By Jan Vaes, Adjudant-Major, Head of Disaster Cell, Queen Astrid Military Hospital
For decades, the Medical component of Belgian Defense has been prepared for an attack by chemical, biological, radiological and nuclear means. However, after the attacks by IS (Islamic State), CBRNe terrorism was considered as a major threat to society throughout Europe and additional measures were taken.
In Belgium, civilian society turned to the expertise of the military, which resulted in cooperation with the MUG/SMUR (Mobiele Urgentie Groep – Medical Team) and the AMBULANCE (paramedical team) of the Military Hospital Queen Astrid (MHQA). A military CBRNe MEDICAL TEAM (where the ‘small’ e stands for explosives), which would be activated throughout the national territory in times of crises, was founded. This cooperation was confirmed in January 2018 by a convention between Belgian Defense and the Department of Public Health, Food Chain Safety and Environment.
The aim of the CBRNe-MEDICAL TEAM is to stabilize victims of a CBRNe-incident by providing the necessary medical care prior to decontamination. This principle of ‘forward medicalization’ aims to increase survival of the victims (ALS – Advanced Life Support in CBRNe environment). This principle was adopted from military doctrine, where a medical team provides medical care prior to decontamination of patients in a casualty decontamination station.
The CBRNe Medical Team is a combination of the Medical Team and the Ambulance Team of the MHQA. They can be tasked directly by the 112 Calls Centers of the EMS (Emergency Medical Services). The team consists of one emergency doctor, one emergency nurse and three emergency medical technicians. CBRNE specialists’ duty.
The decontamination station is provided by the Fire Brigade or the Civil Protection. The CBRNe MEDICAL TEAM works in appropriate clothing. With this PPE (Personal Protective Equipment) the CBRNe Medical Team can work in an environment which is potentially “dirty”. The current protective clothing is a RESPIREX RJS 300 CBRN suit supplemented by butyl boots and adapted gloves. These gloves have been designed to provide an extra grip to enable medical procedures.
The medical treatment is based on the principle of the “SAVING TRIAD” in CBRNe conditions:
1. Emergency decontamination awaiting more thorough decontamination
2. Respiratory policy (oxygen and respiratory protection)
3. Antidotes (Duodote, Diazepam, Atropine, Pralidoxime, Prussian Blue, DTPA, Potassium iodide,) and analgosedation.
This MEDICAL CBRN CAPACITY can treat approximately 10 patients per hour. They have specific CBRNe antidotes (high doses of Atropine, Oximen, …). The doctors, nurses and emergency medical technicians of the MHQA are all trained in these specific circumstances. Further education and training is organized on a regular base.
About the Author
Adjudant-Major Jan Vaes currently serves as as the Head of the Disaster Cell – Emergency Preparedness and Disaster Response at the Queen Astrid Military Hospital. He has 15 years of experience as a Critical Care Nurse and has been a Flight Nurse at the Belgian Armed Forces since 1998. During the attacks at Brussels International Airport in Zaventem on the 22nd of March 2016, Adjudant-Major Vaes was a regulator and responsible for the distribution of patients to medical facilities and hospitals.
