Military Pharmacists and the Management of Chemical, Biological, Radiological, and Nuclear (CBRN) Threats

Background: CBRN incidents compress decision time, destabilize supply chains, and demand rapid, coordinated deployment of medical countermeasures (MedCM). Military pharmacists sit at the intersection of clinical care, logistics, regulation, and informatics, translating doctrine into safe bedside practice under personal protective equipment (PPE) constraints. Aim: To delineate the comprehensive roles of military pharmacists across preparedness, response, stabilization, and recovery phases of CBRN events, with emphasis on portfolio stewardship, EUA implementation, compounding, pharmacovigilance, and interagency coordination. Methods: Narrative synthesis of functional domains derived from CBRN doctrine and pandemic-era pharmacy operations (e.g., oseltamivir pediatric labeling revision, suspension compounding during shortages, and an electronic peramivir EUA-access system), mapped to the “Four Is” casualty framework (Intoxication, Infection, Irradiation, Injuries). Results: Pharmacists (1) curate threat-aligned formularies and shelf-life strategies; (2) author standardized order sets and POD workflows; (3) operationalize EUAs via EHR order sets, point-of-care barcoding, and adverse-event pipelines; (4) execute compounding/alternative dosing for pediatrics and dysphagia; (5) calibrate antimicrobial stewardship during mass PEP; (6) ensure PPE-compatible medication delivery and labeling; (7) build surge logistics, mobile caches, and contamination-aware distribution; and (8) sustain risk communication and training. These functions reduced dosing errors, bridged formulation gaps, accelerated equitable access, and strengthened safety surveillance. Conclusion: Military pharmacists are pivotal to CBRN readiness and consequence management. By integrating regulatory agility, clinical governance, and resilient logistics with decision support and education, they convert complex science into timely, safe, and equitable MedCM delivery, reducing operational risk and preserving force readiness.