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TEN Recommendations for Building Hospital CBRN Programs

In 2015-16, the CBRNE Collaborative reviewed the literature and obtained the input of at risk health care providers to assemble a document called "TEN Recommendations to Consider When Establishing a Chemical, Biological, Radiological-Nuclear (CBRN) Program for Hospitals". In discussing risk with the health care providers, it became clear that most important and powerful form of protection was NOT advanced personal protective equipment, but recognizing the threat. Why? By far the majority of contaminated patients (CRN) will present ambulatory and can be directed (without being touched) to an area where they can self-decontaminate. As for Bio, health care providers "should" know how to protect themselves and isolate patients. The risk comes with those victims who need assistance and require physical contact. In those isolated situations, advanced personal protection may be needed.

The money required to support advanced CBRN training and equipment can be prohibitive and we were told to build recommendations without the promise of advanced personal protective equipment. IMPOSSIBLE or so we thought. The limitations opened our eyes to the reality of the situation and the opportunity to create tools that could potentially protect more people than PPE.

Does that mean you have no advanced CBRN personal protection, decontamination or isolation capabilities? No. You have strategically placed small and nimble teams that train regularly and train others to maintain their skills.

So how can hospitals prepare?


1. Conduct a Hazard Identification and Risk Assessment (But what tool do you use?)
2. Survey your Hospital's CBRN Capacity
3. Build Hospital Decontamination Capacity
4. Conduct CBRN Surveillance
5. Conduct CBRN Awareness Training
6. Build AGILE Hospital CBRN Disaster Plans
7. Perform Hospital CBRN Exercises
8. Establish CBRN Training and Exercise Cycles
9. Build Emergency Stockpiles of Medical Countermeasures
10. Train Local and Regional C, B, and/or RN Specialty Teams

Every section in this documents contains an Overview, Sample Tools, Applied Examples, a Simulation Space (RLAND) and References.

We plan to release the recommendations building up to the World Association of Disaster and Emergency Medicine Congress in Toronto April 25-28, 2017.




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