Chemical, biological, radiological, nuclear and explosive (CBRNe) events

Purpose: To systematically review published literature for the research question ‘what issues are considered (and changes made) for vulnerable groups as part of the Chemical. Biological, Radiological, Nuclear or explosive (CBRNe) response for casualty collection, decontamination, triage and casualty clearing processes?’ Design: Seven-stage framework from the PRISMA statement for research question, eligibility (definition), search, identification of relevant papers from title and abstract, selection and retrieval of papers, appraisal and synthesis. Data sources: Medline, Embase, Cochrane Library, Web of Science, Scopus (Elsevier), Chemical Abstracts, Assia (Proquest), Sociological abstracts Proquest), Cinahl, HMIC, Health business elite, PsycInfo (ebsco), PILOTS (Proquest) and supplemented by other search strategies (e.g. exploding reference lists). Review methods: The included references were critically appraised using the Mixed Methods Appraisal Tool (MMAT) Results: 1855 papers were returned from the literature search, of which 221 were screened by abstract and 48 by full paper. Eleven papers were included for appraisal, of which 3 achieved a quality score of 50% or over. The papers were categorised into 3 phases on CBRNe response; evacuation, triage and decontamination. Conclusions: Although very little new medium/high quality research is available, the findings are summarised as considerations for building design (route choice and information), communication (including vision, hearing and language differences) and the composition of the response team. It is suggested that evidence-based practice from other care domains could be considered (patient movement and handling) for fire service and ambulance guidelines.