If a large mass casualty radiation incident were to occur in the U.S., local health care professionals would deliver most of the medical care initially, supported by surge capacity from Healthcare Coalitions developed under ASPR’s Hospital Preparedness Program grants, surrounding states, the National Disaster Medical System (NDMS), and the Radiation Injury Treatment Network. The local providers could have to evaluate large numbers of individual patients, and then triage, transport, and treat many kinds of radiation-induced injuries. Unfortunately, most providers at hospitals and in the community know little about radiation medicine, but HHS provides a resource that can help them better understand radiation and treat patients if an incident occurs in their area.
The Radiation Emergency Medical Management (REMM) web site, released by HHS’ Office of the Assistant Secretary for Preparedness and Response in 2007, offers health care providers key clinical information about the various types of radiation incidents and injuries, and how to recognize, triage and treat these injuries. It also provides instructional and training material about radiation itself and the federal assets available to help with the response. The REMM web site was recently redesigned to make it more user-friendly and have a more modern navigation system. REMM information also is available for health care professionals through the REMM Mobile app for Apple, Android, and Blackberry devices.
Fortunately, the U.S. has not seen many major radiation incidents. So, up to the present, U.S. health care responders and planners have mainly used REMM extensively to learn more about radiation, participate in formal exercises, and develop response plans. However, during Japan’s Fukushima nuclear reactor incident in 2011, REMM had a huge spike in visitors. REMM was accessed more than 170,000 times in the first day following the Fukushima disaster and hundreds of thousands of times throughout the incident. REMM has also been used extensively during formal radiation incident exercises of various kinds.
Since understanding radiation is complex, the site includes a Multimedia Library to explain the basics of radiation and radiation incidents, injuries, and treatment. In addition, the REMM YouTube channel, provides videos from HHS and other government entities about radiation issues. REMM has many interactive tools that assist with diagnosing and managing radiation injuries in a mass casualty setting.
For users who want to dive deeper into a topic, REMM has an extensive, easy to access bibliography of the key studies that support clinical recommendations for managing radiation injury. If those who want to learn even more, REMM’s training page aggregates many federal and state training opportunities available for those seeking additional information, skills, and credentials. Health care professionals and health physicists have used REMM assets extensively to teach and prepare their students and peers.
During radiation mass casualty incidents in the U.S., state, local, tribal and territorial governments would interact with the national government using plans published in the U.S. government’s Nuclear/Radiological Incident Annex, one of seven Federal Response Framework Incident Annexes. Radiation incidents of concern include a nuclear detonation, a dirty bomb, a nuclear facility incident, and a transportation incident involving radiation, among others.
The National Health Security Strategy and Implementation Plan outlines the strategy for how the U.S. can help protect communities from disasters and support them during emergencies and REMM is one piece in that strategy. Another part of this strategy is maintaining medical countermeasures and supplies in the Strategic National Stockpile (SNS) to help with the treatment of patients affected during a radiological or nuclear incident. In March 2015, the FDA approved the Neupogen (filgrastim) for the treatment of patients with radiation-induced myelosuppression. ASPR purchased Neupogen for the SNS in 2013. In November, Neulasta (pegfilgrastim) also was approved for this indication.
The REMM Team includes subject matter experts and information technology specialists from ASPR, the National Cancer Institute and the National Library of Medicine. Users can contact the REMM Team with comments and/or general questions.
