The response to hazardous materials or chemical, biological, radiological, nuclear (CBRN) incidents typically consists of: (1) cordons regulating access into and egress from designated zones; and (2) use of appropriate personal protective equipment. In most systems emergency medical services (EMS) will stay outside of the “hot zone”. The patient will be rescued by the fire service and, after some gross decontamination, handed over. As mass gatherings are regarded as high-risk events, this system was used in Vienna during the Euro08 and augmented by: (1) casualty decontamination units (seven parallel lines for stretcher decontamination, located before triage); (2) a rapid intervention group for medical care in the hot zone (25 medical personnel), responsible for triage, life support (airway, breathing, bleeding), and antidote therapy; and (3) a joint CBRN incident command for close cooperation with detection units.

After a review of the available open-source literature, a risk analysis was performed and the tactical concept described above was developed with cooperation of all involved services. Special training was performed for all members of the aforementioned units.

As the concept was not tested by an actual emergency, the following observations can be made: (1) readiness of the units could be successfully maintained during the EURO08; (2) me chosen equipment was experienced as appropriate; (3) several minor cases corroborated the risk analysis; and (4) manpower and training requirements were considerable.

While it is possible to perform medical care within the hot zone, concepts are rarely tested in reality and the necessary efforts raise the question of proportionality.

Although 15 years have passed since the Tokyo subway attack, it was the preparations for the Kyushu-Okinawa G8 summit (2000) five years thereafter that catalyzed the development of countermeasures and policy against chemical, biological, radioactive, nuclear, or explosive (CBRNE) threats in Japan.

Report: No substantial progress was made for five years after the subway attack. Preparedness for the Kyushu-Okinawa G8 Summit included promulgation of the Civil Protection Law (2004), which codified the responses to CBRNE terrorist attacks, and consequendy, the effectiveness with which the countermeasures against CBRNE terrorism acts could be deployed at a national level. Countermeasures included the establishment of a CBRNE task force, syndromie surveillance programs, and the stockpiling of antidotes, antitoxins, and antibiotics. Decontamination facilities were introduced throughout Japan.

Preparedness for the summit facilitated recognition of the need for medical countermeasures against CBRNE threats to protect healthcare providers in Japan. In the 15 years since the Tokyo Subway Attack, the measures implemented in the last five years have been most effective. However, future challenges include the promotion of civilian awareness, inter-agency collaboration, and increasing the mutual-aid capacity of local communities.

The response to incidents with chemical and radioactive substances has been shaped primarily by firefighters' experiences with hazardous material (HAZMAT) accidents. Globally, HAZMAT tactics consist of the main elements of: (1) appropriate use of personal protective equipment; and (2) cordons regulating access into and egress from designated zones. Detection and casualty decontamination are far less uniformly organized.

Review and analysis of open-source (medical-and first responder-oriented) English and German Ianguage literature; informal questionnaire survey of first responders in several European countries.

The initial on-scene measures during a HAZMAT response—cordoning off the scene and rescue out of the contaminated area—are done uniformly by fire service responders. In most cases, emergency decontamination of casualties at the scene (disrobing and flushing), is performed by firefighters, however, reliability appears variable. The probability of a coordinated patient handover from fire personnel to emergency medical services (EMS) staff is rated “low” by most sources.

In many countries, specialized casualty decontamination units have been commissioned and are operated by a variety of services: fire, EMS, military and civil protection.

Hospital decontamination facilities are in most countries still the exception and depend mosdy on local commitment. Substantial detection usually invalues only simple measurements performed by the first responders; specialized support is planned to be given mainly by military, civil protection and specialized laboratories.

Initial on-scene response to chemical/radiological incidents is fundamentally similar in most countries. However, distinctive differences beyond the first steps restrict the transferability of organizational solutions.

The objective of this study was to assess the effect of 20 minutes of heavy treadmill exertion in military-style, Level-C chemical and biological personal protective equipment (PPE), including a filtering face piece respirator, on physiological variables including venous pH, venous PCO2, SpO2 and tympanic temperature.

Baseline physiological variables were measured in 19 healthy subjects who undertook heavy physical exertion on a treadmill at a constant room temperature of 20°C: (1) once while wearing a short-sleeved t-shirt, shorts, and running shoes; and (2) once while wearing chemical and biological PPE. Repeat measurements of physiological variables were made after 10 and 20 minutes of exertion in both groups.

