Terrorism, WMD, and Disaster Management – NREMT

What are qualities of the 3 vesciant agents? V-SLP

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Sulfur Mustard (H)

Brownish-yellow oily liquid, very persistent.

Mutagen – damages DNA and cells; also suppresses bone marrow → ↓ WBCs.

Onset 2–24 hours: redness → big fluid-filled blisters.

Vapor inhalation → upper and lower airway injury.

Lewisite (L) & Phosgene Oxime (CX)

Similar blistering to mustard but much faster onset (rapid to immediate).

Intense pain at contact, gray discoloration.

What is the Classic S/S for organophosphates?

SLUDGEM-BS:

S – Salivation

L – Lacrimation (tearing of the eyes)

U – Urination

D – Defecation (diarrhea)

G – GI upset (abdominal pain, cramping)

E – Emesis

M – Miosis (pinpoint pupils)

B – Bradycardia

S – Seizures

EMT management to pulmonary agents (choking agents)

Management (EMT)

• Remove from contaminated atmosphere (by HazMat with appropriate PPE).

• ABCs aggressively: high-flow O₂, assist ventilations as needed, suction.

• Keep patient at rest, in high-Fowler’s; do NOT let them exert themselves.

No antidote– supportive care only;request ALSand considerCPAPif allowed.

Name four types of Chemical agents (C-PVNM)

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Pulmonary agents (choking), Vesicants (blister agents), Nerve agents (organophosphates), Metabolic agents (cyanides: potent poison that disrupts the body's ability to use oxygen)

Management for vesicant (blister agents)

Management (EMT)

• Decontaminate first – copious water irrigation before treatment.

• Cover burns with dry, sterile dressings.

• For inhalation: high-Fowler’s, high-flow O₂, assist ventilations, rapid transport.

• No antidotes for mustard or CX; British Anti-Lewisite exists for L but not in civilian EMS.

What is nerve agents (organophosphates)? Name 4 nerve agents and describe a lil. N-SSTV

N-SSTV Never - Stop Stirring Toxic Vials

Among the most deadly chemicals ever developed.

• Cause cardiac arrest within seconds–minutes if untreated.

• Mechanism: inhibit acetylcholinesterase, causing extreme parasympathetic overstimulation.

Agents:

Sarin (GB) – colorless, odorless, highly volatile; fast evaporation, big vapor hazard.

Soman (GD) – twice as persistent, ~5× more lethal than sarin; binds quickly.

Tabun (GA) – ~½ as lethal as sarin, much more persistent.

VX (Big daddy) – clear, oily, no odor; extremely persistent and >100× more lethal than sarin.

Name three examples of pulmonary agents (choking agents) and S/S

P-CP

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Vapor hazard / inhalation hazard

Damage alveoli & lung tissue → pulmonary edema → impaired gas exchange.

Chlorine (Cl) 

First chemical warfare agent used. May appear as greenish haze, but don’t depend on that.

S/S:

Irritation, choking sensation. Shortness of Breath (SOB), chest tightness

Hoarseness, stridor, coughing, gasping. Pulmonary edema

Phosgene

Product of combustion (burning plastics, synthetics, etc.).

Smell = freshly mown grass/hay.

Delayed onset (hours) → patient may feel fine initially.

S/S:

• Nausea, chest tightness. Severe cough, dyspnea on exertion

• Pulmonary edema; may cough up white or pink frothy sputum

• Can become hypovolemic & hypotensive from massive fluid in lungs

What do metabolic agents do? And name 2 forms

(cyanides: potent poison that disrupts the body's ability to use oxygen). Prevent cells from using oxygen → cellular asphyxia despite normal blood O₂.
Common forms: Hydrogen cyanide (AC), cyanogen chloride (CK)

Two forms of neurotocins

Ricin

From castor bean; one seed can kill a child.

Routes: ingestion, inhalation, injection.

S/S (hours after exposure):

• N/V, abdominal cramping, diarrhea

• Fever, headache, myalgias

• GI bleeding, multi-organ failure, cardiovascular collapse

Botulinum Toxin

Produced by Clostridium botulinum. Causes descending flaccid paralysis:

• Early: weakness, blurred vision, ptosis

• Progresses to respiratory muscle paralysis → respiratory failure in 12–36 h after ingestion.

Name 2 forms of Virus & S/S V-SF

(V-SF: Virus suck fevers)

Smallpox

Highly contagious; concern as stored military virus.

S/S:

• Fever, headache, ALOC, vomiting

• Rash with all blisters same size and stage, starting on face & extremities, then trunk.

• Most contagious when blisters form.

• Vaccine exists and can give lifelong immunity.

Viral Hemorrhagic Fevers (VHF)

Examples: Ebola, Marburg, Yellow fever, Rift Valley fever.

Transmitted via infected blood/body fluids; could be weaponized via aerosol.

Early S/S: headache, fever, sore throat, vomiting.

Late S/S: internal & external bleeding, ecchymosis, bloody sputum.

Death often due to combined hypovolemic & septic shock.

EMT mangement with radiation & nuclear agents? 

EMS Approach

Being exposed to radiation waves alone does not make someone radioactive.

If radioactive material is on the body/clothes → they are contaminated and must first be handled by HazMat.

After decontamintation:

• Standard ABCs, treat burns/trauma.

• Use appropriate PPE, bag all body fluids for special disposal.

Safety principles: time, distance, shielding

• Minimize time near source, maximize distance, use shielding; park upwind.

