Royal Navy medics have trained in dealing with the aftermath of chemical, biological, radiological and nuclear (CBRN) attacks with NATO allies in the Czech Republic.
According to the Royal Navy here, medical experts from 13 nations gathered in Tisá, close to the German border, to work together on treatments, decontamination and dealing with casualties in the wake of a CBRN attack.
“Across four days, personnel shared knowledge and dealt with mock casualties at the site of an old chemical and biological testing ground, while the Royal Navy and Royal Marines combined medical team laid on a demonstration of the techniques and procedures the UK employs. Commando Forward Surgical Group of North Devon-based Commando Logistic Regiment deploy wherever Royal Marines do, no matter how extreme the environment.
Their responsibility is to treat causalities in the field and, as a result, must be highly efficient at setting up medical treatment facilities at a moment’s notice. During the exercises in the Czech Republic, they were at the forefront of the joint casualty decontamination area, which must be set up rapidly to deal with people exposed to a CBRN attack, decontaminating them, and giving them basic medical treatment before passing them onto the next level of medical care.”
Marine George Blake, of Commando Logistic Regiment, was quoted as saying:
“With no previous experience as a team medic or experience with CBRN casualties, I can now happily say in confidence if anything were to unfortunately happen and the Royal Marines were called to assist again, we would know what to do without any issues. It was a great experience and very educational as the majority of us were able to get hands on with the casualties as they came through.
I was in the cutting team so we had to be careful with any tourniquets on limbs, shrapnel sticking out etc. It wasn’t always as easy as just cutting a straight line through the clothes, we had work in sync together and be able to work around the medics without getting into each other’s way and with no time wasted.”
So on my cadre course, (Soltau ranges) it was my turn to lead the section and we are met by a member of the DS who tells us we have entered an area soaked in liquid nerve agent. Whereupon a guy (no NBC suit, no respirator) starts running around like a chicken with no head due to Nerve agent poisoning . I am told to proceed, So I shot him. The DS went up the wall and the officer in charge of the course threaten to RTU me.
So you shot the DS too? 😉
SOLTAU, how I don’t miss that place. I remember being on the road between Bergen and Honne (I think) and stopped for a RTA, picked up this Dutch guy who’s throat was cut from ear to ear by his seat belt I think. Never found out what happened to him but I think it was one of those things that looked worse than it actually was.
Farouk, that’s hilarious!
It was the kindest thing……😂😂
😂 How dare you go ‘off piste’ on an exercise Farouk, these exercises are so the staff can show how clever THEY are, not YOU. 😉
Someone has been watching too much of, ‘The Great.’
That gets a Like!
I love the conveyor belt, thats brilliant. The NHS decontamination kit never had a conveyor belt…we were sort of expected to man handle the casualty through the process. Also I’m not sure about the sealing of that guy in the yellows kit….
Good point about the guy in yellow suit. Why is it yellow anyway?
its so you cant tell when he is going jaundist and about to die
ooh that’s just reminded me of the time I was checking out my department to find a staff nurse has put a bright yellow blanket over a jaundice patient…I was like…were did that blanket come from….innocent looking butter would not melt In mouth staff nurse says….from the linen cupboard.. ask a stupid question get a stupid answer…
After Salisbury and COVID you’d think this would be very high up UK the governments list of needs improvement. Where’s the dedicated permanent CBRN units, deployable casualty decontamination tents, secure ambulances etc… Not all this should come out of the MOD’s pocket where’s the NHS/FIRE plans for a worst case scenario? The government wants the military to do everything it seems but doesn’t want to fund it
Change of focus back from sandy places back to what we spent decades learning to do until the peace dividend took its evenly toll.
This is the sort of thing that needs a drill every few months so that team members can spot each other properly like the guy in the yellow suit not properly protected.
So it is great we are doing it but very worrying that this reveals that it hasn’t been thoroughly drilled for some years particularly since the Sarin attacks.
It’s interesting that they are using what looks to me like type 4 hazmat equipment ( us level C) without an encapsulated face plate. It’s not the best choice of equipment for casualty decontamination to be honest. Far better a fully encapsulated face plate and SCBA.
The NHS and fire service does all this as part of civil contingency, I known ive got all the qualifications and spend many happy a day wandering around in SCBA hazmat level A kit…changing each other’s respirator kits, sealing stuff practicing not falling up and down stairs, connecting water supply’s and blowing up our decontamination module and viciously scrubbing ( a lot of vicious scrubbing and hozzing with cold water goes on so never ever volunteer to be a casualty), all the while getting laughed at by patients and staff.
But pretty much all Trauma centres ( that’s most hospitals with ED) have pallets with SCBA hazmat level A as well as a full decontamination module, there are also local supples of all the required medical to treats for Nuclear, Biological, chemical attacks as well as regional pods for mass casualty events.
