PREPAREDNESS OF THE FIRST REPONDERS FOR THE CBRNE INCIDENT CONSEQUENCE OPERATIONS Pavel CASTULIK CB 050 Military Chemistry, Toxicology and Protection Against High Toxic Agents Masaryk University, Faculty of Nature Sciences Spring 2011 Biography-Pavel Castulik Education: University of Defense, Chemical Engineering and NBC Defense, Dipl. Eng., PhD Commander of NBC Battalion PhD Thesis on Decontamination Head of Research & Development Decontamination Department Head of R&D Protection Division against Weapons of Mass Destruction Search chem/bio program in Iraq and destruction of chemical weapons Development of the Technical Secretariat of the Organization for the Prohibition of Chemical Weapons Head of Training at the OPCW Head of Chemical Weapons Demilitarization at the OPCW Chief Inspector at the OPCW University lecturer Consultant on CBRNE matters Member of the Association for Crisis Preparedness of the Health and Co-Editor of the Association's journal Autor více než: ■ 520 odborných a věd. prací v časopisech ■ 135 výzkumných zpráv ■ 90 patentů, autorských osvědčení a ZN ■ 30 realizací v průmyslu a užití v armádě, CO, ochrany životního prostředí a zdravotnictví ■ >470 konferenčních sdělení ■ 70 knih a kapitol v knihách o chemii toxikolog OPZHN, odzbrojení, konverzi zbrojní výroby, bezpečnosti ochraně životního prostředí, a j. globálních problémech Ocenění ■ 11 státních a vojenských vyznamenání (1955-2008) ■ Pamětní medaile VUT Brno (1999) ■ Distinguished Leadership Award, ABI, USA (2001) ■ Muž roku 2001, ABI, USA (2001) ■ American Medal of Honor (2002) ■ Nositel Mezinárodní mírové ceny United Cultural Convention 2005 ■ Zlatý záchranářský kříž (2007) Prof. Ing. Jiří Matoušek, DrSc Chemik - toxikolog Studium VŠCHT Praha a VTA Brno, Ing. chem. 1954, CSc. 1958, DrSc. 1967, Prof. 1983. Voj. služba 1950-1989 (Plk. v zál.), 1954-89 řídící a výkonné funkce ve voj. výzkumu a tech. a zdrav, ochraně proti ZHN 30 realizací v průmyslu a užití v armádě, CO, ochr. živ. prostředí a zdravotnictví. Člen Čs. delegace na Konf. o odzbrojení v Ženevě. V období "normalizace" zbaven funkce náč. VÚ 070 v Brně. 1990-92 host. prof. Internatl. Inst. for Peace (Wien), 1992-2000 ředitel Ústavu chem. a technol. ochrany živ. prostředí FCH VUT v Brně, ■ Člen 7 stát. zkuš. komisí (Bc, Mgr, RNDr. Ph.D) a řady věd. rad a porad, sborů na úrovni ústavů, fakult a centr, orgánů včetně mezinárodních. ■ Předseda Věd. porad, sboru Org. pro zákaz chem. zbraní (OPCW) v Haagu. ■ Člen řídících grémií 4 mezinár. NGO (INES, WFSW, Pugwash, Dublin, Committee), zabývajících se globálními problémy. ■ Autor více než 520 odb. a věd. prací v časopisech, přes 430 konf. sdělení, 70 knih a kapitol v knihách o chemii, toxikologii, ochr. proti ZHN, ozdbrojení, konverzi zbroj, výroby, bezpečnosti, ochraně živ. prostředí, a j. globálních problémech ■ Naposled prof. Výzk. centra EU pro chemii živ. prostředí a ekotoxikologii PřF MU v Brně (RECETOX). Člen v národních a mezinárodních institucích Akademie věd, Bologna ABC-Abwehrschule Forum, Wien Organizace pro zákaz chemických zbraní, Haag.Předseda mezinárodní vědecké komise OPCW American Biographical lnstitute,USA International Biographical Centre, Cambridge (UK) NATO Research and Technology Organisation, Bruxelles Státní výbor pro jadernou bezpečnost, Praha Ministerstvo vnitra, GŘ HZS, Praha World Federation of Scientific Workers, Paris Stálý výbor pro odzbrojení, akreditovaný představitel WFSW u úřadovny OSN, Wien Pugwash Conferences on Science and World Affairs, Washington, D.C. (USA)-Vedoucí, Česká Pugwashská skupina International Network of Engineers and Scientists, Berlin 7 komisí pro státní závěrečné zkoušky (Be, Mgr, RNDr, PhD) l ■i lJBM i Í5.du i bna 2007 byly v pražském Paláci Žofín