CBRNE Events Research Articles

Unveiling disaster: exploring dam failures and CBRNe events in Brazil and beyond

Unveiling disaster: exploring dam failures and CBRNe events in Brazil and beyond

From Didactics to Disasters: Unveiling CBRNe and Counter-Terrorism Medicine Training in US Medical Schools.

The threat of chemical, biological, radiologic, nuclear, and explosive (CBRNe) terrorist attacks has increased over time. The need for rapid and effective responses to such attacks is paramount. Effective medical counter-measures to CBRNe events are critical and training for such may effectively occur early in physician training. While some medical specialties are more involved than others, counter-terrorism medicine (CTM) spans all medical specialties. All United States allopathic medical schools were examined via online curriculums and queries for academic content related to CBRNe and terrorist medical counter-measures. Analysis of 153 United States allopathic medical schools demonstrated that 15 (9.8%) medical schools offered educational content related to CBRNe and terrorist counter-measures. This is in contrast to legislation following the September 11, 2001 attacks that called for high priority for such education. Effective CBRNe medical counter-measures are currently in place; however, there is room for improvement in education that may begin during medical school. While certain medical specialties such as emergency medicine, primary care, and dermatology may have specific niches in such events, physicians of all medical specialties have something to offer, and even a basic education in medical school can help best prepare the nation for future attacks.

Survey Evaluation of Nursing Emergency Preparedness Training

Introduction:An effective response to CBRNE requires that frontline staff, such as nurses, are adequately trained in Emergency Preparedness (EP). Understanding the current gaps in nursing knowledge of CBRNE is the first step in creating an effective training program. This study assessed EP training gaps and needs among nursing staff.Method:A web-based survey was distributed to all hospital nursing staff. The survey evaluated the CBRNE training that nurses received. Staff listed the types of training they had received and were asked to rate their confidence in performing various disaster-related competencies or capabilities. Competency confidence levels were also surveyed as those who feel; not at all confident or not very confident.Results:The survey assessed previous EP training. 572/763 Nursing Staff had completed the survey, for a response rate of 75%. Of the nurses who responded, areas in which they have been trained included: preparedness for radiological and nuclear agents (17.66% trained), preparedness for biological agents (22.20% trained), preparedness for chemical agents (27.45% trained), hazardous materials and patient decontamination (25% trained), and their own role within the hospital's ICS (31.29% trained), Patient evacuation (63.61% trained) and the hospital's EP plan (54.55% trained). The survey also assessed respondents' confidence in performing EP activities. The respondents reported lacking confidence in treating patients exposed to a radioactive material (59.9%), treating patients exposed to a biological agent (57.17%), and performing decontamination procedures (54.71%). The respondents reported having confidence in evacuating patients from units, departments, or hospitals (69.1%). The top incentives for participating in “nonrequired” training were no costs to complete the training (83.1%) and receiving continuing education credits (79.2%).Conclusion:A majority of nurses reported inadequate training in CBRNE events with a self-reported lack of confidence in responding to these events. A targeted and educational CBRNE curriculum and materials to enhance EP among nursing professionals are clearly indicated.

New technologies for detection, protection, decontamination, and developments of the decision support systems in case of CBRNe events: editorial

New technologies for detection, protection, decontamination, and developments of the decision support systems in case of CBRNe events: editorial

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNe) Preparedness: Perceptions of Australian Emergency Department (ED) Doctors and Nurses

Introduction:Clinicians working in emergency departments (ED) play a vital role in the healthcare response to chemical, biological, radiological, nuclear, and explosive (CBRNe) events. However, ED clinicians’ individual and workplace preparedness for CBRNe events is largely unknown.Aim:The aim of this research was to explore Australian ED nurses and doctors’ perceptions of individual and workplace preparedness related to CBRNe events.Methods:The study populations were Australian nurses and doctors who work in EDs. Data was collected via a survey with 43 questions requiring binary responses or a rating on a Likert scale. The survey consisted of questions relating to the participant’s previous disaster training, perceived likelihood of a CBRNe event impacting their ED, perceived level of knowledge, perceived personal preparedness, perception of ED preparedness, and willingness to attend their workplace. Data were analyzed using descriptive and inferential statistics.Results:There were 244 complete responses, 92 (37.7%) doctors and 152 (62.3%) nurses. When comparing doctors and nurses, there was a statistical difference between gender (p = < 0.001), length of employment (p = < 0.001), and role in the ED (p = < 0.001). Doctors and nurses had a similar level of previous training except for practical training in mask fitting (p = 0.033). CBRNe events were considered separately. Perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness were significant predictors of willingness to work in all CBRNe event. Perceived likelihood of a CBRNe event impacting their ED was not a predictor of willingness.Discussion:This research contributes to an overview of the current status of Australian ED clinicians’ preparedness for CBRNe response. To increase the willingness of ED doctors and nurses attending their workplace for a CBRNe event, strategies should focus on enhancing individuals perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness.

Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review.

A systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An in-depth search strategy was devised to identify studies which focused on the ED and CBRNe events. The inclusion criteria were stringent in terms of the environment (ED), participants (first receivers), situation (CBRNe response), and actions (detection, decontamination, and diagnosis). Fifteen databases and topic-specific journals were searched. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Papers were thematically coded and synthesized using NVivo 10 (QSR International Ltd, Melbourne, Australia). Sixty-seven full-text papers were critically appraised using the MMAT; 70% were included (n = 60) as medium- or high-quality studies. Data were grouped into four themes: preparedness, response, decontamination, and personal protective equipment (PPE) problems.DiscussionThis study has recognized the ED as a system which depends on four key factors - preparedness, response, decontamination, and PPE problems - which highlight challenges, uncertainties, inconsistencies, and obstacles associated with the ED CBRNe response. This review suggests that response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence). Finally, this study highlighted that there was a void specific to detection and diagnosis of CBRNe exposure on self-presenting patients in the ED. The review identified concerns for both knowledge and behaviors which suggests that a systems approach would help understand the ED response to CBRNe events more effectively. The four themes provide an evidence-based summary for the state of science in ED CBRNe response, which can be used to inform future policies and clinical procedures. RazakS, HignettS, BarnesJ. Emergency department response to chemical, biological, radiological, nuclear, and explosive events: a systematic review. Prehosp Disaster Med. 2018;33(5):543-549.

Emergency Preparedness Training for Hospital Nursing Staff, New York City, 2012–2016

Many nurses are trained inadequately in emergency preparedness (EP), preventing them from effectively executing response roles during disasters, such as chemical, biological, radiological, nuclear, and explosive (CBRNE) events. Nurses also indicate lacking confidence in their abilities to perform EP activities. The purpose of this article is to describe the phased development of, and delivery strategies for, a CBRNE curriculum to enhance EP among nursing professionals. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and the National Center for Disaster Preparedness at Columbia University's Earth Institute led the initiative. Curriculum development included four phases. In Phases I and II, nursing staff at 20 participating NYC hospitals conducted 7,177 surveys and participated in 20 focus groups to identify training gaps in EP. In Phase III, investigators developed and later refined the CBRNE curriculum based on gaps identified. In Phase IV, 22 nurse educators (representing 7 of the original 20 participating hospitals) completed train-the-trainer sessions. Of these nurse educators, three were evaluated on their ability to train other nurses using the curriculum, which investigators finalized. The CBRNE curriculum included six modules, a just-in-time training, and an online annual refresher course that addressed EP gaps identified in surveys and focus groups. Among the 11 nurses who were trained by three nurse educators during a pilot training, participant knowledge of CBRNE events and response roles increased from an average of 54% (range 45%-75%) on the pre-test to 89% (range 80%-90%) on the posttest. By participating in nursing CBRNE training, nurses increased their knowledge of and preparedness to respond to disasters. The train-the-trainer curriculum is easily adaptable to meet the needs of other healthcare settings. The CBRNE curriculum can be used to train nurses to better prepare for and more effectively respond to disasters.

Integrating Chemical Biological, Radiologic, and Nuclear (CBRN) Protocols Into TCCC Introduction of a Conceptual Model - TCCC + CBRN = (MARCHE)2.

The authors would like to introduce TCCC [Tactical Combat Casualty Care] + CBRN [chemical, biological, radiological, and nuclear] = (MARCHE)2 as a conceptual model to frame the response to CBRN events. This model is not intended to replace existing and well-established literature on CBRNE events but rather to serve as a response tool that is an adjunct to agent specific resources.

