INTRODUCTION

This Role 1 (including Point of Injury [POI]) through Role 3 Clinical Practice Guideline (CPG) is intended for use in conjunction with Tactical Combat Casualty Care (TCCC) Guidelines. This CPG is meant to provide medical professionals who encounter CBRN exposures with evidence-based guidance where it exists or consensus opinion when evidence is lacking. This CPG is divided into 4 sections:

1. Response to CBRN agents (an approach to all CBRN casualties)
2. Medical management of chemical agent exposure
3. Medical management of radiation exposure and nuclear events
4. Medical management of biologic agent exposure

While encountering conventional casualties on the battlefield remains a more likely scenario, vigilance is necessary for unusual scenarios that might represent the first clue that a CBRN incident occurred. Since environmental sampling for agent detection and rapid point-of-care testing for agent identification will not be routinely available in austere environments or most hospital settings, the initial suspicion of a CBRN attack will rest on clinical recognition of signs and symptoms of poisoning. This guideline is intended to provide an approach to casualty assessment and treatment from POI to established medical facilities.