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CBRNE3 medicine in the austere environment: the challenges
  1. Max Smith1 and
  2. A Weir2,3
  1. 1 Royal Army Medical Corps, Camberley, UK
  2. 2 Emergency Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3 Academic Department of Military Emergency Medicine, Birmingham, UK
  1. Correspondence to LtCol A Weir, Emergency Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; weiralan{at}


Chemical, Biological, Radiological, Nuclear and Explosive/Environmental/Endemic Disease (CBRNE3) incidents encompass a wide spectrum of events from natural events/disasters to industrial accidents through to deliberate military release and nuclear war. The UK military operates globally and in environments that are often austere. The very nature of these environments means that CBRNE3 incidents are a very real risk, and a CBRNE3 incident in a well-developed society could ultimately create an austere environment. Responding to such an event in an austere environment poses challenges.

The very nature of the environment may be problematic. It may be very remote with limited or no access by road and/or air. It may have limited resources such as water and infrastructure required to manage the event. Extremes of temperature and weather may pose a risk to casualties and responders alike. Specialist teams and equipment may be required, but the host or partner nations may not have suitable capability and these resources may take time to mobilise from the home base. The volume of equipment and material needed in the response may overwhelm logistical chains which may not be robust enough to withstand the initial incident.

Proper planning and preparedness is crucial to operating in and managing a CBRNE3 incident in an austere environment. Recognition of the potential threat by intelligence gathering and recognition by personnel on the ground are essential. This requires an appropriate awareness at all levels of command and appropriate prior training, including interoperability training with partner forces. Ultimately, robust planning and training is key to managing CBRNE3 incidents in an austere environment.

  • Toxicology
  • Medical education & training
  • Intensive & critical care
  • Organisational development
  • Risk management
  • Health services administration & management

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  • Contributors Both authors contributed equally to the preparation of this manuscript with AW providing oversight as senior author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note This paper is commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.