
Contents
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Introduction Introduction
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Chemical incidents Chemical incidents
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Biological incidents Biological incidents
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Radiological and nuclear incidents Radiological and nuclear incidents
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Mode of presentation Mode of presentation
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Chemical incidents Chemical incidents
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Scene safety Scene safety
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Triage at a chemical incident Triage at a chemical incident
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Information gathering Information gathering
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The HAZCHEM warning plate The HAZCHEM warning plate
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The Kemler Plate The Kemler Plate
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Transport Emergency (TREM) cards Transport Emergency (TREM) cards
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Chemdata Chemdata
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Decontamination Decontamination
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Clinical management Clinical management
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Clinical syndromes Clinical syndromes
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Specific antidotes Specific antidotes
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Transport Transport
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Advice to the public Advice to the public
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Documentation Documentation
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Debrief Debrief
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Biological incidents Biological incidents
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Presentations of a biological incident Presentations of a biological incident
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Indicators of a potential biological incident Indicators of a potential biological incident
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Characteristics of biological agents—definitions Characteristics of biological agents—definitions
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Pathogenicity Pathogenicity
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Infectivity Infectivity
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Virulence Virulence
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Toxicity Toxicity
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Incubation period Incubation period
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Transmissibility Transmissibility
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Lethality Lethality
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Stability Stability
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Infectious dose Infectious dose
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Lethal dose Lethal dose
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Dissemination Dissemination
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Classification Classification
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Biological agent biodromes Biological agent biodromes
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Early management of a suspected biological agent release incident Early management of a suspected biological agent release incident
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Radiological and nuclear incidents Radiological and nuclear incidents
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Definitions Definitions
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Alpha radiation Alpha radiation
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Beta radiation (electrons) Beta radiation (electrons)
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Electromagnetic radiation—gamma radiation, X-rays, and neutrons Electromagnetic radiation—gamma radiation, X-rays, and neutrons
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Classification of radiation and nuclear incidents Classification of radiation and nuclear incidents
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Units Units
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Risk of exposure Risk of exposure
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Type of accident Type of accident
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Medical effects of radiation Medical effects of radiation
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Triage of radiation and nuclear casualties Triage of radiation and nuclear casualties
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Pre-hospital triage Pre-hospital triage
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Types of devices associated with radiation and nuclear incidents Types of devices associated with radiation and nuclear incidents
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Radiological dispersion devices Radiological dispersion devices
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Covert release of radiation Covert release of radiation
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Improvized nuclear devices Improvized nuclear devices
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Nuclear weapons Nuclear weapons
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Nuclear installation incidents Nuclear installation incidents
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Advice to the public Advice to the public
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Managing a radiation (or nuclear) incident Managing a radiation (or nuclear) incident
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Key facts for managing the acutely irradiated patient Key facts for managing the acutely irradiated patient
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Dealing with an incident involving radioactivity Dealing with an incident involving radioactivity
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Radiation protection Radiation protection
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Radiation and the body Radiation and the body
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Acute radiation effects Acute radiation effects
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The early symptoms of severe acute radiation exposure are The early symptoms of severe acute radiation exposure are
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Classification of acute radiation syndrome Classification of acute radiation syndrome
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Management of acute radiation syndrome Management of acute radiation syndrome
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Supportive treatment Supportive treatment
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Principles of radiation protection Principles of radiation protection
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Agencies and services at a radiation or nuclear incident Agencies and services at a radiation or nuclear incident
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Civil Nuclear Constabulary Civil Nuclear Constabulary
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The police response to a nuclear or radiation incident The police response to a nuclear or radiation incident
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Fire and rescue services response to a radiation incident Fire and rescue services response to a radiation incident
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Roles of the local authority in responding to a radiation incident Roles of the local authority in responding to a radiation incident
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Defra CBRN Emergency Team Defra CBRN Emergency Team
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Managing an unidentified contaminant—white powder incidents Managing an unidentified contaminant—white powder incidents
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Advice to the public Advice to the public
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If a suspicious package has not yet been opened If a suspicious package has not yet been opened
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If the package is already open If the package is already open
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Risk assessment Risk assessment
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11 Chemical, biological, radiological, and nuclear incidents
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Published:November 2020
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Abstract
A chemical, biological, radiological, or nuclear (CBRN) incident may occur as the result of an accident or specific act of terrorism. Events such as the Chernobyl nuclear incident in Ukraine, the Sarin gas release on the underground system in Tokyo, the anthrax releases in the US, and the Salisbury Novichok attack, highlight the necessity for a structured multi-agency and multi-disciplinary response of which medical support is an essential component. This chapter covers the mode of presentation, and then focuses on each type in turn. Scene safety, triage, and information gathering are described. For chemical incidents, decontamination and specific antidotes are also included. Characteristics of biological agents are defined, and methods of managing a radiation and nuclear incident are specifically covered, including managing the patient.
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