Chapter 41 - Terrorism Response and Disaster Management

active shooter event

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

aging

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

alpha radiation

a type of energy that is emitted from a strong radiologic source;

the least harmful penetrating type of radiation and cannot travel more than a few inches or penetrate most objects

anthrax

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

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

routes of entry are inhalation, cutaneous, and GI

Antidote Treatment Nerve Agent Auto-Injector (ATNAA)

a nerve agent antidote kit containing atropine and pralidoxime chloride;

delivered as a single dose through one needle

bacteria

microorganisms that reproduce rapidly by binary fission;

single-cell creatures that can form spores when environmental conditions are harsh

beta radiation

a type of energy that is emitted from a strong radiologic source;

slightly more penetrating than alpha radiation and requires a layer of clothing to stop it

B-NICE

mneumonic device to recall the types of WMDs:

B = biologic

N = nuclear

I = incendiary

C = chemical

E = explosive

botulinum

produced by bacteria, this is the most potent neurotoxin known;

when introduced into the body, it affects the nervous system’s ability to function and causes botulism

buboes

enlarged lymph nodes that are characteristic in people infected with the bubonic plague

bubonic plague

bacterial infection that affects the lymphatic system;

transmitted by infected rodents and fleas;

characterized by acute malaise, fever, and the formation of tender, enlarged, inflamed lymph nodes that appear as lesions (buboes);

aka the Black Death

chlorine (Cl)

the first chemical agent ever used in warfare;

has a distinct odor of bleach and creates a green haze when released as a gas;

initially produces upper airway irritation and a choking sensation

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;

posed by a hazardous agent that gives off very little or no vapors;

aka skin hazard

contagious

an infectious disease that spreads from one human to another;

communicable

covert

an act in which the public safety community generally has no prior knowledge of the time, location, or nature of the attack

cross-contamination

occurs when a person is contaminated by an agent as a result of coming into contact with another contaminated person

cyanide

an agent that affects the body’s ability to use oxygen;

colorless gas that has an odor similar to almonds;

the effects begin on a cellular level and are rapidly seen at the organ and system levels

decay

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

dirty bomb

name given to an explosive radiologic dispersal device

disease vector

an animal that, once infected, spreads a disease to another animal

dissemination

the means by which a terrorist will spread an agent

domestic terrorism

terrorism that is carried out by people in their own country

DuoDote Auto-injector

a nerve agent antidote kit containing atropine and pralidoxime chloride;

delivered as a single dose through one needle

G agents

early nerve agents that were developed by German scientists in the period after WWI and into WWII;

there are three agents: sarin, soman, and tabun

gamma radiation

a type of energy that is emitted from a strong radiologic source that travels faster and has more energy than alpha and beta rays;

easily penetrate through the human body and require lead or several inches of concrete to prevent penetration

incubation

the period of time between a person being exposed to an agent and the time when symptoms appear

international terrorism

terrorism that is carried out by people in a country other than their own;

aka cross-border terrorism

ionizing radiation

energy that is emitted in the form of rays, or particles

lewisite (L)

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

long wolf terrorist attack

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

lymphatic system

a passive circulatory system in the body that transports a plasmalike liquid called lymph, a thin fluid that bathes the tissues of the body

lymph nodes

the area of the lymphatic system where infection-fighting cells are housed

miosis

excessively constricted pupil;

often bilateral after exposure to nerve agents

mutagen

a substance that mutates, damages, and changes the structures of DNA in the body’s cells

nerve agents

a class of chemical called organophosphates;

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

neurotoxins

biologic agents that are the deadliest substances known to humans;

they include botulinum toxin and ricin

neutron radiation

the type of energy that is emitted from a strong radiologic source, involving particles that are among the most powerful forms of radiation;

easily penetrate through lead and require several feet of concrete to stop them

off-gassing

the release of an agent after exposure

pandemic

an outbreak that occurs on a global scale

persistency

how long a chemical agent will stay on a surface before it evaporates

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;

smells like freshly mowed grass or hay

phosgene oxime (CX)

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

pneumonic plague

a lung infection that is the result of inhalation of plague-causing bacteria;

aka plague pneumonia

points of distribution (PODs)

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

primary blast injury

injuries caused by an explosive pressure wave to the hollow organs of the body

pulmonary blast injuries

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

quaternary blast injury

a blast injury that falls into one of the following categories: burns, crush injuries, toxic inhalation, medical emergencies, or mental health disorders

radioactive material

any material that emits radiation

radiologic dispersal device (RDD)

any container that is designed to disperse radioactive material

ricin

a neurotoxin derived from mash that is left from the castor bean;

causes pulmonary edema and respiratory and circulatory failure leading to death

route of exposure

the manner by which a toxic substance enters the body

sarin (GB)

a nerve agent that is one of the G agents;

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

secondary blast injury

a penetrating or nonpenetrating injury caused by ordnance projectiles or secondary missles

secondary device

a secondary explosive used by terrorists, set to explode after the initial bomb

smallpox

a highly contagious viral disease;

it is most contagious when blisters begin to form

soman (GD)

a nerve agent that is one of the G agents;

twice as persistent as sarin and five times as lethal;

fruity odor as the result of the type of alcohol used in the agent, and is a contact and inhalation hazard that can enter the body through skin absorption and through the respiratory tract

