Video Tutorials

Contamination: Diagnose/Manage
Exposure: Diagnose/Manage
Dose Estimator for Exposure
Time/Dose Effects
Manage 4 Subsyndromes of ARS
Time Phases of ARS

Radiation Safety

Nuclear/radiological terrorism: Emergency department management of radiation casualties. J Emerg Med. 2007 Jan;32(1):71-85.
Factors that decrease dose from exposure: Time, distance, shielding
(Illustration)    

Clinical Management

Managing Radiation Casualties
Radiation Emergency Medical Management: Guidance on Diagnosis & Treatment for Health Care Providers
Medical Management of Radiation Injury
Isotopes of Interest, Countermeasures for Internal Contamination
Contamination, Decontamination
Nuclear Detonation Incidents
Late Effects of Ionizing Radiation
History of Radiation Incidents
Hazardous Substances Data Bank (National Library of Medicine)
Medical response to a major radiologic emergency: a primer for medical and public health practitioners. Radiology. 2010 Mar;254(3):660-77.
Medical treatment of radiological casualties: current concepts. Ann Emerg Med. 2005 Jun;45(6):643-52.
Nuclear terrorism: triage and medical management of radiation and combined-injury casualties. Surg Clin North Am. 2006 Jun; 86(3):601-36
Medical management of radiation injuries: current approaches. Occup Med (Lond). 2006 May;56(3):162-72 

Acute Radiation Syndrome

Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems. Disaster Med Public Health Prep. 2011 Oct;5(3):183-201.
First Global Consensus for Evidence-Based Management of the Hematopoietic Syndrome Resulting From Exposure to Ionizing Radiation. Disaster Med Public Health Prep. 2011 Oct;5(3):202-212.
Scarce Resources for Nuclear Detonation: Project Overview and Challenges. Disaster Med Public Health Prep. 2011 Mar;5 Suppl 1:S13-9.
Nuclear Detonation Scarce Resources Project Working Group Publicationsvideo 
Acute Radiation Syndrome Treatment Guidelines (PDF - 1.26 MB) (Radiation Injury Treatment Network, September 2010) 
Radiation Emergencies: Evaluation, Management, and Transplantation. Biol Blood Marrow Transplant. 2007;13:103-6.
The 9-11 Commission's invitation to imagine: a pathophysiology-based approach to critical care of nuclear explosion victims. Crit Care Med. 2007 Mar;35(3):716-23.
Nuclear terrorism: the role of hematology in coping with its health consequences. Curr Opin Hematol. 2006 Nov;13(6):436-44.
Consensus conference on European preparedness for haematological and other medical management of mass radiation accidents. Ann Hematol. 2006 Oct;85(10):671-9.
Medical management of patients with multiple organ dysfunction arising from acute radiation syndrome. BJR Suppl. 2005;27:161-8.
Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004 Jun 15;140(12):1037-51.
The hematologist and radiation casualties. Hematology, (Am Soc Hematol Educ Program). 2003;:473-96.
Hematologic consequences of exposure to ionizing radiation. Exp Hematol. 2002 Jun;30(6):513-28. 

Radiation Skin Effects

Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems. Disaster Med Public Health Prep. 2011 Oct;5(3):183-201.
How to recognize and initially respond to an accidental radiation injury - images of radiation skin effects and injury (poster, PDF - 436 KB) (pamphlet, (Radiation dermatological injuries, IAEA, WHO)
Cutaneous radiation injury: Fact sheet for physicians (HHS/CDC 5/10/2006)
Cutaneous Radiation Syndrome

Late Medical Effects After Radiation Contamination or Exposure

Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2, Biologic effects of ionizing radiation, committee to assess health risks from exposure to low levels of ionizing radiation, National Research Council, 2006
BEIR VII: Health risks from exposure to low levels of ionizing radiation, (The National Academies, 2005)
Radiation Epidemiology Course, (HHS/National Cancer Institute/Division of Cancer Epidemiology and Genetics, May 2007)
Low Dose Radiation Research Program (DOE/Office of Science)    

Isotopes and Countermeasures

Isotopes of Interest: Fact Sheets
Isotope

Government agencies

HHS/CDC*

HHS/ATSDR**

EPA***

Argonne National Laboratory

Americium-241

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Californium-252

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Cesium- 134/137

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Cobalt-57/60

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Curium-244

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Iodine-124/125/129/131

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Iridium-192

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Phosphorus-32
Plutonium-238/239/240/241/242

