Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter VII: Mass Causalties in Thermonuclear Warfare

Initial Treatment for Patients with Whole-Body Radiation Injury

United States Department of Defense

The primary determinants of survival among most patients receiving intermediate (serious but nor uniformly fatal if treated) radiation doses are the management of microbial infections and the arrest of bleeding. If high intermediate doses have been received, fluid and electrolyte loss may cause early deaths. If properly resuscitated, however, these patients can survive until the consequences of hematologic failure become apparent.

For those casualities who have received sublethal whole-body radiation doses, gastrointestinal distress will predominate in the first two days. Antiemetics (metoclopramide, dazopride) may be effective in reducing the symptoms, but currently available drugs have significant side effects. Unless severe radiation injury has occurred, these symptoms will usually subside within the first day. For those patients who continue to experience gastrointestinal distress, parenteral fluids should be considered. If explosive diarrhea occurs within the first hour postexposure, fluids and electrolytes should be administered, if available. For triage purposes, the presence of explosive diarrhea (especially bloody) is likely to be related to a fatal radiation dose.

Cardiovascular support for patients with clinically significant hypotension and neurologic dysfunction should be undertaken only when medical resources permit. These patients are not likely to survive injury to the vascular and gastrointestinal systems combined with bone marrow aplasia.

New means of radioprotection and repair of radiation damage are presently on the horizon. Furthermore, immunomodulators are now under study which may not only facilitate marrow regeneration, but also help reduce the profound immunosuppression responsible for infections associated with severe injury. These agents may be used in combination with radioprotectors and antibiotics to further enhance survival. Leukopenia is a significant problem in irradiated casualties, but hazards exist with leukocyte transfusion into patients. Induction of stem cell regeneration agents into selected populations probably offers the best opportunity to correct this deficiency. Although platelet transfusions are certainly desirable for radiation victims, they are presently not practical for mass casualty scenarios. Enormous progress is being made in autologous bone marrow transplants, but this procedure is not practical in forward facilities. Again, repair by stimulation of surviving stem cells is probably the best near-term hope of solving this problem. Problems of effective wound management and fluid and electrolyte replacement remain to be overcome in the neutropenic patient. Pharmacologic means to regulate performance decrements, such as emesis and early transient incapacitation are still not available for use by military personnel.

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Operational Medicine 2001

Health Care in Military Settings

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