Table 2.

Non-technical competency domains, subcompetencies for on-scene public health responders in CBRN emergencies.

Competency domain (definition)	Subcompetency	Example quotes coded for each subcompetency
1. Situation awareness (ability to perceive environmental elements and events with respect to time or space, the comprehension of their meaning, and the projection of their future status)	1.1. Knowledge applied to detect, project, and identify CBR agents.	1. Knowledge of the CBR agent categories (ZJP). 2. Be familiar with population density, the location of the plant, and other critical infrastructures (FQS). 3. Describe incident types and corresponding causes (ZZJ).
	1.2. Understanding the impact of environmental factors on CBR hazard dispersion.	1. Have knowledge of transmission of infectious disease (FQS). 2. Investigate the local whether, wind, transportation around the incident site (ZZJ). 3. Understand local terrain (ZJP).
	1.3. Knowledge of potential health and environment effects of typical CBR agents.	1. Project number of the casualties (GHD). 2. Determine the extent of the damage (FZL). 3. Correctly anticipate likely consequences (ZJP).
	1.4. Identify limits to individual and team knowledge, skill, and authority.	1. Ability to identify and solve key problem (FZL). 2. Awareness of possible contaminants (FQS).
	1.5. Evaluate and project effectiveness of all actions taken.	1. Understand the critical steps necessary to respond to a range of CBR events (ZZJ). 2. Evaluate and project the needed rescue actions … evaluate the urgency of the actions (CWL).
2. Communication skills (ability to exchange information, ideas, thoughts, or recommendations between or among individuals or organizations through a common system of symbols, signs, or behavior)	2.1. Describe communication role(s), channels, and processes in response to a CBRN incident.	1. Communication is essential- with our own team members, relevant professionals in other organizations, and, with victims and the public (FZL) 2. Communication should be established with local, regional and national authorities, with private sectors, and with the media (FQS). 3. Know the audience and use discretion in sharing data (SXC).
	2.2. Demonstrate correct use of all communication equipment while wearing personal protection equipment in hazardous environments.	1. Use the communication tools in CBR environment (ZZJ). 2. Be flexible and adapt communication tools to the contaminated environment, such as megaphone (SXC). 3. Use the telephone and walkie-talkie (ZP).
	2.3. Outline principles of risk communication in response to CBR events.	1. Use plain language to explain technical issues (FZL). 2. Correctly interpret technical reports of the detection of CBRN agents (ZJP). 3. Recognize the urgency and timeliness of communication (FQS). 4. Be familiar with the techniques of risk communication … Release only confirmed facts … be aware of probable audience emotions and show concern (ZZJ).
3. Collaboration (ability to work together with two or more people or organizations to accomplish a task or achieve a goal)	3.1. Understand and identify agency and partner agency roles, responsibilities, and capacities in response to a CBRN incident.	1. Identify roles and responsibilities of each position within team … collaborate with chemical corps (CWL). 2. Identify and evaluate other response teams at the incident site and propose a plan for collaboration of efforts (ZJP). 3. Know the chain of command, the process and each team's responsibilities (ZZJ). 4. Integrate the volunteers (ZW).
	3.2. Identify and locate agency and relevant partner response plans for CBRN incidents.	1. Become familiar with institutional plans and with local and national response plans (ZJP). 2. Create a plan for organization and deployment (SXC).
	3.3. Understand the methods of identifying and requesting regional, national, and international support.	1. Collaborate on evacuation and patient transportation (CWL). 2. Knowledge of the chain of command and the process (ZZJ). 3. Effective inter-agency coordination on scene (GDH).
4. Resource management (ability to use limited resources effectively and efficiently)	4.1. Ability to identify and predict specific crucial resources needed for response to CBR incidents.	1. Knowledge of the function and limitations of special equipment for CBRN response (FZL). 2. Knowledge of the proper drug treatments for the CBR contamination (FZL). 3. Estimate the pharmaceutical supplies needed for response (GHD).
