The Medical Management in Patients Exposed to Weapons of Mass Destruction (CBRNEObs)

Acute Care For Patients Exposed to a Chemical, Biological, Radiological, Nuclear, Explosive: Attack: Protocol For An International Multicentric Observational Study

Observation study measuring medical response in contaminated environment.

Study Overview

• Status: Enrolling by invitation
• Conditions: Acute Respiratory Distress Syndrome; Medical Emergencies; Distress Respiratory Syndrome; Chemical Injury; Chemicals; Intoxication
• Intervention / Treatment: Procedure: Clinical interventions performed in acute settings (contaminated environment); Procedure: Protection (clinician and patient); Procedure: Decontamination (clinician and patient)

Detailed Description

This is an ongoing multicentric observational study that aims to assess the medical response to chemical, biological, radiological, nuclear, explosive (cbrne) events during the last five (5) decades (i.e.: 1970-2020), and in any future cbrne attack that might occur within the next 15 years (i.e.: 2021-2036). Of note, the data collection will be performed retrospectively and after sites review ethic board (REB) approval.

• Study Type: Observational
• Enrollment (Estimated): 1000

Contacts and Locations

Study Locations

• Canada
  • Manitoba
    • Winnipeg, Manitoba, Canada, R3T 2N2
      • Centre for Defence and Security Studies, University of Manitoba
  • Ontario
    • Ottawa, Ontario, Canada, K1A0K2
      • Royal Canadian Medical Corps
  • Quebec
    • Montreal, Quebec, Canada, H3T 1C5
      • Research Center of the CHU St-Justine, University of Montreal
    • Montreal, Quebec, Canada, H3C 1K3
      • École de Technologie Supérieure Université du Québec
    • Québec, Quebec, Canada, G1V0C8
      • Medical Intelligence CBRNE Inc.
    • Québec, Quebec, Canada, G1V 4G5
      • Research Centre, Quebec Heart and Lung Institute, Laval University
    • Sherbrooke, Quebec, Canada, J1K 2R1
      • Biomedical Telematics Laboratory Platform of the Quebec Respiratory Health Research Network
• Czechia
  • Prague
    • Prague, Prague, Czechia, 10100
      • University of Finance and Administration Department of Criminology and Forensic Disciplines
• France
  • Île-de-France Region
    • Paris, Île-de-France Region, France
      • Sorbonne University
• Japan
  • Tokyo, Japan
    • Department of Critical care, Miyagi Children's Hospital
  • Tokyo, Japan
    • Department of Disaster Medical Management, The University of Tokyo Hospital
  • Shinjuku-ku
    • Tokyo, Shinjuku-ku, Japan
      • Tokyo Women's Medical University, Department of Intensive Care Medicine
• United Kingdom
  • Winchester, United Kingdom, SO23 8UT
    • CBRNE World Journal
  • Redhill
    • Surrey Quays, Redhill, United Kingdom, RH1 5RH
      • Surrey and Sussex Healthcare NHS Trust
• United States
  • Maryland
    • College Park, Maryland, United States, 20740
      • Director, Unconventional Weapons & Technology Division, National Consortium for the Study of Terrorism and Responses to Terrorism University of Maryland

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system.

Description

Inclusion Criteria:

i. a CBRNE attack caused at least one casualty who required the assistance of the participating health care system (e.g.: physicians, nurses, paramedics and other health-care specialists of a medical facility) during a medical extraction from the incident site until admission to a medical facility;

ii. Patients are eligible if they were exposed to the CBRNE attack;

iii. Medical information concerning the CBRNE exposures, even if partial, is accessible to health care professionals for the purposes of filling out the online case report form (eCRF);

iv. Participants must be able to complete the online case report form in English; and

v. The approval of an Ethics Review Board is obtained by each medical centre participant.

Exclusion Criteria:

A negative response to any of the inclusion criteria results in an exclusion.