t předány ■ W Zlaté záchranářské kříž^x^ Chemie/Agrochemie Ochrana ŽP Odzbrojení Vojenství Ochrana Medicína 1 Morfia chmna žiyoía a chrana zdr ayf CYKLUS ČINNOSTÍ PŘIPRAVENOSTI A PROVEDENÍ ZÁSAHU PŘI CBRE INCIDENTECH CBRN Threats Consequence Management Hazards NATURAL HAZARDS CM HAZARDS EXPLOSIVE & FIRE HAZARDS EARTHQUAKES FLOODS WILDFIRES STORMS LARGE SCALE INDUSTRIAL DISASTER CONVENTIONAL WEAPONS IMPROVISED EXPL. DEVICES INCIDIARY DEVICES FIRES COLLATERAL DAMADGE EXPLOSIVES & CBR CHEMICAL (CWAs & TICs & Illicit Labs) BIOLOGICAL RADIOLOGICAL NUCLEAR HAZMAT CBR & EXPLOSIVES Bio/Explosive Bomb Explosions at Railway Station in Madrid Security Scans should prevent a new generation of explosive threats Dual Purpose Items CBRNE - Pentangle Probability of CBRNE Incident Probability of Use Hi9h Scale of HazMat Event Hurtgary-"Ajka" Broken Sediment Lagoon with Waste of Bauxite Or for Aluminum Production Health & Safety Concerns PPE Level „Real" vs Level „A" Health & Safetv Concerns Exposure of Firemen and Public to "Cocktail" of HazMat CBRNE Vulnerable Crowds Unaware and Unprotected Scene of CBRNE Casualties CBRN Detection vs Symptoms ■ Non-conventional event has to be considered in its initial phase as "unknown-whole hazard" case. ■ Early identification nature of victim's exposure is vital for saving lives and protection of their health.* ■ However, detection and monitoring can be time consuming and thus delaying emergency medical responses, as well as complicate and lengthen the decontamination process. ■ Thus all responders are to be knowledgeable and skilled to identified CBRN indicators, as the part of their awareness training. ■ Also responder's knowledge of signs and symptoms associated with CBRN exposure should be mandatory knowledge too. Consequence Management Goals of Consequence Management Natl. Security Save Lives Prevent Protect Environ Protect Property Contain Event Protect Inf rastr. Consequence Management/Operations CM are measures taken to: ■ Protect human life and public health and safety ■ Restore essential local and government services, and ■ Provide emergency relief to governments, businesses, and individuals affected by the consequences of CBRNE situation ■ Planning (of Preparedness) ■ Preparedness ■ Response ■ Recovery (Rehabilitation) CBRNE Incident Objectives ■ Saving lives (grates priority during CM) ■ Search & Rescue (remove victims from harms way) ■ Provide first aid to victims and Temporary Critical Life Support ■ Rescue, consider decontamination, triage, treat and transport victims ■ Assess situation ■ Be cognizant of secondary devices ■ Secure the perimeter, set up operation areas, establish hazard control zones (i.e., hot, warm and cold zone) ■ Control and identify CBRE material involved ■ Stabilize incident ■ Coordinate operations ■ Avoid additional contamination ■ Decontamination ■ Secure evidence and treat as a crime scene ■ Investigate a crime scene ■ Conduct Logistics CM Process PREPAREDNESS I— PLANNING PREPARATION RECOVERY RESPONSE EXECUTION L E V E L of E F F O R T CBRNE INCIDENT PHASES Incident Resolution Operations Phase Pre-incident Phase Post-incident Phase ❖Remediation ► Investigation ►Prosecution/Trial Time ❖Plannig ►Equipping ►Training ►Exercising ❖Crisis Management ❖Consequence Management ❖Lessons learned ❖Improved Operations ❖Improved Training ❖Improved Equipment ❖Higher State of Readiness KEY PROCEDURESS OF CM EFFECTINESS PLANNING TACTICS, TECHNIQUES, AND PROCEDURES PREPAREDNESS TACTICS, TECHNIQUES, PROCEDURES, EQUIPMENTTRAINING AND EXERCISES RESPONSE TACTICS, TECHNIQUES, PROCEDURES AND EQUIPMENT RECOVERY TACTICS, TECHNIQUES, PROCEDURES AND EQUIPMENT IMPROVEMENT TACTICS, TECHNIQUES, PROCEDURES, EQUIPMENT TRAINING AND EXERCISES