Relevance and feasibility of multi-parameter assessment for management of mass casualties from a radiological event

Objective Local, regional, and federal response teams play an integrated role in the early management of mass casualties from a radiologic incident. Evaluation of individuals exposed to ionizing radiation requires an assessment of clinical signs and symptoms and an estimation of radiation dose. Here, we determine the relevance and feasibility of multi-parameter assessment for management of mass casualties from a radiological event. Method An assessment of the value of signs and symptoms and of individual biological dosimetry is made. To determine the feasibility of applying dosimetric data in a mass casualty event, a survey was conducted of the 32 clinical laboratories meeting criteria in the State of Connecticut. Following completion of a training program, a functional drill was conducted to determine efficacy of training and proficiency of sample preparation for the cytogenetic bioassay. Results Based upon reliability and timeliness of clinical information and dosimetric data, it is evident that both forms of data should be provided in a mass casualty scenario. A needs assessment of clinical laboratories in Connecticut identified 30 of 32 clinical laboratories that were qualified and willing to perform initial processing of biodosimitry specimens. Currently, 79 laboratory professionals in 19 of the qualified clinical laboratories were trained in specimen processing. Of these individuals, 37 participated in a functional drill that demonstrated an acceptable cell viability (>95%) and turnaround time for samples (199 minutes). Conclusion Multi-parameter assessment provides useful information to clinicians caring for mass casualties from a radiological event. Assessment of individual radiation dose by the cytogenetic bioassay is made more feasible by building clinical laboratory surge capacity.