CBRN cheat sheet

Chemical agent classes and examples: nerve (sarin GB, soman GD, tabun GA, VX), blister (sulfur mustard HD, lewisite L), blood (hydrogen cyanide, cyanogen chloride), choking (chlorine, phosgene), incapacitating (BZ).

Nerve agent toxidrome: SLUDGE (salivation, lacrimation, urination, defecation, gastrointestinal distress, emesis) plus miosis, bronchorrhea, fasciculations, and seizures; death usually results from respiratory failure.

Sulfur mustard produces delayed injury: blistering and eye damage typically appear 2 to 24 hours after exposure, so casualties may be asymptomatic at initial triage.

Most chemical agent vapors are denser than air and accumulate in low-lying areas, basements, trenches, and confined spaces.

Category A biothreat agents: Bacillus anthracis (anthrax), Clostridium botulinum toxin, Yersinia pestis (plague), variola major (smallpox), Francisella tularensis (tularemia), and viral hemorrhagic fever viruses.

Typical incubation periods: inhalational anthrax 1 to 6 days; smallpox 7 to 17 days; plague 1 to 6 days; botulism 12 to 72 hours.

Radiation penetration: alpha particles are stopped by skin or paper, beta by clothing or thin plastic, while gamma and neutron radiation require dense shielding; gamma dose rate falls with the inverse square of distance.

Alpha-emitting material is hazardous mainly when inhaled or ingested; internal contamination, not external exposure, is the primary concern.

Persistent agents such as VX and sulfur mustard remain hazardous on surfaces for hours to weeks; nonpersistent agents such as phosgene and chlorine dissipate rapidly after release.

Ion mobility spectrometry (IMS) is the detection principle in most handheld chemical agent detectors (for example JCAD, RAID-M, and CAM); it flags agent classes but is subject to false positives.

M8 and M9 detector paper change color on contact with liquid nerve and blister agents; neither detects agent vapor and neither identifies the specific agent.

The M256A1 kit detects vapors of nerve, blister, and blood agents using colorimetric tickets, typically within about 15 to 20 minutes.

Colorimetric tubes measure specific gases; photoionization detectors respond to many volatile organic compounds but are not chemical-agent specific.

Biological field assays such as lateral-flow immunoassays and PCR give presumptive results in minutes to hours; culture remains the confirmatory gold standard.

A Geiger-Mueller survey meter detects beta and gamma radiation as counts per minute; scintillation detectors are more sensitive for gamma, and alpha detection requires a thin-window probe held close to the surface.

Personal dosimeters (TLD or OSL) record cumulative dose over time; survey meters measure dose rate at a point in time.

Sample handling requires an unbroken chain of custody and triple packaging: primary container, secondary absorbent container, and rigid outer container.

A four-gas meter measures oxygen, lower explosive limit, carbon monoxide, and hydrogen sulfide; it does not detect chemical warfare agents.

Level A: fully encapsulating vapor-protective suit with self-contained breathing apparatus (SCBA) and highest chemical resistance. Level B: SCBA with splash-protective suit. Level C: air-purifying respirator with chemical-resistant clothing. Level D: work uniform only.

OSHA 29 CFR 1910.120 (HAZWOPER) sets training, medical surveillance, and PPE requirements; 29 CFR 1910.134 governs respiratory protection, including annual fit testing and medical clearance.

Air-purifying respirators may not be used in IDLH atmospheres, at oxygen concentrations below 19.5 percent, or where the contaminant is unknown or not adequately filtered.

SCBA rated service life is typically 30 to 60 minutes depending on cylinder capacity and pressure, and actual duration is shortened by exertion, stress, and heavy work rates.

Permeation is molecular passage of a chemical through intact suit material; degradation is chemical damage that weakens the material; penetration is flow through seams, closures, and defects.

Doffing reverses the donning order, removing the most contaminated items first, and is performed with a buddy to prevent self-contamination.

Heat stress controls include work-rest cycles, fluid replacement, physiological monitoring, and cooling; encapsulated suits sharply reduce tolerable work time.

The buddy system and two-in/two-out rule require every entry team to have a designated backup team ready outside the hot zone.

NFPA 1991 covers vapor-protective ensembles for hazardous chemical emergencies; NFPA 1994 covers protective ensembles for CBRN terrorism incidents.

Gross or immediate decontamination precedes technical decontamination and should begin within minutes after exposure to a liquid nerve agent, since decontamination speed strongly affects survival.

Removing and bagging outer clothing eliminates the majority of radiological contamination and a large fraction of chemical contamination before washing.

Skin decontamination uses soap and water or reactive skin decontamination lotion; hypochlorite solutions are never applied to skin, eyes, or open wounds.

A 0.5 percent sodium hypochlorite solution, roughly a 1:10 dilution of household bleach, is used on equipment and surfaces with adequate contact time, followed by thorough rinsing.

Decon corridor layout provides one-way flow from hot zone through decontamination to the cold zone, with separate lanes for ambulatory and nonambulatory casualties to prevent cross-contamination.