Explosives
Four Blast Injury Phases and what they cause? 

Four Blast-Injury Phases

Primary – pressure wave

• Affects hollow organs (Gastrointestinal tract) → e.g., pulmonary barotrauma (lungs), tension pneumothorax, tympanic membrane rupture.

Secondary – projectiles

• Shrapnel, glass, debris → penetrating trauma, hemorrhage.

Tertiary – body displacement/structural collapse

• Patient thrown or crushed → blunt trauma, crush injuries.

Quaternary – other effects

• Burns, toxic inhalation (smoke, chemicals), asphyxia.

Define Incendiary Devices & give three examples

Burn extremely hot and produce thick white smoke.

Examples: napalm, white phosphorous, magnesium.

S/S & Management for Metabolic Agents

S/S:

• Low dose: dizziness, headache, N/V.

• High dose: ALOC, coma, seizures, cardiac arrest.

• Spo₂ may appear normal because blood is oxygenated but cells can’t use it.

Management:

• Remove from source; full decontamination (clothes off to prevent off-gassing).

• Manage airway, breathing, circulation; high-flow O₂, ventilate as needed.

• ALS can give cyanide antidote kits (e.g., hydroxocobalamin, nitrites).

Management for organophosphates?

Management (EMT):

Scene safety / PPE first. Support airway & breathing aggressively; prepare for seizures & apnea.

Use DuoDote / Mark I autoinjectors (per protocol):

• Atropine – blocks muscarinic effects (secretions, bradycardia).

• Pralidoxime (2-PAM) – reactivates acetylcholinesterase.

Four Main Categoeis of WMD

Conventional weapon (explosives, incendiaries), chemical agents, biological agents, radiation & nuclear agents

What do vesicant agents do? Name 3 vesicant agents.

• Cause chemical burns & large blisters on skin and mucous membranes; like thermal burns but often delayed.

• Prefer moist areas: armpits, groin, respiratory tract.

Sulfur Mustard (H), Lewisite (L) & Phosgene Oxime (CX)

Two forms of bacteria

Anthrax (Bacillus anthracis)

Forms spores → extremely hardy (survive in soil for decades).

Exposure routes: inhalational, cutaneous, gastrointestinal.

Not communicable person-to-person.

Inhalational S/S:

• Flu-like (fever, fatigue) → dyspnea, nonproductive cough, headache

• Pulmonary edema & respiratory failure

• Very high mortality if untreated.

Plague (Yersinia pestis)

Natural vector: fleas on rats, plus droplet transmission. Forms:

• Bubonic plague: swollen painful lymph nodes (buboes), fever, sepsis.

• Pneumonic plague: severe respiratory form → dyspnea, pulmonary edema, cough, high mortality.

What is the 4 types of Radiation and qualities?

1. Alpha particles: Heavy particles, least penetrating (stopped by paper). Dangerous if inhaled/ingested.

1. Beta particles: High-energy electrons; penetrate further (need clothing/aluminum). Can cause “beta burns” to skin; internal exposure also dangerous.

2. Gamma rays / X-rays: Most penetrating; need lead or concrete to shield. External whole-body exposure = major risk.

Neutrons:Mainly in reactor accidents and nuclear detonations. Requireseveral feet of concrete for shielding.

Name 3 Biologic Agents

Viruses, Bacteria, Neurotoxins

Examples of Viruses (2)? S/S

Smallpox

Highly contagious; concern as stored military virus.

S/S:

• Fever, headache, ALOC, vomiting

• Rash with all blisters same size and stage, starting on face & extremities, then trunk.

• Most contagious when blisters form.

• Vaccine exists and can give lifelong immunity.

Viral Hemorrhagic Fevers (VHF)

Examples: Ebola, Marburg, Yellow fever, Rift Valley fever.

Transmitted via infected blood/body fluids; could be weaponized via aerosol.

Early S/S: headache, fever, sore throat, vomiting.

Late S/S: internal & external bleeding, ecchymosis, bloody sputum.

Death often due to combined hypovolemic & septic shock.

Examples of Bacteria (2)? S/S? B-AP

Black as* pack

Anthrax (Bacillus anthracis)

Forms spores → extremely hardy (survive in soil for decades).

Exposure routes: inhalational, cutaneous, gastrointestinal.

Not communicable person-to-person.

Inhalational S/S:

• Flu-like (fever, fatigue) → dyspnea, nonproductive cough, headache

• Pulmonary edema & respiratory failure

• Very high mortality if untreated. Treat with Ciprofloxacin

Plague (Yersinia pestis)

Natural vector: fleas on rats, plus droplet transmission. Forms:

• Bubonic plague: swollen painful lymph nodes (buboes), fever, sepsis.

• Pneumonic plague: severe respiratory form → dyspnea, pulmonary edema, cough, high mortality.

Neurotoxin

Extremely potent naturally occurring toxins; tiny doses can be lethal.

Examples (2) of neurotoxins? S/S?

Ricin

From castor bean; one seed can kill a child.

Routes: ingestion, inhalation, injection.

S/S (hours after exposure):

• N/V, abdominal cramping, diarrhea

• Fever, headache, myalgias

• GI bleeding, multi-organ failure, cardiovascular collapse

Botulinum Toxin

Produced by Clostridium botulinum. Causes descending flaccid paralysis:

• Early: weakness, blurred vision, ptosis

• Progresses to respiratory muscle paralysis → respiratory failure in 12–36 h after ingestion.