Page 72 - 2023 SMOG Digital

CBRN

CBRN CASUALTY MANAGEMENT

BASIC PRINCIPLES:
Initial care of the CBRN casualty should be approached in the same manner as other casualties.
Life threats require prompt recognition and intervention, and non-life-threatening sequelae can
be addressed when clinically appropriate. Early recognition and categorization of CBRN-exposed
patients is the foundation for further management, and is key not only for initiating patient
treatment but also for preventing contamination of medical personnel, equipment, and
facilities. Thorough and appropriate decontamination is a core skill that requires planning and
practice. Attention to details such as preventing hypothermia in patients undergoing
decontamination and clinical reassessment at each stage of the process will reduce unnecessary
morbidity. Basic life saving measures such as airway management and resuscitation are
fundamental concepts that must be mastered at the appropriate level for each practitioner in
the CBRN care chain.

CBRN CRITICAL TASK LIST:
1. Recognize CBRN exposure that requires action to protect self and others.
2. Don personal protective equipment (PPE) to prevent exposure in self and assist others with
PPE.
3. Egress from the threat:
a. Move upwind, uphill, upstream from threat.
b. Utilize time/distance/shielding for protection.
4. Recognize signs/symptoms of CBRN exposure that prompt immediate self-treatment or
treatment of others utilizing CRESS assessment. (RAPID IDENTIFICATION OF CHEMICAL
WARFARE AGENTS).
5. Apply TCCC integrated with CBRN response [TCCC + CBRN = (MARCHE) ]. (MARCHE )
2
2
6. Apply airway management skills in a CBRN setting (positioning, suction, ventilation to
include manual.
7. Perform Rapid Spot Decontamination.
8. Identify and establish Hot/Warm/Cold Zones.
9. Establish a dirty casualty collection point (CCP).
10. Understand decontamination principles and casualty procedures for partial or complete
removal of PPE, clothing, and equipment (casualty cut out).
11. Understand cross contamination and take appropriate measures to prevent it.
12. Understand available technology that can aid in agent identification.

CBRN MEDICAL REGULATING CONSIDERATIONS:
1. Military Treatment Facility (MTF).
a. DECON/Treatment Coordination. Ensure MTF is prepared to receive dirty casualties
and determine the most appropriate location for DECON.
b. Treatment Capabilities (Toxicology, Critical Care, Trauma Surgery). Determine
CBRN
whether the MTF has the services necessary to care for and sustain the CBRN
casualty on site and/or establish telemedicine support.
c. Capacity. The CBRN casualty is far more resource intensive than a typical trauma or
critically ill casualty. Assess the MTF’s capacity and capability to treat CBRN
casualties and identify potential alternate locations.
2. Integrate the medical regulating system into CBRN casualty evacuation.

72