Decontamination runoff must be contained, collected, and disposed of as hazardous waste; it is never released to storm drains or surface water.

Decontaminate before transport and before invasive procedures when feasible; immediate life-saving care may take precedence over decontamination for critically unstable casualties.

For radiological contamination, wash with warm water and mild soap without abrading the skin, and re-survey after each wash until contamination is reduced or stable.

For biological contamination, 0.5 percent hypochlorite or 70 percent ethanol is applied to surfaces with adequate contact time; effectiveness depends on concentration, contact time, and organic load.

Nerve agent antidotes: atropine 2 mg intramuscularly repeated as needed for muscarinic effects, pralidoxime (2-PAM) for enzyme reactivation if given early, and a benzodiazepine for seizures.

The DuoDote autoinjector delivers atropine 2.1 mg plus pralidoxime chloride 600 mg in a single device.

Cyanide poisoning: hydroxocobalamin is first-line; sodium thiosulfate is an alternative; airway and oxygen support are given concurrently.

Radiological countermeasures: potassium iodide blocks thyroid uptake of radioiodine, Prussian blue enhances cesium excretion, and DTPA chelates plutonium, americium, and curium.

Acute radiation syndrome: whole-body doses above about 1 Gy produce prodromal symptoms, with severity and lymphocyte depletion kinetics used to estimate dose.

Anthrax post-exposure prophylaxis is ciprofloxacin or doxycycline for 60 days plus vaccination; antitoxin is added for systemic toxin-mediated disease.

Botulism is treated with equine heptavalent antitoxin plus intensive supportive care, including mechanical ventilation for respiratory failure.

Smallpox: vaccinia vaccination within about 3 to 4 days of exposure reduces disease severity; tecovirimat is an available antiviral option.

START triage sorts by respirations, perfusion, and mental status into immediate, delayed, minor, and expectant categories.

ICS span of control is three to seven subordinates per supervisor, with five considered optimal.

Command staff consists of the Safety Officer, Public Information Officer, and Liaison Officer; general staff consists of Operations, Planning, Logistics, and Finance/Administration.

Unified Command applies when multiple agencies or jurisdictions share incident authority, producing a single set of objectives and one Incident Action Plan.

An operational period is typically 12 to 24 hours; the Incident Action Plan (ICS 201 through ICS 215 series) documents objectives and assignments for that period.

Zone structure: hot zone is the contaminated exclusion area, warm zone is the contamination reduction zone, and cold zone holds support, command, and staging.

Communications use common terminology and plain language rather than agency-specific codes, with tactical channels assigned by division or group.

Emergency Support Function 8, led by HHS, coordinates federal public health and medical response under the National Response Framework.

Transfer of command requires a briefing covering current situation, objectives, actions taken, and assigned resources.

A Joint Information Center coordinates public information and media releases across all participating agencies during a multi-agency incident.

OSHA HAZWOPER (29 CFR 1910.120) covers hazardous waste operations and emergency response, including 1910.120(q) requirements for emergency responders.

OSHA 29 CFR 1910.134 requires a written respiratory protection program with medical evaluation, fit testing, training, and equipment maintenance.

OSHA Hazard Communication (29 CFR 1910.1200) requires safety data sheets and labels for hazardous chemicals in the workplace.

DOT 49 CFR Parts 171 to 173 govern hazard classification, packaging, marking, labeling, and shipping papers for hazardous materials in transport.

CERCLA and EPCRA/SARA Title III govern release reporting and community right-to-know; releases above reportable quantities are reported to the National Response Center.

The Chemical Weapons Convention of 1993, administered by the OPCW, bans development, production, stockpiling, transfer, and use of chemical weapons; the Biological Weapons Convention of 1972 bans biological weapons.

The CDC and USDA Select Agent Program (42 CFR Part 73 and 9 CFR Part 121) regulates possession, use, and transfer of listed biological agents and toxins.

Federal quarantine authority derives from 42 USC 264 of the Public Health Service Act, while states retain primary police powers for isolation and quarantine.

HIPAA permits protected health information disclosure for public health activities and to prevent a serious and imminent threat; EMTALA requires a medical screening examination regardless of ability to pay.

HSEEP divides exercises into discussion-based types (seminar, workshop, tabletop, game) and operations-based types (drill, functional, full-scale).

A full-scale exercise deploys personnel and equipment in real time with simulated casualties and a defined exercise play area.

The After Action Report and Improvement Plan records strengths, areas for improvement, and corrective actions with assigned owners and target completion dates.

THIRA identifies threats and hazards, gives them context, and establishes capability targets used to set preparedness priorities.

The National Preparedness Goal defines 32 core capabilities across five mission areas: prevention, protection, mitigation, response, and recovery.

POETE denotes the five capability-building elements: planning, organization, equipment, training, and exercises.

Exercise objectives should be SMART: specific, measurable, achievable, relevant, and time-bound.

The preparedness cycle runs plan, organize and equip, train, exercise, evaluate, and improve, then repeats with corrected gaps.

Continuity of operations planning ensures essential functions continue during disruption, and includes orders of succession, delegations of authority, and alternate facilities.