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. Furthermore, easy access to reference materiel to guide advanced therapy should be a part of every provider’s armamentarium. These basic principles will be discussed in more detail in the sections that follow.

Critical Task List

The critical task list is applicable to both medical and non-medical personnel. All personnel should be trained on the concepts and principles identified in the critical task list in order to respond to CBRN casualties. The critical task list addresses core competencies that can be adjusted based on the medical skill level of the responder. These tasks should be trained according to service-specific publications and recognized standards of medical care.

- Recognize CBRN exposure that requires action to protect self and others
- Don personal protective equipment (PPE) to prevent exposure in self and assist others with PPE
- Egress from the threat
- Move upwind, uphill, upstream from threat
- Utilize time/distance/shielding for protection
- Recognize signs/symptoms of CBRN exposure that prompt immediate self-treatment or treatment of others (i.e. nerve agent exposure)
- Apply TCCC integrated with CBRN response TCCC + CBRN = (MARCHE)2

Massive hemorrhage/mask, airway/antidote, respiration/rapid spot decontamination, circulation/ countermeasure, hypothermia/head injury, extraction/evacuation

- Apply airway management skills in a CBRN setting (positioning, suction, ventilation to include manual and mechanical, placement of definitive airway)
- Perform Rapid Spot Decontamination
- Identify and establish Hot/Warm/Cold Zones
- Establish a dirty casualty collection point (CCP)
- Understand decontamination principles and casualty procedures for partial or complete removal of PPE, clothing, and equipment (casualty cut out)
- Understand cross contamination and take appropriate measures to prevent it
- Understand available technology that can aid in agent identification