TMT Handbook: guidelines for treatment and long-term follow up of people exposed to radiation after a malevolent act

Public health emergencies may be triggered in diverse scenarios including malevolent use of radioactive material. The change in global security has shifted the focus of emergency preparedness from nuclear accidents towards radiological terrorism scenarios. In such emergencies, members of the general public will most likely suffer most casualties with the numbers ranging widely depending on the scenario. Radiation doses can also range from very low to substantial life-threatening doses, and possibly combined with conventional injuries. Despite considerable efforts made in this area, there are still some gaps in terms of providing user-friendly tools for effective medical and public health response to such emergencies. The World Health Organization (WHO) participates in the collaborative research project 'Triage, Monitoring and Treatment (TMT) - handbook for management of the public in the event of malevolent use of radiation' under the European FP6 programme. WHO coordinates development of the chapter on hospital phase of response and long-term follow-up. The chapter addresses diagnosis, treatment and follow-up of acute radiation syndrome, local radiation injuries, internal contamination, combined injuries, as well as psychological impact management. Although this chapter is focused on actions conducted at hospital level, critical links between pre-hospital and hospital responses are also addressed. The chapter is based on best available international guidance on health interventions in radiation emergencies, current European consensus and relevant IAEA and WHO publications. A wide distribution of the TMT handbook is envisaged and its incorporation into national exercise and training programmes will be encouraged. (author)