MANAGEMENT OF AN INDIVIDUAL BIOLOGICAL CASUALTY

The successful management of an individual casualty is rooted in a thorough clinical history, physical examination, and using available diagnostic assets. The concept of integrated, layered CBRN defense (Protect, Understand, Mitigate) can be adapted to the managing an individual casualty using a thorough clinical evaluation throughout the medical care process with continuous reassessment (Figure 3). This means the detail gained with a thorough evaluation of an individual case can quickly adapt surveillance, infection control measures, and medical practice if it is indeed an index case of a bioincident (reference Figure 4 for examples).

The first step in managing an individual biological casualty is to PROTECT yourself, your staff, your teammates, and other patients you are treating. The PROTECT phase needs to start at triage and consists of Infection Prevention and Control (IPC) and decontamination procedures. In a known threat environment, a “PROTECT” posture can be planned for in advance, with a low threshold for implementation whenever there are potential warning signs of a bioincident. For an unknown threat environment, IPC precautions and decontamination may have to be adapted as casualties present and more is learned about the common clinical operating picture. It is critical during this step to provide timely information to the Commander, in order to protect the mission and population.