1. SFT
  2. Archiwum
  3. Vol. 67 1/2026
  4. A New Medical Doctrine for CBRNE Thre...

A New Medical Doctrine for CBRNE Threats: a Framework for Developing Poland’s Emergency Medical Services, Civil Protection and Civil Defence

Karol, Łyziński, Ph.D. , Arkadiusz, Trzos, Ph.D.

Download article
Open Access
DOI: 10.12845/sft.67.1.2026.4, pages: 86 – 105

Abstract

Purpose: The purpose of the article is to present the proposition of a modern medical doctrine for chemical, biological, radiation, nuclear and explosive (CBRNE) threats for Poland, focused on the emergency medical services and their connections with health protection, civil protection and civil defence. The proposed doctrine arranges priorities and compromises in relation to activities under the conditions of uncertainty, time pressure and limited resources.

Introduction: From a medical perspective, the primary task is to quickly identify the consequences of an incident and to initiate protection and treatment activities even if the cause of the incident is yet to be clearly determined. The course of care is influenced by: the need for personal protection equipment, the decontamination process and the risk of secondary exposure. The effectiveness of system response is in addition limited by information pressure (including contradictory reports, misinformation and communication overload), as well as disruption of infrastructure and communication (which may destabilise health protection operations regardless of the number of victims). In that perspective, the article presents emergency medical services as an integral part of the public safety, civil protection and civil defence system that requires interoperability and coordinated cooperation with the national rescue and firefighting system and other CBRNE crisis response entities.

Methodology: The article is conceptual in nature and based on a focused narrative review with thematic synthesis. The starting point was the analysis of literature and expert materials in a work repository comprising 308 items from 2020–2025. Following a multi-stage selection, sources of highest operational and medical usability and credibility were included in the qualitative analysis and synthesis. The publications covered medical rescue and hospital operations under CBRNE threats, mass incidents and patient care organisation and coordination. Works unrelated to the medical or operational dimension were excluded. On that basis, thematic categorisation was conducted and ten pillars were introduced as areas of critical capabilities determining the feasibility of medical operations.

Conclusions: The proposed doctrine consists of ten pillars of feasibility of medical operations for CBRNE incidents, related to risk identification, personnel safety, operational effectiveness, coordination, information and detection, care continuity, logistics, cooperation, education, risk communication and social resilience. This framework is a starting point for the development of strategies, minimum performance standards and readiness criteria and then their testing and further validation.

Keywords: emergency medical services, medical doctrine, CBRNE threats, state readiness, crisis response, civil protection and civil defence, crisis management

Type of article: review article

Bibliography:

