Environmentally sustainable emergency medicine.

Emergency clinicians worldwide are demonstrating increasing concern about the effect of climate change on the health of the populations they serve. The movement for sustainable healthcare is being driven by the need to address the climate emergency. Globally, healthcare contributes significantly to carbon emissions, and the healthcare sector has an important role to play in contributing to decarbonisation of the global economy. In this article, we consider the implications for emergency medicine of climate change, and suggest ways to improve environmental sustainability within emergency departments. We identify examples of sustainable clinical practice, as well as outlining research proposals to address the knowledge gap that currently exists in the area of provision of environmentally sustainable emergency care.

[Hypnosis in emergency medicine : let's change our habits!] / Hypnose en médecine d'urgence : bousculons nos habitudes !

The effectiveness of hypnosis in the management of pain and anxiety has been widely demonstrated today. While this technique is commonly used in anesthesia and psychiatry, its use in emergencies is still poorly developed. The fields of application in hospital and extra-hospital emergency are however multiple and, contrary to popular belief, emergencies are the ideal place for the practice of hypnosis. Hypnosis is a reliable, safe, effective and inexpensive technique that any caregiver can learn. It strengthens the caregiver-patient relationship and helps us to treat differently, more humanly and more serenely.

L'efficacité de l'hypnose dans la prise en charge de la douleur et de l'anxiété est aujourd'hui largement démontrée. Si cette technique est d'usage courant en anesthésie et psychiatrie, son utilisation en situation d'urgence est encore peu développée. Les champs d'application en médecine d'urgence (MU) hospitalière et préhospitalière sont pourtant multiples et, contrairement aux idées reçues, les urgences sont le lieu idéal pour la pratique de l'hypnose. C'est une technique fiable, sûre, efficace et peu coûteuse que tout soignant peut apprendre. Elle renforce la relation soignant-soigné et nous aide à intervenir autrement, plus humainement et plus sereinement.

Application of Virtual Reality Technology in Disaster Medicine.

The occurrence of major emergencies often leads to environmental damage, property damage, health challenges and life threats. Despite the tremendous progress we have made in responding to the many challenges posed by disasters in recent years, there are still many shortcomings. As an emerging technology widely used in recent years, virtual reality (VR) technology is very suitable for many fields of disaster medicine, such as basic education, professional training, psychotherapy, etc. The purpose of this review article is to introduce the application of VR technology in the disaster medical field and prospect its trend in the future.

Fournier Gangrene: A Review for Emergency Clinicians.

BACKGROUND: Fournier gangrene (FG) is a rare, life-threatening infection that can result in significant morbidity and mortality, with many patients requiring emergency department (ED) management for complications and stabilization. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of FG. DISCUSSION: Although originally thought to be an idiopathic process, FG has been shown to have a strong association for male patients with advanced age and comorbidities affecting microvascular circulation and immune system function, most commonly those with diabetes or alcohol use disorder. However, it can also affect patients without risk factors. The initial infectious nidus is usually located in the genitourinary tract, gastrointestinal tract, or perineum. FG is a mixed infection of aerobic and anaerobic bacterial flora. The development and progression of gangrene is often fulminant and can rapidly cause multiple organ failure and death, although patients may present subacutely with findings similar to cellulitis. Laboratory studies, as well as imaging including point-of-care ultrasound, conventional radiography, and computed tomography are important diagnostic adjuncts, though negative results cannot exclude diagnosis. Treatment includes emergent surgical debridement of all necrotic tissue, broad-spectrum antibiotics, and resuscitation with intravenous fluids and vasoactive medications. CONCLUSIONS: FG requires a high clinical level of suspicion, combined with knowledge of anatomy, risk factors, and etiology for an accurate diagnosis. Although FG remains a clinical diagnosis, relevant laboratory and radiography investigations can serve as useful adjuncts to expedite surgical management, hemodynamic resuscitation, and antibiotic administration.

[Hyperbaric medicine and emergency medicine, an example of decompression sickness in diving]. / Hyperbarie et médecine d'urgence, exemple de l'accident de désaturation en plongée.

One of the reasons for the emergency use of a hyperbaric chamber concerns a diving-related accident. Decompression sickness is potentially serious; it requires urgent treatment and hyperbaric recompression. It is caused by the formation of nitrogen bubbles in the organism which appear during the diver's ascent and throughout his or her decompression.

