Hospital CBRN Defence — Threat of Chemical, Biological, Radioactive and Nuclear Weapons

Physi­cians, nurs­es and para­medics are the main com­po­nents of a hos­pi­tal CBRN response unit. Who are these peo­ple and why are they doing this? In most cas­es world­wide they belong to the EMS depart­ment of the hos­pi­tal and they know how to han­dle med­ical emer­gen­cies of any kind. The prob­lem is if they all can be involved in CBRN oper­a­tions where usage of per­son­al pro­tec­tive equip­ment is manda­to­ry. Are they all fit to oper­ate under very stress­ful con­di­tions — both phys­i­cal­ly and emo­tion­al­ly? What if those in charge but not fit hap­pen to be on duty the day of the real event?

 -

A ded­i­cat­ed hos­pi­tal CBRN response unit might be a good alter­na­tive. In that respect all per­son­nel involved in this unit are fit to oper­ate under extreme con­di­tions in a con­t­a­m­i­nat­ed envi­ron­ment. But they need shifts and spe­cial arrange­ments regard­ing their dai­ly duties in peace­time. Some­times this is the biggest prob­lem cre­at­ing lots of fric­tion and dis­com­fort in hospital’s admin­is­tra­tion. A best solu­tion that cov­ers all aspects does not exist. Per­haps a fixed unit with var­i­ous lev­els of mobil­i­sa­tion and deploy­ment depend­ing on the threats’ index could do the job.

I strong­ly sup­port the idea of inclu­sion of “Med­ical CBRN Defence” or “Ter­ror Med­i­cine” into the cur­ric­u­la of uni­ver­si­ties’ med­ical and nurs­ing schools. This will be an oppor­tu­ni­ty for future front-line health pro­fes­sion­als to come into con­tact with med­ical CBRN oper­a­tions and have a basic knowl­edge in the back of their heads. If some­thing real hap­pens then this basic knowl­edge might be proven ben­e­fi­cial for the over­all man­age­ment of the cit­i­zens involved

 -

Then it is train­ing (Fig­ure 2). Just a few the­o­ret­i­cal sem­i­nars are not enough to pre­pare some­body to be involved in med­ical CBRN oper­a­tions. Prac­ti­cal train­ing is of huge impor­tance. Accli­ma­ti­sa­tion on per­son­al pro­tec­tive equip­ment is of even big­ger impor­tance. Spend­ing 30 min­utes with a gas mask on is not enough if you do not do it again and again, day after day. Don­ning twice a year for a few hours means noth­ing. It will always be like the first time! Then there are the pro­ce­dures. It is a mis­take to believe that there is noth­ing we can do while in per­son­al pro­tec­tive equip­ment. We can do many things — all the way to intu­ba­tion (Fig­ure 3) — but we need to do them again and again in order to attain pro­fi­cien­cy and self-con­fi­dence. We can cut cloth­ing, pro­vide anti­dotes, suck secre­tions, sup­port breath­ing, clean wounds, stop /control bleed­ing (i.e. by using Quik­lot™) or con­trol seizures. These are life sav­ing inter­ven­tions that along with thor­ough decon­t­a­m­i­na­tion will save the lives of those that were unfor­tu­nate enough to be both wound­ed and con­t­a­m­i­nat­ed at the same time.

Drills and exer­cis­es (Fig­ure 4) is the next log­i­cal step. They will help per­son­nel involved to under­stand plans and prac­tice their pro­ce­dures. Night drills are of par­tic­u­lar impor­tance because then you dis­cov­er that there was no pre­dic­tion for flood lights! But even in this sce­nario, a med­ical respon­der must be able to impro­vise and oper­ate even in the dark. Intu­bate once in the dark and you will nev­er for­get it — for life!

Exer­cise (Fig­ure 4) with oth­er first respon­ders both nation­al and inter­na­tion­al. Par­tic­i­pate in inter­na­tion­al exer­cis­es and try to copy and paste things and pro­ce­dures that will help you improve your own. Cre­ate a net­work of experts that will help you solve prob­lems and exchange ideas rel­e­vant to the core CBRN med­ical oper­a­tions.

Decon­t­a­m­i­na­tion is the most impor­tant task giv­en to the hos­pi­tal CBRN response unit. Should it be fixed or deployed if need­ed? If it is fixed pre­pared­ness time is kept to min­i­mum but the over­all cost is high­er. If it is portable, the cost is low­er but pre­pared­ness time might be a prob­lem espe­cial­ly if the hos­pi­tal is close or adja­cent to the inci­dent site. My per­son­al opin­ion is that all hos­pi­tals should have fixed ded­i­cat­ed decon­t­a­m­i­na­tion sta­tions (Fig­ure 5).

