Chapter 41 - Terrorism Response & Disaster Management

Terrorism

• Involves violent acts or acts dangerous to human life that violate federal or state law

• Appears to be intended (i) to intimidate or coerce a civilian population; (ii) to influence the policy of a government by intimidation or coercion; or (iii) to affect the conduct of a government by mass destruction, assassination, or kidnapping

Types of Terrorist Groups

1. Religious Extremists

2. Extreme political groups

3. Cyber terrorists

4. Single-issue groups

Lone Wolf Terrorist Attack

• An act of terror carried out by a single person to further an ideological goal

• Ex: active shooter

Active Shooter Event

An act of terror in which firearms are used in an ongoing assault of multiple people

Active Shooter Response Mnemonic

• Threat Suppression

• Hemorrhage Control

• Rapid Extraction to Safety

• Assessment by medical providers

• Transport to Definitive Care

Weapon of Mass Destruction (WMD)

• Any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports)

• also known as a weapon of mass destruction (WMD)

Types of Weapons of Mass Destruction

• Biological

• Nuclear

• Incendiary

• Chemical

• Explosive Weapons

Chemical Terrorism

• Chemical agents = manufactured substances with and effects on living organisms

• Liquid, powder, vapor forms

• Types

  • Vesicants (blister agents)

  • Respiratory Agents (Choking Agents)

  • Nerve Agents

  • Metabolic Agents (Cyanides)

Biologic Terrorism

• Biologic Agents = organism that causes disease

• Weaponized to maximize the populations exposure to Germ

• Types

  • viruses

  • bacteria

  • toxins

EMT Response to Terrorism

• Situational awareness

• Triage

• Base care on available resources

Recognizing a Terrorist Event

• Type of location

• Type of call

• Number of Pts

• Victims Statements

• Preincident Indicators

Scene Safety

• Park 1-2 blocks from incident

• wait for law enforcement to secure

• upwind and uphill

• Wait for specialized Assistance

Chemical Agents

Liquids or gases dispersed to kill/injure

Persistency

• How long a chemical agent will stay on a surface before it evaporates.

• AKA volatility

Route of Exposure

The manner by which a toxic substance enters the body

Vapor Hazard

The term used to describe danger posed by an agent that enters the body through the respiratory tract.

Contact Hazard

• The term used to describe the danger posed by a chemical whose primary route of entry into the body is through the skin

• aka skin hazard

Vesicants

• blister agents

• primary route is via skin

• cause burn like blisters to form on skin and respiratory tract

Signs of Vesicant Exposure on Skin

• Skin irritation, burning, and reddening

• Immediate, intense skin pain (with L and CX)

• Formation of large blisters

• Gray discoloration of skin (a sign of permanent damage seen with L and CX)

• Swollen and closed or irritated eyes

• Permanent eye injury (including blindness)

Signs of Inhaled Vesicant Vapors

• hoarseness

• stridor

• severe cough

• Hemoptysis

• Severe dyspnea

Sulfur Mustard (H)

• Mustard gas

• brownish, yellowish oil substance generally considered very persistent

• distinct smell of garlic

• damages skin and mucus membrane cells

• Vesicant & mutagen

• Produces large blisters over effected area that looks like 2nd degree burns

Mutagen

substance that mutates, damages, and changes cell structures eventually leading to cellular death

Lewisite (L)

A blistering agent that has a rapid onset of symptoms and produces immediate, intense pain and discomfort on contact

Phosgene Oxime (CX)

A blistering agent that has a rapid onset of symptoms and produces immediate, intense pain and discomfort on contact.