Just-in-time learning is effective in helping first responders manage weapons of mass destruction events.

Chemical, biologic, radiologic, nuclear, and explosive (CBRNE) incidents require specialized training. The low frequency of these events leads to significant skill decay among first responders. To address skill decay and lack of experience with these high-impact events, educational modules were developed for mobile devices to provide just-in-time training to first responders en route to a CBRNE event. This study assessed the efficacy and usability of the mobile training. Ninety first responders were randomized to a control or an intervention group. All participants completed a pretest to measure knowledge of CBRNE topics. The intervention group then viewed personal protective equipment and weapons of mass destruction field management videos as an overview. Both groups were briefed on a disaster scenario (chemical nerve agent, radiologic, or explosives) requiring them to triage, assess, and manage a patient. Intervention group participants watched a mobile training video corresponding to the scenario. The control group did not receive prescenario video training. Observers rated participant performance in each scenario. After completing the scenarios, all participants answered a cognitive posttest. Those in the intervention group also answered a questionnaire on their impressions of the training. The intervention group outperformed the control group in the explosives and chemical nerve agent scenarios; the differences were statistically significant (explosives, mean of 26.32 for intervention and 22.85 for control, p < 0.01; nerve agent, mean of 23.14 for intervention and 16.61 for control, p < 0.01). There was no statistically significant difference between the groups in the radiologic scenario (mean, 12.7 for intervention and 11.8 for control; p = 0.51). The change in pretest to posttest cognitive scores was significantly higher in the intervention group than in the control group (t = 3.28, p < 0.05). Mobile just-in-time training improved first-responder knowledge of CBRNE events and is an effective tool in helping first responders manage simulated explosive and chemical agent scenarios. Therapeutic/care management study, level II.

Developing Fuzzy Cognitive Mapping Techniques for Consequence Analysis of Second and Third Order Effects

The Defense Threat Reduction Agency (DTRA) is the Department of Defense’s (DOD) official Combat Support Agency for countering weapons of mass destruction (WMD). DTRA focuses on WMD and mitigating the consequences of a chemical, biological, radiological, nuclear and high yield explosive threat (CBRNE). The initial direct effects of a CBRNE incident are well defined and documented; however, the second and third order effect’s are complex and not thoroughly understood or documented. Consequence analysis is the practice of analyzing the effects of major events such as a CBRNE event and can assist in predicting the second and third order effects. Currently there is no method to predict or analyze the second and third order effects of CBRNE events. This research focused on identifying the entities associated with a CBRNE event initially. The use of experts and surveys developed an exhaustive list of entities and associated realtionships. The follow-on research focused on the type and strength of the entity relationships. Next, Fuzzy Cognitive Mapping (FCM) techniques identify and evaluate the complex relationships of the second and third order effects. Using a mind mapping computer program, FCM techniques produced second and third order effect relationships. The final product provided a solid first attempt at analyzing a CBRNE event and the associated second and third order effects. Subsequent research will require greater effort to employ system dynamics techniques to enhance the product and develop a more thorough model.

The Military’s Response to Domestic CBRNE Incidents

The military’s increasing role in response to CBRNE events throughout the US has resulted in the need for a re-structuring of military forces. The development of the CBRNE Consequence Management Enterprise is a prime example of the military’s effort to support federal, state, and local disaster response agencies. The National Guard improved their response capabilities through the development of 57 Weapons of Mass Destruction Civil Support Teams, 17 CBRNE Enhanced Response Force Packages and 10 Homeland Response Forces. With their additional manpower, equipment, and response capabilities the active duty military still has a vital disaster response role. The active duty military does, however, have a primary mission of fighting and winning wars, therefore it is only practical to utilize the National Guard as the main element of a response to a major CBRNE incident. National Guard units are less restricted by both the Posse Comitatus Act and the Title 10 US Code (USC) allowing them greater flexibility during response to CBRNE events. Civilian leaders responsible for leading National Guard units must be well versed in the laws, structure and tactics pertaining to National Guard forces and must be familiar with the National Guard’s capabilities and limitations.