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Chemical, Biological and Radiation Casualties: Critical Care Considerations
  1. Surgeon Commander S A Bland, Royal Navy, Consultant in Emergency Medicine Emergency Department1
  1. 1Queen Alexandra Hospital, Portsmouth and Medical Director Defence CBRN Centre
  1. Queen Alexandra Hospital, Southwick Hill Road, Cosham, PO6 3LY steven.bland{at}


A chemical, biological, radiological or nuclear (CBRN) event would require a critical care response from point of exposure to definitive hospital management. Critical care staff should be aware of the potential agents and possible hazard they present to responders. The treatment of CBRN casualties should reflect the conventional incident and casualty management paradigms with additional safety and treatment considerations. Specific agents may require specific airway and respiratory considerations including surrogate ventilation strategies. All critical care staff training should include CBRN awareness and personal protective equipment training. Some staff may benefit from additional training including the recognition and investigation of CBRN casualties as well as their treatment and the equipment available. Critical care departments should also contingency plans for CBRN events including surge capacity.

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