Hazardous Materials (HAZMAT) and Chemical, Biological, Radiological and Nuclear (CBRN)

Information last updated: 1 February 2022

On this page you will find information about:

Guidance for the initial management of self presenters from incidents involving hazardous materials

Guidance for the initial management of self presenters from incidents involving hazardous materials is an update of the previously available guidance published in 2012 and is applicable across all healthcare settings or NHS branded buildings.  The guidance has been streamlined and updated to include the Initial Operational Response (IOR) and Remove, Remove, Remove messages developed by the Home Office in partnership with the blue light emergency services and UK Health Security Agency (UKHSA).

Every effort has been taken to purposefully keep the document succinct to ensure that it is accessible to a wide range of staff, including those with no, or limited, experience of incidents or patient management.

The document is split into two sections:

  • The first section provides details and advice on how to prepare for an incident.
  • The second section provides a standalone short guide for managing a self presenting patient including an action card.

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Chemical incidents: planning for the management of self-presenters in healthcare settings

The Chemical incidents: planning for the management of self-presenters in healthcare settings gives guidance to National Health Service (NHS) funded organisations in planning, preparing and responding to chemical emergencies and managing people who may have been exposed to chemicals as a result of an accident or deliberate release. It highlights and addresses the particular features of an incident involving chemicals over and above the generic planning and response arrangements that need to be in place for all other major incidents and emergencies.

This guidance provides specific updated information and guidance on changes to aspects of the decontamination process for certain chemical incidents. It does NOT change any aspects of the decontamination process for biological or radiological contamination.

NHS funded organisations need to ensure that they have in place appropriate plans to respond to all hazards.

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Powered Respiratory Protective Suit (PRPS)

The national programme to replace existing PRPS across the NHS in England is currently underway. Below is the latest correspondence on this programme:

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Initial Operational Response (IOR)

The Initial Operational Response (IOR) programme was introduced by the Home Office across all blue light emergency services and to key first responders including the NHS, to improve patient outcomes following contamination with hazardous materials (HAZMAT) or a chemical, biological, radiological or nuclear (CBRN) incident.

The IOR programme has been introduced following extensive research. Principles of the IOR are applicable to NHS settings that may expect to receive ambulant self-presenting patients following an incident – for example emergency departments, walk in centres, urgent care centres or general practices.

In 2018 IOR was refreshed as Remove, Remove, Remove.  This message was redesigned to make the core elements easier to absorb, remember and apply without changing the response.

An IOR training DVD was produced and circulated to all hospitals to support the roll out of the IOR programme.

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UK Reserve National Stock for Major Incidents – Countermeasures access guidance

NHS England has produced guidance for accessing countermeasures in England, this has been placed on Resilience Direct on the NHS England guidance page, through your RD login.

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Patient Group Directions (PGDs)

A specific set of PGDs have been developed by UK Health Security Agency (UKHSA)  in partnership with NHS England, the Department of Health (DH) and other specialist advice to enable the NHS in England to respond to a CBRN event.

The PGDs are provided to ensure a national capability to respond appropriately as required and will be updated in line with any changes to legislation or clinical evidence on efficacy of use and dosage requirements.


Initial supply

Further supply


Initial supply

Further supply

Potassium iodate and potassium iodide protocols

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