The response to hazardous materials or chemical, biological, radiological, nuclear (CBRN) incidents typically consists of: (1) cordons regulating access into and egress from designated zones; and (2) use of appropriate personal protective equipment. In most systems emergency medical services (EMS) will stay outside of the “hot zone”. The patient will be rescued by the fire service and, after some gross decontamination, handed over. As mass gatherings are regarded as high-risk events, this system was used in Vienna during the Euro08 and augmented by: (1) casualty decontamination units (seven parallel lines for stretcher decontamination, located before triage); (2) a rapid intervention group for medical care in the hot zone (25 medical personnel), responsible for triage, life support (airway, breathing, bleeding), and antidote therapy; and (3) a joint CBRN incident command for close cooperation with detection units.

After a review of the available open-source literature, a risk analysis was performed and the tactical concept described above was developed with cooperation of all involved services. Special training was performed for all members of the aforementioned units.

As the concept was not tested by an actual emergency, the following observations can be made: (1) readiness of the units could be successfully maintained during the EURO08; (2) me chosen equipment was experienced as appropriate; (3) several minor cases corroborated the risk analysis; and (4) manpower and training requirements were considerable.

While it is possible to perform medical care within the hot zone, concepts are rarely tested in reality and the necessary efforts raise the question of proportionality.