References for METREPOL: MEdical TREatment ProtocOLs for Radiation Accident Victims

This interactive tool is based on METREPOL guidance provided in the following references.

1. Triage, Monitoring and Treatment of people exposed to ionising radiation following a malevolent act, (PDF - 11 MB) (Chapter J, Table J8) (TMT Handbook Partners, March 2009)
2. Fliedner TM, Friesecke I, Beyrer K. Medical Management of Radiation Accidents: Manual on the Acute Radiation Syndrome. (METREPOL) (PDF - 970 KB) (originally published by Oxford: British Institute of Radiology; 2001) Compendium to the main METREPOL document (PDF - 580 KB)
   • This landmark publication describes in detail the METREPOL system (Medical Treatment Protocols for Radiation Accident Victims). Developed in Europe, METREPOL provides tools for diagnosis and triage of persons exposed to radiation in small and medium size radiation accidents. It was not developed to address triage and management in very large incidents such as an IND.
   • An updated version of METREPOL reflects the new paradigm of radiation-induced pathophysiology: multi-organ injury (MOI), multi-organ dysfunction syndrome (MODS), and multi-organ failure (MOF).
   • See graphic representation of Hematopoietic Subsyndrome: H1, H2, H3, H4.
3. Gorin NC, Fliedner TM, Gourmelon P, Ganser A, Meineke V, Sirohi B, Powles R, Apperley J. Consensus conference on European preparedness for haematological and other medical management of mass radiation accidents. Ann Hematol. 2006 Oct;85(10):671-9. [PubMed Citation]
4. Fliedner TM, Dorr HD, Meineke V. Multi-organ involvement as a pathogenetic principle of the radiation syndromes: a study involving 110 case histories document in SEARCH and classified as the bases of haematopoietic indicators of effect. BJR Suppl. 2005;27:1-8.
5. Fliedner TM. Nuclear terrorism: the role of hematology in coping with its health consequences. Curr Opin Hematol. 2006 Nov;13(6):436-44. [PubMed Citation]
6. Fliedner TM, Graessle D, Meineke V, Dorr H. Pathophysiological principles underlying the blood cell concentration responses used to assess the severity of effect after accidental whole-body radiation exposure: an essential basis for an evidence-based clinical triage. Exp Hematol. 2007 Apr;35(4 Suppl 1):8-16. [PubMed Citation]

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