Radiation Emergency Medical Management (REMM), a Great NLM Resource for Physicians

27 03 2011

NLM’s PubMed is so well know that you almost forget NLM has a lot of other excellent resources. Of course there is NIH/NLM’s MedLine Plus, a health web site for consumers. And there is TOXNET (TOXicology Data NETwork, managed by TEHIP, SIS and NLM) which is a cluster of databases covering toxicology, hazardous chemicals, environmental health and related areas. (see factsheet).

What I didn’t know is that there are databases beyond TOXNET, one of them being Radiation Emergency Medical Management (REMM). I just found it by chance, while looking at NLMs’ apps and mobile websites. (quite a coincidence considering the recent Japanese nuclear disaster and the fact that my searches are seldom about emergencies and acute toxicities).

REMM is produced by the Department of Health and Human Services, in cooperation with the NLM, the Division of Specialized Information Services (SIS), with subject matter experts from the National Cancer Institute, the Centers for Disease Control and Prevention (CDC), and many US and international consultants (see REMMs’ “About This Site”).

REMM is meant primarily for physicians. It aims to provide just-in-time, evidence-based, usable information with sufficient background and context to make complex issues understandable to those without formal radiation medicine expertise. It offers easy-to-follow algorithms on clinical diagnosis, treatment, and management of radiation contamination and exposure during mass casualty radiological/nuclear emergencies.

I found the site impressive. It seems very complete and yet intuitive to use. Although primarily meant for physicians, the background information about radiation emergencies looks suitable for everyone looking for factual information about radiation emergencies.


REMM homepage: click to enlarge

The homepage shows 9 main topics. Five of these can also reached by the drop-down menu at the top (shown: initial event activities).

The topics (and subtopics) are arranged in a very logical way (black: also drop down menu).

  1. What Kind Of Emergency?
  2. On-site Activities
  3. Other Audiences
  4. About this site
  5. Patient Management
  6. Management Modifiers
  7. Tools & Guidelines
  8. Reference/Data Center

At the right, is a column with features and quick links. Very handy if you want to quickly access a specific topic, like Patient Management Algorithms and Dose Estimator for Exposure. There is also a separate page with information for new users: New Users: Where Do I Start?

So depending on one’s knowledge and the situation one can choose where to start.

In the Japanese situation one could start with : “what kind of emergency” and choose Nuclear Reactor Accidents. Here you find basic info about a nuclear reactor, about emergency planning and control, and radioisotopes in the plume. The differences between external exposure to highly radioactive materials within the reactor, and external and internal radioactive contamination is explained in a very concise, but clear way.

From here one could go to initial on-site activities with very important first steps, like Notify appropriate authorities, Wear personal protective equipment (PPE), Use personal dosimeters etc, and to “Manage the Victims: Triage, Treat, Transport”

A very useful part of the websites are the practical triage guidelines, algorithms (see here the algorithm for contamination only; the Fig. below only shows the top part) and calculators

Part of the algorithm: Contamination: Diagnose/Manage (see text)

They have also made many video-instructions available on YouTube. Here is one YouTube video showing 3 biodosimetry tools:

As said there is also a Mobile version of REMM with selected, key files: the content has just been updated for 3 existing platforms (For iPhone®/iPod touch®, For Blackberry®, For Windows Mobile®). It should also include a new Android version, which I fail to find on the site.

In addition, the entire REMM web site can be downloaded to a laptop or desktop computer for use where there is no Internet connection.

To keep updated and join discussions you can join the REMM ListServ.