Practices-SOPs-Standards-Competencies Guidelines NFPA471 Recommended Practice for Responding to Hazardous Materials Incidents 2002 Edition Project on Minimum Standards and Non-Binding Guidelines for First Responders Regarding Planning, Training, Procedure and Equipment for Chemical, Biological, Radiological and Nuclear (CBRN) Incidents THE INTERNATIONAL CBRN TRAINING CURRICULUM NFPA 472 Standard for Professional Competence of Responders to Hazardous Materials Incidents 2002 Edition NFPA 473 Standard for Competencies for EMS Personnel Responding to Hazardous Materials Incidents 2002 Edition Project on Minimum Standards and Non-Binding Guidelines for First Responders Regarding Planning, Training, Procedure and Equipment for Chemical, Biological, Radiological and Nuclear (CBRN) Incidents GUIDELINES FOR FIRST RESPONSE TO A CBRN INCIDENT NATO Standards Allied Engineering Publications STANAGs, Handbooks Field Manuals, Guidelines Structure of the International Shipboard Emergency Egress Trainina Curriculum First and Emergency Responders First Responders are local and governmental police, fire, and emergency medical personnel or nongovernmental organizations who, in the early stages of an incident, are responsible for the protection and preservation of life, property, evidence, and the environment, including: Emergency responders are firefighters, law enforcement, security personnel, emergency medical technicians, emergency management and operations personnel, explosive ordnance disposal (EOD) personnel, physicians, nurses, medical treatment providers at medical treatment facilities, public health, clinical care, mortuary affairs personnel, disaster preparedness officers, public health officers, bio-environmental engineers, armed forces personnel etc., and Emergency response providers include public works, and other skilled support personnel (such as equipment operators) who provide immediate support services during prevention, response, and recovery operations. Qualification of Responders ■ CBRN responders are civilian (local and governmental police, fire, and medical emergency personnel) and/or armed forces personnel who are trained to respond to CBRN incidents and certified to operate safely in CBRNE hazardous environment at the awareness, operations, or technician level according to particular standards Components of CBRNe Consequence Response Operations Principal components: ■ Fire Brigade Rescue Corps ■ Law enforcement (Police, EOD, S.W.A.T., Forensics, Intelligence, Attorney,....) ■ CBRNe & Scientific Experts..... Other components: ■ Civilian Defense ■ Administration ■ Army ■ Red Cross ■ Technical Services ■ Business ■ Companies ■ Associations ■ Foundations Complexity of Activities During CBRNE Consequence Management Search & Rescue Restoration Investigation Detection & Identification Protection Medical econtaminati Countermeasures Mitigation/EOD UNSCOM in Iraq Destroyed CWPF with sarin leaking technology at Al Muthana 3 MT containers with sarin Barrels and tanks with precursors Destruction of 122 mm artillery rockets with leaking sarin Checking residues of sarin in burning pit Hunting of escaped 122mm rockets Destruction of 500 kg aerial HD bombs (pits contaminated with HD) Decontamination of trailer contaminated with HD Emergency decontamination ?Sampling of 122 mm Warhead? ■ Fountain of Sarin ■ The invitation to the Heaven Lessons learned from UNSCOM ■ Experience from ■ UNSCOIVTs operations had been utilized in the a development of the Organisation for the Prohibition of Chemical Weapons Training program for inspectors Selection and improvement of equipment Inspection SOPs for Challenge inspection, Investigation of Alleged Use CWs, Old and Abandoned CWs Training with Live CW Agents