Overview of CBRN part 5

Steps 123+: 

Initially identifying if there are potential risks/hazards to the environment can be difficult when there are no obvious factors. Steps 123+ can help responders identify if there are potential substances or risks within the area that may be causing casualties. The tool can be used as follows; 

  • Step 1 – 1 person incapacitated with no obvious reason – Approach using standard protocols 
  • Step 2 – 2 people incapacitated with no obvious reason – Approach with caution using standard protocols 
  • Step 3 – 3 or more people in proximity, incapacitated with no obvious reason – Do not approach, use caution and follow the ‘plus’ steps. 
  • Plus steps – 
  • Evacuate people away from the scene of contamination 
  • Contact control and request further specialist back up 
  • Advise anyone effected with medical advice and reassurance 
  • Utilise the remove decontamination process where appropriate  

It is important to recognise Steps 123+ as you and others may become additional casualties requiring rescue if there is a CBRN substance nearby causing harm. If you are still not sure, observe the surrounding and look to see if there is anything out of place. For example, there may be two people unconscious in a house, but the family dog is also not responding. What has caused the two people and dog to be incapacitated.  


If you follow Steps123+ and stand off from an incident, Fire Services and specialist resources have the capacity to monitor for a range of poisoning sources. They will also have additional PPE and training to try and manage the scene. 


Remove, Remove, Remove: 

Following research and review of initial responder actions in a CBRN event, the ‘Remove, Remove, Remove’ guidance was updated to help deal with the initial contamination of casualties. 

The first element of Remove looks at advising the casualty to remove themselves from the immediate area of contamination to avoid further exposure and get to ‘fresh air’. 

The second Remove looks at outer clothing removal if contaminated. Try to advise the casualty not to pull clothing overhead, if possible, as to stop further contamination to the face and airway. Instead try unbuttoning, unzipping, or cutting off clothing. Do not pull off clothing which is stuck/melted to skin. 

The third Remove looks at removing substances from skin using a dry absorbent material to either soak it up or brush it off. If the skin is itchy or painful then try to rinse it continually with water, if resources allow, while awaiting further specialist responders. 

Using these initial simple actions can help limit patient exposure to CBRN substances and may benefit their overall outcome moving forward. When completing these actions, consider the following: 

All contaminated clothing and items should try to be contained within the ‘dirty’ area. Consider throwing plastic bags to the patients along with any towels for decontamination. If all contaminated items can be contained, then it lessens the risk of it being blown out of the dirty area. If there are no bags, consider telling the patients to leave contaminated items in a pile where wind is unlikely to disrupt it. 

The remove decontamination may be conducted anytime, anywhere. Patients with removed clothing may come under the effects of hypothermia in the winter or late at night. Patients will also be uncomfortable standing in the open with a lack of clothing. Gather blankets or coveralls together and throw them to the patients following the decontamination process. 

Ensure effective communication takes place. Patients will likely be scared and distressed at the CBRN event and may try to escape from the area whilst contaminated. Try to get their attention and explain what actions they must do and why. Make control and other services aware of the decontamination process taking place and ensure specialist support and further decontamination services/personnel are on route.  

Maintain the ‘clean and dirty’ zones. It is easy during the multi-agency response for responders to inadvertently enter the dirty zone without knowing. You may have to place physical warning signs, such as a cordon, and warn any staff approaching of the dirty zone. When specialist resources are set up, a clear clean/dirty zone can be identified and marked out.