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2018 ; 59
(suppl_2
): ii54-ii64
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Medical management of acute radiation syndrome and associated infections in a
high-casualty incident
#MMPMID29509947
Dainiak N
J Radiat Res
2018[Apr]; 59
(suppl_2
): ii54-ii64
PMID29509947
show ga
A high-casualty incident may result in a significant human toll due to the
inability of a community to meet the health care demands of the population. A
successful medical response requires health care facilities to not only
communicate and integrate medical services, meet surge capacity, protect health
care workers and implement triage and treatment protocols, but also to provide
the venue for clinical management of acute radiation injuries and their
associated infections. Today, clinical management is primarily guided by the
recommendations of a Consultancy that were made at the World Health Organization
(WHO). This international consensus was reached on evidence-based, clinical
management of each of the four sub-syndromes that compose acute radiation
syndrome (ARS), including the hematopoietic subsyndrome (HS), gastrointestinal
subsyndrome (GIS), neurovascular subsyndrome (NVS) and cutaneous subsyndrome
(CS). Major findings in studies meeting inclusion criteria for management
strategies for HS were that (i) no randomized controlled studies of medical
countermeasures have been (or will likely ever be) performed for ARS cases, (ii)
the data for management of HS are restricted by the lack of comparator groups,
and (iii) reports of countermeasures for management of injury to
non-hematopoietic organs are often incompletely described. Here, (i)
recommendations made in Geneva are summarized; (ii) the analysis of
countermeasures for HS is updated by review of two additional cases and extended
to published reports not meeting inclusion criteria; and (iii) guidelines are
provided for management of microbial infections based upon patient risk for
prolonged immunosuppression.