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The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities. Two main features of the revised process are: (1) the introduction of an emergency disrobe and dry decontamination step prior to the arrival of specialist resources and (2) a revised protocol for mass casualty (wet) decontamination that has the potential to double the throughput of casualties and improve the removal of contaminants from the skin surface. Optimised methods for performing dry and wet decontamination are presented that may be of relevance to hospitals, as well as first responders at the scene of a chemical incident.

Background and purpose The sudden increase in the number of exposed individuals, diverse injuries, damage to health equipment, and disruptions in health services highlight the need for a structured response to radiological and nuclear incidents. This study aims to identify the requirements for responding to CBRN incidents in Iran. This research contributes to a deeper understanding of the complexities involved in CBRN preparedness and response in Iran, highlighting areas for potential improvement and policy development. Methodology This qualitative research conducted in 2023 involved semi-structured interviews with 32 specialists selected through purposive sampling until data saturation was reached. Thematic analysis was employed to analyze the data. Findings The requirements for responding to CBRN incidents were categorized into three main classes with nine subcategories: Training Effective training content, establishment of specialized training centers, identification of target audiences, educational needs assessment, and continuous education. Drills Implementation of various operational drills and their content. Emergency response planning Elements of response plans and evaluation of these plans. Conclusion Timely and appropriate responses from the health system during critical phases after such incidents are crucial for mitigating adverse health effects. This study provides insights into the necessary requirements for enhancing readiness in the health sector as Iran progresses towards adopting modern technologies.

Escalating global challenges (such as disasters, conflict, and climate change) underline the importance of addressing Chemical, Biological, Radiological, and Nuclear (CBRN) terrorism for sustainable public health strategies. This study aims to provide a comprehensive epidemiological analysis of CBRN incidents in the Middle East and North Africa (MENA) region, emphasizing the necessity of sustainable responses to safeguard healthcare infrastructures. Utilizing a retrospective approach, this research analyzes data from the Global Terrorism Database (GTD) covering the period from 2003 to 2020. The study focuses on examining the frequency, characteristics, and consequences of CBRN incidents in the MENA region to identify patterns and trends that pose significant challenges to public health systems. The analysis revealed a significant clustering of CBRN incidents in Iraq and Syria, with a predominant involvement of chemical agents. These findings indicate the extensive impact of CBRN terrorism on healthcare infrastructures, highlighting the challenges in providing immediate health responses and the necessity for long-term recovery strategies. The study underscores the need for improved healthcare preparedness, robust emergency response systems, and the development of sustainable public health policies. Advocating for international collaboration, the research contributes to the strategic adaptation of healthcare systems to mitigate the impacts of CBRN terrorism, ensuring preparedness for future incidents in the MENA region and beyond.

This chapter contains sections titled: Test Selection as Determined by Life‐Cycle Phase Issues That May Prevent Effective Evaluations Selection of Test Conditions Designing Methods and Setting Criteria Sources of Methods Preconditioning and Pretreating Physical Properties and Survivability CBRN Performance Human Factors

BackgroundOn-scene improvised and interim decontamination protocols in the Initial Operational Response to chemical incidents aim for rapid intervention to minimise injury before specialist capabilities arrive. This study examines the effectiveness of UK improvised and interim protocols conducted in sequence.MethodA simulant with methyl salicylate (MeS) in vegetable oil and a fluorophore was applied to participants’ shoulders, arms and legs. Participants either received no decontamination or used one of four decontamination protocols: improvised dry, improvised wet, improvised dry followed by interim or improvised wet followed by interim. Remaining simulant on the skin was quantified using gas chromatography tandem mass spectrometry for MeS analysis and UV imaging for fluorophore detection. Additionally, urine samples were collected for 8 hours post application to analyse MeS levels.ResultsSignificantly less simulant was recovered from the skin post decontamination compared with no decontamination. There were no differences in the total simulant recovered across all decontamination conditions. However, significantly more simulant was recovered from the shoulder compared with the arm and leg. Variation in simulant recovery from different application areas was significantly higher in improvised-only conditions than in combined conditions. Decontamination did not affect the amount of MeS excreted in urine over 8 hours.ConclusionThis research supports current practice of starting decontamination as soon as possible after chemical exposure and highlights the importance of implementing interim decontamination following improvised decontamination.

IntroductionCivilian healthcare workers (HCW) and medical facilities are directly and indirectly impacted by armed conflict. In the Russia-Ukraine war, acute trauma care needs grew, the workforce was destabilised by HCW migrating or shifting roles to meet conflict needs, and facilities faced surge events. Chemical, biological, radiological, nuclear and explosive (CBRNE) exposure risks created unique preparedness needs. In response, an academic and international non-governmental organisation partnership was formed to design, implement and evaluate a locally prioritised training programme in Ukraine.MethodsSeven in-person training courses (Advanced Trauma Life Support, Trauma Nursing Fundamentals, Pediatric Trauma Fundamentals, Prehospital Trauma Fundamentals, Stop the Bleed, Mass Casualty Management and CBRNE Preparedness) were adapted, translated, taught and evaluated in seven Ukrainian oblasts (regions; Kyiv, Dnipropetrovsk, Zaporizhzhia, Odesa, Lviv, Chernihiv and Mykolaiv) during the war. Topics were determined by available needs assessments and further adapted based on course participant feedback and evolving logistic and security challenges. Change in participant knowledge and confidence levels was assessed through precourse and postcourse knowledge and self-confidence evaluations and follow-up surveys. Initial courses were taught by international instructors and transitioned to Ukrainian instructors as they were trained. Web-based asynchronous videos in Ukrainian were developed to complement and reinforce in-person training.Results4368 participants were trained in 164 courses from August 2022 to April 2023. 223 instructors were trained. Aggregate participant knowledge and self-confidence significantly improved in all courses. Interval follow-up responses indicated that the training was useful and 83.3% had used the skills within 8 weeks of training. Twenty-seven training videos were created which, as of April 2023, have been viewed over 1 700 000 times in 500 cities throughout Ukraine.ConclusionsLocally prioritised training can be rapidly developed and delivered in an armed conflict setting providing civilians and frontline HCW with the skills and knowledge required to care for patients. Logistics, communication, equipment and security challenges can be overcome through strategic in-country partnerships. Short asynchronous video learning can complement and scale in-person training.

