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

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.

Hospital preparedness and response in CBRN emergencies: TIER assessment tool.

INTRODUCTION: Chemical, biological, radiological, and nuclear (CBRN) emergencies need particular hospital preparedness and resources availability. Also, specific skills and capabilities are required for efficient response to these types of events. The aim of this study was to develop an assessment tool to evaluate hospital preparedness and response performance with respect to CBRN emergencies. METHODS: An evaluation tool was developed using the Delphi technique. A panel of experts from 10 countries, both European and non-European, with more than 5 years of experience in research or practice in CBRN emergency management was involved in this study. The study was run online, and the experts were asked to evaluate a list of items on hospital preparedness and response in CBRN emergencies. A threshold of 85% agreement level was defined as the consensus of experts in this study. RESULTS: The first-round questionnaire was answered by 13 experts. Consensus on the preparedness section was reached for all 29 items during the first round and one item was also added by the experts. Consensus on the response performance indicators were reached in 51 out of the 59 items, during the first round, and eight items were modified and then approved in the second round by the experts. CONCLUSION: Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The assessment tool, developed through experts' consensus in this study, provides a standardized method for the evaluation of hospital preparedness and response performance with respect to CBRN emergencies. The feasibility and reliability of this assessment tool could be evaluated before and during simulated exercises in a standardized manner.

Femtosecond laser fabrication of tubular waveguides in poly(methyl methacrylate).

Femtosecond laser direct writing is employed for the fabrication of buried tubular waveguides in bulk poly(methyl methacrylate). A novel technique using selective chemical etching is presented to resolve the two-dimensional refractive-index profile of the fabrication structures. End-to-end coupling in the waveguides reveals a near-field intensity distribution that results from the superimposition of several propagating modes with different azimuthal symmetries. Mode analysis of the tubular waveguides is performed using the finite-difference method, and the possible propagating mode profiles are compared with the experimental data.

Direct femtosecond laser writing of waveguides in As2S3 thin films.

Single-channel waveguides and Y couplers were fabricated in chalcogenide thin films by use of femtosecond laser pulses from a 25-MHz repetition rate Ti:sapphire laser. Refractive-index differentials (delta n > 10(-2)) were measured through interferometric microscopy and are higher than the typical values reported for oxide glasses. The dependence of the index differential on the peak intensity reveals the nonlinear nature of the photosensitivity in arsenic trisulfide below its bandgap energy, and the refractive-index change is correlated to the photoinduced structural changes inferred by Raman spectroscopy data. A free-electron model to predict the parametric dependence of delta n is proposed.