Developing a practical algorithm for a pediatric emergency department's response to radiological dispersal device events

OBJECTIVE: In the aftermath of the detonation of a radiological dispersal device (RDD), or "dirty bomb," a large influx of children would be expected to present to the emergency department, including many patients not directly affected by the event who present with concerns regarding radiation exposure. Our objective was to develop an algorithm for efficiently and effectively triaging and appropriately treating children based on the likelihood of their having been contaminated or exposed. METHODS: The hospital's disaster preparedness committee with the help of disaster planning experts engaged in an iterative process to develop a triage questionnaire and patient flow algorithm for a pediatric hospital following an RDD event. The questionnaire and algorithm were tested using hypothetical patients to ensure that they resulted in appropriate triage and treatment for the full range of anticipated patient presentations and were then tested in 2 live drills to evaluate their performance in real time. RESULTS: The triage questionnaire reduced triage times and accurately sorted children into groups based on the type of intervention they required. Nonmedical personnel were able to administer the triage questionnaire effectively with minimal training, relieving professional staff. The patient flow algorithm and supporting materials provided direction to staff about how to appropriately treat patients once they had been triaged. CONCLUSIONS: In the event of the detonation of an RDD, the triage questionnaire and patient flow algorithm presented would enable pediatric hospitals to direct limited resources to children requiring intervention due to injury, contamination, or exposure.