Mass-casualty incidents (MCIs), specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, availability, and adequate provision of prehospital and hospital-based emergency care. In the Netherlands, a new model for Mass Casualty and Disaster Management (MCDM) along with a Terror Attack Mitigation Approach (TAMA) was introduced in 2016. The objective of this study was to provide insight in the first experiences of health policy advisors and managers with a medical rescue coordinator and ambulance nursing background regarding the new MCDM and TAMA in order to identify strengths and pitfalls in emergency preparedness and to provide recommendations for improvement. The study had a qualitative design and was performed from January 2017 through June 2018. Purposeful sampling was used and the inclusion comprehended health policy advisors and managers with a medical rescue coordinator and ambulance nursing background involved in emergency preparedness. The respondents were interviewed semi-structured and the researchers used a topic list that was based on the literature and content of the newly introduced model and approach. All interviews were typed out verbatim and qualitative content analyzing was used in order to identify relevant themes. Respondents based their perceptions on large-scale training exercises, as MCDM and TAMA were not yet used during MCIs. Perceived issues of MCDM were the two-tiered triage system, the change in focus from \"stay and play\" towards \"scoop and run,\" difficulties with new tasks and roles of professionals, and improvement in material provision. Regarding TAMA, all respondents supported the principles (do the most for the most; scoop and run; acceptable personal risk; never walk alone; and standard operational procedure); however, the definitions were lacking clarity while the awareness of optimal personal safety of professionals was absent.As there are currently regional differences in the level of implementation of MCDM and TAMA, this may pose a risk for an optimal inter-regional collaboration. The conclusions refer to experiences of professionals in the Netherlands. Elements of the MCDM and TAMA were highly appreciated and seemed to improve emergency preparedness, while other aspects needed further attention, training, and integration in daily routine. The Netherlands' MCDM model and TAMA will need continuous systematic evaluation based on (inter)national performance criteria in order to underpin the useful and effective elements and to improve the observed pitfalls in emergency preparedness.

This study aimed to determine whether the Hamad Medical Corporation Ambulance Service (HMCAS) personnel fulfil the pre-hospital readiness requirements for hazardous material and chemical, biological, radiological, and nuclear (HazMat-CBRN) incidents. This cross-sectional study performed an online assessment of non-specialist paramedics' behaviour and knowledge about HazMat-CBRN incident management, followed by a 'HazMat-CBRN incident management' course with pre-and post-activity assessments. The validity and reliability of the knowledge assessment questions were also tested. The pre-and-post course assessement responses revealed certain deficiencies in staff knowledge. The multiple linear regression and paired groups t-test demonstrated that this was rectified after the training intervention. The results indicate that the implemented course helped HMCAS staff acquire a satisfactory level of knowledge to ensure their readiness for safe and effective responses to potential HazMat-CBRN incidents in Qatar.

One of the important indicators of increasing the capacity of the health system and the chances of survival of patients and injured immediately after chemical, biological, radiation and nuclear (CBRN) accidents is rapid access to medical services. Establishing prehospital health response teams is one of the main strategies to improve the capacity and ability to respond to unusual events. The aim of this study was to investigate the factors influencing the formation of rapid response teams in the field of health in response to chemical, biological, radiation and nuclear accidents (CBRN EDMRT). In this study, the comparative review method was used. The study period was from November 1, 2021 to March 2022. Forming and deploying rapid health response teams based on an extensive multi-step search and keywords in multiple databases such as PubMed, CINHAL, Blackwell, Iranmedex, SID, Cochrane Database of Systematic Reviews, Google Scholar, Scopus Also, the websites of the Ministry of Health and the responsible organizations in different countries and the proposed structure were done by international institutions and sites. After accessing the resources and documents, the process of analysis and comparison of different team structures was performed. After the initial search, the structure and required elements of their teams were extracted. According to published articles and texts, 10 teams from the International Atomic Energy Agency (IAEA), the US Centers for Disease Control and Prevention (CDC), the US Department of Homeland Security, and the North Atlantic Treaty Organization (NATO), Australia, the British Public Health Organization, and the Japanese Red Cross were compared. Team requirements, population distribution, type of accident, level of team activity and training, equipment required by the team after the accident, according to which, each country/organization should consider the above factors to design and establish the structure of CBRN EDMRT to take. A study should be conducted to design a comprehensive and evidence-based structure.