A new review published in the Turkish Journal of Clinical Research examines the state of prehospital preparedness for Chemical, Biological, Radiological, and Nuclear (CBRN) threats. The study analyzes both international literature and Türkiye’s national preparedness landscape, emphasizing the crucial role of emergency medical services in managing these high-impact, low-frequency events. With rising industrial risks and regional instability, the findings have implications for public health systems well beyond Türkiye’s borders.
The Rising Threat of CBRN Events
CBRN events—whether accidental, natural, or intentional—present complex challenges to civilian populations and health infrastructure. From sarin attacks in subways to biological pandemics and nuclear accidents, such events require rapid, coordinated responses. First responders play a pivotal role in identifying threats, performing decontamination, and preventing healthcare system overload.
Prehospital Weaknesses Undermine Response Capability
The review highlights common global challenges:
- Limited Training: Healthcare personnel, particularly in rural areas, often lack CBRN-specific training.
- PPE and Equipment Gaps: Prehospital responders frequently operate without adequate protective equipment or decontamination tools.
- Scenario Blind Spots: Emergency plans rarely include detailed CBRN response protocols, leaving responders unprepared.
- Children at Risk: Vulnerable populations, particularly children, face disproportionate health risks in CBRN scenarios due to their unique physiological responses.
Progress in Türkiye and the Road Ahead
Following the 1999 Marmara Earthquake, Türkiye took steps to address CBRN preparedness, including the formation of CBRN units within the Ministry of Health and the National Medical Rescue Team (UMKE). However, training and awareness remain inconsistent, particularly outside urban centers. The review recommends:
- Nationwide adoption of structured response algorithms like Qatar’s RSDAT* model
- Regular, scenario-based simulations for EMS and UMKE teams.
- Development of protocols for pediatric and other high-risk groups.
- Strengthening interagency coordination and logistics infrastructure.
Good Practices and Lessons from Abroad
International examples reinforce the review’s findings. Qatar’s implementation of the RSDAT protocol has improved field efficiency, while Japan’s Tokyo sarin attack revealed the dangers of uncoordinated prehospital action. Common to all successful models is the integration of practical training with clear operational guidelines.
Policy Recommendations for a Resilient Future
The authors urge systemic reforms to address the current preparedness gap:
- Mandatory CBRN Training for all emergency personnel.
- Field-Ready Protocols tailored to local threat profiles.
- Drills and Simulations that mirror real-world scenarios.
- Inclusive Planning that accounts for vulnerable populations.
- Multi-Stakeholder Coordination involving public health, security, and local government actors.
From Paper to Practice
CBRN incidents test the agility and resilience of healthcare systems in ways few other emergencies do. This review serves as a stark reminder: theoretical readiness is not enough. Systematic, cross-sectoral efforts are needed to turn preparedness plans into real-world capabilities—especially in the critical minutes before hospital arrival.
Topcuoglu U, Ersozlu E. Prehospital preparedness of health systems against chemical, biological, radiological, and nuclear (CBRN) threats: A review. Turk J Clin Res. 2025;1(1):49-54
* The RSDAT protocol is a structured decision-making framework designed to guide prehospital responders in managing HazMat and CBRN (Chemical, Biological, Radiological, and Nuclear) emergencies. It is an acronym that stands for:
- R – Recognition: Identify the presence of a potential CBRN or hazardous materials threat based on environmental cues, symptoms, or intelligence.
- S – Safety: Ensure personal and scene safety by using appropriate personal protective equipment (PPE) and establishing a safe perimeter.
- D – Decontamination: Initiate appropriate decontamination procedures to limit the spread of hazardous agents and protect both patients and responders.
- A – Antidote: Administer specific antidotes if applicable (e.g., atropine for nerve agents).
- T – Transport: Safely transport patients to medical facilities while maintaining isolation and contamination control.
The RSDAT protocol helps standardize the actions of first responders under high-stress, high-risk conditions and minimizes errors during critical early phases of a CBRN event. It has been implemented in Qatar and is cited as an example of good practice for improving CBRN readiness.