RITN Overview

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RITN Overview

• Cullen Case Jr.
• National Marrow Donor Program
• RITN Program Manager
• As of February 5, 2008

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Agenda

• Who is RITN?
• What Needs Does RITN Fill?
• What is RITN Doing to Prepare?
• What Can RITN Offer?
• Key Partners in the Development of RITN
• Concerns
• List of RITN Centers

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Charter

• The Radiation Injury Treatment Network SM (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 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
• Lewisite (a.k.a. Mustard gas)
• Unknown

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What Needs Does RITN Fill?

• 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

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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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What is RITN Doing to Prepare?

• Standard Operating Procedures
• Basic radiation training completed by staff
• Grand rounds presentation in development
• Additional training resources provided on RITN
  Web site
• Conduct an annual tabletop exercise
• Emergency communications tests
• GETS cards and satellite telephones
• Coordinating with government (DHHS-ASPR)

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What Can RITN Offer?

• 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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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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