Assessment of Emergency Nurses’ Preparedness for Chemical, Biological, Radiological, and Nuclear (CBRN) Medical Responses in Saudi Arabia

AIM: To assess emergency nurses' knowledge-based preparedness for medical response to chemical, biological, radiological, and nuclear (CBRN) incidents in Saudi Arabia. BACKGROUND: Emergency nurses are frontline responders, and CBRN readiness affects staff safety and patient outcomes. Evidence on CBRN competence among nurses in Saudi Arabia remains limited. METHODS: A cross-sectional survey was conducted among 183 emergency nurses using a structured questionnaire. The instrument assessed five key CBRN competencies: symptom recognition, contamination detection, personal protective equipment use, patient decontamination, and triage protocols. Descriptive and inferential statistics were used to analyze the data. The Reporting of Observational Studies in Epidemiology guidelines were used. FINDINGS: Fewer than one-quarter of emergency nurses reported prior CBRN training and showed low knowledge overall, with trained ones scoring higher than untrained, though, after demographic adjustments, the difference did not reach statistical significance after demographic adjustments. Knowledge was low across all core CBRN competencies, with the lowest in contamination detection, followed by symptom recognition, patient decontamination, personal protective equipment use, and triage protocols. Knowledge related to chemical agents was consistently the lowest, while biological- and radiological-related knowledge was relatively higher but still suboptimal. DISCUSSION: This finding suggests that existing training initiatives, when available, may be limited in scope, intensity, or retention of clinically actionable knowledge. The low knowledge levels across all core competencies could hinder timely, safe, and effective medical response during CBRN events. CONCLUSION: Emergency nurses demonstrated insufficient knowledge based preparedness across key CBRN competencies, with pronounced deficits in chemical-response knowledge. IMPLICATIONS FOR NURSING AND HEALTH POLICY: National nursing education and professional development programs should integrate CBRN-specific content. Health policymakers must prioritize the implementation of standardized training and preparedness protocols to ensure nurses are equipped to respond effectively to CBRN emergencies.