The Ripple Effect and the Role of the Radiation Injury ... · The Ripple Effect and the Role of the...
Transcript of The Ripple Effect and the Role of the Radiation Injury ... · The Ripple Effect and the Role of the...
RITN Overview Presentation1
The Ripple Effect and the Role of the Radiation Injury Treatment Network (RITN)
Richard J. Hatchett, MD
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Structural, radiation and medical response zones-
spontaneous
Site Radiation Physical damage
RTR 1 √ √
RTR 2 √ 0
RTR 3 0 0
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RITN centers plan to receive patients from impacted area
RITN centers are not first responders or a local response asset
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Outline
• Who is RITN?
• What Needs Does RITN Fill?
• What Can RITN Offer?
• What is RITN Doing to Prepare?
• REMM
• Concerns
National Marrow Donor Program
Radiation Injury Treatment Network
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RITN Goals
1.
Provide facilities and staff
for intensive
supportive care and treatment expertise in the
aftermath of a marrow toxic incident resulting in
mass casualties.
2.
Educate
hematologists, oncologists, and stem
cell transplant practitioners about their potential
involvement in the response to a radiological
incident.
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RITN Distribution
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Primary Transplant Centers► Primary Donor Centers∆
Cord Blood Banks●
Secondary Transplant Centers
RITN includes NCI Cancer Centers and is growing
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RITN Development Timeline1986 - Initiation of NMDP - Navy relationship’86-’01 - Response network realized as an unfulfilled need2001 - NMDP begins organizing concept of core network2003 - NMDP transplant center physicians discuss options2004 - ASBMT joins initiative2005 - ASBMT increases emphasis
NMDP solicits HSCT physician support
2006 - NMDP initiates agreements with 13 transplant centersRITN steering committee finalizes materials
2007 - Expansion of RITN to include donor centers and cord blood banks (52 total centers)
Tomorrow…
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Key Partners in the Development of RITN• American Society for Blood and Marrow Transplantation
(ASBMT)
• Department of Defense - Office of Naval Research (ONR)
• Health Resources and Services Administration (HRSA)
• Center for International Blood and Marrow Transplant Research (CIBMTR)
• Radiation Emergency Assistance Center/Training Site (NNSA, DOE)
• Dept. Health & Human Services - Asst. Secretary of Preparedness and Response (DHHS-ASPR)
• National Library of Medicine - Radiological Event Medical Management (NLM-REMM) www.remm.nlm.gov
• Leading hematopoietic stem cell transplantation physicians
Organization of RITN
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What Need Does RITN Fulfill?
• Provide ready facilities with practicing specialists for intensive supportive care and treatment– Infrastructure and process for transplant if needed
• Increases transplant community awareness about potential need of their services in time of crisis
• Involves transplant community in emergency preparedness
• Most victims of a marrow toxic mass casualty incident will require intensive supportive care to recover without a transplant
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What RITN Offers to the Response?
• Provide expert knowledge based on significant practical experience in treating patients with compromised immune-systems
• Treatment facilities for victims• Regional dispersion other transplant physicians
can talk to a peer in RITN• Available through RITN Website: www.RITN.net
– RITN Acute Radiation Syndrome treatment guidelines– RITN center standard operating procedure templates– Donor selection criteria– NMDP data collection protocol– Training resources– Pertinent publications
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RITN Preparedness Efforts
• Standard Operating Procedures
• Standardized admission and treatment orders
• Standardized data collection protocol
• Training– Basic Radiation Training (over 1800 trained since 2006)
– Additional training resources on www.RITN.net
• Coordination with international organizations– EBMT and WHO - REMPAN
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For treatment guidelines, training & references:
www.REMM.NLM.gov
www.RITN.net
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REMM – www.remm.nlm.gov
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http://remm.nlm.gov/newptinteract.htmhttp://remm.nlm.gov/newptinteract.htm
Algorithms
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Exposurehttp://remm.nlm.gov/exposureonly.htmExposurehttp://remm.nlm.gov/exposureonly.htm
Management
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http://remm.nlm.gov/ars_wbd.htmhttp://remm.nlm.gov/ars_wbd.htm
Tools
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Summary
• Major goals of RITN– Therapy– Research– Data collection– Education of health care providers
• Major goals of REMM– Treatment algorithms and protocols– Just in time information for clinicians
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Resources for further investigation• Incidents:
– IAEA nuclear incidents list: http://www-news.iaea.org/news/– Database of Radiological Incidents and Related Incidents:
www.johnstonsarchive.net/nuclear/radevents/index.html• Treatment:
– Radiation Injury Treatment Network (RITN): www.RITN.net– Radiation Event Medical Management (REMM): www.remm.nlm.gov– Radiation Emergency Assistance Center/Training Site (REAC/TS):
www.orau.gov/reacts– Radiation Countermeasures Center of Research Excellence
(RadCCORE): www.radccore.org• Bio-dosimetry & Treatment:
– Armed Forces Radiobiology Research Institute (AFRRI): www.afrri.usuhs.mil
• Other:– IAEA Library: http://www.iaea.org/DataCenter/Library/catresources.html– Radiation Emergency Medical Preparedness and Assistance Network
(REMPAN): www.who.int/ionizing_radiation/a_e/rempan/
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Acknowledgments
• Dennis Confer• Cullen Case• Norm Coleman• Judy Bader• Nelson Chao • Alan Leahigh• Robert Krawicz• Daniel Weisdorf• David Weinstock• Participating BMT centers