CBRNE Investigation CBRN Investigation Advance Team Team Leader T CBRN Devices Conventional Munitions Communication Data Collection Logistic ) Qualification of Investigators The qualification of those individuals and/or teams doing CBRN Forensic is crucial because the results of the investigation are very important in order to decide if they are conclusive or inconclusive. Technical capabilities of CBRN Forensic individuals are so high that ordinary individuals/responders/soldiers not "forensically minded" could actually compromised the successful identification of CBRN materials and nature of CBRN attack. Investigation team expertise composition ■ Command ■ Crisis and Consequent Management ■ Explosive Ordnance Disposal/Unexploded Ordnance ■ Chemical Weapons ■ Conventional Weapons ■ NBC/CBRN service ■ Analytical Chemistry ■ Chemistry/Chemical Technology ■ Forensics ■ Medicine ■ Pathology Dermatology Toxicology Microbiology Epidemiology Anthropology Plant Pathology Sociology Psychology Ethnology Interviewing Interpretation Communication Logistician ?Crime Investigators? The role of the Forensic Scientists There are several main areas of duties: 1. Examination of physical evidence 2. Reporting on results of a forensic examination 3. To assists in tracing an offender 4. Provision of evidence for presentation of a case to a court 5. Present verbal evidence in court (expert testimony) 6. Training of police officers to become "forensically minded" when investigating crime scene ■ CBRN Forensic Team will in the form of specialists composing multidisciplinary investigation team enable to work effectively under CBRN HazMat environmental conditions When is CBRN Forensic Science Needed? The Forensic Science needs are derived from Conventional Forensic Science in order to investigate crime scene and answer three principal questions: Has a crime act been committed? Who is (are) affected/victimized Who is (are) responsible for crime? and Is the suspect responsible for the crime act? ■ In this regard the link of CBRNE Forensic Science to Conventional Forensic Science should be following: 1. Has a crime act/release of CBRN been committed/occurred? 2. Who is (are) affected/victimized by the CBRN attack? 3. Who is responsible for the crime act/CBRN attack? 4. Is there a suspect responsible for the crime act/release? 5. What is the likely release? Hands-on skills/Training Hazard identification Personal protection Detection Reconnaissance Sample collection (environmental and biological samples) Handling samples (Chain of custody) On-site analysis Non Destructive Evaluation Decontamination First Aid Interviewing Recording/Documentation Reporting Communication Good Laboratory Practice regulations (GLP) Reconnaissance/Detection EOD/UXO Reconnaissance Sampling and Detection Liquid Sample Taking Sampling A.S.A.P Sample Packing and Sealing Packing Samples for Transport and Chain of Custody On-Site Analysis Non-Destructive Evaluation X-Ray Imaging X-Ray Image of Liquid Fill CBRN Exercise Cases Aircraft kidnapped with Bio-Device Hostages released L 1 w'^3 ^T"^ ' ^^^^^^^^^^^^ Transfer hostages for decontamination S.W.A.T. arrests Perpetrators Deliberate Chemical Incident Victims removed by SWAT Sampling Team on Scene Transfer of victims for decontamination EMS available-responding till ZERO+70 Mitigation of Chem/Explosive Device Investigation Team Investigation Team Investigation Team Vitruviarfs Symbol of the Ideal Clashes of Interests Between Patients and Safety of EMS and Hospital Providers VIEW FROM POSITION OF A PATIENT MEDICAL CARE HAVE TO BE PROVIDED AS FROM PATIENT S POINT OF VIEW ASSSUMING REASONABLE RISK FOR HEALTH CARE PERSONELLAND FACILITIES Health&Safety (HS) and Healthcare (HC) Concerns ■ Planning- lack of interagency coordination, not sufficient funds for H&S and HC, not fully materialized ■ Preparedness- limited availability of certified procedures and equipment, lack of training, lack of HC emergency infrastructure preparedness ■ Response- H&S and HC negligence and/or exaggeration and/or mismanaged Serious impact to the life saving of victims ■ Recovery- H&S negligence Current Emergency Medical Train Victims at Collection Point waiting for Decontamination Transfer Victims for Decontamination Assisted Decontamination of Casualties Advanced Emergency Medical Train Emergency Decontamination Prior Protective Mask Donning Airway Protection and Evacuation from Hot Zone What Kind of Help the Victims are Expected ? EXTRACTION All this have to be done in contaminated environment within 30 minutes since chemical incident occur Exposure Elimination Airway Protection 4 Ventilation Urgent Medical Care Antidot Administration Triage Fix and Bandage of Injuries Equipment Equipment-Standards Protecting RESPONDERS Who Respond to Chemical, Biological, Radiological, Nuclear Explosive Events Responders may be involve in responding to HazMat, chemical, biological, radiological, and nuclear incidents. They also may face dangers posed by clandestine drug laboratories, including potential injury from explosions, shooting, flash fires, chemical burns, toxic fumes, x-ray radiation, heat stress, etc. To ensure that responders have adequate personal protective ensemble and other mission oriented essential equipment when responding to these situations, associated authority have to provide adequate standards. There is a variety of other standards existed for various emergency service workers, ranging from firefighters, law enforcement, army, EOD to hazardous materials response teams. However, not all of the standards fully addressed responders needs (e.g., integration, human threats, stealth operations, durability, dexterity, protection factors, readiness, selectivity, sensitivity, broad spectrum, etc.) Personal Protective Equipment All Hazard Protection Level A and B limited performance of responders (air supply, weight, workload, heat stress, vision, communication, dexterity) Level C Air Permeable Ensemble challenged with Toxic Industrial Chemicals and diluted CW Agents Needs for complex evaluation of whole Personal Protective Ensemble (Protection Factor and Heat Stress Factor) Needs of PPE against penetration radiation Needs for airway protection of responders 7/24 (one size) Levels of PPE Protection Efficiency of Personal Protective Ensemble TICs/CWAs/Bio Rad. Contam. CW Agents Chem/Bio Rad&Nuclear Ballistic Protection Underwear Protective Coverall Current CB(RN) PPEquipment All fabrics and skin block a-particles Inhaled or ingested a-particles are hazardous Provides Low Energy a and ß-particles protection only Impermeable PPEs are heat sinks and limit operations Protection against x and y-rays is „Zero" and High Energy ß-particles is also negligible mproving Radiation Protection TIME DISTANCE SHIELDING Um Shielding^. ►1 RDD Blankets and Shields Minimize Time 1 gram of Cesium' 137 lOfcetfrom 20 feet from 30 reel from behind concrete (about [tie tiie ofaflS source .026 HHjnce 0.O7 source QjOia Exposure: 0 06 pellet) Exposure: Exposure; txpoturei Roemgen/hr Radioactivity 87 Curies R&efitoerVhr Roentgen/hf Hoentgen/hr Absorbed Düi&: 0.028 rad/hr Dose Equivalent 0J8 rem/hr At s rate, m: lohn' Recerve avenge annuel dose 190 hrt - Reach occupational annual dose limit foradurtjof Srem experience mHd mention medkal effects Minimizing radiation ex[>osure Multiple Hazard Protection Composite Material Polymer with radiopaque fillers is sendviched between layers of fabric Chemically resistant