Existing Approaches to Chemical, Biological, Radiological, and Nuclear (CBRN) Education and Training for Health Professionals: Findings from an Integrative Literature Review

Kako, Mayumi; Hammad, Karen; Mitani, Satoko; Arbon, Paul

doi:10.1017/s1049023x18000043

Cited by 43 publications

(35 citation statements)

References 26 publications

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“…Complicating a straightforward emergency response is the addition of CBRN factors that add an extra layer of complexity to the emergency response. 21 CBRN emergencies cause trauma on a large scale and demand complex responses including triage, monitoring, diagnosis, decontamination, and self-protection for public health workers. 11,22 CBRN mass casualty situations are normally chaotic.…”

Section: Introductionmentioning

confidence: 99%

Exploring the non-technical competencies for on-scene public health responders in chemical, biological, radiological, and nuclear emergencies: a qualitative study

Chen

2020

Public Health

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S 1 Objectives: The purpose of this study was to define and delineate specific nontechnical 2 competencies for first-line public health responders in Chemical, Biological, Radiological and 3 Nuclear (CBRN) emergencies in China. 4 Study design: A qualitative study was conducted in China involving interviews with key 5 informants in the field of health response to CBRN disasters.6 Methods: One-on-one in-depth interviews were carried out with 20 participants, including 7 expert members of National Medical Response Teams for CBRN Disasters, officials at 8 emergency management authorities, and scholars of academic institutions related to CBRN 9 emergency. Interviews were recorded with audio equipment, transcribed and coded into 10 codable passages according to grounded theory with NVivo software. Themes were identified 11 within the transcriptions by using thematic analysis.12 Results: 159 codable passages were produced. Eight domains of nontechnical core 13 competencies were identified: (1) situation awareness, (2) communication skills, (3) 14 collaboration, (4) resource management, (5) task management, (6) cultural competency, (7) 15 austere environment skills, and (8) physical stamina. 16 Conclusions: The study identified a variety of competencies for on-scene public health 17 responders in CBRN emergencies. The findings of this study could specifically benefit 18 development of strategy and improvement of content of education and training. Further 19 research that involves input from the disaster response community at large are needed for the 20 validation of these competencies. 21 KEY WORDS: Nontechnical Competencies, Chemical, Biological, Radiological and Nuclear 22 Response, Disaster Medicine, Health Personnel Education/Training.23 24 25 Increasing Chemical, Biological, Radiological and Nuclear (CBRN) threats are a public 26 health challenge in China. China has experienced 200-600 accidents every year in hazardous 27 chemical industry 1 , frequent emerging epidemics 2 (e.g., COVID-19, SARS, H5N1 and 28 African Swine Flu), over 43 planned nuclear reactors 3 and unpredictable terrorism attacks. 29 China has invested heavily in the development of CBRN medical response capacity including 30 the CBRN Medical Response Teams (CBRN-MRT) designed to be deployed on the site. 31 In spite of the fact that public health responders adequately respond to the clinical or public 32 health aspects of disasters, they are not always prepared or trained to work in a real hazardous 33 environment and complex temporary situation 4 . The unique nature of intense working 34 relationships and particularly austere environment requires not only technical skills but also 35 nontechnical competencies. A body of previous studies have explored the components of 36 nontechnical competency for health workers in a critical environment 5-10 .It has been 37 established that interpersonal, social, and cognitive skills play an important role on the 38 response performance 11 . Those nontechnical competencies broadly involve a range of 39 kno...

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Section: Introductionmentioning

confidence: 99%

Exploring the non-technical competencies for on-scene public health responders in chemical, biological, radiological, and nuclear emergencies: a qualitative study

Chen

2020

Public Health

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“…Literature reviews have shown that specific training to respond to future crises involving CBRN substances is only offered in a few healthcare programmes, mostly in the United States (US) [17]. There is also very little peer-reviewed literature or guidelines that provide an outline of specific learning objectives and activities to implement and deliver this training to face future crises; particularly amongst clinicians and other health professionals that would be part of an initial response [15].…”

Section: Introductionmentioning

confidence: 99%

“…However, it is imperative that health professionals that will be the first-response workforce, i.e. nurses, doctors, paramedics, biomedical scientists, physician associates, and public health officers, have the necessary skills to effectively respond to HazMat/CBRN threats [17].…”

Section: Introductionmentioning

confidence: 99%

Public Health England’s Recovery Tools: Potential Teaching Resources?