  1. Nisser J., Implementing military doctrine: A theoretical model, "Comparative Strategy" 2021, 40(3), 273–289, https://doi.org/10.1080/01495933.2021.1912514.
  2. Kocaki H. i in., The Science of Disaster Medicine: From Response to Risk Reduction, "Medeni Medical Journal" 2021, 36(4), 281–288, https://doi.org/10.4274/MMJ.galenos.2021.50375.
  3. Hick J.L. i in., Allocating Scarce Resources in Disasters: Emergency Department Principles, "Annals of Emergency Medicine" 2012, 59(3), 177–187, https://doi.org/10.1016/j.annemergmed.2011.06.012.
  4. Mugavero R., Shin H., Safety and Emergency Medical Care in CBRN, CEMEC Handbook Series 3, 2025, https://doi.org/10.23810/CEMEC-4.
  5. Tin D. i in., Hybrid warfare and counter-terrorism medicine, "European Journal of Trauma and Emergency Surgery" 2023, 49(5), 1987–1996, https://doi.org/10.1007/s00068-023-02230-y.
  6. Beishuizen B.H.H. i in., A systematic literature review on public health and healthcare resources for pandemic preparedness planning, "BMC Public Health" 2024, 24, art. 3114, https://doi.org/10.1186/s12889-024-20629-z.
  7. Bezpieczni w czasie kryzysu: jak zadbać o zdrowie obywateli i żołnierzy, kiedy świat się chwieje?, WIM-PIB, Warszawa 2025, https://wim.mil.pl/wp-content/uploads/2025/08/ raport-bezpieczni-w-czasie-kryzysu.pdf [dostęp: 6.01.2026].
  8. Piekarski M., Możliwe scenariusze zagrożeń terrorystycznych na terytorium Rzeczpospolitej Polskiej w kontekście zagrożeń hybrydowych, "Terroryzm – studia, analizy, prewencja" 2022, 2(2), 71–92, https://doi.org/10.4467/27204383TER.22.019.16339.
  9. Trzos A., Łyziński K., The potential of emergency medical response to CBRNE threats in the context of military-civilian cooperation, " Safety & Fire Technology" 2024, 64(2), 158–174, https://doi.org/10.12845/sft.64.2.2024.10.
  10. Ustawa z dnia 5 grudnia 2024 r. o ochronie ludności i obronie cywilnej (Dz.U. 2024 poz. 1907).
  11. Barbee G. i in., Chemical, Biological, Radiological and Nuclear (CBRN) Injury Part I: Initial Response to CBRN Agents (CPG ID: 69), Joint Trauma System Clinical Practice Guideline, 2018.
  12. Kippnich M. i in., Managing CBRN mass casualty incidents at hospitals – Find a simple solution for a complex problem: A pilot study, "American Journal of Disaster Medicine" 2024, 19(1), 45–53, https://doi.org/10.5055/ajdm.0471.
  13. Granholm F. i in., The Complexities of Hybrid Warfare and the Impact on Tactical Emergency Medical Support, "Health Security" 2023, 21(2), 140–147, https://doi.org/10.1089/hs.2022.0161.
  14. Smith M., Weir A.G.A., CBRNE3 medicine in the austere environment: the challenges, "BMJ Military Health" 2022, 168(6), 474–478, https://doi.org/10.1136/military-2022-002259.
  15. Łyziński K., Trzos A., Środki ochrony indywidualnej w praktyce personelu medycznego, „Stany Nagłe po Dyplomie" 2025, 9(1), 1–8, https://podyplomie.pl/stanynaglepodyplomie/ 41311,srodki-ochrony-indywidualnej-w-praktyce- -personelu-medycznego [dostęp: 4.07.2025].
  16. Naushad V.A. i in., A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders, "Prehospital and Disaster Medicine" 2019, 34(6), 632–643, https://doi.org/10.1017/S1049023X19004874.
  17. Deac A.A. i in., Ukrainian healthcare providers under siegeduring the first year of war: challenges and adaptations, "BJPsych International" 2024, 21(2), 35–37, https://doi.org/10.1192/bji.2023.43.
  18. Jaffe E. i in., Managing a Mega Mass Casualty Event by a Civilian Emergency Medical Services Agency, "International Journal of Public Health" 2024, 69, art. 1606907, https://doi.org/10.3389/ijph.2024.1606907.
  19. Binkley J.M., Kemp K.M., Mobilization of Resources and Emergency Response on the National Scale, "Surgical Clinics of North America" 2022, 102(1), 1–12, https://doi.org/10.1016/j.suc.2021.09.014.
  20. Nazari S. i in., Structural elements and requirements in forming prehospital health response teams, "Disaster Medicine and Public Health Preparedness" 2023, 17, art. e300, 1–8, https://doi.org/10.1017/dmp.2022.259.
  21. European Committee for Standardization (CEN), CWA 17974:2023: Basic CBRN training curriculum, CEN, Brussels 2023, https://civil-protection-knowledge-network.europa. eu/system/files/2025-04/cwa-on-eu-training-curriculum. PDF [dostęp: 6.02.2026].
  22. NATO Civil Emergency Planning, The International CBRN Training Curriculum, 2013, https://civil-protection-knowledge- network.europa.eu/media/international-cbrn-training- -curriculum [dostęp: 5.02.2026].
  23. Elfahim O. i in., Artificial Intelligence in Prehospital Emergency Care, "Big Data and Cognitive Computing" 2025, 9(9), art. 219, https://doi.org/10.3390/bdcc9090219.
  24. Tanui D.J., Application of Boyd’s OODA loop to emergency response, "Journal of Emergency Management" 2021, 19(5), 461–468, https://doi.org/10.5055/jem.0564.
  25. Costigan S.S. i in., Hybrid Threats and Hybrid Warfare Reference Curriculum, Brussels 2022, https://nato.int/content/ dam/nato/webready/documents/deep/Hybrid-threats-and- hybrid-warfare-ENGLISH.pdf [dostęp: 5.02.2026].
  26. Trzos A., Łyziński K., Proponowane kierunki rozwoju ratownictwa medycznego…, w: Epidemiologia i bezpieczeństwo CBRNE, t. 4, Zielonka 2025, 143–166.
