In reply: Chemical–biological–radiological (CBR) response: a template for emergency departments

Our personal protective equipment (PPE) conforms to Australian standards1-3 and the three decontamination lines are in keeping with other institutions. We are not aware of any simple decontamination system which, evidence-based, is superior.

The choice of PPE in the ideal situation would be one that would provide adequate protection in all situations with a minimal amount of training, maintenance and expense. Nocera is correct in stating that the respiratory protection in an unidentified chemical hazard is Level A or B. These PPEs are expensive, bulky (which results in poor manual dexterity), and their use requires specialised training. The amount of chemical present on a victim surviving long enough to self-present to an emergency department is significantly less than that involved at the site of the incident. Therefore, the level of protection required for hospital staff would be less than that required by emergency rescue workers.

Our PPEs were supplied by the Victorian health authorities. It is more important for staff to be familiar with their PPEs and for hospitals to have a CBR response that is regularly practised than having excessive protection that is limited to personnel who have undergone specialised training.

The role of the clerk is to take patient details. These are radioed to staff in the hospital to help identify and correctly label patients, which is very important in mass casualty situations.

Recent experience has demonstrated that terrorist acts are a worldwide phenomenon, and Australians are potential targets. This underlines the need for comprehensive training and maintenance of hospitals' CBR response.

Since publication of the article, Victorian health authorities have reprioritised, and we therefore feel we have achieved the aims of our article.