CBRN Incidents Research Articles

STRENGTHENING RESPONSE CAPABILITIES FOR CBRN INCIDENTS: A CALL TO ACTION

We have read with great interest the article titled "Evaluation of Emergency Department Personnel’s Preparedness for Chemical, Biological, Radiation, and Nuclear Emergencies" authored by Bıçakcı and Bıcakcı, published in the final issue of your journal for the year 2023. In their research, the authors examined the preparedness level of emergency department personnel for chemical, biological, radiation, and nuclear (CBRN) incidents and their ability to respond to such events. They highlighted the inadequacy of education, drills, and knowledge level regarding CBRN incidents, emphasizing the necessity for emergency department personnel to be prepared for such events. We extend our thanks to the authors and the editorial board for this insightful contribution and congratulate them. However, we would like to offer two additional suggestions to enhance the response to CBRN incidents.

Chemical, biological, radiological and nuclear event detection and classification using ontology interrogation and social media data

In an era where chemical, biological, radiological, and nuclear (CBRN) incidents present a grave threat to public safety, timely and accurate information is paramount. The complexity of the CBRN concept encompasses a range of incidents, each with unique and overlapping symptoms, related substances, and event descriptions. This study introduces an innovative approach to the development of a CBRN-specific ontology, uniting diverse data sources and domain expertise to construct a comprehensive repository of CBRN events, sub-events, their causes, symptoms, and toxic substances. Unlike prior methodologies reliant on keyword searches and predefined categories, our approach enables a holistic analysis of textual data by capturing intricate relationships between symptoms and toxic substances. We leverage this ontology in conjunction with a tailored interrogation algorithm to detect potential CBRN incidents through social media data. The algorithm was then tested on datasets of three actual CBRN incidents, one fictional incident (TV show) that simulated a nuclear incident and one non-CBRN. The interrogation algorithm was able to detect the five CBRN incidents accurately. However, the study showcased the need to extend the algorithm to distinguish between real and fictional CBRN incidents. These findings underscore the potential of this approach to deliver timely information on potential CBRN incidents. Nevertheless, the study acknowledged the inherent challenges and limitations in utilizing social media data, including the risk of misinformation, fictional events, fake news, and interference from malicious actors, all of which can affect the accuracy and reliability of the information collected.

Public Health Responses to CBRN Terrorism in the Middle East and North Africa.

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.

Vorbereitung deutscher Notaufnahmen auf Notfälle mit chemischen, biologischen, radiologischen und nuklearen (CBRN) Gefahrstoffen

Abstract Background Post-pandemic considerations, as well as lessons learned from terrorist attacks, wars, and disasters worldwide demonstrate that emergency departments must be prepared for mass casualty events related to chemical, biological, radiological, and nuclear (CBRN) hazardous materials. Our aim was to evaluate whether German emergency departments are sufficiently prepared for such events. Methods We developed a survey and distributed it to all chairpersons of emergency departments in Germany via the German Emergency Department Directory. Results of the survey were described using total numbers and percentages. Capacity for decontamination at different sites was graphically displayed using box-and-whisker plots. The primary endpoint of this study was whether German emergency departments are sufficiently prepared for CBRN incidents. Results Of 963 emergency departments, 262 (27.21%) answered the survey: 80.43% (189/235) of the hospitals had a plan for biological incidents, 49.36% (116/235) for chemical incidents, and 34.47% (81/235) for radionuclear incidents. Furthermore, 50% (116/232) reported some kind of decontamination site, but only 31.42% (71/226) reported having a water supply to their decontamination area. Sufficient protective equipment was only available in 27.51% (63/229) of emergency departments. Only 12.02% (25/208) of hospitals were able to decontaminate supine patients properly, following a decontamination scheme. Conclusion Most German hospitals are not adequately prepared to handle casualties resulting from chemical, biological, radiological, or nuclear hazardous materials. Given these results, there is a need for systemic intervention at the national level in order to improve preparedness.

Managing CBRN mass casualty incidents at hospitals-Find a simple solution for a complex problem: A pilot study.

Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management. The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants. The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F). The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.