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Polonium-210

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Radium-226

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Strontium-89/90

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Uranium-235/238

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Yttrium-86/90/91

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*    HHS/Centers for Disease Control and Prevention
**  HHS/Agency for Toxic Substances and Disease Registry
***Environmental Protection Agency
†    For Yttrium-90 radioactive properties and health concerns information
See Strontium-90 Human Health Fact Sheet

Medical Countermeasures in Radiation Events

Medical Countermeasures Against Radiological and Nuclear Threats (NIH, NIAID)    
Potassium Iodide

HHS/FDA

Home preparation procedure for emergency administration of potassium iodide tablets to infants and small children (HHS/FDA)
Drug preparedness and response to bioterrorism (HHS/FDA)
Potassium iodide as a thyroid blocking agent in radiation emergencies December 2001  (HHS/FDA)
Frequently asked questions on potassium iodide (KI) (HHS/FDA)
Other KI resources (HHS/FDA)
Guidance potassium iodide as a thyroid blocking agent in radiation emergencies 
(HHS/FDA)
Potassium iodide (HHS/CDC)
Radiation disasters and children. Pediatrics. 2003 Jun;111(6 Pt 1):1455-66.
Administration of decorporation drugs to treat internal radionuclide contamination - medical emergency response to radiological incidents RSO Magazine 9(5), 2004.
Medical Management of Radiocontaminated Patients (Los Angeles County Department of Health Services, Emergency Medical Services Agency, June 2006).
Radiological and nuclear incidents U.S. Department of State, April 18, 2006.
Federal policy on use of potassium iodide (KI) (DHS/FEMA document, published in Federal Register 7 January, 2002)
Consideration of potassium iodide in emergency planning (NRC)
Radiation exposure from Iodine 131 (HHS/ATSDR)

Prussian Blue

Prussian blue (ferric hexacyanoferrate (II)) for treatment of internal contamination with thallium or radioactive cesium October 3, 2003 (HHS/FDA)
Questions and answers on prussian blue (HHS/FDA)
Prussian blue (HHS/CDC)
Patient Initial Contact Work Sheet for Issuing Prussian (AFRRI)

DTPA

Facts about DTPA (HHS/CDC)
Calcium-DTPA and Zinc-DTPA August 12, 2004 (HHS/FDA)
Calcium-DTPA (Radiation Emergency Assistance Center/Training Site, November 14, 2002 (REAC/TS)
Zinc DTPA (Radiation Emergency Assistance Center/Training Site, November 14, 2002 (REAC/TS)
Radiation Emergencies (HHS/FDA)

Hematopoietic Countermeasures

Hematopoietic Stem Cell Transplantation 
Hematopoietic stem-cell transplantation. N Engl J Med. 2006 Apr 27;354(17):1813-26
Acute radiation injury: Contingency planning for triage, supportive care, and transplantation. Bio Blood Marrow Transplant. 2006 Jun;12(6):672-82.
Lineage-specific hematopoietic growth factors. N Engl J Med. 2006 May 11;354(19):2034-45.
2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. 2006 Jul 1;24(19):3187-205. Epub 2006 May 8
Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol. 2007 Jul 20;25(21):3158-67.
Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007107.
First Global Consensus for Evidence-Based Management of the Hematopoietic Syndrome Resulting From Exposure to Ionizing Radiation. Disaster Med Public Health Prep. 2011 Oct;5(3):202-212. 

Infection Countermeasures

Antimicrobials and Febrile Neutropenia
Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011 Feb 15;52(4):427-31.
Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007107.
Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol. 2007 Jul 20;25(21):3158-67.
Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004386.
Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Int Med 2005; 142(12);975-995.
Systematic reviews and meta-analysis of febrile neutropenia. Mayo Clin Proc 2005;80(9):1122-1125.
Radiation Injury in Common with Trauma or Infectious Disease (NATO RTG-099, 2005)
Facts about neupogen (HHS/CDC)

Granulocyte Transfusion Guidelines

Granulocyte transfusions for treating infections in patients with neutropenia or neutrophil dysfunction. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005339.
Granulocyte transfusions for preventing infections in patients with neutropenia or neutrophil dysfunction. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005341.
Biomedical Advanced Research and Development Authority (BARDA) Strategic Plan 2011-2016 (HHS/BARDA)

White Blood Cell Growth Factors

2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. 2006 Jul 1;24(19):3187-205. Epub 2006 May 8

Platelet Transfusion

Current practice and future directions for optimization of platelet transfusions in patients with severe therapy-induced cytopenia. Blood Rev. 2011 May;25(3):113-22.
Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol., 2001 Mar 1;19(5):1519-38. 

