Chapter 41: Terrorism Response and Disaster Management

Aging

The process where the temporary bond between the organophosphate and acetylcholinesterase hydrolyzes, becoming permanent.

Alpha

A low-energy radiologic emission; least penetrating; stopped by paper/skin.

Anthrax

Disease from Bacillus anthracis spores; routes: inhalation, cutaneous, GI.

Antidote Treatment Nerve Agent Auto-Injector (ATNAA)

Single auto-injector containing atropine + pralidoxime chloride.

Bacteria

Microorganisms that reproduce by binary fission; some form spores.

Beta

More penetrating than alpha; stopped by clothing.

B-NICE

Biological, Nuclear, Incendiary, Chemical, Explosive.

Botulinum

Most potent neurotoxin; causes botulism by paralysis of nervous system.

Buboes

Enlarged lymph nodes characteristic of bubonic plague.

Bubonic plague

Bacterial infection of lymphatic system; transmitted by rodents/fleas.

Chlorine (Cl)

First chemical warfare agent; green haze, bleach odor; causes airway irritation.

Contact hazard

Chemical threat entering through skin; also called skin hazard.

Contagious

A disease spread person-to-person; communicable.

Covert attack

Attack with no prior warning to public safety agencies.

Cross-contamination

Contaminated person spreads agent to another by contact.

Cyanide

Agent preventing oxygen use at cellular level; almond odor; rapid onset.

Decay

Unstable material emits energy to stabilize itself.

Dirty bomb

Explosive radiologic dispersal device (RDD).

Disease vector

Animal that spreads a pathogen to another organism.

Dissemination

How a terrorist spreads an agent (air, food, ventilation, water).

Domestic terrorism

Terrorism carried out by people within their own country.

DuoDote Auto-Injector

Atropine + pralidoxime nerve agent antidote in one injector.

G agents

Original German nerve agents: sarin, soman, tabun.

Gamma rays

Highly penetrating radiation; require lead or concrete shielding.

Incubation

Time from exposure to first sign of symptoms.

International terrorism

Terrorism carried out in a country other than one’s own.

Ionizing radiation

Energy in particles/rays capable of removing electrons from atoms.

LD50

Dose required to kill 50% of exposed population.

Lewisite (L)

Rapid-onset blister agent causing intense pain.

Lymph nodes

Immune system organs housing infection-fighting cells.

Lymphatic system

Circulatory system transporting lymph fluid through tissues.

Miosis

Pinpoint pupils; common after nerve agent exposure.

Mutagen

Substance that damages or changes DNA structure.

Nerve agents

Organophosphate chemicals blocking AChE; cause organ failure.

Neurotoxins

Most deadly biological toxins; include botulinum and ricin.

Neutron radiation

Most penetrating radiation; requires feet of concrete to stop.

Off-gassing

Release of absorbed agent (e.g., from contaminated clothing).

Persistency

How long a chemical remains on surfaces before evaporating.

Phosgene

Pulmonary agent from combustion; delayed respiratory symptoms.

Phosgene oxime (CX)

Blister agent; immediate onset and intense pain.

Pneumonic plague

Plague infection of the lungs; highly contagious.

Points of distribution (PODs)

Sites distributing antibiotics, antidotes, vaccines in emergencies.

Primary blast injury

Injury from pressure wave affecting hollow organs.

Pulmonary blast injury

Lung trauma from high-energy explosive shock wave.

Quaternary blast injury

Burns, crush injuries, toxic inhalation, medical or mental emergencies.

Radioactive material

Any material that emits radiation.

Radiologic dispersal device (RDD)

Device designed to spread radioactive material.

Ricin

Neurotoxin from castor beans; causes respiratory/circulatory collapse.

Route of exposure

How a toxic substance enters the body.

Sarin (GB)

Highly volatile G agent; colorless/odorless; vaporizes rapidly.

Secondary blast injury

Injury from flying debris or shrapnel.

Secondary device

Additional explosive meant to target responders.

Smallpox

Highly contagious virus; most contagious when blisters appear.

Soman (GD)

G agent; persistent; 5× more lethal than sarin; fruity odor.

Special Atomic Demolition Munitions (SADM)

Miniature nuclear weapons for tactical targets.

State-sponsored terrorism

Terrorism funded or supported by governments.

Sulfur mustard (H)

Persistent vesicant; oily; garlic/mustard smell; destroys skin/WBCs.

Syndromic surveillance

Tracking ED visits, EMS calls, OTC medication use to detect outbreaks.

Tabun (GA)

G agent; easy to manufacture; fruity smell; persistent.

Tertiary blast injury

Whole-body displacement followed by impact trauma.

V agent (VX)

Extremely persistent G agent; oily; 100× more lethal than sarin.

Vapor hazard

Agent primarily entering via respiratory tract.

Vesicants

Blister agents entering mainly through skin contact.

Viral hemorrhagic fevers (VHF)

Ebola, yellow fever, etc.; cause bleeding from tissues/vessels.

Viruses

Require living host to reproduce.

Volatility

How fast an agent evaporates.

Weapon of mass casualty (WMC)

Agent designed to cause mass death or infrastructure damage.

Weaponization

Enhancing a biological agent for use as a weapon.

Terrorism definition

Unlawful violence against civilians to intimidate or influence government.

Examples of terrorist attacks

9/11 attacks; Boston Marathon bombing.

Types of terrorist groups

Religious, political, cyber, single-issue extremists.

Weapons of Mass Destruction (WMDs)

Agents causing mass death, injury, or damage.

CBRNE

Chemical, Biological, Radiological, Nuclear, Explosive.

Most commonly used WMD

Explosives.

Chemical agent categories

Vesicants, respiratory agents, nerve agents, metabolic agents.

Biological agents

Viruses, bacteria, and toxins.

Radiological/nuclear devices

Nuclear bombs and dirty bombs.

General WMD care

Scene safety, PPE, ABCs, supportive care.

Pre-incident indicators

Location type, call type, patient count, victim statements.

Rule of thumb for staging

If thumb doesn’t cover scene, you’re too close; stay uphill/upwind.

When to notify dispatch

Event nature, patient count, staging, need for decon.

Incident Command

First arriving unit becomes command until relieved.

Persistent chemical agents

Non-volatile; remain on surfaces long-term.

Non-persistent chemical agents

Volatile; evaporate quickly.

Routes of exposure

Respiratory inhalation and skin absorption.

Vesicant treatment

Decon, ABCs, supportive care, burn-center transport.

Pulmonary agents

Gases damaging lungs → pulmonary edema.

Chlorine symptoms

Coughing, SOB, chest tightness, stridor, pulmonary edema.

Phosgene symptoms

Delayed cough, dyspnea, pulmonary edema.

Pulmonary agent treatment

Remove from area, suction early, ventilate early, no antidote.

Nerve agents (overview)

Most deadly chemicals; rapid cardiac/respiratory arrest.

G-series agents

Tabun, Sarin, Soman, VX.

SLUDGEM

Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis, Miosis.

DUMBELS

Diarrhea, Urination, Miosis, Bronchospasm, Emesis, Lacrimation, Salivation/seizures.

Nerve agent treatment

Atropine + pralidoxime (DuoDote/ATNAA).

Cyanide examples

Hydrogen cyanide (AC), Cyanogen chloride (CK).

Cyanide effects

Dizziness, tachypnea, flushed skin, seizures, apnea.

Cyanide treatment

Remove clothes pre-ambulance, full decon, aggressive airway/ventilation.