Author: Graham Johnson / Codes: CAP26, HAP20, CAP34 / Published: 14/06/2019


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  • Andrew Tabner
  • Graham Johnson


The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities. Two main features of the revised process are: (1) the introduction of an emergency disrobe and dry decontamination step prior to the arrival of specialist resources and (2) a revised protocol for mass casualty (wet) decontamination that has the potential to double the throughput of casualties and improve the removal of contaminants from the skin surface. Optimised methods for performing dry and wet decontamination are presented that may be of relevance to hospitals, as well as first responders at the scene of a chemical incident.

The Paper

Chilcott RP, Larner J, Matar H

UK’s initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals

Emergency Medicine Journal 2019;36:117-123  

What was discussed in the podcast?

Latest changes to practice concerning the management of patients in a CBRN incident, with a focus on the Initial Operational Response (IOR) and dry decontamination.

The 1-2-3+ approach to recognition of a CBRN incident

Remove Remove Remove:

Remove the casualty from the incident

Remove clothes from the casualty

Remove contaminants from the casualty, usually by dry decontamination in the first instance (but see the paper/listen to the podcast for exceptions.)

How to get involved in CBRN planning

RCEM curriculum coverage

HAP 20: Major Incident management

#FOAMed Resources

  1. St Emlyn’s – CBRN: An Introduction
  2. EM3 – HAZMAT and CBRN Decontamination Process 
  3. Radiation Exposure – Reference
  4. Industrial Chemical Incidents – Reference


  • Amy Hughes
  • Susie Roy

What this paper adds

This paper discusses, via the critical appraisal of the current literature, the lack of high quality evidence for omitting a pelvic exam in female patients presenting to the Emergency Department with low abdominal pain, vaginal discharge or bleeding.

The Paper

Plight of the pelvic exam

Mary Elizabeth McLean, Livia Santiago-Rosado

Available here:


A number of recent studies have concluded that a pelvic exam may be routinely omitted from Emergency Department patient assessment in those presenting with the symptoms described above.


The paper analyses and highlights the limitations in a number of recent (some more so than others!) papers advocating that a pelvic exam may not be required in this patient population.  The authors also note that we undertake urogenital examinations for male patients with genitourinary complaints and that we should do the same for females.

Authors Conclusion

The lack of evidence at this time illustrates that by excluding a pelvic exam as part of our workup in females presenting withlow abdominal pain, vaginal discharge or bleeding we are not doing our job.

Our take home

Clearly more work needs to be done if we are to routinely exclude a pelvic exam in the patients discussed.  This article may raise questions for some of us with regard to our current practice.

RCEM curriculum coverage

CAP 26: Pelvic pain

CAP 34: Vaginal bleeding

#FOAMed Resources


These articles are actually quoted in the paper.