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Journal of Medical Chemical, Biological and Radiological Defense
J Med CBR Def  |  Volume 8, 2010
Received 19 November 2009 | Published 28 January 2010

Discussion Regarding CBRN Training for Emergency Room Staff

T.F. McLoughlin

University of Sheffield Medical School, Beech Hill Rd, Sheffield, United Kingdom


Suggested citation: McLaughlin (2010), “Discussion Regarding CBRN Training for Emergency Room Staff", JMedCBR 8, 28 January 2010,




Hospitals will be on the frontline for dealing with the effects of terrorist attacks and should be prepared. How often does the staff need to train?


Letter to the Editor


Dear Editor:

I would be very interested in creating a discussion and generate some input from your readership on the frequency and types of major incident training in their respective Emergency Rooms. I undertook a survey of Emergency Room preparedness across London (United Kingdom) for chemical, biological, radiological, and nuclear (CBRN) incidents and would be interested in how it compares to other Emergency Room training systems.

A CBRN incident would place an unprecedented burden on ER departments principally because the affected patients would need to be decontaminated in a separate area of the department before being transferred for their further management [1]. In addition, if affected patients were not adequately decontaminated, they would pose a risk to all hospital staff and non-CBRN patients [2].

An increase in demand upon the ER department will require key members of staff who are able to respond appropriately and who would have to have a high level of training to deal with the sudden increase in the number of casualties who would need to be decontaminated [3].

The duty charge nurses from every responding emergency department (31 out of a possible 46 ER departments in London responded, 67%) were asked 'How often do key ER staff train for a CBRN incident?" The replies varied considerably between London ER departments.

The results ranged from training weekly to once every 3 years at one department. 42% of ER departments train biannually. Monthly and annual CBRN training is provided by 19% of ER departments, and 6% train their key staff quarterly. The frequency of key staff training ranged from one ER department training weekly to another ER department that trained once every 3 years.

This short study suggests that there is a significant difference in the amount of CBRN training given to key staff at London ER units. Many of the ER departments do provide key staff training twice a year. Given that 42% of units believe that key staff training is required twice a year anything less than this should be considered as being outside the norm and therefore unacceptable. This is of particular relevance in the UK in the run up to the Olympics 2012 where London will be hosting the major sporting event and all eventualities need to be addressed for all potential incidences as soon as possible.

I am very interested in how this small qualitative study compares to other major ER incident training systems across the globe and would value feedback and input from JMedCBR readers.

Yours faithfully,


TF McLoughlin,

Student Doctor,

University of Sheffield Medical School,

Beech Hill Rd, Sheffield, United Kingdom



[1] McLoughlin TF (2009) An assessment of CBRN emergency preparedness:
How prepared are London Accident and Emergency departments for a CBRN Incident? Article available from author

[2] Health Protection Agency (2009) Integrated approach to protecting UK public health. accessed 5th October, 2009

[3] Gibson S, Lemyre L, Clément M, Markon MPL & Lee JEC (2007) Terrorism threats and preparedness Biosecurity and Bioterrorism: Biodefense Strategy, Practice and Science; 5 (2): 134-144