Chapter 41: Terrorism Response and Disaster Management

Chapter 41 Terrorism Response and Disaster Management

NATIONAL EMS EDUCATION STANDARD COMPETENCIES

  • EMS Operations: Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.

  • Mass-Casualty Incidents: Responsibilities of operating on the scene of a natural or man-made disaster. (pp 1528–1533)

KNOWLEDGE OBJECTIVES

  1. Definitions of Terrorism:

    • International Terrorism: Involves violent acts or acts dangerous to human life that violate federal or state law, occurring primarily outside the U.S. and aimed at influencing policy through intimidation, coercion, or mass destruction.

    • Domestic Terrorism: Similar acts occurring within the territory of the United States.

    • Examples:

      • International: Attacks in the Middle East targeting civilian populations.

      • Domestic: Bombing of the Alfred P. Murrah Federal Building (1995), Boston Marathon bombing (2013).

  2. Goals of Terrorist Groups:

    • Four common categories include:

    1. Religious extremist groups/doomsday cults

    2. Extremist political groups

    3. Cyber terrorists

    4. Single-issue groups (e.g., anti-abortion, animal rights, ecoterrorists).

  3. Weapons of Mass Destruction (WMD) & Mass Casualty (WMC):

    • WMD: Any agent designed to cause mass death or casualties (e.g., biological, nuclear, incendiary, chemical, explosive).

    • Examples of WMDs: Biological agents (viruses, bacteria), chemical agents (nerve agents, vesicants).

  4. Department of Homeland Security (DHS) National Terrorism Advisory System (NTAS):

    • Guides EMT actions in daily operations; EMTs must be aware of current threat levels and precautions.

  5. Key Observations for EMTs:

    • Indicators of a potential terrorist attack include:

      • Type of location (governments, large gatherings),

      • Nature of the call (explosions, suspicious devices),

      • Patterns of multiple victims with similar symptoms.

  6. Critical Response Actions:

    • Ensure scene safety, provide personnel protection, follow notification procedures, and establish command at suspected terrorist events.

    • Reassess scene continually for safety.

  7. History of Chemical Agents:

    • Classifications include: vesicants (blister agents), respiratory agents (choking), nerve agents, metabolic agents (cyanides).

    • Effects on patient care include variable signs and symptoms based on exposure.

SKILLS OBJECTIVES

  1. Establishing Scene Safety: Steps for reassessing the safety in scenarios of a terrorist event.

  2. Patient Management: Steps for managing patients exposed to chemical agents using established protocols.

  3. Utilization of Injectors: Demonstration of DuoDote Auto-Injector and Antidote Treatment Nerve Agent Auto-Injector use.

Introduction

  • Growing prevalence of terrorist attacks requires readiness for potential events.

  • Focus shifts toward managing multiple casualties caused by WMDs in civilian populations.

  • Emphasis on situational awareness and preparedness to respond effectively to unforeseen incidents.

Understanding Terrorism

  • Definition & Impact: Terror acts designed to instill fear and achieve ideological goals.

  • Variation in Targets: Domestic vs. international terrorism trends and significant historical examples.

Active Shooter Events

  • Lone Wolf Terrorism: Quick rise of single actor terrorist operations, often resulting in mass casualty events; notable examples include: Charleston church shooting (2015), Pulse nightclub shooting (2016), Las Vegas shooting (2017).

  • Hartford Consensus: Recommendations for public safety regarding active shooter incidents focusing on THREAT principles: Threat suppression, Hemorrhage control, Rapid Extrication, Assessment by medical providers, Transport.

Weapons of Mass Destruction (WMD)

  • WMD Definition: Agents designed to inflict mass casualties and significant property damage.

  • Types: Mnemonics B-NICE (biologic, nuclear, incendiary, chemical, explosive) and CBRNE (chemical, biologic, radiologic, nuclear, explosive).

  • Technology & Acquisition: Post-Cold War access to WMD and potential for misuse by terrorist groups.

Chemical Terrorism/Warfare

  1. Chemical Agents: Types, forms (liquid, gas, powder), and impacts on civilians.

  2. Categories & Effects: Vesicants, pulmonary agents, and their respective exposure routes, harmful effects, and treatments.

Specific Chemical Agents

  1. Vesicants: Leading examples include sulfur mustard (H), lewisite (L), and phosgene oxime (CX); symptoms range from skin irritation to respiratory distress and long-term health complications.

  2. Pulmonary Agents: Chlorine (bleach-like odor) and phosgene (delayed symptoms) cause respiratory distress and require aggressive management.

  3. Nerve Agents: Organophosphates like sarin (GB), VX, and their lethal mechanisms via cholinesterase inhibition; require immediate intervention using DuoDote auto-injectors.

  4. Cyanides: Rapid onset of effects like dizziness and respiratory failure; treatment primarily involves supportive care following decontamination.

Biological Terrorism/Warfare

  • Classification: Viruses, bacteria, neurotoxins; biological agents can be disseminated and have various transmission routes.

  • Diseases: Smallpox (highly contagious), anthrax (inhalational and cutaneous forms), and hemorrhagic fevers (Ebola, Marburg).

  • Syndromic Surveillance: Vital role of EMS in tracking patterns of illness, especially during unusual patient presentments.

  • Points of Distribution (PODs): Mass distribution sites for emergency medications and supplies.

Radiologic/Nuclear Terrorism

  • Radiation Basics: Definitions and types of radiation (alpha, beta, gamma); sources and their possible use by terrorists.

  • Radiologic Dispersal Devices: Dirty bombs, and their psychological impact rather than high physical casualties.

  • Nuclear Equipment: Overview of nuclear munitions and risks associated with known radioactive materials.

Response to Explosive and Incendiary Devices

  • Mechanisms of Injury: Differentiation of blast injuries (primary, secondary, tertiary, quaternary) based on proximity to explosion and types of devices used.

  • Physical Trauma: Anticipatory management of penetrating injuries versus blast-related injuries; vital management protocols for both scenarios.

Ethical Considerations in Patient Care

  • The necessity to treat all patients, regardless of their role in a terrorist event; focus on patient needs and adherence to medical ethics.

  • Provision of care despite potential risks involved in treating suspected terrorists.

Conclusion

  • EMS professionals must maintain an acute awareness of potential terrorism indicators, ensure personal safety, and be well-versed in management protocols for mass casualty incidents involving WMDs. Constant reassessment of scene safety and treatment flexibility are crucial to effectively respond to evolving threats in terrorist events.

Vital Vocabulary

  • Active Shooter Event: Ongoing armed assault targeting multiple individuals.

  • Vesicants: Blister agents like mustard gas affecting skin and respiratory systems.

  • Cyanide: A colorless, toxic gas that impedes the body’s oxygen utilization.

  • Syndromic Surveillance: Monitoring for disease outbreaks to detect potential biological threats early.

  • Incident Command System (ICS): Framework for effective emergency response management.

References

  • American College of Surgeons. Passive role in improving mass casualty response.

  • National Security Task Force Report on lone wolf terrorism.

  • Howard, Eric. "The Hartford Consensus II Recommendations on active shooter incidents."