Guidance for First Rontrol Room Personnel2Guidance aimed at improving the way emergency services personnel respond following CBRN or HAZMAT chemical incidents has now been launched by JESIP, the Joint Emergency Services Interoperability Programme (JESIP).

The Initial Operational Response Programme (IORP) is led by the Office for Security and Counter Terrorism (OSCT) at the Home Office and is based on extensive research from Public Health England, working with the University of Hertfordshire under the ORCHIDS project (Optimisation through Research of Chemical Incident Decontamination Systems) on the most appropriate method of decontamination and how this can be achieved.

The National Ambulance Resilience Unit (NARU) has been fully involved in the production of this guidance and over the winter period will be rolling out an awareness package and Training and Education materials for all front-line Ambulance Staff.

The current guidelines instruct initial police and ambulance at a CBRN incident to await the arrival of CBRN trained specialists with appropriate protective equipment, before carrying out any lifesaving actions

CBRN trained specialists currently work to a “Model Response” which has been seen as large, inflexible and taking a considerable amount of time to respond. It focuses on the mass decontamination by Fire & Rescue Services using water.

This can take a long time to set up and then considerably more time to carry out life saving actions on the casualties. Exercises, and the few real incidents that have taken place have identified that this response does not focus on casualties and the saving of life and it has been recognised that there is a need for a more rapid and flexible response.

The research carried out has shown that by evacuating a contaminated casualty from the scene to a safe environment, disrobing and carrying out improvised decontamination, the majority of skin surface contamination will have been effectively removed, greatly improving the casualties’ survival rate.

Maximum benefit of this will be achieved within fifteen minutes of exposure, i.e. in the period before any CBRN specialists are likely to have arrived on scene. The research also showed that dry decontamination – the blotting and rubbing of exposed skin surfaces with dry absorbent material – is the most effective means and for non-caustic agents on this basis they recommend that dry decontamination should be considered the default process for an incident involving chemicals – unless medical advice has stated otherwise.

A multi-agency IORP Project Board has developed policy and procedure for first responders that focuses on life saving actions in the first few hours of a CBRN incident. The policy and procedures have been designed to put the safety and wellbeing of responders first and foremost in the response.

The IORP Project Board is liaising with JESIP, the Health and Safety Executive, the Police Federation and unions, legal departments and other key stakeholders (as part of a structured rollout) to develop a series of products designed to inform and protect staff.

These products are:

  • The IOR Guidance document
  • An aide memoir which has been designed to be tear-proof and waterproof and to fit within each police, fire and ambulances officer’s uniform
  • A multi-agency e-learning (20 mins) package
  • A “Train the Trainer” package
  • A short film (10 mins) which illustrates a fictional CBRN incident, and outlines the key elements of the IOR operational response.

The products have been tested in several live exercises and have been subject to a wide consultation phase involving both CBRN experts and non-experts. These products will be made available to ambulance staff when they do their training.

Keith Prior
Keith Prior, NARU Director

NARU Director Keith Prior says: “This is the culmination of two years’ work and is a great step forward for patients as it will enable clinicians to treat patients much more quickly whilst maintaining staff safety.

More information on this extremely important area of response will be disseminated by NARU through individual Ambulance Trusts in the near future.”


NARU will also lead an evaluation of the implementation of the IOR guidance in the next financial year, to maximise its impact across all NHS Ambulance Trusts.

For a copy of the guidance contact JESIP via



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