DC RITN SOP Template
How to use this template: Please note that this is an example of areas to consider
including in the development of your SOP. Items included may not be applicable
to your center as described and may need to be modified to fit your organization
and culture. Some items may not be applicable at all and need to be omitted. If
you have any questions please do not hesitate to contact the NMDP Emergency
Preparedness Administrator for feedback (ccase@nmdp.org).
1) Participation in RITN statement:
a. We are a member of the Radiation Injury Treatment Network (RITN), and have agreed to
participate in a response to an incident resulting in Hematopoietic toxicity.
b. RITN is a collaboration of the NMDP and ASBMT.
c. As a Radiation Injury Treatment Network donor center, we will coordinate/facilitate the
processing of donors in an expedited manner.
2) Purpose: 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).
3) RITN Composition and organization:
a. RITN is composed of transplant centers, donor centers and cord blood banks.
i. Transplant centers are further divided into primary and secondary TCs based on a
hub and spoke design for communication and support.
ii. Primary TCs are the central center per FEMA region to provide guidance and
expertise as needed with in each FEMA region (example FEMA region map:
http://www.fema.gov/about/contact/regions.shtm).
b. This organization ensures that the entire transplant process is incorporated into RITN.
4) Operations impact statement:
a. In the event of the activation of RITN there is a high possibility that there will be a
significant increase in the number of patients requiring a transplant.
b. As part of the RITN we are prepared to support the treatment of patients with
Hematopoietic toxic events (HTE) by the expedited processing of donors.
c. Advanced preparation includes training of staff in basic radiation awareness, advanced
training where possible, adoption of the RITN ARS guidelines, coordination internally
and externally (when necessary) to handle a significant increase in donors.
d. These patients will not immediately follow the incident, but most likely will present
themselves slowly initially and more rapidly one to two weeks after an event as their
condition is diagnosed. A possible scenario resulting in the activation of RITN would be
an Improvised Nuclear Device (terrorist nuclear bomb); this could result in thousands of
likely patients with Acute Radiation Syndrome (ARS). Thousands of patients could
translate to a 10x increase in work load as donors are processed for possible transplant.
Specific areas of SOP:
5) Processing of donors in connection with a mass casualty event.
a. Prior to an event staff work capacity should be determined:
i. What is the maximum number of donors that can be processed in an 8 hour shift
ii. What limitations are there to this capability: hospital, physician for PE, etc…
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iii. How many staff are cross trained to perform other duties
b. Upon notification of event impacting operations / activating RITN: document the
processes needed to handle a significant increase in donor work up
c. Organize staff, prioritize work:
i. How is staff notified during non-standard work hours
ii. Will hours need to be modified to work longer days (e.g. Amy starts at 7 AM,
and Todd starts at 10 AM)
iii. How do you track the work so that a staff member does not overwork
iv. Identification of work priorities, redistribution of non-critical tasks:
1. Reassignment of staff from lower priority work to higher priority activity
2. Transfer non-work-up tasks to staff not qualified to perform work-ups
d. Identify critical deficiencies in staff, supplies, equipment and other resources:
i. Identify necessary resources to handle the increased workload (e.g. additional
staff, volunteers, computers, tables, drivers, temporary housing, etc…)
ii. Once identified list how this need can realistically be met, if not possible, it
should be left as something requiring outside assistance (possibly from the
NMDP)
e. Possible sources of assistance
i. Volunteers for WU, PE, transporting donors
ii. Additional hospitals/physicians for PE/Clearance
5) Develop systems and relationships and coordinate processes to assure priority scheduling of work
ups, physical exams, and collection.
f. List current relationships for standard work processing
i. Work to have them agree to increased priority and faster processing during a
national disaster
g. Develop contacts for other organizations to assist to meet increased workload
h. Develop processes for laboratory prioritization for Infectious Disease Marker (IDM)
testing:
i. For expedited processing local facilities are prefered
1. Coordinate with existing laboratories for emergency situations
2. Create new relationships with other facilities
ii. Use of NMDP centralized laboratories can be coordinated if no local options are
available
6) Plan for a mechanism to transport, house donors for extended periods.
i. Identify local temporary housing
i. Donors being processed faster than usual may need to stay locally (e.g. at a hotel,
church members homes, etc….until WU and PE are complete
ii. Ideally this is one location or multiple adjacent facilities to easy transportation
requirements
j. Identify possible transportation support:
i. Donors will need to be moved from the temporary housing to the donor center or
hospital for WU and PE
ii. Sources of transportation could be a contracted vendor, local volunteers from
high schools, churches, or other places
7) Concept of operations: Once notified by RITN of a Hematopoietic toxic event (HTE) we will
perform the following:
k. Notify center staff of the event and the possibility of increased activity.
l. Notify appropriate supporting organizations:
i. Hotel to house donors
ii. Transportation for donors
iii. Potential volunteers to assist
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iv. Hospital/physicians for PE
m. Inventory supplies and order additional where needed:
i. Forms
ii. Swabs
iii. Tubes
iv. Etc…
n. Review current and projected workload.
o. Meet with key players to war game options for handling a significant increase in donors.
p. Report to RITN center status every 24 hours in accordance with the Center Status Report.
i. Center Status Report is located in the Transplant Center Manual of Operations
https://network.nmdp.org/TRAINING/EMERGENCY/ch19_emergency_preparedn
ess.pdf
ii. Through faxed status report: Fax number 612.627.5894
iii. WebEOC interface:
https://www.aireoc.com/eoc6/default.asp?organizationname=NMDP
8) Sources for volunteers:
National Volunteers Active in Disaster: http://www.nvoad.org
American Red Cross: www.redcross.org
Salvation Army: www.salvationarmyusa.org
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