Experts' Opinion on Decontamination and Antidote Strategies: Complementing Contemporary Expert Consensus and Evidence to Optimize Preparedness and Response to CBRN Threats in the Middle East and North Africa

Abstract

Chemical, biological, radiological, and nuclear (CBRN) incidents present escalating challenges, particularly in geopolitically unstable regions such as the Middle East and North Africa. Despite advances, gaps exist regarding optimal decontamination protocols and agent-specific antidote selection algorithms, exacerbated by variable operational contexts, fragmented services and inconsistent training initiatives. This paper synthesizes recent evidence, building on an artificial intelligence-enhanced Delphi study with 40 international experts, to assess current CBRN response strategies. Findings support immediate dry decontamination within 5–15 min, removing over 80% of contaminants and avoiding ‘wash-in’ effects. Triple-phase protocols achieve > 97% reduction. Medical oversight during decontamination is critical. Antidote readiness must expand beyond organophosphates to include cyanide, biological agents, radiological decorporation, and synthetic opioids. Special populations, such as paediatric, older, and pregnant individuals, as well as those with disabilities, require tailored approaches. Effective CBRN readiness demands integrated, evidence-based strategies that emphasize rapid response, medical integration, and population-specific adaptations within global collaboration frameworks to address evolving threats.