Chapter 41 - EMS Response to Terrorism

The unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segments thereof, in furtherance of political or social objectives

What is terrorism?

Groups or individuals whose terrorist activities are directed at their own government or population

What is domestic terrorism?

Environmental terrorists, antigovernment militias, racial-hate groups, and groups with extreme political, religious, or other philosophies

What are examples of domestic terrorism?

Groups or individuals whose terrorist activities are foreign-based and/or directed by countries or groups outside the targeted country, or whose activities cross national boundaries

What is international terrorism?

Chemical, Biologic, Radiologic, Nuclear, Explosive

What does CBRNE stand for in terrorism incidents?

Weapons of mass destruction (WMD)

What are CBRNE agents also known as?

Safety of EMS providers

What is the most important consideration for EMS providers at a terrorism incident?

Terrorists may deliberately target responders

Why must EMS be cautious of multiple or secondary devices at a terrorism incident?

Occupancy, Type, Timing, On-scene warning signs

What does "OTTO" stand for when identifying a potential terrorism threat?

Symbolic and historic targets, public buildings or assembly areas, controversial businesses or doctor’s offices, infrastructure systems

What are examples of Occupancy or Location to watch for in OTTO?

Explosions, firearms, non-traumatic MCIs (e.g., biological warfare)

What should be considered under Type of Event in OTTO?

National holidays/observances, anniversaries of previous attacks, incidents in major public areas at high-traffic times

What is considered under Timing of Event in OTTO?

Unexplained pattern of illnesses/death, unexplained signs and symptoms of skin, eye, or airway irritation, suspicious containers

What are On-scene warning signs in OTTO?

Caused by extreme heat or extreme cold

What is thermal harm?

Caused by alpha particles, beta particles, or gamma rays (usually nuclear events)

What is radiologic harm?

Caused by lack of oxygen available in the atmosphere of the area

What is asphyxiation harm?

Caused by toxic or corrosive materials

What is chemical harm?

Caused by disease resulting from the event

What is etiologic harm?

Caused by physical trauma (gunshot, bomb fragments, etc.)

What is mechanical harm?

Results from any violent event

What is psychological harm?

Minimize time in any dangerous areas or those exposed to hazardous material, biological warfare, or radiation

What is the "time" principle in hazard response?

Maximize the distance from the hazard area or projected hazard area and follow ERG guidelines

What is the "distance" principle in hazard response?

Use appropriate shielding for specific hazards, such as vehicles, buildings, fire-protection clothing, HAZMAT suits, SCBA, or PPE; vaccinations against specific diseases

What is the "shielding" principle in hazard response?

They may be inhaled, ingested, absorbed, or injected; can include industrial chemicals or warfare-type agents

What types of hazardous materials may be involved in chemical events?

Caused by chemical reactions that generate heat, potentially resulting in burns

What causes thermal harm in a chemical incident?

Caused by chemical reactions that deplete oxygen in the ambient air

What causes asphyxiation in a chemical incident?

Caused by toxic chemicals that produce systemic effects impairing normal physiology

What causes chemical harm in a chemical incident?

Caused by corrosive chemicals that weaken anatomical structures

What causes mechanical harm in a chemical incident?

Results from trauma or stress secondary to the chemical event

What causes psychological harm in a chemical incident?

Use respiratory protection, protective clothing, and be aware of potential contamination from patients

What self-protection measures should EMS take during a chemical incident?

Focused emergency setting (point of origin identified, damage minimized) and public health emergency (sudden demand on public health infrastructure)

What are the two types of biologic incident settings?

Bacteria, viruses, and toxins

What agents may cause biologic incidents?

Dose or concentration multiplied by time; can be small amounts over a long period or large amounts over a short period; often measured in mg/kg or ppm

What qualifies an exposure in a biologic incident?

Absorption (skin), ingestion (mouth), injection (needles/projectiles), inhalation (breathing)

What are the four major routes of entry for biologic agents?

Material present where it does not belong and is harmful to people, animals, or the environment; includes surfaces, skin/hair, and clothing

What is qualifying contamination?

Exposure: substance enters the body via a route of entry; Contamination: substance is present but has not entered the body

What is the difference between exposure and contamination?

Exposure to chemicals that cause harm to the body

What causes chemical harm in a biologic incident?

Agents classified as poisons

What causes etiologic harm in a biologic incident?

Explosives used to disperse biological agents

What causes mechanical harm in a biologic incident?

Distress caused by the thought or fear of the event

What causes psychological harm in a biologic incident?

PPE and respiratory protection

What are self-protection measures at a biologic incident?

Get as much information as possible

What should EMS do to prepare at a biologic incident?

Self-protection first, then buddy system, then protection for civilians

How should protection be prioritized at a biologic incident?

Radiologic dispersion devices ("dirty bombs") are difficult to detect because radiation symptoms may be delayed for hours or days

What is a challenge in responding to radiologic/nuclear incidents?

Thermal harm, radiologic harm, chemical harm, mechanical harm, psychological harm

What types of harm can occur in a radiologic/nuclear incident?