Pena-Fernandez¹,

Nisbet²,

Duarte‐Davidson³

et al. 2019

ICERI Proceedings

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Training to combat chemical and radiation accidents, incidents or attacks is critical for health professionals due to recent events involving these hazards or their use as unconventional weapons, such as the use of the nerve agent novichok in Salisbury, UK. Health professionals need to have appropriate knowledge and skills to effectively respond to future events involving any of these substances, which requires a rapid and coordinated response from different professionals to protect the environment and minimise the number of people exposed and reduce morbidity and mortality. However, despite chemical and radiation incidents becoming increasingly prevalent, literature reviews have shown that there is a lack of teaching of appropriate competences to face future crises in Europe, particularly amongst clinicians and other health professionals that would be part of the initial response. Thus, De Montfort University (DMU, UK) in collaboration with different academics from the University of Alcalá (Spain) and researchers from Public Health England (PHE) with comprehensive experience in environmental decontamination and restoration, have created a short training course for providing undergraduate/postgraduate students with basic skills to respond to chemical incidents, basic skills that are based on the major competences recently identified by the European Commission [1]. This novel training has been tested with students from different backgrounds in various European universities, recording high degrees of acquisition of the various basic competences that we developed to initially respond to chemical events [2]. To develop the practical part of this chemical training, we have incorporated the novel guidance and methodology developed by PHE to successfully tailor a protection and recovery response to any incident involving chemical substances, which is available in the "UK Recovery Handbook for Chemical Incidents" [3] and its web-based tools: "Chemical Recovery Navigation Tool" (CRNT, [4]) and "Chemical Recovery Record Form" (CRRF, [5]). These innovative resources aid the user to select effective protection, decontamination and restoration techniques or strategies from a pool of up-to-date options applicable to different environments according to the physicochemical properties of the chemical(s) involved and the area affected. The CRNT is accompanied by the CRRF, which facilitates collection and analysis of the necessary data to inform decisions, and an e-learning resource named "Chemical Recovery: Background" (CRB, [6]), which could facilitate the learning of environmental decontamination and restoration. We are currently developing a short training course to cover minor radiation incidents; this radiation training will follow the same methods used to develop the chemical training, but with the specific PHE recovery tools to tackle such events, specifically the "UK Recovery Handbooks for Radiation Incidents" [7] and its associated web-based tools "Radiation Recovery Navigation Tool" (Rad RNT, [8]), one for each environme...

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“…A critical step in the aftermath of a biological incident or accident (accidental or deliberate release of a biological hazard) is to decontaminate and recover the affected environment [2,3]. Biological incidents can affect different areas and environments, requiring cross-government efforts and special tools and agents to decontaminate [4], in conjunction with personnel appropriately trained and skilled to respond to the incident [5]. Despite medical doctors and related health care professionals and public health officers providing the first-response to incidents involving biological threats, recent studies have reported insufficient knowledge or skills to respond to these events by many such personnel [5].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Environmental Recovery Training Response to Biological Incidents in a Human Health Degree

Pena-Fernandez¹,

Peña²

2019

INTED2019 Proceedings

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Agents involved in biological incidents and outbreaks of infection can spread easily, so response teams are required to quickly implement a recovery plan to decontaminate and restore the environment impacted by these incidents to minimise public risks. A group of academics at De Montfort University (DMU, UK), with support from first responders during the 2014-16 Ebola outbreak, are developing appropriate training to provide basic skills so human health science students can respond to biological incidents. Following the competences identified by the European Commission, we have created key competences for these students based on the core skills that any medical first responder to biological emergencies should have. To provide students with the key competences related to environmental planning, we have created specific training that consisted of a 2 hours practical plus theory related to emerging diseases and the international response provided to tackle the Ebola pandemic. The practical component was a research-led workshop to develop a complete protection and recovery plan to respond to an outbreak of infection by Cyclospora cayetanensis in an urban area. Students used the novel methodology developed by Public Health England ["UK Recovery Handbook for Biological Incidents" (Pottage et al., 2015)] [1] to select appropriate options or techniques to protect and recover the affected environment, according to the physiological characteristics of the biological agent/microorganism involved and the environment impacted. Critical thinking and discussion is also needed to select recovery options (R.O.), e.g. use of chlorine-based decontamination liquids as part of the R.O. "reactive liquids" will have limited efficacy as oocysts of Cyclospora are resistant to these. After successful testing of the training with postgraduate students, we introduced it in a level 6 module in the DMU degree programme BMedSci in Medical Science in 2016/17 (n=24). A small proportion of these BMedSci students reported that they did not enjoy (13.4%) or were not satisfied (20%) with the training provided, which could be attributed to the fact that the topic of the training (environmental sciences) was not of direct interest for these students who are studying a degree more related to medicine. However, despite the short duration of the training, students were able to tailor an appropriate response with the resources and information provided (physiological characteristics and a literature review on decontamination/inactivation techniques for Cyclospora was provided to overcome time constraints). Specifically, 73.3% indicated that they gained some public health prevention/preparedness knowledge against a biological incident; 80% highlighted that they learnt how to establish some public health interventions; and 60% learnt how to tailor a recovery plan. A few students (20%) had difficulties with the recovery concepts and the interpretation of the physiological characteristics, which may be attributed to limited background knowledge of microbiology ...

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Existing Approaches to Chemical, Biological, Radiological, and Nuclear (CBRN) Education and Training for Health Professionals: Findings from an Integrative Literature Review

Cited by 43 publications

References 26 publications

Exploring the non-technical competencies for on-scene public health responders in chemical, biological, radiological, and nuclear emergencies: a qualitative study

Exploring the non-technical competencies for on-scene public health responders in chemical, biological, radiological, and nuclear emergencies: a qualitative study

Public Health England’s Recovery Tools: Potential Teaching Resources?

Implementation of Environmental Recovery Training Response to Biological Incidents in a Human Health Degree

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