A proposal for field-level medical assistance in an international humanitarian response to chemical, biological, radiological or nuclear events.

A capacity for field-level medical assistance for people exposed to chemical, biological, radiological or nuclear (CBRN) agents or medical support for people potentially exposed to these agents is intrinsically linked to the overall risk management approach adopted by the International Committee of the Red Cross (ICRC) for an international humanitarian response to a CBRN event. This medical assistance articulates: ▸the characteristics of the agent concerned (if known) ▸the need for immediate care particularly for people exposed to agents with high toxicity and short latency ▸the imperative for those responding to be protected from exposure to the same agents. This article proposes two distinct capacities for medical assistance--CBRN field medical care and CBRN first aid--that take the above into account and the realities of a CBRN event including the likelihood that qualified medical staff may not be present with the right equipment. These capacities are equally pertinent whether in support of ICRC staff or for assistance of victims of a CBRN event. Training of those who will undertake CBRN field medical care and CBRN first aid must include: ▸knowledge of CBRN agents, their impact on health and the corresponding toxidromes ▸skills to use appropriate equipment ▸use of appropriate means of self-protection ▸an understanding of the additional complexities brought by the need for and interaction of triage, transfer and decontamination. The development of CBRN field medical care and CBRN first aid continues within the ICRC while acknowledging that the opportunities for learning in real situations are extremely limited. Comments from others who work in this domain are welcome.