British specialists in chemical, biological, radiological and nuclear (CBRN) response and decontamination procedures shared their expertise with 22 delegates from 5 European countries during a study visit, organized by WHO, to the National Health Service (NHS) Resilience Emergency Capabilities Unit at the United Kingdom’s Fire Service College.

The event, which was funded by the European Union, through the EU4Health CBRN Action, offered participants an in-depth look at the English ambulance service’s operational capability. Delegates from Estonia, Hungary, Lithuania, Romania and Ukraine engaged with subject-matter experts, observed live demonstrations and participated in discussions exploring international collaboration.

The United Kingdom has experienced major public incidents, including terrorist attacks in Manchester and London in 2017, and the 2018 Novichok nerve agent poisonings in Salisbury. Each response has called upon multiples agencies, including police, ambulance and fire services. Based on lessons identified from statutory public enquiries into these incidents, the United Kingdom has been working on systems to enhance the interoperability of their emergency services response, equipment and protocols, with the aim of getting life-saving interventions to patients as quickly as possible.

Key insights

Specialist paramedics speak to participants about mass casualty management – Moreton-in-Marsh Fire Service College, United Kingdom.

A live CBRN decontamination demonstration of a “worst case CBRN scenario” offered delegates learning on how to set up decontamination facilities, use personal protective equipment (PPE), and manage and triage casualties. The session provided a unique opportunity to observe realistic operational conditions and the coordinated functioning of response teams.

“One of the key insights from this study trip was the realization of the importance of a systematic approach to preparedness, where the main focus is not only on response, but also on the constant maintenance of operational capacity through regular training, intersectoral interaction and clearly defined roles of each participant in the process,” said Tetiana Orafina, Deputy Director of the Public Health Centre, Ukraine.

“I was impressed by the interagency working models,” said Odeta Vitkūnienė, Director of Personal Health Care, Ministry of Health, Lithuania. “Lithuania is doing a lot on preparedness, but intersectoral decision-making is an area we can work on. International collaboration and the sharing of good practices improve our health system preparedness.”

Scaling up skills

A demonstration of a “wet” decontamination.

Christian Cooper, Associate Director of the NHS Emergency Capabilities Unit explained that the demonstration staged during the visit was of a worst-case scenario, “a big wet decontamination of a large number of people using the highest levels of PPE that we have”.

“But those same staff are trained to go out every day and deal with chemical spills and industrial accidents. That’s routine for them, so they’re simply scaling up a skill set that they already have, and that allows us to make sure that they maintain a good state of readiness for the wide range of incidents that they might face.”

He added: “Having health professionals with a lot of experience from a very diverse range of health systems and economies across Europe come and see what we’re doing but also comment on and compare it to what they do and see where the gaps may be in both our responses, is absolutely invaluable”.

The expert group at the NHS emergency training site.

“WHO continues to advance CBRN preparedness and response across the Region. The United Kingdom’s leadership and commitment to partnership underscore the vital role of European knowledge exchange and cooperation in developing interoperable CBRN standards,” said Kamal Akbarov, Technical Office CBRN, WHO Country Office in Ukraine.

“The United Kingdom’s extensive CBRN experience offers practical models and expertise that can be adapted and applied to support national preparedness and response capacities, strengthening collective health security across borders.”