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  You are here:  HOME  >  Medical/Operational Guidance for Managing Radiation Casualties

Medical/Operational Guidance for Managing Radiation Casualties

Some AFRRI information products are available to qualified users from the Defense Technical Information Center.
"AD" numbers that appear after titles are assigned by DTIC for its use in locating documents.
  Depleted uranium
  Potassium iodide
  Prussian blue therapy for radiocesium contamination
  • Q&A on Prussian blue (2003)—Questions are answered by the FDA
  • AFRRI guidelines (PDF; 2005)—Use of Prussian blue (Radiogardase™) for treatment of internal radiocesium contamination, supplements Food and Drug Administration (FDA) guidance
  • AFRRI Prussian blue work sheet (PDF; 2005)—Form describing the initial assessment and treatment of casualties from a radiation dispersal device (RDD) event that involves the dispersal of radioactive cesium or thallium
  • DoD HA Policy 05-007 (PDF; 2005)—Procedures for using Prussian blue (ferric hexacyanoferrate or Radiogardase™), approved by the FDA for patients with known or suspected internal contamination with radioactive cesium and/or radioactive or nonradioactive thallium
  • FDA label for Radiogardase™ (PDF; 2008)—Manufacturer's product information for capsules containing Prussian blue insoluble powder
  Medical Management of Radiological Casualties handbookMedical Management of Radiological Casualties, Fourth Edition
The July 2013 handbook provides concise supplemental reading material for the Medical Effects of Ionizing Radiation (MEIR) Course.

The 3.75- by 5.5-inch, spiral-bound, laminated handbook fits readily in a pocket. It provides tabs to topics that include acute radiation syndrome, biodosimetry, skin injury, internal contamination, psychological support, delayed effects, and decontamination. Charts and photos provide at-a-glance detail.

The information was prepared by Ronald E. Goans, PhD, MD, and edited by the AFRRI Military Medical Operations staff. The handbook is designed to be used by emergency responders and medical professionals who may have minimal knowledge of the effects of ionizing radiation on the human body.

The Fourth Edition also is available free of charge as a PDF (portable document format) file via the View/save link below.


Planning Guidance for Response to a Nuclear DetonationPlanning Guidance for Response to a Nuclear Detonation, Second Edition—The guidance was developed by a Federal interagency committee led by the Executive Office of the President (National Security Staff and Office of Science and Technology Policy) with representatives from the Departments of Defense, Energy, Health and Human Services, Homeland Security (DHS), Labor, Transportation, Veteran’s Affairs, the Environmental Protection Agency, the National Aeronautics and Space Administration, and the Nuclear Regulatory Commission.

From the Second Edition's Foreword: "The First Edition planning guidance summarized recommendations based on what was known about the consequences of a nuclear detonation in an urban environment extrapolating from the experience base of nuclear weapons testing. It provided recommendations based on existing knowledge and existing techniques. The Federal government immediately initiated ongoing studies that have provided more robust and comprehensive recommendations. Some recommendations in this Second Edition planning guidance are updated or expanded to capture recommendations that have been drawn from these studies. Most notably, a chapter has been added to address public preparedness and emergency public communications."
  Emergency Radiation Medicine Response—AFRRI Pocket Guide
AFRRI Pocket GuideThe 2008 Pocket Guide can be consulted quickly to assess and control an emergency situation. It defines radiation exposure and describes steps in diagnosis, treatment, decontamination, and reporting.
  • View/Save (PDF)
  • Print on 8.5- by 11-inch paper, landscape, two-sided, and fold

Textbooks of Military MedicineDOD Textbooks of Military Medicine—Medical Consequences of Radiological and Nuclear Weapons (2012)—An updated version of the 1989 TMM, this volume addresses nuclear events and their consequences for the medical community. Topics covered include acute radiation syndrome, triage and treatment of radiation and combined-injury mass casualties, treatment of internal radionuclide contamination, behavioral and neurophysiological consequences of radiation exposure, cytogenetic biodosimetry, and more.

Developed by AFRRI in conjunction with the Borden Institute, this version was adapted from its original hardbound version published by the Office of the Surgeon General, Department of the Army, United States of America. Chapters (PDF files):

  1. Radiological Events and Their Consequences (Woodruff CR, Alt LA, Forcino CD, Walker RI)
  2. Acute Radiation Syndrome in Humans (Goans RE, Flynn DF)
  3. Triage and Treatment of Radiation and Combined-Injury Mass Casualties (Flynn DF, Goans RE)
  4. Treatment of Internal Radionuclide Contamination (Kalinich JF)
  5. Therapy for Bacterial Infections Following Ionizing Radiation Injury (Elliott TB, Ledney GD)
  6. Early-Phase Biological Dosimetry (Blakely WF)
  7. Behavioral and Neurophysiological Consequences of Radiation Exposure (Obenaus A, Mickley GA, Bogo V, West BR, Raber J)
  8. Psychological Issues in a Radiological or Nuclear Attack (Becker SM)
  9. Late and Low-Level Effects of Ionizing Radiation (Miller AC, Satyamitra M, Kulkarni S, Walden T)
  10. Radiological Considerations in Medical Operations (Madrid JP)
  11. Perspectives in Radiological and Nuclear Countermeasures (Kumar KS, Kiang JG, Whitnall MH, Hauer-Jensen M)
  12. Cytogenetic Biodosimetry (Prasanna PGS, Coleman CN)

For sale ($54.00) by the Superintendent of Documents, U.S. Government Printing Office (bookstore.gpo.gov). Telephone: 866-512-1800; DC area: 202-512-1800. Fax: 202-512-2104.


AFRRI CD07-1Radiation Training and Assessment Tools,
AFRRI CD 07-1, Fourth Edition
—The December 2007 shirt pocket-size CD contains tools and information for the medical management of radiation casualties; many of the contents are available individually from this page and others at this Web site.

Contains specialized software Biodosimetry Assessment Tool, BAT) for recording relevant data supporting medical management of radiation casualties.

CD distribution is controlled by AFRRI Military Medical Operations.

TMT HandbookTMT Handbook—Triage, Monitoring and Treatment of People Exposed to Ionising Radiation Following a Malevolent Act
The handbook provides practical tools to help emergency responders train, plan, and execute responses to incidents involving the malevolent use of ionizing radiation.

Content includes radiological triage, monitoring, and treatment as well as protection of responding personnel.

This handbook was developed in a European research project (2006–2009) under the FP6 Euratom program. The project includes six European partners plus the World Health Organization (WHO).

The handbook was presented at the Third European IRPA Congress in Helsinki, Finland, June 14–18, 2010.

PDF available HERE.

  Quick Reference Information—Recommendations of the National Council on Radiation Protection (NCRP) and Measurements, from its Management of Persons Contaminated with Radionuclides: Handbook, NCRP Report No. 161.