Ultrasonido de urgencia realizado por cirujanos en pacientes ingresados en el Departamento de Urgencia / Surgeon-performed emergency ultrasonography on patients admitted to the Emergency Department

Introducción: a nivel mundial, el uso del ultrasonido en el departamento de urgencia se considera una herramienta importante para la evaluación inicial del paciente con patologías quirúrgicas. En nuestro país, por diferentes cuestiones, se hace difícil la realización rápida de este proceder. Objetivo: determinar si el uso del ultrasonido por cirujanos generales es un método de diagnóstico eficaz en pacientes ingresados en el departamento de urgencia. Método: se realizó un estudio observacional, descriptivo, longitudinal, de carácter prospectivo, en el departamento de urgencia del Hospital Universitario Dr. Miguel Enríquez desde 1 enero hasta 30 abril de 2017 con una totalidad de 96 pacientes. Se efectuó estudios ultrasonográficos a los pacientes que presentaron criterio para su uso. Se determinó la coincidencia entre el diagnóstico clínico, quirúrgico y el ultrasonográfico. Resultados: se analizaron 96 pacientes con predominio del sexo femenino 50 (52,1 por ciento). El diagnóstico clínico más frecuente encontrado fueron las afecciones por traumas 41 (42,7 por ciento). Se logró una mejor coincidencia entre el diagnóstico clínico y ultrasonográfico en las afecciones traumáticas (p= 0,021) y ginecológicas (p= 0,034). Todas las variables de manera general presentaron buena coincidencia entre el diagnóstico posquirúrgico y ultrasonográfico. Conclusiones: la utilización del ultrasonido por parte de los cirujanos resultó ser un estudio favorable para complementar el diagnóstico en los pacientes atendidos en el departamento de urgencia()AU)

Introduction: The use of ultrasonography at the emergency department is worldwide considered an important tool for the initial evaluation of patients with surgical pathologies. In our country, due to different issues, it is difficult to carry out this procedure quickly. Objective: To determine if the use of ultrasonography by general surgeons is an effective diagnostic method in patients admitted to the emergency department. Method: An observational, descriptive, longitudinal, prospective study was carried out in the Emergency Department of Dr. Miguel Enríquez University Hospital, from January 1st to April 30, 2017, on a total of 96 patients. Ultrasonographic studies were performed on patients who presented criteria for its usage. The coincidence between clinical, surgical and ultrasonographic diagnosis was determined. Results: 96 patients, with a predominance of the female sex (50, 52.1 percent) were analyzed. The most frequent clinical diagnosis found was traumatic affections (41, 42.7 percent). A better coincidence between clinical and ultrasonographic diagnosis was achieved in traumatic (p=0.021) and gynecological (p=0.034) conditions. General speaking, all the variables presented fair coincidence between the postoperative and ultrasonographic diagnosis. Conclusions: The usage of ultrasonography by surgeons turned out to be a favorable study to complement the diagnosis in patients seen in the emergency department(AU)

Ultrasonido de urgencia realizado por cirujanos en pacientes ingresados en el Departamento de Urgencia / Surgeon-performed emergency ultrasonography on patients admitted to the Emergency Department

Introducción: a nivel mundial, el uso del ultrasonido en el departamento de urgencia se considera una herramienta importante para la evaluación inicial del paciente con patologías quirúrgicas. En nuestro país, por diferentes cuestiones, se hace difícil la realización rápida de este proceder. Objetivo: determinar si el uso del ultrasonido por cirujanos generales es un método de diagnóstico eficaz en pacientes ingresados en el departamento de urgencia. Método: se realizó un estudio observacional, descriptivo, longitudinal, de carácter prospectivo, en el departamento de urgencia del Hospital Universitario Dr. Miguel Enríquez desde 1 enero hasta 30 abril de 2017 con una totalidad de 96 pacientes. Se efectuó estudios ultrasonográficos a los pacientes que presentaron criterio para su uso. Se determinó la coincidencia entre el diagnóstico clínico, quirúrgico y el ultrasonográfico. Resultados: se analizaron 96 pacientes con predominio del sexo femenino 50 (52,1 por ciento). El diagnóstico clínico más frecuente encontrado fueron las afecciones por traumas 41 (42,7 por ciento). Se logró una mejor coincidencia entre el diagnóstico clínico y ultrasonográfico en las afecciones traumáticas (p= 0,021) y ginecológicas (p= 0,034). Todas las variables de manera general presentaron buena coincidencia entre el diagnóstico posquirúrgico y ultrasonográfico. Conclusiones: la utilización del ultrasonido por parte de los cirujanos resultó ser un estudio favorable para complementar el diagnóstico en los pacientes atendidos en el departamento de urgencia()AU)

