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The “RTR” Medical Response System for Nuclear and Radiological Mass-Casualty Incidents: A Functional TRiage-TReatment-TRansport Medical Response Model

Published online by Cambridge University Press:  28 June 2012

Chad M. Hrdina ,
C. Norman Coleman ,
Sandy Bogucki ,
Judith L. Bader ,
Robert E. Hayhurst ,
Joseph D. Forsha ,
David Marcozzi ,
Kevin Yeskey  and
Ann R. Knebel
Chad M. Hrdina*
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA
C. Norman Coleman
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
Sandy Bogucki
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA Section of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Judith L. Bader
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
Robert E. Hayhurst
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA
Joseph D. Forsha
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA
David Marcozzi
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA
Kevin Yeskey
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA
Ann R. Knebel
Affiliation:
Office of the Assistant Secretary for Preparedness and Response), US Department of Health and Human Services, Washington, DC, USA
*
HHS/(ASPR) Office of the Assistant Secretary for Preparedness and ResponseHubert H. Humphrey BuildingSuite 638G200 Independence Avenue SWWashington, DC 20201USA E-mail: chad.hrdina@gmail.com
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Abstract

Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The “RTR” system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other sites such as nursing homes and outpatient clinics, nationwide expert medical centers (such as cancer or burn centers), and possible alternate care facilities such as Federal Medical Stations. Assembly Centers for displaced or evacuating persons are predetermined and spontaneous sites safely outside of the perimeter of the incident, for use by those who need no immediate medical attention or only minor assistance. Decontamination requirements are important considerations for all RTR, Medical Care, and Assembly Center sites and transport vehicles. The US Department of Health and Human Services is working on a long-term project to generate a database for potential medical care sites and assembly centers so that information is immediately available should an incident occur.

Keywords

emergency medical responsemass casualtynuclear terrorismradiological terrorismterrorismtriagetransporttransportationtreatment
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 3 , June 2009 , pp. 167 - 178
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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