CBRN Treatment requires the members of your survival group or militia to be properly trained in basic medical skills to advanced medical skills like CBRN treatment. This guide will describe SOP for CBRN medical personnel in the event of post-attack contamination requiring medical treatment. When evacuating contaminated victims’ psychological stress reactions will cause erratic behavior. Casualty care issues should be addressed at all times.
CBRN Response Unit Responsibilities
When operating within a medical capacity to CBRN response, your unit will be asked to be mentally prepared to carry out your responsibilities in a moral and ethical fashion, while addressing the prevention of further contamination among personnel. CBRN response units should be trained in the following standards;
- MOPP (Mission Oriented Protective Posture) Training Standards – Click to view MOPP Standards
- Coordinate and monitor NBC defense training. Ensure the integration of NBC defense training in all aspects of training.
- Assist in establishing and receiving unit-level mission-essential task list. Provide guidelines to ensure tasks can be performed under NBC conditions.
- Evaluate individual and collective NBC training. Determine training needs and recommend training required to correct deficiencies.
- Project NBC training ammunition requirements, based on current threat conditions and operational data.
- Instruct all personnel on basic decontamination procedures.
- Assign medically trained personnel key treatment roles and training parameters.
CBRN Medical Response Unit Guidelines
Medical response units will be tasked with the supervision of patient decontamination, while supporting units will be required to assist in decontamination and perform lifting and washing. Non-medical personnel should be included in the CBRN treatment planning parameters when mass casualties are expected as a part of the decontamination effort. The standard for CBRN MRUs unit structure require a minimum of fifteen operators that include, medical personnel, decontamination personnel, containment personnel, assisting personnel to handle likely CBRN incidents. As a patriot group, or militia, common armed forces standards for CBRN troop size are unrealistic. This calls for several more operators.
The role of CBRN response units composed of civilian/militia personnel should be clearly defined per incident by unit commanders, unit commanders must outline a clear decontamination strategy and response plan before committing personnel to the incident.
CBRN response units are equally susceptible to contamination; this requires individual responsibility. CBRN personnel must take immediate steps to prevent themselves from becoming a casualty to include but are not limited to;
- Skin decontamination should be immediately performed by contaminated personnel and/or assisting medical personnel.
- Assisting personnel known as ‘buddy-aid’ consists of emergency actions to maintain vital body functions in a casualty who cannot self-administer. These responsibilities include; decontaminating casualty, immediately don uncontaminated/decontaminated personal protective equipment to prevent further absorption through the skin, and evacuating casualties as soon as possible.
- Full wipe downs within 10 minutes should be performed to remove contaminated materials. Use RADIAC on all surfaces. In addition, responders can utilize CDS (Civil Defense Simultest Sets) that will detect alcohol, methanol, aliphatic hydrocarbons, n-hexane, armoatics, touene, chlorinated hydrocarbons, perchloroethylene, ketones, acetone, and hydrochloric acid in as little as 5 minutes.
- There is no such thing as ‘too much caution’ during CBRN incidents. Contaminated units must establish the following principles;
- DED – Detailed Equipment Decontamination
- DAD – Detailed Aircraft Decontamination (including civilian operated aircrafts)
- DTD – Detailed Troop Decontamination (i.e. personnel)
- Personnel should be prepared and sufficiently trained in self-treatments.
CBRN Medical Response Unit Assisting Personnel
CBRN medical support should be trained in; decontamination standard procedures, knowledge of operation specific equipment, basic patient treatment and evacuation standards, containment and defensive protocols. When CBRN incidents require extended durations, assisting personnel can assist in the development of sleep rotation planning. However, post SHTF CBRN attacks will not likely accommodate for extended stays, meaning operations should be completed within 24 hours to prevent further casualties.
CBRN Medical Personnel Triage Guidelines
Triage guidelines for civilian operators and militia members differ from military standards, primarily due to the lack of equipment available to civilians. Military personnel operating in the capacity of a militia are more likely to be better equipped to acquire the required items and applying triage guidelines.
The CBRN START protocol means simple triage and rapid treatment. The START protocol is SOP for providing primary triage efforts in a CBRN incident. The method employs the use tagging patients by medical personnel in the following method;
- Immediate (critical) [Red Tag] ventilation present after positioning the airway or ventilation are over 30 per minute or capillary refill greater than 2 seconds or no radial pulse or cannot follow simple command.
- Delayed (urgent) [Yellow Tag] Any patient not in the immediate or minor categories. These patients are generally non-ambulatory.
