Executive summary

This is the first full revision of a suite of advice originally published in 2006 by the Health

Protection Agency, a predecessor body of Public Health England, under the title ‘CBRN

incidents: clinical management and health protection’.

This new edition updates the chemical and biological guidance given in the 2006 edition and

adds additional material on a range of new and emerging threats in these areas.

The radiation incident response section has been completely re-written to integrate the

well-established European Society for Blood and Marrow Transplantation’s rapid clinical

assessment tool with care pathways derived from the WHO global consensus guidelines on

radiation injury.

Additional materials have also been included concerning the health protection elements of

response to mass casualty incidents including hearing loss, blood-borne virus transmission,

antibiotic prophylaxis for bomb injury wounds and screening for cognitive impairment.

The audience for this publication remains to be first responders, emergency departments and

public health and health protection professionals.

We have retained the system of keeping the disease, syndrome, or agent specific advice

sheets as being capable of being used as standalone items that can be printed out and used

to inform staff responding to identified threats.

This publication is the product of the advice and guidance offered by very many colleagues

from the United Kingdom’s National Health Service, Defence Medical Services, and Public

Health England. The guidelines on the management of chemical casualties was reviewed by

colleagues from the UK’s National Poisons Information Service; and the contents of the whole

document approved by National Health Service England’s Emergency Preparedness and

Response Clinical Reference Group.

The editors and principal authors wish to thank all of these colleagues, too numerous to list

individually, for all their help and support.