We thank Fliedner et al for their comments on our review1 and look forward to collaborative efforts between the Radiation Injury Treatment Network (RITN) and the European Group for Blood and Marrow Transplantation (EBMT) to enhance event response, communication, and data collection. We agree that logistically cumbersome approaches to biodosimetry will not be useful for classifying the vast majority of victims after a mass casualty incident. Protocols that rely on clinical findings and/or peripheral blood cell counts, such as METREPOL (Medical Treatment Protocols for Radiation Accident Victims), are currently the most practical means for large-scale dosimetry.2 In fact, the RITN Acute Radiation Syndrome Treatment Guidelines3 incorporate the METROPOL assessment, but include additional dosimetry estimators that rely solely on time-to-vomiting or lymphocyte depletion kinetics.4
Although METREPOL can accurately identify victims of radiation accidents with irreversible marrow damage,5 it does not clearly distinguish those who may benefit from hematopoietic stem cell transplantation from those who received invariably lethal doses. The latter group may best be served with only comfort measures. Also, METREPOL is based on collective experience from victims of radiation accidents. Important differences between accidental and intentional exposures may exist. For example, partial body shielding from buildings and other structures may differ between radiation accidents and intentional events like an improvised nuclear device.
There are significant research efforts under way in the United States to develop more efficient and accurate technologies to estimate radiation dose. With the impending availability of personalized genomic sequencing,6 future methods for biodosimetry could even include genetic polymorphisms that affect radiation response. Obviously, practical aspects such as cost, turnaround time, ease of use, and availability within a disaster zone remain of paramount importance.
Manuscript space limitations prevented us from outlining RITN efforts at training and emergency communications. Since August 2006, more than 700 staff members at RITN centers have completed the RITN Basic Radiation Training Course.7 RITN is also coordinating an advanced Radiation Emergency Medicine course through the Radiation Emergency Assistance Center/Training Site (REAC/TS).
To enhance communication after an event, RITN established a comprehensive program designed for various scenarios. After events that cause minimal disruption to the communication infrastructure, RITN centers will utilize WebEOC, an Internet-based crisis information management system, to interact with other centers, review incident updates, and submit incident-related documents. All RITN centers are equipped with National Communication System Government Emergency Telecommunications Service (NCS GETS) calling cards, which allow users to bypass congested telephone lines and place calls during even the most disruptive events. Finally, all RITN centers are issued a portable satellite telephone.
Authorship
Conflict-of-interest disclosure: The authors declare no competing financial interests.
Correspondence: David M. Weinstock, MD, Dana-Farber Cancer Institute, 44 Binney Street, D510B, Boston, MA 02115; e-mail: DavidM_Weinstock@dfci.harvard.edu.
Acknowledgment:
This project has been supported by funding from the National Marrow Donor Program and the Department of the Navy, Office of Naval Research grant #N00014-06-1-0704 to the National Marrow Donor Program. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Office of Naval Research or the National Marrow Donor Program.
