"Work as Done in the Emergency Department response to CBRN events: A comparative study"

The Emergency Department (ED) is the highest risk area in healthcare. Chemical, Biological, Radiological, and Nuclear (CBRN) events are multi-faceted emergencies which could result in an influx of casualties to arrive in the ED. Responding to a CBRN event presents major challenges to ED staff (first receivers). This study aimed to understand the actions of first receivers in response to CBRN presentations by mapping Work as Done (WAD) in the event of a CBRN incident, using Hierarchical Task Analysis (HTA) to capture and compare the CBRN responses in two NHS Trusts in the UK. WAD was established by presenting first receivers with CBRN scenario cards. Field notes were made, converted to HTAs, and analyzed using thematic analyses. The results found similarities between the 2 Trusts, for example, in isolation and containment. The differences highlighted that although first receivers were adhering to clinical recommendations and governmental guidance for treatment and investigation of CBRN presentations, variation still existed. CBRN events are time critical situations in which the clinical and organizational skills of first receivers should be prioritized. This variation between NHS Trusts can be overcome by standardizing the NHS CBRN response.