TIER competency-based training course for the first receivers of CBRN casualties: a European perspective

Eur J Emerg Med. 2017 Oct;24(5):371-376. doi: 10.1097/MEJ.0000000000000383.


Introduction: Education and training are key elements of health system preparedness vis-à-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events.

Objective: The current study was designed to determine which competencies are needed by hospital staff when responding to CBRN emergencies, define educational needs to develop these competencies, and implement a suitable delivery method.

Methods: This study was carried out from September 2014 to February 2015, using a three-step modified Delphi method. On the basis of international experiences, publications, and experts' consensus, core competencies for hospital staff - as CBRN casualty receivers - were determined, and training curricula and delivery methods were defined.

Results: The course consists of 10 domains. These are as follows: threat identification; health effects of CBRN agents; planning; hospital incident command system; information management; safety, personal protective equipment and decontamination; medical management; essential resources; psychological support; and ethical considerations. Expected competencies for each domain were defined. A blended approach was chosen.

Conclusion: By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level.

MeSH terms

  • Competency-Based Education* / methods
  • Curriculum
  • Delphi Technique
  • Disaster Planning
  • Europe
  • Humans
  • Mass Casualty Incidents* / prevention & control
  • Personnel, Hospital / education*
  • Surveys and Questionnaires