foil/membrane Chem/Bio Carrying and binding fabric ^ Mechanical, Fire, Ballistic Nano-Radiopaque filler in a polymer > > .»s .vy .t ^ Radio/Nuclear (Chem/Bio) Inner fabric Skin contact Shielding composite with nano-particles radiation Shielding layer with nano-size particles Cs-137 (ß)512 keV and (y)662 keV Dose Rate and Attenuation Ratio of DEMRON Shielding with Cs-137 in% ItemsofDose Rate and Attenuation Ratio Measurement ■ During the measurement background dose rate fluctuated between 0,04-0,05 uGy/h and Cs-137 source gave dose rate of 0,552 uGy/h. Folding of DEMRON layers provide synergy effect in increasing of attenuation rate. 4 layers of DEMRON are surprisingly equivalent to 2 mm of Pb. Sample of multiply DEMRON layers as RDD shield provide effective attenuation of 79% against Cs-137 source. 2,500 --2,000 c 1,500 51,000 0,500 0,000 Normalized Ration of Attenuation F (0,5 Pb Apron) versus Voltage at RTG Voltage at RTG U [kV] 20 40 0 0 » 60 80 0 100 0 ♦ -[— 120 * Demnon 1 Layer ■ Demron 2 Layers Demroti 3 Layers Demnon a Layers Demnoi 5 Layers • Apron 0,25 Pb 0 Apron 0,35 Pb —Apron 0,5 Pb 140 Light-weight x-ray(rtg) Apparel Old generation of Pb composite with poor mechanical properties and tendency to defects Non-lead (Pb) composite Nano-sized fillers -30 % lighter Attenuation improvement CBRN protection/shielding Mechanical improvement Whole body apparel Thermo conductivity Recycling Integrity of the mask with optical device(s) "State-of-the-art" how to aim with small arms wearing the mask Only the mask in the World compatible with optical devices Respiration and Dermal Protection 7/24 Availability Emergency Medical Service CBRNE Intervention and Protection Equipment EOD responder CBR vulnerable hazmat against Ventilation of EOD helmet without CBR protection Lack integrity of EOD's helmet with respiratory protection EOD^s CBRN Integrated Helmet Air-way Support Means in Contaminated Environment j Intraosseous (10) Administration of Antidotes and Fluids Ben-Abraham 2003 Acad Emerg Med 10:1407-1410 Scissors versus Cutter Swatch Testing with Permeation Cell Adsorption of HD at Charcoal Fabrics Dynamic Adsorption 50 45 40 - ■ 20 10 3 ■ 0 07Derop OTOBfop 07 □ sfOp ■ 0HHRc32$ 07tSc G7DBQ 07080 ■07DBO Tinin (hour) Technology Failure Particle Charcoal Fallen Apart from Carrier Fabric Testing PPE with Volunteer Individuals in Gas Test Chamber Testing PPE with Semi-robotic Mannequin in Gas Test Chamber Visual Man-In Simulant-Test is enable precisely and objectively identified penetration of challenge agents/simulant through deficiencies of personal protective ensembles Mannequin „Golem" in PPE and V-MIST detection of Chlorine penetration Image of Whole Body Exposure WHOLE BODY S=18322 cm2 D= 1022 |jg PF= 760 „Chimney" Effect of Legs Exposure when Trousers are Worn over Boots „Bellows" Effect of Under-suit Exposure Wind Shield" Penetration Effect Sub-millimeter hole (0.9mm) Penetration „signature" through a hole Heat Stress Collapse Physiology evaluation in Climate Test Chamber Climate Chamber Heat Workload and Ventilation/Cooling Evaluation Thermo-imaging of Heat/Cooling Decontamination There is firm opinion and exercised practice, that victims exposed with the CBR contaminants have to be decontaminate directly on-site of an CBRNE incident prior medical emergency aid will be provided and also prior their transportation to medical facilities for advanced emergency care. This approach significantly delayed measures for saving lives of victims on-site and also complicate their health recovery at the medical facilities. Therefore, there is vital recommendation, that r to be equipped with independent stand by decontamination Another improvement should be considered that the emergency