Pre-hospital Emergency Services

Recommendations for managing a nuclear weapons accident 
(Radiation Emergency Training Center/ Training Site [REAC/TS])

Hospital Planning

Hospital Incident Command System
Hospital Incident Command System    

State and Hospital Planning For Radiation Disasters

Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):16-24.
Best practices for hospital-based first receivers of victims from mass casualty incidents involving release of hazardous substances (OSHA)
Providing mass medical care with scarce resources: a community planning guide (AHRQ)
State and Local Planners Playbook for Medical Response to a Nuclear Detonation (HHS/ASPR)

See Also:

Develop a Radiation Response Plan
Equip an Emergency Department for Decontamination
Hospital Staff
Preparedness and Response Planning
Nuclear Detonation Scarce Resources Project Working Group Publicationsvideo   

Public Health Issues

Understanding radiologic and nuclear terrorism as public health threats: preparedness and response perspectives. J Nucl Med. 2006 Oct;47(10):1653-61.

Federal Protective Action Guides (PAGS) for Radiation Events: Key Federal Documents

Manual of protective action guides and protective action for nuclear incidents (400 R 92-001, EPA, May 1992)
Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010  (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats)    

Pregnancy, Infants and Children

Possible health effects of radiation exposure on unborn babies (HHS/CDC)
Prenatal radiation exposure: a fact sheet for physicians (HHS/CDC)
Prenatal Radiation Exposure: Background Material for Counseling Pregnant Patients Following Exposure to Radiation. Disaster Med Public Health Prep. 2011 Mar;5(1):62-8.
Guidance on the application of dose coefficients for the embryo, fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Health Protection Agency, 2008)
Health risks of low dose ionizing radiation in humans: a review. Exp Biol Med (Maywood). 2004 May;229(5):378-82
Doses to infants from radionuclides ingested in mothers' milk, ICRP Publication 95, Ann. IRCP 34(3-4), 2004. 
Biological effects after prenatal irradiation (embryo and fetus), ICRP Publication 90, Ann. ICRP 33(1-2), 2003.
Pregnancy and medical radiation, ICRP Publication 84, Ann. ICRP 30(1), 2000. (International Commission on Radiological Protection)
Pregnancy and radiation (Health Physics Society)
Pregnancy and Radiation Exposure (Health Physics Society)
National Advisory Committee on Children and Terrorism (NACCT)
Radiation disasters and children. Pediatrics. 2003 Jun;111(6 Pt 1):1455-66
Pediatric disaster and terrorism preparedness, by David Markenson, M.D., Columbia University, July 13, 2004 (PowerPoint® - 1135 KB)

U.S. Civilian Agencies With Information / Web Sites About Radiation Issues

Centers for Disease Control and Prevention (HHS/CDC)
Department of Energy (DOE)
Food and Drug Administration (HHS/FDA)
Department of Health and Human Services (HHS)
National Council on Radiation Protection & Measurements (NCRP)
Nuclear Regulatory Commission (NRC)
Radiation Emergency Assistance Center / Training Site (REAC/TS)
Occupational Safety & Health Administration (OSHA    

Military Publications / Military Web Sites

Armed Forces Radiobiology Research Institute (AFRRI)
Defense Threat Reduction Agency (DTRA)
NATO handbook on the medical aspects of NBC defensive operations (AMedP-6(B), Part 1 - Nuclear,  DOD)
Nuclear weapon accident response procedures  (DOD)    

International Agencies with Radiological Expertise

United Nations Scientific Committee on the Effects of Ionizing Radiation(UNSCEAR, Vienna, Austria)
International Atomic Energy Agency (IAEA)
International Commission on Radiological Protection (ICRP)
Radiation Emergency Medical Preparedness and Assistance Network of the World Health Organization (REMPAN)
Radiation Effects Research Foundation — A Cooperative Japan-US Research Organization    

Professional Group Publications

Institute of Medicine (IOM)
Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report (Institute of Medicine of the National Academies, 2009).
Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, a Letter Report (Institute of Medicine of the National Academies, 2009).
Medical Surge Capacity, Workshop Summary, Forum on Medical and Public Health Preparedness for Catastrophic Events (Institute of Medicine of the National Academies, 2010).    

