On the spot ethical decision-making in CBRN (chemical, biological, radiological or nuclear event) response: approaches to on the spot ethical decision-making for first responders to large-scale chemical incidents.

First responders to chemical, biological, radiological, or nuclear (CBRN) events face decisions having significant human consequences. Some operational decisions are supported by standard operating procedures, yet these may not suffice for ethical decisions. Responders will be forced to weigh their options, factoring-in contextual peculiarities; they will require guidance on how they can approach novel (indeed unique) ethical problems: they need strategies for "on the spot" ethical decision making. The primary aim of this paper is to examine how first responders should approach on the spot ethical decision-making amid the stress and uncertainty of a CBRN event. Drawing on the long-term professional CBRN experience of one of the authors, this paper sets out a series of practical ethical dilemmas potentially arising in the context of a large-scale chemical incident. We propose a broadly consequentialist approach to on the spot ethical decision-making, but one which incorporates ethical values and rights as "side-constraints".

[Lessons learned from Magen David Adom's activities during the 2nd Lebanon War].

The activities of Magen David Adom (MDA) during the 2nd Lebanese War led to a series of conclusions (some established during the fighting) regarding the operational concept of the organization, the response to the needs of the team members, and the resource requirements. The fighting led to an update in the operational concept, moving to the smaller based operational unit--the station, creating a flexible concept, enabling response to various simultaneous scenes, quickly generating a common situational awareness, and relocation of resources to the more relevant events. TechnoLogy must support the operational concept. The response to stress-related victims should be part of the operational concept during conflict. Debriefing and learning processes are part of the response and enable adaptation to the changing reality. A comprehensive response to the needs of the team members is required, by relocation of family members, meeting the daily needs and preventing stress-related reactions among them. A rotation of leave of absence, central management of human resources and the management of volunteers--spontaneous and those who return to active work, are other components of this issue. The required resources--personal protective equipment, collective protection, command control and communications equipment, the supplies level and the different vehicles required for the operation, are important issues in the operational program of the organization. Collecting blood, maintaining a strategic stockpile and protecting the units, are all part of MDA missions.