RITN Overview

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RITN Overview

• National Marrow Donor Program
• As of September 4, 2009

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Agenda

• Who is RITN?
• What Needs Does RITN Fill?
• What Can RITN Offer?
• What is RITN Doing to Prepare?
• Concerns

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Charter

• The Radiation Injury Treatment Network (RITN)
  provides comprehensive evaluation and treatment
  for victims of radiation exposure or other marrow
  toxic injuries. RITN develops treatment
  guidelines, educates health care professionals,
  works to expand the network, and coordinates
  situation response. RITN is a cooperative effort
  of the National Marrow Donor Program (NMDP) and
  The American Society for Blood and Marrow
  Transplantation (ASBMT).

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RITN Goals

• Provide facilities and staff for intensive
  supportive care and treatment expertise in the
  aftermath of a marrow toxic incident resulting in
  mass casualties.
• Educate hematologists, oncologists, and stem cell
  transplant practitioners about their potential
  involvement in the response to a radiological
  incident.

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RITN Development Timeline

• 1986 - Initiation of NMDP - Navy relationship
• 86-01 - Response network realized as an
  unfulfilled need
• 2001 - NMDP begins organizing concept of core
  network
• 2003 - NMDP transplant center physicians discuss
  options
• 2004 - ASBMT joins initiative
• 2005 - ASBMT increases emphasis
• NMDP solicits HSCT physician support
• 2006 - NMDP initiates agreements with 13
  transplant centers
• RITN steering committee finalizes materials
• 2007 - Expansion of RITN to include donor centers
  and cord blood banks (52 total centers)
• Tomorrow

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Key Partners in the Development of RITN

• American Society for Blood and Marrow
  Transplantation (ASBMT)
• Department of Defense - Office of Naval Research
  (ONR)
• Health Resources and Services Administration
  (HRSA)
• Center for International Blood and Marrow
  Transplant Research (CIBMTR)
• Radiation Emergency Assistance Center/Training
  Site (NNSA, DOE)
• Dept. Health Human Services - Asst. Secretary
  of Preparedness and Response (DHHS-ASPR)
• National Library of Medicine - Radiological Event
  Medical Management (NLM-REMM) www.remm.nlm.gov
• Leading hematopoietic stem cell transplantation
  physicians

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Organization of RITN
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RITN Distribution Across USA
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Possible Events Involving RITN

• Focus of preparations Any incident resulting in
  mass casualties with a marrow toxic injury
• Examples of possible events
• Radiological
• Improvised Nuclear Device (IND)
• Military grade nuclear weapon
• Radiological exposure device (open source)
• Radiological Dispersal Device (RDD) a.k.a. dirty
  bomb
• Less likely to overwhelm existing response
  resources
• Chemical Mustard gas
• Unknown

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What Need Does RITN Fulfill?

• Provide ready facilities with practicing
  specialists for intensive supportive care and
  treatment
• Infrastructure and process for transplant if
  needed
• Increases transplant community awareness about
  potential need of their services in time of
  crisis
• Involves transplant community in emergency
  preparedness
• Most victims of a marrow toxic mass casualty
  incident will require intensive supportive care
  to recover without a transplant

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RITN centers plan to receive patients from
impacted areaRITN centers are not first
responders or a local response asset
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RITN Centers are Cancer Specialists

• RITN centers are NOT first responders
• Not HAZMAT (Hazardous Materials) technicians
• Not victim triage experts
• Not decontamination specialists
• Not emergency medical specialists
• Not trauma or burn specialists
• RITN staff are cancer treatment experts

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RITN Centers are Cancer Specialists

• In the aftermath of a marrow toxic incident, RITN
  centers may be asked to
• Accept patient transfers to their institutions
• Provide treatment expertise to practitioners
  caring for victims at other centers
• Travel to other centers to provide medical
  expertise
• Provide data on victims treated at their centers

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What RITN Offers to the Response?

• Provide expert knowledge based on significant
  practical experience in treating patients with
  compromised immune-systems
• Treatment facilities for victims
• Regional dispersion other transplant physicians
  can talk to a peer in RITN
• Available through RITN Website www.RITN.net
• RITN Acute Radiation Syndrome treatment
  guidelines
• RITN center standard operating procedure
  templates
• Donor selection criteria
• NMDP data collection protocol
• Training resources
• Pertinent publications

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RITN Preparedness Efforts

• Standard Operating Procedures
• Standardized admission and treatment orders
• Standardized data collection protocol
• Training
• Basic Radiation Training (over 1800 trained since
  2006)
• Additional training resources on www.RITN.net
• Coordination with international organizations
• EBMT and WHO - REMPAN

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RITN Preparedness Efforts

• Conduct readiness exercises
• Annual tabletop exercise
• Participate in national exercises (TOPOFF 4,
  Pinnacle 07)
• Participate in international exercises (IAEA
  ConEX 2008)
• Emergency communications equipment
• Government Emergency Telecommunication Service
  (GETS) calling cards
• Satellite telephones
• Contracted HLA typing laboratories 6 10,000 per
  week during an emergency
• Internet based cord blood unit searching
• Data collection protocol

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Office of Assistant Secretary for Preparedness
and Response
http//www.hhs.gov/aspr/
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For treatment guidelines, training references
www.RITN.net
www.REMM.NLM.gov
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Concerns

• Funding to cover cost of treatment
• Catastrophic event may overwhelm national
  capabilities
• 10KT device ? 30,000 victims for treatment??
• Complacency in absence of an actual event
• International coordination

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Resources for further investigation

• Incidents
• IAEA nuclear incidents list http//www-news.iaea.
  org/news/
• Database of Radiological Incidents and Related
  Incidents www.johnstonsarchive.net/nuclear/radev
  ents/index.html
• Treatment
• Radiation Injury Treatment Network (RITN)
  www.RITN.net
• Radiation Event Medical Management (REMM)
  www.remm.nlm.gov
• Radiation Emergency Assistance Center/Training
  Site (REAC/TS) www.orau.gov/reacts
• Radiation Countermeasures Center of Research
  Excellence (RadCCORE) www.radccore.org
• Bio-dosimetry Treatment
• Armed Forces Radiobiology Research Institute
  (AFRRI) www.afrri.usuhs.mil
• Other
• IAEA Library http//www.iaea.org/DataCenter/Libra
  ry/catresources.html
• Radiation Emergency Medical Preparedness and
  Assistance Network (REMPAN) www.who.int/ionizing
  _radiation/a_e/rempan/

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