1 / 23

David Weinstock, MD Dana-Farber/Harvard Cancer Center Radiation Injury Treatment Network

Radiation Injury Treatment Network: Leveraging existing expertise to provide radiation casualty management. David Weinstock, MD Dana-Farber/Harvard Cancer Center Radiation Injury Treatment Network dweinstock@partners.org. Radiation Injury Treatment Network (RITN): Definition.

artie
Télécharger la présentation

David Weinstock, MD Dana-Farber/Harvard Cancer Center Radiation Injury Treatment Network

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Radiation Injury Treatment Network: Leveraging existing expertise to provide radiation casualty management David Weinstock, MD Dana-Farber/Harvard Cancer Center Radiation Injury Treatment Network dweinstock@partners.org

  2. Radiation Injury Treatment Network (RITN): Definition • Voluntary network of 47 academic medical centers, 7 blood donor centers and 7 umbilical cord blood banks • Organized by National Marrow Donor Program and American Society of Blood and Marrow Transplantation • Supported by the US Navy • Coordinated with the Office of the ASPR, DHHS

  3. Radiation Injury Treatment Network (RITN): Pre-event • Education and training: • REAC/TS mini-course • Grand rounds and online presentations (<2300 trained) • REMM (www.remm.nlm.gov) treatment algorithms • Annual tabletop exercises • International consensus guidelines • National planning • Scarce Resources project • National Planning Guidance • State and Local Planners Playbook for Medical Response to a Nuclear Detonation

  4. State and Local Planners Playbook for Medical Response to a Nuclear Detonation • 0-76, Be aware of the Radiation Injury Treatment Network (RITN) • I-19, HHS activation of National Disaster Medical System (NDMS) and other HHS assets (DMATs and burn teams). HHS to activate AABB TF for blood supports through Assistant Secretary for Health (ASH) activate RITN • II-6, Prepare for air-based transfer of victims to other jurisdictions, NDMS hospitals, RITN and Veterans Administration hospitals. • II-36, Support transfer and tracking of victims and potential victims of acute radiation syndrome to regional, NDMS, and RITN centers • II-42, Work with hospitals to identify patients for transfer to regional facilities, NDMS, RITN centers or burn facilities. • III-6, Continue transfer of victims who may need delayed medical care to National Disaster Medical System (NDMS), RITN and other jurisdictions.

  5. Radiation Injury Treatment Network (RITN):Response • Surge capacity • National guidance – online, teleconsult • Coordination of stem cell transplantation: • Donor searches (>10,000 per week) • Product harvesting and transport • Treatment guidelines

  6. Specialty care & treatment centers Trauma centers Triage Decon Victim collection points Evacuation Specialty care & treatment centers Decon Triage Ground Zero Trauma centers

  7. Radiation events Potential for life-threatening exposure during clean-up

  8. DHHS evacuation strategy – 2 types of radiation injury Critical MC AC RTR1 (collection) Ambulatory MC AC RTR2 (plume) RTR2 (plume) RTR1 (blast) Evacuation centers RTR3 (collection) MC MC MC AC AC Referral center Modified from Weinstock et al. Blood 2008

  9. Hiroshima after the bomb Hiroshima before the bomb

  10. New York City 2011 Hiroshima before the bomb

  11. Estimated number of irradiated victims 300,000 600,000 Waselenko et al. Annals Int Med 2004

  12. Resource demand and availability after a nuclear detonation in Washington DC Modeling Division of BARDA Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Blood and Tissue Requirements Working Group Gryphon Scientific

  13. Surge capacity based on tabletop exercises

  14. Combined injury worsens outcome in humans R. Cassagrande, Gryphon Scientific

  15. Hick JL, Weinstock DM et al. Disaster Med Health Prep 2011

  16. Alert and Notification Prepare to receive Patients Earliest patients arrive at distant RITN centers Preparation for HSCT Manifest illness Day: 0 3 10 21 35 60+ Initiate G-CSF Recovery Prodromal symptoms

  17. ~40 radiological accident victims have been reported More are known to have undergone HSCT after Chernobyl but details are limited Treated with a variety of approaches and HSC products Many had multiorgan dysfunction 4 survived more than one year All 4 reconstituted autologous hematopoiesis Unclear how many others would have Almost none received growth factors prior to HSCT 25% died of transplant-related mortality HSCT for radiological injury: the experience

  18. Lessons learned from industrial accidents • Highly heterogeneous exposure • High dose rate - 22 second exposure at sterilization facility (15 Gy/min) • Responded to cytokines - Cytokine treatment only Gourmelon et al. Health Physics 2010

  19. Ongoing Initiatives • Strengthen relationships with: • State/local/territorial public health • NDMS • Pediatric treatment guidelines • Support planning of outpatient and inpatient capabilities at non-RITN centers • Educate non-physician hospital staff 22

  20. www.RITN.net www.REMM.NLM.gov

More Related