Triage

Nuclear/Radiological Medical Management Medical Management of Nuclear & Radiological Patients

The following information contains adaptations and excerpts from the US Army Center for Health Promotion and Preventive Medicine (USACHPPM) Tech Guide 244, The Medical NBC Battlebook.

All combined-injury patients should be treated initially as if no significant radiation injury is present. Triage and care of any life-threatening injuries should be rendered without regard for the probability of radiation injury or contamination. The physician should make a preliminary diagnosis of radiation injury only for those patients for whom radiation is the sole source of the problem. This is based on the appearance of nausea, vomiting, diarrhea, hyperthermia, hypotension, and neurologic dysfunction.

Symptoms	Possible category of radiation injury
	Unlikely	Probable	Severe
Nausea	Absent	Excessive	Very Excessive
Vomiting	Absent	Present	Very Excessive
Diarrhea	Absent	Absent to Present	Absent to Very Excessive
Hyperthermia	Absent	Absent to Present	Present to Very Excessive
Hypotension	Absent	Absent	Present to Very Excessive
Erythema	Absent	Absent	Absent to Excessive
CNS dysfunction	Absent	Absent	Absent to Excessive

Starting Triage Classifications	Final Triage Classifications
	Less than 150 cGy	150-550 cGy	Over 550 cGy
Radiation Only	Minimal	Delayed**	Delayed**
Immediate	Immediate	Immediate or Expectant*	Expectant
Delayed	Delayed	Delayed or Expectant*	Expectant
Minimal	Minimal	Minimal**	Expectant
Expectant	Expectant	Expectant	Expectant
* Select Expectant in the case of full or partial thickness burns covering more than 18% of the body surface, or trauma which would either result in significant infection or be categorized as severe but not immediately life threatening, such as a fractured femur. This is a clinical decision and not necessarily subjectively reproducible. ** Includes the probable requirements for antibiotics and transfusion at a later time. So this classification does not suggest that the patient is not in need of treatment, but rather that he does not need immediate specialized care.