Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies are one involving CBRN agents (i.e., toxic and hazardous chemicals/materials, chemical and biological warfare agents, toxic radiological materials, etc.). CBRN emergencies occur as a result of occupational exposure, fire, explosion, release of toxicants, and warfare, and are caused either by ignorance, negligence, incompetence, accident, or malicious intention. Threat perception is further compounded by activities of hostile countries, non-state actors, terrorists leading to low-intensity conflicts, tempering/sabotage, etc. The emergence of state-sponsored terrorism, proliferation of chemical/biological weapons, availability of materials and scientific weapons expertise, and recent increases in less discriminate attacks, all points toward a growing probability of occurrence of mass casualty incident. A disastrous situation implies severe disruption, which greatly exceeds the coping capacity of the affected community. Governmental agencies, healthcare professionals, and public health advocates always look for the best ways to mitigate the potential impact of mass casualty potential of CBRN emergencies. During mass casualty incidences, the overwhelming of local resources is one of the biggest challenges.
CBRN threats are no longer hype or horror, but a stern reality throughout the world, and India being no exception, is equally prone. CBRN terrorism would aim at drawing attention to terrorist's propaganda/demands, because such organizations are publicity hungry. Soft targets for such terrorist activities would include densely populated locations, crowded areas like fairs, religious congregations, entertainment clubs, rallies, mega cultural/sports events, etc. There is a distinct probability of use of ‘Dirty Bombs – aka radioactive dispersal devices’ and chemical/biological agents to kill or incapacitate the military/paramilitary forces and the undefended civilian targets – impending Common Wealth Games 2010 being no exception. The CBRN threat perception settings are developing at a very fast pace. Various likely scenarios of CBRN incidents are depicted in Table 1.
Table 1.
CBRN emergencies prospects
However, it must be remembered that both predictable surprises and improbable scenarios are likely to emerge every time. This is precisely the reason why even the most meticulous planning may fail in real-time situations.
CBRN agents enter the body by several routes, and the nature and onset of signs and symptoms may vary accordingly. Gases, vapours, and aerosols, when inhaled, may be absorbed through any part of the respiratory tract, from the mucosa of the nose and mouth to the alveoli of the lungs. The eye may also directly absorb them. Droplets of liquid and, less commonly, solid particles may be absorbed through the surface of the skin and mucous membranes. Toxic compounds with a characteristic action on the skin can produce their effects when deposited on the skin as solid or liquid particles. Agents that penetrate the skin may form temporary reservoirs so that delayed absorption may occur. Even the vapour of some volatile agents can penetrate the intact skin and intoxication may follow. Wounds or abrasions present areas that are more permeable than intact skin. CBRN agents may contaminate food and drink, and so be absorbed by the gastrointestinal tract. The penetration of agents by these various routes may be accompanied by irritation or damage to the surfaces concerned. The toxicants leaked into the environment may pollute the ground water, soil, and air, leading to long-term effects on the living organisms.
The CBRN incidents leave a long trail of profound sufferings beyond the range of normal human experience. The common peculiarity among CBRN incidences is ‘contamination’ and ‘lethality’ that needs specialized preparedness in terms of heightened awareness, use of specialized equipment including personal protective equipment, detectors, decontamination aid, and specialized medical support measures. Such incidents would result in a larger population in a state of panic and fear, affecting their morale. Chaos at the incident site is inevitable and cannot be prevented. The impact is multipronged (physical, psychological, economical, and social). The survivors may also experience panic reaction as an immediate effect, possibility of Post-Traumatic Stress Disorder, survivor guilt syndrome and other types of psychosocial ailments. Environment could also get affected as water bodies like wells, rivers, ponds getting toxic and, even air may get contaminated, affecting crops, food, poultry, fish, etc.
There is an age-old saying – ‘Being forewarned is being forearmed.’ In this thematic issue of Journal of Pharmacy and Bioallied Sciences on CBRN Disaster Management, we have briefly discussed the key issues in CBRN emergencies and typical problems encountered in their management, with special emphasis on the management of radiological emergencies, technologies including their mitigation aspects through an assortment of pioneering articles, reviews, notes, and letters to editor.