Twenty minutes of physical exertion was undertaken by healthy subjects wearing chemical and biological PPE resulted in moderate hypoxemia, significantly decreased pH (p = 0.003), elevated PCO2 (p = 0.018) and elevated tympanic membrane temperature (p < 0.001), compared to baseline values. Despite these significant differences, none of the mean venous blood gas values deviated from the normal range during physical exertion.

The degree and duration of physical exertion undertaken in chemical and biological PPE induced some significant changes in physiological variables compared to control but, with the exception of SpO2, did not result in changes considered to represent abnormal physiology. However, it is likely that core body temperature was underestimated by tympanic measurement. Blood gas data indicating that CO2 was retained during exertion in this type of PPE were unanticipated and require further investigation.

Emergency medical services (EMS) providers are ill-prepared in the areas of training and equipment for weapons of mass destruction (WMD) events and other public health emergencies.

A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in WMD and/or public health emergencies, as part of their initial provider training and as continuing medical education (CME) within the past 24 months. Providers also were surveyed as to whether their primary EMS agency had the necessary specialty equipment to respond to these specific events.

More than half of EMS providers had some training in WMD response. Hands-on training was associated with EMS provider comfort in responding to chemical, biological and radiological events and public health emergencies (OR = 3.2; 95% CI = 3.1–3.3). Only a small portion (18.1%) of providers surveyed indicated that their agencies had the necessary equipment to respond to a WMD event. The comfort level and having equipment to respond these incidents was not as highly associated as the comfort level and having had training to respond to these incidents.

Lack of training and education as well as the lack of necessary equipment to respond to WMD events is associated with decreased comfort among emergency medical services providers in responding to chemical, biological, and radiological incidents. Better training and access to appropriate equipment may increase provider comfort in responding to these types of incidents.

Mass-casualty incidents involving radiation are rare but potentially devastating events. Even incidents with a small number of casualties are challenging due to the specific nature of the information and decisions required, and the rate of decay of knowledge about radiation. A package of specific forms and guidelines could assist emergency department (ED) physicians with this process.

A seven-page tool was developed as part of a project (METER 2008) funded by the Canadian Chemical, Biological, Radiological, and Nuclear Research and Training Initiative (CRTI) to facilitate the ED management of radiation casualties. These forms cover triage, the history and physical examination, diagrams to mark areas of contamination, standing orders, and a means of estimating Acute Radiation Syndrome severity. The tool was piloted at a workshop in Quebec City in November 2007. Later, a questionnaire was distributed to participants to assess the usefulness. The tool will be further tested at other workshops across Canada during the winter.

Participants found the tool to be useful, Their comments and improvements will be presented.

The tool demonstrated in this presentation can be used to assist ED staff with the triage and management of casualties with exposure to radiation.

Although there is information about hazardous materials and related activity during hazardous material accidents, chemical disasters, or chemical terrorism, it is not comprehensive, cannot be accessed easily, and is not sufficient for the specific situation, as in a toxic accident in a household or chemical accident in industry. Additionally, the information is not prepared for the emergency medical response in general. The authors developed a comprehensive database system for medical hazardous materials and assessed the application of the system.

A questionnaire was answered by 534 persons who are hazardous materials-related workers, experts, or laypersons about the necessary contents of the database and the methods of application. Forty-six database fields were developed relating to chemical accidents and hazardous materials, the most important contents were extracted through a four-stage process. The database fields were prioritized in 19 classification groups based on an existing database and our survey.

There were 111 chemicals that were determined to be most necessary to include in the database. The final classification of database fields was eight groups. A Website was constructed of the resulting database for real application.

Although it has become possible to provide emergency information about chemical accidents, terrorism, or disaster, comprehensive information from the accident site to hospital still is needed for a quicker response, such as die identification of chemicals. The next step will be developing an information-providing system using mobile devices.

The study presents the generalized results of the long-term epidemiological, clinical, biochemical, cyto-genetic, and immunological studies dedicated to the mechanisms of the development of somatic pathology in the remote period in the victims of radiation accidents. The major accidents were included, i.e., Chernobyl nuclear power plant accident, radiation accidents on ships with nuclear energy devices, nuclear weapons tests, and other accidents.

