(3) Patient Management 4: Care of Special Populations: (a) Special populations include pregnant women, immunocompromised patients, equipment-dependent patients (especially those requiring ventilators), disabled persons requiring wheelchairs or other mechanisms of assistance, nursing home and jail residents, people with various physical challenges, the mentally ill, children, elderly, and persons with cultural and language barriers. (b) In general, special populations should not be treated differently from other populations. One exception would be pregnant women and small children: (b-1) There are no special pharmaceutical treatments for a pregnant woman, but they will require considerable reassurance and communication. (b-2) If radioactive iodine exposure has occurred, consider giving children potassium iodide tablets according to FDA guidance (8). (www.fda.gov/cder/guidance/4825fnl.htm). (c) Patient Discharge and Follow-up (c-1) Patient discharge sheets should include basic information about radiation exposure and accurate information about the long-term health effects of radiation exposure. Hospitals can customize and relate these possible effects to the specific situation. If the incident is thought to be of criminal intent, the discharge staff should explain the need for reporting to and cooperation with law enforcement. (c-2) Along with discharge sheets hospitals should provide Q&A sheets and fact sheets. Fact sheets should include expert contacts and phone numbers and reliable sources of information. (c-3) There is the risk of information overload to the patient. Printed materials should be brief and easy to understand (e.g. reading level of Flesch-Kincaid 6.0 or lower). (c-4) Hospitals should avoid generic discussions about radiation, which could promote unwarranted concern. The more that information is customized to an individual's circumstances, the more helpful it will be. (d) Laboratory Issues. (d-1) In the management of mass casualties, basic precepts of medicine should take hold with regard to testing: minimize the amount of testing, only doing those tests that can affect the immediate care of the patient. (d-2) In a mass casualty incident, hundreds to thousands of patients may attempt to come to a hospital, putting the hospital in the position where it cannot practically take a blood count on every patient. Anyone who has or might exhibit prodromal effects (see Appendix B) would need to be considered for a CBC with differential to test for acute radiation syndrome. If practicable, this should be repeated every 6 hours for about 72 hours. (e) Other laboratory tests to consider if warranted include cytogenetic analysis, i.e., collecting blood for dosimetry. All samples must be placed in separate, labeled containers that specify patient name, date, and time of sampling. Hospitals should consider in the planning process how to manage the shipping and transportation of samples to qualified laboratories. (f) Preparation steps that hospitals can take to address laboratory capacity include: (f-1) Ensuring that mutual aid agreements with area laboratories are in place. (f-2) Determine if it is possible to transfer non-critical patients to other local facilities. (f-3) Keep a stockpile of CBC tubes (use purple top tubes1 for CBCs). (g) Hospitals should keep in mind that while they are treating the casualties, other local, state, and federal organizations are dealing with the scene. Hospitals need to know how to connect with these responding organizations to get needed information, such as radionuclide data and radiation dose assessment. (h) A lesson learned from past incidents is that healthcare providers should have heightened awareness of significant political pressure to use the most accurate tests available and avoid reliance on random testing of individuals