The fire service also do their own training (better training) and have the kit as they are the cat one responder for nuclear, biological and chemical major incidents.
The army would only be involved if the civil contingency responders ( fire, ambulance, NHS, Police, local authorities, coast guard, health protection agencies etc) decide that it’s beyond their capabilities make a MACA request. This goes from one of the CAT one responders up to there responsible minister of state who then asks the MOD nicely describing the situation, the MOD then decide if an what military support they will provide ( you cannot ask for specifics just describe the problem and why it’s overwhelming civil contingency). The specific aid provided is then charged to the government agency requesting and the MOD gets paid for the provided services.
Just as in interesting aside, all the capacity for the NHS to act as casualty receivers and being able to decontaminate and treat victims of Nuclear, Biological and chemical attacks was put in place by the last labour government ( the Blair government was the best I’ve seen on civil contingency and managing mass casualty attacks on U.K. soil). Before the Blair government we simply could not treat you if you were a victim of an NBC attack…I’ve been out of the civil contingency game for a could of years now, but it has been generally degraded over the last 12 years.
Problem is there is a bit of a water shortage at the moment due to all the leaks, prodigious use by the general public and having the infrastructure in the UK for 20 million people, when in fact surprise surprise, there is nearly 70 million people living on this small island now. We cant do too much rigorous hosing down and decontamination.
well if there is a hosepipe ban it will be back to the watering cans.
Thank you for the informative answer, this is an aspect as Joe public we don’t get to see. This is where government need to publish there plans, the problem I see is there are too many agencies involved for a swift response in the avent of a disaster on a grand scale. We need an independent agency outside health and MOD just like the US to oversee our response plans and have everything in place.
For example we no longer have an early warning system to warn against incoming nuclear attack (not that you’d want to know) that went with the rest of civil defence. It’s presumed the government have a modern system in place but we know by FOI request this isn’t ready yet or at a scale to deal with a national incident.
Then it’s goes to the local resilience groups, who pre COVID most people never knew existed or what purpose they serve. So from my understanding they would form the lead in any crisis and I understand would direct the relevant agency to there task, I just hope as you’ve stated they are up to task and have the relevant tools at hand.
Hi Fosterman
Since one of my work passions is civil contingency and I’m a major incident/emergency control room manager your in luck…so ready for the how the U.K. Does things like floods, airliner crashes, pandemics, nuclear blasts and random snowmagedons.
The basic building block of everything is the civil contingency act 2004.
The first part describes the role of what’s call Cat one and Cat Two responders these are the agencies who will prevent deaths if poss and try and put humpty together again ( there has been a few minor changes since 2004, mainly around the big structure changes that the idiot Langsley put I place to try and destroy the NHS so he could asset strip it and flog it to a some Americans ( he was possibly the worst sec state for health ever honest).
The second part is around emergency power, which basically allow the government to suspend all other laws, acts and rights for up to 30 days ( longer if voted on by the commons) apart from the human rights act ( and the contingency act itself).
from this you then have the guidance on emergency preparedness, which provides the what to do for the 2004 act and it’s associated regulations and non statutory requirement.
At a nation level civil contingency is strategy is overseen by the office of the civil contingencies secretariat who oversees the Resilience Capabilities Programme..which is essentially the national plan. This is a part of the Cabinet office and is run by No10.
At a local level the cat 1 agencies all come together to form what’s called a local resilience forum, this is by Police Area and is made up of fire, Police, local authority,NHS, Environment agency and health protection. The cat two agencies ( transport agencies,
infrastucture suppliers, train and rail etc) all support the core local resilience forum.
Each agency should have an individual responsible for ensuring they are able to fulfil their function as part of the resilience forum, so having major incident procedures ( we use action cards for each role), have full set of 24/7 call out lists for executive level decision maker ( the person that decides the big calls) trained control centre managers ( the person who acts as the person who decides right hand, makes recommendations, and who run the control centres, the expert in the shits going down essentially), loggists ( everything is recorded formally for later public enquiry and archiving in the national archives), comms people, Admin teams etc, each agency has to have its own control centre, fully equipped with phones, electronic comms, independent power etc. These control room control the individual responses of agencies resources, acting as command and control nodes.
This is all bound by a Gold, silver, bronze command structure, with the cabinet office acting as a potential platinum command level ( but I’ve never know a platinum level intervention apart from with covid and that was a right f%ck up with constant useless missives.
Gold is that strategic level, these are the decision makers sitting in each command centre, they will meet by teleconference regularly to co-ordinate responses.
Silver level tends to be the Control centre managers, who distribute the commands of the gold level strategic decision makers as well as manage the more minor decision making around balancing risk and resources.so for the NHS that they guys and girls who work at my level, in planning and managing risk.
