Author: Dr Denis JOSSE holds a Pharmacy degree (Univ of Lyon, France) and a PhD in molecular and cellular biology (Univ of Grenoble, France).He worked as a researcher in the French Army Health Services from 1986 to 2011 (Toxicology, Medical Counter Measures, Protection & Decontamination) then joined the French Firefighters Health Services where he advises the Command on toxicological and CBRN risks management and contributes to CBRN education & training of responders at an interagency level (Ministries of Health, Interior and Defence). He is part of the CBRNe R&I Conference organizing committee and of the board of directors of the French medical society for disaster management.
Chemical Biological Radiological and Nuclear (CBRN) risks refer to the risks of being exposed to highly toxic or infectious agents or to highly energetic ionizing radiations following either a natural event, a technological accident or an intentional attack perpetrated by a terrorist group or a state.
CBRN risks are part of High Impact Low Probability risks in the sense that they arise randomly and unexpectedly, and they can have immediate effects and significant impacts.
Besides their lethal effects, for some of them in the microgram order of magnitude, one of the specificities of the CBRN agents is that they are usually not perceptible and their effects might not be detectable for hours or days after victims’ exposure. As a result, from a few victims unaware of being contaminated on their skin, hair or clothes, the most stable and persistent of these agents might easily spread by transfer of contamination to surfaces and to people initially far from the dispersion site, which could lead to mass contamination.
For a long time, such risks have exclusively concerned the military due to the potential use of CBRN agents in armed conflicts.
In 1995, the Tokyo subway attack perpetrated by members of the Aum sect who synthesized and dispersed sarin, a chemical warfare agent, demonstrated that civilian exposure to such agents could no longer be excluded. This was the first time that mass chemical exposure happened in a terrorist context, which resulted in 12 deceased and about 1,000 exposed victims.
Since then, in many countries, plans to manage CBRN risks in a civilian context have been designed, tested and regularly updated by taking into account not only evidenced-based research data and new technologies but also evolving threats. In this regard, civil-military cooperation is crucial.
In such context, unlike the military, the civilian populations have no specific equipment to protect themselves, to self-decontaminate or to quickly start a medical treatment with antidotes specific to agents they have been exposed to. Additionally, as opposed to the military populations which are relatively homogenous in terms of age, preparedness, language and health, the civilian populations are quite heterogeneous and vulnerable. Such specificities should be highly considered when testing plans.
To improve CBRN risks management, efforts could be put on several facets of the preparation and response.
The preparation phase should ideally rely on education and training of every stakeholders, which include responders but also local populations, more specifically those living and working in large cities, and state representatives at different levels. The responders should ideally include employees from the security services of public spaces (stations, airports, shopping malls,…) who, as “immediate responders”, could provide basic guidelines to victims.
In a long-term perspective, the majority of the population should know how to react to potential exposure to CBRN agents and how to be compliant with the first responders since timely organization of the initial response, ie victims’ triage, emergency decontamination and treatment, will be key for the response efficiency.
Current needs include the implementation of reliable alert systems in critical places, the development of broad spectrum CBRN detection tools, of decision-aid tools to help managing complexity in short time and anticipating the resources needed for an appropriate response, and that of quicker logistic delivery system at the incident site.
CBRN hazards should clearly be included in the all-hazards and whole of society approach promoted to improve societal resilience when facing disasters. To better face complexity of CBRN risks management, citizens compliancy and appropriate communication are key elements to consider. Continuing education and training of all stakeholders will help consolidating the societal resilience towards these risks in the long term.