Vesicant Agent Treatment

• Decontaminate

• Airway support

• Take to burn center

Pulmonary Agents (Choking Agents)

• gases that cause immediate harm to people exposed to them

• ex: Chlorine and phosgene

• Produce respiratory-related symptoms

• Primary route of exposure = respiratory tract

• Damage lung tissue and fluid leaks into lungs → pulmonary edema

Chlorine (Cl)

• First chemical agent used in warfare

• smells like bleach

• creates green haze when released as a. gas

Signs of Chlorine Gas

• upper airway irritation

• choking sensation

• shortness of breath

• tightness in chest

• hoarseness and stridor

• gasping and coughing

Phosgene

• A pulmonary agent that is a product of combustion, resulting from a fire at a textile factory or house, or from metalwork or burning Freon.

• very potent agent that has a delayed onset of symptoms, usually hours

Signs of Phosgene Exposure

• Nausea

• Tightness in chest

• severe cough

• Dyspnea on exertion

• Pulmonary edema

Pulmonary Agent Treatment

• remove pt from contaminated atmosphere

• Manage ABCs

• No activity for pt

• pt in position of comfort

• Rapid Transport

Nerve Agents

• A class of chemical called organophosphates

• function by blocking an essential enzyme in the nervous system, causes the body’s organs to become overstimulated and burn out

G agents

• Early nerve agents that were developed by German scientists in the period after World War I and into World War II

• Ex: sarin, soman, and tabun

Sarin (GB)

• Highly volatile colorless and odorless liquid that turns from liquid to gas within seconds to minutes at room temperature

• G agent

• Route of entry = respiratory tract

• Dangerous in enclosed spaces

• off-gassing on clothing

off-gassing

Soman (GD)

• fruity odor

• no color

• contact and inhalation hazard

• binds to cells rapidly → aging

Aging

The process by which the temporary bond between an organophosphate and acetylcholinesterase undergoes hydrolysis, resulting in a permanent covalent bond

Tabun (GA)

• remains present for several days

• fruite semel

• looks similar to sarin

• contact/inhaltion hazard

V agent (VX)

• clear, oily agent → looks like baby oil

• no odor

• contact hazard

Nerve Agent Symtoms Mnemonic

• Diarrhea

• Urination

• Miosis & muscle weakness

• Bradycardia, bronchospasm, & bronchorrhea

• Emesis

• Lacrimation

• Seizures, salivation, sweating

Miosis

• bilateral pinpoint constricted pupils

• few conditions with this symptom

Nerve Agent Treatment

• ABCs with emphasis on ventilation and airway support

• DuoDote Auto-Injector or Antidote Treatment Nerve Agent Auto-Injector (ATNAA)

DuoDote Auto-Injector

nerve agent antidote kit containing atropine and pralidoxime chloride; delivered as a single dose through one needle

Cyanide

• colorless gas

• smells like bitter almonds

• affects bodies ability to use oxygen

Signs of Cyanide Poisoning

• dizziness

• lightheadedness

• headache

• vomiting

• Shortness of breath and gasping respirations

• Respiratory distress or arrest

• Tachypnea

• Flushed skin (may be difficult to detect in dark-skinned people)

• Tachycardia

• Altered mental status

• Seizures

• Coma

• Apnea

• Cardiac arrest

Cyanide Agent Treatment

• Remove pt from source of exposure

• remove pts clothes

• decontaminate pt

• ABCs

• bag mask device or O2 powered ventilator

Dissemination

the means by which a terrorist spreads the agent

Disease Vector

animal that spreads disease once infected, to another animal

Communicability

how easily a disease is spread

Contagious

An infectious disease that spreads from one human to another; communicable

Incubation

time between the person becoming exposed to agent and first symptoms

Viruses

• germs that require a living host to survive and multiply

• spreads via direct methods or vectors

Smallpox

• A highly contagious viral disease

• produces highly contagious blisters/rashes on the skin

• wear all the PPE when treating

Viral Hemorrhagic Fevers

• A group of diseases caused by viruses that include the Ebola, Rift Valley, and yellow fevers, among others

• causes the blood in body to seep out from the tissues and blood vessels

Bacteria

• fast reproducing, single celled microorganisms

• do not require a host to multiply and live

• treated with antibiotics

Anthrax

• A disease caused by a deadly bacterium (Bacillus anthracis) that lies dormant in a spore (protective shell)