- Minor (ambulatory) [Green Tag] Any patient requiring medical attention who is not immediate or delayed and who is able to walk.
- Deceased (expired) [Black Tag] No ventilation present after the airway is opened.
CBRN response unit personnel are not required to follow the START protocol during secondary and subsequent triage. Knowledge of the medical consequences of various injuries (e.g., burn, blast, or crush injuries or exposure to chemical, biological, or nuclear weapons) is critical when considering the following triage guidelines.
- Immediate Treatment – to include those requiring immediate life or limb saving surgery, while ensuring treatment is not time-consuming and those treated have a high chance for survival.
- Delayed Treatment – Those in need of time-consuming surgery and/or resuscitation but whose general condition permits a delay in treatment. Such examples would include major bone fracture, uncomplicated major burns, and respirator effects of CBRN agents. When treating delayed treatment patients antibiotics should be administered, in addition to; catheterizations, gastric decompressions, administration of intravenous fluids, splinting, pain relief and respiratory/pharmalogical support of CBRN effects.
- Minimal Treatment – Relatively minor injuries such as minor lacerations, abrasions, fractures and non-incapacitating effects of CBRN agents.
- Expectant Treatment – represents casualties who’ve received multiple serious injuries and whose treatment would be time-consuming with a low chance of survival. Such patients would include those patients exhibiting severe burns, severe and multiple effects of CBRN agents described in the usCrow Introduction into CBRNE, and intractable CNS (central nervous system) respiratory effects of CBRN agents.
- For more information on triage in a CBRN environment, refer to Emergency War Surgery and The Textbook of Military Medicine, Medical Aspects of Chemical and Biological Warfare.
- In CBRN mass casualty incident, the site should be divided into zones/sectors and, in addition to the appointment of an overall triage officer, triage officers should be appointed for eachidentified zone. Field medical triage must be conducted at three levels; on-site triage, medical triage, evacuation triage.
CBRN assisting Personnel basic medical Treatment Guidelines
Site and personal safety is of paramount concern for the responder. Site Safety “standard practices” shall include baring entry into the Hot Zone without proper precautions, proper protective clothing based on the risk, and knowledge and permission of the Incident Commander. Treatment can begin when it is safe to do so this would include but not limited to Basic Life support procedures. Patients should be evaluated for contamination and decontaminated accordingly. Assisting personnel should follow standard CBRN medical response guidelines when treating expectant casualties;
- Secure Airway
- Avoid body fluids and protect against secondary contamination
- Avoid further contamination due to burping or emesis
- Supplement oxygen while recording vitals
- Obtain patient history
- Report findings to CBRN response unit medical personnel
CBRN Radiological Treatment Guidelines
RDDs (radiological dispersion devices), also known as dirty bombs can cause mass casualties from extreme heat, explosion, debris, and radiological dust. RDDs consist of radioactive material attached to improvised munitions and explosive devices. Fatalities and future radiation levels should be assessed after detonation.
The RTR system (radiation specific triage, treatment and transport sites) is a role assumed by medical response unit assisting personnel, characterizing the organized and efficient deployment of material and personnel assets. The RTR system is not a triage system for each patient but for overall mission effectiveness while preserving personnel safety. RTR sites should be determined by mission commanders accommodating for such environment, residual, and infrastructure factors.
CBRN Enemy Combatants and Threats to Personnel
Certain casualties and patients who pose a risk to other casualties and personnel are to be retained and segregated. Typically EPWs (enemy prisoners of war) i.e. detainees are treated identically to non-combatants personnel. However, civilian CBRN operations may not permit such operations risks. Commanders of CBRN units should ascertain operational security procedures for the intake and/or elimination of enemy combatants organically throughout the mission, weighing the advantages and disadvantages of the situation.
CBRN Mass Casualties
The expectation of mass casualties should be developed at an early stage in training to prevent medical personal from suffering traumatic disorders (everyone is different). In the event of mass casualty due to a bio-terrorist attack they are likely to exceed local capabilities, this is a fact.
CBRN mass casualty incidents are often brought down to saving limbs and lives with a martial minded triage effort. CBRN victims should be completely decontaminated before providing medical treatment to contaminated victims and performed in cold zones (uncontaminated area).
This CBRN guide is to be used in conjunction with the following downloadable PDF guides issued by various HazMat/CBRN Organizations:
- HAZMAT Medical Protocols Part I
- HAZMAT Medical Protocol Second Edition
- The International CBRN Training Curriculum
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