A qualitative study on barriers and strategies to hospital preparedness against chemical, biological, radiological, and nuclear incidents.

The effects of chemical, biological, radiological, and nuclear (CBRN) incidents on human society can be irreparable. Preparing the health system for these incidents is essential. This study aims to identify obstacles to hospital preparedness against CBRN incidents and provide solutions. This qualitative study was conducted using semi-structured interview method in 2022. The research community included experts in the fields of CBRN, and 17 persons were included in the study through purposive sampling. The interviews were collected by interview guide and recorded face-to-face and online and were analyzed using thematic content analysis method in MS Word 2016. The interviews' analysis was classified into two main categories and 34 sub-categories. Some of the most important obstacles to the hospital preparedness against CBRN incidents were the lack of proper crisis management, the lack of specialist staff, the stress of employees, the lack of turnover and sufficient rest for employees, legal gaps, and so on. The main strategies were determining the type and extent of the risk factor, strong crisis management, the lack of parallelism, continuous monitoring, having a protocol and road map, appropriate training programs, having skilled personnel, rapid response of personnel, positive attitude of the staff, and the favorable condition of the building. The appointment of an expert in the field of CBRN and having a specialized unit, the existence of specialized and trained staff along with access to the required facilities, clear instructions, and intra-departmental and inter-departmental cooperation affect the readiness of hospitals against CBRN incidents.

Evaluation of CBRN Preparedness of German Hospitals with Higher Level of Care: A Cross- Sectional Survey.

Chemical, biological, radiological, and nuclear (CBRN) events with multiple casualties are rare events, but preparedness is crucial for hospitals to respond properly. This study evaluated the preparedness and disaster planning of German hospitals for CBRN incidents. In a cross-sectional study, German hospitals with level III (highest level) emergency departments were surveyed using an online questionnaire focusing on risk assessment, infrastructure, hospital disaster planning, and preparedness for CBRN events. Between June and July 2023, 50 hospitals were surveyed. 62.5% of the hospitals had a section on chemical incidents in their disaster plan. A decontamination facility was available in 29.8% of the hospitals and chemical protective suits in 46.8%. The minority of the hospitals trained the correct handling of personal protective equipment (PPE) (39.1%) regularly or had frequent CBRN drills (21.3%). Most hospitals had the infrastructure for medical isolation (93.6%). The level of CBRN preparedness is heterogeneous for German hospitals. Most were well prepared for infectious patients, but only half of all hospitals had sufficient PPE for chemical incidents and only 30% had a decontamination facility available. Overall, the level of CBRN preparedness is still insufficient and needs further improvement.

Investigating the Level of Preparedness of Iranian Hospitals against CBRN Incidents: A Case Study of Hospitals in West Azerbaijan Province

Background: Hospitals are the front line of dealing with Incidents. Chemical, biological, radiological, and nuclear (CBRN) incidents are alarming for governments' healthcare providers and the public. Therefore, they must make the necessary preparations to deal with these incidents. Objectives: This study aimed to evaluate the preparedness of hospitals against chemical, biological, radiological, and nuclear incidents and the related influential factors. Methods: The present study was a cross-sectional survey in northwest Iran, 2020-2022. The statistical population was the hospitals of West Azerbaijan province. The inclusion criteria were that hospitals must be university or therapeutic affiliated with the West Azerbaijan University of Medical Sciences, and at least one year had to be passed since the hospital’s operation. Also, the exclusion criteria were that the hospitals were on the verge of closing or changing their use. In this way, 26 hospitals in West Azerbaijan were studied. The "Canadian Center for Emergency Preparedness" evaluation checklist research tool was used to determine the level of preparedness of the studied hospitals in CBRN incidents. The data was collected for 5 months, from January to May 2021. Cronbach's alpha score for this checklist was 0.94. Descriptive and analytical statistics indicators were used for data analysis using SPSS 20 software. Results: The study showed that the hospitals lacked the preparation, capacities, and abilities to deal with CBRN incidents. In the single-variable mode, in the chemical dimension, the number of morgues of the deceased (P = 0.006); in the biological aspect, per capita educational factors in the biological domain (P = 0.03), the number of facility personnel (P = 0.04), the number of infectious disease specialists (P = 0.02), the number of equipment with optimal laboratory capabilities (P = 0.04), and the number of morgues of the deceased (P = 0.006); in the radiological and nuclear dimensions per capita of nuclear education (P = 0.01) and dosimeter (P = 0.03), and the general dimension the CBRN training per capita (P = 0.004), the number of personnel (P = 0.015), and laboratory equipment (P = 0.006) had a significant relationship with the preparedness of hospitals against CBRN incidents (P < 0.05). Conclusions: Overall, this study's results showed that hospitals' preparedness against CBRN incidents was unsatisfactory, and appropriate policies needed to be adopted to improve it.

