Forces, and universities with expertise in acute radiation injury. The working group reviewed published information and met during face-to-face and telephone conferences to discuss the recommendations. What did the authors find? Information about the acute radiation syndrome comes from studies of animals, studies of accidents at nuclear power plants, or studies of the effects of the atomic bomb detonated over Hiroshima, Japan. Published information supports a strategy in which health care providers first assess the radiation dose to an individual patient on the basis of symptoms and blood counts during the days after exposure. Body systems most affected in the acute radiation syndrome include the blood-producing system, the digestive system, the brain, and the skin. Symptoms and consequences of the acute radiation syndrome vary depending on the amount of exposure but can include nausea, vomiting, diarrhea, confusion, skin burns, low blood pressure or shock, infections, breathing difficulty, and death. What does the SNS Radiation Working Group suggest that patients and doctors do? If an event involving radioactive materials occurs, health care providers should evaluate patients' likely degree of exposure by monitoring their symptoms and blood counts. When the degree of exposure is high, the patient is almost certain to die. In such cases, the goal of treatment should be only to make the patient comfortable. In less severe exposures, treatment with blood transfusions; substances called hematopoietic cytokines to stimulate the production of blood cells; and, in some cases, stem-cell transfusions may increase survival rates. Other treatments include antibiotics to fight infections, medicines to decrease nausea and vomiting, skin care, and pain medications. Treatment of pregnant patients should consider the risks to the fetus. If the exposure involves substances called radioiodines, the victims can be at risk for thyroid cancer. Treatment with potassium iodide can reduce the risk for thyroid cancer. Psychological support is also an important part of treatment. Health care providers should refer to the official recommendations document at www.annals. org for more specific treatment recommendations and a list of additional resources. What are the cautions related to these recommendations? These recommendations may change as new information becomes available.