ritn ® overview national marrow donor program as of april 9, 2010
TRANSCRIPT
RITN® Overview
National Marrow Donor Program
As of April 9, 2010
RITN Overview Presentation2
Agenda
• Who is RITN?
• What Needs Does RITN Fill?
• What Can RITN Offer?
• What is RITN Doing to Prepare?
• Concerns
RITN Overview Presentation3
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).
RITN Overview Presentation4
RITN Goals
1. Provide facilities and staff for intensive
supportive care and treatment expertise in the
aftermath of a marrow toxic incident resulting in
mass casualties.
2. Educate hematologists, oncologists, and stem
cell transplant practitioners about their potential
involvement in the response to a radiological
incident.
RITN Overview Presentation5
RITN Development Timeline1986 - 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 emphasisNMDP solicits HSCT physician support
2006 - NMDP initiates agreements with 13 transplant centersRITN steering committee finalizes materials
2007 - Expansion of RITN to include donor centers and cord blood banks (52 total centers)
Tomorrow…
RITN Overview Presentation6
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
Executive CommitteeCo-Chaired by
NMDP & ASBMT
Steering Committee
Original 13 RITN
Transplant Center Medical
Directors
External Advisors
(civilian and government)
43 NMDPTransplant Centers
7 NMDPDonor
Centers
7 NMDP & NCBI
Cord Blood Banks
ASBMT NMDP
RITN Oversight and Management
RITN Network
Composition
57 RITN Centers
Organization of RITN
RITN Overview Presentation8
RITN Distribution Across USA
RITN Overview Presentation10
• 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
Possible Events Involving RITN
RITN Overview Presentation11
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
RITN Overview Presentation12
RITN centers plan to receive patients from impacted area
RITN centers are not first responders or a local response asset
RITN Overview Presentation13
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
RITN Overview Presentation14
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
RITN Overview Presentation15
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
RITN Overview Presentation16
RITN Preparedness Efforts
• Standard Operating Procedures
• Standardized admission and treatment orders
• Standardized data collection protocol
• Training
– Basic Radiation Training (over 2000 trained since 2006)
– Additional training resources on www.RITN.net
• Coordination with international organizations
– EBMT and WHO - REMPAN
RITN Overview Presentation1717
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/
ASPRASPRDr. Nicole Lurie
Office of Policy &Strategic Planning
BiomedicalAdvanced Research
& Development
Authority
Office of Medicine, Science
& Public Health
Immediate Office of the ASPR
Office ofPreparedness &
EmergencyOperations
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For treatment guidelines, training & references:
www.REMM.NLM.gov
www.RITN.net
RITN Overview Presentation20
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
RITN Overview Presentation2121
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/radevents/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/Library/catresources.html – Radiation Emergency Medical Preparedness and Assistance Network
(REMPAN): www.who.int/ionizing_radiation/a_e/rempan/