In this section, we will define CBRNE and several related terms to lay the foundation for the rest of the course. We will also consider differences between hazardous materials (hazmat) incidents and CBRNE incidents, and review some health-related issues associated with CBRNE incidents.
When chemical, biological, radiological, nuclear, and explosive devices or agents are used to cause mass disruption and possibly mass casualties, they are referred to as CBRNE incidents.
CBRNE incidents are most associated with terrorism, and CBRNE agents or devices are often referred to as weapons of mass destruction, or WMD. However, this is not entirely accurate. Although CBRNE agents often cause mass destruction—and certainly many have the potential to do so—this is not necessarily the case. Use of CBRNE agents by terrorists may actually cause a limited number of casualties, but have a large terrorizing effect and lead to disruption of society.
For example, in 2001, after the devastation of the World Trade Center, letters containing anthrax spores were sent to various media outlets and politicians. Although there were only five deaths and 22 others sickened by the anthrax, the nation was terrorized. Office workers were afraid to open mail, reports of white powder were investigated regularly, and mail delivery was disrupted. The fear and psychological damage were disproportionate to the number of deaths or injuries.
As illustrated in Table 1, there is a wide variation in CBRNE types based on the time of the incident, the magnitude of the impact, and the availability of the agent or device. Some are silent killers, some have a very small likelihood of occurrence, and some are widely available.
|Incident||Warning / time to injury or illness||Magnitude||Availability|
|Chemicals||Seconds to hours||Localized to regional||High|
|Biologicals||Days to weeks||Local to global||Medium|
|Radiologicals||Hours to days||Local||Medium|
|Nuclear||Minutes to hours||City to regional||Very low|
Table 1: Warning, magnitude, and availability of materials for CBRNE incidents
For example, in general, chemicals are easily available, and can take seconds to hours for injury or illness after exposure. The impacts tend to be localized. The likelihood of occurrence is high and with lower disruption to society. Contrast this to a nuclear incident, which would have immediate- to long-term impact, depending on the location. The magnitude can be large and the potential for social and economic disruption huge, but the chance of occurrence is extremely low.
It is important to understand the differences between terms used when working with disasters, hazardous incidents, and CBRNE activities. Select each term below to learn more about it.
Hazardous Materials, or Hazmat, are substances that, if not properly controlled, pose a risk to people, property or the environment. Hazmat incidents are likely to be accidents, not deliberate acts of terrorism. Hazmat incidents are generally contained and thus do not become mass casualty events or disasters.
Hazard is a circumstance or condition that can cause harm. Examples include:
What hazards or vulnerabilities can you identify in your own community?
An incident or event is the actualization of a hazard that may cause damage. Examples include:
A "natural or manmade event that results in an imbalance between the supply and demand for existing resources." Examples include:
An incident or event becomes a disaster when the local response capacity is insufficient and external assistance is required. In a disaster, basic services of society become disrupted and losses exceed the local capacity to respond. In other words, there is a massive disruptive impact. All disasters can be thought of as local, until they are not.
Hazards themselves are not disasters, but rather are factors that cause disasters. It is the impact on people (medical and psychological), infrastructure, and environment that combine to result in a disaster.
Source: Noji E. (ed.) The public health consequences of disasters.
A CBRNE incident differs from a hazardous material incident in both effect scope and intent. CBRNE incidents are responded to under the assumption that they are deliberate, malicious acts with the intention to kill, sicken, and disrupt society. A hazardous material (hazmat) incident is likely accidental. Evidence preservation and perpetrator apprehension are of greater concern with CBRNE incidents than with hazmat incidents.
Yet, a hazmat incident can also be a disaster incident. Consider this example: an industrial chemical disaster is defined as the release or spill of a toxic chemical that results in an abrupt and serious disruption of the functioning of society. This leads to widespread human, material, or environmental losses that exceed the ability of the affected society to cope using its own resources alone. However, these are rare. Most hazmat incidents are smaller scale.
Most of the information tools that are presented in this training do not differentiate between hazmat and CBRNE. They can be used for both types.
Table 2 compares the effect scope, intent, and nature of CBRNE and hazmat incidents.
|Characteristic||CBRNE Incident||Hazmat Incident|
|Effect scope||Small to large scale, potentially mass casualty||Usually small scale (rarely a widespread disaster)|
|Intent||Deliberate, malicious acts with intention to kill, sicken, and/or disrupt society||Likely accidental|
|Nature||Chemical, biological, radiological, nuclear, and/or explosive||Usually chemical, but can be biological and radiological|
Table 2: Comparison of the effect scope, intent, and nature of CBRNE and hazmat incidents
Typically, disasters are discussed in four phases.
Are all CBRNE incidents disasters? No, not all are disasters. As stated earlier, an incident becomes a disaster when the local capacity to respond is exceeded. When a CBRNE incident has mass casualties, it becomes a disaster. A mass casualty incident is defined as large numbers of dead and injured that stress the capacity of the responders and the health care system. Therefore, all mass casualty incidents are disasters.
Remember the example of the anthrax attacks in 2001. This was a deliberate biological attack intended to generate mass fear and disruption, thus it was a CBRNE incident. However, the low number of dead and injured means it was not a mass casualty incident.
When thinking about CBRNE incidents, there are a number of health-related issues to consider. In addition to injuries one would expect to find, there are other issues to be prepared for, many of which stem more from the fear and disruption to society caused by the incident than from mass casualties. These issues include:
After any type of CBRNE incident, the major areas of concern are as follows.
There are three basic ways a person can be exposed to these types of agents:
The agent is breathed into the respiratory tract.
The agent is taken into the body via contaminated drinks or food.
The agent is absorbed through the skin, sometimes even through layers of clothing.
Exposure can occur as a combination of the different routes.
After Hurricane Harvey hit Texas in August 2017, flooding disabled the refrigeration systems at the Arkema Inc. chemical plant in Crosby, TX, which manufactures organic peroxides. With personnel evacuated and lack of refrigeration, the peroxides exploded and fires ensued (learn more).
True or False: The Arkema Inc. Chemical Plant Fire was a CBRNE incident.
In this section, we covered the following main points: