The Ripple Effect and the Role of the Radiation Injury ... · The Ripple Effect and the Role of the Radiation Injury Treatment Network ... – Radiation Injury Treatment Network (RITN):

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