From a nuclear explosion

What causes thermal harm in a radiologic/nuclear incident?

Exposure to radiologic materials; can be an ongoing hazard

What causes radiologic harm in a radiologic/nuclear incident?

Radiological substances that also include chemical hazards

What causes chemical harm in a radiologic/nuclear incident?

Explosions

What causes mechanical harm in a radiologic/nuclear incident?

Immediate or delayed reaction to the event

What causes psychological harm in a radiologic/nuclear incident?

Principles of time, distance, and shielding still apply

What are the key self-protection measures at a radiologic/nuclear incident?

Using radiologic detecting equipment

How can responders determine the effectiveness of protective measures at a radiologic/nuclear incident?

Assume there is dissemination of radiologic, biologic, or chemical materials

What assumption should responders make regarding materials at a radiologic/nuclear incident?

Follow decontamination procedures

What procedure should be followed for contamination at a radiologic/nuclear incident?

Wide variety from small pipe bombs to large vehicle bombs

What types of explosive devices might EMS encounter?

Fixed targets or groups of people

What types of targets may be involved in explosive incidents?

Disperse biologic, chemical, or radiologic materials

What additional hazards may explosive devices be designed to create?

Thermal harm

What type of harm results from the heat of an explosion?

Asphyxiation

What type of harm can occur from extremely dusty conditions after an explosion?

Chemical harm

What type of harm results from chemical reactions at the detonation site?

Mechanical harm

What type of harm is typically seen at bombing incidents?

Psychological harm

What type of harm can result from a stunned or delayed emotional response?

Multiple detonations

What should EMS be aware of after an explosion?

Operations after a warning but before the explosion takes place

What are pre-blast operations?

Operations that occur after at least one detonation

What are post-blast operations?

The respiratory route

What is the most effective and common route for dissemination of biologic or chemical agents?

The lungs have a vast, delicate surface area and multiple passageways allowing deep penetration

Why is the respiratory route so effective for dissemination?

Ingestion, dermal exposure, and human-to-human contact

What are other possible routes of dissemination besides inhalation?

The process of enhancing an agent’s ability to cause harm, typically by maximizing inhalation exposure

What is weaponization in the context of CBRNE agents?

It allows particles to enter deep into the lungs where they can be more harmful

Why is the inhalation route preferred for weaponization?

As small as 3–5 microns in diameter

How small can weaponized particles be?

By applying energy through heat, explosives, or sprayers to create an airborne mist or cloud

How can materials be aerosolized for airborne dissemination?

Chemical agents can exist as gases, liquids, or solids

What physical forms can chemical agents take?

Vapor pressure and density influence how the agent spreads and behaves in the environment

Why do physical properties matter in chemical agents?

How readily a chemical evaporates into a vapor

What does volatility describe in chemical agents?

A low boiling point and high vapor pressure

What characteristics increase a chemical agent’s volatility?

It allows the agent to become airborne more easily, increasing exposure risk

Why is high volatility dangerous?

Whether the agent is stable enough to survive dissemination and reach the target area

What is the key chemical consideration for an agent’s effectiveness?

Unstable agents may degrade before affecting victims

Why is stability important for chemical agents?

Individual variations among people and the route of entry into the body

What influences a chemical agent’s toxicological effects?

Different exposure routes (inhalation, absorption, ingestion, injection) can change how harmful the chemical is

Why does the route of entry matter for toxicity?

Salivation, Lacrimation, Urination, Defecation, GI Upset, Emesis, Miosis

What does SLUDGEM stand for in nerve agent poisoning?

Salivation

What symptom does "S" in SLUDGEM represent?

Lacrimation (tears)

What symptom does "L" in SLUDGEM represent?

Urination

What symptom does "U" in SLUDGEM represent?

Defecation

What symptom does "D" in SLUDGEM represent?

GI Upset

What symptom does "G" in SLUDGEM represent?

Emesis

What symptom does "E" in SLUDGEM represent?

Miosis (pupil constriction)

What symptom does "M" in SLUDGEM represent?

Chemicals that are predominantly inhaled and damage the respiratory system

What are choking agents?

Cause chemical changes in cells of exposed tissues, leading to blisters

What do vesiculating (blistering) agents do?

They prevent cells from using oxygen for cellular respiration

How do cyanides harm the body?

Inhibit enzymes needed for proper nerve transmission, causing uncontrolled parasympathetic stimulation

What do nerve agents do?

SLUDGEM: Salivation, Lacrimation, Urination, Defecation, GI Upset, Emesis, Miosis

What signs indicate nerve agent exposure?

Irritating chemicals and lacrimators that increase tearing and cause discomfort

What are riot control agents?

Microorganisms or toxins that can cause disease processes

What are biologic agents?

Small, free-living microorganisms

What are bacteria?

Organisms that require a host cell to live and reproduce

What are viruses?

Poisonous chemicals produced or derived from living organisms

What are toxins?

Infectivity, virulence, toxicity, incubation period, transmissibility, lethality, stability

What features make biologic agents useful as weapons?