Emerging Technologies for the Early Location of Entrapped Victims Under Collapsed Structures and Advanced Wearables for Risk Assessment and First Responders Safety in SAR Operations, Search and Rescue Project

Introduction:Natural disasters and catastrophes are challenges faced by emergency services. These are dangerous environments in which there are life-threatening victims as in other CBRN incidents, which can add great risks for nearby populations and the environment. The main objective of this project is the development and testing of new technologies that increase the safety and efficiency of the work of first responders in disasters.Method:The SnR consortium, with 28 partners, has designed, implemented, and tested new technologies, with an advanced communication and monitoring system for professionals, victims, and other first responders, with innovative positioning and assistance ICT that facilitate the exploration and evaluation of disaster areas.These technological advances are validated and evaluated with performance, efficiency, and usability indicators, in laboratories and in real working conditions, through a total of seven case studies, in seven different countries, covering a wide range of representative disaster scenarios.Results:The development of a new communication and monitoring system for professionals and victims, coordinated on the Concorde platform, together with chemical alert sensors, synchronized with smartwatches, smart uniforms, and pediatric immobilizers, are some of the tools tested. The pilots carried out to confirm the usefulness of the 26 technological tools designed and tested in the field, which have helped to reduce the damage and casualties that can occur in S&R operations.Conclusion:In conclusion, the H2020 European Search and Rescue project (S&R), through the development of new technologies, offers a holistic approach to the effective response to emergencies and provides increased capabilities and resources to first responders in the field, increasing their effectiveness and safety. This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement (No. 882897).

Про результати міжнародного співробітництва наукового центру у сфері хімічної, біологічної та радіаційно-ядерної безпеки (2017-2021)

Abstract. The scale and nature of the existing external and internal threats form the directions of international security cooperation for Ukraine, which today focus on a range of topical issues in the field of chemical, biological and radiation safety. Aim. Evaluation of the results of international cooperation of the Scientific Center in the field of chemical safety, in particular in matters related to the identification of controlled and toxic chemical substances. Materials and Methods. The results of the international activity of the Scientific Center in the field of chemical safety for the past 5 years are summarized; cooperation with international donors, representatives of the government of Ukraine, scientists and non-governmental organizations is summarized. Results. A key event in the field of international cooperation was participation in G-7 Regular Meeting within the framework of the Global Partnership (Munich, Germany, 2014), where Ukraine presented about 90 projects in three areas: chemical, biological and physical nuclear safety. The results of the implementation of OSCE Project Coordinator in Ukraine: "Integrated Chemical Safety and Security Program in Ukraine (ICSSP) (2014-2019) and "Enhancing Ukraine's Chemical Emergency Response Capacity) (2020-2021) are highly appreciated. Participation in Project Project 57: Strengthening crime scene forensics capabilities in investigating CBRN incidents in the South East and Eastern Europe Centers of Excellence Region (2018-2020) and "South East and Eastern Europe CBRN Risk Mitigation and Security Governance Program (UNICRI) (2021) had significant scientific and practical results. Conclusions. Participation in the work of international projects is invaluable in shaping the professional worldview of scientists and specialists whose activities belong to the sphere of CBRN security. The joint implementation of international initiatives provides a real opportunity for the operational implementation of new experience in practice, which is reflected in the plans of scientific works, the content of trainings and educational programs for the training of specialists who, according to their professional duties, need modern knowledge in the field of managing the consequences of CBRN threats. Key Words: chemicals, chemical safety, toxicology.