Introduction: The use of ultrasonography at the emergency department is worldwide considered an important tool for the initial evaluation of patients with surgical pathologies. In our country, due to different issues, it is difficult to carry out this procedure quickly. Objective: To determine if the use of ultrasonography by general surgeons is an effective diagnostic method in patients admitted to the emergency department. Method: An observational, descriptive, longitudinal, prospective study was carried out in the Emergency Department of Dr. Miguel Enríquez University Hospital, from January 1st to April 30, 2017, on a total of 96 patients. Ultrasonographic studies were performed on patients who presented criteria for its usage. The coincidence between clinical, surgical and ultrasonographic diagnosis was determined. Results: 96 patients, with a predominance of the female sex (50, 52.1 percent) were analyzed. The most frequent clinical diagnosis found was traumatic affections (41, 42.7 percent). A better coincidence between clinical and ultrasonographic diagnosis was achieved in traumatic (p=0.021) and gynecological (p=0.034) conditions. General speaking, all the variables presented fair coincidence between the postoperative and ultrasonographic diagnosis. Conclusions: The usage of ultrasonography by surgeons turned out to be a favorable study to complement the diagnosis in patients seen in the emergency department(AU)

Preparing Emergency Medicine Residents as Teachers: Clinical Teaching Scenarios.

Introduction: Preparing residents for supervision of medical students in the clinical setting is important to provide high-quality education for the next generation of physicians and is mandated by the Liaison Committee on Medical Education as well as the Accreditation Council for Graduate Medical Education. This requirement is met in variable ways depending on the specialty, school, and setting where teaching takes place. This educational intervention was designed to allow residents to practice techniques useful while supervising medical students in simulated encounters in the emergency department and increase their comfort level with providing feedback to students. Methods: The four role-playing scenarios described here were developed for second-year residents in emergency medicine at the Indiana University School of Medicine. Residents participated in the scenarios prior to serving as a supervisor for fourth-year medical students rotating on the emergency medicine clerkship. For each scenario, a faculty member observed the simulated interaction between the resident and the simulated student. The residents were surveyed before and after participating in the scenarios to determine the effectiveness of the instruction. Results: Residents reported that they were more comfortable supervising students, evaluating their performance, and giving feedback after participating in the scenarios. Discussion: Participation in these clinical teaching scenarios was effective at making residents more comfortable with their role as supervisors of fourth-year students taking an emergency medicine clerkship. These scenarios may be useful as part of a resident-as-teacher curriculum for emergency medicine residents.

Palliative Care Symptom Management in The Emergency Department: The ABC's of Symptom Management for The Emergency Physician.

BACKGROUND: Palliative care is a rapidly evolving area of emergency medicine. With an estimated 5,000 to 10,000 baby boomers per day reaching retirement age, emergency departments (EDs) are treating more patients with chronic and serious disease. Palliative care offers comprehensive care for patients with advanced medical illness, aims to alleviate suffering and improve quality of life, and plays an important role in caring for these patients in the ED. OBJECTIVES: We sought to increase the emergency physician's knowledge of and comfort with symptom control in palliative and hospice patients. DISCUSSION: Having the skills to deliver efficient and appropriate palliative and hospice care is imperative for emergency physicians. Palliative care should be considered in any patient suffering from symptoms of a life-limiting illness, whereas hospice care should be considered in the patient with likely <6 months left to live. Palliative care is appropriate earlier in the course of disease, and is appropriate when the practitioner would not be surprised if the patient died in the next 2 years ("The Surprise Question"). This article discusses management in the ED of pain, nausea, dyspnea, agitation, and oral secretions in patients appropriate for hospice and palliative care. CONCLUSION: The need for palliative and hospice care in the ED is increasing, requiring that emergency physicians be familiar with palliative and hospice care and competent in the delivery of rapid symptom management in patients with severe and life-limiting disease.

Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions.

Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.

Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department.

OBJECTIVES: We surveyed Canadian emergency physicians to determine how skin and soft tissue infections (SSTIs) are managed and which risk factors were felt to be important in predicting failure with oral antibiotics. METHODS: We performed an electronic survey of physician members of the Canadian Association of Emergency Physicians (CAEP) using the modified Dillman method. RESULTS: The survey response rate was 36.9% (n=391) amongst CAEP members. There was a lack of consensus regarding management of SSTIs. CAEP respondents identified 14 risk factors for predicting treatment failure with oral antibiotics, including hypotension, tachypnea, and patient reported severity of pain >8 of 10. CONCLUSIONS: The survey demonstrates significant variability regarding physician management of SSTIs, and we have identified several perceived risk factors for treatment failure with oral antibiotics that should be assessed in future studies.

Pharmacist addition to the post-ED visit review of discharge antimicrobial regimens.

OBJECTIVE: Our objective was to evaluate whether pharmacist addition to the postvisit review of discharged adult emergency department (ED) visits' prescriptions/cultures would reduce the prevalence of revised antimicrobial regimen inappropriateness. METHODS: We conducted a retrospective observational study of discharged adult ED visits to a single center with positive cultures requiring antimicrobial regimen revision (May 1 to October 31, 2012, nurse process; February 1 to July 31, 2013, nurse/pharmacist process). Investigators abstracted cohorts' medical records for demographic, ED diagnosis, original/revised antibiotic regimen, culture result, medical history, medications, and patient instruction data and determined whether the revised regimen was inappropriate based on Infectious Diseases Society of America/Centers for Disease Control and Prevention and clinical guidelines. We used the large sample z-test to compare the prevalence of revised antimicrobial regimen inappropriateness between the 2 cohorts. RESULTS: In the prepharmacist cohort, there were 411 positive ED discharge cultures. Seventy-three (17.8%; 95% confidence interval [CI], 14.1%-21.5%) required antimicrobial regimen revision; 34 of these met 1 or more level of inappropriateness (46.6%; 95% CI, 35.1%-58.0%). In the postpharmacist cohort, there were 459 positive ED discharge cultures. Seventy-five (16.3%; 95% CI, 13.0%-19.7%) required revision; 11 of these met 1 or more level of inappropriateness (14.7%; 95% CI, 6.7%-22.7%; z = 4.2; P < .0001 for comparison). CONCLUSION: In this single-center study, pharmacist addition to the postvisit review of discharged adult ED patients' prescriptions/cultures reduced the prevalence of revised antimicrobial regimen inappropriateness.

Emerging drugs of abuse.

Many new emerging drugs of abuse are marketed as legal highs despite being labeled "not for human consumption" to avoid regulation. The availability of these substances over the Internet and in "head shops" has lead to a multitude of emergency department visits with severe complications including deaths worldwide. Despite recent media attention, many of the newer drugs of abuse are still largely unknown by health care providers. Slight alterations of the basic chemical structure of substances create an entirely new drug no longer regulated by current laws and an ever-changing landscape of clinical effects. The purity of each substance with exact pharmacokinetic and toxicity profiles is largely unknown. Many of these substances can be grouped by the class of drug and includes synthetic cannabinoids, synthetic cathinones, phenethylamines, as well as piperazine derivatives. Resultant effects generally include psychoactive and sympathomimetic-like symptoms. Additionally, prescription medications, performance enhancing medications, and herbal supplements are also becoming more commonly abused. Most new drugs of abuse have no specific antidote and management largely involves symptom based goal directed supportive care with benzodiazepines as a useful adjunct. This paper will focus on the history, epidemiology, clinical effects, laboratory analysis, and management strategy for many of these emerging drugs of abuse.

"How high do they look?": identification and treatment of common ingestions in adolescents.

Adolescents have access to a variety of legal or illicit substances that they use to alter their mood or "get high." The purpose of this review is to provide an overview of common substances adolescents use to get high, including the illicit substances synthetic marijuana or "Spice," salvia, MDMA, synthetic cathinones, and 2C-E. Dextromethorphan and energy drinks are easily accessible substances that teenagers abuse. The toxic effects of common ingestions and treatment of overdose is discussed to inform pediatric providers who provide care for adolescents.