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Retrospective

Number of groups / cohorts

8

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
adult inflicted by a CBRNE weapon; Part of the Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.
Infant inflicted by a CBRNE weapon; Part of the population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.
Women inflicted by a CBRNE weapon; Part of the Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.
Men inflicted by a CBRNE weapon; Part of the Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.
Elderly inflicted by a CBRNE weapon; Part of the Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.
Diagnosed with chronic disease(s) inflicted by a CBRNE weapon; Part of the Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.
Clinician (adult) whom performs his/her clinical interventions; Clinician (adult) whom performs his/her clinical interventions while integrating competences in protections and decontamination. Part of the Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system. This is the case of when the clinician is required to ensure safety toward his/her patient while performing his/her interventions & procedures.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.
Clinician (adult) injured by duties circumstances; Part of the Population is being studied includes any individual who was affected by CBRNE attacks and needed an intervention of the healthcare system. This is the case of when the clinician becomes inflicted by a CBRNE weapon while intervening toward contaminated patient due to any failure in protection and decontamination.	Procedure: Clinical interventions performed in acute settings (contaminated environment); Any clinical intervention performed on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic).; Procedure: Protection (clinician and patient); As interrelated competence of the clinical intervention, any protection procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with.; Procedure: Decontamination (clinician and patient); As interrelated competence of the clinical intervention and protection, any decontamination procedure and capability applied on the patient inflicted by at least one of Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) weapons in acute settings (from the incident site up to his/her admission to the clean zone of a emergency room or its equivalent (ie.: walking clinic). Concerning the clinician, the protection implied for his/her own safety and for the patient to whom she/he was in closed/contact with. This crucial step is usually expected prior the patient's transfer into a clean zone like the emergency room or its equivalent.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intervention and location	The percentage of patients to whom the World Health Organization's healthcare guidelines were applied without any delay (i.e.: during a medical extraction/evacuation)	At the patient's admission at the hospital emergency room (i.e.: end-point of the medical extraction/evacuation).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Contamination is under-control due to efficient protective measures applied during a medical extraction/evacuation	The percentage of patients whose health condition remained stable during a medical extraction due to efficient WHO's protective measures applied	At the patient's admission at the hospital emergency room (i.e.: end-point of the medical extraction/evacuation).
Contamination under-control due to efficient decontamination measures applied during a medical extraction/evacuation	The percentage of patients whose health condition remained stable during a medical extraction due to efficient WHO's decontamination measures applied	At the patient's admission at the hospital emergency room (i.e.: end-point of the medical extraction/evacuation).
Deterioration of the patient's health condition due to compromised means of protection	The percentage of patients whose health condition deteriorate during a medical extraction due to the misuse of WHO's protective measures (e.g.: mask, suit, gloves, boots, etc).	At the patient's admission at the hospital emergency room (i.e.: end-point of the medical extraction/evacuation).
Deterioration of the patient's health condition due to compromised means of decontamination	The percentage of patients whose health condition deteriorated during a medical extraction due to the misuse of WHO's decontamination measures (e.g.: immediate (roughly) or/and thorough (specialized one)).	At the patient's admission at the hospital emergency room (i.e.: end-point of the medical extraction/evacuation).

Collaborators and Investigators

• Sponsor: St. Justine's Hospital
• Collaborators: University of Maryland, College Park; Tokyo Women's Medical University; Tokyo University; Sorbonne University; Quebec Heart and Lung Institute, Quebec City, Canada; Medical Intelligence CBRNE inc.; Quebec City, Canada; Department of Intensive Care Medicine, Tokyo, Japan; Centre for Defence and Security Studies, University of Manitoba, Winnipeg, Canada; Biomedical Telematics Laboratory, Quebec Respiratory Health Research Network, Sherbrooke, Canada
• Investigators: Principal Investigator: Stephane Bourassa, Ste-Justine's Hospital

Publications and helpful links

General Publications

• Bourassa S, Noebert D, Dauphin M, Rambaud J, Kawaguchi A, Leger F, Beijer D, Fortier Y, Dligui M, Ivanovski H, Simard S, Jouvet P, Leclerc J. Acute care for patients exposed to a chemical attack: protocol for an international multicentric observational study. BMJ Open. 2022 Sep 29;12(9):e065015. doi: 10.1136/bmjopen-2022-065015.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2020
• Primary Completion (Estimated): November 1, 2036
• Study Completion (Estimated): December 1, 2036

Study Registration Dates

• First Submitted: August 18, 2021
• First Submitted That Met QC Criteria: August 23, 2021
• First Posted (Actual): August 30, 2021

Study Record Updates

• Last Update Posted (Estimated): October 1, 2025
• Last Update Submitted That Met QC Criteria: September 29, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Decontamination; Treatments; Protection; CBRNE Defence; Acute Settings; Pre-Hospital Settings; Respiratory Insults
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Respiration Disorders; Respiratory Distress Syndrome; Pulmonary Atelectasis; Public Health; Environment and Public Health; Public Health Practice; Decontamination
• Other Study ID Numbers: 2020-2561

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: At this stage, we do have any plan. However, for the interest of pursuing the research, that matter will require to be addressed in due time.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No