INTRODUCTION

This document is part three to the CBRN clinical practice guideline (CPG) series. It provides guidance for the recognition, decontamination, treatment, and triage of suspected or confirmed irradiated and/or contaminated patients.

Since Level 1 evidence does not exist to guide the management of these casualties, the subject matter experts (SMEs) who drafted this CPG used references, best medical advice, and historical precedents to develop guidelines for the management of this unique patient population. This CPG can be used in conjunction with the Medical Management of Radiological Casualties Handbook. Reach back and consultation is available 24/7/365 with Armed Forces Radiobiology Research Institute (AFRRI) SME at 301-295-0530 by requesting the Medical Radiobiology Advisory Team.

When you suspect radiation exposure or a wartime or environmental nuclear event: 1

1. Notify your chain of command immediately.
2. Set up separate triage and clinical care areas for management of these casualties.
3. Record as much clinical data as possible in the medical record.
   - Document time of exposure
   - Document exposure time (duration of exposure)
   - document % TBSA if burn is present
   - document any PPE that the casualty was wearing
   - document initial symptoms and time that the symptoms started
4. Call AFRRI (301-295-0530) and request the Medical Radiobiology Advisory Team for clinical guidance or Radiation Emergency Assistance Center/Training Site (REAC/TS), 865-576-1005.
5. Submit all clinical records to the Joint Trauma System (JTS) so rapid performance improvement (PI) can be conducted to develop evidence-based clinical practice guidelines.