CBRN Incident Awareness of Healthcare Professionals Working in Public and University Hospitals

Introduction
 The aim of this study is to investigate the perception, information and experiences of healthcare professionals working in public and university hospitals who will respond to the CBRN incidents in order to raise an awareness for requirements of knowledge, training and practice about this topic.
 Methodology
 Our study was a survey study. Data acquisition were carried out between the dates 10.05.2021-10.11.2021. The questionnaire was applied to health care professionals working in public and university hospitals. There were 26 questions in our questionnaire. Questions were prepared to be short, clear and understandable. Each question was provided with 3 options as “Yes/No/Partially”. 
 Results
 A total of 103 people participated to the study. 65 (63.1%) of the participants were male, 38 (36.9%) were female. The ages of the participants were categorically evaluated and 44 (42.7%) were in age group 26-35, 38 (36.9%) were in 18-25, 17 (16.5%) were in 36-45, and 4 (3.9%) were above 46. 
 When the answers were evaluated according to education status, people with bachelor’s degree answered “Yes” to the question “Injured people with possible exposure to an CBRN agent are accepted to the emergency service after decontamination process in the health care facility I work in” significantly higher than the other groups (p:0.04). 
 The question of “I have come across with hospitalized injured in the region I work” were answered as “No” by 17 doctors, 41 nurses, and “Yes” by 1 doctor and 1 nurse, while the majority of people answering “Yes” to this question were emergency medical technician and paramedics. The difference was statistically significant (p

Managing CBRN mass casualty incidents at hospitals-Find a simple solution for a complex problem: A pilot study.

Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management. The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants. The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F). The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.

Hazardous materials and CBRN incidents: Fundamentals of pre-hospital readiness in the State of Qatar

Background: Hazardous Materials and Chemical/Biological/Radiological/Nuclear (HazMat-CBRN) incidents represent a serious threat to the population and the environment. They require a pre-hospital medical response system well equipped and supported with logistics and clinicians with appropriate knowledge and skills to prevent exposure and mitigate risks. Our aim is to determine if the Hamad Medical Corporation Ambulance Service (HMCAS) fulfils the pre-hospital readiness requirements for such incidents. Methods: This cross-sectional study was performed in HMCAS. An online survey assessed staff behaviour and knowledge in relation to HazMat-CBRN incidents. Responses were obtained on health risks and pre-hospital medical management of related threats in Qatar. Based on the results, a training module “HazMat Incident Management” was prepared with pre-/post-activity assessments. The results were explored using a multivariate linear regression and non-parametric Wilcoxon test for paired samples. Specialized Emergency Management (SEM) staff opinion about this training was assessed through an online survey. Both surveys’ validity and reliability tests were conducted. Ishikawa cause and effects diagram was built for the identification of the factors leading to a pre-hospital successful response to HazMat-CBRN incidents. Results: HMCAS has the proper logistics and plans to manage potential HazMat-CBRN incidents. The knowledge survey demonstrated that the pre-hospital medical staff information about this topic needs reinforcement. The multivariate linear regression and non-parametric Wilcoxon test demonstrated that this was obtained thanks to the implemented training module. The course satisfaction survey showed not only a big interest in this activity but also staff recommended more related topics. Earlier-RSDAT (Recognition, Safety, Decontamination, Antidot, Transport) is a tool proposed as a response acronym to build a successful risk-based response for HazMat CBRN incidents in pre-hospital setting. Conclusion: HMCAS fulfills the readiness requirements for safe and effective response to potential HazMat-CBRN incidents in Qatar. The RSDAT response matrix might help in mitigating pre-hospital response risks.

Terrorism-Related Chemical, Biological, Radiation, and Nuclear Attacks: A Historical Global Comparison Influencing the Emergence of Counter-Terrorism Medicine.

