Lt. Colonel Dr. Eisenkraft (Ret.), MD, MHA was formerly Head of Medicine Branch for the Israeli Ministry of Defense where he led pre-clinical & clinical studies and product development for chemical, biological, radiological, and nuclear (CBRN) medical countermeasures. Prior to that, he was Chief of Chemical Medical Section for the Israeli Defense Forces’ (IDF) Medical Corps where he was leading the development of national medical preparedness doctrines, working closely with governmental agencies, the IDF, and the Israeli Ministry of Health. Dr. Eisenkraft is now the Director, Homeland Defense Projects. Dr. Eisenkraft will lead development and global commercialization of Pluristem’s cell therapy products for Homeland Security applications.
Acute radiation syndrome results from exposure to high levels of ionising radiation. This may be the result of an accident, such as exposure of individuals to x-ray diagnostic and therapeutic devices, or a possible large scale exposure following a nuclear facility accident (for example the Chernobyl and Fukushima incidents).
It may also be the result of an intentional act of terrorism, involving the use of a radiological dispersal device (i.e., dirty bomb), an improvised nuclear device, or may involve an attack on a nuclear power plant, or any number of potential nuclear scenarios.
Following the 9/11 attacks, and more recently the use of non-conventional weapons and toxic industrial compounds in the Syrian civil war and in Iraq by both state and non-state actors, the possibility of intentional exposure to radiation seems to be rising. Since the primary objective of these perpetrators is to create fear and panic to the general public, and since most of the public, as well as first responders, healthcare providers, and the mass media, may have misunderstandings regarding such an event, radiation is attractive. On top of that, the shortage of available medical countermeasures (MCMs) against ARS could make it even worse. The major goals of a response plan to a radio-nuclear emergency are to protect the public, as well as the emergency personnel while performing their duties. To achieve these goals, local, regional and national resources should be brought together to address such an incident of national impact.
In a radio-nuclear exposure scenario, the numbers of casualties, some with life-threatening injuries and resulting complications, may be very high. This means major challenges of assessing the precise levels of individual exposure, and possible delayed medical support and care to those who need it. In any case, these are regarded as complex and resource-intensive efforts, driving research towards approving novel MCMs against ARS.
This syndrome involves life-threatening injuries especially to the hematopoietic, gastrointestinal, and the neurovascular systems. Victims exposed to high levels of ionized radiation show a prodromal phase in the first few hours following exposure, followed by a latent phase, which shortens as the radiation dose increases, and finally, develop a manifest phase. The bone marrow involvement is considered as the major contributor to mortality.
Though different countries have different approaches and doctrines to handle a radio-nuclear catastrophe, there are several basic assumptions and procedures that cross all nations and organizations. The scope of the response and the resources needed are determined by the extent of the incident, involving local, regional, and national players.
Once a radio-nuclear event is recognised, the next step is to notify all relevant organisations, both first responders on site and on the way, as well as governmental departments, crisis management authorities, public health agencies, healthcare facilities and more – depending on the relevant resources allocated for such an incident. A novel protection device that recently reached the markets is the StemRad 360 Gamma wearable shield, which allows the protection of enough bone marrow tissue among first responders and all those who may be exposed to high radiation levels in a way that will ensure their survival. Though these individuals may still be injured and suffer from signs of ARS, this may well save their lives once given the appropriate medical care.
Medical response varies between countries, from field triage, medical condition and contamination assessment, and on site decontamination, to a more scoop-and-run approach, in which contaminated casualties are rushed to the nearest medical facility, where they go through the same process of triage, clinical and contamination assessment, and decontamination at the entrance to the hospital, and then taken inside.
The different approaches are driven mainly from evacuation distances, but also from cultural differences between nations. In any case, most of the medical care on site is related to damage control and supportive treatment, and following immediate medical interventions and stabilisation efforts as needed, patients are classified based on physical injury, level of exposure, and contamination. The first 36-48 hours following exposure are critical, as this is the time window in which patients with significant exposure will develop haematological and immunological suppression.
Laboratory assessment includes complete blood count, cytogenetic tests for chromosomal aberrations, and estimation of internal contamination.
Since there are prodromal and latent phases before the actual clinical deterioration appears, there is a time window allowing for treatment even in a mass casualty scenario.
In general, as medical countermeasures are intended for use in the event of a public health emergency, they must have several characteristics enabling the best response by end-users, including first responders and hospital personnel.