Overview of CBRN part 3

Historically, the Ambulance Services within the UK were unable to provide medical care to patients within hazardous areas due to lack of PPE and training. This would require the Fire Service to rescue patients and extricate them to an area where casualty care could be given. This would result in a delay in treatment, attributing to the overall negative outcome of the patient. Over recent years, specialist resources were developed to bridge this care gap: 

Specialist resources within the UK Ambulance Services – HART and SORT: 

The Hazardous Area Response Team (HART) concept began from the identified need of providing early treatment and care to patients within the ‘danger’ area of hazardous incidents. Research shows that delays in medical treatment would have detrimental outcomes on patients during major incidents. Prior to teams being set up around the UK from 2008 – 2012, there were limited response capabilities available where Ambulance services could provide personnel safely within a danger area to provide treatment.  

HART staff consist of Paramedics who undergo additional training in many specialities to be able to respond safely to hazardous areas. They are also equipped with specialised PPE and equipment to allow them to operate safely and effectively. 

There are 4 main areas of HART operations: 

Incident Response Unit (IRU) involves dealing with CBRN and Hazardous Material (HAZMAT) incidents. Staff receive further training and understanding on numerous components that make up the CBRN and HAZMAT fields. Accompanying this, staff are trained in a range of different specialised PPE to deal with potential hazards; Extended Duration Breathing Apparatus (EDBA), Gas Tight Suit (GTS), Powered Respirator Protective Suit (PRPS), and Civil Responder (CR) PPE. 

Urban Search And Rescue (USAR) involves dealing with incidents where there is working at height, confined space, or where there is a building collapse. Staff receive further training in the USAR subjects, along with additional specialised training in confined space and working at height. Staff are also equipped with Incident Ground Kit (IGK), Safe Working At Height (SWAH) harnesses and equipment, and equipment to help them navigate confined space such as gas detectors and emergency breathing devices. 

Inland Water Operations (IWO) involves dealing with incidents in water, such as flooding, river rescue, and drowning. Staff receive further training on how to operate water rescues and the overall safety and dynamics involved. Staff are also equipped with water rescue PPE and equipment, such as inflatable rafts and rope kits. 

Tactical Medical Operations (TMO) involves dealing with firearms and weapon incidents, along with supporting Police special operations. Staff receive further training on how to operate safely within a TMO environment. Staff are also equipped with TMO PPE and equipment, such as ballistic helmet and ballistic vest. 

HART staff also undergo additional training in some Ambulance services to be able to provide further medical support and care, such as the use of pre-hospital Ketamine. An array of specialist equipment and stores are also available to be deployed such as mass casualty treatment kits. 


Special Operations Response Team (SORT) consist of Ambulance staff who have additional training similar to some aspects of HART to be able to provide support within major/hazardous incidents. These can include working in PRPS, specialised training in decontamination, operating at a lower level of IWO, and more. SORT staff are usually used as on-call responders, who normally operate as road staff until an incident occurs and they are called in to assist.