Terrorist attacks are growing in complexity, increasing concerns around the use of chemical, biological, radiation, and nuclear (CBRN) agents. This has led to increasing interest in Counter-Terrorism Medicine (CTM) as a Disaster Medicine (DM) sub-specialty. This study aims to provide the epidemiology of CBRN use in terrorism, to detail specific agents used, and to develop training programs for responders. The open-source Global Terrorism Database (GTD) was searched for all CBRN attacks from January 1, 1970 through December 31, 2018. Attacks were included if they fulfilled the terrorism-related criteria as set by the GTD's Codebook. Ambiguous events or those meeting only partial criteria were excluded. The database does not include acts of state terrorism. There were 390 total CBRN incidents, causing 930 total fatal injuries (FI) and 14,167 total non-fatal injuries (NFI). A total of 347 chemical attacks (88.9% of total) caused 921 FI (99.0%) and 13,361 NFI (94.3%). Thirty-one biological attacks (8.0%) caused nine FI (1.0%) and 806 NFI (5.7%). Twelve radiation attacks (3.1%) caused zero FI and zero NFI. There were no nuclear attacks. The use of CBRN accounted for less than 0.3% of all terrorist attacks and is a high-risk, low-frequency attack methodology.The Taliban was implicated in 40 of the 347 chemical events, utilizing a mixture of agents including unconfirmed chemical gases (grey literature suggests white phosphorous and chlorine), contaminating water sources with pesticides, and the use of corrosive acid. The Sarin gas attack in Tokyo contributed to 5,500 NFI. Biological attacks accounted for 8.0% of CBRN attacks. Anthrax was used or suspected in 20 of the 31 events, followed by salmonella (5), ricin (3), fecal matter (1), botulinum toxin (1), and HIV (1). Radiation attacks accounted for 3.1% of CBRN attacks. Monazite was used in 10 of the 12 events, followed by iodine 131 (1) and undetermined irradiated plates (1). Currently, CBRN are low-frequency, high-impact attack modalities and remain a concern given the rising rate of terrorist events. Counter-Terrorism Medicine is a developing DM sub-specialty focusing on the mitigation of health care risks from such events. First responders and health care workers should be aware of historic use of CBRN weapons regionally and globally, and should train and prepare to respond appropriately.

Real-time detection of Chemical Warfare Agents at clearance decontamination levels for surface contamination: a challenge for civilian authorities

NATO doctrine considers clearance decontamination to be applicable after the termination of a CBRN incident and largely deems the conduct of clearance decontamination to be a civilian, not a military, capability (NATO Standard NATO STANREC 4784 CBRN Clearance Decontamination, Study Draft 1, November 2015). Clearance decontamination procedures are such that the process is verified as being achieved by determining the residual contamination levels on every part of various surfaces of equipment and infrastructure, and by demonstrating that such levels are below the ones that are pre-determined by the relevant civilian authorities, who are responsible for the safety of the civilian population (NATO Standard NATO STANREC 4784 CBRN Clearance Decontamination, Study Draft 1, November 2015). The current desirable surface contamination detection levels for some Chemical Warfare Agents are technically challenging and may be beyond the capabilities of current technologies of military and civilian authorities. Can those low levels be detected, in real time, with existing technologies? Proton Transfer Reaction–Time of Flight–Mass Spectrometry (PTR–ToF–MS) enables simultaneous real-time detection, monitoring, and quantification of volatile organic compounds. Trials and evaluations with this PTR–ToF–MS technology, using Chemical Warfare Agents as contaminants, will show that this technology is an invaluable asset in supporting civilian authorities when determining safe levels of surface contamination in real time, after the completion of decontamination operations.

The Correlation between the Commander’s CBRN Expertise and the Commander’s Crucial Information Requirement

The CBRN environment of joint operations determines that future joint operations are to be planned and commanded in a way that considers the risks posed by CBRN weapons against the forces participating in such operations. In addition to that, materials detrimental to the health of personnel may be released from destroyed industrial plants and nuclear facilities. Consequently, friendly forces shall prepare not just for the protection against conventional attacks, but also for CBRN incidents to. The commander’s critical information requirement has great importance during the operations planning period, and CBRN proficiency is critical in analyzing various sets of CBRN information.

Decontamination and Management of Contaminated Hair following a CBRN or HazMat Incident.

