Introduction Due to an increasing risk of hazardous chemical terrorist attack and the need for rapid emergency medical care to be provided to the victims, the NHS is expecting frontline emergency health care providers (in ambulance services and hospital emergency departments) to be competent to perform life saving interventions whilst wearing chemical, biological, radiological and nuclear (CBRN) protective suits. Studies in the performance of clinical skills have shown an improvement with repetition. Likewise there have been studies in the learning effect with repetitive wearing of CBRN suits, but not on the performance of skills within those suits. A study was conducted to determine the best method for preparing drugs for intravenous administration whilst wearing a CBRN suit. As part of this study an analysis of the learning effect of repeat performances of the skill was conducted.

Methodology 81 qualified nurses, paramedics and student paramedics participated. Each participant was required to prepare the drugs using four different methods whilst wearing street clothes and the CBRN suit; the order of use of the methods and wearing of the CBRN suit was randomised. Each participant performed each method twice in a CBRN suit. Times for preparation and volume of drug wasted were recorded and analysed.

Results Significant improvements in time (15%) were shown from the first to second attempts in the suit. The improvement was found across all drug preparation methods and throughout all levels of clinical education and experience. No significant improvement in volume of drug wasted was noted.

Conclusion A learning effect has certainly been shown, demonstrating that practice in the skills is as important as familiarising the health care professional with the CBRN suit. It is recommended that a longitudinal study be conducted to determine what frequency of practice is required for skill retention.