The response to incidents with chemical and radioactive substances has been shaped primarily by firefighters' experiences with hazardous material (HAZMAT) accidents. Globally, HAZMAT tactics consist of the main elements of: (1) appropriate use of personal protective equipment; and (2) cordons regulating access into and egress from designated zones. Detection and casualty decontamination are far less uniformly organized.

Review and analysis of open-source (medical-and first responder-oriented) English and German Ianguage literature; informal questionnaire survey of first responders in several European countries.

The initial on-scene measures during a HAZMAT response—cordoning off the scene and rescue out of the contaminated area—are done uniformly by fire service responders. In most cases, emergency decontamination of casualties at the scene (disrobing and flushing), is performed by firefighters, however, reliability appears variable. The probability of a coordinated patient handover from fire personnel to emergency medical services (EMS) staff is rated “low” by most sources.

In many countries, specialized casualty decontamination units have been commissioned and are operated by a variety of services: fire, EMS, military and civil protection.

Hospital decontamination facilities are in most countries still the exception and depend mosdy on local commitment. Substantial detection usually invalues only simple measurements performed by the first responders; specialized support is planned to be given mainly by military, civil protection and specialized laboratories.

Initial on-scene response to chemical/radiological incidents is fundamentally similar in most countries. However, distinctive differences beyond the first steps restrict the transferability of organizational solutions.