	4.2 Identify special resources available for the CBRN incident site from state, regional, and federal agencies.	1. Knowledge of pharmaceutical stockpiles for CBRN incidents and the supply chain logistics (FZL). 2. Know the distribution and storage of vaccines and other reagents (ZZJ).
	4.3. Ability to construct process to mobilize, request, and manage resources.	1. Know storage location of the medical supplies, how to get authorization to obtain them and how to deliver them (ZJP). 2. Be up to date with drug renewal processes (SXC & ZP). 3. Demonstrate the safe administration of vaccines (GDH). 4. Know and communicate the recommended maintenance of the equipment (ZZJ & ZW).
5. Task management (ability to identify, monitor, and progress the work through its life cycle)	5.1. Ability to identify the critical tasks in the CBR response. (e.g. triage, detection, decontamination, psychological counseling, dispose of medical waste, specimen collection and moving, fatality management, and scene management)	1. Identify the first priority tasks on the scene (CWL). 2. Recognize the importance of psychological protection and mental support (ZZJ).
	5.2. Knowledge and maintenance of the principles, guidelines, and protocols of the critical tasks.	1. CBRN operation is characterized by professionalism. Every medical responder should have a relevant professional background (LYD). 2. You do require expertise in every field, but you must understand the core requirements and key processes to finish the task (LYD).
6. Cultural competency (ability to effectively deliver medical services that meet the social, cultural, religious, and linguistic needs of victims under ethical and legal regulations)	6.1. Knowledge of domestic health and safety legislation and its relevance to CBRN response.	1. Know relevant regulations governing infectious disease prevention and CBR response (FQS). 2. Have some knowledge of the law related to CBRN response (DB). 3. Abide by regulations on disposal of the CBR wastes (ZW). 4. Follow requirements for contaminated water disposal (GDH).
	6.2. Consider international support and conventions (IAEA, WHO, OPCW).	1. Know the core content of the international agreements and conventions, such as Chemical Weapons Convention (JJC). 2. Understand how to deal with the refugees (ZW). 3. Be aware of the legal issues when dealing with the refugees (SXC).
	6.3. Maintain general ethical principles in the context of emergence.	1. Utilize privacy considerations during decontaminations such as separate areas for men and women (ZJP). 2. Know medical ethics and how to face the expected casualties (ZP).
	6.4. Cross-cultural respect.	1. Speak native languages when operating overseas (ZP). 2. Have knowledge of the local cultural values and belief system such as cultural attitudes regarding death and burial (FQS).
7. Austere environment skills (ability to survive and maintain health in the austere environment)	7.1. Physical protection in CBRN contaminated areas.	1. Physical protection competency is imperative. Use appropriate protection but not excessive protection. Understand the protection levels required for different zones (ZP). 2. Take advantage of terrain and architecture as cover (ZJP). 3. Self-protection- the knowledge of the protective measures for the hazardous materials present is essential (FQS).
	7.2. Mental protection in CBRN contaminated areas	1. Psychological resilience is important when facing chaotic circumstances such as food contamination (FQS). 2. Be optimistic and strong-willed. Practice emotional self-control (ZZJ). 3. Overcome the psychophobia of WMD (JJC).
	7.3. Flexibility/adaptability	1. Be able to follow and understand the changing dynamics of the situation (CHL & DB). 2. Be prepared to deal with the surprise and devastation of emergency events (TH). 3. Expect the unexpected, such as communication interruptions and mass casualties (ZP).
8. Physical stamina (ability to sustain prolonged physical effort)	–	1. Physical endurance is a critical consideration. The workload is multiplied when wearing personal protection equipment (FQS). 2. Long periods of work in an austere environment requires good physical conditioning. Decontamination is an exhausting physical task (ZW). 3. Heat acclimatization is necessary (ZP).

WHO = World Health Organization; CBRN = Chemical, Biological, Radiological, and Nuclear; IAEA = International Atomic Energy Agency; OPCW = Organization for the Prohibition of Chemical Weapons.