  27. Regulation (EU) 2021/821…, "Official Journal of the European Union" 2021, L206, 1–461, https://eur-lex. europa.eu/eli/reg/2021/821/oj/eng [dostęp: 5.02.2026].
  28. Granholm F. i in., Not war, not terrorism, "American Journal of Emergency Medicine" 2022, 60, 178–183, https://doi.org/10.1016/j.ajem.2022.10.021.
  29. Tsagarliotis I. i in., Assessing the Role of Military Units, "Military Medicine" 2025, 190(1–2), e1–e10, https://doi.org/10.1093/milmed/usaf548.
  30. Kalkman J.P., Military crisis responses to COVID-19, "Journal of Contingencies and Crisis Management" 2021, 29(1), 99–103, https://doi.org/10.1111/1468-5973.12328.
  31. Jaffe E. i in., Prehospital Care Under Fire, "Prehospital and Disaster Medicine" 2024, 39(3), 275–278, https://doi.org/10.1017/S1049023X24000438.
  32. Quinn J. i in., Prehospital Lessons From the War in Ukraine, "Military Medicine" 2024, 189(1–2), 17–29, https://doi.org/10.1093/milmed/usad253.
  33. Kako M. i in., CBRN Education and Training, "Prehospital and Disaster Medicine" 2018, 33(1), 100–107, https://doi. org/10.1017/S1049023X18000043. [34] Długosz K. i in., CBRNE education and training for Polish health professionals, "Folia Medica Cracoviensia" 2025, 65(2), 113–125, https://doi.org/10.24425/fmc.2025.156129.
  34. Bury G. i in., Ukraine Trauma Project, "BMJ Open" 2023, 13(11), art. e077895, https://doi.org/10.1136/bmjopen-2023-077895. [36] Dzhemiliev A. i in., Enhancing trauma care in Ukraine, "World Journal of Surgery" 2024, 48(11), 2716–2727, https://doi.org/10.1002/wjs.12362.
  35. Baetzner A.S. i in., Preparing medical first responders, "Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine" 2022, 30, art. 56, https://doi.org/10.1186/s13049-022-01056-8.
  36. Ranse J. i in., Strengthening emergency department response, "Australasian Emergency Care" 2024, 27(4), 100–108, https://doi.org/10.1016/j.auec.2024.09.003.
  37. World Health Organization, Hospital Safety Index, Geneva 2015, https://iris.who.int/handle/10665/258966 [dostęp: 2.02.2026].
  38. World Health Organization, Risk communication and community engagement, Geneva 2020, https://iris.who.int/bitstream/ handle/10665/331513/WHO-2019-nCoV-RCCE- -2020.2-eng.pdf [dostęp: 4.03.2026].
  39. European Centre for Disease Prevention and Control, Recommendations for preparedness planning, Stockholm 2025, https://www.ecdc.europa.eu/en/publications-data/ recommendations-preparedness-planning-public-health- -threats [dostęp: 4.03.2026].
  40. Khan S. i in., Risk communication and community engagement during COVID-19, "International Journal of Disaster Risk Reduction" 2022, 74, art. 102903, https://doi.org/10.1016/j.ijdrr.2022.102903.
  41. do Nascimento I.J.B. i in., Infodemics and health misinformation, "Bulletin of the World Health Organization" 2022, 100(9), 544–561, https://doi.org/10.2471/BLT.21.287654.
  42. Goniewicz K. i in., The importance of pre-training gap analyses, "BMC Public Health" 2021, 21, art. 114, https://doi.org/10.1186/s12889-021-10165-5.
  43. NATO Standardization Office, AMedP-7.1, 2018, https:// coemed.org/files/stanags/03_AMEDP/AMedP-7.1_EDA_ V1_E_2461.pdf [dostęp: 5.02.2026].
  44. Konieczny M., Cooperation and interoperability…, "Acta Iuris Stetinensis" 2024, 47(1), 9–25, https://doi.org/10.18276/ais.2023.47-01.
  45. Farhat H. i in., Preparedness and emergency response strategies, "Journal of Contingencies and Crisis Management" 2024, 32(2), 215–227, https://doi.org/10.1111/1468-5973.12592.
  46. European Commission, EU Civil Protection Mechanism, https://civil-protection-humanitarian-aid.ec.europa.eu/ what/civil-protection/eu-civil-protection-mechanism_en [dostęp: 01.03.2026].
  47. International Organization for Standardization, ISO 22398:2013, Geneva 2013, https://www.iso.org/standard/ 50294.html [dostęp: 5.03.2026].
  48. U.S. Department of Homeland Security, HSEEP Doctrine, Washington DC 2020 [dostęp: 5.03.2026].
  49. Lawry L.L. i in., Health System Organization and Logistics of Trauma Care, "Inquiry" 2025, 62, art. 469580251333327, https://doi.org/10.1177/00469580251333327.
  50. Walravens S. i in., Characteristics of Medical Evacuation by Train, "JAMA Network Open" 2023, 6(6), art. e2319726, https://doi.org/10.1001/jamanetworkopen.2023.19726.
  51. Erickson T.B. i in., Evaluation of CBRNE Knowledge Change, "Disaster Medicine and Public Health Preparedness" 2023, 17, art. e387, https://doi.org/10.1017/dmp.2023.52.
  52. Kivlehan S.M. i in., Evaluation of change in emergency care knowledge, "BMJ Open" 2022, 12(6), art. e050871, https:// doi.org/10.1136/bmjopen-2021-050871.
  53. Truppa C. i in., Health systems resilience, "Conflict and Health" 2024, 18, art. 2, https://doi.org/10.1186/s13031-023-00560-7.
  54. WHO Regional Office for Europe, Health financing in Ukraine, Copenhagen 2022, https://iris.who.int/bitstream/handle/ 10665/361645/WHO-EURO-2022-5882-45647-65535- eng.pdf [dostęp: 9.03.2026].
  55. Christiaens W. i in., Organisation des soins médicaux…, Brussels 2023, https://doi.org/10.57598/R374BS.
  56. Del Pinto M. i in., The National and Local Dimension…, Bristol 2024, 204–221, https://doi.org/10.46692/9781529226775.013.
  57. Morton H., Johnson C., Chemical, biological, radiological and nuclear major incidents, "Surgery (Oxford)" 2021, 39(8), 500–507, https://doi.org/10.1016/j.mpsur.2021.05.005.