Special Atomic Demolition Munitions (SADM)

small suitcase-sized nuclear weapons that were designed to destroy individual targets

state-sponsored terrorism

terrorism that is funded and/or supported by nations that hold close ties with terrorist groups

sulfur mustard (H)

a vesicant;

brown-yellow oily substance that is generally considered very persistent;

garlic or mustard odor;

when released, quickly absorbed into the skin and/or mucous membranes and begins an irreversible process of damaging the cells;

aka mustard gas

syndromic suveillance

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

tabun (GA)

a nerve agent that is one of the G agents;

36 times more persistent than sarin and half as lethal;

fruity odor;

unique because the components used to manufacture the agent are easy to acquire and the agent is easy to manufacture

tertiary blast injury

an injury from whole body displacement and subsequent traumatic impact with environmental objects

V agent (VX)

one of the G agents;

a clear, oily agent that has no odor and looks like baby oil;

more than 100 times more lethal than sarin and extremely persistent

vapor hazard

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

vesicants

blister agents;

the primary route of entry is through the skin

viral hemorrhagic fevers

a group of diseases caused by viruses that causes the blood in the body to seep out from the tissues and blood vessels;

ex: Ebola, Rift Valley, and yellow fevers

viruses

germs that require a living host to multiply and survive

volatility

how long a chemical agent will stay on a surface before it evaporates

weaponization

the creation of a weapon from a biologic agent that is generally found in nature and that causes disease;

the agent is cultivated, synthesized, and/or mutated to maximize the target population’s exposure to the germ

weapon of mass casualty (WMC) or weapon of mass destruction (WMD)

any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure

What points does the US Department of Justice define both international terrorism and domestic terrorism?

• involves violent acts or acts dangerous to human life and violate federal or state law

• appears to be intended…

  • to intimidate or coerce a civilian population

  • to influence the policy of a government by intimidation or coercion

  • to affect the conduct of a government by mass destruction, assassination, or kidnapping

Where is modern'-day terrorism common?

in the Middle East

What are the four types of groups that turn toward terrorism?

1. religious extremist groups/doomsday cults

2. extremist political groups

3. cyber terrorists

4. single-issue groups

What is the response plan that Hartford Consensus recommends for active shooter response?

THREAT:

T = threat suppression

H = hemorrhage control

R, E = rapid extrication to safety

A = assessment by medical providers

T = transport to definitive care

What has been the preferred WMD for terrorists?

explosive devices

What types of agents are included in chemical terrorism/warfare?

• vesicants

• respiratory agents

• nerve agents

• metabolic agents

What types of agents are included in biologic terrorism/warfare?

• viruses

• bacteria

• toxins

Which has materials that are easier to acquire and requires less expertise to use, nuclear or radioactive weapons?

radioactive

The planning of most acts of terror is…

covert

What is important to know when recognizing a terrorist event?

know the current threat level issued by the federal government through the Department of Homeland Security

In April 2011, the color-coded Homeland Security Advisory System was replaced by…

the National Terrorism Advisory System (NTAS)

To determine the potential for a terrorist attack, what observations should you make on every call?

• type of location

• type of call

• number of patients

• victims’ statements

• preincident indicators

The greatest threats facing you in a WMD attack are…

contamination and cross-contamination

What should you do when you suspect a terrorist or WMD event has taken place?

notify the dispatcher:

• nature of the event

• additional resources needed

• estimated number of patients

• upwind route of approach

As the first person on scene, you may need to…

establish command until additional personnel arrive

What should you do if the initial ICS is already in place?

immediately find the medical staging officer to receive your assignment

What can happen if vesicants are left on the skin or clothing long enough?

they can produce vapors that can enter the respiratory tract

What are examples of vesicant agents?

• sulfur mustard (H)

• lewisite (L)

• phosgene oxime (CX)

Where do vesicants usually ause the most damage?

in damp, moist areas of the body;

ex: armpits, groin, respiratory tract

What are signs of vesicant exposure on the skin?

• skin irritation, burning, and reddening

• immediate, intense skin pain

• formation of large blisters

• gray discoloration of skin

• swollen and closed or irritated eyes

• permanent eye injury (including blindness)

What are signs of vesicant exposure in the respiratory tract?

• hoarseness and stridor

• severe cough

• hemoptysis

• severe dyspnea

What attacks vulnerable cells within the bone marrow and depletes the body’s ability to reproduce white blood cells?

mustard gas

Which vesicant has a delayed onset of symptoms, taking up to 4-6 hours after exposure?

mustard gas

Which vesicants are highly volatile and have a rapid onset of symptoms?

lewisite (L) and phosgene oxime (CX)

Does lewisite (L) or phosgene oxime (CX) cause secondary cellular injury?

no, just mustard gas

Is there an antidote for mustard gas or phosgene oxime (CX) exposure?

no

What kind of facilities are best equipped to handle the wounds and infections produced by vesicants?

burn centers

What are examples of pulmonary agents?

• chlorine (Cl)

• phosgene

What happens once a respiratory agent is inside the lungs?

they damage the lung tissue and fluid leaks into the lungs;

pulmonary edema develops, resulting in difficulty breathing

What are the effects of exposure to chlorine (Cl)?

• shortness of breath

• tightness in chest

• hoarseness and stridor as the result of upper airway constriction

• gasping and coughing

• pulmonary edema

• complete airway obstruction

• death