Bronze is the on site leaders, so for NHS that’s the hospital managers and matrons etc.
It all tend to get practiced at a regional level every year ( as a desk top pretend exercise) with every 3 years a so and actual exercise with actors for casualties and, full police, fire service, ambulance and Emergency department involvement. Then each organisation usually runs through its own procedures in an internal exercise every year to six months.
We are also pretty adaptable how we do things…I have managed a few weather based critical incident rooms from my kitchen table as everything got shut down and we could not get to our control room…it still worked ( who new you could do a MACA from your kitchen table).
Thank you it’s nice to know that some for of disaster preparedness is taken seriously, especially as you say with your first hand experience in NHS.
My other question is again compare us to our tinfoil hat American cousins, is there a lead agency that in say for example the NBC attack aspect that is constantly on guard for these sort of events like FEMA and some extent CDC. Does PHE/COBRA perform some kind of early warning system in place? Or is it as simple as waiting for that first causality to turn up at the local hospital i.e after Salisbury, have we gotten more aware of the threats or is it ‘business as usual”?
Hi Fosterman
From the point of view of natural issues, weather, disease etc the systems are pretty good, so as soon as your have a potential threat say Ebola popping up or monkey pox we have specific systems that throw our warnings, what to do and what to look for.
In regards to security, we do get alerts around threat level or potential threats ( so the big one at present is cyber risk and we have enhanced warnings and advice our to staff).
In regards to NBC attack that’s the realms of security services and that’s outside my understanding ( my job was always preparation not prevention).
Do you think the Civil contingency had to up its game after 9/11?
Hi Robert, yes massively, there was a significant review and change in focus, but it was not just 9/11, the London bombings as well. All the treatment pods and ensuring plenty of doses of meds for NBC events as well as radiological detection equipment all came in after 9/11.
Before 9/11 we had started to get better from 2004 ( when the new act came in) before then the peace dividend had killed any civil defence planning ( the same end of history bull, that gutted the millitary).
The NHS has a plan. Its well funded with billions and billions of budgetary allocation. You get the tens and tens of thousands of clipboard carrying managers in suits to waft all NBC victims down with their prodigious clipboards. They generate so much hot air all particles of contamination will be blown away.
Mr Bell NHS incident control rooms are run by volunteers who offer to be woken at any time to manage a catastrophe incident. The only individual who is being paid to be on all is the Director. There is a bizarre delusion that the NHS has more managers than other systems and yet it’s one of the most lean management structures you will fine if you compare with any like organisation…most NHS managers are specialists that bring required skills ( like how to set up an incident response for civil contingency, ect), we just tend to call them managers when other organisations call them other things. All our clinical leaders are also managers. We do need a shed load of planner as well, something like the NHS just not just keep working…it’s ever changing to demand, need and new innovations…all of which need managers to sort out…we don’t sell bakes beans we run the most complex system ever created by man on behalf of 60 million people, healthcare systems are the most complex systems ever created, nothing else comes close to the moving parts are immense in number, interactions in the billions each each year, with some many unintended consequences and moral dilemmas as to stagger… once I was a nurse and my decisions affected a handfull of people’s lives each day, then I was a charge nurse in an ED and my decision affected maybe 100 lives a day, now I make decisions for a whole health system and my decisions on what gets funded and what does not effects thousands.
One of the NHS,s biggest problems is that we culled our senior managers in the langsley reforms and lost a lot of capability and knowledge, which then had to be hired in at extra cost from management consultancy companies at great expense ( who just hired all the redundant NHS managers on better pay).
I will say this only once… in all OECD countries the NHS always comes our as the most efficient or second most Efficient healthcare system ( we tend to swap around with Newzeland) ….the NHS has been so underfunded during its lifetime that it’s estimated the British public would need to pay around 200 billion to bring it up to the same funding other comparable European systems have been paid over the 70 years of its life.
Thanks for the informative posts mate. Lots of misconceptions about the NHS. Fantastic organisation, It has its issue’s, but my word, we don’t realise how fortunate we are in this country to have it. And like so many other things, we take it for granted.
Seconded. It’s fascinating reading.
Yes indeed, like all complex systems with limited resources and unlimited demand it has its issues especially post covid. But what it’s provided to the British people for what we have put in is second to none really. People do forget that just something like a sprained ankle and X-ray check would set you back £300 in a private system ( nhs Charges £79,00) and as for a knee replacement your looking at £15,000 for private care ( the nhs charges the taxpayer around £4500).
But it does like everything need constant upkeep.
They have planned for no electric or connectivity. There is a warehouse full of clipboards and pens for just such a situation. Trouble is they need the army to move clipboards and pens because driving a van from A to B to deliver it is to difficult to organise in the NHS.