• germ is released from the spore when exposed to the optimal temperature and moisture

• routes of entry are inhalation, cutaneous, and gastrointestinal

Bubonic Plague

• infects lymphatic system

• lymph nodes become infected and grow producing buboes

• infection spreads through body causing sepsis or death

Pneumonic Plague

A lung infection, also known as plague pneumonia, that is the result of inhalation of plague-causing bacteria

Neurotoxins

• most deadly substances known to humans

• produces from plants, marine animals, molds and bacteria

• route of entry=. inhalation, ingestion, injection

• not contagious

• fast onset of symptoms

Botulinum

• produced by bacteria

• affects nervous systems ability to function by causing muscle paralysis

• kills by paralyzing the accessory muscles and diaphragm

Ricin

• produced from mash that is left from the castor bean

• causes pulmonary edema and respiratory and circulatory failure leading to death

• least toxic by oral route

Signs of Ricin Ingestion

Fever

Chills

Headache

Muscle aches

Nausea

Vomiting

Diarrhea

Severe abdominal cramping

Dehydration

Gastrointestinal bleeding

Necrosis of the liver, spleen, kidneys, and gastrointestinal tract

Signs of Ricin Inhalation

Fever

Chills

Nausea

Local irritation of eyes, nose, and throat

Profuse sweating

Headache

Muscle aches

Nonproductive cough

Chest pain

Dyspnea

Pulmonary edema

Severe lung inflammation

Cyanosis

Seizures

Respiratory failure

Syndromic Surveillance

The monitoring, usually by local or state health departments, of patients presenting to emergency departments and alternative care facilities, the recording of EMS call volume, and the use of over-the-counter medications.

Points of Distribution (PODs)

existing facilities that are used as mass distribution sites for antibiotics, antidotes, vaccinations, and other medications and supplies during an emergency

Ionizing Radiation

energy emitted in form of rays/particles

Radioactive material

material that admits reaction

Decay

A natural process in which a material that is unstable attempts to stabilize itself by changing its structure

Alpha Radiation

• least harmful

• cannot penetrate through most objects

• stopped by skin

Bete Radiation

• slightly more penetrating

• requires layer of clothing to stop

Gamma (x-ray) radiation

• travel faster and have more energy

• require led/several inches of concrete to prevent penetration

Neutron Radiation

• most powerful form

• penetrate lead and need several feet of concrete to stop them

Sources of Radioactive Material

• Hospitals and other health care facilities with radiology departments

• Colleges and universities

• Nuclear power plants

• Chemical and industrial sites

Radiologic Dispersal Device (RDD)

• dirty bomb

• container designed to disperse radioactive material

Signs of low exposure to radiation

• nausea

• vomiting

• diarrhea

• dizziness

• headache

Signs of moderate exposure to radiation

• first degree burns

• hair loss

• compromised immune system

• cancer

Signs of severe exposure to radiation

• second/third degree burns

• cancer

• death

Incendiary and Explosive Devices

• weapons used to start fires

• be aware of secondary device possibility

• come in various shapes and sizes

Primary Blast Injury

• direct effects of pressure on body

• mainly effects hollow organs

• be aware of lung injuries

Secondary Blast Injuries

Penetrating or nonpenetrating injury that results from being struck by flying debris, such as ordnance projectiles or secondary missiles

Tertiary Blast Injury

Results from whole-body displacement and subsequent traumatic impact with environmental objects (eg, trees, buildings, and vehicles).

Quaternary Blast Injury

any other injury caused by an explosion

• ex: toxic inhalation of combustion gases, burns, a medical emergency (such as a myocardial infarction) sustained while fleeing the scene of an explosion, and even a mental health disorder that develops immediately after or days to weeks after detonation of an explosive device

Pulmonary Blast Injuries

Pulmonary trauma resulting from short-range exposure to the detonation of high-energy explosives.