CRESS: A SIMPLIFIED APPROACH TO  CBRN CASUALTY ASSESSMENT

Just as trauma casualties present differently (blunt trauma, GSW, blasts, etc.), CBRN casualties also have varied presentations. For example, chlorine casualties will require more attention to the toxic inhalation symptoms contrasted with a mustard casualty whose associated trauma may initially require more prompt intervention than the mustard-specific effects. CBRN casualties can be categorized by circumstances of exposure and presence or absence of trauma and CBRN effects.

In a CBRN-threat environment, casualties may have traumatic, CBRN, or mixed injuries. Before applying TCCC, it is important to identify whether CBRN injuries are present to allow first responders to protect themselves before treating the patient. While this often can be deduced using intelligence reports, technologic agent identification resources, and circumstances of the CBRN event, there will be times when agent identification will need to be made solely based on clinical assessment of symptoms. Clinical clues can be aggregated to identify the most likely agent responsible for symptoms according to the CRESS assessment. Infectious agent exposure, for example, is unlikely to cause early symptoms (see CBRN CPG Part 4), while toxins, chemical and high dose radiologic exposures may lead to symptoms in minutes to hours (see CBRN CPGs Part 2-4). A CRESS assessment can be used to assess which chemical toxidrome exposure may be linked to. Each letter in CRESS corresponds to physical exam findings that can be used to categorize the suspected chemical based on the constellation of findings (Table 3). A depiction of time to onset of signs/symptoms as well as common chemical toxidromes and biological and radiological syndromes can be found in Figure 4.