Matching biodosimetry to likely types of exposure and needs for triage for medical management of radiation syndrome following a nuclear event

This paper characterizes types of biodosimetric tools used for response and treatment in a large-scale nuclear event. Using US official documents to define dangerous zones and centers for triage and treatment, the types of biodosimetry needed in various circumstances, based on likely volumes, types of radiation and extent of combined injuries of people arriving at different center locations, are defined. Appropriate biodosimetry methods should consider the type of radiation received (predominantly prompt mixed gamma-neutron irradiation or gamma rays from fallout), probability of physical injury/burns, the likelihood of receiving a significant dose, and the location and number of likely victims. The types of parameters needed for using biodosimetric techniques most effectively in a nuclear event, including for methods to be developed, are denoted for seven distinct situations that would occur with a large-scale nuclear event. The analysis leads to the conclusion that the benefit of using qualitative biodosimetry for stage 1 triage of people who were in dangerous zones is low and not recommended in a nuclear detonation. For this cohort, stage 2 triage will be very important but the type of biodosimetry depends on whether the irradiation occurred immediately or from fallout, because anyone from the detonation zones would more likely have physical injuries and/or burns and have received neutron exposures. Biodosimetry in stage 3 (medical care) would have only a modest role. Biodosimetry for people nearby but outside of the detonation and fallout zones requires a different approach, perhaps also benefitting from new methods.