Table 7.

Recommendations for medical response following radiological triage screening by radionuclide and estimated range of effective dose based on survey meter count rate measurements.

	Ranges of Effective Dose and Their Corresponding Recommended Medical Response
	Effective Dose	Effective Dose	Effective Dose	Effective Dose
	< 50 mSv	50–250 mSv	250–500 mSv	>500 mSv
Radionuclide	Triage Condition I	Triage Condition II	Triage Condition III	Triage Condition IV
Am-241	K	K, M	A, B, C, D, E, F, L, M	A, B, C, D, E, F, J, L, M
Co-60	K	K, M	A, B, C, D, E, F, L, M	A, B, C, D, E, F, J, L, M
Cs-137	K	K, M	A, B, C, D, E, G, L, M	A, B, C, D, E, G, J, L, M
I–131	K	K, M	H, L, M	H, L, M
Ir-192	K	K, M	A, B, C, D, E, I, L, M	A, B, C, D, E, I, J, L, M

Recommendations based on availability of resources:

^AIf medical evaluation is within 30–60 minutes of inhalation, perform nasal swabs (see NCRP Report No. 161)

^BIf medical evaluation is within 24 hours of ingestion, provide cathartics

^CObtain baseline Complete Blood Count (CBC), Serum Electrolytes, and Chemistry Panel

^DCollect 24-hour urine and stool samples for bioassay analysis

^EObtain serial CBCs every 8 to 12 hours for 3 days, and then daily for an additional 4 days to rule out Acute Radiation Syndrome.

^FPrescribe DTPA per FDA guidelines (see FDA website or NCRP Report No. 161). DTPA is FDA approved only for chelation of americium, curium, and plutonium. Other uses of DTPA are off-label. If DTPA will not be available for several hours, consider initiating EDTA treatment per FDA guidelines. EDTA is FDA approved only for lead poisoning. Other uses of EDTA are off-label. Change to DTPA when available.

^GPrescribe Prussian Blue (Ferric Ferrocyanate, Radiogardase®) per FDA guidelines (see FDA website or NCRP Report No. 161). Prussian Blue is FDA-approved only for cesium and thallium intakes. Other uses are off-label.

^HPrescribe potassium iodide (KI) per FDA guidelines. KI is FDA-approved only for treatment of radioactive iodine (RAI) intake. Criteria for treatment and dosing is dependent on subject age and pregnancy and lactation status.

^IThere is limited clinical experience with the use of DTPA or EDTA for internal contamination with iridium. Recommend to consider using DTPA off-label and follow FDA drug guidance. If DTPA is not available, consider using EDTA off-label.

^JAt the physician’s discretion, consider performing lung lavage for inhalational injury with effective dose > 2000 mSv based on risk/benefit

^KFollow-up with primary care physician for routine cancer screening.

^LFollow-up with primary care physician for high-risk cancer screening.

^MConfirm triage condition (dose range) via (1) urine bioassay, (2) whole-body counting, or (3) gamma-camera imaging (see http://www.bt.cdc.gov/radiation/ clinicians/evaluation)