All-Scenario Medical and Public Health Response for Chemical, Biological, Radiological, Nuclear, and Explosive Incidents Open Access

Abstract

Abstract

 

Chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents can occur as a result of deliberate use or through accidental means.  Response guidelines and handbooks focus primarily on acts of CBRNE violence.  However, as CBRNE incidents can occur through accidents this SSP places emphasis on an all-scenario approach to these incidents.  Through an all-scenario approach, CBRNE first responders can aid in a wider range of incidents. For example, the contrast between cyanotic pesticides that were released into the atmosphere in an industrial accident in Bhopal, India, and the deliberate use of sarin gas in a subway in Tokyo, Japan, for political goals demonstrates the need to have an all-scenario approach to response.

 

In addition to focusing primarily on acts of violence, most of the emphasis in current guidance has been placed on medical treatment of CBRNE victims following an incident.  These incidents can cause devastating and long-term impacts on victims and community members and little emphasis has been made to integrate public health practice into initial CBRNE incident response to mitigate these long-term effects. This project begins the integration process of public health practice into initial incident response.  

 

In order to fulfill this integration goal, a medical and public health response manual was created.  This is accomplished by providing medical countermeasures relating to clinical features, diagnosis, and treatment options along with public health practice including infection control, decontamination, post-incident mental well-being, surveillance, working with law enforcement, and after-action reviews.   Through the integration of these measures, response to CBRNE incidents will become more comprehensive.  

 

Integrating these changes to the response systems should continue to provide competent on-site medical care, while improving the overall well-being of the community as it works to rebuild.  These changes are designed around improving long-term outcomes during the recovery phase after the incident. 

Table of Contents

Table of Contents

 

Chapter 1: Introduction………………………………………………………1

Scope of the Project……………………………………………………………1

Chemical Agents………………………………………………………………2

Biological Agents………………………………………………………………2

Radiological Agents……………………………………………………………3

Nuclear Agents…………………………………………………………………3

Explosive Agents………………………………………………………………4

 

Chapter 2: Literature Review…………………………………………………5

USAMRIID Blue Book………………………………………………………5

Chemical Warfare Handbook & Chemical Casualties Handbook……………8

Radiological Casualties Handbook……………………………………………13

Emergency War Surgery……………………………………………………16

Jane’s Chem-Bio Handbook…………………………………………………18

CDC & WHO………………………………………………………………22

Historical Sources…………………………………………………………23

 

Chapter 3: Methods………………………………………………………24

 

Chapter 4: The Manual……………………………………………………29

Introduction………………………………………………………………20

All-Scenario Preparation…………………………………………………33

Part One: Chemical Agents………………………………………………43

Part Two: Biological Agents………………………………………………57

Part Three: Radiological/Nuclear Agents…………………………………98

Part Four: Explosive Agents……………………………………………105

Personal Protective Equipment…………………………………………108

Decontamination…………………………………………………………113

Annexes…………………………………………………………………115

 

Chapter 5: Discussion, Conclusion, and Next Steps………………………121

Discussion…………………………………………………………………121

Conclusion…………………………………………………………………123

Next Steps…………………………………………………………………124

 

References…………………………………………………………………125

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	CBRNE All-Scenario Public Health Response
Committee Chair / Thesis Advisor	McFarland, Deborah, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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