The two databases were created at the Nikiforov Russian Center of Emergency and Radiation medicine (St. Petersburg) in order to monitor the health status of the victims of radiation accidents: (1) epidemiological database with sub-registries for leukosis, thyroid cancer and other cancers, (2) scientific clinical database.

The full range of all up-to-date and evidence-based clinical investigations was used including tomography, bio-and immunochemical methods, cancer markers and hormone levels assessment.

The epidemiological analysis showed that after five years following the exposure there is a significant rise in the incidence of somatic pathology across all age groups. After 10 years following the exposure 38% of clean-up workers already developed chronic diseases, while among those who were exposed to the dose of more than 25 cGy the incidence was more than 50%. Over 20 years of observation, the average number of diagnosed chronic diseases per clean-up worker increased from 1.4 to 10.6.

The most prevalent symptoms (>60%) are cardiovascular diseases, musculoskeletal and gastrointestinal diseases. From the results of cytogenetic and biochemical investigations the main pathological mechanism is the disturbance of microcirculation and endothelial dysfunction. In 60–80% of clean-up workers' muscular-skeletal diseases were diagnosed with the main manifestation and possible mechanism being an osteopenic syndrome.

The cytogenetic studies showed that across all age groups, the incidence of chromosome aberrations is significantly higher than in the control group. The assessment of cancer markers confirmed the elevated risk of developing cancer. This was accompanied by markedly elevated levels of hydrogen peroxide and other free-radical and lipid oxidation indicators in the blood.

The results of the complex epidemiological, clinical, biochemical, cytogenetic, and immunological investigation performed on the patients exposed to ionizing radiation due to a number of radiological accidents described the mechanisms of the development of somatic pathology due to radiation exposure.

People with disabilities largely have been excluded from emergency preparedness plans. Emergency Preparedness for Persons with Disabilities was developed to help assist such persons to deal with a variety of emergency situations.

Phase I focused on healthcare professionals who care for such persons. An eight-hour, basic, core course includes triage, transfer and transport, personal protection, patient decontamination, equipment decontamination, developing an office emergency plan, evacuation, communications, and emergency contacts. Modules for non-medical office staff include communications, staffing, personal protection, and Internet access to helpful sites.

Phase II focused on the person with disability and his/her caregivers—health professionals (visiting nurse or Home Health Aide) and families. Training modules include home preparations, preparedness kit development, and evacuation.

Methods of evacuation and transportation of patients in vertical and horizontal situations were tested. Training staff noted a lack of familiarization of triage methods, patient and staff accountability, and equipment that could be used in case of an evacuation. Training modules were modified following evaluation of the above.

Professionals and persons with disabilities can benefit from receiving emergency preparedness training. The experience and materials presented can accomplish this task. This training can serve as a model for rehabilitation professionals and the populations they serve.

Pregnant females are uniquely vulnerable to morbidity and mortality associated with trauma and from secondary exposure to environmental agents during and following a terrorist attack. For clinicians and emergency management planners, there are several specific considerations for pregnant victims of terrorist events in the planning and response phases of a terrorist event.

A review of scientific, medical, and academic literature pertaining to women and terrorist activities was performed. In addition, government reports and media accounts of terrorist attacks where women were direcdy or centrally involved as perpetrators were collected and reviewed. Common elements, themes, and similarities were analyzed by the investigator to determine trends in injury patterns, distribution of exposed individuals, and the acute and long-term health effects associated with the gravid female and her unborn child.

Several causes of morbidity and mortality among pregnant females and their unborn children as the result of terrorist attacks were discussed in the literature. Physical trauma, toxic inhalation effects, bioterrorism considerations, and psychosocial impacts were among those discussed most often. The disaster epidemiology associated with these health events is described, as well as the strategies for prevention and clinical management of this unique group of victims.

A greater understanding of the types of hazards and exposures which may affect a pregnant woman or her unborn child during or following a terrorist attack can assist in developing plans for medical counterterrorism. This epidemiological information can benefit both clinicians and emergency planners in anticipating the potential health and medical needs as well as planning for potential protective actions that can be implemented before or immediately following a terrorist incident.