National Council on Radiation Protection and Measurements (NCRP) Reports

Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident, (NCRP Report No. 166), Bethesda, MD, 2011.
Radiation Dose Reconstruction: Principles and Practices (NCRP Report No. 163), Bethesda, MD, 2009.
Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases(NCRP Report No. 161, Vol. II), Bethesda, MD, 2010.
Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Vol. I), Bethesda, MD, 2008.
Risk to the Thyroid from Ionizing Radiation (NCRP Report No. 159), Bethesda, MD, 2008.
Cesium-137 in the Environment: Radioecology and Approaches to Assessment and Management (NCRP Report No. 154), Bethesda, MD, 2006.
Key elements of preparing emergency responders for nuclear and radiological terrorism(NCRP Commentary No. 19), Bethesda, MD, December 2005.
Radionuclide exposure of the embryo/fetus (NCRP Report No. 128), Bethesda, MD, 1998.
Deposition, retention and dosimetry of inhaled radioactive substances (NCRP Report No. 125), Bethesda, MD, 1997.
Genetic effects from internally deposited radionuclides (NCRP Report No. 89), Bethesda, MD, 1987.
Management of persons accidentally contaminated with radionuclides (NCRP Report No. 65), Bethesda, MD, 1980.

International Atomic Energy Agency (IAEA) Resources
IAEA publications: complete library (IAEA)
Cytogenetic Dosimetry: Applications in Preparedness for and Response to Radiation Emergencies (IAEA, PAHO, WHO, September 2011)
Generic Procedures for Medical Response During a Nuclear or Radiological Emergency (IAEA, WHO, July 2005)
Practical Radiation Technical Manual, Health Effects & Medical Surveillance (IAEA, 2004)
Follow-up of delayed health consequences of acute accidental radiation exposure: Lessons to be learned from their medical management (IAEA-TECDOC-1300, Sponsored by IAEA and WHO, July 2002)
Medical Preparedness and Response (Educational Material) (IAEA, WHO, 2002)
Cytogenetic Analysis for Radiation Dose Assessment: A Manual. IAEA Technical Report Series No. 405, pp.127, Vienna, 2001
Diagnosis and Treatment of Radiation Injuries (IAEA Safety Reports Series No. 2, Vienna 1998)
Generic Assessment Procedures for Determining Protective Actions During a Reactor Accident  (IAEA-TECDOC-955, August 1997)
International Nuclear and Radiological Event Scale (INES)  (IAEA, 1990)
The Radiological Accident in Goiania (IAEA, 1988)    

World Health Organization (WHO) Resources
WHO BioDoseNet (WHO)
Mass Casualty Management Systems (WHO, 2007)
WHO Model Lists of Essential Medicines (WHO, March 2007)
Health Effects of the Chernobyl Accident and Special Health Care Programmes (WHO, 2006)    

Health Protection Agency (HPA) Resources

Risk of Solid Cancer Following Radiation Exposure, Estimates for the UK population, see especially pages 198-211 (Health Protection Agency, August 2011)
An Introduction to the Estimation of Risks Arising from Exposure to Low Doses of Ionising Radiation (HPA-RPD-055) (Health Protection Agency, June 2009)
High dose radiation effects and tissue injury, RCE 10 (Health Protection Agency/United Kingdom, Independent Advisory Group on Ionising Radiation, March 2009)
Guidance on the application of dose coefficients for the embryo, fetus and breastfed infant in dose assessments for members of the public (RCE-5) (Health Protection Agency, 2008)
Dose assessment of inhaled radionuclides in emergency situations (Health Protection Agency/United Kingdom and Treatment Initiatives After Radiological Accidents (TIARA) project/European Commission, August 2007)
Risk of Leukaemia and Related Malignancies following Radiation Exposure: Estimates for the UK Population (Health Protection Agency, 2003)    

United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Resources

The Chernobyl accident — UNSCEAR's assessments of the radiation effects
Hereditary effects of ionizing radiation: UNSCEAR 2001 Report
Sources and effects of ionizing radiation: UNSCEAR 2000 Report

Other Professional Society Publications and Web Sites With Information About Radiation Medical Response

Disaster preparedness for radiology professionals: Response to terrorism (PDF - 357 KB), (American College of Radiology, 2005, Government Version 3.0)
Executive summary: Developing objectives, content, and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical (NBC) incidents. Ann Emerg Med. 2001 Jun;37(6):587-601
Conference of Radiation Control Program Directors    