You would not believe the number Of vans the nhs has out… just consider the logistics of blood tests: If you consider most counties have around 60-70 GP practices and a ton of community services. Every day each of those needs to get huge numbers of urine and blood tests to labs….from all GP practices in the county you are looking at 300,000 blood tests a day moved from GP practices in a timely and safe way to labs.
Each of those 300,000 daily tests will use around 7 consumable items at the GP practice that need need restocking so that’s 2.1 million items moved just for daily GPs blood tests.
The health requirements for for 60 million people involve the moving of untold billions of items each year.
just two examples:
1.2 billion prescription items
500 million bio chem tests and 130 million haematology tests, even at 3 different 3 blood bottles filled per stab, that’s a couple of billion gloves, 630 million blood bottles, 200milliom plus phlebotomy needles, 200milliom bottle receivers, 630 million sets of reagents 200million tourniquets, 200 million alcohol wipes, 200million gauze packs). Or about 2.5 ish billion items.
nhs supply chain has a total of 28 million individual types of items it supplies to the nhs each year.
The NHS moves and transports more stuff and more types of stuff than this really compressible to an individual.
.
Where are the dedicated units?
We have a structure in place across all 3 emergency services and the military, backed up by some of the world’s leading CBRN experts.
We have a dedicated unit back with the Army.
28 RE took on the CBRN role from the RAF.
Winterbourne Gunner has the CBRN Defence School, next door to Porton.
They are a part of the HRF high readiness response force which includes RLC and RS squadrons at short notice to move to assist with a UK incident.
Police have an equivalent at Ryton in the Midlands I think?
Jonathan is the man to comment on civil contingencies NHS side.
What I was trying to say in a roundabout way is what’s changed since Salisbury? And is the government prepared for another attack? Since we’ve taken on the lead roll in Europe of support for the Ukrainian government one feels were sticking our neck out a bit and what with the Russians ok with striking nuclear power stations it kind of important for general public to understand what assets/systems the government has in place to prevent in the first place.
It’s good to know and very interesting what Jonathan is saying about the civil response plans to minimise death in every aspect but prevention is better than a cure right?
Right, I’m with you.
What has changed? We won’t know. But I find comfort in the details that J provides that contingencies and assets are at least in place.
Whether an asset is ever present in enough numbers is another matter!
Interesting on amounts of assets as that’s something you can never really plan for.., I mean a worst case of say major contamination of a cities water supply would overwhelm any and all plans you could ever put in place…. I could think up and plan through any number of scenarios that would overwhelm any system. Unfortunately you can only put in place what is reasonable. So moderate to low casualty numbers even for mass casualties events Any ED would be overwhelmed with 15 major casualties arriving at any one time. most EDs have 3-4 resus bays for trauma arrest and life threading stuff and although they can manage a casualty in each, that sort of depends on the my coming in at a staggered rates and that sucks all the resources. The most I have have ever seen is 4 red phon resus calls coming from the ambulance service over 10 minutes and to get 4 resus teams together we had to suck everything we had free from the staff base of a major district general hospital…one more causality and I would not have been able to pull together a Team and one person would not have had a resus team.
You also have to remember the staff are just as at risk as the public, infact more so..you get contaminated casualties and you have lost your ED to contamination before you know what’s happened.
It is good to see this old skill being revised.
It used to be a regular part of annual training and field exercises.
The Czechs are Nato’s NBC specialists and will be good teachers.
My NBC knowledge and training dates back decades, and probably couldn’t be less relevant now. I thought the 58 pattern gas mask was a good piece of kit, however I did think at the time, that the supposed charcoal lined NBC suits, would probably fail miserably in a chemical attack. Someone please tell me they managed to do away with those rubber ‘over-boot’ things… They were shocking, so bad that no one ever wore them.
Sky News majoring on RAF training problems:
https://news.sky.com/story/uks-ability-to-train-fast-jet-pilots-in-crisis-due-to-faulty-aircraft-and-instructors-shortage-leaked-documents-suggest-12666275
“UK’s ability to train fast jet pilots in crisis as threats grow from Russia and China, leaked documents suggest”
True?
1 FTS and 7 FTS reduced to 1 squadron in 4 FTS, 170 odd Tucano replaced by 9 then I think 13 Texan?
That is the basic side alone. Too few assets as post Cold War and post 2010 they were cut back.
From 2015 there have been small incremental improvements but it takes time to set in place.
I’m also reading some of the issues are at the OCU stage which is the RAFs problem not contractors at the basic level.
Nice yellow suit with a S10 AND exposed skin. Must be a sailor.
Ohhh go on then ..Ill bite!
Looks like a civvy or other Nato nation member.
The RN is rather good at CBRN…Whilst everyone else was playing COIN in Iraq and Afghan the RN carried on doing its day to day training on the wet and lumpy stuff. CBRNDC is well practised. The RN never got skill fade.