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The 1st EBMT-NAC training course
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| Participants at the 1st NAC Training Course |
The first EBMT training course for transplant physicians from various EBMT centres was held in Munich on 28th to 30th Nov 2007.This was a pivotal moment in the activity of the NAC, because after five years of planning we now have started a pathway for the practical delivery of help for victims in the event of a large nuclear accident.
The background to this success started after 9/11 in 2001. The NAC committee was formed following meetings with interested bodies such as World Health Organisation / International Atomic Energy Association and various national nuclear protection agencies in which it became clear there was an increasing risk of a large nuclear accident particularly from a terrorist source.
The next step was a consensus conference of EBMT member physicians held in October 2005 at Vaux de Cernay, Paris (Gorin NC et al, Annals Haematology, 2006: 85(10): 671-9) at which we agreed on some practical principles relating to triage, and treatment. From that meeting a pocket guide was produced and distributed to all EBMT centres in March 2007. However, we knew that to make it work we would need training for individual doctors within the EBMT hospitals in Europe who do not have adequate information regarding the challenges that would be posed in case of a radiation accident/nuclear emergency if it were to occur. In such a scenario, radiation victims will probably end up in EBMT centres anyway for haematopoietic support and possibly stem cell transplantation and we feel we have a commitment to optimise this resource by training physicians and nurses within EBMT centres to handle this problem.
There are also currently no guidelines/Standards of Practice (SOP) for treating these patients and the focus of guidelines until now has been on first responders at the site of accident (for e.g. the IAEA guidelines) with the recommendation of being admitted or seen at a hospital. EBMT centres with their trained physicians and nursing staff are used to dealing with these patients who are likely to have multi-organ involvement. However, there are some differences between patients treated with total body irradiation (TBI) as part of their conditioning regimen, who receive a homogenous dose within a controlled environment compared to radiation victims who are likely to be exposed to a dose of radiation, the characteristics of which are unknown and these patients may also have other effects of radiation on neurovascular, cutaneous and gastro-intestinal system. A multi-disciplinary team approach to treating these patients would be required. From past experiences of accidental irradiation worldwide, EBMT is in the process of developing practice-oriented guidelines for clinicians who will treat these patients.
This first Munich course was overbooked and feedback says it was a huge success. It was a comprehensive course that dealt with the background information on biophysical and radiobiological facts on ionizing radiation exposure, consequences of radiation exposure on various organ systems. Central to the course was the use of the METREPOL response categories criteria document which uses information from nearly 1000 previous victims to evaluate patients for severity of exposure (based on clinical signs and symptoms), optimal treatment options available including the indications and non-indications for stem cell transplantation, and addressing the pre-requisites for patients care including legal and administrative problems. The Munich course also included practical exercises for participants, using case report reviews of previous accidental exposures, so as to gain experience in triage and the impact of response categories on guiding treatment decisions and outcome. The well attended course received accreditation from EACCME (European Accreditation Council for Continuing Medical Education) and was successfully organised by Prof Ted Fliedner and Prof Viktor Meineke. It was in part supported financially by the German government. This course was a forerunner to regular courses throughout Europe, and other NAC Committee work including a planned mock exercise within a year and an education session at the EBMT Annual meeting at Florence in March 2008.
Further coordinated and integrated effort is needed at European and national levels to obtain funding that would allow systematic studies in the patho-physiology and treatment of radiation induced health impairments.
Dr Bhawna Sirohi
Secretary to the EBMT nuclear accident committee
Prof Ray Powles
Chairman, EBMT NAC
Prof Dietger Niederwieser
President EBMT
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