decontamination means have to be permanently available to responders for their safety and for assisted decontamination of critical parts victim's body prior providing first aid on-site. This measure can significantly contribute for saving lives of patients and protection their health with minimized delay. CBRN Training & Skills Preparedness of Responders Key Assumptions Policy (HazMat vs CBRNe) Standards (equipment, operations, competencies of FRs) Standard Operations Procedures (consistent with CM) Equipment (consistent with policies, standards, SOPs, mission oriented, interoperability, tested) First Responders (medical and psychological examinations, fitness) Training of FRs (consistent with CM, SOPs, equipment, competency criteria) Individual training-Team training Awareness-Advanced-Specialized-Rehearsal Levels Exercises (individuals-teams-inter agencies) Feed back for improvement of operations, SOPs, equipment, FR performance, training&education Training Programs Training programs are vital part of the process for preparedness and response in order to prepare the responders for their prime and secondary roles. Training programs will serve also for validation of the guidelines, SOPs, working procedures, protocols, agreed roles, competencies, capabilities and capacities for effective response in CBRNE consequence operations. The exercises of different level verify and help to improved tactical response operations and associated guidelines, SOPs, protocols and proficiency of specialized protection and intervention equipment. Priority of Training Program Development Define the program aim(s) and individual/team competencies, measurable goals and enabling objectives. Content of policies, guidelines, SOPs and protocols is the basis for development of particular courses, instructions, lessons, their content, performance evaluation and exercises. Quality Assurance/Quality Control Development of courses should be also managed according quality assurance and quality control (QA/QC) standards. This would the part of training programs/courses certification and accreditation, in order to be able issued formal performance certificate to graduators. Taken into account variety of agencies and specialized responders it will be important to guarantee consistency and integrity of individual and team knowledge and skills. Modular Training Program ■ THREATS OF CBRNE ■ ■ CBRNE SUBSTANCES AND MATERIALS ■ ■ EXPOSURE TO CBRNE ■ ■ HEALTH AND SAFETY AT ■ CBRNE EVENTS . ■ PROTECTION AGAINST CBRNE . ■ HEAT STRESS MANAGEMENT ■ MEDICAL COUNTERMEASURES ■ AGAINST CBRNE ■ EMERGENCY MEDICAL ■ RESPONSE AT CBRNE EVENTS . ■ DETECTION, MONITORING AND IDENTIFICATION OF CBRNE . ■ DECONTAMINATION AND CLEAN-UP OF CBRNE CRISIS AND CONSEQUENCE MANAGEMENT RISK ASSESSMENT CRISIS PREPAREDNESS INTEGRATED RESCUE SYSTEM RESPONSE TO CBRNE EVENTS INCIDENT COMMAND-CONTROL-COMMUNICATIONS INVESTIGATION OF CBRNE EVENTS SECURITY AND PUBLIC RELATIONS EQUIPMENT MAINTENACE, REPAIR AND STORAGE EXERCISE OF CBRNE RESPONSE Level l-Basic Course(s) ; Level ll-Advance Course(s); Level Ill-Specialist Course(s) (awareness) (operations) (technicians/specialists) Intervention Response On-site in Contaminated Zone First Aid Support in Staging Area Victim's Emergency Decontamination Disrobing (Cut-Off) of Victims CBRN TTC-First Aid-Emergency Cut Off TTC-Hot Site-Control Tower Command & Operations Room supervising Hot Area re-Hot Site Pictures by courtesy Blaz Mihelic Detection tasks FTC-Demonstration of explosive dissemination of a contaminant CBRN TTC-Decontamination tasks NINCBO-Blasting Area "Dirty Bomb" simulation Opening Munitions for Sampling I Pictures by courtesy SUJCHBO Thank you for your Attention Pavel Castulik, Dcastulik(a).vahoo. co. uk