Terrorism and Disaster Management

How does the US Department of Justice define international and domestic terorrism?

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

• Appears to be intended to:

  • Intimidate or coerce a civilian population

  • Influence the policy of a government by intimidation or coercion

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

THREAT

Threat supression

Hemorrhage control

Rapid extrication to safety

Assessment by medical providers

Transport to definitive care

What does persistence or volatility describe in cases of chemical agents?

How long the agent will stay on a surface before it evaporates

• Highly persistent: weeks to months

• Persistent: 24 hours+

• Nonpersistent: evap relatively fast

Vesicants

• Blister agents

• Usually skin contact

  • However if left on clothing, can evaporate and enter respiratory system (off-gassing)

• Cause the most damage to damp or moist areas of the body

• Signs:

  • Skin irritation and pain

  • Large blisters

  • Gray discoloration of skin

  • Swollen and closed or irritated eyes

  • Permanent eye injury

• Signs of inhalation:

  • Hoarseness and stridor

  • Severe cough

  • Hemoptysis

  • Severe dyspnea

Mutagen

Mutates, damages, and changes structure of cells (Mustard gas)

Mustard gas (mutagen)

• 4-6 hours after exposure: progressive reddening → large blisters

• Attacks vulnerable cells within the bone marrow and depletes body’s ability to produce white blood cells (heightened risk of secondary infection)

Lewisite (L) and phosgene oxide (CX)

• Mutagens

• Immediate intense pain, blisters, grey discoloration of skin

Chlorine

• Odor of bleach, green haze in gas form

• SOB, tightness in chest, hoarseness and stridor, gasping and coughing

• Severe: pulmonary edema, complete airway obstruction, death

Phosgene

• May be produced as a result of a fire involving other chemicals

• Delayed signs and symptoms:

  • Nausea

  • Tightness in chest

  • Severe cough

  • Dyspnea on exertion

  • Pulmonary edema

    • Continuously coughing up white or pink-tinged fluid

    • Can be severe enough to cause hypovolemia and hypotension

Nerve agents

• Can cause cardiac arrest within seconds to minutes

• Can cause seizures that will continue until patient dies or treatment is given

• Organophosphates: block an essential enzyme in nervous system, causing body’s organs to become overstimulated and burn out

Duodote Auto-Injector

Atropine to block nerve damage and 2-PAM to eliminate agent from the body

Cyanide

Binds with body’s cells, preventing oxygen from being used

Smallpox

Lesions identical in development

Begin on face and extremities and move toward chest and abdomen

Bubonic plague

• Infects lymphatic system

• Lymph nodes become infected and grow (buboes)

• Sepsis and possibly death

Botulinum toxin

Patient’s accessory muscles and diaphragm become paralyzed → respiratory arrest

Ricin

• Pulmonary edema and respiratory and circulatory failure leading to death

• Ingestion causes local hemorrhage and necrosis of the liver, spleen, kidneys, and GI tract

Petechiae

Pinpoint hemorrhages that show up on skin in cases of blast injuries

Which type of brain bleed is most common in blast injuries?

Subarachnoid

Types of radiation and what it takes to stop them

Alpha: least harmful, cannot travel more than a few inches or penetrate most objects

Beta: slightly more penetrating, requires clothing to stop it

Gamma (x-ray): penetrate through human body and require lead or several inches of concrete to prevent penetration

Neutron: easily penetrate lead and may need several feet of concrete to stop them

Anthrax

Disease caused by bacterium that lies dormant in a spore; released when exposed to optimal moisture and temperature

B-NICE

Weapons of mass destruction

Biological

Nuclear

Incendiary

Chemical

Explosive