Use of Clinical Decision Guidance as a New Public Health Tool for the Medical Management of Internal Contamination in Radiological Mass Casualty Scenarios.

This review is a discussion of special issues associated with the medical and public health management of persons at risk of internal contamination from radionuclides, following various radiological mass-casualty scenarios, as well as definition, discussion and use of the Clinical Decision Guidance (CDG) in such scenarios. Specific medical countermeasures are available for reducing the internal radiation dose and the subsequent stochastic and deterministic risks to persons internally contaminated with radionuclides from nuclear power plant, fuel processing and nuclear weapon accidents/incidents. There is a public health need for rapidly identifying and quantifying the 'source term' of such radiation exposures and assessment of the associated committed doses, so that appropriate medical countermeasure(s) can be given as soon as possible. The CDG, which was initially defined in NCRP-161, was specifically developed to be a new public health tool for facilitating the integration of local community healthcare professionals into the general medical, mass casualty, triage and treatment response of internally contaminated populations.