National Planning Documents

National Response Framework
NRF Resource Center
NRF Training Courses
Emergency Support Function #8 — Public Health and Medical Services 
Nuclear/Radiologic Incident Annex 
Catastrophic Incident Annex 
Worker Safety and Health Support Annex     

National Incident Management System (NIMS)

NIMS home page    

Incident Command System (ICS)

See: REMM Incident Command System (ICS)
Incident Command System (OSHA)

Printed Publications About Radiation Events

Books About Radiation Medical Response
Shrieve DC, Loeffler JS, eds.: Human Radiation Injury, Wolters Kluwer | Lippincott Williams & Wilkins, Philadelphia, PA, 2011. 
Mettler FA Jr, Upton AC: Medical Effects of Ionizing Radiation, 3rd ed. Philadelphia, Pa: Saunders Elsevier, 2008.
Gusev IA, Guskova AK, Mettler FA Jr, eds.: Medical Management of Radiation Accidents, 2nd ed. Boca Raton, Fl: CRC Press, 2001.
Hall EJ, Giaccia AJ: Radiobiology for the Radiologist, 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2006. 
Ricks RC, Berger ME, O'Hara FM Jr, eds.: The Medical Basis for Radiation-Accident Preparedness: The Clinical Care of Victims. Proceedings of the Fourth International REAC/TS Conference on the Medical Basis for Radiation-Accident Preparedness, March 2001, Orlando, Florida. New York, NY: Parthenon Publishing Group, 2002. 
Browne D, Weiss JF, MacVittie TJ, Pillai MV, eds.: Treatment of Radiation Injuries. Proceedings of the First Consensus Development Conference on the Treatment of Radiation Injuries, Washington, D.C., May 10-13, 1989; New York, NY: Plenum Press, 1990. 
MacVittie TJ, Weiss JF, Browne D, eds.: Advances in the Treatment of Radiation Injuries. Proceedings of the Second Conse nsus Development Conference on the Treatment of Radiation Injuries, Bethesda, MD, April 14-17, 1993; Tarrytown, NY: Pergamon/Elsevier, 1996. 
Glasstone S, Dolan PJ: The Effects of Nuclear Weapons, 3rd ed. Washington, D.C.: US Government Printing Office, 1977.
Walker RI, Cerveny TJ, eds.: Part I, Vol. 2, Medical Consequences of Nuclear Warfare. In: Zajtchuk R, Jenkins DP, Bellamy RF, Ingram VM, eds.: Textbook of Military Medicine. Falls Church, VA: Office of the Surgeon General, Department of the Army, United States of America, 1989. 
Solomon F, Marston RQ, eds.: The Medical Implications of Nuclear War. Steering Committee for the Symposium on the Medical Implications of Nuclear War, Institute of Medicine, 1986. 

Handbooks About Radiation Medical Response

The Medical Aspects of Radiation Incidents (The Radiation Emergency Assistance Center/Training Site [REAC/TS] - May 2010) 
Medical Management of Radiological Casualties (AFRRI, June 2010) 
Handbook for the Triage, Monitoring and Treatment of People in the Event of the Malevolent Use of Radiation - Access through PubMed.gov (Registration required for download)
Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event. Workshop Report. (Institute of Medicine of the National Academies. June 15, 2009. Purchase required.)
Medical Management of Radiation Accidents: Manual on the Acute Radiation Syndrome. (METREPOL) (originally published by Oxford: British Institute of Radiology; 2001) 
Compendium to the main METREPOL document (PDF - 580 KB) 
NATO Handbook on the Medical Aspects of NBC Defensive Operations (Part 1 - Nuclear), (AMEDP-6(B)), (Departments of the Army, Navy, and Air Force), Washington, DC, 1996. 
AFRRI pocket guide: emergency radiation medicine response (AFRRI, July 2008) 
Armed Forces Radiobiology Research Institute (AFRRI) 
Biodosimetry worksheet (AFRRI)
The Medical Aspects of Radiation Incidents (REAC/TS) 

Software Tools for Radiation Event Response

Mobile REMM: Download selected REMM files to your mobile device 
Overview of hazard assessment and emergency planning software of use to RN first responders. Health Phys. 2009 Aug;97(2):145-56.
Interactive RadioEpidemiological Program For Estimating Assigned Share (Probability of Cancer Causation) for Exposures to Radiation (HHS/NIH/NCI).
MEDECOR--a medical decorporation tool to assist first responders, receivers, and medical reach-back personnel in triage, treatment, and risk assessment after internalization of radionuclides. Health Phys. 2010 Oct;99(4):581-90. 



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