Organisation of medical care in large scale incidents: a practice-oriented research in Belgium

Abstract Background CBRNe incidents are emergency situations involving the release of chemical (C) or biological (B) substances or radiological/nuclear (RN) contamination, sometimes through an explosion (e). They can result from intentional malicious acts (e.g. terrorism) or unintentional situations (e.g. accidents). In this context, people (victims, care providers, witnesses), equipment (infrastructure, vehicles), animals, objects and/or the environment (buildings, ambulances) may be contaminated by a substance that could pose a threat to health. CBRNe incidents can quickly overwhelm the response capabilities of the affected region and put the healthcare system under great pressure. This research investigated ways of improving the organisation of medical care in CBRNe incidents in Belgium. Methods this study involved a mixed method approach in 2022-2023 with scoping and in-depth interviews with actors at operational and strategic levels (public health, Internal Affairs, army, fire departments), participative workshops with stakeholders, contextual desk search, ad hoc literature review and international comparison completed with interviews with national experts (Norway, The Netherlands, France and United Kingdom, United States of America). Results hospitals need to be distinguished in type 1 specialized hospitals for decontamination, major trauma management and advanced care for severely burned patients and in type 2 hospitals managing spontaneous arrivals of victims and non-specialised care. All hospitals need to have a strict lock-down policy. On the incident site, an emergency medical mobile team needs to manage the decontamination with the firefighters before the transfer to the most appropriate facility. Additional conditions were found to improve the efficiency of medical care. Conclusions this practice-oriented research contributes to a better organization of medical care in case of CBRNe incidents, with the emergence of practical and feasible solutions. Key messages • Hospitals need to be distinguished according to the need for specialised care in case of CBRNe incidents. • On site decontamination needs to be performed by health professionals and firefighters.