 -
Click to enlarge

The final ques­tion is “why should they do it?” A good answer could be “for their coun­try, their fam­i­lies and their soci­ety”. Although log­i­cal, log­ic is some­thing that is very rare — espe­cial­ly in West­ern soci­eties. There in order to do some­thing extra from your giv­en assign­ments you must have a very good moti­va­tion. And moti­va­tion is usu­al­ly trans­lat­ed to mon­ey. To a cer­tain point there is some right in this way of think­ing. Why? Med­ical CBRN defence is prac­ti­cal­ly a new med­ical spe­cial­ty. With a lot of study­ing, a lot of labo­ri­ous train­ing, a lot of respon­si­bil­i­ty and a very dan­ger­ous one since med­ical per­son­nel will have to save lives in a poten­tial­ly lethal envi­ron­ment. So why a sur­geon who spent many years in the med­ical school, then some addi­tion­al years in order to become a spe­cial­ist / con­sul­tant and now is work­ing in a hos­pi­tal and has his own pri­vate prac­tice to be involved in a sec­ond spe­cial­ty with no extra ben­e­fits for his future progress, no reg­u­lar patients, no extra salary and no recog­ni­tion of his role in the over­all defence of his coun­try? I expe­ri­enced all kind of atti­tudes from “what is in it for me” (Greece) all the way to “for the coun­try and the Queen” (UK) or “because they are told to” (India). Truth is always some­where in the mid­dle. I strong­ly sup­port the strat­e­gy of moti­va­tion but also the feel­ing of com­mu­ni­ty and uni­ver­sal sup­port. If there is no gain at all, then even the most pas­sion­ate respon­ders will retreat soon­er or lat­er. So why not keep­ing every­body hap­py by apply­ing a car­rot and stick pol­i­cy?

Towards the future

Igno­rance is a bad advi­sor and lack of knowl­edge regard­ing new emerg­ing threats and CBRNE in par­tic­u­lar is the main rea­son for this reluc­tant atti­tude of med­ical com­mu­ni­ty observed almost uni­ver­sal­ly. In that respect, I strong­ly sup­port the idea of inclu­sion of “Med­ical CBRN Defence” or “Ter­ror Med­i­cine” into the cur­ric­u­la of uni­ver­si­ties’ med­ical and nurs­ing schools. This will be an oppor­tu­ni­ty for future front-line health pro­fes­sion­als to come into con­tact with med­ical CBRN oper­a­tions and have a basic knowl­edge in the back of their heads. If some­thing real hap­pens then this basic knowl­edge might be proven ben­e­fi­cial for the over­all man­age­ment of the cit­i­zens involved. In oth­er words, if you have many cas­es of flu-like ill­ness­es in August and the only thing you know is flu then your dif­fer­en­tial diag­no­sis will bal­ance between “flu” and “flu” and you will miss “res­pi­ra­to­ry anthrax” because you have nev­er heard about it and how you can iden­ti­fy it and set an alarm.

“They have to be lucky all the time. We have to be lucky only once!” State­ment made by an IRA spokesper­son fol­low­ing the unsuc­cess­ful attempt to mur­der for­mer UK Prime Min­is­ter Mar­garet Thatch­er.

Many peo­ple in high places usu­al­ly mum­ble why spend all that mon­ey for some­thing that will not hap­pen. Well, if in Jan­u­ary 2011 some­one pre­sent­ed a sce­nario involv­ing a mega-earth­quake, a mega-tsuna­mi and a mega-nuke cat­a­stro­phe, then the audi­ence would sure­ly laugh and com­ment on presenter’s sci-fi capa­bil­i­ties. And then it hap­pened in Japan! So keep in mind that “the unex­pect­ed always hap­pens!” and sup­port the med­ical / hos­pi­tal CBRN pre­pared­ness by all means. It is nev­er too late to do the right thing and it has been proven that by doing the right things it costs less!

Accli­ma­ti­sa­tion on per­son­al pro­tec­tive equip­ment is of even big­ger impor­tance. Spend­ing 30 min­utes with a gas mask on is not enough if you do not do it again and again, day after day. Don­ning twice a year for a few hours means noth­ing

About the Author
Brig Gen Ioan­nis Galatas, MD, PhD, MA, MC (retd) — The writer holds a PhD degree in Med­i­cine and a Master’s Degree in “Inter­na­tion­al Ter­ror­ism, Organ­ised Crime and Glob­al Secu­ri­ty” from Coven­try Uni­ver­si­ty, UK. He is the Edi­tor of the on-line “CBRNE-Ter­ror­ism Newslet­ter”. Since August 2010 he is the CBRN Sci­en­tif­ic Coor­di­na­tor at Research Insti­tute of Euro­pean- Amer­i­can Stud­ies, holds the posi­tion of Vice Chair­man of Greek Intel­li­gence Stud­ies Asso­ci­a­tion and CEO of CBRN Hydra Con­sult­ing while being a CBRN con­sul­tant for Cristani­ni S.p.A (lead­ing Ital­ian decon­t­a­m­i­na­tion com­pa­ny). His last mil­i­tary appoint­ment before his vol­un­tary retire­ment in August 2010, was as Head of the Depart­ment of Asym­met­ric Threats at the Intel­li­gence Analy­sis Branch, of Joint Mil­i­tary Intel­li­gence Divi­sion of the Hel­lenic Nation­al Defense Gen­er­al Staff in Athens, Greece.

Defence and Secu­ri­ty Alert (DSA
Defence and Secu­ri­ty Alert (DSA) mag­a­zine is the only ISO 9001:2008 cer­ti­fied, pre­mier world class, new wave month­ly mag­a­zine which fea­tures par­a­digm chang­ing in-depth analy­ses on defence, secu­ri­ty, safe­ty and sur­veil­lance, focus­ing on devel­op­ing and strate­gic future sce­nar­ios in India and around the world.

Team GlobDef

Team GlobDef

Seit 2001 ist GlobalDefence.net im Internet unterwegs, um mit eigenen Analysen, interessanten Kooperationen und umfassenden Informationen für einen spannenden Überblick der Weltlage zu sorgen. GlobalDefenc.net war dabei die erste deutschsprachige Internetseite, die mit dem Schwerpunkt Sicherheitspolitik außerhalb von Hochschulen oder Instituten aufgetreten ist.

Alle Beiträge ansehen von Team GlobDef →