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Emory leads two-day radiation response exercise at Emory Hospital and Dobbins Air Reserve Base

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Holly Korschun

At Dobbins Air Reserve Base (DARB) in Marietta on Saturday morning, Sept. 17, Emory nursing and public health students walked onto the airfield and into the cavernous body of a C-130 Hercules aircraft, where they were cheerfully strapped onto stretchers piled five-high. Moments after the two back flaps of the airplane were folded up behind them, they heard the call: "the exercise has begun."

Georgia State Defense Force and Cobb Medical Reserve Corps personnel walked in formation onto the airplane, secured the stretchers, and briskly carried the volunteers, who were simulating patients with radiation injuries, into a bustling triage area established in a huge aircraft hangar nearby.

Emory and Atlanta VA Medical Center physicians and nurses performed simulated medical evaluations, and EMTs from Atlanta Fire and Rescue and Gwinnett County Fire and Emergency Services placed the most severely injured "patients" onto rolling stretchers, wheeled them into two mobile ambulance buses, and placed them on stretchers stacked in bunk-bed fashion. Cobb/Douglas Public Health personnel assisted the VA with command and control functions.

This mock scenario was part of a drill named "Operation Gateway," which included more than 250 people representing over 15 health care and government agencies simulating the local response to a mock radiation incident with mass casualties. The drill began in reverse at Emory University Hospital the day before, as medical personnel and EMTs simulated unloading the injured patients from the mobile ambulance buses.

Sam Shartar, senior administrator of Emory's Office of Critical Event Preparedness and Response (CEPAR), directed the full-scale exercise. "This exercise is important because we are able to test the processes required to receive large numbers of casualties. Improvised nuclear detonations are low probability, high consequence events. Having said this, these same processes will be utilized for response to hurricanes, floods or earthquakes, which are a higher probability event," says Shartar.

The drill was conducted by the Emory Radiation Injury Treatment Network (RITN), which is part of the national response plan for  a mass casualty radiation incident resulting in bone marrow-toxic injuries. Emory University Hospital (EUH) is a RITN center. If a nuclear device were detonated somewhere in the United States, the National Disaster Medical System (NDMS) would be activated. Military aircraft would transport persons injured by ionizing radiation to DARB. The patients would then be transported to Emory University Hospital and Northside Hospital for treatment. Radiation injuries would include bone marrow damage, with some patients potentially requiring bone marrow transplants.

Emory's RITN is a collaborative effort of Emory University's Bone Marrow & Stem Cell Transplant Program, Winship Cancer Institute, Emory's CEPAR, the Department of Emergency Medicine in Emory School of Medicine, the Georgia Poison Center and Emory University Hospital.

The overall exercise evaluated the operational capabilities required for Emory and its regional partners to treat and transport patients exposed to radiation. It also assessed coordination of the EUH response with the Federal Coordinating Center (FCC) at the Atlanta Veterans Affairs Medical Center, DARB, Cobb/Douglas Public Health, and other state and regional partners.

The RITN is coordinated through the National Marrow Donor Program and is funded by the Department of Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR), and the Office of Naval Research. RITNs have broad responsibility during a response. The RITN centers may accept patient transfers from other institutions, provide intensive supportive care to victims, provide treatment expertise for practitioners at other locations, travel to other centers to provide medical expertise, facilitate marrow transplant when required, and collect and provide data on patients treated.

"It is important for these agencies to test processes. Given the multiple agencies involved, the intersection of these interfaces can create challenges with communications. These exercises allow our responders to be better postured to respond during an actual event," says Shartar.

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