This in vitro study evaluated the “triple protocol” of dry decontamination, the ladder pipe system (a method for gross decontamination), and technical decontamination for the decontamination of hair following chemical contamination. First, we assessed the efficacy of the 3 protocols, alone or in combination, on excised porcine skin and human hair contaminated with either methyl salicylate (MS), phorate (PHR), sodium fluoroacetate (SFA), or potassium cyanide (KCN). A second experiment investigated the residual hair contamination following decontamination with the triple protocol at different intervals postexposure. In a third experiment, hair decontaminated after exposure to MS or PHR was evaluated for off-gassing. Though skin decontamination was highly effective, a substantial proportion (20%–40%) of the lipophilic compounds (MS and PHR) remained within the hair. The more water-soluble contaminants (SFA and KCN) tended to form much smaller reservoirs within the hair. Interestingly, substantial off-gassing of MS, a medium volatility chemical, was detectable from triple-decontaminated hair up to 5 days postexposure. Overall, the decontamination strategies investigated were effective for the decontamination of skin, but less so for hair. These findings highlight the importance of contaminated hair serving as a source of potential secondary contamination by contact or inhalation. Therefore, consideration should be given to the removal of contaminated hair following exposure to toxic chemicals.

Hospital management preparedness tools in biological events: A scoping review.

INTRODUCTION:The objective of the present study was to systematically review the current research knowledge on hospital preparedness tools used in biological events and factors affecting hospital preparedness in such incidents in using a scoping review methodology.MATERIALS AND METHODS:The review process was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to identify papers published that evaluated instruments or tools for hospital preparedness in biological disasters (such as influenza, Ebola, and bioterrorism events). The search, article selection, and data extraction were carried out by two researchers independently.RESULTS:A total of 3440 articles were screened, with 20 articles identified for final analysis. The majority of research studies identified were conducted in the United States (45%) and were focused on CBRN incident (20%), Ebola, infectious disease and bioterrorism events (15%), mass casualty incidents and influenza pandemic (10%), public health emergency, SARS, and biological events (5%). Factors that were identified in the study to hospitals preparedness in biological events classified in seven areas including planning, surge capacity, communication, training and education, medical management, surveillance and standard operation process.CONCLUSIONS:Published evidences of hospital preparedness on biological events as well as the overall quality of the psychometric properties of most studies were limited. The results of the current scoping review could be used as a basis for designing and developing a standard assessment tool for hospital preparedness in biological events, and it can also be used as a clear vision for the healthcare managers and policymakers in their future plans to confront the challenges identified by healthcare institutes in biologic events.

Individual Kit for Immediate Decontamination

Abstract In case of CBRN incidents, the individual decontamination is an extremely urgent measure, for the rescue of personnel from all categories of military forces or from specialized intervention teams, as well as the civilian population unprotected or with minimal protection. Any delay has a significant impact on the fulfillment of combat missions, volume of losses and success of recovery. In this context, it must be considered the possibility that your own troops operate in areas with CBRN risk. The activities with top priority are those relating to the individual protection and immediate decontamination of the personnel, within a very short time, guaranteeing the chances of survival. The paper presents the research results of a multidisciplinary team in the decontamination of chemical, biological and radiological domain for achieving a new individual kit for immediate decontamination, according with the NATO required standards. In the paper the performance and technical-tactical features of the product are iterated, as well as the aspects related to the testing and evaluation of the product development.

Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis.

Introduction: Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants. Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols. In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups.Methods: Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination. The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base.Results: Psychosocial aspects of incident management receive limited attention in current decontamination guidance. In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence. For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges. We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination.Conclusions: Effective communication and respect for casualties’ needs are critical in ensuring decontamination is completed quickly and effectively. We identify a number of areas requiring further research including: identifying effective methods for communicating in an emergency; better understanding of the needs of vulnerable groups during decontamination; effective training for emergency responders on psychosocial issues, and pre-incident public education for incidents involving emergency decontamination. It is essential that the psychosocial aspects of mass decontamination are not neglected in the pursuit of solely technical solutions.