Thus, the ethical criteria, which have to be considered for the application of HBM in CBRN scenarios, are comparable with the general ethical issues of medical diagnostics (Engelhardt, 1980 and Decker et al., 2013). Communication is another crucial issue in the whole process. It comprises crisis communication with the exposed groups and the public and individual communication

with trained crisis intervention personnel and physicians. In line with the ethical guidelines of medical diagnostics for HBM the acting physician needs to inform the patient on the tasks and risks of the planned examination and request buy PD0325901 an informed consent of the patient prior to the sampling of the specimens. Therefore a ready-to-copy informed consent form is part of the compendium. Ideally the physician can give the patient information on the medical follow-up while collecting the sample. If this is not the case a contact point, e.g., the local public health authorities, needs to be assigned by the on scene commander

to coordinate crisis/risk communication and communication of HBM results in the aftermath. see more Prior to sample collection exposed persons have to be decontaminated to avoid exposure of the medical personal. Basic rules of hygiene and personal protection have to be obeyed during the sampling process. In a medical interview the physician may ask for personal data and general HBM influencing factors like smoking, medication

and food consumption, e.g., eating fish and seafood modulates DOK2 levels of arsenic in blood and urine. In addition self-reported exposure data shall be gathered. This comprises time-point and duration of exposure, status (person of the general population/member of the disaster relief forces), proximity to the source of exposure, personal or technical protection equipment (yes/no), signs of intoxication and medical treatment so far. For self-reported exposure data a ready-to-copy form is included in the compendium, the human specimens collected can be documented on the same data sheet. The generated documents and the collected specimen(s) need to be assigned to the exposed individual without doubt anytime during the HBM process. Ideally a unique code number or barcode label(s) supplied by the HBM laboratory are used for this purpose. As already indicated in the introduction the ultimate safe-guarding of samples in line with the “public interest–legal liability approach for the application of chemical incident HBM” is the preferred way to implement HBM in a CBRN incident in Germany. Therefore, if the substance is unknown or a HBM method for a known substance is not available urine sampling is requested for “validated HBM” after the development of a new HBM analysis method.