Human biological monitoring--a versatile tool in the aftermath of a CBRN incident

Human biological monitoring (HBM) is a well established tool in occupational and environmental medicine. It allows to determine the internal dose of a chemical absorbed by an individual after acute or chronic exposure. Biological reference and threshold values may be used to evaluate the internal dose and estimate its health impact(s). HBM and its advantages have not been broadly recognized from a civil protection point of view in Germany, therefore we have designed a compendium to define state-of-the-art HBM sampling after a release of chemicals in a civil protection scenario. The compendium integrates the sampling of biological agents and the sampling of radio-nuclear target isotopes, to be analyzed by HBM, in a single sampling approach, thus limiting burden on the potentially exposed persons and facilitating comparison of their individual exposure to different CBRN agents. HBM analysis methods are evaluated and basic toxicity data (including biological reference and threshold values) are given for a list of 50 agents, previously identified as relevant in civil protection. For on scene commanders and healthcare professionals the compendium may help to generate HBM and biological-radio-nuclear (BRN) exposure data after a CBRN incident which can be used to improve risk communication.