Factors associated with failure to correct the international normalised ratio following fresh frozen plasma administration among patients treated for warfarin-related major bleeding. An analysis of electronic health records.

This study assessed the frequency and factors associated with failure to correct international normalised ratio (INR) in patients administered fresh frozen plasma (FFP) for warfarin-related major bleeding. This retrospective database analysis used electronic health records from an integrated health system. Patients who received FFP between 01/01/2004 and 01/31/2010, and who met the following criteria were selected: major haemorrhage diagnosis the day before to the day after initial FFP administration; INR ≥2 on the day before or the day of FFP and another INR result available; warfarin prescription within 90 days. INR correction (defined as INR ≤1.3) was evaluated at the last available test up to one day following FFP. A total of 414 patients met selection criteria (mean age 75 years, 53% male, mean Charlson score 2.5). Patients presented with gastrointestinal bleeding (58%), intracranial haemorrhage (38%) and other bleed types (4%). The INR of 67% of patients remained uncorrected at the last available test up to one day following receipt of FFP. In logistic regression analysis, the INR of patients who were older, those with a Charlson score of 4 or greater, and those with non-ICH bleeds (odds ratio vs. intracranial bleeding 0.48; 95% confidence interval 0.31-0.76) were more likely to remain uncorrected within one day following FFP administration. In an alternative definition of correction, (INR ≤1.5), 39% of patients' INRs remained uncorrected. For a substantial proportion of patients, the INRs remain inadequately or uncorrected following FFP administration, with estimates varying depending on the INR threshold used.

Asociación de otras drogas de abuso en la intoxicación por cocaína / Cocaine intoxication in association with other drugs of abuse

El objetivo del presente trabajo ha sido llevar a cabo un análisis de las urgencias atendidas en un hospital urbano de tercer nivel que se han relacionado con el consumo de cocaína. Para ello se ha realizado un estudio retrospectivo, con exclusión del área de pediatría y ginecología, durante los años 2005 y 2006. Se revisaron todas las asistencias clínicas que consultaron por intoxicación por cocaína. Los datos fueron analizados con el paquete estadístico SPSS 15.0 para windows. Durante el periodo de estudio se produjeron 1.531 intoxicaciones (1,2% del total de las urgencias). De éstas, 327 eran por cocaína (21,4% de las intoxicaciones). La edad media fue de 31 (8) años y la moda de 26 años. Un 76,5% eran varones. El 69,1% ingresaron en ambulancia. La mayor afluencia se produjo en fin de semana (46,8%) y en horario nocturno (54,1%). El 53,2% eran consumidores habituales y el 25,4% esporádicos. Un 55,7% asociaron más de 2 drogas: el 53,5% alcohol, el 31,2% opiáceos, el 17.4% benzodiacepinas, el 17,1% cannabis, el 11,3% GHB y el resto otras drogas. El 77,1% consumieron en un lugar público. Tenían antecedentes de intoxicaciones previas un 59,3%. El 93% presentaban síntomatología: (52,6% neurológicos, 48% conductuales, 28,4% cardiovasculares, 19% respiratorios y 8,3% digestivos). Se administraron antídotos a un 20,5%. El destino final fue alta en las primeras 12 horas en el 60,9%, con solo un 5,7% de ingresos. Se realizó valoración psiquiátrica en el 21,1%. En conclusión, el perfil del usuario que consulta por intoxicación por cocaína es un varón de 26 años traído en ambulancia de un lugar público, en fin de semana, en horario nocturno, consumidor habitual, con sintomatología cardiológica y neurológica y dado de alta en menos de 12 horas. La intoxicación aguda por cocaína no es pura. Destaca la asociación de alcohol, opiáceos y benzodiacepinas. Menos de una cuarta parte fueron valorados por Psiquiatría (AU)

