A New Paradigm for Management of Combined Trauma and CBRN Exposure

Introduction: This presentation proposes an overarching treatment paradigm for the management of trauma patients with simultaneous chemical, biological, and radiological exposure, which has not been explicitly documented in the literature. Methods: Literature search and expert opinion. (There is a limited body of unclassified work available for reference. Much data is derived from animal studies or inferred from historical events.) Results: Whether it’s another pandemic, a chemical accident or deliberate attack, or a radiological exposure from a dirty bomb or nuclear detonation, trauma patients are increasingly exposed to CBRN. While military physicians regularly plan for these patients, in civilian medicine, trauma and CBRN casualty management are considered separate problems. Decontamination, isolation, and newer treatments all impact the patient and the physician. Although there is some experience with COVID-19-exposed patients with trauma, this has primarily been with single or small numbers of casualties. Providers wear appropriate PPE,and patients remain in isolation during care. Future pandemic diseases or bio-warfare agents may require higher levels of PPE than were needed during COVID-19. There have been few chemical casualties with combined traumatic injuries in civilian hospitals. Terrorism or warfare with chemical weapons can potentially create large-scale combined casualties. Nuclear detonation presents the potential to produce the greatest number of casualties with a mixture of explosive injury, burns, acute radiation syndrome, and radioactive contamination. Neither modern civilian hospitals nor military facilities have experience with this level of casualty production. Although it is difficult to prepare for large-scale casualties, having a well-understood plan of action can help improve the medical response. Particularly important is appropriate triage to ensure the optimum distribution of scarce resources while helping the greatest number of casualties possible. Conclusion: Using available open-source literature and expert opinion, a new scheme for patient flow and management priorities has been proposed.