CBRN and EMS – A Dangerous Disconnect

Updated: Mar 24

When CBRN is brought up in the civilian emergency services circles, it is usually brushed under the rug. There are very few municipal public service agencies that are truly capable of effectively responding to an event involving a chemical, biological, radiological, or nuclear material used in a malicious nature. For the most part, only those agencies that maintain a “Type 1” HAZMAT team, as defined by FEMA are really in the headspace to perform an initial response to these sorts of events. Aside from that, there may be a “regional team” comprised of numerous departments and agencies. Lastly, there are Department of Defense Civil Support Teams (CSTs) and CERF-Ps, which are full-time reserve units whose primary responsibility is to respond to CBRN events in their State – each State and territory in the US has at least one CST.

So, there are full-time resources available to deal with these events, so what is the problem?


Chemical warfare agents work very, very quickly. By the time these resources arrive, they will be decontaminating bodies. This is absolutely unnecessary. The entire concept of EMS operating in a contaminated environment is vilified by the old “rule of thumb” from everyone’s HAZMAT awareness class, and that EMS cannot and should not operate in a contaminated environment, only HAZMAT techs.

In the last few years, there have been numerous events involving the use of nerve agents as assassination tools, not used for attacks producing dozens or hundreds of patients.

Consider this: What if when PD and EMS in Salisbury, UK responded to the Skripals, who were intentionally contaminated with micrograms powerful nerve agent, the responding units immediately identified this is a nerve agent event and backed-out to wait for a massive HAZMAT response. Both Sergei and his daughter would have been long dead by the time EMS would be able to put hands-on. Instead, nobody realized it was a nerve agent until they were at the hospital. Thankfully, none of the responders were contaminated, and everything was fine, both recovered.

What if: PD and EMS responded to the incident, identified it as nerve agent poisoning, and continued doing their job instead of sitting back and watch two people needlessly die. By donning simple PPE, conducting basic spot decontamination, and using other basic protocols, a trained and equipped EMS unit could safely and effectively manage these patients without a massive response involving level A PPE and technical decontamination.

Most EMS providers have probably heard something about “SLUDGEM” and/or “DUMBELLS” as reminders for what nerve agent poisoning looks like. How many of you remember what those stand for? Good, because there is a very good chance it will not look like that anyway. What is your organophosphate/nerve agent treatment protocol? DuoDotes? Atropine? What about managing all the other problems that atropine will not fix? These patients will be sick, but manageable.

Am I saying every ambulance should have this capability? Absolutely not. But there should be more, many more. A few large agencies always have specialized resources on the road that can perform these sorts of operations, but they are the exception.

Think of it like this: TCCC/TECC’s most basic principle is to reduce instances of survivable deaths by bringing good medicine as far forward as possible. This is the exact same concept, the only difference being instead of bombs, guns and rockets, we are facing liquids, powders, and vapors.

About the Author:

Kevin has been involved in the fire and EMS service since 2003 when he first became an explorer at a volunteer fire department. Since then, he has worked as a medical provider in urban, suburban, and rural EMS systems, as well as a firefighter, paramedic, technical rescue specialist, and hazardous materials technician in various capacities world-wide. He has supported Federal operations as a contractor throughout the world. He holds numerous advanced certifications and specialized training through a variety of Federal agencies, credentialed DHS instructor, and chairs the CBRN subcommittee of the Committee on Tactical Emergency Casualty Care.

Virginia National Guard Soldiers and Airmen assigned to the Richmond-based 34th Chemical, Biological, Radiological, Nuclear and High Yield Explosives Enhanced Response Force Package, also known as CERFP, conduct a confirmation exercise with the National Guard CBRN Response Enterprise Information Management System Feb. 28, 2019, at Fort Pickett, Virginia. (U.S. National Guard photo by Cotton Puryear)

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