The main of this study was to analyze all patients with cocaine intoxication attended in the emergency department of a tertiary-care hospital. For this, a retrospective study for the years 2005 and 2006, excluding peadiatric and gynecological areas, has been carried out. All cases in which the main reason for seeking urgent medical care was cocaine intoxication were reviewed. Data were analyzed with the SPSS statistical package (version 15.0) for Windows. During the study period, a total of 1531 subjects with drug of abuse intoxication were attended, which accounted for 1.2% of all patients attended in the emergency department. Cocaine was the drug of abuse responsible for the intoxication in 327 cases (21.4% of all intoxications). The mean (SD) age of the patients was 31 (8) years (mode 26 years). A total of 76.5% were men, and 69.1% arrived to the emergency department in ambulance. A large percentage of subjects were attended on weekends (46.8%) and during the night shift (54.1%). A total of 53.2% were regular cocaine consumers and 25.4% consumed the drug sporadically. In 55.7% of the cases, more than two drugs were concomitantly consumed, including alcohol in 53.5% of cases, opioids in 31.2%, benzodiazepines in 17.4%, cannabis in 17.1%, gamma hydroxybutyric acid in 11.3%, and other drugs in the remaining cases. Drugs were consumed in a public place in 77.1% of cases. History of previous episodes of intoxication was recorded in 59.3% of cases. Symptoms were present in 93% of subjects (neurological in 52.6%, behavioural in 48%, cardiovascular in 28.4%, respiratory in 19%, and gastrointestinal in 8.3%). Antidotes were administered in 20.5% of cases. A total of 60.9% of subjects were discharged from the emergency department within the first 12 hours and only 5.7% were admitted to the hospital. Twenty-one percent of subjects underwent psychiatric assessment. In conclusion, the profile of a subject with cocaine intoxication attended in the emergency department is a man of 26 years of age, transferred in ambulance from a public place, on weekends and at night, regular cocaine consumer, presenting with neurological and cardiological symptoms, and discharged from the emergency department in less than 12 hours after admission. Cocaine intoxication occurred frequently in association with alcohol, opioids, and benzodiazepine use. Less than one fourth of subjects underwent psychiatric assessment (AU)

Rapid determination of uranium isotopes in urine by inductively coupled plasma-mass spectrometry.

Following a radiological or nuclear emergency involving uranium exposure, rapid analytical methods are needed to analyze the concentration of uranium isotopes in human urine samples for early dose assessment. The inductively coupled plasma mass spectrometry (ICP-MS) technique, with its high sample throughput and high sensitivity, has advantages over alpha spectrometry for uranium urinalysis after minimum sample preparation. In this work, a rapid sample preparation method using an anion exchange chromatographic column was developed to separate uranium from the urine matrix. A high-resolution sector field ICP-MS instrument, coupled with a high sensitivity desolvation sample introduction inlet, was used to determine uranium isotopes in the samples. The method can analyze up to 24 urine samples in two hours with the limits of detection of 0.0014, 0.10, and 2.0 pg mL(-1) for (234)U, (235)U, and (238)U, respectively, which meet the requirement for isotopic analysis of uranium in a radiation emergency.

Use of epidemiological data and direct bioassay for prioritization of affected populations in a large-scale radiation emergency.

Following a radiation emergency, evacuated, sheltered or other members of the public would require monitoring for external and/or internal contamination and, if indicated, decontamination. In addition, the potentially-impacted population would be identified for biodosimetry/bioassay or needed medical treatment (chelation therapy, cytokine treatment, etc.) and prioritized for follow-up. Expeditious implementation of these activities presents many challenges, especially when a large population is affected. Furthermore, experience from previous radiation incidents has demonstrated that the number of people seeking monitoring for radioactive contamination (both external and internal) could be much higher than the actual number of contaminated individuals. In the United States, the Department of Health and Human Services is the lead agency to coordinate federal support for population monitoring activities. Population monitoring includes (1) monitoring people for external contamination; (2) monitoring people for internal contamination; (3) population decontamination; (4) collecting epidemiologic data regarding potentially exposed and/or contaminated individuals to prioritize the affected population for limited medical resources; (5) administering available pharmaceuticals for internal decontamination as deemed necessary by appropriate health officials; (6) performing dose reconstruction; and (7) establishing a registry to conduct long-term monitoring of this population for potential long-term health effects. This paper will focus on screening for internal contamination and will describe the use of early epidemiologic data as well as direct bioassay techniques to rapidly identify and prioritize the affected population for further analysis and medical attention.