Multi-purpose Model of General Emergency of Hospitals in CBRN Conditions: Narrative Review

Hospitals are often the front line in dealing with incidents. With the technological trends and threats of Chemical, biological, nuclear, and radiation (CBRN) incidents, considering future wars and the risk of community epidemics and complex threats in the field of CBRN, the importance of the issue has doubled. The most rational way to manage a potential danger is having sufficient preparation in the face of critical situations, this, however, requires scientific models. Therefore, the aim of this study was to, first, look at the level of preparedness of emergency rooms to respond to CBRN incidents and, second, to construct a multi-purpose model of hospitals’ general emergency in CBRN conditions.

This study was a narrative review. The statistical population included available documents and articles about CBRN emergencies between January 2000 and April 2022. Document review tools were used to aggregate documents related to general emergency, trauma, chemical, biological, nuclear, and radiation. Validation was done by searching reliable Persian and English scientific databases such as PubMed, Scopus, Magiran, IranMedex and Google Scholar. Also, for reliability testing, a comparative study of documents was performed. The keywords "General Emergency", "Trauma Emergency", "Chemical Emergency", "Biological Emergency", "Nuclear Emergency", and "Radiation Emergency" and their Persian equivalents were utilized. Then it was analyzed using the Prisma checklist.

Considering the entry and exit criteria, a total of 22 articles from 7 countries; Iran (10), America (5), Canada (3), Great Britain (1), Belgium (1), Australia (1), and Hong Kong (1) were evaluated. The results of the research indicated that the most important success factor against CBRN incidents in the emergency department is the anticipation and preparation of necessary measures. The findings of the present study according to the documents, articles, and the subsequent comparison of their common factors and also using the indicators of international organizations in the field of crisis management indicated that there are 6 axes in the field of CBRN emergency. The axes are namely; 1. Design of the emergency department, 2. Medicines and required equipment, 3. Required staff, 4. Education and training of staff, 5. Structure and organization, 6. Processes and instructions.

Studies have been conducted and the analyzes performed based on the axes showed that many organizations and countries do not use a specific model to deal with CBRN incidents. It can be said that most hospitals, except for the hospitals that have a dedicated emergency room for one of the CBRN agents, are not prepared to manage such incidents. In this regard, developing a comprehensive CBRN crisis management model including the dimensions of human resources, structure and organization, physical space, instructions and processes, and equipment is of particular importance.